A burning sensation begins in the stomach one afternoon and then just will not quit. After a couple of weeks of high antacid consumption to get relief she finally gives in to the pain and seeks medical help. The patient presents to my office and after completing a stool profile, a small gram-negative bacteria is identified: Helicobacter pylori or more commonly referred to as H. pylori. Helicobacter pylori can adhere to and penetrate through the lining of the stomach; thus creating inflammation that can be mistaken for GERD, gastritis or peptic ulceritis. H. pylori affect approximately 20% of both ends of the spectrum – those under 40 and those over 60.18
Stomach troubles are a common complaint of patients seeing their doctors. Often a diagnosis of gastritis is made and a prescription for Zantac or another proton pump inhibitor is written. Some of these individuals will actually have H. pylori that will be missed but inadvertently treated with the proton pump inhibitor. However, once that is stopped the problem will arise again and potentially add to the stress of trying to figure out what is wrong. The H. pylori bacteria thrive in an acidic environment and stress creates a condition called stress-induced gastritis.18 Stress-induced gastritis can actually create erosions in the stomach lining; thus potentiating the possibility of an H. pylori infection.
Typical treatments for H. pylori include H-2 blockers, antibiotics, and proton pump inhibitors. All of these treatments, at best, will alleviate symptoms in the moment. However, the door is left open for the bacteria to take hold again. Certain foods and beverages can irritate the lining of the stomach, making the symptoms worsen. Caffeine, alcohol and smoking are some of the greatest offenders as they make the body more acidic and an acidic environment is what the bacteria prefer to thrive in.
Naturopathic doctors might also prescribe antibiotics or another natural antimicrobial to address the H. pylori. Glutamine is shown to be helpful in reducing the stomach acid, especially when taken after meals. Melatonin is helpful in tightening the pyloric valve to prevent stomach acid backflow into the esophagus. However, sometimes these treatments alone just are not enough.
What most doctors, allopathic and naturopathic alike, fail to realize is why people turn to those substances. The one area always left untouched is stress. Stress is documented to lower the heart rate variability (HRV) in individuals, postprandial vagal activity, gastric emptying and colonic motility; therefore, leading to an increase in acidity. 17 Patient stress reductions are essential, but the clinician’s approach is indispensable!
It is very easy to tell a patient to relax, stop stressing so much, and find a more appropriate way to release stress and then send that patient on her way to figure it out. Well, what if the process of trying to figure out how to alleviate stress actually caused more stress in the long run? People who are stressed often find themselves more stressed when told that they are stressing too much and to figure out a way to de-stress. It is like adding one more plate on to the already tipping pile and everything comes down crashing.
However, even if we address the issue of the stomach acidity and eradicate the H. pylori, the risk of the redevelopment if the patient’s stress levels are not decreased is still very real. Thus, it is a critical matter to address the issue of stress reduction and management for the individuals prone to H. pylori bacterial infections. At this point the mind must be integrated with the body therapies presented above.
The Functional Medicine approach takes into account the whole person — from mind to body to spirit – and seeks to heal on all three planes. What are the underlying antecedents, triggers and mediators that would have allowed bacteria to flourish? Anything from diet, to environment, to emotions is considered. For example, someone who eats chemical-laden meats as the primary source of calories is more likely to have an acidic gut. Or someone who stresses because his work is highly demanding and results-driven could also have a more acidic gut. The person who has limited friendships may also be of concern because she lacks a supportive social network; thus a potential for depression and stress may be prevalent.
The first step would be to alleviate the current symptoms. No one can even begin to think about de-stressing when in a constant state of pain. Therefore, it is essential to begin with a nutritional plan that will address the pain.
Once those painful symptoms are removed the patient will be able to more closely focus on the change of lifestyle that is to be presented. Many modalities within the mind-body connection have proven effective in reducing stress levels so there will be many for the patient to experiment with and choose based on preferences. Each one in its own right has been studied and demonstrates stress reduction.
Meditation and mindfulness help to alleviate stress, an important factor in treating the H. pylori patient. 2,6 A huge aspect of mindfulness is breathing and that is something that many Americans forget to do. Many shallow-breathe and only fill the longs partially, never allowing the full effect of oxygen to cycle through the blood stream and release the chemicals that help induce relaxation. In fact, Martha Davis authored an entire workbook on relaxation and stress reduction – with a key component being breath control. 5 Along those same lines, Qigong, a Chinese modality that focuses on breathing, helps to relieve stress. 9, 10 In a study done in 2007 on computer operators a marked decrease in the activity of the sympathetic nervous system was witnessed. 14 Furthermore, Qigong was able to help reduce inflammation alongside standard treatment in a study done in 2012 on cancer patients. 17 Both of these modalities, albeit proven to be helpful in stress reduction
Maybe the patient would prefer a more physically active role in reducing her stress. Tai Chi, which combines rhythmic movements timed to breathing. Tai Chi was found to be safe in a 2010 study of gastric cancer survivors.11
Finally, Reiki, a passive energy-based healing system, is another positive modality for stress reduction; and in particular for the relief of psychological stress (shore) and work related stress.4 Many studies exist that show the positive effects of Reiki the emotional status of the participants, especially those who are stressed and depressed.3 This treatment, as well as the others, could easily be combined with any of the modalities mentioned here.
