What’s the Best Autoimmune Atrophic Gastritis Diet? - Dr. Michael Ruscio, DC

Does your gut need a reset?

Yes, I'm Ready

Do you want a second opinion?

Yes, I Need Help

Do you want to start feeling better?

Yes, Where Do I Start?

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 atrophic gastritis.
Lazy bowel syndrome: woman clutching her stomach in pain

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.

Young woman making fresh juice

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: 
  • Dietary habits to remember: 
    • Eat slowly
    • Avoid irregular mealtimes 
    • Avoid leftovers 
  • Helpful supplements: 

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.

What’s the Best Autoimmune Atrophic Gastritis Diet? - Dysbiosis Quadrants L

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?

Ketogenic low carbs diet healthy foods

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.

What’s the Best Autoimmune Atrophic Gastritis Diet? - What%20To%20Eat%20On%20The%20Paleo%20Diet 01 L

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.

What’s the Best Autoimmune Atrophic Gastritis Diet? - FODMAP%20Food%20List Larger%20Text L

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.

What’s the Best Autoimmune Atrophic Gastritis Diet? - autoimmiune%20food%20list landscape L

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

Vitamin B12 Tablets Spilled from the Bottle

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
What’s the Best Autoimmune Atrophic Gastritis Diet? - Symptoms of Atrophic Gastritis Square L

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

Young cheerful woman eating fruit salad

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 medicine 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.

