H. Pylori and SIBO: Can you have both?
Updated: Apr 3
What is H. Pylori?
H. Pylori is a bacteria that has a unique ability to survive the very acidic environment of your stomach. For most bugs, the stomach acid kills them, but not H. Pylori!
You can get H. Pylori from infected water or food, even through shared utensils and (here is a surprise) through kissing.
H. Pylori can survive your stomach acid and makes itself at home by secreting an enzyme to make things more comfortable for itself. The enzyme – urease – reduces acid in the stomach (1). While more comfortable for the H. Pylori to settle in, not having enough acid in your stomach is a big problem for you. We’ll cover why a bit later in this article.
Many of us have H. Pylori in our stomachs without even knowing it. The bacteria can live in our stomach, without causing any issues at all. But for some of us we can develop symptoms from this resident bug, sometimes years after we may have gotten it!
What does H. Pylori do in your body?
There are multiple strands of H. Pylori and not all cause infection. If we have an infectious strand, we might not start to feel symptoms for months or even years later.
Normally, we have a stable lining of mucus along the inside surface of our stomach. The role of this lining is to protect our own tissue from the very acidic contents of our stomach. The acid has several very important roles which include helping us to digest proteins, killing pathogenic bugs and allowing us to release vitamin B12 from our food. But, we need to protect our own muscle tissue from the acid: it is protein, after all!
Certain strains of H. Pylori can burrow through the lining and expose the stomach wall. Without the protection of the mucus layer, the acid in your stomach attacks your own stomach tissue. This is where you can start to feel unwell: the infectious H. Pylori bug has just led to an ulcer!
H. Pylori can cause ulcers in your stomach and in the upper GI tract. Before the discovery of H. Pylori in 1982, we used to blame spicy foods and stress for causing ulcers. Now we know that this bacteria is to blame (2).
What are the symptoms of an ulcer?
Everyone is different, so you may not have the exact same symptoms as anyone else. If you have an ulcer, you may feel any pain in your stomach that might be worse when your stomach is empty and may feel better with food, milk or taking an antacid. You might also have:
● A loss of appetite
● Unintended weight loss
If your ulcers are in your intestine, you might also:
● See dark black or red stool
● Feel dizzy or faint, tired
● Have pale skin
These symptoms all relate to blood loss.
If you suspect that you have an H. Pylori infection, please visit your doctor. He or she can offer breath testing to diagnose an H. Pylori infection. Your doctor can also confirm the presence of ulcers by a few testing methods, including using a small camera to look down your throat into your stomach.
Treatment of a stomach ulcer
Conventional treatment of a stomach ulcer involves using antibiotics to kill the bacteria as well as acid-reducing medication to protect the lining of the stomach as you heal. While the antibiotics may do a great job of killing the intended bacteria, they may have the unintended consequence of throwing the good bacteria in your intestine out of balance.
And, the trouble with taking acid-reducing medication for the long term is that it interferes with normal digestion and absorption.
Having an acidic environment is important for protecting against pathogens, the absorption of vitamin B 12 as well as triggering the release of digestive enzymes in your small intestine.
Not only does having reduced stomach acid increase your risk of an ulcer, it can increase your risk of many other issues. H. Pylori is one tricky bug.
What else can H. Pylori do?
H. Pylori is probably the most notorious for its role in stomach ulcers. What may surprise you is that H. Pylori infection can actually cause other issues, some that are a bit more subtle than the stomach ulcer symptoms we have already discussed.
H. pylori doesn't always create GI symptoms, sometimes it's fatigue. Why? Because with reduced stomach acid we have a harder time breaking down protein-rich food into amino acids.
Amino acids are building blocks for our body’s machinery, things like hormones, muscle tissue and hemoglobin. Without sufficient hemoglobin to carry around oxygen to each and every cell in our body, we feel tired and worn down, even if we are breathing deeply.
Other issues brewing from low stomach acid can be things like reduced immune function. Can you guess what antibodies are made from? Protein! Once again, without optimal digestion to gather the building blocks that we need from the food we eat, we can’t optimally build the important machinery to perform at our best.
