Ann Marie Legge, DipION Issue: Autumn Year of publication: 2000 Statistics indicate that over half of the

planets population may be infected with Helicobacter pylori. Ann Marie Legge Dip.ION, discusses the problems associated with the bacterium and offers holistic based advice on its treatment and control. The discovery of Helicobacter pylori, a spiral bacterium which lives in the inhospitable environment of the human stomach, must rank amongst the greatest medical triumphs of the twentieth century. The bacterium was discovered by two Australian doctors, Barry Marshall and Robin Warren in 1982. It took six long years for the medical profession to begin to acknowledge the importance of Marshall and Warrens work and the first clinical treatment trial was conducted in 1987. Over half the planets population is reckoned to be carrying the bacteria and an estimated 5,000,000 cases of gastric cancer and duodenal ulcer occur annually as a result of the infection. Figures show that up to 20% of young adults and about 50% of those over 50 are infected in the West, indicating that rates of infection are falling. This may be as a result of improved living conditions and increasing antibiotic use, but since it is not known how the infection is transmitted this is open to speculation. A recent study in South America found H. pylori under index fingernails in over half of the participants and it is commonly found in the mouth of infected individuals implicating a gastro-oral route of contamination. GASTRO-INTESTINAL ASSOCIATIONS Initial research on H. pylori focused on gastric complications, and figures now show that, excluding a small proportion of cases caused by non-steroidal anti-inflammatories and antibiotics, the bacteria is implicated in an amazing 99% of duodenal ulcers. In addition approximately 60% of gastric ulcers and up to 80% of stomach cancers are associated with the bacteria. The association with stomach cancer has gained H. pylori the doubtful accolade of being the only bacterium recognised as a Grade 1 carcinogen by the World Health Organisation. Its presence is estimated to increase the likelihood of stomach cancer six fold. Between 10-20% of those with H. pylori will experience peptic (gastric and duodenal) ulceration, and approximately 1% stomach cancer will experience as a result of the infection ACTION OF H. PYLORI One of the major consequences of H. pylori infection is its effect on acid production in the stomach. If the bacteria colonised the area where the stomach joins the small intestine, it can affect the cells which control stomach acid secretion. This can lead to overproduction of hydrochloric acid, paving the way for ulceration. However, if the bacteria colonise the central

part of the stomach, the acid-producing cells themselves are affected and less acid is secreted, causing hypochlorhydria or low stomach acid. Some people escape these complications and acid production is unaffected although gastritis or stomach inflammation always accompanies infection. H. pylori is able to glue itself to cell surfaces under the mucosal layer of the stomach, thus protecting itself from immune reactions. Chronic gastric inflammation results as the immune system fails to eradicate the invader and many oxidising agents are released. Possibly as a result of these oxidising reactions there are measurably lower levels of vitamin C and other antioxidants in the gastric juice of sufferers. H. pyloris survival in the stomach depends on its ability to neutralise stomach acid through the production of urease which reacts with urea to form ammonia. This ammonia along with other products of H. pylori metabolism is toxic to human cells. H. pylori infection can be a chronic process lasting for decades and the combination of complications can have far-reaching effects on the health of the person carrying the infection, particularly if their nutritional status is compromised. It is of no surprise that increasing connections with many non-gastro-intestinal illnesses are being made. NON-GASTRO-INTESTINAL ILLNESS The non-gastro-intestinal consequences of H. pylori infection have only been a subject of research in the last 10 years, yet when Barry Marshall first began treating H. pylori he found unrelated conditions clearing up on remission of the infection. Among these were skin conditions, depression, low energy levels and headaches. Subsequent findings have shown a relationship with rosacea and urticaria. These conditions may be linked in part to the increased gut permeability, or leaky gut, associated with H. pylori. In addition to influencing gut permeability, H. pylori infection can also impede the absorption of iron and vitamin B12 by affecting digestive activity in the stomach and duodenum. This may contribute to the slightly raised risk of cardiovascular problems in sufferers, although these may also be related to other effects of infection such as low levels of antioxidants or high levels of inflammation. Other vascular conditions such as headaches, migraines and Reynauds phenomenon have all been linked with H. pylori. Higher rates of infection than expected have been found in those suffering with autoimmune diseases such as rheumatoid arthritis, Sjogrens syndrome and autoimmune thyroiditis, but the mechanism in this connection is not yet understood. H. pylori has also been found in bile and in the liver as well as in many sites in the mouth where it is associated with periodontal disease and halitosis. Recent work has found connections with hyperismus gravidum (a severe form of morning sickness), spontaneous recurrent abortion and in colon and pancreatic cancer. SYMPTOMS Unfortunately as yet, there are no generally accepted symptoms, although pain after eating, a classic sign of duodenal ulcer, may be taken as one. Dyspepsia does not seem to be particularly

related to infection, but nausea, chronic vomiting, constipation, and ulcer-like symptoms are somewhat common in H. pylori sufferers, as is a high Body Mass Index. If your spouse or longterm partner has been found positive, then you may well consider testing, as over 70% of partners have been found to share the infection. Guidelines for doctors suggest that people with a family history of stomach cancer should also be tested and treated.

