PA from Autoimmune Gastritis - do the... - Pernicious Anaemi...

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PA from Autoimmune Gastritis - do the stomach issues improve?


Hello, and I'm sorry in advance if I'm posting in the wrong place, since this is more stomach related. I was diagnosed earlier this week with PA and early atrophic autoimmune gastritis, but I still have heartburn and some GERD-like symptoms. It makes me wonder whether there is something else going on? I got an impression from reading online that the autoimmune stomach problem is fairly asymptomatic for most people. Does anyone else have similar issues? I'm not even sure on what to do for relief, I'm afraid taking PPIs will make things worse since I may have low acid production due to parietal cell destruction.

24 Replies

Low stomach acid causes the same heartburn symptoms like high stomach acid.

Try drinking orange or tomato juice - if your stomach calms down you know the acid was low.

I suspect the acid issues are a result of the destruction of the parietal cells. These cell produce both intrinsic factor as well as hydrochloric acid.

I usually have a bit of tomato salsa with everything I eat. You need the acid to digest food.

jade_s in reply to pvanderaa

I would be careful with tomato. I have low stomach acid and use Betaine HCl, but things with concetrated tomato (soup, pasta sauce) do a number on my stomach.

Ahernj in reply to jade_s

Yes me too - cant do tomato with chronic gastric atrophy

Dorus in reply to pvanderaa

Thanks! I actually thought those symptoms were limited to high acid problems! I appreciate the suggestions.

It's the low or no stomach acid (Hypochlohydria or Achlorhydria) which cause the stomach problems This goes hand in hand with P.A. The NHS has no advice or treatment. No or low acid upsets the stomach flora , as bad bacteria flourishes . This can be helped by establishing a good colony of probiotic bacteria . I tackled this with a water based probiotic called Symprove , I used this daily for about 4 months , and the effect was marvellous . I gradually lowered the dosage , and now rely on home made raw organic sauerkraut ( can be purchased in health food shops and Amazon) I eat a small portion everyday . But it must be eaten RAW. , never cooked There are other probiotics which might be effective for you , but Symprove was extraordinarily effective for me . Your stomach problems are caused by low acid, so PPIs would be the worst thing you could take . I was told catagorically by a gastroenterologist that P. A. patients have low or no stomach acid , but no treatment is offered ! I would suggest also that avoiding wheat flour products is a good idea . I now eat sourdough rye bread , but occasionally indulge myself with white bread or a piece of cake to no ill effect . I do hope that the above was useful to you , and that you can overcome the stomach problems . Very best wishes to you

P. S. Some people find organic cider vinegar diluted a help . Or lime juice diluted , before meals . Maybe you will get some more tips . There are also capsules of betain Hydrochloric acid with pepsin that can be taken before a protein meal ( google that ) You could also seek advice from a nutritionist as the NHS have none .

Dorus in reply to wedgewood

Thanks for the tips! I don't have much variety on my diet. I guess I will have to make some changes. I will look into the probiotics, they seem promising.

pvanderaa in reply to wedgewood

Rye as well as sourdough both have gluten. My wife was trying to get me to do sourdough, what is your experience with these? I take it you do not have an issue with gluten.

wedgewood in reply to pvanderaa

Yes , rye does have gluten but a lot less than wheat . I chose organic sourdough rye because it is easier to digest. Wheat has been massively interfered with in modern times , and now contains more gluten than wheat breeds from the past .No , I don't have a problem with gluten , but I did start avoiding it when I had the tummy problems . Sourdough bread can also be made with wheat . All it is , is a small amount of wheat or rye is mixed with water , and it is kept at a warm temperature whilst naturally occurring yeasts in the air form colonies in the mixture . When it is mature enough it is incorporated into the chosen flour and it will make the loaf rise . The more gluten the greater the rise . I have never tried wheatsourh dough, but I often see it on sale .

Yes I have similar issues and in fact extreme discomfort in my stomach and bloating were my first symptoms of PA, a few years before diagnosis.

I've improved the situation by using Symprove, as recommended by wedgewood, which definitely helped. I've been taking bio kult tablets for a while now.

