H Pylori is one of the most recently discovered organisms; as far as the medical literature is concerned, it has only just celebrated its 38th birthday. And while it can (and indeed does) live peacefully in many, H Pylori issues represent one of the most common hidden obstacles that stops individuals from responding to protocols that should generate improvements.
While its role in gastric disorders is no longer denied, H Pylori can have systemic effects. This centres on the way can wreck the digestive process (it can trigger both SIBO and increased intestinal permeability, which can be a big problem as it is also an endotoxin-producing species). A cruel irony here is that this GI-distorting effect is driven by the alkalinity of ammonia, yet this ammonia also drives anxiety directly (via the NMDA receptor). Add in the cytokine release that is linked with hypothalamic/brain stem activation, and you have a potent cocktail of negative effects on health and wellbeing. Last but not least, the amino acid sequences found in its proteins also throw up the possibility of molecular mimicry and thyroid autoimmunity.
H Pylori and Antibiotic Resistance
Standard approaches for H Pylori have been based on ‘triple therapy’, which uses a proton pump inhibitor (lansoprazole) and two antibiotics (amoxicillin and clarithromycin). While many undertaking the process have typically had concerns over collateral damage that antibiotics might have on the wider microbiome, it was a traditionally a case of weighing up the pros and cons and making choices with the greater good in mind. However, this has become a more complex decision in recent years, with antibiotic resistance is on the rise, with many studies now showing eradication only 50% of the time (results of recent years have all come back with eradication rates between 50-70%).
As a consequence, it has become more common to include natural agents into the mix. As is often the case with natural alternatives, dogma is king: some websites get evangelical and others dismiss them entirely. So let’s get straight to the main question: how effective are these alternative options?
A 2005 paper is our first port of call before embarking into a more detailed breakdown of each item. This is because it took a great sample of promising herbs and then ran in vitro studies to see if any of the compounds had potential in killing H Pylori. This does not mean that such effects will be been ‘in vivo’ (in living creatures) because of the complexity of mammalian metabolism, but it allows us to determine the where we should look for the human studies.
In any case, the researchers found that:
- nightshade, garlic, dill, black pepper, coriander, fenugreek and black tea did nothing
- Columbo weed, long pepper, parsley, tarragon, nutmeg, yellow-berried nightshade, threadstem carpetweed, sage and cinnamon showed anti-H Pylori activity but did not kill the organism
- There were several compounds that did kill the bacteria – of these, turmeric was the most efficient, followed by cumin, ginger, chilli, borage, black caraway (black cumin), oregano and liquorice
Of course, this is nowhere near all of the foods and herbs that have bene touted as having benefits in the fight against H Pylori, but it’s certainly a great start and the like-for-like nature of the study allows us to identify legitimate options and then begin to build a picture from there.
So what more do we need to know about these agents? I’m glad you asked…
As per the 2005 study noted above, Curcumin shows impressive results in vitro. But how does this play out in the front line? A 2009 study showed 100% eradication of H Pylori as well as impressive effects on reducing inflammation and supporting healing of the stomach lining. However, such emphatic results must be tempered by the high doses involved and the fat it was a mouse model. When it came to a study on human patients with H Pylori infection, the results were mediocre. Whereas triple therapy showed eradication in 79% of the patients, only 6% of the curcumin group achieved the same outcome. Hmm.
But the Curcumin story doesn’t stop there, as it offers an array of benefits. As well as impressive anti-inflammatory and protective effects on the gut lining, particularly in regards to suppressing IL-8 and NfkB. It can also disrupt H Pylori biofilms. It shows particularly impressive effects in animal models in preventing H Pylori-induced stomach cancer.
Summary: Curcumin looks good in preclinical models and clearly shows a range of ‘side’ benefits but, in the only front-line study, it was disappointing in eradicating infection.
My thoughts: Despite the impressive in vitro studies, I rarely include Curcumin by default. That being said, it can be very useful if the individual suffers any signs if physical irritation during treatment (although it does have some pro-detox effects that can be challenging in those who are sensitive).