RISK FACTORS Between 10-20% of those with H. pylori will experience peptic (gastric and duodenal) ulceration, and approximately 1% will experience stomach cancer as a result of the infection. These outcomes are due to the complex interaction between genetic tendencies, the virulence of the strain of H. pylori and environmental factors. For example, genes influence the development of gastric cancer, which is more prevalent in type A blood group, and of duodenal ulcers which are more prevalent in type O. H. pylori itself has different strains of which cag A is the most virulent and most strongly associated with ulceration and cancerous outcomes. Environmental influences such as diet, overcrowding, poor water supply and hygiene also impact on acquisition rates. DIETARY RECOMMENDATIONS A diet based on optimum nutrition shows that genetic susceptibility to H. pylori can be modified and there is mounting scientific evidence to show that such a diet not only helps prevent acquisition of the bacteria but also protects from disease consequences in those who are infected. In one study, research on vitamin C in both mice and humans has shown that in amounts of 5g a day, it can rid the body of H. pylori in up to 30% of individuals. Epidemiological studies have also shown, more or less across the board, that diets high in fruit and vegetables and therefore rich in vitamin C, as well as other antioxidant nutrients, are associated with lower rates of infection and less disease outcome when infection is present. Fibre is essential for the proper functioning of the digestive system and there is an inverse association between fibre levels, particularly soluble sources from fruits, vegetables, oats, legumes and seeds, and duodenal ulceration Foods to be avoided in any H. pylori diet are those sugar which can be used by the bacteria, chocolate, coffee, dairy products, red and processed meat, pickled products, refined grains, salt, and spirits and gastric cancer. The introduction of steel rolling mills to produce white flour in the latter part of the nineteenth century coincided with a rise in cases of duodenal ulcer. The benefits of the probiotic family of lactobacilli have also been proven through research. Studies show possible benefits from fructo-oligosaccharides (FOS), the food for these beneficial gut bacteria as well. Various strains of Lactobacillus acidophilus, and Lactobacillus salivarius inhibit the growth of helicobacter in mice, probably through the production of lactic acid, although they also interfere with H. pyloris ability to stick to cells. The same study showed that

as well as eliminating existing colonies of H. pylori, the presence of lactobacilli prevented colonisation by the bacteria. Consumption of tea, both black and green, and red wine is associated with lower incidence of the infection, while coffee and spirits have negative associations. According to Dr Batmanghelidj, author of Your Bodys Many Cries for Water (Global Health Solutions, Inc.), six to eight glasses of water a day ensure proper hydration and optimal conditions for the mucous layer in the stomach. Vitamin A has also been shown to increase mucous production in the stomach. Foods to be avoided in any anti-H. pylori diet are those high in sugar which can be used by the bacteria, chocolate, coffee, dairy products, red and processed meat, pickled products, refined grains, salt and spirits. These foodstuffs have all been variously associated in many research papers with higher incidence of, or disease resulting from, infection with H. pylori.

Supplements Many plants have shown an ability to kill H. pylori in the test tube but animal or human research has yet to prove these connections. Among the substances tested in the laboratory and found to have activity against the microbe is garlic, glycyrrhizic acid, Iceland moss, Manuka honey, cinnamon, garlic, capsaicin and Rheum palmatum (rhubarb root). Barry Marshall notes that H. pylori is sensitive to berberine, and that citrus seed extract is moderately effective in eradicating H. pylori. Mastic gum from the Pistacia lentiscus plant, an ancient remedy for digestive problems, is currently being used with some success. Research on vitamin C in both mice and humans has shown that in amounts of 5g a day, it can rid the body of H. pylori in up to 30%of individuals H. pylori has the potential to cause lifelong problems in those unfortunate enough to be infected with it, but following an optimum diet high in whole grains (excluding wheat), legumes, fruit, vegetables, fish and yoghurt, and avoiding aggregative foods, can reduce health risks and in some cases may help to eradicate infection.

DIETARY GUIDELINES FOR THOSE WITH A FAMILY HISTORY OF GASTRIC CANCER

Increase vitamin C rich foods - fresh, raw fruit and vegetables - sweet peppers, watercress, kiwi fruit, strawberries and melon. Increase iron rich foods dark leafy greens, legumes and dried fruit. Increase carotenoid rich foods - carrots, apricots, parsley, watercress, spinach, cantaloupes, mangoes and sweet potatoes.

Increase soluble and insoluble fibre whole grains, legumes, vegetables, dried and fresh fruit and seeds. Avoid smoked and pickled foods. Avoid sugar, saturated fat and salt. Avoid overeating.

