H. Pylori with Dr. Vivian Abenaa Asamoah: Rational Wellness Podcast 407

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Dr. Vivian Abenaa Asamoah discusses H. Pylori with Dr. Ben Weitz.

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Podcast Highlights

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Dr Vivian Abenaa Asamoah is a board-certified Gastroenterologist who combines conventional and Integrative Medicine.   She went to the University of Geneva Medical School and did a residency and fellowship in Gastroenterology, Hepatology and Nutrition at John’s Hopkins.  You can find out more about her at HoustonGastroInstitute.com

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com.  Thanks for joining me, and let’s jump into the podcast.

 Hello, rational Wellness podcasters. Today the topic is H. pylori, the Functional Medicine Enigma with Dr. Vivian Abena. I hope I pronounce that properly. Helicobacter pylori, H. pylori. It’s a bacteria that lives in the stomach. How can a bacteria live in the stomach when it’s all this hydrochloric acid?  Well, it burrows into the mucosal lining and at least two thirds of the world’s population has it in their bodies. Though in the US the level is much lower, maybe 25 or 30%, and maybe as low as 5% in young children. H pylori can cause various GI symptoms or it can be asymptomatic. Testing can include stool, antigen test stool test, breath test, or blood antibody test. It’s generally accepted in the gastroenterology world that if you find a patient that is positive for Pylori, that they should be treated. In 1983, Dr. Barry Marshall proved that H. pylori can cause ulcers. And if you hadn’t heard, if you hadn’t heard about a story, you should read about it, because in order to prove this, he really had to drink the solution of H. pylori, give himself an ulcer, take triple antibiotic therapy, cure himself. And then [00:02:00] he also was gone and he scoped himself. And so for this, he won a Nobel Peace Prize. H Pylori can cause ulcers in the stomach and duodenum, and it can increase the risk of stomach cancer, but it also helps the immune system mature in children, and it may reduce the risk of hay fever, food allergies, asthma and inflammatory bowel disease like Crohn’s. It’s also protective against reflux, merits, esophagus and esophageal cancer. Dr. Martin Blazer in his book Missing Microbes makes the case that we are better off with H. pylori than without it, and suggests that we should consider taking a probiotic containing various strains of h pylori.  Dr. Steven Sandberg Lewis, who I’ve interviewed on this podcast four times now who is an Integrative GI expert, says that unless the patient has gastritis or the symptoms of an ulcer or stomach cancer, then we probably would be better off not testing for h pylori and therefore not treating it.

To help sort things out, we have Dr. Vivian Asamoa, who is a board certified gastroenterologist. She emphasizes evidence-based integrative and functional medicine, combining integrative and conventional care. She went to the University of Geneva Medical School and did a residency and fellowship in Gastroenterology, Hepatology and Nutrition at Johns Hopkins.  Dr. Asamoa, thank you so much for joining us.

Dr. Asamoa: Thanks for having me on, Ben. Thank you so much.

Dr. Weitz: I’m surprised you can get a fellowship that includes nutrition from Johns Hopkins. Now, how much nutrition did they really talk about? 

Dr. Asamoa: Not a lot. Not a lot.

Dr. Weitz:  Oh, okay.

Dr. Asamoa: And I was one of those fellows who did a lot more nutrition rotations.  

Dr. Weitz:  Right.

Dr. Asamoa:  And work with obesity groups, so I was always very interested.

Dr. Weitz:  There we go. So let’s talk about H. pylori. Is H. Pylori a friend or a foe?

Dr. Asamoa: I think H. pylori. That’s a great question, Ben. I think H. pylori is a sneaky bugger. It’s definitely a sneaky, it’s a sneaky bugger because it can metamorphosize into many different shapes, right?  It has. It’s a helical rod, which has flagella, right? Eight flagella, so it can latch onto the epithelium and bury its way into that gastric mucosa and under unfavorable conditions, it can also form into a sort of like cocoon. We call it the OID form and hide away. And hide itself and almost undetectable, right?  But there are also many strains of H. pylori, which is what I think we don’t realize. And there are two strains that are definitely associated with badness in the stomach. That’s the VAC A and the CAG A strains that are the virulent strains, but there are lots of other strains that are non virulent.  And another important thing is that multiple strains can coexist in the same person.