Ginger has shown to inhibit growth of H Pylori in test tube studies, and that this was especially noticeable in CagA+ strains (which can be identified on certain stool tests, such as Diagnostics Lab’s GI Map, which one of the stool test that I use). It has also shown to have proton pump inhibition activities, which may starve H pylori of the hydrogen ions it loves. It also has impressive anti-inflammatory effects on the mucosal lining. A human trial last year showed impressive results; 3g a day for four weeks saw 53% of patients eradicate H Pylori and it reduced the dyspepsia symptoms. This outcome is one of the best outcomes ever recorded from natural agents (and almost rivals triple therapy for effectiveness, although with a much more preferable side-effect profile) so, if such results can be replicated, this may see ginger go from underused to head of the queue for H Pylori protocols.
Summary: proven to reduce complications but, most importantly, proven to eradicate H Pylori in 53% of patients when used alone.
My thoughts: Ginger has a whole load of benefits for the upper digestive tract and this is always one of my go-tos.
Black Cumin (aka Black Caraway)
There’s few herbal products that can claim as glorious a history as black cumin, which was named panacea in old Latin – literally, ‘cure all’. This is partially explained by the way that the thyrmoquinone in black cumin can protect the mitochondria of the cells that line the gut, avoiding the endotoxemia that would otherwise result from the breakdown. As I have discussed here, endotoxemia is the most central mechanism that turns gut issues into systemic symptoms. But black cumin does more; it turns out that it has anti-H Pylori effects, which appears mediated by both direct antibacterial effects and immunomodulatory actions.
Saudi researcher gave H Pylori patients a four-week course of Black Cumin at either 1g, 2g, or 3g per day, and then provided a further group with triple therapy. The latter came in with a 82.6% eradication rate, but 2g of Black Cumin performed well with 66.7% (the 1g and 3g group achieved 47 and 48%).
This puts Black Cumin up there as one of the most promising natural candidates, especially when we consider it’s added value in reducing endotoxemia (a common complication of H Pylori) via its supportive effects at the gut lining.
Summary: another option that rivals triple therapy in studies, with an eradication rate of 67%.
My thoughts: one of the most useful agents and up there with Ginger as top of my go-to list, although some people do get burping and discomfort when it’s added.
Oil of Oregano
Test tube studies show the essential oils of oregano to be effective in switching off the urease activity of H Pylori; interestingly, this was enhanced when given alongside cranberry extracts (even though the cranberry wasn’t particularly effective on its own). Surprisingly enough, there are not yet any animal or human studies using Oil of Oregano so it remains difficult to know what to expect from the herb, despite its reliable effects against a range of other pathogens.
Summary: there is not yet any good evidence showing effectiveness against H Pylori, unless used as an add-on.
My thoughts: while it showed anti-bacterial effects against a wider range of pathogens than any other natural agent I know, oregano is not a primary player in the protocols I use against H Pylori. This may change when evidence appears.
It is somewhat surprising that Mastic was not investigated in the 2005 study I linked to above. Mastic has long been the go-to for natural treatment of H Pylori, and for good reason. The resin of the Pistacia lentiscus tree, which is found in large numbers Greece, demonstrates anti-bacterial effects against H Pylori as went as anti-ulcer effects. This has been linked to a unique myrcene compound found in the gum as well as the terpenes it contains.
Despite promising in vitro findings, some early studies found that mastic had no impact on eight patients who were infected. A particularly interesting study found that Mastic gum alone, when used at 350mg three times per day, saw an eradication rate of 31% after fourteen days treatment. This increased to 38% when they doubled the dosage and hit 77% when they added triple therapy to the mastic gum.
Summary: proven to enhance effectiveness of triple therapy and proven ability to eradicate H Pylori, but only achieved this in 31-38% of patients when used on its own.
My thoughts: Mastic gum has always been fantastic when it comes to providing symptomatic relief (which is why I use it a lot), but almost never achieves eradication by itself.