RECOMMENDED NUTRITIONAL DIETARY GUIDELINES FOR THOSE WITH A FAMILY HISTORY OF ULCERS

Increase vitamin A rich foods - carrots, apricots, parsley, watercress, spinach, cantaloupes, mangoes, legumes, sweet potatoes and broccoli. Increase soluble and insoluble fibre whole grains, legumes, vegetables, dried and fresh fruit and seeds. Avoid bacon and smoked foods. Avoid sugar.

SUPPLEMENTS FOR THE TREATMENT OF H.PYLORI NUTRIENTS

Antioxidants: Vitamins A,C,E and selenium, N-acetyl cysteine, alpha lipoic acid. Probiotics: Lactobacillus salivarius and Lactobacillus acidophilus Prebiotics: F.O.S. Multivitamin and mineral Gastro-intestinal: (where appropriate) Hydrochloric acid (HCl), digestive enzymes, LGlutamine Antibacterials: Garlic, citrus seed extract, mastic gum, berberine

REFERENCES 1. Harris AV, Misiewicz JJ, Helicobacter pylori Blackwell Healthcare Communications 1996.British Medical Bulletin Helicobacter Pylori 1998 54: 1.Realdi G, Dore MP, Fastame L, Extradigestive Manifestations of Helicobacter pylori Infection. Fact and Fiction. Dig Dis Sci. 1999 44: 2 229-236.

2. Jarosz M, et al Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in Gastric 3. Juice. Eur J Cancer Prev. 1998 7: 6 449-454. 4. Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC, Prospective Study of Diet and the Risk of Duodenal Ulcer inMen. Am J Epidemiology 1997 145: 1 42-50. 5. Buiatti E, et al A Case-Control Study of Gastric Cancer and Diet in Italy: II Association with Nutrients. Int J Cancer: 45 896-901. 6. Tayomago A et al Epidemiological Study on Food Intake and Helicobacter pylori infection Kurumo Med J 2000 47: 1 25-30. 7. Kabir AMA, Aiba Y, Takagi A, Kamiya S, Miwa T, Koga Y Prevention of Helicobacter pylori infection by lactobacilli in a gnotobiotic murine model Gut 1997 41: 4955.Http://www.helico.com Helicobacter Foundation (Barry Marshall).

8.Foods to avoid during H pylori infection

9. 10. Avoid spices during H pylori infection 11. Helicobacter pylori is a type of bacterium that causes inflammation in the stomach or small intestine. The bacteria can lead to gastritis and ulcers in the stomach. The most common symptom is the burning pain in the abdomen. The infection is acquired by ingesting contaminated food or water and through person to person contact. Here is a list of foods to avoid during H pylori infection. 12. .

13.

How to avoid H Pylori infection:

14. 15. 1. Avoid spicy foods and spice powders: Avoid spices such as chilli powder, black pepper, red pepper, mustard powder, cinnamon, cloves, nutmeg and mustard seeds. Try to avoid these spices if they bother your stomach. Especially avoid these foods during H Pyroli infection as they provide a perfect ground for these bacteria growth. 16. 2. Avoid tomato rich foods: Avoid tomatoes, tomato juice, pasta sauces, tomato soups. You can eat foods rich in flavonoids such as onions, garlic, apples, celery and cranberries may inhibit the growth of H pylori bacteria. 17. 3. Avoid high fat foods: Cut back on high fat meat and high fat dairy products. High fat foods may increase inflammation in the stomach lining. Try to avoid red meats in your diet. 18. 4. Avoid vinegar: Avoid vinegar and things made with vinegar. You can use apple cider vinegar instead of regular vinegar. 19. 20. Avoid french fries and onion rings

21.

More foods to avoid during H Pyroli infection

22. 5. Avoid fried foods: Avoid fried foods and fatty foods including french fries, doughnuts, processed foods and margarine. Instead of frying, you can bake, saute or boil in a pan.

23. 6. Avoid refined foods: White sugar, cocoa, cake, jam, icecream, pastries, canned juice, chocolates, doughnuts, artificial sweeteners, cream, pies, jaggery and syrup.It is better to avoid refined foods during H pylori infection. 24. 7. Avoid beverages: Avoid beverages that can irritate the stomach lining including coffee, decaffeinated coffee, tea, alocohol, soft drinks and alcohol. Must avoid Coffee. 25. 8. Hot foods and drinks: Try to avoid hot foods and drinks. AIt may help to protect esophageal tissues. 9. Refined flours: Another important food to avoid with diabetes is refined flours. Avoid pasta, white bread, all purpose flour (maida), pretzels, puffs, pizza and processed foods. 26. 10. Oils: Avoid hydrogenated and partially hydrogenated oils. You can use healthy oils such as canola oil and olive oil. 27. 11. Others: Try to limit the use of cabbage, and cooked dried beans may increase the acid secretion. 28. Try to avoid any food that may cause heartburn, bloating, acid reflux and stomach upset.

Time schedule

Combination Diet

Food