Managing gastritis possibly exacerbated by anxiety

August 3, 2021 6:08 AM

tldr is I have gastritis caused by taking a magnesium supplement. I've stopped the magnesium, felt better, but now the pain is back again. Seeing my GI specialist or GP is difficult as we're in the middle of a bad third wave and I'm only partially vaccinated. (I'm in South Africa). Also, the appointment is extremely expensive. So I need a reality check (hopefully from others who've had similar problems) Is this just a bump on the road to recovery? Or serious enough to make an appointment? Also appreciate any tips for managing gastritis. Would prefer no alternative diagnosis though - please don't tell me about the auto immune condition I might have.

More detail (OK I realise that posting this question is probably me seeking reassurance but what the hell). I'm 49 year old and female.
My symptoms at the moment are burning pain in my upper abdomen, unpleasant but not unbearable, some acid reflux, and occasional diarrhea. So that doesn't sound so bad, but I've been through a bit of a stressful journey to find the cause which has left me pretty rattled.
In the process of trying to diagnose this I've had a pelvic ultrasound, an xray, a gastro scope, a colonoscopy, and a stack of blood tests to eliminate all kinds of infections, liver, thyroid, kidney, and I don't know what else. Also, a mammogram just for fun since I was at it.
All of the tests and scopes were normal except for the gastro scope that revealed damage to my stomach lining as one would get from NSAID painkillers. Which I don't take.
The only culprit seems to be the effervescent magnesium supplement I've been taking daily for more than a year and a half. The GI specialist was pretty sure that was the cause. He said "stop taking the supplement and see me in a month if the symptoms don't clear up".
I gradually improved as the month went by, to the point that I thought I was pretty much back to normal. But now, a month and a half after stopping the magnesium, I'm back to stomach pain and acid reflux again.
I suspect that this might be as the result of anxiety - a glance at my Ask history will reveal that I have been struggling with anxiety. Dealing with figuring out the third wave situation, figuring out what the Delta variant means, and getting my first pfizer shot two weeks ago in not-so-socially distant conditions, maybe that's just bumped up my anxiety levels again.
Could it take that long to heal from this kind of damage to stomach lining? Would gastritis make me more susceptible to anxiety related symptoms? I've been taking a probiotic, and L-Glutamine powder. Good idea? Or not? It seems to help?
I already avoid all the standard gastritis exacerbating things like caffeine, alcohol, spices. Onion seems to be a bad one as well. I get plenty of exercise and I thought I had a pretty good handle on managing my anxiety with meditation and the skills taught me by my therapist (not seeing her at the moment). I've also started HRT for my anxiety and while it's a bit early to say for sure, it seems to have made quite a difference already and I don't feel quite so desperate any more.
A heat pack helps a lot. So does a hot bath. Is this just a matter of managing my symptoms and waiting to see how things develop? The process of being diagnosed, with all those tests and scopes was incredibly stressful and I feel like I need a reality check from somebody who has experienced managing this kind of situation themselves, rather than going to my doctor who might just want to start another round of tests "just in case".
Apologies for how long this is.

posted by Zumbador to Health & Fitness (15 answers total)

I would at least stop taking any and all supplements and/or vitamins for now, because they often contain unadvertised ingredients that may well be irritating your stomach. I'd revert to a very very simple diet, like BRAT (bananas rice applesauce toast, maybe some simple protein but without sauces or additions) for a few days, and see where that leaves you.
posted by Dashy at 7:43 AM on August 3, 2021 [3 favorites]

Based on your age and gender, did they do anything like liver function tests or do an US of your gall bladder/pancreas? Gall stones are common in women, especially of European extraction, so if you're not "40, fat, and blonde" (diagnostic criteria from ages past) they might not check.
It presents like heartburn in some people but it's not.
posted by fiercekitten at 7:43 AM on August 3, 2021 [2 favorites]

From some past experience, gastritis can be a very slow recovery, especially because your microbiome is likely all fucked up too and takes a while to right itself. But also just because stomach acid is a necessary thing, damage is slow to heal.

I would recommend logging everything you eat and your symptoms as well, because given your other sensitivities I'd guess something - maybe just until the gastritis really heals up, maybe ongoing - is maybe giving you flares. I agree to simplify and blandify your diet for a week or two to refresh your slate (but! it's easy to go on a diet so bland you don't get any fiber and then your problems get worse, so DO eat plenty of vegetables but maybe avoid nightshades and alliums since they're the most likely vegetable culprits). You don't need to poach all your proteins but do be boring in seasoning them, again avoiding at least alliums.

