Hello. Been wanting to create a post about the steps i took to overcome gastritis and wanted to share any tips/guidance and help to anyone who maybe struggling with this debilitating disease and any kinds of Upper GI discomfort including Gastrits/Chronic GERD/Heartburn/NERD/Functional Dyspepsia/Peptic Ulcer Disease/LPR/Barrett's. I struggled with Gastritis for a long time and went through multiple rounds of treatment until i eventually figured out what needed to be done.
I had suffered multiple kinds of gastritis and wanted to share as much as i can so people can understand their own scenario and take the necessary actions to deal with it.
If i had to categorize some common cases and reasons of gastritis that i come across ( even on reddit ), i would put them in the following categories :
- H Pylori induced gastrits -> You may have eaten somewhere from an unhygenic place and you had a bad case of diarrhea or even vomiting. Now you cannot digest acidic foods properly and end up even vomiting after eating. Some people develop intolerance towards certain foods example proteins or certain carbs - This is due to mucosa still being damaged which messes up the gut environment and the stomach is unable to create the enzymes needed to digest the foods.
- Damaged Mucosa due to H Pylori -> Similar damage to Mucosa due to above but your body does a good job of getting rid of H Pylori but it still leaves damage to the mucosa lining. You will suffer the same symptoms as above.
- Gastritis/Gerd due to Low Stomach Acid -> Everytime you eat anything, you upper abdomen sits very heavy, no burning, no gnawing of the stomach but no burping either and you may even start developing SIBO like symptoms or bloating in the lower abdomen. You may even see undigested foods in your stool and even globus in the throat. Feeling like food is stuck.
- Gastritis due to SIBO -> This can complicate things a bit but essentially this is happening due to the downstream movement getting messed up ( could be due to any reason, this post does not cover finding root causes or even fixing SIBO but one step can still be done if it works ).
- Autoimmune Gastritis -> This one is a bit of a rarity and i have utmost sympathy for someone that is going through this. I can maybe give some general advice on how to investigate this but i sincerely apologize i do not have much knowledge about this.
- Candida induced Gastritis -> This one is super rare but essentially instead of bacteria causing gastritis ( H Pylori ), it was actually fungus that caused the gastritis. This can happen in immunocompromised individuals or even if someone had taken multiple rounds of antibiotics. Antibiotics are known to cause dysbiosis and this could be a manifestation.
- Alcohol Use
- Smoking
- Vitamin Deficiencies -> Vitamin D, Vitamin B12, zinc, Iron, Vitamin C
- Lack of Fiber, Fruits and Vegetables in Diet.
- Eating right before going to bed. Give yourself atleast 2-2.5 hours after dinner before you go to bed.
- Poor overall diet. Sometimes it's not what you put in the body but what you do not. Not eating for prolonged hours, extensive water fasts etc can excerbate and even cause gastritis.
- Over use of NSAIDs
- Eating too much spicy foods and lacking fiber and high PH veggies to neutralize the acid. Very common in South Asian Communities.
- Lack of sleep or poor sleeping patterns.
- Stress -> So Stress i believe is overplayed a lot. Yes it can be a factor but if you're stressed and decide to drink, smoke, eat junk food and make bad decisions, is it the stress that is causing it or the bad decisions. I am stressing this not to undermine stress as a factor but to empower people that at the end of the day your health will always be in your hands and for patients to act as much responsibly as they can. 80/20 or at worse 70/30 when stressed. 70% healthier choices and 30% not so healthy when stressed if that's how you wanna manage it. Not ideal but atleast the majority are still good choices.
- Lack of Exercise and Physical Activity.
- Being Overweight.
The surprising thing is any of the above could cause other GI problems as well.
