I was diagnosed with PA approx 9yrs ago with some atrophic gastritis and metaplasia (I think) I also have arthritis in my knees/hips
I SI every 7 to 10 days
Im 56 and I’m fairly fit and active so I know I’m lucky compared to some
what I’m confused about is stomach acid. Do I have low /no stomach acid if I have autoimmune PA (I assume it’s autoimmune given I was told to have injections and have large red blood cells ) I can’t remember what was said about IF but I’m sure I was told a definite diagnosis of PA.
If I have low stomach acid then what are the best painkillers ? When I look up gastritis it’s all about too much stomach acid from what I can tell. So why is it thought that atrophic gastritis (which is what I assume caused the PA) gives low stomach acid ?
Apologies if this is obvious but even after research and reading stuff on this forum I still find it confusing.
Thanks everyone
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lifegems
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Well lifegems , being diagnosed with Pernicious Anaemia which is an autoimmune condition, means that your body attacks itself with anti bodies . In the case of P.A. the antibodies are called Intrinsic Factor antibodies . These I.F. antibodies destroy the Parietal cells , in the lining of your stomach ( precisely, in the Fundus region ) These cells produce The Intrinsic Factor and also stomach acid , both of which are required to digest and absorb vitamin B12 .. Stomach acid also keeps harmful bacteria in the stomach in check .If not kept in check by enough stomach acid , bad bacteria can take over , and cause pain and bloating .Too little ( Hypochlorhydria) stomach acid and no ( Achlorhydria) stomach acid can also lead to mal-absorption of other vitamins and minerals .
I had this problem when first diagnosed with P.A. My GP wanted me to take an anti-acid preparation ( worst thing possible ) I got over the problem by taking a pro-biotic preparation. called Symprove , and getting sufficient B12 injections ( obtain byS.I. ) The pro-biotic gives the stomach the good bacteria , and they thrive and outnumber the bad . Recovered from that , and it has never returned
B12 deficiency can be caused by overuse of proto-pump inhibitors (Omeprazole being one of many of those preparations . There are other overused medical preparations that can lead to B12 deficiency ..
Thanks so much. I tried symprove few years back but I can’t get it where I live in Portugal . It did help. I drink kefir and betain and fibre but does not help as much as symprove and I get terrible bloating .
Any ideas on what painkillers are best to take when needed ?
I really can’t answer that question . I doubt if a painkiller would help much anyhow . You could try a probiotic capsule instead of Symprove . You should be able to find one that suits . Also PROPER porridge for breakfast can help a lot( it really helps me) I don’t love porridge, but it’s a useful tool in dealing with gut problems. Cheap and effective ( But NOT those flavoured packaged processed quick -cook ones ! REAL PORRIDGE OATS are called for . I’d needed mixed with sone flax seeds either whole or ground .
I’m not a fan of porridge but I’ll give it a go ! The painkillers are actually for toothache but I’m conscious that painkillers can cause gut issues so I was wondering if there’s one that is not as bad as the NSAID type. Thanks for the tips !
I’m afraid that it’s expensive . I only had to take it for 3 months though .Then you need to look after the good bacteria that has. been established . I now eat proper porridge for breakfast every day I do not love it , but I love the good it does my gut . Try to keep down the use of sugar . Best wishes .
I took Symprove for 3 months only,which combined with self -injecting B12 , ( Doctor would only allow me 1 injection every 3 months )did the trick for me . Of course everyone is different. I also now have porridge ( REAL OATS , not processed ) every morning with ground flax seeds . I don’t know if that would suit you , but I find it is so good for my gut . Try to avoid sugar as much as possible! Best wishes .
Hi lifegems, I'm also confused as my GP has told me I haven't been diagnosed with low stomach acid. I pointed out to him that I have been diagnosed with PA and I also have Atrophic Gastritis with extensive Metaplasia. I have also read that the Metaplasia is caused by glandular atrophy which has involved the Parietal cells that produce the digestive acid it would surely follow that stomach acid is compromised.
I have been using Symprove which wedgewood told you about. I am currently taking it in a lower than stated dose to ease into it gently. Some weeks ago wedgewood also suggested porridge which has been a life saver to me , so thank you wedgwood it's been a great help. I have days when I feel really positive about this condition and feel I have some control then follow periods of feeling panicky about it after reading about cancer, malabsorption, sibo and cofactors it all becomes a bit overwhelming compounded by unhelpful practitioners. I have recently started taking Betaine hcl and that seems to help with my evening meal. Sorry lifegems this doesn't really answer your question , wishing you all the best.
Hi heliborous . Thanks it’s so confusing I know !! The painkillers were fir my tooth ache but I’ve just gone with the NSAID s but will keep it minimal.
