What’s the Best Autoimmune Atrophic Gastritis Diet?

How to Establish an Effective Diet Plan for Autoimmune Atrophic Gastritis

Key Takeaways:

  • Hidden food sensitivities or intolerances can contribute to gut health imbalances and autoimmune conditions, including autoimmune atrophic gastritis.
  • A step-by-step elimination diet process can help you to determine your ideal autoimmune atrophic gastritis diet, which may be based on a Paleo or low FODMAP framework.
  • Dietary habits like scheduling regular mealtimes, eating slowly, and avoiding leftovers can help to improve symptoms of atrophic gastritis.
  • Supplements including probiotics, vitamin B12, and N-acetylcysteine (NAC) can help alongside an anti-inflammatory diet to improve autoimmune gastritis.

More than half of chronic atrophic gastritis patients report that what they eat (and how they eat) triggers their symptoms. In general, hidden food sensitivities have been linked to autoimmunity, inflammation, and disrupted gut health. Addressing these sensitivities can help you to improve gastritis symptoms, including stomach pain, bloating, indigestion, and fatigue.

So what’s the best diet for autoimmune gastritis? The most effective autoimmune atrophic gastritis diet involves identifying the kinds of foods that work best for you, reducing inflammation, and healing your gut. 

In this article, we’ll guide 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.

Autoimmune atrophic gastritis diet: 3D illustration of a stomach overlaid on a woman with an aching stomach

Autoimmune Atrophic Gastritis Diet: A Snapshot

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 2-3 weeks and observe symptoms
    • If symptoms improve, gradually reintroduce healthy foods while monitoring how you feel 
    • If symptoms don’t resolve, try 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 

What Is Autoimmune Atrophic Gastritis? 

Atrophic gastritis is a condition in which chronic inflammation leads to the wasting away of components of the stomach’s mucosal lining. In the case of autoimmune atrophic gastritis, the condition is brought on by the immune system mistakenly attacking stomach cells (“autoimmune” refers to the immune system attacking the body’s own cells or tissues). 

Other cases of atrophic gastritis may be caused by infections, particularly helicobacter pylori infections(H. pylori) [1]. 

The stomach lining damage that occurs in atrophic gastritis can lead to low stomach acid secretion, which can then lead to malabsorption and nutritional deficiencies as well as increased risk of infection. Many of the symptoms that are associated with chronic atrophic gastritis occur as a result of this low stomach acid production. 

Autoimmune atrophic gastritis may also be referred to as chronic autoimmune atrophic gastritis (CAAG), autoimmune metaplastic gastritis, or simply autoimmune gastritis. The prevalence of autoimmune atrophic gastritis is thought to be around 2% of the U.S. population [2 Trusted SourcePubMedGo to source].

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 [3 Trusted SourcePubMedGo to source]. Others may experience non-specific symptoms like stomach pain, indigestion, or fatigue. 

Symptoms of AIG may include [4, 5]

  • Pain in the upper part of the stomach 
  • Generalized abdominal pain 
  • Nausea or vomiting 
  • Fatigue 
  • Feeling full early when eating
  • Bloating
  • Indigestion 
  • Nutritional deficiencies (especially vitamin B12 deficiency, iron deficiency anemia, pernicious anemia)
  • Peptic ulcers
Autoimmune atrophic gastritis diet: Symptoms of atrophic gastritis

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 [6].

Co-occurring autoimmune conditions may include [7 Trusted SourcePubMedGo to source, 8 Trusted SourcePubMedGo to source, 9 Trusted SourcePubMedGo to source, 10 Trusted SourcePubMedGo to source, 11 Trusted SourcePubMedGo to source]:

  • Rheumatoid arthritis 
  • Crohn’s disease
  • Celiac disease
  • Hashimoto’s thyroiditis
  • Autoimmune thyroid conditions including Grave’s disease
  • Type 1 diabetes 
  • Vitiligo

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 collect a tissue sample. 

One less invasive option compared to endoscopy is antibody testing. Antibodies are proteins the body produces in response to threats, and autoantibodies are antibodies that are directed against the body’s own tissues or cells. 

Because autoimmune atrophic gastritis involves the immune system attacking the stomach’s parietal cells, it seems logical to test for parietal cell antibodies. 

However, research has shown that levels of these antibodies tend to fluctuate over the course of the disease, so the results of antibody testing in this case may be confusing or misleading [12, 13 Trusted SourcePubMedGo to source]. 

Treatment guidelines for autoimmune atrophic gastritis haven’t been well established. Identifying the condition early is helpful, and measures can be taken to reduce stomach inflammation and prevent nutritional deficiencies and other effects that may be brought on by low stomach acid [13 Trusted SourcePubMedGo to source].

What Causes Autoimmune Atrophic Gastritis? 

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

Many different factors, including genetic predisposition, your internal environment, and environmental factors, can contribute to the development and/or symptoms of autoimmune conditions including autoimmune atrophic gastritis [12].

Research also suggests that even in cases of autoimmune atrophic gastritis, H. pylori may be involved [13, 14].

Common causes and contributing factors may include: 

Autoimmunity and the Gut

Autoimmune atrophic gastritis diet: Signs of an unhealthy gut

Research shows that gut imbalances and inflammation can drive autoimmunity [19, 23 Trusted SourcePubMedGo to source, 24 Trusted SourcePubMedGo to source]. Imbalanced gut bacteria (dysbiosis) and increased intestinal permeability (leaky gut) have both been associated with multiple different autoimmune conditions [15 Trusted SourcePubMedGo to source, 16, 17 Trusted SourcePubMedGo to source, 18, 19, 20 Trusted SourcePubMedGo to source, 21 Trusted SourcePubMedGo to source, 22 Trusted SourcePubMedGo to source]. 