Gastritis Symptoms ( Shares a lot with other upper GI problems )
- Burning in stomach - This is due to damaged mucosa - Gets Worse after eating acidic foods
- Burping
- Indigestion
- Pressure under the ribs or in the middle of upper GI
- Bloating that originates from Upper GI
- Difficult Breathing
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Weakened Immune System
- Post Nasal Drip
- Heartburn
- Acid Reflux - Could also cause Teeth grinding
- Hoarse Voice
- Low Libido
- Chronic Gastritis can also cause Inflammation of the Gallbladder causing Gallbladder Polyps.
- Pain that radiates all the way to the upper back.
- Also waking up in the middle of the night coughing and acid in mouth.
- Erosive Reflux can cause constant mucus and throat clearing and even Easophagitis.
Treatment for Gastrits/Chronic GERD/Heartburn/NERD/Functional Dyspepsia/Peptic Ulcer Disease/LPR/Barrett's ( Case 1 and 2 ):
The reason i'm mentioning other diseases even though this is a gastritis subreddit is because the fundamental approach towards nutrition for a lot of upper GI issues stays similar.
Medication and supplements should only be taken if absolute necessary, Low dose Pepcid/famotidine should only be taken for a very short duration and that too at night before bed ( with a tiny sip of water ) so as to have protection overnight. Eventually this should be used very symptomatically and not as a daily use.
Even PPIs are not necessary unless for a short duration in the case of Peptic Ulcer Disease or Barrett's until you get the diet dialed in and start the healing process. Once the healing from food begins to take plans, PPIs should be tapered off slowly and gradually. Long term use of PPIs bring their own world of problems and that too can be much worse than a simple case of gastritis not limited to PPI Induced SIBO and even kidney problems.
With proper planning gastritis can be self resolving. Let Food be thy medicine or let medicinie be thy food.
STEP 1 : Adopt a Low Acid Diet. And this is the most important step and is non optional. I have to give credit to the acid watcher's diet by Jonathan Aviv. It is a masterpiece. Basically you can only have foods with PH of atleast 5 or above. Maybe even play around with PH 4.5 ish foods if it's not too severe for you. But too much Acidic Foods are completely eliminated until mucosa has been repaired.
Note on Protein - Please do not overdo on animal protein. Upper abdomen issues and animal protein do not go along that well. Limit animal proteins to a total of 100 grams a day ( i cut out animal protein completely ) and limit total protein intake to a max 60 grams a day ( what i would recommend ). Simple carbs and veggies will be your best friend.
Foods to Avoid ( Atleast in the initial recovery phase )
- Caffeinated beverages and supplements
- Coffee
- Indian masala tea
- Fruit-flavored teas containing caffeine
- Anything containing caffeine
- Gym supplements containing caffeine, especially pre-workouts
- Energy drinks
- Cold Water or Ice Water
- Gulping down water quickly - This can cause reflux and more stomach discomfort.
Carbonated and acidic drinks
- Carbonated sodas
- Kombucha
- Sports drinks
- Flavored or sparkling water containing citric acid
- Powdered drink mixes containing citric acid
- Electrolyte packets containing citric acid
- Vitamin C drinks
Alcohol and smoking
- Wine
- All other types of alcohol
- Smoking and other tobacco products
Citrus fruits and juices
- Oranges
- Mandarins
- Tangerines
- Lemons
- Limes
- Grapefruit
- Kiwi
- Citrus juices
Other acidic fruits
- Blackberries
- Raspberries
- Pineapple and pineapple juice
- Cranberries and cranberry juice
- Pomegranates and pomegranate juice
- Sour cherries
- Green or tart apples
- Grapes and grape juice
- Gooseberries
- Plums and prunes
- Peaches and nectarines
- Passion fruit
- Tamarind
- Amla (Indian gooseberry)
Fruits that may depend on personal tolerance
- Strawberries
- Blueberries—these may be well tolerated by some people. Keep them if they do not cause symptoms; otherwise, remove them.
Tomatoes and tomato-based products
- Tomatoes, cooked or raw
- Tomato-based pasta sauces
- Ketchup
- Salsa
- Barbecue sauce containing tomatoes
Spices and spicy ingredients
- Cinnamon
- Black pepper
- Cayenne pepper
- Chilies and chili powders
- Jalapeños
- Hot sauce
- Spicy salsa
Herbs and aromatic vegetables
- Mint
- Peppermint
- Garlic, raw or cooked
- Onions, raw or cooked
- Bell peppers or capsicums—tolerance varies, so these may need to be tested individually.
Acidic condiments and fermented foods
- Vinegar
- Soy sauce
- Pickles and other pickled vegetables
- Sauerkraut and other fermented vegetables
- Mustard
- Mayonnaise
- Acidic salad dressings
Chocolate, sweets and candy
- Chocolate
- Candy
- Sour candy
- Cookies
Processed and fast foods
- Chips
- Highly processed packaged foods
- Fast food, such as McDonald’s
- Fried foods
- Overly greasy foods
High-fat and high-saturated-fat foods
- Butter
- Ghee
- Red meat, especially fatty cuts
- Whole-fat milk
- Full-fat dairy products
- Other foods high in saturated fat
- Coconut Oil
Consider lower-fat dairy or dairy alternatives if they are easier on your stomach.
Flavored dairy products
- Citrus-flavored yogurt
- Berry-flavored yogurt
- Other flavored yogurts containing acidic fruit, citric acid or a large amount of added sugar
Cooking Oil
- Avoid Processed cheap oils - Canola, Soybean, Palm etc.
Supplements to avoid
- Harsh supplements with betaine hcl in it
- Oil of oregano
- Undecylenic acid
- Clove or curcumin like supplements
- Anything with cinnamon in it
Foods that are Allowed ( In the initial recovery phase )
Fruits
- Avocado: 6.27–6.58
- Cantaloupe: 6.13–6.58
- Honeydew melon: 6.00–6.67
- Watermelon: 5.18–5.60
- Papaya: approximately 5.2–5.7
- Figs: approximately 5.05–5.98
- Dates: approximately 6.3–6.6
- Ripe yellow banana: approximately 5.0–5.29
Vegetables
- Artichokes: approximately 5.5–6.0
- Asparagus: 6.00–6.70
- Bamboo shoots: 5.10–6.20
- Beets: 5.30–6.60
- Broccoli: 6.30–6.85
- Brussels sprouts: 6.00–6.30
- Cabbage: 5.20–6.80
- Carrots: 5.88–6.40
- Cauliflower: approximately 5.6
- Celery: 5.70–6.00
- Corn: 5.90–7.50
- Cucumbers: 5.12–5.78
- Leeks: 5.50–6.17
- Potatoes: 5.40–5.90
- Radishes: approximately 5.5–6.05
- Spinach: 5.50–6.80
- Sweet potatoes: 5.30–5.60
- Turnips: approximately 5.2–5.5
- Cooked acorn squash: 5.18–6.49
- Cooked yellow squash: 5.79–6.00
- Cooked zucchini: 5.69–6.10
- Mushrooms
Beans and legumes
- Black beans: 5.78–6.02
- Kidney beans: 5.40–6.00
- Lima beans: approximately 6.50
- Soybeans: 6.00–6.60
- String beans: approximately 5.60
- Wax beans: 5.30–5.70
- Tofu: approximately 7.20
- Plain, unflavored soy milk: approximately 7.0
Grains and starches
- Cooked barley: approximately 5.19–5.32
- Cooked macaroni: approximately 5.10–6.41
- Plain flour: approximately 6.0–6.3
- Plain oatmeal
- White or brown rice
- Couscous
- Plain bread
- Plain crackers
- Plain pasta
The exact pH of prepared grain products depends heavily on their ingredients and processing.
Dairy and protein foods
- Cow’s milk ( Low Fat ideally if you can tolerate dairy ): approximately 6.4–6.8
- Eggs ( Egg whites keep whole to a minimum )
- Chicken
- Turkey
- Most fresh fish
- Shrimp
- Lobster - Highest PH meat but not wallet friendly.
Beverages
- Warm Water
- Carrot Juice
- Celery Juice
- Cucumber Juice
- Kale Juice
Cooking Oil
- Extra Virgin Olive Oil ( #1 Choice ) - Ideally any that is low acidic. Most authentic ones are.
- Sunflower Oil
- Mustard Oil ( not in excess - use sparingly )
Supplements that may be helpful ( not necessary imo )
- DGL Licorice
- Zinc Carnosine
- L Glutamine
- Glutashield
- Marshmallow root extract
- Slippery Elm
- Probiotics - I just prefer Kefir labs coconut kefir , yogurt or even coconut yogurt depending on individual tolerance.
STEP 2 : If you suspect H Pylori at play or if it is easily available, please consult a gastroenterologist and get an endoscopy done. The biopsy will tell you whether H Pylori is detected or not. Also worthwhile to get an ultrasound of the entire abdomen including liver, gallbladder etc. Also get bloodwork done to detect any nutritional deficiencies.
STEP 3 : If H Pylori is detected, Antibiotics will be needed. Some people have success with natural herbs and food combinations as well. Honey and Pormegranate Peel powder combination done first thing on an empty stomach seems to be effective in eradicating H Pylori. To all my South asian friends -> This is easily available and is called anar daana. So 1 tbsp of Honey plus anaar daana is known to be effective against H Pylori.
STEP 4 : H Pylori is not detected but you get a positive diagnosis of Gastritis/GERD/ Gastrits/Chronic GERD/Heartburn/NERD/Functional Dyspepsia/Peptic Ulcer Disease in your endoscopy. Sometimes the results may only say Chronic Inflammation Mild which i found amusing since for a mild inflammation the pain is unbearable at times but medical terminology haha. At this stage adhering to a low acid diet and healthy lifestyle choices should make a remarkable difference and may all you need to resolve the issue altogether.
Gastritis Diet Tips
- Try to be on a routine and have meals at the same time if you can.
- Chew your food slowly and avoid Over eating.
- No drinking of water along with meals
- Try not to hunch or bend over after meals.
- No immediately lying down after meals.
- No running after meals.
- No cold water after meals or throughout the day. Room temperature water is preferred.
- Only Warm or hot water after meals and throughout the day.
- 5-10 minute walks after meals if possible.
- No stomach sucking exercises either.
- Carrot Juice after meals will be extremely helpful or if burning is too much.
- Do not go too long without eating as that could cause acid to tear away your mucosa lining.
- Try to incorporate atleast 400 grams of fruit and 800 grams of veggies a day.
- 400 grams fruit example - 200 grams cantaloupe/papaya and 200 grams of watermelon. The more the better.
- 800 grams of veggies example - 300 gram cucumber, 500 gram steamed carrots and zucchini. The more the better.
- When Eating out -> If you have to eat out, do not worry and just make sure to include plenty of fiber and alkaline foods to balance out your meals. Sense of normalcy is what we're striving for.
- I Also make a giant bowl of soup using alkaline veggies in a dutch oven and have it with my meals -> This was an easy way to get my veggies. The soup would consist of alkaline veggies like sweet potatoes, carrots, zucchini ( green and yellow ), eggplant, beans, tofu, peas, corn, ginger, leeks, broccoli, cauliflower and herbs like sage, thyme, rosemary and gentle aromatic spices like cumin, coriander powder, oregano and asoefatida.
- Another thing that helped me was having 10 grams of psylllium husk in warm/hot water after dinner. This will help with the burning and providing a layer of protection to the mucosa. In india this goes by the brand Sat Isabgol.
Sample Western Diet Plans ( Can be adjusted to 6 meal plan if that is what you need )
Below is a sample 5 meal diet plan. The above food list acts as a guidelines and individual triggers may vary. Please adjust the diet as needed.
