Sunday, August 17, 2008

Helicobacter and hydrogen

This one just has to jump the queue of posts, it had me cracked up. Thanks to Marco for the abstract and press release, the full text doesn't say anything much you can't get from those two sources.

Here's the gist of it:

If you are eating to one of those complex carb high fiber diets beloved of Ornish and his ilk, your flatuses (flati?) may be room clearing, but you're probably healthier if you just drop them and run. Clamping tight to save embarrassment could seriously damage your health, as could eating the high fiber diet in the first place of course. The only significant source of hydrogen in your body is colonic fermentation of carbohydrate by bacteria.

Helicobacter is a harmless or potentially beneficial commensal in your stomach, unless you feed and feed and feed it with, guess what? Hydrogen. This carbohydrate derivative may be more important than sugar for H pylori gastritis, though perhaps not in the gastric carcinogenesis aspect. Looks like it might also be a preferred energy source for assorted serious nasties, here's the speculation from the press release:

"Though unstudied, it's possible that this hydrogen could serve as an energy source for pathogens in other areas of the body, including the lungs and internal organs.

Since the amount of hydrogen produced in the colon varies based on diet, and since the researchers have shown that H. pylori uses this hydrogen as an energy source, something as simple as a diet change could affect virulence and persistence of this and other pathogens"

I don't think it's practical to eliminate all fiber from your diet. The absolutely indigestible fiber from grains can go very easily as cereal avoidance is a major step towards health, but getting rid of all remaining vegetable fiber is more difficult. I suspect having some hydrogen in your blood stream is probably normal. I've heard in various places on the net that LC eaters do still produce some flatus (but it's usually odourless) so must be making some hydrogen and methane, but the amount is low. So too will be the molecular hydrogen in their gastric mucosa.

So be tolerant if a whole grain fiber derived room clearer gets you. It's there for health purposes. Better out than in.



. said...

Many a time I've been sitting in a tedious business meeting and wished I had a heliobacter so I could escape.

Rather windy here today, as it happens ... but fortunately only outside.

Peter said...

Hee hee


marco said...


I've read again you post "Helicobacter and glucose" and yes, the Hisayama study suggested an increase in Fasting Plasma Glucose (FPG) to be a risk factor for gastric cancer (Helicobacter Pylori positive).

A modest increase in the FPG, but not a "modest increase" in the incidence of gastric cancer.

7.2 gastric cancers per 1000 person/years in the high FPG (> 5.8 mmol/l) vs. 2.2 per 1000 person/years in the low FPG (< 5.3 nmol/l) in men.

In women 2.5 per 1000 person/year in the high FPG vs. 0.8 per 1000 person/years in the low FPG.

More than three times higher incidence?!?

Good if you have a low FPG. Ok, but do you have a low FBG if you're on a LC diet?

I don't want to spoil the party to many LCers here, but I read on this Blog that "LC eating rapidly induces insulin resistance" and that "elevated non esterified fatty acids induce physiological insulin resistance and a higher than expected FBG level.".

Uhmm... Bad news for LCers who carry their "beast"?

p.s. - Peter, you said: "This carbohydrate derivative may be more important than sugar for H pylori gastritis, though perhaps NOT IN THE GASTRIC CARCINOGENESIS ASPECT".
I don't understand. Why "not in the carcinogenesis aspect"? Could you explain?

Thanks again.


Unknown said...

OK some anecdotal verification ... I try to low carb nowadays, and I've noticed that the only time I really let rip is when I've been (a) on the beer or (b) on the pizza and other high-carb sources.

And my wife keeps tellng me that I fart because I don't eat enough *fruit*. [Sigh ...]

PS thanks for the good work, Peter.

Anna said...

Trying to understand how hydrogen produced from colonic fermentation gets to the h. pylori bacteria, lungs, and internal organs. Does it get into the blood stream in excessive amounts?

Eric, I can always tell when my husband has been "hitting the bread basket" when he returns from a restaurant dinner; it's quite dramatic. I doubt the bread is high fiber, however (white flour does it to me, too).