Lactoferrin and NAC
Lactoferrin is a component of mammalian milk and exerts its anti-microbial benefits through its capacity to tightly bind iron, releasing this only to key receptors in human cells. This helps in two ways; this starves bacteria of the iron they need to grow and, through scavenging the iron that makes up the surface matrix, it breaks biofilms that bacteria use to evade immune cells. Both are very relevant in H Pylori infections. Lactoferrin shows direct antibacterial effects against H Pylori in vitro, although most human studies have looked to the agent as an add-on to improve the efficacy of triple therapy. Lactoferrin has not yet been tested in isolation but it has been shown to increase the effectiveness of triple therapy from 75% to 96%, an affect attributed to its affects on starving H Pylori of iron.
NAC (N-acetyl-cysteine) is not known to demonstrate any direct anti-bacterial effects but is another agent that breaks biofilms through chelating metals. As such, it has been studied to determine if this helps improve eradication alongside antibiotics (good ol’ triple therapy). A 2014 study showed only a minor effect from the addition of NAC (achieving eradication in 85% versus 83% in triple-therapy alone), with 107 taking part in this study. A similar study on 79 subjects recorded a more impressive effect, with eradication rate going from 61% to 73%.
Summary: both biofilm busters have a proven effect in helping eradicate H Pylori although Lactoferrin, which provides the added iron-starvation effect, appears superior.
My thoughts: Lactoferrin does appear to be the preferred choice for assisting an existing protocol, although the systemic effects of NAC (anti-oxidant, liver protective) may see this coming out as the preferred choice for some individuals.
Broccoli sprouts (Sulphurophane)
Broccoli sprouts have demonstrated direct antibacterial effects in vitro, mammal and human cell lines. A short human study, whereby treatment was only provided (at a dose of 14g-56g of sprouts) for seven days, 78% of individuals showed eradication of the microbe. However, it should be pointed out that this was a small sample size, with just nine patients. A similar study on a larger population (which actually provided the 25 patients with a higher dose of 70g of sprouts, doing so daily for eight weeks) found eradication occurred in 32%.
Summary: broccoli sprouts is another of the items that has shown proven effect in eradicating H Pylori when used alone (although again has mixed success rates).
My thoughts: I like Sulphurophane because of the added effects on upregulating detox but, for the same reasons, I would be cautious of using it in particularly sensitive individuals (who almost always react badly to it).
Cranberry contains a particularly special sugar called mannose, which inhibits the ability of bacteria to adhere to mucosal walls. This is the same mechanism that helps with UTIs (where E Coli tend to gain a foothold in the walls of the urinary tract), for which cranberry is more famous for. However, further research suggests that cranberry is something of an all-rounder when it comes to H Pylori, establishing multiple effects that include blocking the formation of biofilms, inhibition of growth, reducing urease activity and even a minor but direct antibacterial effect.
When used alongside triple therapy, the use of cranberry (at 500mg capsules, twice per day) increased the eradication rate from 74% to 89%. Previous trials found that it improved eradication rate from 74% to 85%. Cranberry has been used in trials in isolation and alongside a lactobaccilus probiotic (johnsonii La1 strain), where it showed an eradication rate of 16.9% in isolation and 22.9% when used with the probiotic.
Summary: proven ability to enhance triple therapy and, proven ability to eradicate H Pylori when used in isolation (albeit at low rates and therefore not a reliable strategy).
My thoughts: a fairly gentle addition, but one that can do a great job of improving eradication rates of existing protocols (which is why I will use it regularly).
Propolis has demonstrated excellent ability to reduce the urease activity of H Pylori; this was linked with the polyphenol content of the propolis. While this itself is unlikely to eradicate the organism, it may reduce the way that H Pylori can mess with the acidity of the gut (and lead to SIBO and further complications at the gall bladder, etc) and cause insomnia (as the ammonia produced by this enzyme is a strong agitating factor in the central nervous system). Most of the studies on propolis have been in vitro studies, which gives us little idea of how effective its usage will be in humans, although one human study demonstrated that propolis improved the eradication rate when added to standard protocols. When used as a stand-alone, only 2/18 (11%) had eradicated the bacteria after 40 days of treatment.
