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This week's topic: Natural Treatments for H. Pylori
As we know, there is a high potential for antibiotic resistance when treating H. pylori and treatment involves multiple antibiotics to eradicate H. pylori (which often have side effects during the treatment phase).
In functional medicine, there are many combination herbal treatment options used to address H. pylori. Until this email, I never really looked at the research on efficacy of these nutraceuticals, and I went down a "rabbit hole" on the research!
Overview of today's email:
- List of natural treatments purported to be effective against H. Pylori
- Highlight one of the most commonly recommended nutraceuticals
- Practical clinical tips
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1. List of natural treatments purported to be effective against H. Pylori
There's a long list of non-pharmaceuticals that can address H. pylori, either by helping to eradicate it, enhance the body's immune response, or address the inflammation caused by it. Some are bactericidal, although not strongly bactericidal, and others work by decreasing the adhesion or decreasing replication of the bacteria.
I’m taking a deep dive into the literature on most of these for a workshop in the mentorship, but so far I’m finding that the majority of the studies on these are in combination with pharmaceuticals (usually enhancing efficacy, such as in this 2023 RCT), in vitro, or in animal models (and as we know, in vitro and animal studies down't always translate to benefits in humans).
Some nutraceuticals frequently used or studied in treatment of H. pylori:
- Chios mastic gum: Inhibit growth (bactericidal) and alleviate symptoms
- Black seed oil: Antibacterial (bactericidal) and anti-inflammatory
- Berberine: Antimicrobial (bactericidal)
- Essential oils (e.g. clove oil): Antimicrobial
- Quercetin and other flavenoids: Anti-inflammatory, may inhibit adhesion (mild bactericidal effects) and urease
- Zinc-carnosine: Protective effects on gastric mucosa
- Slippery elm: Coats and soothes the stomach when mixed with water (alleviates symptoms, promotes healing)
- DGL: May protect the stomach lining, anti-inflammatory
- Aloe vera: Soothes stomach lining; antibacterial (mild bacteriostatic effects, but at high doses)
- Vitamin C: High doses may inhibit growth (bacteriostatic)
- Probiotics: Inhibit growth, reduce inflammation, modulate immunity
Some foods that may be effective in supporting eradication:
- Ginger: Anti-inflammatory and inhibit bacterial growth, alleviates symptoms
- Broccoli sprouts: Antibacterial
- Pomegranate extract: May inhibit growth
- Propolis: May sooth stomach lining, inhibit bacterial growth
- Extra Virgin Olive oil: Has antimicrobial activity
- Cranberry Juice: High phenolic content may inhibit adhesion of H. Pylori on the stomach lining
- Green tea: Catechins have antibacterial effects
- Manuka honey: May inhibit growth via it's hydrogen peroxide content
- Garlic: Antimicrobial growth
- Fennel seeds: Bacteriostatic, soothe GI tract
- Cabbage juice: High vitamin U content, which supports healing
- Turmeric: Curcumin is anti-inflammatory and may inhibit growth of the bacteria
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2. Highlight one of the most commonly recommended nutraceuticals
Let’s take mastic gum, for example. Here's an excerpt from the webinar I'm working on.
What is mastic gum?
- It’s essentially resin from a variety of mastic trees (scientific name = Pistacia lentiscus) that grow on Chios Island in Greece. It’s officially called Chios mastic gum or CMG, and has been used in traditional Greek medicine for over 2500 years for GI issues, as a seasoning in Mediterranean cuisine, in chewing gum production, in perfumery, and in dentistry
Research involving human subjects:
- One RCT from 2010 looked at 52 patients. Mastic gum alone eradicated H. pylori in 4 out of 13 and 5 out of 13 patients at two different doses (350mg TID and 1 gram TID), while standard triple therapy without mastic gum achieved eradication in 10 out of 13 patients.
- Another small study done in 2003 looked at 9 patients who took 1 gram mastic gum 4x/day for 14 days; none had eradication of H. pylori
Potential problems with the research: They focused on a 14 day protocol (but in clinical practice, we often treat for at least 2 months)
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3. Practical Clinical Tips
Addressing H. Pylori via non-pharmaceutical treatments is just as complicated as using pharmaceuticals, and also often involves multiple treatments.
Over the 12+ years I've been practicing functional medicine, I’d estimate that maybe 30-40% of patients who chose the nutraceutical path for treatment were able to eradicate it. That’s not a high success rate, but I suspect that a lot of the lack of success may be because the herbal treatment must be on an empty stomach 3x/day for optimal efficacy which takes consistency and dedication (and many of my patients weren’t truly addressing stress, which is key in a treatment plan)!
My current approach to treatment is to offer pharmaceutical antibiotic treatments in those that may need to urgently address an H. pylori finding (such as those addressing infertility, are highly symptomatic, or have significant autoimmune symptoms/lab findings). For other patients, I consider a combination of the following:
- NAC biofilm prep for 1-2 weeks prior to initiating treatment (NAC on an empty stomach for maximum effectiveness), and ideally during the treatment
- Alinia (a topic for another newsletter or in the mentorship - this is not your typical antibiotic!) for 10-14 days
- Anti-candida treatment (multiple studies suggest H. pylori can hide in yeast)
- If I recommend a nutraceutical, usually I use Gastromend HP by Designs for Health or Pyloricil. But education on this is key - it needs to be taken on an empty stomach at a therapeutic dose for at least 2 months (this can add up in cost as well, costing $300+ dollars for 2 months just for this treatment and not including any supporting treatments noted below)
In a treatment plan, I always include:
- If a patient is willing, pre-testing and re-testing with validated diagnostics (commercial lab testing) if the H. pylori finding was on a GI Map or other stool test
- Anti-inflammatory diet and nourishing GI nutraceuticals/food (to strengthen the sIgA response, lower inflammation, alleviate symptoms if present). Included in the nutrition plan are supportive foods (green tea, cranberry juice, broccoli sprouts in particular) that enhance eradication.
- Address stress and cortisol balance (something I learned from Dr. Kalish; can’t eradicate H. pylori without addressing the inflammatory effects of stress; consider testing for CAR to make sure - especially when someone says they don’t have a lot of stress!)
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I hope this was clinically useful!
I am going in depth into more of the nutraceuticals listed above in a workshop I'm putting together for the mentorship, so if this is a topic of interest to you and you want more "evidence-based" information, join the Collective!
If you are just interested in just purchasing the webinar when it's available, and want me to email you a link, sign up here.
Meg
Additional resources that may be helpful
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