We've heard it since we were kids: germs are nasty. Even more so in the recent COVID-19 pandemic, the same rhetoric is being echoed: germs are harmful; wash and sanitize any bit of life off your hands. However, as most know, humans have co-evolved with bacteria from the beginning. Not all bacteria are bad, but some can become more problematic when given the right opportunity. In our case, that bug is Helicobacter Pylori (H.Pylori).

Inside Scoop

Around half of the population may have it. It is a gram-negative, helical-shaped bacteria usually found in the human stomach. It is a risk factor for acute and chronic gastritis (inflammation of the stomach) and peptic ulcer disease (1). But does 50% of the population get peptic ulcer disease or gastritis? No! Do you know what that means?

H.Pylori may be normal for some of us to have.

It becomes problematic when it takes over more of your gut microbiome "garden" than normal. Or when it starts producing more "flower-destroying" compounds. 

Interestingly, the man who discovered that H. Pylori was the causative agent in gastritis purposefully infected himself with the bacterium to prove this link. He literally drank it, all in the name of science…I don't think he struggles with commitment issues. 

H.Pylori and Thyroid Function

As we previously discussed, even though many of us have H. Pylori, not all of us will have an immune response to it. But, those with an immune response to it may be at a higher risk for Hashimoto's or Graves Disease. 

Hashimoto's Thyroiditis is an autoimmune disorder where your immune system wrongly attacks different tissues in the thyroid gland. Hashimoto's is also the most common cause of hypothyroidism. TPO (Thyroid Peroxidase) or TG (Thyroglobulin) antibodies indicate Hashimoto's. Graves Disease is also autoimmunity to the thyroid, but instead, it causes hyperthyroidism.

An immune response (antibodies) to a specific strain of H. Pylori, CagA, was associated with a higher incidence of autoimmune thyroid (2). CagA (Cytotoxin-associated Gene A) is a protein the bacteria releases into infected cells. This is the flower-destroying compound. Antibodies to CagA strains were associated with a greater than 300% chance of Graves Disease(3). But, there was no significant increased risk for Hashimoto's. This is a good sign because Hashimoto's is far more common than Graves! 

Your doctor may run a thyroid blood panel to assess your thyroid function. They may also conduct a physical exam to check for abnormal nodules on the thyroid gland; they may inspect the outer ⅓ of your eyelids and fingernails or listen to your heart or bowel sounds. All of which can give us insight into the function of the "metabolic regulator."

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What Can We Do About It?

First, you should consider what behaviors and environmental factors contribute to H.Pylori's greater residence in the garden. These include chronic use of NSAIDs (Aspirin, Advil, Aleve, Motrin, etc.) and regular PPI (proton-pump inhibitor) use (Prilosec OTC, Prevacid).

Once H.Pylori has taken up residence in your garden, the conventional approach is to use combination Combination therapy including antibiotic(s) and PPI given together. PPIs help expose the bacteria to antibiotics, while antibiotics do the actual "killing." 

We all have heard, read about, or experienced the side effects of antibiotics, so researchers started examining using probiotics in combination with conventional treatment.

A recent meta-analysis (pooling studies together) revealed that multi-strain probiotics may reduce adverse effects of H. Pylori eradication, improve eradication rates, and reduce bouts of antibiotic-associated diarrhea (4).

Most of the probiotics studied were in the Lactobacillus and Bifidobacterium genus. Enterococcus Faecalis also showed excellent efficacy. The critical thing to point out here is that probiotics were combined with the conventional triple eradication therapy, not as a stand-alone therapy.

Probiotics as a stand-alone therapy aren't as supported (5); however, one study did show that using a high-dose multi-strain probiotic for ten days achieved a 32.5% eradication rate. This study used the gold standard, randomized, double-blind, placebo-controlled method. The critical point, most eradication rates with the standard combination therapy aren't deemed significant until they reach a 75% eradication rate. Still, a long way for probiotics to go, but we're on the right track. If you want to know more about how probiotics work and how they're named, check out my article 'Why Kombucha isn't fixing Your Gut Health.'

Natural Herbs

Herbal antimicrobials have been used in Traditional Chinese and Natural Medicine for thousands of years and are becoming more relevant as the number of antibiotic-resistant H. Pylori strains increases. Herbs with the most promise include broccoli sprouts, resveratrol (found in the grapes of red wine), berberine (when combined with the standard triple therapy mentioned above), Goldenseal and Chinese Goldthread Extract, licorice (as a stand-alone therapy), and even potentially curcumin (a compound present in the turmeric spice) (6, 7, 8). 

These herbs work their magic in the gut. 

And when you heal the "gut garden", many thyroid symptoms resolve independently. 

That's because as you allow the gut to thrive, it can do its prominent role of keeping problematic bugs such as H.Pylori, out of the garden. 

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If you are suffering from thyroid-type symptoms and looking for more concrete guidance, please get in touch with your medical provider to discuss options. If you're looking for someone to help get to the root cause of your symptoms and condition, I'd recommend seeking a Functional Medicine Practitioner with knowledge of H.Pylori and thyroid function.

As always, trust in Your Gut.

Disclaimer: The contents of this article are for educational purposes only and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.

References

1. Ahmed, Niyaz. 23 years of the discovery of Helicobacter pylori: is the debate over?. Annals of clinical microbiology and antimicrobials, 2005; 4,17. Doi: https://dx.doi.org/10.1186%2F1476-0711-4-17
2. Soveid M, Hosseini Asl K, Omrani GR. Infection by Cag A positive strains of Helicobacter pylori is associated with autoimmune thyroid disease in Iranian patients. Iran J Immunol. 2012;9(1):48–52.
3. Shi WJ, Liu W, Zhou XY, Ye F, Zhang GX. Associations of Helicobacter pylori infection and cytotoxin-associated gene A status with autoimmune thyroid diseases: a meta-analysis. Thyroid. 2013;23(10):1294–1300. doi:10.1089/thy.2012.0630
4. McFarland L, Huang Y, Wang L, Malfertheiner P. Systemic review and meta-analysis: Multi-strain probiotics as adjunct therapy for Helicobacter pylori eradication and prevention of adverse events. Un Eur Gastro J. 2016; 4(4):546–561.
5. Losurdo G, Cubisino R, Barone M, Principi M, Leandro G, et al. Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis. Wor J Gastro. 2018; 24(1):139–149.
6. Vale F, Oleastro M. Overview of the phytomedicine approaches against Helicobacter pylori. Wor J Gastro. 2014; 20(19): 5594–5609.
7. Hu Q, Peng Z, Li L, Zou X, Xu L, et al. The efficacy of berberine-containing quadruple therapy on Helicobacter pylori eradication in China: A systemic review and meta-analysis of randomized clinical trials. Front in Pharm. 2020; 10: 1694.
8. Seifollah S, Mousavi B, Naghdifar S, Rafieian-Kopaei M. Treatment of Helicobacter pylori infection by herbal drugs; a review on current data. Rev J of Prevent Epid. 2016; 1(1): 6