It seems unlikely that anything so emergent is happening that you must return to your doctor in exactly 30 days, or that anything that would happen there will miraculously end your discomfort immediately, so this feels like something that can wait a bit for follow-up. Obviously if there is an escalation of symptoms, blood anywhere it shouldn't be, or new pain, you should go back.
posted by Lyn Never at 8:00 AM on August 3, 2021 [3 favorites]

I take magnesium a few times a week for muscle cramps. A friend does, too, and swears by magnesium oil, applied near affected muscles, and absorbed by the skin.

Some years ago, I had esophageal damage and my doctor prescribed a medication that thickened the esophageal and stomach lining. I could feel a light difference in my throat, no big deal. Worth asking about.
posted by theora55 at 8:06 AM on August 3, 2021 [1 favorite]

My partner suffers with gastritis and finds Pepcid/Famotidine provides good rapid relief.

I also assume you've been checked for H Pylori infection? Might be an idea to get that test if not.
posted by knapah at 8:41 AM on August 3, 2021 [1 favorite]

Response by poster: Yes I've been tested for h pylori, thanks :) I thought it was that myself as I've been kayaking on the Vlei, which can be polluted. But tests ruled out all infections of that kind as well as (as far as I know) gallbladder.
posted by Zumbador at 9:11 AM on August 3, 2021 [1 favorite]

I had ongoing issues caused by acid reflux and my gastro just put me on omeprazole permanently. Which seemed like a big deal but he seems pretty blasé about it. I am not a doctor, I am not your doctor, but you can take proton pump inhibitors to treat things like this. It doesn't have to be permanent - the standard OTC dose for omeprazole is a two-week course. Maybe ask your doctor if you can take a PPI to help settle things or at least get some symptomatic relief.
posted by GuyZero at 10:25 AM on August 3, 2021 [2 favorites]

There is plenty of building evidence showing that our mental and digestive health are linked. I think right now there is more research being done in depression and GI disorders but it’s entirely possible that for you one affects the other and it expresses itself as anxiety and gastritis. Ask anybody with IBS if they feel like their mental health is a trigger, for example. My anxiety expressed itself as heartburn for a while, before moving on to terrifying (but not actually dangerous!) chest pain.

So I think in addition to your ongoing physical diagnostics, you would benefit from some behavioral health help. I mean, regardless, everybody is dealing with anxiety right now at globally high levels. It’s perfectly understandable. But just because it’s understandable doesn’t mean you wouldn’t benefit from outside help and a professional perspective. I have no idea what the situation is like where you are for mental health stuff, but here it is getting more and more standard and integrated with GPs. I had a couple meetings with a kind of consulting psychiatrist who made a bunch of notes for my GP who can handle my prescriptions, but seeking ongoing talk therapy is on me. It was all telehealth, zoom meetings, no in person stuff for behavioral health for a long while, probably.

You can always say no to having a test done. This is something I wrangle with as an adult. Like, it seems like we have to do all the things a doctor says we must. But actually it’s a balancing act of what is going to stress us in the short term vs long term diagnostic benefit. Could you talk to your specialist in a telehealth office visit and have a discussion about this?
posted by Mizu at 11:46 AM on August 3, 2021 [1 favorite]

If you are using cannabis or cannabis based products on a regular or frequent basis, for anxiety or
for whatever reason, CBD oils or edibles or other . You should consider stopping all use for a a couple of weeks.
posted by yyz at 3:16 PM on August 3, 2021 [1 favorite]

Just wanted to nthing the PPI comment. I had a friend who had issues, and weird hives/allergies, and her doctor told her to take a PPI.

So that's something you can ask about, even over the phone, I would imagine. If the dr would have no objection to you trying it for a couple of weeks, and see how you feel.
posted by Marie Mon Dieu at 3:55 PM on August 3, 2021 [1 favorite]

I agree with others recommending a PPI; they can have some nasty long-term side effects but a short course (like 4-8 weeks, including tapering down) is standard. I was amazed at how much they helped my stomach heal! I do think it would be worth just giving yourself some time first before trying something like that though. Stomach and esophageal irritation can take quite awhile to settle down. My advice is to keep working on managing anxiety with the things that work for you (gut and brain health are sooo linked) and avoiding the supplements and trigger foods for a couple months, and see if you are starting to feel better by then.