What each of these modalities offers is a way to increase mindfulness, inner peace and stress reduction. Whether a patient chooses a more formal approach to the Mind-Body healing modalities, goes for a walk in a park1 or participates in the simple act of stress reduction via laughter, 12 is irrelevant. What does matter is consistency and appreciation for the work being done to reduce stress within the individual.
Mind-body medicine is versatile, allowing it to be added to other mind-body forms as well as more traditional therapies. Regardless of the modality that the individual chooses, the concept of interoceptive awareness: the individual sensitivity for one’s own bodily clues 8 is an essential part of healing from within. Teaching the patient to learn to listen to internal clues is an integral part of his wellbeing. Once he is able to do this, he is well on his way to being able to slow the process of stress and avoiding extraneous illnesses.
While Helicobacter pylori requires medical treatment, it is also important to stop and take a look at what has made the patient more susceptible to developing an overgrowth of this bacteria. Stress plays a key role in the development of many gastroenterological conditions and the current medical paradigm will continue to fail the patients if it continues to deem pharmaceuticals as the only relevant treatment for H. pylori. Mind-body medicine modalities such as Qigong, Reiki, meditation, and Tai Chi also have their place in the treatment of stress-exacerbated conditions and once we as practitioners are willing to embrace them as part of our treatment protocol our patients will fully benefit from a fuller recovery.
- Aspinall, P., Mavros, P., Coyne, R., & Roe, J. (2013). The urban brain: analysing outdoor physical activity with mobile EEG. British Journal of Sports Medicine.
- Astin, J. A. (1997). Stress reduction through mindfulness meditation. Psychotherapy and psychosomatics, 66(2), 97-106.
- Collier, Z. (2009). The impact of Reiki in controlling Stress and Depression. Health Psychology Homepage.
- Cuneo, C. L., Cooper, M. R. C., Drew, C. S., Naoum-Heffernan, C., Sherman, T., Walz, K., & Weinberg, J. (2011). The effect of Reiki on work-related stress of the registered nurse. Journal of Holistic Nursing, 29(1), 33-43.
- Davis, M., Eshelman, E. R., & McKay, M. (2008). The relaxation and stress reduction workbook. New Harbinger Publications.
- Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits-A meta-analysis. Journal of psychosomatic research, 57(1), 35-44.
- Hawrelak, Jason, ND. UWS lecture series. 2012.
- Herbert, B. M., Muth, E. R., Pollatos, O., & Herbert, C. (2012). Interoception across Modalities: On the Relationship between Cardiac Awareness and the Sensitivity for Gastric Functions. PloS one, 7(5), e36646.
- Jouper, J., & Johansson, M. (2012). Qigong and mindfulness-based mood recovery: Exercise experiences from a single case. Journal of Bodywork and Movement Therapies.
10. Koh, T. C. (1982). Qigong—Chinese breathing exercise. The American journal of Chinese medicine, 10(01n04), 86-91.
11. Lee, L. Y., Chong, Y. L., Li, N. Y., Li, M. C., Lin, L. N., Wong, L. Y., … & Man, S. Y. (2012). Feasibility and Effectiveness of a Chen‐style Tai Chi Programme for Stress Reduction in Junior Secondary School Students. Stress and Health.
12. Noji, S., & Takayanagi, K. (2010). A case of laughter therapy that helped improve advanced gastric cancer. Japan-hospitals: the journal of the Japan Hospital Association, (29), 59.
13. Oh, B., Butow, P. N., Mullan, B. A., Clarke, S. J., Beale, P. J., Pavlakis, N., … & Vardy, J. (2012). Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial. Supportive Care in Cancer, 20(6), 1235-1242.
14. Park, C. (2012). Mind‐Body CAM Interventions: Current Status and Considerations for Integration Into Clinical Health Psychology. Journal of Clinical Psychology.
15. Shore, A. G. (2004). Long-term effects of energetic healing on symptoms of psychological depression and self-perceived stress. Alternative therapies in health and medicine, 10(3), 42.
16. Skoglund, L., & Jansson, E. (2007). Qigong reduces stress in computer operators. Complementary therapies in clinical practice, 13(2), 78-84.
17. Yin, J., Levanon, D., & Chen, J. D. Z. (2004). Inhibitory effects of stress on postprandial gastric myoelectrical activity and vagal tone in healthy subjects. Neurogastroenterology & Motility, 16(6), 737-744.
18. http://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori
