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Autoimmune Gastritis: Tell-Tale Signs & Gut Health Solutions

Written by Dr. Michael Ruscio, DC on October 14, 2024

Written by Dr. Michael Ruscio, DC on October 14, 2024 — Reviewed by Dr. Hannah Hamlin

How to Calm Stomach Inflammation Symptoms with Effective Natural Treatments

• What Is Autoimmune Gastritis|
• Symptoms|
• Diagnosis|
• Link With Gut Health|
• Manage AIG|
• Diet|
• Supplements|

Ever felt nauseous after eating, experienced vague stomach pain, or dealt with constant fatigue? Maybe you’ve noticed an odd tingling or “pins and needles” sensation in your hands or feet. 

These symptoms may seem random, but they could be connected to a condition called autoimmune gastritis.

Autoimmune gastritis is a specific type of chronic atrophic gastritis—ongoing stomach inflammation—that involves the immune system. Its estimated prevalence is up to 2.7% of the general population 1.

Sounds serious? It can be, especially when the condition remains undiagnosed until more severe symptoms start to show up.

However, when correctly identified and treated with a focus on holistic gut health, autoimmune gastritis can be effectively managed. At the clinic, we’ve found that with the right treatment, most people with the condition can manage it effectively and lead a largely symptom-free life.

What Is Autoimmune Gastritis?

Autoimmune gastritis (AIG), also known as autoimmune metaplastic atrophic gastritis, is an autoimmune disease. 

Under normal circumstances, the immune system creates antibodies to attack harmful things like bacteria, viruses, fungi, and toxins. But in autoimmune disorders, the immune system forms antibodies against healthy tissue, creating inflammation where it is not needed.

In AIG, the immune system makes anti-parietal cell antibodies that attack the parietal cells of the gastric mucosa (stomach lining). This prevents the stomach from making enough acid. Too little stomach acid can lead to nutrient malabsorption and iron deficiency anemia 2.

The immune system in a person with AIG also makes antibodies that attack a stomach protein called intrinsic factor. Intrinsic factor helps us absorb vitamin B12, which we need to protect our nerves and make strong red blood cells. Too little intrinsic factor and B12 can weaken our nerves and blood cells 2. 

If untreated, vitamin B12 deficiency can lead to pernicious anemia, which causes symptoms like crippling fatigue, nerve problems, heart palpitations, indigestion, and weight loss from a lack of appetite 3. 

Autoimmune gastritis can also cause the mucosal lining in the stomach and upper part of the intestines to thin (a process called atrophy). This can put us at high risk‌ of developing intestinal metaplasia (abnormal cell growth) or hyperplasia (too much cell growth) in the lining of the intestine 4.

Symptoms of Autoimmune Gastritis

Symptoms of AIG can be subtle and develop slowly, making it easy to miss the early signs. Common symptoms include 5:

• Nausea and vomiting
• Upper abdominal pain or discomfort
• Feeling full after eating small amounts
• Fatigue or weakness (related to anemia)
• Tingling or numbness in the hands and feet (signs of B12 deficiency)

Decreased stomach acid puts people with AIG at an increased risk of Helicobacter pylori infection. In turn, H. pylori is a risk factor for a type of stomach tumor called gastric adenocarcinoma and peptic ulcers 6. 

Autoimmune gastritis often coexists with other autoimmune diseases. These include  7:

•  Hashimoto’s thyroiditis
• Type-1 diabetes mellitus
• Crohn’s disease
• Addison’s disease
• Vitiligo

Diagnosing Autoimmune Gastritis

Early diagnosis of AIG is key to preventing longer-term complications, such as gastric cancer or severe nutrient deficiencies. Diagnosing AIG typically requires a combination of the following tests 6.

Blood Tests

Blood tests for AIG may measure:

• Gastrin (a hormone that stimulates stomach acid production)
• Pepsinogen (an enzyme linked to stomach acid secretion)
• Anti-parietal cell antibodies
• H. pylori antibodies

Gastrin and pepsinogen levels can give clues about the health of your stomach lining.

