The Gut Infection Most People Don't Know They Have
If I asked you to list common bacterial infections, H. pylori probably wouldn't make your list. And yet it's one of the most prevalent infections worldwide, estimated to be present in a significant proportion of the global population. Most people who carry it have no idea, because it can live undetected in the stomach lining for years, sometimes decades, before symptoms emerge or a practitioner thinks to test for it.
In clinic, I come across H. pylori more than most people might expect. And when it's present, it tends to explain a great deal.
What H. Pylori Does
H. pylori (Helicobacter pylori) is a resourceful organism. It burrows into the stomach's mucus lining, where the acidity is much lower, and sets up residence. In doing so, it directly suppresses the parietal cells, the cells responsible for producing stomach acid. Acid output starts to fall almost immediately.
That alone has significant downstream consequences: poor protein digestion, impaired absorption of iron, B12, zinc, calcium, and magnesium, and a loss of the antimicrobial function that healthy stomach acid provides. With the gut's natural sterilisation mechanism compromised, the conditions for bacterial overgrowth (SIBO) further down the digestive tract become much more favourable.
As the immune system recognises the infection and mounts a response, antibodies are produced against H. pylori. Here's where it becomes more complex. In a process called molecular mimicry, these antibodies can also target the vascular endothelium and the parietal cells themselves, potentially triggering autoimmune gastritis and other autoimmune conditions over time.
In a later stage, H. pylori stimulates G cells in the stomach to overproduce gastrin, which pushes any remaining parietal cells to produce more acid. The result is dysregulated acid: periods of too little, punctuated by episodes of too much. This is the classic pattern behind a gnawing or burning pain between meals or at night, and it's one of the more distinctive signs I look for in clinic.
Recognising the Symptoms
H. pylori doesn't always produce obvious symptoms, which is partly why it goes undetected for so long. When symptoms do appear, they can include:
A gnawing or burning sensation in the stomach between meals or at night
Persistent hiccups
Abdominal bloating and pain
Loss of appetite
Nausea or frequent stomach upset
Dark or tarry stools
Indigestion
Hiccups alongside bloating is a combination I pay close attention to. The gnawing stomach pain between meals is also a significant flag. If this sounds familiar, it's worth investigating.
Testing
Testing for H. pylori is straightforward. A urea breath test, which your GP can arrange, is non-invasive and reliable. A stool antigen test is another good option. What's worth knowing is that an H. pylori antibody blood test is not representative of an active infection. It only tells you whether you've been exposed at some point, not whether the bacteria is currently present. If that's the test you've had previously, it doesn't give you the full picture.
Treatment Approach
Addressing H. pylori before doing anything else to support stomach acid production is essential. There's no point starting HCl supplementation or digestive enzyme work if the infection is still suppressing and damaging parietal cells.
A naturopathic approach typically starts with a mucosa-healing phase, around six to eight weeks of supporting the gastric lining using a range of supplements. This creates the conditions for the lining to repair before any antimicrobial work begins.
Well-researched antimicrobial botanicals used against H. pylori include berberine-containing herbs (barberry, goldenseal), oregano, and the probiotic strain Lactobacillus reuteri, which has specific anti-H. pylori activity and also helps with reflux symptoms during recovery. This is work best guided by a practitioner, particularly if you're also managing any medication.
The knock-on effects of H. pylori on B12 are important to address in parallel. B12 absorption depends entirely on intrinsic factor being produced by the parietal cells that H. pylori is suppressing. Oral B12 supplements often fail in these cases. Sublingual B12 (dissolved under the tongue) or injectable B12 bypasses the issue entirely, which is why these routes are preferred.
If you have ongoing gut symptoms, persistent low B12 or iron, or recurring digestive infections, H. pylori is always on my radar as something to rule out.