Atrophic Gastritis (AG) is a chronic condition where inflammation progressively thins the stomach lining. This inflammation destroys specialized parietal cells that produce Hydrochloric Acid (HCL) and Intrinsic Factor (IF). Since these substances are necessary for digestion and nutrient absorption, a specialized diet serves two primary functions. The first is to minimize mechanical and chemical irritation to the compromised gastric mucosa, managing symptoms like pain and bloating. The second is to address the significant risk of malabsorption and subsequent nutritional deficiencies that develop as the condition progresses.
General Dietary Principles and Irritants
The primary dietary goal is to reduce the workload on the stomach and avoid foods that provoke inflammation. Food choices should favor soft, bland, and easily digestible options requiring minimal gastric effort. This includes well-cooked vegetables, ripe non-citrus fruits, lean proteins, and low-fat dairy products.
Specific irritants that chemically or mechanically stress the stomach must be severely limited. Highly acidic foods (citrus fruits, tomatoes, vinegar) exacerbate symptoms by irritating the mucosa. Spicy foods containing capsaicin or excessive common spices also trigger discomfort and inflammation.
High-fat meals should be restricted because fat significantly slows gastric emptying, prolonging food retention. Alcohol and caffeine stimulate acid production and are direct irritants, requiring restriction. Choosing low-fat cooking methods and bland preparations supports healing.
Critical Nutritional Deficiencies Associated with AG
The loss of HCL and IF production creates a serious risk for specific nutrient deficiencies. Parietal cell destruction reduces IF, which is required to transport Vitamin B12 for absorption. This malabsorption can lead to megaloblastic anemia and potentially irreversible neurological damage. Since the absorption mechanism is compromised, B12 usually requires supplementation via injection or high-dose oral forms that bypass the need for IF.
The severe reduction in stomach acid, known as achlorhydria, also impairs iron absorption. Iron requires an acidic environment to be converted into its absorbable form. Without sufficient HCL, the uptake of iron from food is significantly diminished, leading to iron deficiency anemia. Monitoring iron levels is a necessary part of long-term care for individuals with AG.
The lack of stomach acid negatively affects the absorption of Calcium and Vitamin D. Gastric acid is needed to properly dissolve and ionize calcium for its uptake. Chronic malabsorption of these bone-building nutrients increases the risk of developing osteopenia or osteoporosis. Regular monitoring for skeletal health is necessary for AG patients.
Optimizing Digestion Through Eating Habits
Since the chemical phase of digestion is compromised by reduced HCL, the mechanical phase must be optimized. Eating small, frequent meals prevents the stomach from being overwhelmed, which avoids prolonged gastric emptying and discomfort. Consuming food slowly and chewing thoroughly is important, as this mechanical breakdown reduces particle size for the chemically-impaired stomach to process.
Attention should also be paid to the temperature and timing of meals. Foods that are extremely hot or cold can provoke irritation, so lukewarm or room-temperature options are preferable. Avoid consuming significant amounts of liquids with meals, as this can dilute the limited digestive juices. To allow the stomach to rest, stop eating and drinking at least three to four hours before lying down to sleep.