Even though parietal cell antibody tests are popular in functional medicine, they aren’t reliable on their own. These antibodies can also appear in other autoimmune conditions, particularly autoimmune thyroid disease 8. 

Additionally, parietal cell antibodies may only be elevated in the early stages of autoimmune gastritis, sometimes decreasing as the disease progresses. This can make results confusing or misleading 8 9.

Gastric Endoscopy (AKA Gastroscopy)

Gastric endoscopy involves inserting a thin tube with a camera into the stomach to examine the lining. This endoscopic surveillance can detect early-stage cell abnormalities. 

But to properly confirm an AIG diagnosis, your doctor may order a biopsy of the fundus (top part of the stomach) and possibly of the antrum (bottom part of the stomach)—also known as an antral biopsy.

Although it’s more invasive than a blood test, the gastric endoscopy is the gold standard for diagnosing AIG. 

The Gut Health-Autoimmunity Link

Managing autoimmune gastritis successfully means addressing the underlying immune response. This could call for a gut-health overhaul. 

Why? A common thread across autoimmune conditions is the gut microbiome. In short, autoimmune diseases have been associated with disruptions to the healthy balance of bacteria in the gut 10.

In particular, studies have linked autoimmune diseases with increased intestinal permeability, or leaky gut 11. A leaky gut can let foreign substances leak into the bloodstream and cause the immune system to go into overdrive.

A study of 266 anonymous volunteers found that those with intestinal permeability had higher levels of self-attacking antibodies than those with a healthy gut lining. Self-attacking antibodies related to intestinal tight junctions were strongly linked to those found in autoimmune diseases, including AIG 12. 

This and other evidence suggest that a leaky gut may contribute to the development of autoimmune conditions, including AIG, type-1 diabetes, multiple sclerosis, and Crohn’s disease. 

Whatever autoimmune disease may be lurking, improving the balance of bacteria in the gut to strengthen the intestinal lining may keep autoimmunity at bay.

How to Manage Autoimmune Gastritis

At the clinic, we’ve found that autoimmune gastritis can be well managed with a holistic approach that combines dietary changes and targeted supplements. Diet and supplements can be very helpful for balancing gut bacteria, improving gut health, and tackling autoimmune conditions.

Gut-Friendly Diets for Autoimmune Gastritis

In the clinic, we help clients identify and remove the foods that may be driving their microbiome imbalances, inflammatory processes, and autoimmunity.

As a first step, this means cutting out highly processed foods like candy bars, white bread, fast food, deli meats, and sodas. Consuming these regularly may increase inflammatory processes and the risk of autoimmunity 13. 

As our usual go-to in the clinic, the Paleo diet is centered on whole, unprocessed foods and light on (or absent of) wheat and dairy. It can be a great choice for people with autoimmune conditions and immune systems that may be activated by specific foods. Although the Paleo diet hasn’t been tested in people with AIG, it has been beneficial for improving thyroid antibodies in autoimmune thyroid diseases 14.

If their symptoms don’t improve on a Paleo regimen, many of my clients benefit from following a low-FODMAP diet. This plan eliminates a range of potentially problematic foods that can fuel overgrowths of troublesome gut bacteria.

The Autoimmune Protocol (AIP) diet is a more restrictive Paleo-like plan that eliminates many foods, including nightshade vegetables, grains, nuts and seeds, coffee, eggs, alcohol, refined sugars and oils, legumes, and dairy.

Despite its name, the AIP isn’t always the best first step for autoimmune conditions. It’s better to start with less restrictive diets and get more strict if necessary. 

The AIP has shown promise for autoimmune conditions, including inflammatory bowel disease 15 and Hashimoto’s thyroiditis 16. But it hasn’t been scientifically tested for autoimmune gastritis.

Before trying any elimination diet, it’s important to consult with a healthcare provider who understands your symptoms and can help monitor your progress. 

Our rule of thumb is to begin with the least restrictive diet and adjust as needed, with more supervision for more food restriction. When followed for too long, overly restrictive diets can lead to nutrient deficiencies, potentially worsening autoimmune gastritis symptoms.

