Is there an H Pylori diet ? Just treating the H pylori infection is not enough, a healthy diet is very important. The diet can help reduce the levels and/or the virulence of H pylori colonization prevent gastritis, ulcer and possibly cancer- but can’t completely eradicate the infection- keep this in mind [8].
What would H pylori diet look like? The goal of the H pylori diet is to decrease the inflammation and support the repair of the stomach and intestinal lining. This means you should be a low lectin diet such as this one.
If you experience a lot of digestive symptoms such as significant bloating, stomach upset, diarrhea or constipation, you could also benefit from avoiding high FODMAP foods (use low FODMAP foods for a short period of time, during the h pylori treatment).
It is also important to take in the account your food intolerances. For example, blueberries can fight h pylori growth, but if you are intolerant to them, you should consume other berries instead. Does it make sense?
Many foods that have the ability to limit bacterial growth and even kill H Pylori are extremely healthy and should be on everyone’s diet, not just considered as part of the h pylori diet:
Cruciferous vegetables
Isothiocyanates (substances found in abundance in cruciferous vegetables), and particularly sulforaphane from broccoli sprouts can fight H pylori, including clarithromycin-resistant strains. Sulforaphane has strong antioxidant qualities and protects the stomach lining during H pylori infections. In one study, consumption of broccoli sprouts twice daily for a week resulted in normal h pylori breath test [9]. Note: many cruciferous vegetables are high FODMAP, but if you eat them in small quantities they are safe.
Berries
Phenolic compounds from fruits (ie raspberry, strawberry, blackberry, and bilberry extracts showed potent bacteriostatic activity against clarithromycin-resistant H. pylori strains). Blueberry juice was also tested and showed anti h pylori effects in a study, and pomegranate as well. Cranberry juice (250 ml twice daily for a week) can help fight h pylori and make the triple antibiotic therapy more effective [10].
Honey
Way before Starbucks made it available for your coffee – for about four thousand years- honey was used as a medicine. Manuka honey had been researched more than other types of honey, showing the ability to inhibit the growth of h pylori in test tubes. However, the studies in humans infected with h pylori are limited (in these studies honey is combined with other supplements like black cumin) [11],[12]. Note: Honey is on the high FODMAP foods list.
Technical: Mechanism of action: natural honey exerts its inhibitory effects against H. pylori by inhibiting NF-κB and AP-1 activation and downregulation of COX-2 expression [13].
Healthy Fats
Healthy fats from blackcurrant seed oil, fish oil, carrot seed, or grapefruit seed oils, olive oils have potent bacteriostatic activity against H. pylori, at least in test tubes [14], while fish oil showed activity against h pylori in studies conducted in humans [15]. I would add black cumin oil (2-3 teaspoons daily) to the h pylori diet.
Garlic
Garlic. Garlic can fight H pylori. One small study found that 2 cloves of garlic per day (taken with lunch and dinner) had significantly antibacterial effects, as it improved the urease breath test [16]. Garlic works well and has synergistic actions with PPI medication for treating H pylori infections [17], and may reduce the risk of stomach cancer associated with H pylori [18].
Besides its antibiotic properties, research shows that garlic also great for the brain as it protects against neurodegeneration [19]. It possesses anti-cancer, antioxidant and anti-inflammatory qualities; it can lower blood sugar levels and has protective effects on the cardiovascular system. In addition, it is much safer and cheaper than antibiotics [20]. Garlic should be consumed raw if tolerated (as it loses its benefits in the cooked form) or as a supplement (similar efficacy raw garlic vs supplements). Note: garlic is a high FODMAP food.
Aloe vera
Aloe vera protects the stomach, has anti-ulcer anti-inflammatory qualities and helps reduce the acidity while increasing the mucus [21]. Aloe vera gel can inhibit h pylori strains that are resistant to antibiotics [22], or can be used in combination with the antibiotic amoxicillin to treat gastric ulcers/ h pylori [23]. Rather than taking supplements you can consume one teaspoon (5 g) of the gel after meals (use only the translucent gel)
Ginger
Ginger can help treat h pylori infections and prevent re-infection, thus should be on your h pylori diet too. Rather than taking in supplement form, you can consume it fresh. A daily dose would be 1-5 grams. A review of multiple studies confirms the anti-pylori effects of ginger. It also has anti-inflammatory, antioxidant, antiulcer and anti-cancer qualities. It is also safe and effective to be used in pregnant women with hyperemesis (pregnant women with h pylori infections are more likely to suffer from hyperemesis). Ginger seems to be particularly effective against h pylori CagA+ strains [24], which are strongly associated with stomach cancer.