It might also be worth considering whether you have any additional trigger foods, by going on a very basic bland diet for a bit (sorry, believe me I know how much it sucks). Are you eating things like dairy? Or highly acidic foods? I eventually realized that there were a couple of things in my diet that were really bothering me: garlic & ginger. =( Cutting those out completely for a bit also really helped me.
posted by DTMFA at 6:14 PM on August 3, 2021 [1 favorite]

Response by poster: Thank you for mentioning cannabis based products, yyz. I am not taking any, but I had been taking CBD oil in addition to the magnesium in the month leading up to the start of the pain. I suspect that might be what pushed it over the edge.
Thanks everyone for your answers. I must investigate PPI. I had taken one for about two weeks with no noticeable improvement but that was before I realized the magnesium was a problem and I was still taking magnesium at the time. So I suppose it's worth trying PPI again. I am going to see if my doctor is willing to prescribe it.
Also thanks for mentioning the dietary stuff. I'm not sure if I can go full on Bart, but cutting out garlic and ginger etc is certainly possible.
posted by Zumbador at 8:49 PM on August 3, 2021

I'm afraid these suggestions will counter some above advice, but for you to consider:
A few things I've used to help an ulcer (duodenal, I think) are capsules of dried marshmallow or slippery elm, capsules or tablets of boswelia, and DGL tablets. Per a quick GIS they appear to be considered possibly helpful for gastritis, too. After taking them I have a relatively quick healing period. As long as I eat/drink health-consciously, I actually go a long time without needing them. I do not do this, hence the variety of options. They're all relatively cheap. You might want to ask or look up which form is best to use for your guts. I really hope you can find some relief.
posted by JulesER at 8:49 PM on August 3, 2021 [1 favorite]

2 more cents, FWIW (warning, gross details): a while ago I tried some CBD honey for sleep issues. It worked really well for this, but the next three days I pooped bright red blood. Never found or figured out why. I suspect pesticides/poor processing, but maybe there's more to it, gut-wise. Good luck-
posted by JulesER at 8:57 PM on August 3, 2021 [1 favorite]

This is a bit different from the advice above, and I've waited a few days because I wanted to feel sure about what I am experiencing. I've suffered from gastritis and IBS for years since I was on anti-depressive medicine, and like you I've been through tons of tests with no good results. My doctor and everyone around me thought my diet was healthy and good, and I don't have serious food allergies or intolerances. Then about three weeks ago, I read an article about the gut microbiome (as I have often before, no idea why this one was the trigger, it wasn't that special), and decided to go really seriously for eating six servings of fruit and veg a day, and get 30 grams of fiber a day. The article also emphasized a lot of variation, preferably about 30 different foods a week! I am nowhere near this goal, but I am a lot closer than I was, and already within the first week, I no longer had any reflux. My stomach rumbles a lot, but I have far less bouts of pain. I still have some other digestive issues, so it isn't a miracle cure, just a really good improvement, and I hope that over time, perhaps the other things will go away too. I'm also hoping it eventually can help with my mental health issues.

When I fall back to my less varied and less fibrous habits, the pain returns almost immediately. Just one meal made with industrially processed food, even if it is vegetarian, will send me back. Otherwise, I eat onions, garlic, cabbage, ginger, gluten, lactose, but all in small amounts, since otherwise there won't be room for all the other stuff. Herbs and chocolate count as variation, even just a tablespoon or two, so that helps. Out of curiosity, I've even eaten a bit of pineapple, which I was allergic to, with no bad consequences.
An other article I read suggested not to jump from a low fiber intake to a lot, because the gut needs to get used to the new regime. So now, a bit more than three weeks in, I've gone from 8 grams of fiber pr day to 20.

I was supposed to start on a new regime of anti-anxiety medicine, but decided to get this working first, because it is really a big relief to not have the daily bouts of pain, and again, some research indicates that a better diet can help with one's mental health.

I often find it hard to cook and eat well when I am anxious or depressed, so doing this has been hard to begin with. I've made a spreadsheet where I write what I have eaten and calculate the amounts of fruit and veg and fiber, and a dairy where I note how I am feeling. I forgive myself when I just can't handle it. But, specially after I have realized that the reflux and the pain are really going away, I'm beginning to feel the reward and act accordingly. And naturally, I learn as I go and my fridge contents get better.
posted by mumimor at 2:32 AM on August 4, 2021 [2 favorites]