To add acidity, I use raw apple cider vinegar before breakfast and betaine HCL with pepsin with protein based meals (only protein is digested in the stomach by the acid that should be there).

I find I'm mostly ok with the above regime but the bloating etc can soon return if I drink more than the occasional glass of alcohol, if I over eat or just randomly sometimes.

Dorus in reply to JanD236

Thankfully I don't drink much alcohol. It never occurred to me it would be best to make dietary changes, the doctor didn't really elaborate much. Symprove does seem promising, I'm definitely going to look for it.

I have the same exact issues as you and have even made a couple of posts on the topic recently on this forum. My hematologist told me I have pernicious anemia/atrophic gastritis while my GI doctor recently diagnosed me with Barrett's esophagus and since getting this diagnosis I have been so confused about what to do for treatment. The symptoms are getting worse though. My GI dr has prescribed a number of PPIs because he says my Barrett's esophagus is caused by high stomach acid and will get worse but I've held off on taking them because of the whole atrophic gastritis/pernicious anemia/possible low stomach acid issue. I'm sorry I don't have any answers but I just wanted to let you know that you're not alone and if I ever find out any info I'll be sure to post about it.

Dorus in reply to yogamom1

I think I did read one of your posts! Thank you for the support. I'm sure we'll figure this out eventually.

Yup, if you have Autoimmune Metaplastic Gastric Atrophy then your immune system is killing Gastric Parietal Cells (GPCs). This causes two main problems -

1. GPCs produce Intrinsic Factor (IF) which is needed to carry B12 across the gut wall. So a lack of it causes PA.

2. GPCs also produce stomach acid. This does several things. It activates the enzyme that digests protein. It kills any bacteria that make it into the stomach from lower down the gut. It release B12 from the proteins it is bound to in food. It helps things like iron to dissolve - which is required for absorption. It switches off the production of gastrin.

So a lack of acid has several consequences - bacteria lower down the gut can migrate into the stomach. The ones that stay put get an unexpected bonus of lots of undigested protein - and they party on it. This all results in the unpleasant symptoms you're having.

When you eat food your body releases gastrin. One thing this does is to tell your GPCs to release acid. This lowers the stomach pH - which switches off the gastrin production. It's a negative feedback loop. But if no acid is produced the 'off' switch is broken and gastrin production continues - you get hypergastrinaemia.

This can cause problems in itself. The gastrin stimulates the stomach to produce more cells - and this extra growth can go wrong, causing Neuroendocrine Tumours (NETs, or Gastric Carcinoids) to grow. Nets tend to be fairly harmless (thankfully, as I have them). But it's a good idea to have them looked for by a gastroscopy.

With so many consequences of low stomach acid you'd think that the medical profession would have loads of ways to diagnose and fix it. You'd be wrong.

My treatment is to have 1/2 dose of Symprove once a month and one Bio-Kult every day. That helps maintain a good balance of gut bacteria. I also take around 30 ml of lime juice - diluted in water/orange/tonic with each large meal. I also have an annual gastroscopy to check on my NETs (due next week).

Dorus in reply to fbirder

I did get "neuroendocrine proliferation" from the biopsy. I'm somewhat hypergastrinemic as well (203pg/mL) so I'm probably getting the whole package. The doctor told me not to worry about tumors as we're doing surveillance endoscopy from now on.

I do have low ferritin and he didn't address it because I still have normal hemoglobin and serum iron.

Thanks for the suggestions, apparently Symprove is quite essential.

I have autoimmune Hashimoto's and had associated digestive problems for years, including gastritis, heartburn, IBS and H/pylori. This and the prescribed PPIs, etc. caused other problems and depleted b12.

It took a long time for the penny to drop and realise that autoimmune/leaky gut was at the root of it all.

Since g/f and taking daily spoonfuls of sauerkraut, I've been free of all the painful digestive problems I was plagued with for years and don't need to take medication at all 🤗

Sauerkraut is a very old European remedy with many healing properties as well as being one of the most effective probiotics you can take. I believe this is healing the villi in my digestive system, keeping H/pylori and digestive problems at bay, and allowing better absorption of all nutrients, but especially B12!