Lactoferrin
Lactoferrin (chelates iron ions, and thus limits the availability of this element to bacteria) is found in mother’s milk. Since cow’s milk can cause serious troubles in autoimmune conditions, the best choice would be goat lactoferrin or lactoferrin supplements ( which have no lactose and very little casein). When lactoferrin supplement is added to triple and quadruple therapy was found to increase efficacy and decrease the side effects from antibiotics [25].
Curcumin and cranberries also have anti-pylori qualities. You can read more details about the mechanism of action of some foods here [82].
During the h pylori treatment you need low stomach acidity to kill the bacterium, thus would be best to avoid acidic foods (for example decaf coffee increases stomach acidity more than regular coffee).
2 . H Pylori Natural Supplements
Most people will use first standard therapy with antibiotics. If you choose this option, would be a good idea to add some natural supplements (like probiotics) during the treatment, then use supplements to restore the gut microbiome and prevent Candida.
Natural supplements are typically used :
in addition to standard therapy (to increase efficacy and reduce the side effects of the antibiotics)
if standard therapy cannot be tolerated (too many side effects, allergies to antibiotics)
if antibiotics fail to eradicate the infection
if the reinfection with h pylori occurs on a regular basis
as a first choice (before trying the antibiotics) – various combinations possible (and quite effective too, if you choose the supplements and dosages carefully)
Secondary infection with Candida happens frequently following antibiotic therapy. For this reason, I will tell you when a supplement has not only anti- h pylori, but also anti-Candida properties.
I will also mention how natural supplements compare with the standard therapy which includes 1.antibiotics, 2. an acid blocker, and 3. bismuth.
There are hundreds of scientific studies that describe the anti h pylori activity of various herbal products. Some of these herbs work just in test tubes, while others work in real life and can actually treat the infection- I will focus on the last ones. Some studies even looked into the great details and examined the effect of various compounds on bacterial virulence factors (like urease, adherence, motility, vacuolization, or on some key metabolic enzymes) [26].
Black cumin aka black seed or black caraway- efficacy comparable to antibiotics (2 antibiotics combined), mild acid blocker, anti-Candida, gastroprotective
Black cumin had been used for thousands of years in folk medicine, and its many health benefits had been researched in over six hundred scientific studies. It protects the stomach against h pylori, has anti-inflammatory, antioxidant, antidiabetic, anti-cancer and immunomodulatory qualities. It is also researched for its neuroprotective effects and its benefits to treat MS, Parkinson’s and Alzheimer’s disease [27].
An open, randomized clinical trial compared the efficacy of standard triple therapy (two antibiotics: clarithromycin, amoxicillin plus the acid blocker omeprazole) with black cumin ground seeds plus omeprazole (for 4 weeks). The result: Eradication rates with 2 grams Nigella sativa (black cumin) seed and antibiotic therapy “ were statistically not different from each other”. The dosage (2 grams of black cumin seeds) is important, as lower and higher doses (1 gram and 3 grams) were less effective against h pylori. Black cumin has some acid blocker qualities, which were enhanced by omeprazole in this study [28]. A combination of black cumin (6 g/day of ground seeds) and honey (12 g/day) can work as well, but less effective than black cumin plus omeprazole. The black cumin plus honey combo eradicated H. pylori in about 57% of infected patients, in a small pilot study [29]. Black cumin also has anti-Candida effects [30] .
In a 2005 in vitro study, black cumin extract produced within 60 minutes, a 100% inhibition of the growth of all the strains of H. pylori that were tested [31]. Several other studies showed the anti h pylori effects of black cumin (seeds or oil) [32],[33]
Probiotics can help eradicate the infection and reduced the side effects of the antibiotics
(particularly Saccharomyces boulardii, Lactobacillus species). Lactobacillus fermentum, Lactobacillus casei and Lactobacillus brevis are three specifics strains of probiotics that have been highlighted in scientific research for their ability to fight H. pylori bacteria [34],[35].
