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Fiona Godlee
Testing common sense
BMJ 2007; 334: 0 [Full text]
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[Read Rapid Response] Subject for opinion poll
Andrew J C Carmichael   (5 June 2007)

Subject for opinion poll 5 June 2007
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Andrew J C Carmichael,
Foundation Trust Governor
27, Newton Road, Preston PR2 1DY

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Re: Subject for opinion poll

Dear Editor, I consider the subject of whether to routinely eradicate Helicobacter pylori to be important in view of its widespread occurrence and its vile effects. In support I append a study carried out by myself for the gastroenterologists in our Trust. My own interest in this was aroused by the positive effect on some PD patients following eradication of Hp and thus the study is slanted in that direction. Having said that the range of conditions covered is staggering.

A review of Helicobacter pylori and what it may do to you

There should be great concern about the gap in time between research findings and the practical medical use of them in the treatment of patients. (A)

Eradication of Helicobacter pylori, a common stomach bacterium, can greatly reduce your chances of suffering these diseases or in some cases, reduce the symptoms already noticed: gastritis/ dyspepsia ( 1, 4 ) gastric / duodenal ulcer ( 2, 3, 4 ) gastric cancer ( 3, 4, 5, 6,7 ) high blood pressure ( 8, 9, 10, 11 ) resolution of Syndrome X (heart and chest pain) ( 12 ) altered lipid metabolism leads to obesity, heart attack and stroke (13, 14, 15 ) iron deficiency anaemia ( 16, 17 ) abnormal blood counts (neutrophils and monocytes) ( 18, 19) neurological damage such as Parkinson's, Alzheimer's, MS, ME, optic nerve damage leading to blindness due to Vitamin B12 deficiency (20, 21, 22, 23 ) chronic sub-clinical vitamin deficiency of A, B6, B12, C, E (24,25,26,27,28,29 ) skin conditions such as itchy, flaky, hard skin ( 30, 31 ) rheumatoid arthritis ( 32 ) chronic cholecystitis ( 33 ) glaucoma ( 34, 35 ) insulin resistance ( 36 ) macular degeneration leading to blindness ( 37 ) periodontal disease, tooth loss, reservoir of Hp infection in mouth (38, 39, 40) some sexually acquired infections of nipples, vulva (41 )

These are the subjects of a large number of peer-reviewed articles in learned journals over many years. ( reference list in numerical order is attached) Now it is time to do something about it. ALL medical and gastroenterology surgical patients should be tested for helicobacter species ( 42 ) and appropriate eradication commenced as a matter of routine using antibiotics if required. This should be in addition to dietary supplementation with probiotics, omega-3 oils and / or fish oils and supplements of Vitamins A, B6, B12 and E. Together with these there are two food additives both widely used in the processed food industry and therefore already of proven safety for human consumption. One of these, 6-O-palmitoyl-l-ascorbate, (E 304), is a fat-soluble variant of Vitamin C (ascorbic acid). It is already in use in anti-wrinkle creams, infant formula milk, beefburgers and is used by bodybuilders to add collagen to their intestinal and over-developed muscles. It also has the effect of reducing the formation of new blood vessels. It is known to eradicate Helicobacter at least as efficiently as antibiotics, is a powerful anti-oxidant and can provide a source of ascorbate to replace the Vitamin C lost to the Helicobacter infestation. Ascorbate is essential for tissue repair and this lack of repair in subclinical chronic Vitamin C deficiency accounts for many of the disease effects listed above. It also provides a source of palmitoyl useful in the repair process. Concentrations of this Vitamin C ester are found up to 10 times that of 'ordinary' Vitamin C in the brain. The suggested daily intake of this powder is 250mg and it is intended to investigate the supply of suitable tablets or capsules as soon as possible in order to make this useful stuff available in the UK. A daily intake will cost about 10 pence. ( 43, 44, 45 )

The second additive is a modified form of fructose sold as Trehalose (trade name Ascend™) made by Cargill Inc. It acts as a fructose replacement and has been shown to assist with the unfolding of misfolded proteins such as those in Lewy bodies and amyloid plaques. It is in use by some Huntington's patients as a delaying measure and is taken in a dose of 10 –30 grams three times a day. It is available in 1350 Gram (3 pound) packs from the USA @ about £25 per pack including postage.The suggested daily intake is 30gm costing about 48pence ( 46, 47 )

Combination of these measures with the use of probiotics such as Danone Fruit Layer™ yoghurt and Actimel ™ lactobacillus drink and Omega-3 oils or alternative fish or plant oils can make significant positive differences to Parkinson's and the other diseases listed. They enable self -repair to take place using the body's own naturally occurring stem cells or cell repair mechanisms. Taken before hospital admission for surgery there could be a significant reduction in recovery time and thereby shorter SPELLS.

