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What’s the Best Autoimmune Atrophic Gastritis Diet?

Written by Dr. Michael Ruscio, DC on August 18, 2022

Written by Dr. Michael Ruscio, DC on August 18, 2022 — Reviewed by Heidi Turner

How to Establish an Effective Diet Plan for Autoimmune Atrophic Gastritis

• Autoimmune Gastritis Snapshot|
• Autoimmunity and the Gut|
• The Best Autoimmune Atrophic Gastritis Diet|
• Dietary Habits|
• Supplements|
• Understanding Autoimmune Atrophic Gastritis|
• Individualize Your Diet|

More than half of chronic atrophic gastritis patients report that their diet (and how they eat) triggers gastric symptoms 1. In the general population, hidden food sensitivities, chronic inflammation, dysbiosis, and leaky gut have all been linked to autoimmune disorders. Addressing these underlying factors can help you to improve gastritis symptoms, including stomach pain, bloating, indigestion, and fatigue.

The most effective autoimmune atrophic gastritis diets are anti-inflammatory, gut-healing, and tailored to your specific needs and sensitivities. By starting with an elimination diet like the Paleo diet, AIP Paleo diet, or the low FODMAP diet you can determine your trigger foods. Which one works for you will be for you to determine through experience, but we will guide you along the way. Making note of trigger foods is key in developing a great plan of action.

In this article, I’ll walk you through a step-by-step plan to find the diet that provides you with the most symptom relief and the least amount of restriction. We’ll also cover optimal dietary habits, helpful supplements — including probiotics and B12 — to take alongside your diet, and some of the most common food triggers for gastritis. I’ll also review the basics of the disease itself to help you better understand the reasoning behind this approach.

Before we dive into the details, let’s take a quick look at the key principles of establishing your autoimmune atrophic gastritis diet. 

• Follow an elimination and reintroduction approach: 
  • Start with the least restrictive diet framework possible 
  • Follow your new diet for two-to-three weeks and observe symptoms
  • If symptoms improve, gradually, reintroduce healthy foods while monitoring how you feel 
  • If symptoms don’t resolve, follow up with a more specialized diet 
• Diets that may help: 
  • Paleo diet
  • Low FODMAP diet
  • Autoimmune Paleo diet (AIP)
• Dietary habits to remember: 
  • Eat slowly
  • Avoid irregular mealtimes 
  • Avoid leftovers 
• Helpful supplements: 
  • Probiotics 
  • B12
  • Iron 
  • Amino acids (glutamine, NAC) 
  • HCl (hydrochloric acid)

Autoimmunity and the Gut

Autoimmune atrophic gastritis is an autoimmune condition that attacks the parietal cells in the stomach. It results in decreased stomach acid (hypochlorhydria) and intrinsic factor, which can lead to impaired digestion and a vitamin B12 deficiency. 

As it turns out, this abnormal immune response may be linked to your gut health. 

Gut imbalances and chronic inflammation can drive autoimmunity 2 3 4. Imbalanced gut bacteria (dysbiosis) and increased intestinal permeability (leaky gut) have both been associated with a multitude of autoimmune conditions 4 5 6 7 8 9 10 11.

Healing your gut, therefore, is among the most important actions to take to improve an autoimmune condition. This approach gets at the root cause of the problem, not only setting you up to calm autoimmunity but to prevent further damage that could lead to additional illnesses.

Food Sensitivities

Identifying food intolerances is the first step on the road to restoring gut health. Hidden food intolerances or sensitivities create an inflammatory environment that contributes to dysbiosis, leaky gut, intestinal stress, immune system dysfunction, and more 12 13 14 15 16 17.

In a 2020 observational study, 58% of chronic atrophic gastritis patients reported that their symptoms correlated with dietary factors 18.