A meta-analysis /review of 33 clinical studies on the effects of probiotics on H pylori concluded that more people achieve h pylori eradication if they use probiotics compared with those who do not. Lactobacillus species have anti-inflammatory and immune modulating activities, plus reduce the side effects of the antibiotics. Saccharomyces boulardii is another well studied probiotic, showing benefits when added to antibiotic therapy [36]. In a placebo-controlled study, a combination of eight strains of probiotics helped eradicate the infection in 10 days with a success rate of 32% [77].
Probiotics ( a combination of Lactobacillus casei (3.3 x 10(7) UFC), Lactobacillus plantarum (3.3 x 10(7) UFC), Streptococcus faecalis (3.3 x 10(7) UFC) and Bifidobacterium brevis ) were found to be more effective compared with the antibiotic metronidazole [85].
Mastic gum had been used for more than 2500 years in many cultures: Greek, Roman, Byzantine, Arab for various conditions. It is best known for treating digestive problems like gastritis and ulcers. It has antimicrobial, antifungal, antioxidant and anti-inflammatory qualities, can improve high cholesterol levels, anti-Crohn and anticancer effects as well [37]. In low doses (ie 1 mg daily for 2 weeks) can treat peptic ulcers very rapidly [38] . Mastic gum has bactericidal effect (has the ability to kill H pylori), according to multiple studies [39],[40],[41]. Although a randomized study showed modest benefits of using mastic gum short term (2 weeks) [43] longer treatments ( 1-2 months) and in combination with other supplements are needed for maximum benefits.
Mastic gum works even when standard antibiotics don’t work, thus being helpful in antibiotic-resistant infections [44]. Not only kills H pylori, but helps improves dental health by inhibiting bacterial growth in saliva and plaque formation on teeth, according to a couple of small, randomized placebo-controlled studies [45]. Added bonus: mastic gum also has anti-Candida effects [46].
Berberine – antibiotic, alternative to bismuth, anti-Candida, gastroprotective
Berberine can successfully replace bismuth from quadruple therapy, according to a randomized study, which compared the efficacy of 2 antibiotics plus PPI plus colloidal bismuth versus 2 antibiotics plus PPI plus berberine for 14 days. Berberine is one of the most researched supplement in the last decade for a good reason: it has multiple health benefits. Berberine can help improve cholesterol and blood sugar levels, manage heart rhythm problems, has anti-cancer qualities. May also help treat MS and other autoimmune conditions, although more research is needed [47], [48]. It also has antibacterial, antiviral[49] anti-Candida qualities [50], and antiparasitic effects. Regarding h pylori infections, berberine can effectively suppress multiple strains of this bacterium, even in antibiotic-resistant cases.
Technical: possible mechanisms of action: berberine may inhibit arylamine N-acetyltransferase activity of H pylori. In addition, berberine could act as urease inhibitors [51] and can help treat gastritis and ulcers caused by H pylori [52] . Overall has strong anti-inflammatory effects, especially related to the digestive tract and may help prevent and treat cancers related to h pylori infections like the stomach or intestinal cancers.
Technical: Berberine reduces proinflammatory cytokines i.e. TNF-α, IL-13, IL-6, IL-8 and IFN-γ; berberine is able to completely antagonize the TNF-α-mediated barrier defects in cell models; it also has the ability to ameliorate pro-inflammatory cytokine-induced intestinal epithelial tight junction damage [53].
Licorice and DGL (The Deglycyrrhizinated form of licorice): antibiotic, acid blocker, an alternative to bismuth, anti-Candida
Licorice is a common herb which has been used since ancient Egyptian, Greek, and Roman and China. In traditional Chinese medicine, licorice is one of the most frequently used drugs, especially to treat digestive problems, infections and allergies. As an antibiotic, antiviral and antifungal supplement, licorice can help fight many infections, especially those caused by Gram-positive bacteria and Gram-negative bacteria, like H.pylori, S.aureus E.coli, P.aeruginosa; Methicillin-resistant S. aureus (MRSA); Bacillus subtilis; Candida [54] ; and viruses like Hepatitis C, influenza virus, herpes simplex I and more.