Dr. Weitz: Okay, so can you explain what these virulent factors are? ’cause so those of us in the functional medicine world who are doing say the GI Map stool test, see that there’s a report on how much H. pylori is there and then they have a listing of these virulent factors. 

Dr. Asamoa:  Absolutely.  Absolutely.

Dr. Weitz:  So the, so do each virulence factor denote a different strain or is this something besides being a strain?

Dr. Asamoa: Besides a straight As, something that’s expressed, it’s a protein that’s, that can result in high oxidative stress in the body high. 

Dr. Weitz: So it’s kind of like an endotoxin?

Dr. Asamoa:  Exactly.  Release a low grade L, you know, endotoxin, LPS, that’s permanently there and increase the risk that virulence increases the risk of developing either peptic ulcer disease, gastric cancer. Mild lymphoma for those are the virent vir. The 50% of the time when someone has gastric cancer or peptic ulcer disease, that H. pylori carries those virulent strains that CAG A and the VAC A.  Yeah. So that’s important. But some of them are non-virulent and really perhaps are friends and not foe. 

Dr. Weitz: So it’s too bad that these, some of these tests aren’t telling us about the specific strains. Maybe that’s something that’ll be coming down the road.

Dr. Asamoa: Possibly. But one thing that’s also important to know is that these strains usually are, you know, when they’re present, they usually correlate with some kind of symptom or disease, right?  There’s active disease, so you wanna look for a strain. Of course, I feel when someone has symptoms, right, someone has symptoms, you want to go looking, because if you find it in an asymptomatic patient, then that begs the question, what are we looking for and what does this actually mean?  so when

Dr. Weitz: Are there good strains and bad strains?

Dr. Asamoa:  There are potentially good and bad strains. I think there are strains that are protective because we know that there are certain strains that they even say that some h pylori strains are actually protective against things like asthma, developing asthma help us build our immune system as kids and even protective about against some forms of cancer, like esophageal cancer in Barrett’s esophagus.  Right? Right. But then some strains actually increase our risk of. The common things we’ve talked about, peptic ulcer disease, gastric cancer, but also may potentially increase our risk of pancreatic cancer and colon cancer. But I just don’t think we know enough to really distinguish and really have, you know, a clear sense of which strains are doing what and how the microbiome interacts with, you know, the rest of the other back bacteria interact with each other when it comes to H. pylori.  Right. Yeah, I think we need a lot more data. We need a lot more information, but it’s a very interesting bacteria.

Dr. Weitz: Now, a lot of people in the functional medicine world are giving their patients a GI Map stool test, and I. This is one of the stool tests that reports on H. pylori, and not only does it tell you whether it’s high or low, but it gives you a number and so some feel that anything above detectable levels may be significant.

Dr. Asamoa: Yeah. And I, you know, there are comprehensive stool tests are helpful for many reasons. Right, right. We see how the, I think it’s important to kind of know what’s in there, right? What’s the microbiome? What’s the microbiome? Got the gen. Absolutely. Absolutely. And h pylori does. Play a role in there as well, right?  It plays a significant role, but it is a complex organism, right? And so I think the issue we run into, and I think even the team from GI Maps will say, whenever you ask them, should I treat or not treat? Their answer is always, it depends, always, every time I call for a consult and I ask, they say, it depends.  It depends on so many things, Ben. It depends on the host. It depends on the host immune system. It depends on the environment. What else is in that microbiome? Are we seeing there’s complete dysbiosis and everything is off? What are the strains virulent and how, what is the quantity?  Sometimes they’ll say, well, it’s in the red, but it’s not that high, and they’re not virulent strains, so do nothing. Maybe this is dysbiosis and you could call a different consultant, and they give you the complete opposite. Information. So you always wonder, and so sometimes the question is not always, you know, should we just get all that information?