The use of Lactulose (prescribed by your GP) gives a further boost to the eradication of Helicobacter and assists with the reduction of the constipation so often a dreaded complication of Parkinsons.

By eradicating Helicobacter you will reduce the amount of antigen to it which circulates in your blood and which has been suggested as the cause of death of sensitive long-axon nerve cells possibly because it stimulates platelet activity. ( 48 )

All these measures are safe and proven to be useful but it must be remembered that your neurological condition may have taken years to develop so expect results in months rather than days.

References re Helicobacter pylori eradication and food additives

A. The Translation of Helicobacter pylori Basic Research to Patient Care Peter B. Ernst, David A Peura and Sheila E. Crowe Gastroenterology Volume 130, Issue 1, January 2006, Pages 188 - 206

1. The bidirectional communication between neurons and mast cells within the gastrointestinal tract Luc Van Nassauw, Dirk Adriaensen and Jean-Pierre Timmermans Autonomic Neuroscience doi: 10.1016/j.autneu.2006.10.003

2. Critical role of an endogenous gastric peroxidase in controlling oxidative damage in H. pylori-mediated and non-mediated gastric ulcer Mrinalini Bhattacharjee, Samir Bhattacharjee, Arnab Gupta and Ranajit K. Banerjee Free Radical Biology and Medicine Volume 32, Issue 8, 15 April 2002, pages 731 – 743

3. Helicobacter pylori infection, not gastroesophageal reflux, is the major cause of inflammation and intestinal metaplasia of gastric cardiac mucosa John R. Goldblum M.D., Joel E. Richter M.D., Michael Vaezi M.D., Gary W. Falk M.D., Thomas W. Rice M.D. and Richard M. Peek M.D. The American Journal of Gastroenterology Volume 97, Issue 2, February 2002, pages 302 – 311

4. Serum and plasma concentration of oxidant and antioxidants in patients of Helicobacter pylori gastritis and its correlation with gastric cancer Shruti S. Khanzode, Suchet D. Khanzode and Ganesh N. Dakhale Cancer Letters Volume 195, Issue 1, 30 May 2003, pages 27 – 31

5. Carcinogenic role of tumor necrosis factor-alpha inducing protein of Helicobacter pylori in human stomach Suganuma, Masami; Kuzuhara, Takashi; Yamaguchi, Kensai; Fujiki, Hirota Journal of Biochemistry and Molecular Biology Volume 39, Issue 1, January 31, 2006, Pages 1 – 8 6. Will eradication of Helicobacter pylori infection influence the risk of gastric cancer? Richard H. Hunt FRCP, FRCP(C), FACG American Journal of Medicine Supplement Volume 117, Issue 5, Supplement 1, 6 September 2004, pages 86 – 91

7. Can gastric cancer be prevented by Helicobacter pylori eradication? Peter Malfertheiner, Professor, Lucia C Fry, Consultant and Klaus Munkenuller, Consultant Best Practice and Research Clinical Gastroenterology Volume 20, Issue 4, 2006, pages 709 – 719

8. Eradication of Helicobacter pylori infection improves blood pressure values in patients affected by hypertension Migneco, Alessio; Ojetti, Veronica; Specchia, Lucia; Franceschi, Francesco; Candelli, Marcello; Mettimano, Marco; Montebelli, Rita; Savi, Luigi; Gasbarrini, Giovanni Helicobacter Volume 8, Issue 6, December 2003, pages 585 – 589

9. Prevalence of Helicobacter pylori infection in coronary artery disease and effect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty Kowalski M.; Konturek P.C.; Pieniazek P.; Karczewska E.; Kluczka A.; Grove R.; Kranig W.; Nasseri R.; Thale J.; Hahn E.G.; Konturek S.J. Digestive and Liver Disease Volume 33, Issue 3, 2001, Pages 222 – 229

