Addressing Reoccurring H. Pylori Infection | Podcast #238

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H. Pylori is a bacterial infection. This kind of infection is something that we always see in our patients with gut issues or poor digestion, or mood and energy issues. H. Pylori is anywhere between 20 to 50 percent of the population that could have this infection.

Know more about more symptoms that could lead to H. Pylori infections, advanced tests and medications, added symptoms, and a lot more.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

00:57 What is H. Pylori Infections

02:49 Antibiotic Resistance

03:19 H. Pylori Medications, Tests

08:13 H. Pylori Symptoms

14:31 Other H. Pylori complications



Dr. Justin Marchegiani: Hey there it's Dr. We are live. Evan, how are we doing today? 

Evan Brand: Hey man I'm doing good. Happy Monday to you. 

Dr. Justin Marchegiani: Very good. Happy Monday to you as well. Well we talked about today we're going to be chatting about H pylori and H pylori infections. The topic that we see weekly in our office of patients coming in with gut issues or poor digestion and even patients that don't even have gut or digestive issues that have just strictly mood and energy issues. H pylori is anywhere between 20 to 50 percent of the population could have this infection and I see it a lot in my clinic.

Evan Brand: Yeah I would rate this is one of the top five roadblocks to achieving optimal health. You know you and I will zoom in and focus on maybe smaller more nuanced topics. But to me this is like one of the biggest roadblocks there is, mainly because of the mechanism that H pylori is doing on the body which is reducing your ability to produce stomach acid.

Dr. Justin Marchegiani: 100 percent. So H pylori is a bacterial infection. H stands for helico so it's like a helix shape and they can kind of like burrow and turn and twist into that gut lining it can create inflammation and there are virulence factors that we look at the big ones are gonna be [inaudible]. These are cytotoxic proteins that are being produced by H pylori by the bacterial infection and they can create more inflammation. It's a good sign that the H pylori stronger. It's a big player to be creating a lot more problems. I do see patients still have issues that don't have these various factors but if we see them it's a good idea that we want to clear them out by knocking out the infection. And it's.. for me it just kind of like puts the infection at a higher level in priority in the treatment protocol.

Evan Brand: Worst case scenario with H pylori and those virulence factors you can develop gastric ulcers, you can develop gastric cancer, you can have major damage to your esophagus, so this stuff can get pretty nasty. And we've seen cases like that where someone comes to us where they've already had an ulcer diagnosis by doing like a barium x ray where you drink a terrible chalky drink they do an x ray on you and they can visualize the ulcers and then the gastro doc in that case generally they're just gonna put you on acid blocking medication. So I think maybe we should spend just a minute here talking about conventional treatment for this stuff. It's not very pretty. Triple or quadruple therapy is often used which is three or four antibiotics used at the same time. Now we know that that doesn't work. Number one, because the CDC admitted that antibiotic resistance is happening. But number two, you and I measure antibiotic resistance on our stool testing and we find a lot of positives which would indicate, hey if you take this antibiotic, you throw it down the hatch you try to treat the H. Pylori with it. It won't work. 

Dr. Justin Marchegiani: Yeah I see that a lot as well. I also see a lot of the antibiotic resistance even clear after herbal treatments. Do you see that at all?

Evan Brand: I do too and I've always been interested in that. And people asked me and I don't ever have a good answer to why 

Dr. Justin Marchegiani: Yeah I'll have to call the lab about that and figure out why that is. But I think —

Evan Brand: I think I know the answer yes. So if we clear the H. Pylori, maybe they can't test the resistance of the antibiotic towards it because the actual bacteria that showed positive flow.

Dr. Justin Marchegiani: And that very well could be maybe you need enough of that bacteria there to actually test the resistance against other antibiotics. Now that it's low enough we don't have enough of that sample, it's possible. I think that's a possible theory. But we see H pylori frequently. Now we've been testing the DNA. And that's a good way to test the PCR, the polymerase chain reaction testing is the newer DNA technology to assess the infection. It's about two to three thousand times more sensitive than the previous gold standard which was the antigen testing. So antigen means it's the foreign. It's a piece of the H Pylori. They use a specific stain and they visualize it under a microscope. That was kind of the old type of testing.