But what do we do with the information, right? What do we really do with it? Because like Dr. Lewis says, he says, I. Leave it alone. Only test for it if our [00:10:00] patient has symptoms, right? And in gastroenterology today, we always say, well, if you’re gonna test for it because a patient has symptoms, you gotta treat it.  So when you find it and you’re not sure how to interpret it on a GI Maps test, because the PCR stool test. Is definitely not specific or sensitive to detect an active h pylori infection. I think that has to be made clear to everyone because in my experience, Ben, what I have seen is some overly aggressive practitioners.  Treating our patients with antibiotics and these patients for H. pylori, and these patients subsequently developing c diff infection because they got antibiotics they didn’t need. And then coming to me for FMT, now I may wanna do FMT anyway. Right. Because I think it’s gonna help, but we could have avoided that if we just left that guy alone.  Right.

Dr. Weitz: So, disrupted the microbiome that affected the gut immune system.

Dr. Asamoa: Yeah. 

Dr. Weitz: Yeah, by using broad spectrum antibiotics that the patient might not have needed.

Dr. Asamoa: Absolutely, and now the guidelines are very clear and we can talk about that. Ben, whenever you’re ready. The guidelines are very clear about what types of antibiotics we can actually use to target h pylori, because we’ve seen so much resistance develop in the last two decades.

Dr. Weitz: In terms of, yeah, let’s just clarify for functional medicine practitioners who may be listening, who see H. pylori on a stool test and then decide to use a herbal regimen.  Let’s say they put the patient on mastic gum and oregano oil. What you’re saying about the use of the antibiotics leading to C. diff is different than what you would say to the practitioners putting the patients on herbal therapy.

Dr. Asamoa: Abso completely different. Of course, on herbal therapy we’re not going to cause C. diff, [00:12:00] but I think what I want to also share is that the presence of h pylori on a PCR stool test is not indicative of an active h pylori infection in the stomach. 

Dr. Weitz: So if you really want that, that alone is not enough. You need to do a second test to confirm it.

It’s

Dr. Asamoa: Absolutely. It can indicate that there’s dysbiosis and there could be virulent strain, so we wanna pay attention to that, right? But we know that children who even get virent strains of h pylori children, if they have a strong immune system. They go through it, they move past it, they cure it.  They don’t need antimicrobials necessarily. Even herbal antimicrobials. So you want to confirm, especially if your patient has symptoms, nausea, abdominal pain early satiety, acid reflux, bloating, you want to confirm that this is indeed an active infection by either doing a urea breath test, a stool antigen test, and the most expensive one would of course be an endoscopy with histology.

But all of those have a sensitivity and [00:13:00] specificity of greater than 92 to 95%. Okay. But if you look at the results, and we never look at microbes in isolation, we look at the full picture. What does the garden look like? We’re looking at what are, what do the commensals look like? It’s an opportunistic bug.  So what did the other opportunistics, is there dysbiosis? And at that point, we’re targeting not just h pylori, but the full picture. We’re trying to, as we say, weed, seed and feed. Right. The whole picture, right? Yeah.

Dr. Weitz: Do you like the concept of the four R or A five R program in general as a way to approach microbiome restoration?

Dr. Asamoa:  I do U Okay. I do. It works.

Dr. Weitz:  I’ve, I’m an early Jeffrey Bland symposium goer for like 30 years, and I got the 4 R program drilled into my head.

Dr. Asamoa: You have it down, you’ve had it down for many years. Yeah. New in the integrative GI space. I see that it works.  It works consistently if done right? Absolutely.

Dr. Weitz: So, does H. Pylori increase or decrease stomach acid?

Dr. Asamoa: That’s a great question. That’s a really good question. So when we are. When h pylori thrives under acidic environments. Okay. And that’s why we treat it with, when we are actually giving the antibiotic regimen, we always add the acid block in medication, the PPI, because suppressing the acid formation, we’ll kind of put it into an environment that it doesn’t like.  It’ll actually go into that OID form, right? It does thrive in acid, you know, acidic environments. That’s why the person who’s gonna get the H. pylori ulcer is the person taking an NSAID and non-steroid anti-inflammatory that’s gonna drive acid up, that’s gonna make the h pylori just have a field.  They thrive in that environment. So it does, and that’s how ulcers are formed. So it does thrive, and that’s why we use the [00:15:00] PPI. So you don’t necessarily want to be giving HCL. In someone who has an H active h pylori infection.