➕ References
  1. Rodriguez-Castro KI, Franceschi M, Noto A, Miraglia C, Nouvenne A, Leandro G, et al. Clinical manifestations of chronic atrophic gastritis. Acta Biomed. 2018 Dec 17;89(8-S):88–92. DOI: 10.23750/abm.v89i8-S.7921. PMID: 30561424. PMCID: PMC6502219.
  2. De Luca F, Shoenfeld Y. The microbiome in autoimmune diseases. Clin Exp Immunol. 2019 Jan;195(1):74–85. DOI: 10.1111/cei.13158. PMID: 29920643. PMCID: PMC6300652.
  3. Clemente JC, Manasson J, Scher JU. The role of the gut microbiome in systemic inflammatory disease. BMJ. 2018 Jan 8;360:j5145. DOI: 10.1136/bmj.j5145. PMID: 29311119. PMCID: PMC6889978.
  4. Xu H, Liu M, Cao J, Li X, Fan D, Xia Y, et al. The Dynamic Interplay between the Gut Microbiota and Autoimmune Diseases. J Immunol Res. 2019 Oct 27;2019:7546047. DOI: 10.1155/2019/7546047. PMID: 31772949. PMCID: PMC6854958.
  5. Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71–8. DOI: 10.1007/s12016-011-8291-x. PMID: 22109896.
  6. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky gut as a danger signal for autoimmune diseases. Front Immunol. 2017 May 23;8:598. DOI: 10.3389/fimmu.2017.00598. PMID: 28588585. PMCID: PMC5440529.
  7. de Oliveira GLV, Leite AZ, Higuchi BS, Gonzaga MI, Mariano VS. Intestinal dysbiosis and probiotic applications in autoimmune diseases. Immunology. 2017 Sep;152(1):1–12. DOI: 10.1111/imm.12765. PMID: 28556916. PMCID: PMC5543467.
  8. Yap YA, Mariño E. An insight into the intestinal web of mucosal immunity, microbiota, and diet in inflammation. Front Immunol. 2018 Nov 20;9:2617. DOI: 10.3389/fimmu.2018.02617. PMID: 30532751. PMCID: PMC6266996.
  9. Dong L, Xie J, Wang Y, Zuo D. Gut microbiota and immune responses. Adv Exp Med Biol. 2020;1238:165–93. DOI: 10.1007/978-981-15-2385-4_10. PMID: 32323185.
  10. Fitzgibbon G, Mills KHG. The microbiota and immune-mediated diseases: Opportunities for therapeutic intervention. Eur J Immunol. 2020 Mar;50(3):326–37. DOI: 10.1002/eji.201948322. PMID: 31991477.
  11. Honda K, Littman DR. The microbiota in adaptive immune homeostasis and disease. Nature. 2016 Jul 7;535(7610):75–84. DOI: 10.1038/nature18848. PMID: 27383982.
  12. Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018 Nov;17(11):1078–80. DOI: 10.1016/j.autrev.2018.05.011. PMID: 30213697.
  13. Pietschmann N. Food Intolerance: Immune Activation Through Diet-associated Stimuli in Chronic Disease. Altern Ther Health Med. 2015 Aug;21(4):42–52. PMID: 26030116.
  14. Levy J, Bernstein L, Silber N. Celiac disease: an immune dysregulation syndrome. Curr Probl Pediatr Adolesc Health Care. 2014 Dec;44(11):324–7. DOI: 10.1016/j.cppeds.2014.10.002. PMID: 25499458.
  15. Briani C, Samaroo D, Alaedini A. Celiac disease: from gluten to autoimmunity. Autoimmun Rev. 2008 Sep;7(8):644–50. DOI: 10.1016/j.autrev.2008.05.006. PMID: 18589004.
  16. Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017 Mar 15;11(2):196–208. DOI: 10.5009/gnl16126. PMID: 28274108. PMCID: PMC5347643.
  17. Caminero A, Meisel M, Jabri B, Verdu EF. Mechanisms by which gut microorganisms influence food sensitivities. Nat Rev Gastroenterol Hepatol. 2019 Jan;16(1):7–18. DOI: 10.1038/s41575-018-0064-z. PMID: 30214038. PMCID: PMC6767923.
  18. Li Y, Su Z, Li P, Li Y, Johnson N, Zhang Q, et al. Association of Symptoms with Eating Habits and Food Preferences in Chronic Gastritis Patients: A Cross-Sectional Study. Evid Based Complement Alternat Med. 2020 Jul 9;2020:5197201. DOI: 10.1155/2020/5197201. PMID: 32695209. PMCID: PMC7368216.
  19. Lin S, Gao T, Sun C, Jia M, Liu C, Ma X, et al. Association of dietary patterns and endoscopic gastric mucosal atrophy in an adult Chinese population. Sci Rep. 2019 Nov 12;9(1):16567. DOI: 10.1038/s41598-019-52951-7. PMID: 31719557. PMCID: PMC6851133.
  20. Fontham E, Zavala D, Correa P, Rodriguez E, Hunter F, Haenszel W, et al. Diet and chronic atrophic gastritis: a case-control study. J Natl Cancer Inst. 1986 Apr;76(4):621–7. DOI: 10.1093/jnci/76.4.621. PMID: 3457199.
  21. Whalen KA, McCullough ML, Flanders WD, Hartman TJ, Judd S, Bostick RM. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults. J Nutr. 2016 Jun;146(6):1217–26. DOI: 10.3945/jn.115.224048. PMID: 27099230. PMCID: PMC4877627.
  22. Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J. 2014 Jan 16;13:5. DOI: 10.1186/1475-2891-13-5. PMID: 24428901. PMCID: PMC3896778.
  23. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897–906. DOI: 10.1007/s00394-015-0922-1. PMID: 25982757.