10. A link between Helicobacter pylori and/or Chlamydia spp. infections and atherosclerosis Magdalena Chmiela, Magdalena Kowalewicz-Kulbat, Anita Miszczak, Monika Wisniewska, Tomas Rechcinski, Katarzyna Kolodziej, Jaroslaw Kasprzak, Torkel Wadstrom and Wieslawa Rudnicka FEMS Immunology and Medical Microbiology Volume 36, Issue 3, 25 May 2003, pages 187 – 192

11. Helicobacter pylori (H. pylori) infection in coronary artery disease: influence of H. pylori eradication on coronary artery lumen after percutaneous transluminal coronary angioplasty. The detection of H. pylori specific DNA in human coronary atherosclerotic plaque Kowalski, M Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society Volume 52, Issue 1, Supplement 1, August 2001, pages 3 – 31

12. Resolution of Syndrome X after eradication of virulent CagA- positive Helicobacter pylori Nocente, R; Gentiloni, N; Cremonini, F; Giorgi, A; Serricchio, M; Santoliquido, A; Gasbarrini, G; Gasbarrini, A Southern Medical Journal Volume 93, Issue 10, October 2000, pages 1022 – 1023

13. Helicobacter pylori is associated with modified lipid profile: impact on lipoprotein(a) G. Chimienti, F. Russo, B. L. Lamanuzzi, M. Nardulli, C. Messa, A. Di Leo, M. Correale, V. Gianuzzi and G. Pepe Clinical Biochemistry Volume 36, Issue 5, July 2003, pages 359 – 365

14. Does eradication of Helicobacter pylori infection help normalise serum lipid and CRP levels? Kanbay M.; Gur G.; Yucel M.; Yilmaz U.; Boyacioglu S. Digestive Diseases and Sciences Volume 50, Issue 7, 2005, Pages 1228 – 1231

15. Association between chronic Helicobacter pylori infection and acute ischemic stroke: Fukuoka Harasanshin Atherosclerosis Trial (FHAT) Yasunori Sawayama, Iwao Ariyama, Maki Hamada, Shigeru Otaguro, Takao Machi, Yuji Taira and Jun Hayashi Atherosclerosis Volume 178, Issue 2, February 2005, Pages 303 – 309

16. A hematologist's view of unexplained iron deficiency anemia in males: Impact of Helicobacter pylori eradication Chaim Hershko, Mara Ianculovich and Moshe Souroujou Blood Cells, Molecules and Diseases doi 10.1016/j.bcmd.2006.09.006

17. The clinical importance of hypochlorhydria (a consequence of chronic Helicobacter infection): Its possible etiological role in mineral and amino acid malabsorption, depression, and other syndromes R. E. Cater 11 Medical Hypotheses Volume 39, Issue 4, December 1992, Pages 375 – 383

18. Helicobacter pylori eradication decreases blood neutrophil and monocyte counts Kondo Y.; Joh T.; Sasaki M.; Oshima T.; Itoh K.; Tanida S.; Kataoka H.; Ohara H.; Nomura T.; Itoh M. Alimentary Pharmacology and Therapeutics, Supplement Volume 20, Issue1, 2004, pages 74 – 79

19. Effect of Helicobacter pylori eradication in patients with chronic idiopathic thrombocytopenic purpura – A randomised controlled trial Suzuki T.; Matsushima M.; Masui A.; Watanabe K.-L; Takagi A.; Ogawa Y.; Shirai T.; Mine T. American Journal of Gastroenterology Volume 100, Issue 6, 2005, Pages 1265 – 1270

20. Alzheimer's disease and Helicobacter pylori infection: Defective immune regulation and apoptosis as proposed common links Jannis Kountouras, Emmanuel Gavalas, Christos Zavos, Christos Stergiopoulos, Dimitrios Chatzopolous, Nikolaos Kapetanakis and Dimitrios Gisakis Medical Hypotheses Volume 68, Issue 2, 2007, Pages 378 – 388

21. Role of inflammation in gastrointestinal tract in aetiology and pathogenesis of idiopathic parkinsonism Clive Weller, Norman Oxlade, Sylvia M. Dobbs, R. John Dobbs, Andre Charlett and Ingvar T. Bjarnason FEMS Immunology and Medical Microbiology Volume 44, Issue 2, 1 May 2005, pp 129-135