Dr. Weitz: Now, you know, this is not what’s often said in the functional medicine world.  And I think it has to do with which part of the stomach the h pylori is present in. But it’s generally told in the functional medicine world, H. pylori is a hydrochloric acid suppressor rather than something that increases hydrochloric acid.

Dr. Asamoa: So it, so there are almost two phases, right?

Dr. Weitz: Okay. 

Dr. Asamoa: When you are initially infected and there’s a lot of stomach acid, it can thrive in that acidic environment as it becomes chronic. And over time it can goes into a dormant phase, right? It will reduce, it will cause that chronic atrophic gastritis, which has lower stomach acid. Right.  So it’s almost like a phase that it replicates in. Absolutely. Oh, interesting. Yeah. But the phase that [00:16:00] we can knock it out in is when there’s less stomach acid, right? When we suppress it, we know that when we add those acid blocker medications for 14 days and we  suppress it reduces the replicative phase.  It goes into that cocoon Coxoid phase, and we’re able to, and the antibiotics are a lot more efficient in that in that non-acid milieu.

Dr. Weitz: Now it is able to survive in the stomach by burrowing into the mucosal lining in the mucus layer. Okay? Yes. Recently had a discussion with Dr. Mark Pimentel from Cedars and he’s working on a new form of rifaximin, which is combined with a timed release N acetylcysteine. Because that breaks up the mucus. And when I talked to him about using NAC that’s available now over the county. He said, well, most of [00:17:00] that would get used up in the stomach, helping to break down the mucus layer there.  So I can’t help but wonder, adding NAC to a h pylori regimen where you’ve got a bacteria that’s in the mucus layer would potentially be something that could be helpful.

Dr. Asamoa: That’s my secret sauce. You got it. That’s exactly what I do. 

Dr. Weitz: Is that right?

Dr. Asamoa: Pre-treatment, that’s my secret sauce. So pre-treatment of my patients before antibiotics, or even before anti-microbial herbals.  If I decide not to go the antibiotic route, I treat with NAC

Dr. Weitz:  Or why not do with it at the same time?

Dr. Asamoa: I usually will start with one. Antibiotics can be quite harsh on a patient, so they’re already struggling with taking, if it’s quadruple therapy, it ends up being 56 pills with the bismuth. Okay. Before that time.  Okay. So I usually will pretreat them for about two weeks and then start the the antibiotics. And [00:18:00] there are studies that have shown that it definitely, there’s a potentiating effect. It breaks up. It is a mucolytic, so it works a lot better. It scatters the organisms and the antibiotics and the antimicrobial microbials can target them and really reach and eradicate, right.  And so that, and there’s also studies actually, and that’s my second secret sauce is probiotic use. Okay. While giving antibiotics. Now this has not made it into the American Gastro Association guidelines, but there’s, there are quite a few studies that have shown that addition of probiotics, while, you know, having your patient of antibiotic on antibiotics potentiates and potentially improves the eradication rate rates post-treatment.

Dr. Weitz: So are there particular strains of probiotics that are more beneficial?

Dr. Asamoa: Be. And lactobacilli Rui. So certain specific strains have been shown, but it’s usually a combination of those commensals Yeah. And

Dr. Weitz: better [00:19:00] with it than afterwards.

Dr. Asamoa:  I don’t know if there are studies that are looking at it during and after the study that I know is during with antibiotics.  Okay. So what I typically do is give it during the antibiotic course, which is always 14 days, and then I prolong it. I give it for an additional 30 days afterwards, you know? Sure. Okay.

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Dr. Weitz:  So when you suspect that there might be H. pylori, let’s say you have a patient with gastritis or symptoms of ulcer, for example, what is your favorite go-to test?

Dr. Asamoa: But the easiest one, I think is the urea breath test. It’s easy. It can be done in the office, or you know, the patient can go to any traditional lab and get it done over it takes less than 20 minutes. Most important thing to tell the patient is stop the anti-acid medication. So a PPI don’t take a PPI for two weeks, and this again is because the PPI will cause the H. pylori to go hide.  It’ll put it into that coxoid form. So it will not, you may not detect it, so it may end up Right, exactly. So we say make sure you have stopped your PPI for two weeks before doing the test, but that test is extremely sensitive and specific. Yeah.