I would never suggest he eat eat more fruit, though, :-). We're both having a hard time limiting our consumption of the bounty from our fig tree this summer, giving away about 3/4 of the fruit that ripens daily.

Peter said...

Marco, Marco, Marco... Have I failed you that badly?

OK, here we go.

A LC eater has a FBG of 5.5mmol/l, technically pre diabetic, but blood insulin is 3.5 IU/ml This is VERY low. Glucose is in very short supply but blood glucose is maintained by physiological insulin resistance, ie the muscles are full of triglycerides assembled from free fatty acids (NEFA) from lipolysis. The LC eater has breakfast, with enough protein from his eggs or particularly casein from his yoghurt to raise insulin from 3.5 IU/ml to 5.0IU/ml. This inhibits lipolysis enough to reduce NEFA in the bloodstream, intramuscular triglycerides fall and muscle insulin sensitivity returns. There's minimal glucose coming from the gut and so plasma glucose drops to between 4.0 and 5.0mmol/l, probably nearer 4.0mmol/l. It fluctuates between 4.0 and 5.0 after and between each LC meal. In the early hours of the morning there is a growth hormone surge and NEFA from lipolysis peak early morning to give insulin resistant muscles and an elevated FBG.

MEAN glucose over 24h will be in 4 point somethingish, HbA1c will be between 4 and 5%. INSULIN will probably average out around 5-10 IU/ml, averaged out over 24h.

A SAD eater has a FBG of 5.5, prediabetic, because he is prediabetic. His muscles and liver are permanently and pathologically insulin resistant. His pancreas is cranking out 50 IU/ml of insulin to just keep that FBG in the 5.5mmol/l range. He eats bagels, jam and a large mocha for breakfast and his blood glucose hits 15mmol/l. His pancreas ups the insulin output as high as it can get it, perhaps to 150 IU/ml and just manages to to get blood glucose back down to 5.5mmol/l before lunch. Lunch is pasta and the cycle repeats.

Mean glucose over 24 hours will be between 7 and 12mmol/l. HbA1c might just hover around 7%. INSULIN will average 100 IU/ml over the 24 hours.

Helicobacter lives on the hydrogen from flatus, so is present in far too high a number for health in our flatulent carb eater and chronically irritates the gastric lining. Insulin-like Growth Factor-1 (IGF-1) receptor is over expressed and converts disorderly proliferation of gastric mucosa in to gastric cancer. See here.

Insulin acts on IGF-1 receptor to achieve this transformation.

A high carb eater with FBG of 5.5mmol/l implies chronic hyperinsulinaemia, 24/7 and is looking for something to die from.

A LC, very high fat eater with a FBG of 5.5mmol/l implies they haven't had breakfast yet. They are not going to be hyperinsulinaemic at any stage. Unless they eat a bagel instead of their normal bacon and eggs that is. If they do this their blood glucose will hit 10mmol/l before insulin can shut down lipolysis and get the muscle accepting glucose.

It's NOT the FBG of 5.5mmol/l that matters. It's what that means about insulinaemia if you are eating a rice based diet. It's bad. The Kitavans eat a sweet potato based diet, are not insulin resistant and have FBG of 3 point something.

Does that clarify matters? Did I screw up in terms of clarity in the posts on physiological insulin resistance and H. pylori? If so, I'd better get a new post up!

Thinking in terms of FBG = 5.5mmol/l = huge cancer risk is thinking like a cardiologist. Don't go there. Think why, think holistically.


Peter said...

Hi Eric,

Hmm, know what you mean about the beer. Back as a Nottingham teenager we used to drink Shipstone's Laxative. More than just farts!


Peter said...

Hi Anna,

Yes hydrogen gets in to the blood stream. Exactly how much constitutes "a lot" I don't know. But the "hydrogen breath test" in response to a carbohydrate challenge is a standard test for overgrowth of bacteria in the small intestine in humans. There has to be a bit more to it than carbs though, as we know rhe Kitavans and many other non industrialised people eat plenty of fiber without cancer. But then they are happy with their H. pylori...


mtflight said...