There is much research on the autoimmune/leaky gut connection and two of the best books I have read on this are by Dr Datis Kharrizian

Dorus in reply to Polaris

Thanks for the help! I'm not very used to sauerkraut, but it's worth trying. I think my mother will develop Hashimoto's at some point as she has high thyroid-related antibodies, and her physician has told her she will eventually develop hypothyroidism. She does have some stomach issues occasionally because of H. pylori, so maybe she could benefit from sauerkraut too.

Polaris in reply to Dorus

Your family, like mine, Dorus, appear prone to autoimmune disease - (four members with it now, possibly five) and once you have one, you are vulnerable to others, such as PA/B12def.

I've been gluten free for about a year - My antibodies and all symptoms have vastly improved on this protocol and taking sauerkraut (only buy from health food shop or, better still, make your own).

Dr Kharrizian, in his books, explains why a gluten free diet helps reduce antibodies and, if borderline, could prevent further damage and heal the vulnerable thyroid, which he regards as another symptom of autoimmune disease.

It seems to explain why so many on this site have Hashi's as well as B12 deficiency. As your mother is borderline, it might be worth her trying g/f to reduce antibodies now before her thyroid is damaged further ? This is what we are trying with my granddaughter, who is borderline Hashi's as well as anaemic.

Highly qualified, he lectures to post graduates all over the world and explains Hashimoto's very well.

Dorus in reply to Polaris

Yep, I may have inherited my autoimmune issue from her. I'm quite worried about her thyroid, as her doctor isn't really treating it at all, he's probably following the traditional criteria mentioned in the video. She did start a lower carb diet some months ago because of a liver issue, and I think it reduced gluten too, though not completely. Her results last week showed a very significant reduction in antibodies, however it's still way off the charts of normal range, but that's probably unavoidable. She also lost some pounds and is very happy with the results.

GERD is caused by low stomach acid. This is treated by doctors with Proton Pump Inhibitors that LOWER stomach acid. This is just plain bonkers. It gives short-term relief but makes matters worse long term. With low stomach acid (as someone has already pointed out) you cannot get the B12 out of the meat. If this goes on for any length of time you WILL become B12 deficient.

Consider the possibility that you may have a Helicobacter pylori infection in your stomach. (40% of people have it). This bacteria survives in the stomach by suppressing the parietal cells that produce acid (and Intrinsic Factor). You might want to consider Gum Mastic (marketed as Mastika). You can get this from a health-food shop. It is non-toxic to humans but kills H. pylori. Getting rid of this nasty little bug will take a couple of months but is well worth the effort.

Gambit62Administrator in reply to Johnathan

GERD can have a number of causes.

It is treated with PPIs because the general assumption is that it will have been caused by high stomach acidity.

However, it can also be a symptom of low stomach acidity but awareness of this is low.

fbirder in reply to Gambit62

It is treated with PPIs because the general assumption is that it will have been caused by high stomach acidity.

And, most of the time, that assumption is correct.

wedgewood in reply to fbirder

But it is well nigh impossible to get a test for stomach acidity .( there is one ) I tried very hard, only to be told that it is only carried out in research situations . So they are usually guessing about stomach acidity . High stomach acidity is quite rare .

Dorus in reply to Johnathan

I did test for H. pylori in the biopsy and blood serum, but they came negative. The doctor seemed to be really convinced my issue was H. pylori at first, so he did what he could to be certain it wasn't.

I really thought the symptoms were due to higher acid, so I took PPIs for some two months before I was diagnosed. I guess that probably was a bad idea. It's good to know what's causing the symptoms though, I will follow the tips you all shared with me and hopefully it'll get better. :)

Start a logbook of your symptoms. Also record your food and drink. The symptoms show up between 3 and 48 hours after you eat something,

It is hard to sort everything out at first. As you suspect a particular food, remove it from your diet for 2 weeks to allow your liver and bile to completely detoxify.

Then reintroduce and monitor your symptoms. You may get different symptoms at different times.

Another trick I used was to eat the same food for two meals (breakfast and lunch) a day for a week at a time. This was for me a rice casserole with ingredients that I trusted. This allowed me to experiment with food at the other meal (supper), I was pretty lucky as my symptoms typically came 24 hours later,

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