Dr. Weitz: Are there any foods or diets that affect H. Pylori?

Dr. Asamoa: I’m not sure about foods, but what I have read, and there’s a lot of data to support [00:22:00] this, is that micronutrient deficiencies right, will increase.  Like, will that’s sort of like A terrain to get h pylori, right? Especially vitamin D. So they’re seeing that a deficiency in vitamin D. Increase in h pylori incidence I this just goes to show how powerful vitamin D is in the immune system. Yeah. They didn’t see it as much with vitamin C, which I expected as an antioxidant.  They didn’t see it as much as with vitamin C and vitamin E, but vitamin D deficiency, definitely. And the healthier your diet, meaning non-processed foods, wholesome organic plant base, the lower the chance of you getting h pylori as well. So that too has been shown.

Dr. Weitz: Interesting. So let’s let’s talk about treatment.

Dr. Asamoa: Which kind?

Dr. Weitz: Well, why don’t we start with the evil sister, the pharmaceutical.

Dr. Asamoa: The pharmaceutical, the evil stepsister. So, so, [00:23:00] so we gotta talk about the evil stepsister, because the evil stepsister does work. Okay. It does work. And I, and trust me, I have tried herbal therapies for months and months trying to eradicate and I have not been successful. But when we’re talking about antibiotics, we have to look at the recent guidelines from the American Gastro Association. They’ve come up with these guidelines because, more so now than never, everyone’s been on some form of antibiotics. As you know, Ben, everyone’s taken, you know, azithromycin and this and that for a little something they didn’t need it for.  And so the resistance level has just increased. Like substantially, right? So in a state like Texas where we have people from all over the world, right? We’ve got people from Africa, like myself, from Ghana, where h pylori is very common. People from South America, Latin America, we see that influx.  And so the resistance profile for h pylori is significant.  Clarithromycin, we’re seeing over 30% resistant rates. Metronidazole, same very, some as even high as 50% resistance rates. We’re seeing resistance as high as 15 to 20% with Levofloxacin. So those are no longer first-line therapy. I. Not at all.  That old school regimen of amoxicillin, clarithromycin and a PPI… gone.  First Line therapy right now is actually the quadruple therapy, which is amoxicillin, which has very low resistance rates. Less than 1%, I hear less. Very low tetracycline, very low resistance rates as well. A PPI, right, a proton pump inhibitor and bismuth.  And this is a hefty regimen because they have to take it four times a day. And as I said, 56 pills. It’s usually not my first line my, it’s not my first line because nobody, most patients are calling me in the middle of the night like Dr. BI hate you. This is horrible. I cannot, I am nauseous, my tummy hurts. [00:25:00] I can’t take this anymore.  So I usually go to the, what’s the second line Therapy, which is amoxicillin. So amoxicillin is a staple here. So unless the patient has a penicillin allergy, we’re seeing very low resistance. But we’re using amoxicillin at a higher dose at one gram with rifabutin, with a PPI and what’s new on the market now?  Are these potassium competitive? Proton pump like P cabs, right? Ana ze prm, 

Dr. Weitz:  An alternative for acid reduction?

Dr. Asamoa: It’s an alternative for acid reduction. Actually, it’s a much more powerful acid reducing agent. It’s been used in Asia for many years. Just was approved FDA approved in the states probably a year to a year and a half ago.  But it does suppress acid for a lot longer, more than even 24 hours than the traditional PPIs. And using that in combination with amoxicillin and rifabutin or whatever other strategy, we’re seeing better eradication rates, right? The treatment is always 14 days.  Nothing less than that. So that’s the stepsister that’s, those are the recommendations there. 

Dr. Weitz:  Okay.  And what percentage eradication rate do you get with that? 

Dr. Asamoa: I.  Oh, so, so it really varies, but anywhere between 85 and 88%. So it’s not perfect even with that. Yeah, I think we’ve seen higher numbers with the p cabs at in the 92, 92, 90 3%.