Licorice can replace bismuth for treating h pylori infections [55] and appears to be as effective as the acid blocker cimetidine to treat peptic ulcers (Caved-S brand of licorice) [56],[57]. It protects the gastric mucosa, reduces stomach acidity and inflammation [58], [59]. Added benefits: licorice has anti-depressant and anti-diabetes effects as well [60].
NAC (N-acetyl-cysteine)- biofilm disruptor, increases the efficacy of antibiotic therapy
NAC is derived from the amino acid L-cysteine. NAC increased the efficacy of triple therapy (2 antibiotics plus omeprazole) by 12% in a double-blind, randomized placebo-controlled study. The rate of H. pylori eradication was 72.9% (NAC + triple therapy group) and 60.9% (triple therapy only group) Dosage: NAC 600 mg twice daily. Few other studies showed similar results [62],[63],[64],[65]
Technical: Mechanism of action: lowers the gastric mucus viscosity, antioxidant function, inhibition of neutrophil activation, vasodilation, and reduces microbial attachment [61].
In an open-label, randomized controlled trial, NAC also has the ability to disrupt the biofilm produced by a bacterium (biofilms create resistance to antibiotics, and are responsible for failure to eradicate the infections/re-infections)[62]. NAC and turmeric appear to be the best two supplements that have the ability to disrupt the biofilm [63]. Supplementing with NAC only can help prevent gastritis induced by h pylori and reduces the growth of bacteria [64]. Other benefits of NAC: great for brain health, reduce inflammation and autoimmunity as well as improving neuropathic pain (tingling and numbness)[65],[66],[67].
Zinc Carnosine (Polaprezinc)- antibiotic, increases the efficacy of triple therapies, helps treat ulcers
Zinc carnosine combines the amino acid L-carnosine and zinc, developed by Japanese researchers and used for over two decades. It is a prescription drug for h pylori treatment in Japan. The combination of zinc and L-carnosine in this chelate form makes this supplement 3 times more effective than taking the mineral and amino acid alone. Zinc is involved in hundreds of biochemical reactions, has antibacterial qualities and promotes tissue repair, where L-carnosine has antioxidant qualities. Zinc carnosine has antioxidant qualities, promotes the repair of the stomach tissue and reduces inflammation [68].
By inactivating urease, it also inhibits the growth of h pylori. Works well in peptic ulcers caused by h pylori or aspirin. Zinc carnosine makes triple therapy with antibiotics more effective, eradication rate increased by as much as 20%, according to randomized clinical trials. Dose of zinc carnosine: 150 -300 mg/day [69],[70],[71],[72].
Vitamin C (low dose & high doses )- antibacterial, increases the efficacy of antibiotics
Small doses of vitamin C (250 mg twice daily) added to antibiotic therapy reduced the need of the antibiotic clarithromycin in a half. Similar eradication of Helicobacter pylori was found between the triple-only group with 500 mg of clarithromycin and the triple with 250 mg of the clarithromycin-plus vitamin C group, according to a study [73].
High doses of vitamin C (5 grams a day for four weeks) did eradicate h pylori in 30% of the participants of a study [86].
Melatonin: antiulcer
Melatonin not only inhibits demyelination and increases remyelination [74], but can also help eradicate h pylori. Adding melatonin and tryptophan to the PPI omeprazole can help heal stomach and duodenal ulcers caused by H pylori [75].
Kamala: antibiotic
Mallotus philippinenesis (the supplement Kamala) is effective against clarithromycin-and metronidazole-resistant strains of Japanese and Pakistani H. pylori [76].
Fucoidan
Fucoidan from brown seaweed shows promise for the treatment of Helicobacter pylori-related diseases, including gastric cancer, but we don’t have clinical trails yet [84].
H pylori natural protocols should include a combination of natural antibiotics, acid blocker and an alternative to bismuth. Also add probiotics (they compete with H pylori, plus can increase the efficacy of the treatment), and the biofilm disruptor NAC.
Examples: Black cumin seed + Licorice+ NAC + Probiotics or
I think black seeds will become the key component of natural protocols for h pylori eradication in the future, as right now everyone focuses on mastic gum. I use black cumin and I found it very useful.