  24. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9). DOI: 10.3390/nu9090940. PMID: 28846594. PMCID: PMC5622700.
  25. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010 Feb;25(2):252–8. DOI: 10.1111/j.1440-1746.2009.06149.x. PMID: 20136989.
  26. Gibson PR, Shepherd SJ. Food choice as a key management strategy for functional gastrointestinal symptoms. Am J Gastroenterol. 2012 May;107(5):657–66; quiz 667. DOI: 10.1038/ajg.2012.49. PMID: 22488077.
  27. Gibson PR. Use of the low-FODMAP diet in inflammatory bowel disease. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:40–2. DOI: 10.1111/jgh.13695. PMID: 28244679.
  28. Pedersen N, Ankersen DV, Felding M, Wachmann H, Végh Z, Molzen L, et al. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World J Gastroenterol. 2017 May 14;23(18):3356–66. DOI: 10.3748/wjg.v23.i18.3356. PMID: 28566897. PMCID: PMC5434443.
  29. Chandrasekaran A, Groven S, Lewis JD, Levy SS, Diamant C, Singh E, et al. An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct;1(3):otz019. DOI: 10.1093/crocol/otz019. PMID: 31832627. PMCID: PMC6892563.
  30. Konijeti GG, Kim N, Lewis JD, Groven S, Chandrasekaran A, Grandhe S, et al. Efficacy of the autoimmune protocol diet for inflammatory bowel disease. Inflamm Bowel Dis. 2017 Nov;23(11):2054–60. DOI: 10.1097/MIB.0000000000001221. PMID: 28858071. PMCID: PMC5647120.
  31. Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. DOI: 10.7759/cureus.4556. PMID: 31275780. PMCID: PMC6592837.
  32. Leblhuber F, Steiner K, Schuetz B, Fuchs D, Gostner JM. Probiotic Supplementation in Patients with Alzheimer’s Dementia – An Explorative Intervention Study. Curr Alzheimer Res. 2018;15(12):1106–13. DOI: 10.2174/1389200219666180813144834. PMID: 30101706. PMCID: PMC6340155.
  33. Toribio-Mateas M. Harnessing the power of microbiome assessment tools as part of neuroprotective nutrition and lifestyle medicine interventions. Microorganisms. 2018 Apr 25;6(2). DOI: 10.3390/microorganisms6020035. PMID: 29693607. PMCID: PMC6027349.
  34. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic With or Without Fiber Controls Body Fat Mass, Associated With Serum Zonulin, in Overweight and Obese Adults-Randomized Controlled Trial. EBioMedicine. 2016 Nov;13:190–200. DOI: 10.1016/j.ebiom.2016.10.036. PMID: 27810310. PMCID: PMC5264483.
  35. Frei R, Akdis M, O’Mahony L. Prebiotics, probiotics, synbiotics, and the immune system: experimental data and clinical evidence. Curr Opin Gastroenterol. 2015 Mar;31(2):153–8. DOI: 10.1097/MOG.0000000000000151. PMID: 25594887.
  36. Mujagic Z, de Vos P, Boekschoten MV, Govers C, Pieters H-JHM, de Wit NJW, et al. The effects of Lactobacillus plantarum on small intestinal barrier function and mucosal gene transcription; a randomized double-blind placebo controlled trial. Sci Rep. 2017 Jan 3;7:40128. DOI: 10.1038/srep40128. PMID: 28045137. PMCID: PMC5206730.
  37. Sindhu KNC, Sowmyanarayanan TV, Paul A, Babji S, Ajjampur SSR, Priyadarshini S, et al. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014 Apr;58(8):1107–15. DOI: 10.1093/cid/ciu065. PMID: 24501384. PMCID: PMC3967829.
  38. Lamprecht M, Bogner S, Schippinger G, Steinbauer K, Fankhauser F, Hallstroem S, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. DOI: 10.1186/1550-2783-9-45. PMID: 22992437. PMCID: PMC3465223.
  39. Losurdo G, Cubisino R, Barone M, Principi M, Leandro G, Ierardi E, et al. Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis. World J Gastroenterol. 2018 Jan 7;24(1):139–49. DOI: 10.3748/wjg.v24.i1.139. PMID: 29358890. PMCID: PMC5757118.
  40. Shi X, Zhang J, Mo L, Shi J, Qin M, Huang X. Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis. Medicine (Baltimore). 2019 Apr;98(15):e15180. DOI: 10.1097/MD.0000000000015180. PMID: 30985706. PMCID: PMC6485819.
  41. Massironi S, Cavalcoli F, Rossi RE, Conte D, Spampatti MP, Ciafardini C, et al. Chronic autoimmune atrophic gastritis associated with primary hyperparathyroidism: a transversal prospective study. Eur J Endocrinol. 2013 May;168(5):755–61. DOI: 10.1530/EJE-12-1067. PMID: 23447517.
  42. Lenti MV, Rugge M, Lahner E, Miceli E, Toh B-H, Genta RM, et al. Autoimmune gastritis. Nat Rev Dis Primers. 2020 Jul 9;6(1):56. DOI: 10.1038/s41572-020-0187-8. PMID: 32647173.
  43. Sun A, Chang JY-F, Wang Y-P, Cheng S-J, Chen H-M, Chiang C-P. Effective vitamin B12 treatment can reduce serum antigastric parietal cell antibody titer in patients with oral mucosal disease. J Formos Med Assoc. 2016 Oct;115(10):837–44. DOI: 10.1016/j.jfma.2016.05.003. PMID: 27474730.