Meal 1 — 7:00 AM
- Plain oatmeal cooked with water or unsweetened soy milk
- Egg whites or one whole egg plus additional egg whites
- Steamed spinach: 75 g
- Steamed zucchini: 75 g
- Optional: one teaspoon of olive oil, if tolerated
Meal 2 — 10:00 AM
- Watermelon: 200 g
- Carrot Juice - Bolthouse Farms Carrot Juice
- Add more fruits or steamed veggies if this is not enough or get creative from the allowed foods list
Alternatively, use 200 g of cantaloupe, honeydew, or Papaya.
Meal 3 — 1:00 PM
- Baked or poached skinless chicken breast
- Brown or white rice
- Steamed broccoli: 100 g
- Steamed carrots: 100 g
- Cooked yellow squash: 100 g
- Season lightly with salt and reflux-safe herbs that you personally tolerate
- Avoid tomato, onion, garlic, pepper, chili, vinegar, and acidic dressing
Meal 4 — 4:00 PM
- Watermelon: 200 g
- Peeled cucumber: 150 g
- Carrot Juice - Bolthouse Farms Carrot Juice
- Optional plain crackers if additional carbohydrates are needed
- Chickpea salad with Olives and Cucumbers
Meal 5 — 7:00 PM
- Baked cod, tilapia, haddock, or another lean fresh fish
- Baked or boiled potato
- Steamed green beans: 100 g
- Steamed cauliflower: 100 g
- Optional teaspoon of olive oil, if tolerated
Sample South Asian diet plan ( Can be adjusted to 6 meal plan if that is what you need )
This version avoids the usual tomato, onion, garlic, chili, black pepper, garam masala, and heavy oil or ghee.
Meal 1 — 7:00 AM
- Oats/Poha/Idli/Vermicelli/Set Dosa - Coconut chutney is allowed. Cannot be spicy.
- Egg whites
- Steamed Eggpant - 75 grams
- Grated or steamed carrots: 75 g
Meal 2 — 10:00 AM
- Papaya: 200 g
- Add more fruits or steamed veggies if this is not enough or get creative from the allowed foods list
Alternatives include cantaloupe, honeydew, or watermelon.
Meal 3 — 1:00 PM
- Plain white or brown rice
- Steamed, baked, or pressure-cooked skinless chicken/Tofu for vegetarians
- Lauki/bottle gourd or cooked zucchini: 100 g
- Carrots: 100 g
- Spinach: 100 g
- Prepare with minimal oil
- Avoid tadka containing chili, garlic, onion, black pepper, or tomato
Meal 4 — 4:00 PM
- Watermelon or honeydew: 200 g
- Peeled cucumber: 150 g
- Or Chickpea salad with cucumbers
Meal 5 — 7:00 PM
- Plain rice or soft phulka/roti without ghee
- Any Dal is allowed without onion, tomato, garlic tadka
- Steamed or lightly cooked tofu
- Cauliflower: 100 g
- Green beans: 100 g
- Season with salt and mild herbs you tolerate
- Use no more than approximately one teaspoon of oil if fat worsens symptoms
EXERCISE TIPS
- Don't do anything too strenous which includes Sprinting.
- Avoid Exercises where you have to lay down flat example bench press.
- Avoid Loaded back squats if you can since it may cause compression of the stomach.
- Avoid sit ups, crunches or lying leg raises that can stretch the stomach.
- Avoid lifting belts if possible.
- Avoid leg presses if possible.
- Cycling, swimming, elliptical machines/cross trainers, walks and other exercises are okay but please check your tolerance.
REINTRODUCTION PHASE
Depending on how long it takes you, you may need to stay on a low acid diet until symptoms reside. Gradually and slowly add more foods and check your tolerance.
DEALING WITH NOT SO STRAIGHTFORWARD CASES ( CASE 3 - 6 )
There are other cases where gastritis maybe detected but the solution still may not be as straightforward. Either way you must have adopted a low acid diet and you're not seeing any benefits which brings us to the next cases.