One more example of H. Pylori causing a ruckus? How about having rogue blood sugars that might have nothing to do with food and everything to do with not producing enough insulin which – yep you guessed it – requires amino acids. Hormones, including thyroxine, melatonin and serotonin, can’t be built without the proper building blocks.
As you can see, H. Pylori modifying your stomach environment to suit their preferences has a profound impact on your health and wellness. Having a stomach environment that is not acidic enough, or overuse of antibiotics (or both) can make you at risk of developing many conditions, including SIBO.
What is SIBO?
SIBO is short for small intestinal bacterial overgrowth. When things are working as they should, we have a diverse colony of bacteria and other helpful organisms living in our large intestine. You may have heard of this by another name: the microbiome.
These beneficial organisms help with the digestion of our food, feed the cells lining our digestive tract and we thank them by giving them their preferred foods: fiber.
The trouble comes when the bacteria migrate: if the bacteria aren’t where they should be – mostly in the large intestine – they can cause symptoms. Our small intestine is not sterile, or free of all bacteria, but there should be far more in the large intestine.
There is a kind of door between the large intestine and the small intestine that helps to keep most of the bacteria contained in the large intestine. If that door – the ileocecal valve – is not working properly, you’re at greater risk of bacteria roaming into your small intestine.
What are the symptoms of SIBO?
Your symptoms of SIBO may vary from those of others, but may include:
● Loss of appetite
● Unintended weight loss
● Fullness too soon while eating
There is a lot of overlap between the symptoms of these two conditions, which is why having an expert in functional nutrition can help you to uncover which condition (or conditions) might be making you feel bad, as well as get to the bottom of why you got the condition to begin with.
This is important: without understanding the root cause of why you have SIBO, you are susceptible to relapse.
Without treatment to put SIBO in check, further complications to your health and wellness may be on the way. SIBO – left untreated – can lead to malnutrition. And the domino effect continues: we know that lack of nutrients can lead to fatigue, low immunity, hormonal imbalance, disturbed sleep, depression/anxiety and more. Yikes!
SIBO and ulcers require more care than an antacid and antibiotic. That’s the magic – well, science – of an functional nutrition registered dietitian. We get down to root causes to craft effective solutions.
What can cause SIBO?
Unfortunately, a lot of things can increase the chance that you can develop SIBO (3). These can include:
● Gastric surgery for ulcers
● Crohn’s disease
● Celiac disease
● Food poisoning
● Medications or treatments that slow the passage of food along the digestive tract
How to diagnose SIBO?
The most accurate, “gold standard” testing for SIBO is quite invasive. It involves a healthcare provider running a very small tube down your nose, down into your stomach, and all the way to your small intestine. There it can collect fluid for testing.
However, because that is invasive, that isn’t usually a physician’s first choice. As with H. Pylori, the more common method of diagnosing SIBO is through breath testing. It is much less invasive and can even be done at home.
What is the recommended treatment for SIBO?
Physicians typically offer antibiotics and/or herbal remedies as a standard treatment for SIBO. And more than likely, they’ll offer relief. However, a relapse may be around the corner.
From a functional nutrition perspective, the best treatment for SIBO helps to prevent relapse. As a registered dietitian, my recommended SIBO protocol will depend largely on investigating why the SIBO developed to begin with. If H. Pylori and SIBO are happening together, the H. Pylori may have happened first.
While it is common to treat stomach pain and GERD with antacids, having low stomach acid may create more problems later. As we chatted about earlier, having enough stomach acid is important for normal digestion and absorption, to help protect us from getting sick from pathogens in our food and to trigger the release of needed digestive enzymes.
And, only treating symptoms means that SIBO can happen again. To be most effective, we have to identify and address the root cause to work towards long-lasting remission. That is the magic of functional nutrition: to get to root causes to prevent relapse.
Key take-aways about H. Pylori and SIBO
It is absolutely possible to have issues with both H. Pylori and SIBO. It is tricky to tell which one might be causing problems, or if you have both conditions, since so many of the symptoms overlap.
There are so very many factors that contribute to how you feel on a given day: it can feel really confusing and frustrating to be dealing with symptoms that are not specific – how do you know what is really going on when so many conditions share the same symptom list?