  44. Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018 Mar 15;3:CD004655. DOI: 10.1002/14651858.CD004655.pub3. PMID: 29543316. PMCID: PMC6494183.
  45. Lin HP, Wang YP, Chia JS, Chiang CP, Sun A. Modulation of serum gastric parietal cell antibody level by levamisole and vitamin B12 in oral lichen planus. Oral Dis. 2011 Jan;17(1):95–101. DOI: 10.1111/j.1601-0825.2010.01711.x. PMID: 20659263.
  46. Zhang Z-D, Liu H, Lyu J, Yu D-D, Sun M-H. [Systematic review and Meta-analysis of efficacy and safety of Xiangsha Yangwei Pills in treatment of chronic gastritis]. Zhongguo Zhong Yao Za Zhi. 2020 Jun;45(11):2668–76. DOI: 10.19540/j.cnki.cjcmm.20200102.502. PMID: 32627502.
  47. Cao Y, Zheng Y, Niu J, Zhu C, Yang D, Rong F, et al. Efficacy of Banxia Xiexin decoction for chronic atrophic gastritis: A systematic review and meta-analysis. PLoS ONE. 2020 Oct 27;15(10):e0241202. DOI: 10.1371/journal.pone.0241202. PMID: 33108375. PMCID: PMC7591022.
  48. Farinati F, Cardin R, della Libera G, Pallotta T, Rugge M, Colantoni A, et al. Effects of N-acetyl-l-cysteine in patients with chronic atrophic gastritis and nonulcer dyspepsia: a phase III pilot study. Current Therapeutic Research. 1997 Oct;58(10):724–33. DOI: 10.1016/S0011-393X(97)80106-3.
  49. Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019 Jun;68(6):996–1002. DOI: 10.1136/gutjnl-2017-315136. PMID: 30108163.
  50. Raza M, Bhatt H. Atrophic Gastritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 33085422.
  51. Cheung DY. Atrophic gastritis increases the risk of gastric cancer in asymptomatic population in korea. Gut Liver. 2017 Sep 15;11(5):575–6. DOI: 10.5009/gnl17356. PMID: 28874038. PMCID: PMC5593317.
  52. Massironi S, Zilli A, Elvevi A, Invernizzi P. The changing face of chronic autoimmune atrophic gastritis: an updated comprehensive perspective. Autoimmun Rev. 2019 Mar;18(3):215–22. DOI: 10.1016/j.autrev.2018.08.011. PMID: 30639639.
  53. Rodriguez-Castro KI, Franceschi M, Miraglia C, Russo M, Nouvenne A, Leandro G, et al. Autoimmune diseases in autoimmune atrophic gastritis. Acta Biomed. 2018 Dec 17;89(8-S):100–3. DOI: 10.23750/abm.v89i8-S.7919. PMID: 30561426. PMCID: PMC6502205.
  54. Atrophic Gastritis: Background, Pathophysiology, Etiology [Internet]. Available from: https://emedicine.medscape.com/article/176036
  55. Miceli E, Lenti MV, Padula D, Luinetti O, Vattiato C, Monti CM, et al. Common features of patients with autoimmune atrophic gastritis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):812–4. DOI: 10.1016/j.cgh.2012.02.018. PMID: 22387252.
  56. Gillberg R, Kastrup W, Mobacken H, Stockbrügger R, Ahren C. Gastric morphology and function in dermatitis herpetiformis and in coeliac disease. Scand J Gastroenterol. 1985 Mar;20(2):133–40. DOI: 10.3109/00365528509089645. PMID: 3992169.
  57. Sterzl I, Hrdá P, Matucha P, Čeřovská J, Zamrazil V. Anti-Helicobacter Pylori, anti-thyroid peroxidase, anti-thyroglobulin and anti-gastric parietal cells antibodies in Czech population. Physiol Res. 2008 Feb 13;57 Suppl 1:S135–41. DOI: 10.33549/physiolres.931498. PMID: 18271683.
  58. Lahner E, Annibale B. Pernicious anemia: new insights from a gastroenterological point of view. World J Gastroenterol. 2009 Nov 7;15(41):5121–8. DOI: 10.3748/wjg.15.5121. PMID: 19891010. PMCID: PMC2773890.
  59. De Block CEM, De Leeuw IH, Van Gaal LF. Autoimmune gastritis in type 1 diabetes: a clinically oriented review. J Clin Endocrinol Metab. 2008 Feb;93(2):363–71. DOI: 10.1210/jc.2007-2134. PMID: 18029461.
  60. Youssefi M, Tafaghodi M, Farsiani H, Ghazvini K, Keikha M. Helicobacter pylori infection and autoimmune diseases; Is there an association with systemic lupus erythematosus, rheumatoid arthritis, autoimmune atrophy gastritis and autoimmune pancreatitis? A systematic review and meta-analysis study. J Microbiol Immunol Infect. 2021 Jun;54(3):359–69. DOI: 10.1016/j.jmii.2020.08.011. PMID: 32891538.
  61. Annibale B, Esposito G, Lahner E. A current clinical overview of atrophic gastritis. Expert Rev Gastroenterol Hepatol. 2020 Feb;14(2):93–102. DOI: 10.1080/17474124.2020.1718491. PMID: 31951768.
  62. Song H, Zhu J, Lu D. Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions. Cochrane Database Syst Rev. 2014 Dec 2;(12):CD010623. DOI: 10.1002/14651858.CD010623.pub2. PMID: 25464111.

Need help or would like to learn more?
View Dr. Ruscio’s, DC additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!