Hashimoto’s Thyroiditis and Helicobacter Pylori

Discovered in 1982 in those with gastritis and ulcers, Helicobacter pylori or “H. pylori” is one of the most common infections connected to Hashimoto’s disease and also Graves’ disease for that matter. Like Yersinia enterocolitica and Epstein-Barr Virus infections, Hashimoto’s thyroiditis can be triggered by H. pylori through a process called molecular mimicry which basically means that the infection looks similar to your thyroid tissue so the immune system attacks the infection and the thyroid gland.

What is Helicobacter pylori?

H. pylori is a bacteria (gram-negative) usually found in the stomach of 50% of the world’s population. It tends to found in those with gastritis, GERD(heartburn), gastric ulcers and stomach cancer. It burrows into the stomach lining resulting in inflammation and damage.

H. pylori is capable of forming biofilms which protect it from the immune system and antibiotics.

H. pylori doesn’t like the acid in your stomach so it will infect areas of low acid production. Low stomach acid also known as hypochlorhydria, can set you up for H. pylori infection.

Hypothyroidism leads to low stomach acid production which makes you more susceptible to H. pylori infection. Also, if you are taking antacids for a long time then you are more prone to infection.

Stress(cortisol and adrenaline), Zinc deficiency, adrenal imbalances, intestinal dysbiosis and b-vitamin deficiencies also contribute to low stomach acid production.

Helicobacter pylori and Hashimoto's disease

Is it contagious?

We actually don’t really know for sure how it is transmitted but it can be contagious. It is most likely transferred from mouth to mouth or oral to fecal routes. We do know that H. pylori is found in contaminated food and water as well as dental plaque, saliva, vomit and feces of those who are infected. This would indicate a simple kiss may result in infection or sharing of a drink.

What are the symptoms of H. pylori infection?

Up to 85% of those with H. pylori are asymptomatic! Symptoms can include:

Stomach pain, burning or ache (worse when your stomach is empty)
Black stool
Loss of appetite
Weight loss

Is H. pylori actually beneficial?

Some strains of H. pylori can actually help with the following:

Normalizing stomach acid production
Inflammatory bowel
Esophageal cancer prevention
Barrett’s esophagus
Appetite normalization

Your stomach makes a hormone called ghrelin which makes you hungry. H. pylori can potentially suppress ghrelin levels so you aren’t hungry all the time. Sometimes after H. pylori is treated, people will say that they always feel hungry, even after they eat. This is because ghrelin levels are no longer suppressed by the H. pylori.

We also know that people gain weight after being treated for H. pylori so we must use caution in someone who is obese or has type 2 diabetes.

What are the best tests for H. pylori?

There are five ways to test for H. pylori:

Urea breath test
Blood test
Stool test
Stomach biopsy
Urine test

The urea breath test and the stool test are the most accurate for active infection. The blood test can show past infection and active infection, however, it can remain positive for years after the infection is gone. The blood test is adequate if you have never been treated for H. pylori before. The blood test has advantages because it can show an infection that has gone systemic meaning it has left the stomach and is now present in arterial plaques for example.

After a review of many research publications on testing, they all report different results as to what the best test is for H. pylori. A biopsy is very invasive but highly accurate so we have to choose between stool, blood and urea breath test. Blood testing is 76-85% sensitive, the urea breath test is >93% sensitive and specific, and the stool test is 93-98% sensitive and 88-96% specific.

I recommend the urea breath test or the stool test as a first-line test for H. pylori in people with Hashimoto’s thyroiditis. If someone is on proton pump inhibitors then the blood test is fine as long as they have never been treated before for H. pylori.

How is H. pylori treated?

Conventional treatment consists of what is called the “triple therapy” which includes a proton pump inhibitor to reduce stomach acid and the two antibiotics amoxicillin and clarithromycin. This is usually only given to those with ulcers however, since doctors aren’t usually looking for H. pylori for other reasons like Hashimoto’s disease.

This is a strange therapy because it reduces stomach acid that helps H. pylori and the antibiotics don’t always work creating “antibiotic resistant H. pylori.”

Alternative treatments work extremely well and don’t create resistant strains of H. pylori.

There are a number of effective natural compounds shown to eradicate H. pylori including:

Mastic gum
N-acetyl cysteine(works on H. pylori biofilm)
Oil of oregano
Omega-3 fatty acids
Buffered vitamin C
Saccharomyces boulardii
DGL (deglycrrhizinated licorice)
Aloe vera
Bismuth citrate

You should be retested after 4 weeks of treatment to be sure the infection is gone.

Hashimoto’s disease and Helicobacter pylori summary

If you have Hashimoto’s disease you should definitely get tested for H. pylori infection due to the strong connection. There are a number of studies on the connection including this one if you would like to read research on this topic.

If your tests come back positive, your functional medicine doctor can put together a strong treatment plan that will not create drug-resistant H. pylori or disrupt your entire gut flora which can happen with antibiotics. After you are treated for 4 weeks, get checked to see if the plan was successful.

You may see a drop in your thyroid antibodies and improvement in your symptoms when this infection is treated successfully.

I get great results with my patients who have Hashimoto’s disease and H. pylori infection so make sure you get tested soon.

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