Linking H. pylori and Iron Deficiency

By Andrea Bartels CNP NNCP RNT Registered Nutritional Therapist 06 Jul 2022

Linking H. pylori and Iron Deficiency

Is there a link between h. pylori infection and iron deficiency?

A recent population study published in the Pakistan Journal of Medical Sciences in 2021 sheds light on the question. Researchers sought to find out the frequency of iron deficiency anemia in patients with diagnosed h.pylori-associated gastritis—a condition in which the stomach lining becomes inflamed and sensitive in the presence of measurable levels of the bacteria. 

A total of 112 infected patients were studied; of these, 53 were males and 59 were females. As this was a population study rather than an experimental study, all participants had acquired h.pylori naturally before becoming part of the study.  Once h.pylori infection was confirmed among all participants via blood or breath-testing, the frequency of iron-deficiency anemia was identified.

The findings? Iron-deficiency anemia was present in 37.5 percent of these h.pylori-infected patients. So, why is this, and what does it mean for the millions of individuals diagnosed with h. pylori when iron status assessment is overshadowed by treatment of the infection and its symptoms?

Incidence of Disease

The World Health Organization (WHO) calls iron deficiency “the most common and widespread nutritional disorder in the world…the only nutrient deficiency which is also significantly prevalent in Industrialized Countries”.¹   Since iron is necessary for proper hemoglobin formation and oxygen transport within the body, iron deficiency is a pretty important problem to be screening for, especially in women and children. However, in industrialized countries, iron-deficiency anemia is not viewed as life-threatening unless blood loss from trauma, childbirth or surgery is significant and quite severely lowers blood pressure, affecting vital physical and cognitive processes. This is a disservice to the community when chronically insufficient iron is known to affect productivity and well-being.

Meanwhile, helicobacter pylori is a potentially pathogenic bacterium that is estimated to exist in the digestive systems of over 50 percent of the world’s people.² Although h. pylori infection is thought to be most prevalent in developing countries due to increased ease of spread thanks to higher-density living and lower sanitation standards, it is a surprisingly common diagnosis in North American populations as well.

What’s the Connection?

The key to understanding the prevalence of iron-deficiency in h. pylori-infected individuals may lie in the fact that it is most frequently diagnosed in people with symptoms and signs of ulcer.  Since ulcers have long been associated with h.pylori infection, it’s important to realize how infection can lead to iron deficiency.

First, it’s important to realize that bacterial infection of any kind tends to reduce the body’s iron levels because bacteria use iron to multiply.⁴  So, the longer the infection goes undiagnosed, the greater the opportunity to develop iron-deficiency.

Second, ulcers that develop as a consequence of h.pylori-induced gastritis are essentially open wounds within the tissue, and like any open wound, they bleed. The blood loss is often low, slow and chronic, leading to gradual reduction of red blood cells (hemoglobin) as well as the iron they store as ferritin to carry out their oxygen-carrying function. 

Finally, in patients with diagnosed infection who are also ulcerated, the standard ‘triple therapy’ used to treat the infection while making the patient more comfortable includes the use of an antibiotic, an acid neutralizer and a stomach acid suppressor (i.e. proton pump inhibitor).³  Unfortunately, the antacids and PPIs make it more difficult to absorb iron because iron is dependent upon sufficient hydrochloric acid output by the stomach in order to be dissolved and absorbed.

Insights for the North American Population

Although the findings of the study summarized above were observed in a relatively small group of patients residing in Pakistan, the findings are likely very relevant to the North American population and beyond due to the prevalence of h.pylori worldwide.  Ulcers always involve some degree of blood loss, and many people with ulcers have h.pylori infection. Both of these facts lead to a decrease in iron availability.  Of course, access to medical services, speed of diagnostics and compliance of the patient are all factors that are universally going to affect prognosis of a disease, and in this case, the complication of iron-deficiency anemia.  After all, iron-deficiency is the most common nutritional deficiency worldwide.

Monitor and Maintain Iron Stores

Testing is the next step towards feeling better.  It’s important to have iron status checked regularly. Ask your primary healthcare practitioner for ferritin and hemoglobin testing if you have been diagnosed with h.pylori, gastritis, ulcer or fatigue, pallor, loss of stamina and/or mental dullness.  If your iron status warrants supplementation, choosing a stomach-friendly product is essential.  A quality iron supplement like carbonyl iron has a superior absorption rate compared to traditionally prescribed ferrous sulfate and ferrous fumarate.  This makes it more gentle on the digestive system, which is an especially important feature for infected and/or ulcerated individuals.  After all, in choosing quality supplementation, a product that is virtually free of uncomfortable side-effects has the capacity to replenish iron stores more swiftly because there are no objections to taking it.

References

¹World Health Organization. “Micronutrient Deficiencies: Iron deficiency anaemia”. Accessed on June 29, 2022.

²Rahat A, Kamani L. Frequency of iron deficiency anemia (IDA) among patients with Helicobacter pylori infection. Pak J Med Sci. 2021 May-Jun;37(3):776-781. 

³ Laine L, Suchower L, Frantz J, Connors A, Neil G. Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease: results of three multicenter, double-blind, United States trials. Am J Gastroenterol. 1998;93(11):2106-2112. 

⁴ Zughaier SM, Cornelis P. Editorial: Role of Iron in Bacterial Pathogenesis. Front Cell Infect Microbiol. 2018 Oct 16;8:344.