Dr. Weitz: And my understanding is that H. pylori can be transmitted through saliva or bodily fluid. So, if a patient comes in with h pylori, do you recommend testing your spouse or significant other, or other people in their household?

Dr. Asamoa: Absolutely 100%. This is another thing that changed in the guidelines. Before the gastroenterologist would just be like, oh no, no need to test.  But that has changed in the guidelines. The recommendation is test the family. Those living in close proximity in the home. I. Test all of them. Now, when it comes to children, I think give kids a [00:27:00] chance, right? Because if we start just doing antibiotics, a lot of, I think 85% of kids would’ve had h pylori at some point in their life, especially kids who are coming from different parts of the world, right?

I hate that term developed and non developed. I hate. More exotic parts of the world. Right. So, so that’s why we are the p pediatricians are reluctant to just testing kids and just treating them because there are some protective benefits of this bacteria, right? And it helps develop immune system.

So, but yes, I treat the adults. Treat the spouse, treat the kids. Treat, you know, treat. Sorry, treat the sibling. Your dogs get h pylori dogs get h pylori. Absolutely. Yes. 

Dr. Weitz: You gotta test the dog too.

Dr. Asamoa: Yes. Dogs get pylori. Yes. So, yes, we do test.

Dr. Weitz: How do you get your dog to take 56 pills a day?

Dr. Asamoa: You know, dogs take medications. We have our, we have dogs on BPC peptides and all of that. You know, I. I have a very good friend, [00:28:00] she’s a functional veterinarian, and we share a lot of ideas. You know, she’s giving them BPC, and you know, they’ve been using that in the vet world for many years. Oh really?

Dr. Weitz: For orthopedic issues.

Dr. Asamoa: For, yeah, exactly. Yeah. In horses, orthopedic issues. Absolutely.

Dr. Weitz: Huh, interesting. Yeah. What’s the status of BPC 1 57?

Dr. Asamoa: I mean, we have it in a subq formulation. We also now have it in an oral formulation. 

Dr. Weitz: I thought it was made a class one medication by the FDA. It may be, But you can still prescribe it?

Dr. Asamoa: Oh, yes. We do prescribe it. Yeah. I mean, they’re trustworthy peptide manufacturing companies that you can use. 

Dr. Weitz: I thought he had essentially taken it off the market.

Dr. Asamoa: Not to my knowledge, I don’t believe. 

Dr. Weitz: Okay. Okay.  Alright.

Dr. Asamoa: Not to my knowledge. We can still just, okay.

Dr. Weitz: So, what are some of the natural [00:29:00] treatments that you can provide for patients with h pylori?  And everybody talks about Mastic gum as one of the Yes. Parts of.

Dr. Asamoa: Absolutely. I think doing the nac before and maybe even during and for as long as you can is definitely beneficial. Adding probiotics mast 

Dr. Weitz: And for NAC, are we talking about like 600 milligrams three times a day or something like that?

Dr. Asamoa: 600 milligrams. I usually pair it with the antibiotics and usually they’re about three times a day, so 600 milligrams three times a day. If I can go higher or I would just depending on what the patient can tolerate a good quality probiotic. Look at the strains of bifido and lactobacilli. You can even you, and you can prolong that for 90 days if you want.  We see how many of our patients have tummy issues after those antibiotics. Right. And if you wanna go for something natural, and I’m not, I don’t I’m not really, I don’t believe that we are at a place where I can comfortably say that herbal therapies will completely eradicate HD pylori if it’s a true [00:30:00] h pylori infection, like.

By urea breath tests or stool testing. Now, if it’s dysbiosis that you’re seeing on a GI maps, what you may just be doing is just seeding, weeding, and improving things in the microbiome generally, and this we would do for. Whatever micro opportunistic bacteria is there, but MAs gum for sure. And I use MAs gum even in just gastritis, non infection related gastritis, maybe chemical induced, antibiotic induced, stress induced.