Healing your gut, therefore, is regarded as one of the most important things you can do to improve an autoimmune condition. 

Can Food Sensitivities Lead to Autoimmune Atrophic Gastritis

Identifying food intolerances is one of the best ways to restore your gut health. Hidden food intolerances or sensitivities can contribute to dysbiosis, leaky gut, intestinal inflammation, immune system dysfunction, and more [25 Trusted SourcePubMedGo to source, 26 Trusted SourcePubMedGo to source, 27 Trusted SourcePubMedGo to source, 28 Trusted SourcePubMedGo to source, 29, 30]. 

In a 2020 observational study, 58% of chronic atrophic gastritis patients reported that their symptoms correlated with dietary factors [33]. 

A few different kinds of foods have been associated with increased atrophic gastritis symptoms in observational studies and surveys [33, 34, 35 Trusted SourcePubMedGo to source]: 

  • Alcohol 
  • Spicy foods 
  • Sugary foods 
  • Fish
  • Legumes 
  • Meat
  • Coarse cereals 
  • Milk

What’s the Best Autoimmune Atrophic Gastritis Diet?

Autoimmune atrophic gastritis diet: Various healthy food ingredients on a dirty white surface

Research on the best autoimmune atrophic gastritis diet is limited, but the general principles of a therapeutic diet can always be applied. 

Finding and addressing hidden food intolerances 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, 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. 

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

  • Start with the least restrictive option. 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 2-3 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 diet. 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 kind of diet.
  • Optimize and maintain. Once you’ve landed on a diet 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 intolerances, but is also not overly restrictive [36 Trusted SourcePubMedGo to source, 37 Trusted SourcePubMedGo to source]. Many people feel significantly better within just 2-3 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 2-3 weeks on a Paleo diet, and then move on 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 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 more restrictive diet, like the Autoimmune Paleo diet or a low FODMAP Paleo diet, at least while working on addressing underlying imbalances and improving your gut health. 

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

Low FODMAP Diet

Autoimmune atrophic gastritis diet: FODMAP food list

The low FODMAP diet aims to reduce certain types of carbohydrates that bypass the digestive system and are fermented by gut bacteria. 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 digestive symptoms and conditions including abdominal pain, bloating, gas, IBS, IBD, SIBO, leaky gut, and more [38 Trusted SourcePubMedGo to source, 39, 40 Trusted SourcePubMedGo to source, 41 Trusted SourcePubMedGo to source, 42 Trusted SourcePubMedGo to source, 43 Trusted SourcePubMedGo to source].  

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 and digestive supports, and sometimes antimicrobial treatments down the road. 

Autoimmune Paleo Diet 

The Autoimmune Paleo Diet (AIP) 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 [44, 45 Trusted SourcePubMedGo to source, 46], it’s important to note that in spite of its name, this diet is not ideal for everyone who has an autoimmune condition. 

Still, many individuals experience significant symptom improvement on this diet. 

Removing food triggers can help to 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. 

Best Dietary Habits for Autoimmune Atrophic Gastritis 

A successful diet strategy involves considering when and how you eat, not just what you eat. Self-reported surveys and observational studies have found that certain dietary habits seem to worsen symptoms of gastritis [33, 34, 35 Trusted SourcePubMedGo to source]. 

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

  • Avoid eating too fast: Try to be as relaxed as possible when eating. Sit comfortably, avoid distractions, and eat mindfully. 
  • 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 [33]. 

Supplements for Autoimmune Atrophic Gastritis

Pink tablets spilling out of the bottle

Alongside dietary changes, there are a few different kinds of supplements that may help with autoimmune atrophic gastritis. 

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 [47 Trusted SourcePubMedGo to source, 48 Trusted SourcePubMedGo to source, 49 Trusted SourcePubMedGo to source, 50 Trusted SourcePubMedGo to source, 51 Trusted SourcePubMedGo to source, 52 Trusted SourcePubMedGo to source, 53 Trusted SourcePubMedGo to source]. 

Multi-strain probiotics have also been shown to help eradicate H pylori infections [54]. 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 lowest number of side effects [55].

Missing Micronutrients (B12, Iron, Vitamin D) 

Damage to the gastric mucosa (stomach lining) can lead to low gastric acid and intrinsic factor (which helps the body absorb B12), and malabsorption of other micronutrients (i.e. vitamins and minerals) including iron. A high incidence of vitamin D deficiency has also been observed in autoimmune atrophic gastritis patients [56 Trusted SourcePubMedGo to source].

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 [13, 57, 58]. In addition to improving levels of B12, these injections have been shown to help reduce stomach autoimmunity [59].

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. 

Herbal Treatments

A few herbal treatments and blends used in traditional Chinese medicine, including banxia xiexin decoction (BXD) and xiangsha yangwei, have been shown to be effective and safe in treating abdominal pain, inflammation, gastric atrophy, intestinal metaplasia, gastric precancer, and H pylori infections in chronic atrophic gastritis [60, 61 Trusted SourcePubMedGo to source]. 

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 been shown to help prevent gastritis following an H. pylori infection and to improve gut healing in those with atrophic gastritis [62]. Another amino acid, L-glutamine, has been shown to help improve the health of the gut lining and may help with autoimmune atrophic gastritis [63 Trusted SourcePubMedGo to source].

Stomach Acid (HCl)

Given that autoimmune atrophic gastritis leads to low stomach acid, supplemental 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.

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, you can 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 including 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 medicine center.

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