22. Link between Helicobacter pylori infection and idiopathic parkinsonism S.M. Dobbs, R.J. Dobbs, C. Weller and A. Charlett Medical Hypotheses Volume 55, Issue 2, August 2000, pp93-98

23. Epidemic Optic and Peripheral Neuropathy in Cuba: A Unique Geopolitical Public Health Problem Thomas R. Hedges 111, MD, Michio Hirano, MD, Katherine Tucker, PHD, and Benjamin Caballero, MD, PHD Survey of Ophthalmology Volume 41, Number 4, January-February 1997

24. Plasma levels of antioxidant vitamins C and E are decreased in vascular parkinsonism George P. Paraskevas, Elizabeth Kapaki, Olga Petropolou, Maria Anagnostouli, Vasileious Vagenas and Constantine Papageorgiou Journal of The Neurological Sciences Volume 215, Issues 1-2, 15 November 2003, pages 51 – 55

25. Influence of gastric juice pH on the metabolism of vitamin C in gastric mucosa and juice Safranow K, Korzonek M, Dziedziejko V, Jacubowska K, Sulzyc-Bielicka V, Domanski L, Ciechanowski K, Chlubek D. Pol Merkur Lekarski, 2006 Feb; 20(116);168 –172

26. Relationship of Helicobacter pylori CagA(+) status to gastric juice vitamin C levels Rokkas T.; Liatsos C.; Petridou E.; Karameris A.; Ladas S.D.; Raptis S.A. European Journal of Clinical Investigation Volume 29, Issue 1, 1999, Pages 56-62 27. Omeprazole and dietary nitrate independently affect levels of Vitamin C and nitrite in gastric juice Craig Mowat, Andrew Carswell, Angela Wirz and Kenneth E. L. McColl Gastroenterology Volume 116, Issue 4, Pages 813 – 822

28. Investigation of Helicobacter pylori ascorbic acid oxidating activity Lars Odum and Leif P. Andersen FEMS Immunology and Medical Microbiology Volume 10, Issues 3-4, February 1995, Pages 289 – 294

29. Vitamin B12, demyelination, remyelination and repair in multiple sclerosis Ariel Miller, Maya Korem, Ronit Almog and Yanina Galboiz Journal of the Neurological Sciences Volume 233, Issues 1-2, 15 June 2005, Pages 93 – 97

30. Tumor initiating activity of Helicobacter pylori water extract on mouse skin carcinogenesis Takeshi Ishikawa, Norimasa Yoshida, Harukuni Tokada, Eiichiro Ichiishi, Masashi Kuchide, Satoshi Kokura, Yuji Naito, Shinya Toyokuni, Hoyoko Nishino and Toshikazu Yoshikawa Cancer Letters Volume 191, Issue 1, 28 February 2003, Pages 41 – 47

31. Therapeutic effects of the antibacterial treatment on intractable skin diseases in Helicobacter pylori-positive patients Mikihisa Sakurane, Matsunaka Masahiro, Koji Uede, Akiko Shiotani, Shingo Nishioka Department of Dermatology; Second Department of Internal Medicine, Wakayama Medical University, Japan (Poster Display P249)

32. Eradication of Helicobacter pylori may reduce disease severity in rheumatoid arthritis Zentillin, P; Seriolo, B; Dulbecco, P; Caratto, E; Iiritano, E; Fasciolo, D; Bilardi, C; Mansi, C; Testa, E; Savarino, V Alimentary Pharmacology and Therapeutics Volume 16, Issue 7, July 2002, Pages 1291 – 1299 33. Helicobacter pylori and other Helicobacter species in gallbladder and liver of patients with chronic cholecystitis detected by immunological and molecular methods Apostolov E.; Abu Al-Soud W.; Nilsson I.; Kornilovska I.; Usenko V.; Lyzogubov V.; Gaydar Y.; Wadstrom T.; Ljungh A. Scandinavian Journal of Gastroenterology Volume 40, Issue 1, 2005, Pages 96 – 102

34. Eradication of Helicobacter pylori may be beneficial in the management of chronic open-angle glaucoma Kountouras J.; Mylopoulos N.; Chatzopoulos D.; Zavos C.; Boura P.; Konstas A.G.P.; Venizelos J. Archives of Internal Medicine Volume 162, Issue 11, 10 June 2002, Pages 1237 – 1244