So we use MAs gum quite a bit. Clove is one that has been shown to have pretty, pretty good results for h pylori. Ginger is another one. Pretty good results for h pylori as well. So there’s use Allison. Allison. Yeah, pretty good results as well. So there’s several of them out there that we can, and in combination, I think when you’re trying to sort of clear out dysbiosis combination therapy in terms of herbals very helpful.  But those are my go-tos.

Dr. Weitz: Okay. And then [00:31:00] once you put the patients on these antimicrobials, do you ever rotate ’em on a monthly basis or anything like that?

Dr. Asamoa: So if we’re looking, if h pylori is part of a dysbiotic picture and usually it’s not the only one, there’re usually other pathogens or opportunistic involved elevated

Dr. Weitz: strep and stab.

Yes, exactly. So I

Dr. Asamoa: would usually treat for at least a good two to three months. Right, right on low some antimicrobials. Right.

Dr. Weitz: And after treatment, do you retest?

Dr. Asamoa: So if I have a positive you know, urea breath test, for example, right? Definitely confirmed. I’m not just treating dysbiosis here. I’m actually treating an acute active h pylori infection.  It’s very important to retest. Very important to retest because again. This bacteria is a sneaky bugger and can go and hide. So we wanna make sure it’s been successfully eradicated. So you wanna retest about four to six weeks after treatment, four weeks after antibiotics, and about two [00:32:00] weeks after you’ve stopped the proton pump inhibitor.

Dr. Weitz: Right. Okay. And is there anything you do after they’re done with their treatment?

Dr. Asamoa: Five protocol all the way. Okay. I just go back. So you try to rebuild

Dr. Weitz: a microbiome

Dr. Asamoa: rebuild? Absolutely. Absolutely. 

Dr. Weitz: So what are some of your favorite strategies, products that you like to use?

Dr. Asamoa: So, I love to go with a lot of natural products, so I do tell patients if they have no histamine issues, I love for them to use some colostrum do some bone brothing.  Right? Okay. Go green leafy greens as much as possible. So

Dr. Weitz: what do you think about colostrum versus serum bovine immunoglobulins?

Dr. Asamoa: I think they’re both very helpful. I do use both in practice. I lean more towards the chorum for different reasons. Some of it could be financial. I don’t know.  I find the colostrum more affordable for patients. But I think both are very helpful. Both are part of that five R protocol in rebutting the immune gut system. Yeah. [00:33:00] Okay. And then what else? Glutamine. I think a lot of data in terms of glutamine and leaky guts, so we can never go wrong there. A good quality glutamine at five grams three times a day, and I like to keep it on for about four to six weeks, really just to rebuild.  Definitely using, I. I, you know, you always have to make sure that micronutrients have been repleted, right? So I wanna make sure Vitamin DI always notice when there’s dysbiosis, there’s mild pancreatic insufficiency, so I’m repleting with digestive enzymes at the time. Zinc carnosine is a big one for the GI tract, as you know, Ben.  So just making sure we’re just following that five R protocol and giving the gut enough time to reseal and heal.

Dr. Weitz: Yeah, I often like to give the patient a micronutrient test as well to see where they’re at in terms of micronutrients.

Dr. Asamoa: Very helpful. Very helpful.

Dr. Weitz: Yeah. Alright. Are there certain favorite products?  Do you use combination products? Do you like individual glutamine, you know, et cetera?

Dr. Asamoa: I do like individual glutamine just to get the dose in. ’cause sometimes, ’cause as a gi, you know, functional person, I’m trying to always get the optimal doses when patients come to right. They’ve already tried little things

Dr. Weitz: And there aren’t that many products that have five grams.  Exactly. And if you’re gonna use some of those products three times a day, it

Dr. Asamoa: Exactly. 

Dr. Weitz: It’s going to get more costly than just using glutamine.

Dr. Asamoa: Exactly. Exactly. So I try and go for the pure glutamine forms. Yeah. As much as possible. Yeah. Right?

Dr. Weitz: So, what else do we want to talk about? Are there any other things you want, confusions you want to clear up in about the integrative GI world?

