Dear Editor,
The global prevalence of Helicobacter pylori infection in children is approximately 32.3% (1). It is a well-established cause of iron deficiency anemia (IDA) (2), affecting up to 53.1% of infected pediatric populations (3). Helicobacter pylori is suggested to disrupt gastric acid secretion and compete with the host for iron, potentially through genes encoding major outer membrane proteins (OMPs) — a mechanism proposed to contribute to the pathogenesis of H. pylori-associated anemia (2). Although combining H. pylori eradication therapy with oral iron supplementation is effective, treatment adherence is often compromised by the gastrointestinal side effects of iron supplements, which can exacerbate infection-related distress (3, 4).
To address this challenge, we hypothesize that Spirulina — a nutrient-dense cyanobacterium — could represent a promising dual-action approach for managing H. pylori-induced iron deficiency in children. Spirulina is a rich source of protein, essential amino acids, carbohydrates, lipids, essential fatty acids, fiber, vitamins (such as β-carotene, vitamin C, D, E, and especially B vitamins), and minerals including calcium, magnesium, manganese, selenium, and zinc, with iron content ranging from 28.5 to 100 mg per 100 g (4, 5). Preclinical studies suggest that it may enhance iron absorption by forming soluble complexes with both heme and non-heme iron via its phycocyanin and polysaccharide components, and it has been proposed to upregulate divalent metal transporter 1 (DMT1) and promote ferritin synthesis in enterocytes (6). Its broad micronutrient profile could further support erythropoiesis and child development (7). Spirulina may compensate for iron deficiency or reduce the required dosage of iron supplements, thereby improving treatment tolerability.
Some clinical studies indicate Spirulina’s efficacy in improving hematological parameters and alleviating anemia in children, pregnant women, and patients with ulcerative colitis, effects that may be related to its antioxidant, anti-inflammatory, and iron-mobilizing properties (4, 8-11). However, direct evidence in pediatric H. pylori infection is lacking. Additionally, preclinical research indicates that Spirulina-derived bioactive peptides and polysaccharides exhibit anti-H. pylori activity by inhibiting bacterial adhesion and colonization, protecting the gastric mucosa, and modulating oxidative and inflammatory pathways. These compounds interact with key H. pylori enzymes, such as alkyl hydroperoxide reductase (AhpC) and urease; suppress reactive oxygen species and NF-κB-mediated proinflammatory cytokines (TNF-α and IL-8); and enhance antioxidant defenses (12-15). Phycocyanin, a purified Spirulina protein, has been shown in vitro to suppress H. pylori-induced gastric epithelial hyperproliferation by modulating the ROS/MAPK signaling cascade and downregulating c-Myc and cyclin D1, highlighting its potential for further investigation in H. pylori-associated gastric disorders and carcinogenesis (16, 17).
Based on this emerging preliminary evidence, we propose the following hypothesis: Spirulina may play a dual role in attenuating H. pylori infection and enhancing iron metabolism. Its phycocyanin and polysaccharides could provide synergistic antioxidant, anti-inflammatory, and iron-boosting effects, potentially alleviating H. pylori-associated anemia by reducing bacterial iron competition and restoring host iron balance. We conclude that this safe, nutrient-rich supplement warrants rigorous randomized clinical trials — especially in children with H. pylori-induced anemia — to validate the proposed hypothesis and establish optimal dosing and efficacy.