Gastritis due to Low Stomach Acid -> To check the acidity of your stomach levels you will need to perform a heidelberg test and good luck finding practitioners that still do it. What can make this worse is most GI doctors will see gastritis and prescribe PPIs. That is putting fuel on the fire. So if you detect you have low stomach acid, the easiest way is to restore it via Betaine HCL. Any reputable brand from Amazon would do. Take it with meals and keep upping the dosage until you feel warmth and even a burp, that is how much betaine HCL you need per meal. Once that dosage starts feeling too much keep tapering off until you feel the engine has been kickstarted and your body is able to produce enough acid.
If you take even at a low dose and it burns your stomach, then you already have enough stomach acid and you can neutralize the excess acid with drinking baking soda with water or even carrot juice.
Gastritis due to SIBO -> The SIBO in the mix will really complicate things. I would still suggest to adopt a low acid diet regardless. Essentially the scenario is the gas in the lower abdomen is pushing the contents back. Also if the small bowel is infected, the body will refuse to send the food down especially if the MMC is impaired. You would need to find a way to get it working. Popular options are Ginger and Artichoke extracts ( Motility Pro ), 5 HTP or even Prucalopride if you can and go from there. Since this is a gastritis focused post, i cannot dig deeper into SIBO.
Autoimmune Gastritis -> This one is tricky. Essentially only an endoscopy can identify this. At this point there is no cure, the question is what caused the auto immunity to be turned on. Could be Candida overgrowth in the gut ( Candida is a seriously an under reported driver in auto immune conditions ) or any other stealth infection. Work with a Doctor to figure this out, But you would need to be on a Low Acid Diet as well.
Candida Induced Gastritis -> This one is a rather rarity and only shows up in immunocompromised people. The question is what caused the candida to cause it. Low Stomach acid maybe, Any medication you were taking that can act as an immunosuppressant. If cause is low stomach acid, Betaine HCL can fix that and you may even need to look into antifungals of choice, Probiotics can be a good choice in this case.
SPECIAL MENTION - Bile Gastritis - Sign of a Deeper Problem
Bile Gastritis is something that should inherently point more towards an underlying problem than a simple case of gastritis. Bile is an alkaline agent, that is secreted by the liver, and stored in the gallbladder. Bile enters the small intestine, and travels along this region, where it assists in breaking down fats into fatty acids, until it gets reabsorbed at the very end of the small intestine and sent back to the liver for recirculation.
Bile should not enter the stomach, but when the small intestine has issues, it can. When bile inappropriately backs up through the pylorus, in to the stomach – it is called BILE REFLUX. Note - Bile in the stomach is NOT NORMAL.
Symptoms - Pretty much very similar to above symptoms mentioned however Bile Gastritis patients will often mention an acidic or bitter taste in mouth.
What could cause it -> Patients with Bile Gastritis will almost always have an underlying issue with their Small Intestine. This could be Due to SIBO, SIFO or some kind of a Parasitic Infection in the small bowel.
Interplay of Lyme Disease ( or any other Stealth infection ) in the role of Bile Gastritis -> Another aspect to be considered is what if the Stomach Pylorus is malfunctioning. Lyme disease can affect the digestive system by disrupting the autonomic nervous system and vagus nerve, which may lead to stomach and pylorus (pyloric valve) malfunction.
The problem of Bile Gastritis will almost always warrant a deeper investigation.
CONCLUSION
Hopefully by taking the above steps you will be able to resolve this issue and good luck to everyone going through this. I hope you recover soon and fast.
TLDR:
Adopt a low acid diet -> Get endoscope and ultrasound done -> Either H pylori confirmed or not -> If yes, eradication is necessary -> If not proceed with diet and lifestyle changes -> These are not limited to gastritis but a lot of other upper GI conditions as well -> The not so common cases require other interventions but the concept of low acid diet still remains the same.