Don’t worry about the cancer risk. I’ve read it’s less likely for us Than gen pop as we have more endoscopy/colonoscopy than most so that’s a blessing
Hi lifegemsLow/no gastric acid is common for those with autoimmune PA. PA being, in your case it seems, is a late stage manifestation of autoimmune metaplastic atrophic gastritis (AMAG).
There are three types of antibodies with this condition. Parietal Cells Antibodies (PCAB), then two subtypes of Intrinsic Factor Antibodies IFAB) one attacking the IF binding site and the other attacking the IF protein itself. As the Parietal cells are destroyed there is less and less stomach acid produced until eventually there is none. This no gastric acid state is called achlorhydria. The best way to "definitively" test for this is during an upper GI endoscopy or gastroscopy depending on which country you are in, they can suck some gastric juice and simply test the pH level. A higher pH means lower acidity. Normally a fasting stomach will be highly acidic around a pH of 1.5 to 2 or 3. I had this done and my pH measured at 6 or basically no gastric acid (achlorhydria).
The pain you are experiencing may be caused by the acid, an ulcer caused by low/no acid and the thinning of the mucosa. Very low or no stomach acid will cause a whole host of digestive issues. Proper acid controls the whole digestive process from opening and closing the Esophageal and Pyloric Sphincters to the contraction of the gallbladder releasing bile, to maintaining a proper "good bacteria" microbiome in your digestive tract. Any of these can cause bloating, diarrhea, constipation, pain. If you have not had an endoscopy in a while then maybe request one.
A remedy I use for my no stomach acid prescribed by my doctor (although available OTC) is to take, before each meal, a 1.3g capsule of Betaine HCI and another couple of capsules of digestive enzymes. Before I started these and figured I had no acid, I was incorrectly prescribed a PPI!! I also could not keep food down, I would just vomit about 30 minutes after I ate and I noticed how dry it was and painful to vomit as there was no gastric juice. I ended up losing 90 pounds. I also ended up with SIBO. All is corrected now.
The "Metaplastic" in the name AMAG refers to the gastric intestinal metaplasia (GIM) cells that your body is replacing the destroyed Parietal cells with. These I call imposter cells as they don't belong in the stomach but rather resemble cells from the small intestine or in some cases from the colon.
Please know that doctors just don't know about our form of autoimmune gastritis as it's not that common. 98% of atrophic gastritis is a result of H-pylori bacteria infection which is in the Antrum or very lowest part of the stomach. This type of Gastritis can be cured through eradication of the bacteria "antibiotics" and then a lengthy healing process. Our AMAG, however, starts in the Gastric Fundus which is the bulbous part at the very top of the stomach where most of the Parietal cells are located and also the upper 1/3rd of the gastric body. So make sure you communicate/educate, if you can, your doctor on this aspect of your condition.
OK, I ramble again and now I'm not sure if I even stayed on topic! 😳
If you like clarification on anything please let me know.
Thanks Rexz for the comprehensive reply. I’m not sure I fully understand but it certainly helps. My problem is compounded with living in Portugal and having language barriers. But I shall try !
Hi Rexz...this is so interesting and so relevant. My situation is that I've had Hashimotos thyroid disease (autoimmune) since 2007 but an endoscopy about 5 years ago alerted me to the presence of gastritis. My doc didn't react and as I was pretty unsymptomatic so I added B12 to the B complex, Selenium, Magnesium and zinc I was supplementing for the thyroid issues. Apart from a weird and un-predictable 'event' that would knock me out for a day where I would have intense migraine + vomiting bile + diarrhea I didn't feel that the gastritis could be that bad. These events were difficult to predict but sometimes linked to even tiny amounts of alcohol, or they followed a day where I had not eaten enough or skipped meals but it wasn't causal. I have just had a follow up endoscopy and now I am being told they have taken a biopsy to rule out Barrett's eosophagus! Plus further confirmation of gastritis. Since the endoscopy last week I have become super aware of acid reflux, regurgitation and even undigested food in my stools (sorry!!). The reflux and regurgitation are settling down and may of course be exacerbated after the endoscopy. You seem very knowledgable and your account of low acid is very illuminating. My worry is that my GP will just prescribe PPI's and I don't know how to approach the conversation. How can I suggest I have low stomach acid ? Is there a test other than the one you describe as part of the endoscopy? I've recently started taking a tablespoon of apple cider vinegar first thing in the morning and I'm sure this would create a bad reaction if I had high acidity. As it is I find it quite a good start to the day. Is there a way of testing for the antibodies you mention [Parietal Cells Antibodies (PCAB), Intrinsic Factor Antibodies (IFAB)]? And would they help me argue that I am more likely to have low stomach acid? I'd be very interested in knowing how you think AMAG condition can be reversed as I understand that the cell lining is actually changing. Sorry for all the questions but you mention 1.3g capsule of Betaine HCI and digestive enzymes. Can you tell me what the Betaine HCL is and what digestive enzymes do you take? I'd be so interested to hear your experience if you have time to tell. All the very best
Of course, I'll send you details on tests and references you can take to your doctor. It will be later today (I'm in California) as I'm getting ready to see GI doc this morning. If you don't mind me asking your age and what country you're in? You can DM me if you like.