Evan Brand: Or remember about five years ago, you and I were just starting to get into the DNA PCR testing but we were still using the old antigen testing where it took three days of stool samples. Remember that?

Dr. Justin Marchegiani: Yeah I remember that.

Evan Brand: So we it would test negative and then we'd have the DNA and we'd see positive and then we'd look at symptoms and we'd say Wow. So now, I mean you tell me if you if you're doing it differently but I believe you and I both have ditched doing the antigen based testing pretty much completely because we used to run both because we were not sure which one was more accurate. Now we know the DNA is much better.

Dr. Justin Marchegiani: Yes, exactly, so the DNA is great. I will still every now and then if someone is, I think to have an H pylori infection but they're not coming back up every now and then I will order a blood test where we'll look at IGG IGA IGM to get a window into acute infections or chronic infections. Right. IGA IGM is more acute, IGG is more chronic. It's possible that you had exposure to H Pylori. It's cleared and the IGG still positive. You don't ever want to treat based off of the IGG blood test for the H Pylori anyway. And then there are breath test, so breath test essentially work by testing and elevation in CO2. So essentially you have and they think they also may assess urea as well. So you have ammonia or you have protein in your tummy and that protein breaks down into urea. And when you have the ureae that's elevated from H Pylori that urea is can cause that you re to break down into ammonia and CO2. And so you're getting a lot of that CO2 that's coming back positive as an indirect indication that H Pylori is active in the gut. So it's that increase in CO2 that's giving you that indirect measurement that H Pylori is there.

Evan Brand: Yeah. So one of the questions that we get from people is well, hey I tested positive on this stool test now you gave me this horrible protocol to address this infection. Can we just do a breath test because it's cheaper or my doctor is going to run the breath test for me. Can't we just do that to prove that we got rid of it. 

Dr. Justin Marchegiani: Right. So typically you always want to compare apples to apples so if we ran let's say a genetic stool test and we came back with H Pylori we'd always want to compare apples to apples. We want to compare it to the other tests to assess the, to assess the veracity. So you came back with the G.I. map positive. We want to retest on the G.I. map.

Evan Brand: Now you could throw in the breath on top of it if you want to but I wouldn't try to replace breath or blood. You know I wouldn't try to use those to replace a stool panel. We still find the stool is most accurate and also too, you know when you're looking at somebody who's got it's very rare to see H. Pylori by itself. Why don't we discuss that? I mean, if we look at right now it's on page two of the stool test. That's where we see all these H Pylori markers we'll look at the beneficial bacteria which are often low. But that's not all. I mean usually there's a handful of other things like Candida overgrowth that happens as kind of a, I would consider maybe a secondary issue that happened due to the primary H Pylori infection.

Dr. Justin Marchegiani: Oh totally, 100 percent. So just kind of looking at the breath test they are assessing urea but the big thing that does come up is carbon dioxide does come as a byproduct. So just to be clear they are looking at a lot of the urea and that's a lot of the protein breakdown because H pylori does have that enzyme urea. So just kind of giving you an update of kind of what that breath test is looking at. So we have we have our genetic stool test that we like and they can also assess and look at the virulence factors, and they can also look at the antibiotic resistance. The big antibiotics are typically going to be a combination of triple or quadruple therapy usually it's in to be Clarithromycin, Amoxicillin Prilosec or PPI and or Bismuth. And sometimes they'll throw in Tetracycline or Doxycycline to pull those other antibiotics out. So that's kind of the general triple slash quadruple therapy. And then on the IRB as we may use other things like or goldenseal or CLO or mastic gum or higher dose of oil oregano or even probiotic species can be very helpful at knocking down H Pylori. So there's a lot of things that we may use to help knock down that H Pylori.

