Hmmmm, why am I not growing and why am I so grumpy? Do I have H. pylori?

Persistent presence of H. pylori slows growth rate

Mera RM. Pediatr Infect Dis J. 2012;doi:10.1097/INF.0b013e31824434fec.

Children whose Helicobacter pylori infection was eradicated quickly grew faster than those who were not treated early, according to a study from Vanderbilt University Medical Center in Nashville, Tenn.

Robertino M. Mera, MD, PhD, and colleagues in the division of gastroenterology, hepatology and nutrition examined data from 295 school-age children from rural communities in Nariño, Colombia, who were separated into two groups: 150 who were treated for H. pylori and 145 who were not.

Children in the treatment group who tested positive for H. pylori were treated with lansoprazole, amoxicillin, metronidazole and bismuth for 14 days, and they were re-treated if they remained positive 3 months after baseline. Six months after baseline, height and weight measurements were taken, and presence of H. pylori was evaluated; children were measured every 3 months and checked for H. pylori every 6 months using a urea breath test. Children were followed for an average of 3.7 years.

Researchers concluded that children from the treatment group were 2.98 cm taller on average, even after adjusting for other fixed variables such as sex, father’s education and number of siblings. Similarly, children in the treatment group were 1.1 kg heavier on average, even with fixed variable adjustment.

My commentary on the above research:

I have treated well over 100 patients with H. pylori in the last 2 years. Upon CBC evaluation I usually note elevated MCV and lowered MCH. Note: Proper RBC and WBC differentiation and ratios are achieved only when there is adequate B12 and folic acid. When I do run B12 and serum folate levels, I will usually see one or both depressed.

H. pylori infection has been linked to lowered plasma levels of B12 and folic acid. An April 2002 study published in the “American Journal of Gastroenterology” and conducted at the Oita Medical University in Japan tested the levels of vitamin B-12 and folic acid in patients with H. pylori. The researchers performed endoscopic testing on 93 patients, 57 of whom had H. pylori and 36 of whom did not. Researchers found patients with H. pylori had almost 20 percent lower levels of folic acid than patients without H. pylori.

The above is corroborated by the fact that patients with elevated homocysteine levels can experience a reduction when their concurrent H. pylori infection is eradicated. (1)

B12 deficiency has also been linked to decreased maternal weight and gestational weight gain (2), and as early as the 1930 researcher knew that B12 deficiency led to growth retardation in children (3).

In conclusion, it’s my theory that the eradication of the H. pylori infection allowed the children to achieve more thorough digestion and absorption of macro and micro nutrients, B12 and folic acid being just a small part of this. With increased digestion and absorption, proper growth was reestablished.

(1) World J Gastroenterol 2005; 11(18): 2764-2767
Helicobacter pylori eradication lowers serum homocysteine level in patients without gastric atrophy.
(2) Eur J Clin Nutr. 2006 Jun;60(6):791-801. Epub 2006 Jan 11.
Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians.
(3) Effect of Vitamin B12 on Growth-Retarded Children: A Review By E. E. HOWE, PH.D. 1958