Nickel Free-Diet Enhances the Helicobacter pylori Eradication Rate: A Pilot Study

Overview

This Digestive Diseases and Sciences randomized pilot trial from the Gemelli Hospital (Rome) group tests whether a nickel-free diet added to standard triple therapy increases H. pylori eradication. The rationale: H. pylori requires the nickel-containing metalloenzymes urease and [NiFe]-hydrogenase to survive at low gastric pH; depleting dietary nickel could disable the pathogen’s acid-tolerance machinery and expose it to gastric acid plus amoxicillin. 52 first-diagnosis H. pylori patients were randomized 1:1 to standard LCA triple therapy (lansoprazole + clarithromycin + amoxicillin for 7 days) with a common diet, versus the same regimen plus a 30-day nickel-free diet starting 14 days before triple therapy. The intervention nearly doubled the eradication rate.

Key numbers

Side-effect rates did not differ between arms (9/52 reported mild therapy-related side effects).

Methods (brief)

Single-site pilot RCT, sex- and age-matched. The nickel-free diet was the standard low-Ni protocol used by the Gemelli allergology group; patients followed it for 30 days total, with triple therapy starting on day 15. Eradication confirmed by post-treatment H. pylori testing.

Implications

• Certification: Strong primary clinical-trial evidence that dietary nickel modulates H. pylori virulence machinery in vivo. The H. pylori urease and hydrogenase Ni-dependence is consistent with Maier and Benoit 2019 mechanism review; Campanale 2014 is the in-vivo human RCT confirming that nickel-availability manipulation translates to clinical pathogen-clearance outcomes. HMTc Ni-threshold rationale gains primary clinical support beyond the EFSA TDI exposure-assessment framing.
• Microbiome: Direct evidence for the nickel-microbial-pathogenesis mechanism translating to a human clinical endpoint.
• Courses: Standard reference for the dietary-nickel-and-pathogenesis bridge.

Wiki pages updated on ingest

• Nickel
• Nickel in microbial pathogenesis

Update history

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