Evan Brand: I want to talk more about like confections that come with this. Yeah. So bacterial overgrowth you know we'll talk about gut inflammation permeation of the gut barrier. But first why don't we talk about symptoms because people may be hearing H Pylori all this talk and the like. OK well how the heck do you know besides testing that you have it. You mentioned some people may not show any symptoms at all but they still have a very high level of it. But most people that come to us they're symptomatic right. They're not just reaching out just for fun. They're reaching out because they're symptomatic. So I would see I would say weight loss or weight gain. In my case, I lost a bunch of weight with H Pylori where I just wasn't digesting my proteins very well and so I lost muscle mass. I would say bloating, heartburn, gas burping, bad breath is pretty common your breath gets bad because your food's rotting in petrifying in the gut, your nails my nails develop vertical ridges like my nails became more weak and at ridges because of my malabsorption. What else would you say symptom wise?

Dr. Justin Marchegiani: Can you talk a little closer to the mic? 

Evan Brand: Yes. So your audio right there. Your audio did the same thing it sounded like you were really far away but you weren't I think then something. 

Dr. Justin Marchegiani: Okay. All right guys we'll just keep it really close. Perfect. All right. So in general yes. So the low hanging fruit with H Pylori is gonna be getting enough stomach acid.  acid, super super important when it comes to H Pylori. Now it's a double edged sword with H pylori because with H pylori your gut lining could be a lot thinner. It could be a lot more inflamed due.. due to its inflammation. So hydrochloric acid is like it's like trying to get a massage for your back pain or an adjustment for your back pain when you have a sunburn like you may need it. It may be the right thing but it may be too much for the amount of inflammation that's present in your body. So we it's really important that you work with a clinician to have this kind of dialed in. So we may come in with very low dose on hydrochloric acid or maybe even not maybe just use some gentle bitters or enzymes to support the digestive process and then assess how much inflammation, make sure there's no bleeding, make sure we add in things to kind of cool off the gap before we do anything on the acidic side. And everyone's a little bit different. So it just depends I'm always airing on the side of talking to the general public in doing things that aren't going to set you up for more pain or more inflammation and then work with a clinician that can help individualize things as you start to stabilize.

Evan Brand: Nausea is another symptom I forgot to mention. What about you? Do you have any other symptoms I mentioned the gas bloating burping– 

Dr. Justin Marchegiani: Your gas, your bloating, your constipation, your diarrhea, anytime enzymes or acids are affected motility can be affected. And then of course you have, there's a couple of studies out there saying, hey look at these symptoms of H Pylori. They have nothing to do with digestive symptoms. These are mood issues, depression, anxiety, cognitive issues so you can have a lot of issues that aren't H pylori driven, and they can be mood in emotional and cognitive stuff and this is hard because people are kind of like indoctrinated to think, oh I have to have acid burning, I have to have stomach pain, I have to have an ulcer for H pylori to be a problem, and you may not have no symptoms at all connected to digestion.

Evan Brand: Yeah absolutely. I had depression, I had anxiety, I had panic episodes. I mean I was a wreck when I had H Pylori. So I can agree and attest to the fact that yes there probably are some cognitive, psycho, emotional stuff involved and you know, your, your counselor is not going to tell you to go get a stool test for your depression.

Dr. Justin Marchegiani: Exactly yes. And that's an important part. And why does this happen? What's the mechanism? The mechanism is pretty simple. I think if we don't have enough hydrochloric acid if we don't have enough digestive support, we have to break down these amino acids, right? So think of like a necklace you're wearing. Think of that as protein, right. If we go to break each pearl off of that necklace. Those are amino acids, and essentially digestive was we have to break those little pearls up so we can utilize, assimilate, and absorb them. And then of course in our body they get converted into a lot of our neuro chemicals, serotonin is going to be tryptophan, or five HDP, tyrosine will get converted to dopamine and adrenaline and norepinephrine and then you're going to have some of these amino acids convert to GABA which will help you relax and wind down. So we have to essentially take this necklace and break each individual off so we can digest it absorbing assimilate.