35. Induction of apoptosis as a proposed pathophysiological link between glaucoma and Helicobacter pylori infection Jannis Kountouras, Christos Zavos and Dimitrios Chatzopoulos Medical Hypotheses Volume 62, Issue 3, March 2004, Pages 378 – 381

36. The effect of Helicobacter pylori on insulin resistance Aydemir S.; Bayraktaroglu T.; Sert M.; Sokmen C.; Atmaca H.; Mungan G.; Gun B.D.; Borazan A.; Ustundag Y. Digestive Diseases and Sciences Volume 50, Issue 11, 2005, Pages 2090 – 2093

37. Association of Helicobacter pylori with central serous chorioretinopathy: hypotheses regarding pathogenesis Christiano Giusti Medical Hypotheses Volume 63, Issue 3, 2004, Pages 524 – 527

38. Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection? Anand P.S.; Nandakumar K.; Shenoy K.T. Journal of Periodontology Volume 77, Issue 4, 2006, Pages 692 – 698 39. Expression cloning of a periodontitis-associated apoptotic effector, cagE homologue, in Actinobacillus actinomycetemcomitans Yen-Tung A. Teng, and Wenqui Hu Biochemical and Biophysical Research Communications Volume 303, Issue 4, 18 April 2003, Pages 1086 – 1094

40. Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy Gebara E.C.E.; Faria C.M.; Pannuti C.; Chehter L.; Mayer M.P.A.; Lima L.A.; Journal of Clinical Periodontology Volume 33, Issue 5, May 2006, Pages 329-333

41. Some fibrocystic breast change may be caused by sexually transmitted H. pylori during oral nipple contact: Supporting literature and case report of resolution after gut H. pylori eradication treatment R.E.Kast Medical Hypotheses doi:10.1016/j.mehy.2006.09.050 (article in press)

42. Helicobacter pylori "Test and Treat" or Endoscopy for Managing Dyspepsia: An Individual Patient Data Meta-analysis Alexander C. Ford, Michelle Qume, Paul Moayyedi, Nicolas L.A. Arents, Annmarie T. Lassen, Richard F.A. Logan, Kenneth E.I. McColl, Paul Myres and Brendan C. Delaney Gastroenterology Volume 128, Issue 7, June 2005, Pages 1838 – 1844

43. Palmitoyl ascorbate: Selective augmentation of procollagen mRNA expression compared with L-ascorbate in human intestinal smooth muscle cells Rosenblat G.; Willey A.; Zhu Y.-N.; Jonas A.; Diegelmann R.F.; Neeman I.; Graham M.F. Journal of Cellular Biochemistry Volume 73, Issue 3, 15 May 1999, Pages 312 - 320

44. Diverse effects of ascorbic acid and palmitoyl ascorbate on Helicobacter pylori survival and growth M.Tabak, R.Armon, G. Rosenblat, E. Stermer and I. Neeman FEMS Microbiology Letters Volume 224, Issue 2, 29 July 2003, Pages 247-253

45. Ascorbyl Palmitate as a Carrier of Ascorbate into Neural Tissues Mieczyslaw Pokorski, Magdalena Marczak, Aneta Dymecka, Piotr Suchocki Journal of Biomedical Science Volume 10, Issue 2, 2003

46. Multiple Effects of Trehalose on Protein Folding In Vitro and In Vivo Mike A. Singer and Susan Lindquist Molecular Cell Volume1, Issue 5, April 1998, Pages 639 – 648

47. Aggregation mechanism of polyglutamine diseases revealed using quantum chemical calculations, fragment molecular orbital calculations, molecular dynamics simulations, and binding free energy calculations Koki Tsukamoto, Hideaki Shimizu, Takashi Ishida, Yutaka Akiyama and Noboyuki Nukina Journal of Molecular Structure: THEOCHEM Volume 778, Issues 1-3, 11 December 2006, Pages 85 – 95

48. Cholesterol synthesis inhibitors protect against platelet- activating factor-induced neuronal damage Clive Bate, Louis Rumbold and Alun Williams Journal of Neuroinflammation Volume 4, Issue5, 18 January 2007

Competing interests: None declared