The foods that are associated with increased atrophic gastritis symptoms in observational studies and surveys include 18 19 20:

• Alcohol 
• Spicy foods 
• Sugary foods 
• Fish
• Legumes 
• Meat
• Coarse cereals (sorghum, pearl millet, ragi, small millets, maize, and barley)
• Dairy

This doesn’t mean that you can never eat any of these foods again. Nor does it mean that every last one of these is affecting you and causing problems with your stomach. But by experimenting with temporary elimination of these foods and observing how your body responds, you will have a clearer picture of which foods are creating problems and which ones aren’t. 

Making your way through the gut-healing process will eventually allow you to reintroduce many of the foods you have removed from your diet.

What’s the Best Autoimmune Atrophic Gastritis Diet?

Research on the best autoimmune atrophic gastritis diet is limited, but the general principles of a therapeutic dietary approach can help address the primary concerns of the condition. 

Finding and addressing hidden food intolerances and sensitivities is one of the best ways to reduce inflammation, create a healthier environment for your gut bacteria, and improve your gastrointestinal symptoms. It can be challenging to identify which foods are problematic for you, which is why a methodical, but simple, step-by-step approach is best. 

Remember that while someone else may swear by a specific diet for their autoimmune atrophic gastritis, that doesn’t necessarily mean it’ll be right for you. This is why it’s so important that you work through these steps to create your own, personalized diet plan.

The following elimination diet process can help you to determine which diet works best for you: 

• Start with the least restrictive option first. There’s no need to jump to an overly challenging or restrictive diet right away. A simple, balanced, anti-inflammatory diet like the Paleo diet (see below) can often provide significant symptom relief.
• Start any new diet with a two-to-three week elimination phase. During the elimination phase of a diet, follow the guidelines closely, paying attention to how you feel overall.
• If symptoms improve, begin a reintroduction period. Begin to reintroduce healthy foods that have been eliminated one at a time, monitoring how you feel. If your symptoms worsen or you have a reaction, continue to avoid that food. But if a food does not trigger symptoms, you can add it back into your diet.
• If symptoms don’t improve, try another dietary approach. Depending on the degree of symptom relief you experience during the elimination phase, you may either need to try a more restrictive version of the diet you’ve been following (see examples below) or a different diet plan entirely.
• Optimize and maintain. Once you’ve landed on a way of eating that works for you, continue to use it as a framework, reintroducing as many nutritious foods as you can over time. This is also the time to move on to any additional gut healing treatments you may need while maintaining your healthy diet as a foundation. 

Paleo Diet

The Paleo diet is a great starting point — it reduces inflammation and limits common food intolerances and sensitivities, but is also not overly restrictive 21 22. Many people feel significantly better within two-to-three weeks on a Paleo diet.

The Paleo diet eliminates sugar, additives, and processed foods, as well as common inflammatory triggers like dairy and gluten. 

Unless you know you’ll benefit from a different kind of diet based on an existing sensitivity or underlying condition, begin with two-to-three weeks on a Paleo diet and then proceed based on how you feel.

If you see significant improvements on a Paleo diet: Continue to follow this diet as a framework, and move on to any additional gut healing treatments (like supplements) as needed. 

If you see some, but not enough, improvements on a Paleo diet: Your body may be in a more sensitive or reactive state. Try a narrower diet, like the Autoimmune Protocol (AIP) Paleo diet or a low FODMAP Paleo diet, to reduce the amount of stress on your gut while you’re addressing underlying imbalances and improving your gut health with supplements. 

If you see no improvements on a Paleo diet: You may have an underlying imbalance that requires a different approach. Try a different diet, like the low FODMAP diet, rather than a more restrictive version of Paleo. 

Low FODMAP Diet

The low FODMAP diet aims to reduce certain types of carbohydrates that bypass digestion and are fermented by gut bacteria instead. In cases of imbalanced gut bacteria/dysbiosis or small intestinal bacterial overgrowth (SIBO), these types of carbohydrates may fuel the problem. The goal is to reduce digestive symptoms by starving overgrown or pathogenic gut bacteria. 

The low FODMAP diet has been shown to improve gastrointestinal symptoms and conditions, including abdominal pain, bloating, gas, IBS, IBD, SIBO, leaky gut, and more 23 24 25 26 27 28.