Supplements for Autoimmune Gastritis

Once you’re supporting your body with a gut-healthy diet you may be able to further minimize symptoms of AIG with targeted supplements. Probiotics are top of the list of supplements to try.

Probiotics

Probiotics are an excellent way to repair a leaky gut and put a damper on autoimmunity. That’s why I strongly recommend that my clients with autoimmune gastritis start taking probiotics.

There’s not much research looking directly at the benefits of probiotics on autoimmune gastritis. But plenty of studies show that probiotics can help with autoimmune diseases in general by improving gut health and helping to reduce gut permeability 17 18.

Probiotics can also help if a coexisting H. pylori infection is contributing to AIG. A 2018 systematic review found that even when taken alone (without antibiotics), multi-strain probiotics eradicated H. pylori in 14% of cases 19. 

But, as a meta-analysis (high-quality study of studies) found, adding probiotics to conventional treatment probably works the best 20.

In the clinic, we usually get the best results when using multi-strain probiotics, specifically a blend of:

• Lactobacillus and Bifidobacterium species
• Soil-derived bacteria (Bacillus species)
• Saccharomyces boulardii (a beneficial yeast)

For convenience, we’ve formulated a 3-in-1 blend that combines these probiotics, is easy to use, and requires no refrigeration. 

Gut-Rebuilding Glutamine

Glutamine is an important part of a gut rebuild supplement we use in the clinic to help rebuild the gut lining 21. 

While not yet studied for its effects on autoimmune gastritis, glutamine can repair a leaky gut and improve symptoms in people with intestinal permeability and diarrhea-predominant irritable bowel syndrome (IBS) 22.

Vitamin B12

Autoimmune gastritis destroys cells that produce intrinsic factor, that protein we need for vitamin B12 absorption. As a result, those with AIG usually need high doses of vitamin B12 23.

Studies on the effect of vitamin B12 in autoimmune gastritis have shown that:

• When implemented early in AIG, vitamin B12 combined with iron (see below) may prevent the anemia and neurological problems that can develop from autoimmune gastritis 9.
• Compared to oral vitamin B12, injections may reduce anti-parietal cell antibodies by more than half and help to reduce stomach autoimmunity 24. 

Traditionally, vitamin B12 is injected directly into the muscle to get around absorption problems in AIG, but this might not always be necessary. For example, limited research has shown that high oral B12 doses can be as effective as injections in some people with AIG and B12 deficiency 23. 

Regardless, always discuss B12 supplementation with a doctor to find out what works best for you.

Iron

Reduced stomach acid in AIG makes dietary iron hard to absorb, increasing the risk of iron deficiency anemia. 

Iron supplements are often required to prevent or correct iron deficiency in autoimmune gastritis 9. Finding out the best way to get iron (supplements or injections) and regularly monitoring iron levels is an important part of living with AIG. 

Betaine Hydrochloric Acid

Not only can AIG cause B12 and iron deficiencies, but the lack of stomach acid may also cause insufficient absorption of vitamin C, calcium, and vitamin D 25. 

And beware of proton pump inhibitors—they can further worsen iron and nutrient absorption 1.

Although it hasn’t been researched in people with AIG, betaine hydrochloric acid (HCl) can improve poor digestion related to low stomach acid and may be worth a try with a doctor’s supervision 25. 

Whether HCl helps or not, assessing nutrient levels periodically with clinical guidance is wise for anyone with AIG. A knowledgeable healthcare provider can help locate the right supplements to stay balanced.

Living Well With Autoimmune Gastritis

Though autoimmune gastritis symptoms can range from uncomfortable to debilitating, the right care can help you manage the condition and your symptoms. Supporting gut health and nutrient absorption with diet changes and supplements is key.

It’s also important to talk to a healthcare professional to ensure you have the right diagnosis and treatment plan for your own needs. If you need help with this, you can reach out to us at the Ruscio Institute for Functional Health for a consultation.

The Ruscio Institute has developed a range of high-quality formulations to help our clients 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. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.