LOL Peter.

Great sleuth work. You should make your response to Marco as a post of its own. You have a way for putting puzzles together. Please continue to keep up the good work!



mtflight said...

hmmm I wonder what the "poly-ols" do?

Anyone that has tried a batch of sugar-free candy/chocolate/ice cream knows that those products upset the, ehem, "hydrogen balance."

Particularly maltitol and sorbitol come to mind. I avoid them like the plague, but they're probably preferrable to HFCS.

On a sidenote: always rememeber to read the ingredient list--I've seen low carb ice cream with straight fructose listed in the ingredients (for glycemic control--ha).

Peter said...

Hi Alex,

Yes, the polyols are laxative, I believe it's known as Montezuma's revenge. We use "Lactulose" clinically for assorted poorly validated reasons, less enjoyable than LC chocolate but I think it was Frank who suggested that polyols might convert to fructose... mmmm


marco said...

Thanks, Peter, for clarification about insulin and FBG.
So neither HP nor carbs provoke gastric cancer (even in association).

Kitavans have both.

It's sad when two supposed murderers suddenly disappear...

Peter said...

Certainly H. pylori doesn't look to be the problem to me. Nor carbs per se, I'd be willing to bet that the Kitavans have HbA1c values below 5% and process their carbs with the minimum amount of insulin required, ie they are not insulin resistant, not hyperinsulinaemic and not chronically hyperglycaemic. I don't know this, as the only papers of Lindeberg's I've seen only looked at fasting values and didn't check HbA1c, frcutosamine or post prandial glucose.... The fasting values look pretty good.


Anonymous said...

Peter: "I don't think it's practical to eliminate all fiber from your diet."

Not really. Just stop eating things like whole fruit, whole vegetables, chocolate, beans, grains, nuts, and seeds. Easy. I find that I react a lot better to fiber-free juices any way. They provide more stable blood sugar and energy, paradoxical as it may seem. Unheated honey causes no energy problems at all.

"The absolutely indigestible fiber from grains can go very easily as cereal avoidance is a major step towards health, but getting rid of all remaining vegetable fiber is more difficult."

The problem with grains is that the modern grocery store variety aren't prepared right. Here is an article which refutes your claims about the hazards of gluten (all of which are based on studies that use incorrect modern preparation methods). Seems that many with "gluten intolerance" can digest long fermented sourdough bread (6 hour fermentation or more) without any symptoms of distress. I think you are blindered to reality, like Weston Price's own findings of healthy groups eating grains. Maybe they knew something you don't.

Eric: "I try to low carb nowadays, and I've noticed that the only time I really let rip is when I've been (a) on the beer or (b) on the pizza and other high-carb sources."

Beer and pizza can't be compared to "other high-carb sources" like comb honey, fruits, or maple syrup. Most carbs eaten by SAD followers are in the form of refined sugars and fast foods. Maybe your results would be totally different with yeast-free, long-fermented sourdough breads. It could be that pizza and beer are a problem, esp if eaten together, but traditional old-fashioned bread of the long-fermented variety is not.

It's amazing that people here go on and on about the hazards of grains, but they make fermented cream. They realize that fermentation improves milk/cream, but fail to realize the same applies to grains. Maybe their problems with grains are due to the method of preparation and not just the gluten or the hydrogen, etc. It makes sense to look at all sides of the issue, but many posts here are dogmatic and one-sided.

Unknown said...

Sorry Bruce, I was just indulging in a bit of toilet humour. Perhaps I should ingest some raw honey or some sourdough bread and see whether I manage the truly remarkable feat of waking up my sleeping six-year-old with a burst of flatus (as I actually did manage twelve hours after some beers and a pizza). Science calls!

Bryan - oz4caster said...

Eric, I'm in trouble. My 10 yo daughter wanted to go to the pizza buffet tonight. They give a free pint of beer with the pizza buffet :)

Peter said...

Bryan, yes, I think you're in trouble. 10 year olds can be very judgemental: No excuses, clamp tight!