Keep in mind that if you respond well to a low FODMAP diet, it may be a sign that you have gut bacteria imbalances. These imbalances can be addressed with diet, probiotics,  other digestive support, and sometimes antimicrobial treatments down the road.

Autoimmune Paleo Diet 

The Autoimmune Protocol (AIP) Paleo Diet is a more restrictive version of the Paleo diet, eliminating additional foods, including eggs and nightshade vegetables (tomatoes, potatoes, peppers, eggplants). These additional food groups are essentially the next tier of foods that have been shown to trigger inflammation and immune system reactions for some individuals. 

While the AIP diet has been shown in some studies to reduce symptoms of autoimmune conditions, including IBD and Hashimoto’s, it’s important to note that despite its name, this diet is not always necessary for every type of autoimmune condition 29 30 31.

Still, many individuals experience significant symptom improvement on this diet, and it’s worth exploring if you don’t see results from standard Paleo or low FODMAP diets. 

Removing food triggers can help reduce inflammation, improve gut health, and calm the immune system. Over time, you should be able to reintroduce many of the healthy foods you’ve eliminated.

Mealtime Behaviors for Autoimmune Atrophic Gastritis 

A successful diet strategy considers more than just the food aspect of your overall plan. Believe it or not, when you eat (the time of day) and how you eat (how fast and where) can have a profound impact on your digestion. 

Self-reported surveys and observational studies have found that certain dietary habits seem to worsen symptoms of gastritis 18 19 20.

Here are a few tips that might help to reduce symptoms: 

• Avoid eating too quickly: Chew your food thoroughly to stimulate the production of enzymes in your mouth and stomach acid, and begin the process of digestion before you swallow. 
• Eat mindfully: Smell your food before you pick up your fork. Look at it and try to experience gratitude and peace before you begin eating. Try to be as relaxed and undistracted as possible during the meal, and engage all your senses. Sit comfortably and focus on the food. 
• Try to eat meals around the same time every day: Irregular meal times have been associated with increased symptoms. 
• Try to avoid leftovers: Leftovers have been reported by 28% of chronic gastritis patients to worsen symptoms 18.

Supplements for Autoimmune Atrophic Gastritis

Alongside dietary changes, there are a few different kinds of supplements that may help with autoimmune atrophic gastritis. The most critical for improving overall gut health is probiotics. 

Vitamin B12, iron, and vitamin D are also really important if you’re experiencing malnutrition that can result from the condition. Herbal treatments may help reduce painful symptoms, and the addition of amino acids can further promote gut healing. 

Finally, supplementing betaine HCl in order to boost the acid content of the stomach can be a temporary but effective fix for symptom reduction and improving digestion.

Probiotics

Probiotics can be incredibly helpful for patients with autoimmune conditions, as they’ve been shown to promote a healthy immune system response, balance the gut microbiome, and improve leaky gut 32 33 34 35 36 37 38.

Multi-strain probiotics have also been shown to help eradicate H. pylori infections, which can cause gastritis 39. While some research has shown that they can act alone, a 2019 systematic review and meta-analysis concluded that probiotics in combination with antibiotics led to the highest rate of eradication and lower treatment side effects 40.

Missing Micronutrients (B12, Iron, Vitamin D) 

Damage to the gastric mucosa (stomach lining) can lead to low gastric acid and ​intrinsic factor, which help the body absorb B12. It also leads to malabsorption of other micronutrients, including iron and  B12. A high incidence of vitamin D deficiency has been observed in autoimmune atrophic gastritis patients, as well 41.

Depending on the progression of your condition, high doses of oral B12 may be sufficient, while in other cases, B12 injections will be recommended by your doctor 42 43 44. In addition to improving levels of B12, these injections have been shown to help reduce stomach autoimmunity 45.

Levels of B12, iron, vitamin D, and other vitamins and minerals can be assessed with a simple blood test in order to determine if supplementation is necessary. Your doctor will help you determine proper dosing for iron and vitamin D, as you don’t want to overdo either one. As a reminder, vitamin D is best absorbed when taken alongside vitamin K2. 