Propolis inhibits more than just urease, and has also been shown to inhibit xanthine oxidase and acetylcholinesterase, meaning that is may have an impact in gout and brain sharpness respectively.
Summary: proven ability to limit H Pylori-related complications and the bug’s own defence strategies against gastric acid, proven ability to enhance standard treatment but eradication of H Pylori is possible-but-still-unlikely when used alone.
My thoughts: it shows a very similar mechanism to Mastic Gum. And, like Mastic, it is well-tolerated and reliably provides symptomatic relief (even if this rarely sees direct eradication) but its urease inhibition makes it particularly valuable.
Lactobacillus Reuterii and Probiotics
Lactobacillus reuterii is a species that has been commonly included in probiotic products and can be found as one of the species within kefir. Specific sub-species within this group have been shown to both physically interact with H Pylori in a way that stops them attaching to the mucus lining of the stomach, and also to kill them through the release of a chemical that has been dubbed reuterin. This strain is available commercially as Pylopass.
When researchers added L Reuterii to the standard triple therapy, eradication rate increased from 65.7% to 74.3%. A meta-analyses found that lactobacillus strains generally increased success of triple therapy (by an average of 8.4%) although they noted that lactobacillus GG did nothing and L casei and L reuterii performed particularly well.
Other lactobacillus strains may also be just as effective against H Pylori and there is research going on right now to determine how useful they may be. A study on children with H Pylori infections found that a lactobaccilus-based formula (containing nine strains) improved the effectiveness of triple therapy from 76% to 88%.
Summary: proven to reduce H Pylori load, proven to enhance effectiveness of standard therapy, unlikely to be enough on its own.
My thoughts: there are loads of benefits of kefir beyond simply L Reuterii, and I will generally make use of kefir during the late stages of a H Pylori protocol (unless there are yeast-sensitivity issues or other reasons not to).
When it comes to natural anti-microbial options, few items can boast as rich a history as this humble allium. It was the go-to anti-microbial for Medieval peoples and its widespread use in the educated classes, in which priests were over-represented, it gave birth to the common myth that it conferred protection from vampires. However, while its ability to ward off mythical creatures is yet to be tested in double blind trials, it has proven effects against a wide range of bacterial, viruses and yeast.
So how does it perform against H Pylori? Interestingly, although garlic remains a popular recommendation in these instances, garlic does not appear to be one of our best bets. It has proved that it can have anti-bacterial effects against the species in test tube studies, but does this play out in the real world? There are population studies that associate garlic consumption with reduced risk of H Pylori infection and gastric cancer, but this does not prove any causation and further population studies show no effect. A study on infected gerbils found that garlic supplementation improved gastritis symptoms but had no impact on H Pylori count. Further to this, garlic showed no effect in a trial on humans with H Pylori infections.
It’s worth noting that plenty of people report benefit from taking Garlic in these circumstances. Is this placebo? Probably not, as garlic has reliable effects across a wide range of other microbes; such widespread imbalance is likely to be the case whenever we find H Pylori infection, purely because the acid-neutralizing effects of this microbe can induce such chaos in the intestinal tract. Therefore garlic may serve well as a ‘next step’ towards better digestive balance, although it appears to offer little direct benefit in eradicating H Pylori itself.
Summary: arguably one of the single most useful plants we have access to, but very little effectiveness against H Pylori.
My thoughts: I use Garlic regularly when it comes to supporting better intestinal microbiota, although its not something I turn to for H Pylori issues.
One of the most overlooked agents in attempts to clear out H Pylori, perhaps because we see it more as a daily food rather than a intervention. However, olive oil has been shown to possess interesting properties and the dialdehydic polyphenols show an anti-H Pylori effect.
In human studies, olive oil has shown to eradicate the H Pylori in 40% of participants (when consumed at 30g/day for 40 days).