I'm sorry got my delayed response. I looked at your profile and your post here and I know you've been diagnosed with Hashimoto's Thyroiditis. Hashimoto's is an autoimmune disease with a fairly high association (40%) with Autoimmune Gastritis (AIG) aka autoimmune pernicious anemia (PA). If you have not been diagnosed with PA then you should be tested. I recommend that you schedule the following tests. Anyone with Hash should be tested for PA/AIG.
1. B12 serum test
2. Homocysteine Serum Test
3. Methylmalonic Acid (MMA) Serum Test
3. Gastrin Serum Test
If B12 is below normal or marginal and Homocysteine and MMA are high then that indicates B12 deficiency. High levels of serum Gastrin can indicate low or no stomach acid.
If the above results appear positive for B12 deficiency the run the following
4. Parietal Cell Antibody Test (PCaB)
5. Intrinsic Factor Antibody Test (IFaB)
A Positive PCaB along with higher than normal serum gastrin is diagnostic of PA.
A positive IFaB is diagnostic by itself of PA.
Regarding acid reflux...I don't know your age so I will just say if you are over 60 and your acid reflux is new to you then if we think logically it does not make sense that your body is producing more gastric acid. Simply as we age we have less and less gastric acid. Please know that I am not a doctor... but in my opinion PPIs are very much overprescribed. The Serum gastrin blood test is a great indicator of low/no gastric acid. the lower the acid the higher the gastrin. My Gastric pH, as tested was 6 which is achlorhydria or no acid. I too was prescribed a PPI and I only took one before I demanded to be tested.
For me with achlorhydria I lost 90 pounds before we figured things out. I now take the following before meals.
1. Betaine HCI - 1.3g; from Integrative Therapeutics. They have a dose of 0.3g which you may want to start at to see if it helps.
2. PANPLEX 2-PHASE - two capsules. these are digestive enzymes that include and additional 320 mg of Betaine HCI plus pancreatic enzymes and Ox-Bile. Thank God for Ox's!
You might even want to start with just two capsules of PANPLEX 2-PHASE as that has 640mg of Betaine HCI and see what impact that has on you. Nothing in these supplements will hurt you. Just depending on your current gastric acid levels you will know if you take too much.
The issue with too little gastric acid is it also impacts the amount of pancreatic enzymes and bile released from your gallbladder. So with low/no acid these will be reduced or as in my case with achlorhydria they were not functioning.
So it's hard to say what is going with you on exactly. But if you have your doc run these tests it will at lest rule AIG/PA out. Also low acid wreaks havoc on your gut microbiome and you may have Small Intestinal Bacteria Overgrowth (SIBO). I had that also due to my achlorhydria. All of this can cause for acid reflux, constipation, diarrhea, bloating etc.
I know this all can be confusing and I may have missed some points so please let me know if you need clarification or references to provide your doctor with.
hello lifegems, I also have athropic gastritis with intestinal metaphases. also B12 deficient about 8 years, lots of permanent nerve damage. Injections every 10 days. Also had h pylori which was eradicated with antibiotics about 5 years now. Also gluten for me is poison, was unable to prove celiac as was unable to stay off gluten long enough to be tested during endoscopy as after 14 days joins in hands and knees so swollen couldn’t walk or use hands.
My diet to keep pain at bay and nourish my body , totally gluten free diet. I start the day first food small cup of natural kefir. I take gluten free porridge along with blueberrys , banana and papaya, almond milk and natural Greek yogurt . I make sauerkraut and eat a couple of spoonfuls daily. I use high grade manuka honey when I feel the need. I cannot tolerate high glycemic or starchy foods as these cause bad pain. I eat chicken, fish and I have a small amount of beef once or twice a month. I also eat lots of green vegetables. My last food of the day is a square of 85% chocolate and a further cup of kefir. Also just started drinking bone broth daily. Also I take lots of vitamins. The pain from gastritis is excruciating and I manage to keep it at bay with diet. I hope you find ways of managing the pain and that some of these food suggestions may help. Take care. Kind regards. Potter5
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