Herbal Treatments

Herbal treatments used in traditional Chinese medicine (TCM), including banxia xiexin decoction (BXD) and xiangsha yangwei, have been shown to be effective and safe in treating gastritis. They can help reduce abdominal pain, inflammation, gastric atrophy, intestinal metaplasia, gastric precancer (dysplasia), and H. pylori infections in chronic atrophic gastritis 46 47.

Make sure to purchase these supplements from a reputable source that has formulas free of heavy metals, like lead. You can also get them from a certified acupuncturist or TCM doctor.

Amino Acids

Some amino acid supplements have been shown to help improve gastritis and repair the gut lining. N-acetylcysteine (NAC), an amino acid with powerful antioxidant properties, has can help prevent gastritis following an H. pylori infection and improve gut healing in those with atrophic gastritis 48.

However, NAC can worsen heartburn, especially when taken on an empty stomach, so keep a close eye on your symptoms.

Another amino acid, L-glutamine, may improve the health of the gut lining and help with autoimmune atrophic gastritis 49.

Stomach Acid (Betaine HCl)

Given that autoimmune atrophic gastritis leads to low stomach acid — also known as hypochlorhydria or achlorhydria — supplemental betaine HCl may help to improve symptoms. If trying HCl, try to make it the only change you make to your protocol for a couple of weeks so you can monitor whether or not your symptoms are improving as a result. If not, it should be discontinued, unless your healthcare provider advises otherwise.

Avoid taking HCl on an empty stomach, as it may damage your stomach lining. If you ever experience burning while taking it, it’s best to stop to prevent any issues.

Understanding Autoimmune Atrophic Gastritis: The Nuts and Bolts

Autoimmune atrophic gastritis is an autoimmune disease condition in which chronic inflammation leads to the wasting away of components of the stomach’s mucosal lining, including the oxyntic glands which help with digestion.

The condition is brought on by the immune system mistakenly attacking stomach cells. Specifically, the immune system develops anti-parietal cell antibodies (PCA) and intrinsic factor antibodies (IFA) that destroy parietal cells and intrinsic factor, both of which contribute to a healthy digestive tract and the digestion of nutrients.

Other cases of atrophic gastritis may be caused by infections, particularly Helicobacter pylori infections (H. pylori) 50.

In some cases, the stomach lining damage can result in precancerous lesions, eventually leading to gastric carcinoid tumors (neuroendocrine tumors), gastric adenocarcinoma, and other types of gastric cancer if left untreated 51. 

More commonly, it leads to low stomach acid secretion and hypergastrinemia, which can cause enterochromaffin-like cell hyperplasia (ECL), malabsorption, and increased risk of infection. 

Pernicious anaemia, gastric polyps, and nutrient deficiencies (namely iron and vitamin B12) are other potential results of the disease. 

In gastroenterology (the study of the digestive system), autoimmune atrophic gastritis may also be referred to as chronic autoimmune atrophic gastritis (CAAG), autoimmune metaplastic atrophic gastritis, or simply autoimmune gastritis (AIG). 

The prevalence of autoimmune atrophic gastritis is thought to be around 2% of the U.S. population 52.

Symptoms of Autoimmune Atrophic Gastritis

Many people don’t experience obvious symptoms of autoimmune atrophic gastritis, which means that it may go undiagnosed for some time 53. Others may experience non-specific symptoms like stomach pain, indigestion, or fatigue. 

Many of the symptoms that are associated with chronic atrophic gastritis occur as a result of low stomach acid production 54.

Symptoms of AIG may include 1 53:

• Pain in the upper part of the stomach 
• Generalized abdominal pain 
• Nausea or vomiting 
• Fatigue 
• Feeling full early when eating
• Bloating
• Indigestion 
• Heartburn
• Nutritional deficiencies (especially vitamin B12 deficiency and iron deficiency anemia)
• Megaloblastic anemia and/or pernicious anemia
• Peptic ulcers
• Symptoms due to a B12 deficiency, like numbness, tingling, and mood changes

Autoimmune atrophic gastritis may also occur alongside other autoimmune diseases. One observational study reported that more than half of autoimmune atrophic gastritis patients also had at least one other diagnosed autoimmune condition 55.