Most natural treatments I came across last about 6 to 8 weeks. I created a combination of natural supplements which works quite well (as confirmed by biopsy/lab tests ), in less time. Natural supplements support your body’s ability to fight infections such as H pylori.
Some may benefit from taking PPIs along with anti h pylori natural supplements (short term). But be aware of both pros and cons of the PPIs:
Pros
PPIs have some antibacterial action (technical: PPIs have anti-urease activity and anti-ATPase activity)
Low stomach acid is detrimental to h pylori (at pH 6 or below), this is easier to eradicate it
PPIs help increase the success rate of therapy
PPIs make antibiotics more effective and help treat the ulcers caused by h pylori (antibiotics do not heal the ulcer)
PPIs promote faster healing of the stomach – they decrease the acidity, meaning less irritation to the inflamed lining of the stomach lining
think about that randomized controlled study 2 antibiotics plus PPIs vs black seed plus PPIs, having comparable efficacy. I think was a very good idea to add PPIs to the natural supplement in order to make it more effective.
The many cons of PPIs
PPIs lower the absorption of the macro and micronutrients from food
PPIs in general, and especially omeprazole may not be effective for people who have a genetic makeup that alters the activity of enzyme CYP2C19. The so-called CYP2C19 rapid metabolizer genotype do not respond well to PPIs, which may be one of the reasons why the antibiotics PPI therapy fails (This issue is more common in Europeans and North-Americans compared with Asians) [87]
PPIs increase the risk of multiple nutrient deficiencies, SIBO [88], aggravation of IBS
Side effects like nausea, changes in bowel movement, headaches are also common with PPIs use
Long term use of PPIs is very detrimental, being associated with:
increased intestinal permeability (leaky gut)
kidney disease
stomach infections and damage of the lining, increased risk of stomach cancer (even after h pylori was eradicated)
heart diseases (including heart attacks)
pneumonia
bone fractures
dementia
significantly increased risk of death (even more than compared with anti H2 histamine drugs). The longer were used PPIs, the more increased of diseases [89],[90],[91].
PPIs will be slowly replaced by other antiacids. Vonoprazan is the newest antiacid. It has a different mechanism (unlike PPIs it is not influenced by cytochrome P450 (CYP) 2C19 ) and had been found more effective than PPIs when added to antibiotics for H pylori treatment [92]. We don’t know its long term safety, though.
Since PPIs have lots of pros, but also a lot of cons, I did look into more natural options.
Herbs like licorice have mild acid blocker quality
Sodium citrate: as it is effective (works within minutes), has a short duration of action (approx two hours and a half) and has no other ingredients, artificial fillers, colors, flavors, etc. Sodium citrate combined with another drug shows some potential to kill stomach cancer cells [93]
Calcium carbonate with magnesium oxide is another safe, effective antiacid
To use or not to use the following supplements?
L glutamine
It appears that h pylori infections cause glutamine deficiency, and this amino acid can improve the lining of the stomach and gut and decrease abnormal inflammation and permeability. However, supplementing with l glutamine is controversial [94], because glutamine is used by the bacterium itself and may enhance the h pylori survival mechanisms, colonization, and growth. After eradicating the h pylori, l-glutamine can help repair the digestive tract [95]. However, I do not recommend l glutamine as a single supplement because can cause excess glutamate (which is already a problem in autoimmune conditions). It is also detrimental for people with cancer (cancer cells love glucose and glutamine). Therefore, I prefer NAC and zinc carnosine as alternatives to l glutamine.
Matula Tea: I was unable to find any scientific evidence. This tea includes several herbs, therefore is a source polyphenols and antioxidants. When I checked this tea the first time, the ingredients were secret (only the family of plants included). I was easy to figure out some of the ingredients ie olive leaf, licorice, Rooi Bos and Honeybush (all available in most supplement stores, by the way). The list of herbs is now available on the official website. It also carries big claims- “98% success rate in a month, all natural, no side effects “, etc. If would have been more cost effective I would have said: “looks ok, may help, why not ?”But is way too overpriced (should not cost more than $30).
What do you think about my approach to H pylori infections? I can tell you there is a lot more than what I wrote here. Do you have questions or do you need personalized consultations via skype? If so, feel free to email me (via the “contact” page of this blog).