Evan Brand: Yep. Well said. All right, so let's go back to the point I mentioned earlier. So the Coinfections like what else happens with H Pylori, we often see Candida overgrowth happening. We often see bacterial overgrowth happening, so at that point maybe more GI symptoms will come on board, and it may not be the H Pylori directly. It may be know pseudomonas or streptococcus or Klebsiella. Some of these other bad guys. And then we know too that all this undigested food has collateral damage on the gut barrier, right? So we're going to see the secretory IGA go low and then we know someone has a leaky gut situation. Now what about  Do you test Zonulin? I don't because I just haven't found it worth the extra expense for people. But some people this beg and plead that they want on when tested.

Dr. Justin Marchegiani: Yeah there is some data on it. I mean most of the data is kind of circular it comes from Alessio Fasano over at Harvard but there's some good data that that's good. That's the number one protein forgot permeability so if I see a lot of auto immune people I will definitely run it just to assess how permeable the gut is. So Zonulin, this protein when it's elevated it means the tight junctions are kind of getting unzipped in your gut and the epithelial lining, and then the more permeable your gut is, the more bacteria and infectious debris and or foods that aren't broken down fully can get into your bloodstream, and create an immune response and create more inflammation, because your immune system not used to seeing all these foods not broken down in the bloodstream. So that creates a lot of immune stress. So it's nice to have that. I'll look at it more patients that are have a lot of autoimmune stuff going on just to assess if treatment brings it down. But again it's not causation for me that's more correlation. How does this improve as we do these things over here to get rid of inflammation or digest foods or get rid of other infections, so it's kind of a corollary marker for me.

Evan Brand: Makes sense. I mean I just generally look at the low secretory IGA. I'd say based on that hey you know probably a leaky gut situation. 

Dr. Justin Marchegiani: Yeah, 100 percent. So looking at the H Pylori right today's podcast is on H Pylori. It's going to be affecting the digestion of protein. It's going to affect the lowering of that PH in the got that nice low PH does three things, it, one it makes it harder for bacteria to grow think of nice low PH as like bleach on a dirty picnic table. It kind of cleans things up and sterilize those things bacteria hates acidic environments to grow and likes actual the alkaline environments. Number two, it gets enzymes activated. So those nice active enzymes are PH sensitive so we drop down that nice PH. These enzymes perhaps energy and turns the peps in. We get these nice protein like enzymes going and then all that food that's all kind of mushed up. That's called kyme. All right that gets emptied into the small intestine and that nice low PH triggers a whole bunch of Bicarbonate from the pancreas, a whole bunch of enzymes, proteolytic enzymes, light ballistic enzymes that means protein and fat digesting enzymes. And it's also gonna trigger that gallbladder to bruise a whole bunch of bile which will help you digest fat as well. So three things, right, it's creating an environment that's harder for bad critters to grow, it's activating enzymes, right? And it's activating a lot of our proteolytic portions and as well as getting the pancreas and the gallbladder involved so really important.

Evan Brand: Yeah, the whole domino effect has to happen with enough HCL which you can't make if you have that infection, and we find 80 plus percent of partners share H Pylori too, so this is why sometimes we have to get the husband or the wife or even the kids involved too, because if someone gets better and then two to three months later, symptoms come back or issues return then we know it's probably just a case of reinfection.

Dr. Justin Marchegiani: 100 percent. So if H Pylori is one of these predators that you know typically a lot of parasites the more fecal oral so we usually have to be a higher level of intimacy for that infection to pass back and forth outside of the fact maybe someone did wash their hands and they cook a meal for the family. That could happen every now and then. But the bigger thing with H Pylori that can be spread with saliva. So just you know a kiss between a mom and her son easily spread that, or sharing silverware or sharing a drink in a household– pretty common among family members so that could easily be spread. So, definitely if we see a husband or wife come in, I definitely want at least those two treated. And then we may look at what's going on with the kids that have any issues that are kind of abnormal on the radar. Meanwhile a little bit deeper right.