Co-occurring autoimmune conditions may include 55 56 57 58 59:

• Rheumatoid arthritis: an autoimmune attack on joints and connective tissue
• Crohn’s disease: an autoimmune attack on the gastrointestinal tract
• Celiac Disease: an autoimmune attack on the small intestine triggered by gluten
• Hashimoto’s thyroiditis: an autoimmune lymphocytic infiltration and destruction of the thyroid
• Other autoimmune thyroid diseases: most often Grave’s disease
• Type 1 diabetes: an autoimmune attack on the pancreas
• Vitiligo: an autoimmune attack on melanocytes, the cells in your skin that create pigment
• Addison’s disease: an autoimmune attack on the adrenal glands

Risk Factors for Autoimmune Atrophic Gastritis 

Atrophic gastritis is generally thought to result from either an autoimmune etiology or an underlying H. pylori infection. 

Epidemiology research points to various risk factors that include genetics, your internal environment, and external factors that contribute to the pathogenesis and/or symptoms of autoimmune conditions including autoimmune atrophic gastritis 52.

Research also suggests that in some cases of autoimmune atrophic gastritis, H. pylori may be involved, meaning that there can be two causes in a single case 42 60.

Common risk factors may include: 

• Increased intestinal permeability (“leaky gut”) 4 6 7 8 11
• Gut dysbiosis 2 3 4
• Food intolerances 12 13 14 15 16 17
• Infections (including H. pylori) 42 60.
• Long-term use of reflux medications like proton pump inhibitors (PPIs) 61 (evidence is mixed) 62

Diagnosis and Treatment

Autoimmune atrophic gastritis may be diagnosed with an endoscopic biopsy, in which a thin tube with a light and camera at the end is inserted into the stomach to retrieve a histological (tissue) sample. This sample can be taken from any part of the stomach, including the antrum and fundus.

You can also measure serum gastrin, which may be elevated in chronic atrophic gastritis. Gastrin is a hormone that stimulates the secretion of stomach acid and is secreted into the bloodstream by the gastric lining in response to the presence of food.

Serological (blood) antibody testing is another option. It’s less invasive than endoscopy and determines whether stomach antibodies are present. While healthy antibodies are proteins the body produces in response to legitimate threats (aka antigens), autoantibodies like PCA and IFA are antibodies that are directed against the body’s own tissues or cells. They represent the immune system going haywire.

Antibody testing might seem like the preferred approach, but research has shown that levels of these antibodies tend to fluctuate over the course of the disease, so the results may be confusing or misleading 42 52.

Treatment guidelines for autoimmune atrophic gastritis aren’t well established. Identifying the condition early is helpful, especially in preventing gastric carcinoma. Once you’ve been diagnosed, taking measures to reduce inflammation and prevent nutritional deficiencies and other effects that may be brought on by low stomach acid is key to mitigating symptoms 42.

A focused diet that helps to accomplish these goals is a primary component of the functional medicine approach to dealing with autoimmune atrophic gastritis.

The Best Autoimmune Atrophic Gastritis Diet Is Individualized

Hidden food intolerances and sensitivities can contribute to inflammation, gut imbalances, and immune system dysfunction, all of which may drive autoimmune atrophic gastritis. 

Using a simple, step-by-step approach,  can help identify which foods work best for you (and which don’t) and establish an ideal autoimmune atrophic gastritis diet. 

Optimizing dietary habits and adding in supplements such as probiotics, vitamin B12, glutamine, or NAC as needed can also help to improve symptoms of gastritis. 

For more guidance on healing your gut and reducing your autoimmune symptoms, check out my book, Healthy Gut, Healthy You. You can also sign up to be a patient at my functional health center.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.