This study was all the more interesting because they did a follow up several weeks after and found that only 11% remained free of H Pylori, mirroring the experience of many individuals who experience a brief spell of relief following treatment (a phenomenon found with both allopathic and natural treatments).
Summary: easily the most under-rated item in these circumstances, you’ll rarely see an agent so overlooked despite an eradication rate of 40%.
My thoughts: you’ve got to consume oil each day, so why not make it Olive Oil? One of the easiest switches to make to boost eradication rates. But I wouldn’t make this the centrepiece of any program.
Berberine, the ammonium salt extracted from barberry and goldenseal, is almost never mentioned in regards to H Pylori. I feel this is an important oversight, as is has been well-established that one of the mechanisms responsible for the organism’s increased antibiotic resistance is the use of efflux pumps (which physically eject the antibiotic agent from the bacterial cell, thus giving them the ability to survive). Berberine’s primary anti-bacterial impact comes via blocking these efflux pumps. And it has indeed been shown to do this on H Pylori (although, interestingly, this increased the effectiveness of some antibiotics but had no impact on others). Berberine also inhibits the urease function of H Pylori.
A meta-analyses showed Berberine to be a consistent help in increasing success of triple therapy, finding that it increased eradication rates by an average of 18%. Another concluded it increased eradication rates by 22%. I am not aware of any study that has tested this used alone (although berberine has typically demonstrated peak benefit as a ‘team mate’, enhancing the impact of antimicrobials already in place).
Summary: Berberine has proven impacts in improving the effect of triple therapy, shows promise in enhancing protocols based on natural antimicrobials but there is not yet any support in the literature for it as a stand-alone agent.
My thoughts: Berberine is something I like to add in should there be any signs of stalling. It’s impact on the efflux pumps is a very useful ally in these circumstances. However, the population I work with tends to be low on resources and highly sensitive, so I try to use it on an ‘as necessary’ basis.
Chamomile has been shown to have reliable anti-bacterial effects across a spectrum of various bacteria. However, it has only been tested against H Pylori in vitro and in combination with other herbs. These results were encouraging but still leaves us with scant evidence to frame chamomile as a premium option in the fight against this GI disruptor. And yet I see interesting responses to chamomile that make me think that this herb may be a huge asset in the H Pylori sphere.
What I find most tantalizing here is the way that Chamomile is still the only herb identified (by ‘our’ science, anyway) as having antagonistic effects on the receptor for Substance P. Why do I bother brining up this esoteric brain chemical? Because Substance P has traditionally been regarded as the ‘pain neuropeptide’ but is now acknowledged to drive inflammation and is especially key in translating gut challenges into neural agitation (mainly sleep and anxiety). H Pylori effectively induces Substance P, and this chemical may prove a central feature for those with both H Pylori issues and intractable insomnia.
Summary: there is very little research to fully characterize Chamomile’s role in H Pylori issues, although patterns of natural use, emerging mechanisms and my own observations indicate that Chamomile may be particularly useful. This is due the possibility that it may help eliminate the H Pylori while, at the same time, protecting sufferers from some of the neural symptoms. This is very much ‘one to watch’.
My thoughts: Chamomile does not currently feature on most of my protocols but I have added it in where there have been both confirmed H Pylori overgrowth and sleep issues. It has been hit-and-miss, but there have been some ‘hits’.
There are others that stand out as promising, especially lemongrass and thyme, but I shall save this for another article. So too the antibacterial and anti-adhesion effects of Turmeric and the gastric protection of Licorice. One particularly tantalizing avenue of research is the effects of Hibiscus, which has been tested in vitro to show potent antibacterial and bacteriostatic effects against H Pylori, together with anti-biofilm and urease inhibition effects; this frames it as a potential multi-tool for these circumstances, although it is yet to be tested in vivo. Suffice to say that the natural world has bestowed us plenty of promising options that deserve further investigation.