Evan Brand: Yeah. Well said well I don't think there's anything else we need to cover on this subject. I'm sure we could, we could pick and add more things to the picture. I would you say if you don't have gut symptoms that doesn't mean that you're clear. 

Dr. Justin Marchegiani: Correct. I think it's good to look at that. And then if you have cognitive issues or let's say you have mood issues and you're on an SSRI, maybe a medication that may not be getting to the root cause, it's stabilizing. Right. But let's get to the root cause. And then, once we address that then you can go back to your prescribing doctor and look at tapering off that correctly but we always want to get to the root cause. 

Evan Brand: Absolutely. 

Dr. Justin Marchegiani: Now don't find one thing here I'm just kind of highlight it is gluten is a big deal. I find the more inflamed we keep the gut it's harder for H Pylori to be eradicated. So, in other words, if people don't change their diets even with really good herbs it can be harder to knock out the infection. So the more we can keep inflammation down, the better the patient responds to a lot of these natural herbal treatments that.. you notice that too?

Evan Brand: Yeah. Well most of the people that come to us they've already changed their diet. So it's rare that we have to have that, hey you need to be off gluten and dairy conversation. But yeah it does act as a roadblock, especially when we see teenagers that are going out and eating pizza and stuff like that. I don't get as much success as quickly with them.

Dr. Justin Marchegiani: I agree I think it has to do with getting the inflammation in the gut and the digestive tract drops, but also I think it has a major effect on the immune system. I think if your immune system is continuing to be pounded with the entire course, eventually that performance would drop. 

Evan Brand: Good call. I didn't think of the mechanism. What do you mean system that makes perfect sense. With the dairy piece especially, I could think of kids that are saying oh my skin is still bad you know cause skin issues can result from H Pylori too. Right. Because that rotting food will create some acne. OK. Well what are you eating and they say well I go out and eat pizza twice a week. Well there you go.

Dr. Justin Marchegiani: Exactly. Find the big thing in a lot of the skin issues are what happens because poor digestion is going to be a skin issue. That's why you see, lots of people talking about improving. You know when they start adding apple cider vinegar into their diet because you're asking. To see the gas and that's helping to break down proteins and therefore you see improvement. Yes. That's another mechanism. Why skin improves with better gut out, better acid and digestion, less putrefaction to the patient and the skin is always going to be used as a means to detoxify. So if you have stress and we can't get it out giving you to deliver, the skins into the next organ system that's going to be leaned upon to help with the thoughts of the patient.

Evan Brand: Yeah if I start to break out of my face, I start to think, OK what's going on. Am I not doing something right. Is my gut? Is it my diet? Is it my liver? Like what's going on.

Dr. Justin Marchegiani: Exactly. Good point. All right. So just kind of recapping the if someone's struggling with issues that digestive side or even mood side and muscle look at that. That's the H pylori infection connection. Make sure you click down below. Reach out to Evan at or Dr. Justin Marchegiani. Myself at  Links down below. We also have transcriptions available if you guys want to look at or read transcriptions there's a great option for you. Make sure you click and subscribe as well so you get new great content that is coming out of your way. Right. Anything else you want to say here?

Evan Brand: No that's it. I would just say get yourself tested. You never know until you test.

Dr. Justin Marchegiani: I totally agree. You're not testing,  if you're not testing, your guessing. Right. We want you to assess and getting that correct data so we can make the right.

Evan Brand: My daughter showed up with H Pylori. She had loose stool, and so we tested her around age 2 and she had H Pylori. So we gave her some liquid herbs. We retested her H Pylori, now gone. So I mean this doesn't discriminate no matter how old or young. I mean, you could be two years old with this infection and that could lead into potentially issues with growth and development and all that. If you're just not digesting, her gut inflammation was high with that as well. So I'm glad that we were able to catch it early and take care of it.

Dr. Justin Marchegiani: Awesome. Pretty cool. Well great podcast today. We'll be back next week. You guys have a phenomenal day. Thanks guys. 

Evan Brand: Take care. Bye

Dr. Justin Marchegiani: Bye.


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