Dr. Asamoa: Like, like what? No, I think this, I think h pylori was a good topic. Yeah. I think h pylori. Yes. And I think something that, you know, patients always get very scared about is the risk of stomach cancer. Like, oh, am I gonna get a month Lymphoma, a gastric cancer? Right. You know, and the incidence you know of a stomach cancer is [00:35:00] relatively low.  It’s like 0.3%, which is why

Dr. Weitz: 0.3%. Yeah,

Dr. Asamoa: 0.3%. Which is why I think Dr. Sandberg Lewis is saying, Hey, it may not be a bad guy all the time and treat only if you must treat, if the patient has symptoms, because the chance that your patient is gonna probably develop another kind of cancer from metabolic. Issues and balance and insulin resistance is probably higher than.  Targeting this H. pylori that’s going to destroy their microbiome. So sometimes if I have a patient that’s been treated 3, 4, 5 times with antibiotics, I leave them alone. Right? I really just put them through the 5 R protocol and I leave them alone and I focus on. What else is going on? What is the immune system telling us, right?  Are there any other hits that we must focus on? And figure out why your oxidative stress is so high, and how do we drive this down overall instead of just targeting h [00:36:00] pylori and hitting our head against a brick wall? And usually that helps a lot. We may see this bacteria regress on its own.  And disappear. So yeah, I think you kind of have to take every case as we do in functional medicine, individualized, personalized, customized for the patient.

Dr. Weitz: Great. Any final thoughts for our viewers and listeners? I.

Dr. Asamoa: It’s been wonderful being on your show, Ben. I think this is a great topic. We don’t hear a lot about it, but I really wanted to speak up on the stool, PCR and everyone being careful ’cause I get the back end of it when patients come to see me and say, I’ve been treated overtreated and so we wanna be cautious.  H pylori is not always foe. It can sometimes. Be a friend.

Dr. Weitz: You know what’s kind of interesting is if a stool antigen test is considered pretty valid way to verify that there’s an active h pylori infection, that would be an interesting thing for them to add [00:37:00] to totally a task. So that way we got both of those positive than we, we have a different perspective on it.

Dr. Asamoa: Absolutely. It’s just that the PCR is overly sensitive and picking up just too many different strains that may not be, you know, significant phenotypically significant. 

Dr. Weitz: Now, it could an antigen test be added to a PCR test or is that a whole different type of test? 

Dr. Asamoa: I mean, I don’t see why not. Right. I don’t see why not.  It could just be an add on. Yeah, that would be interesting. They do zonulin and a whole bunch of other things, right? Yeah, exactly. Yep. Why not? Yeah, absolutely. That’s great. Great idea. We should create our own test.

Dr. Weitz: There you go. 

Dr. Asamoa: It’s over.

Dr. Weitz: So, how can listeners and viewers get in contact with you, find out more about you should they go to your website? Where should they go?

Dr. Asamoa: Yes, so, so I’m on social media as Dr. Vi [00:38:00] SWA on Instagram, LinkedIn. We also have a private Facebook group called Natural Gut Relief, where we try and talk about everything integrative GI with in relation to gut health.  So yeah, you can find me in all of those places and you are all welcome to Connect if I can help in any way. 

Dr. Weitz: And what is your web address?

Dr. Asamoa: I don’t have my web address, just my website. My website is Houston Gastro Institute.

Dr. Weitz: That’s the website of the practice itself?

Dr. Asamoa: Yes. 

Dr. Weitz: Yeah. Okay. And that’s the best one to use?

Dr. Asamoa: Yes. That’s the best one to use.

Dr. Weitz:  Great. And do you consult with patients virtually?

Dr. Asamoa: I do consult with patients in the state of Texas and 12 other states. Now. We are credentialed and have malpractice in 12 other states. I work with about three dieticians, functionally trained, so we’re a little team of health coaches and dieticians, and our focus is really, chronic GI issues. So we see quite a bit of MCAS, we see a lot of IBD patients, complex IBD patients. We see a lot of SIFO, we see a lot of SIBO and that’s eoe that those are our favorite patients.

Dr. Weitz: Alright, great. Thank you Dr. Asamoa.

Dr. Asamoa: You’re welcome. Thank you so much for having me on. Ben.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast.  For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for Functional Medicine and I will talk to everybody next week.