The Big Question
We have characterized H Pylori as a hardy enemy, one whose resistance to protocols becomes understandable when we look at the variety of mechanisms it has to evade the usual strategies. It is clear that any item with anti-H Pylori effects should be able to simply kill the bacteria, yet the use of antibiotics, mastic gum or propolis perform poorly when used as standalone interventions. This is because the organism shows an ability to:
- Evade hydrochloric acid through the acid-to-alkaline converting enzyme it expresses (urease)
- Physically hiding from the bulk of antimicrobial chemicals through borrowing into the gastric mucosa
- Produce biofilms to block access of the anti-microbials
So the question is this: if we were to use herbs with a proven bactericidal effect against H Pylori (mastic, olive oil, black seed oil) then block its ability to protect itself against acid by disabling the urease function (ginger, propolis, broccoli sprouts, berberine), blocking its escape-to-the-mucus strategy (L reuteri and cranberry extract), then breaking up any protective biofilms (lactoferrin and NAC), what would the success rate be? Given that ginger alone demonstrated a 53% eradication rate, it is a tantalizing question. Unfortunately, this is a study that is yet to be done. It’s possible we will be left waiting here, given that evidence-based medicine has a strong preference for ‘independent variables’ and thus tends to test items one at a time and funding is rarely offered for non-pharmaceutical options. However, I can report near-universal shifts from combination approaches (both in regards to clinical response and before/after lab testing).
Other Considerations and Developments
The above steps are focused heavily on the eradication of H Pylori and has not touched on the clinical consideration of gastritis, which is a common concern with H Pylori infection and can flare up during treatment. This tends to manifest as either reduced appetite, pain, bloating alongside a general malaise. Should such symptoms be present, it is normally quite important to provide additional mucosal support ahead of the anti-microbial phase (this is because any inflammatory activity tends to have highly disruptive effects on the mucus, so particularly relevant if this layer is already compromised). DGL Licorice, Slippery Elm and Aloe Vera can helpful in these circumstances.
It is relevant that H Pylori can be both stored and transmitted in saliva. The implications here? You may also want to consider testing/treatment for anyone you kiss on a regular basis. H Pylori is found in up to 90% of intimate partners of those founds to have issues. Equally, taking steps to support the conditions in the oral cavity may also be important to ensure that you don’t kill off the problematic bugs in the stomach, only for surviving populations to descend from the mouth to reinfect you afterwards. For this reason, propolis mouthwashes (or gargling with lemongrass and ginger tea) and flossing during treatment stands out as an attractive option.
One topic I have not included here (as it is a little to esoteric) is the role of arginase, an enzyme expressed by H Pylori to ‘steal’ available arginine and convert it into ornithine and urea. This is relevant for two reasons; first, the urea is something the organism can use to aid survival but, just as importantly, the arginine is needed by your immune cells to produce nitric oxide (vital for optimal circulation). I have not gone into this because of the fact it is somewhat esoteric and also by the fact that most people are consuming arginase inhibitors anyway in the form of green tea, coffee and, most importantly, in ginger (which is likely to be included in any protocol I put together). However, this is likely to become a more common discussion point in the future and, given that a wide range of polyphenols that generate the arginine inhibition effect, point tentatively to a future where natural approaches are considered the ‘first line’ treatment for H Pylori infections. Watch this space.
Testing for H Pylori
The most basic tests for the organism are on antibodies (either in blood or stool). Blood markers are not useful for follow-up testing (to determine eradication) as antibodies tend to linger in the bloodstream for some time. Another issue with antibody-based testing is that they may show a ‘false negative if the individual is not mounting an effective response against the bacteria (in my experience, this is fairly common in individuals suffering from chronic fatigue and other complex metabolic problems). The alternative approach (and the most commonly used to track outcomes in the studies referred to above) is the urea breath test, which skips the need for a strong immune response and instead looks for the product that H Pylori so reliably produces. This is a reliable test but often requires the individuals to visit labs to provide samples, making it less feasible for many.
For this reason, qPCR stool testing is the method of choice in my clinic. This is generally taken as part of a comprehensive check on the microbiome (offered by several providers, eg. Genova’s GI Effects or Nordic’s GI Map, both of which I run regularly).