Longevity entrepreneur Brian Johnson recently shared some bad news on social media. “I have an autoimmune disease. My stomach eats all by itself,” he wrote to X. The good news? “I’ll try to figure it out.”
The disease in question is autoimmune gastritis, a chronic inflammatory disease in which antibodies destroy acid-producing cells in the stomach, preventing iron absorption. Although not a fatal disease in itself, it can lead to an increased risk of stomach cancer and ultimately vitamin B12 deficiency, leading to anemia and neurological complications.
Autoimmune gastritis is estimated to affect an estimated 4% of people worldwide, but it may be more common than we know. Experts say the disease is notoriously difficult to diagnose, and gastroenterologists often fail to recognize autoimmune gastritis in their patients. Now, the disease is in the spotlight thanks to Johnson, an unexpected spokesperson for all kinds of illnesses, given the extreme measures he takes to protect and maintain his health. The 48-year-old billionaire biohacker whose Blueprint company sells supplements, baseball caps with red light laser therapy to reverse hair loss, and other longevity products is also the founder of what he describes as a religion called “Don’t Die.” In recent years, Mr. Johnson has amassed millions of followers on social media and at one point made national headlines for his longevity efforts, which included transfusions of plasma from his teenage son.
Jennifer Dowd, professor of population dynamics and population health at the University of Oxford, said Johnson’s announcement was a reminder that no matter how hard everyone tries to optimize their health, “it’s not really possible to biohack your way out of disease and death completely.”
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Toby Cornish, a gastrointestinal pathologist and professor at the Medical College of Wisconsin, said this could also be an opportunity to raise awareness about the importance of performing biopsies to diagnose chronic diseases that are often overlooked and difficult to treat.
“I think gastroenterologists should actually take more ‘normal’ looking stomach samples from patients with a history of treated iron deficiency, because many of these patients actually turn out to have autoimmune gastritis,” Dr. Cornish said.
What causes autoimmune gastritis?
Cornish said Johnson’s post explaining autoimmune gastritis was a great explanation of the disease. He and other experts say there is no specific research to support Johnson’s suggestion that there may be a link between a childhood diet of fast food, sugary cereals and soda and later weight gain of 40 pounds.
“I think that’s very speculative,” Cornish said.
The specific cause of autoimmune gastritis is unknown, but it may be a combination of genetic factors, environmental factors, and chronic inflammation, Mimi Chan Tan, assistant professor of gastroenterology at Baylor College of Medicine, said in an email. It’s true that people like Johnson with autoimmune thyroid disease are more likely to be diagnosed with autoimmune gastritis, even though one doesn’t cause the other.
How is autoimmune gastritis diagnosed?
In Johnson’s case, the first symptom was consistently low levels of ferritin, a blood protein measured to show how the body stores iron. However, blood tests revealed that there were no problems with his hemoglobin and hematocrit levels, which are used to diagnose anemia. So it was easy to ignore the problem.
Autoimmune gastritis is “notoriously insidious, often remaining silent for decades, and symptoms often manifest outside the gastrointestinal tract as fatigue, weakness, or neurological problems,” Tan said. Johnson’s disease-like ferritin levels are often an early sign, but a definitive diagnosis requires an upper endoscopy with biopsy.
“People with low ferritin levels or iron deficiency anemia should undergo upper endoscopy and colonoscopy to screen for AIG as well as other causes of anemia, such as colorectal cancer, colon polyps, and colorectal cancer.” Helicobacter pylori It’s a stomach infection, Tan said. She points out that the latter three conditions are all more common than autoimmune gastritis.
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One of the notable pieces of information in Johnson’s post is the context he provided about the colonoscopy he underwent while searching for answers. “I was 48 years old and overdue.” The U.S. Preventive Services Task Force recommends starting colonoscopies at age 45. Why is Mr. Johnson, who calls himself “the most biologically measured person in history” and who spent $2 million on treatment in 2023 alone, late for routine tests?
Johnson did not respond to requests for comment. However, Cornish pointed out that it was only recently in 2021 that guidelines lowered the starting age for colonoscopies from 50 to 45. “Sometimes people get lost in the shuffle,” especially people in Johnson’s age group, he said.
And Johnson himself admits he has had blind spots in the past. “Guys, I’m an idiot,” he wrote to X this spring. “We’ve been trying not to die all this time, but we had toxic grass, or artificial turf, in our backyard. Some people are worried about being exposed to harmful chemicals.”
Treatment of autoimmune gastritis
Johnson paints a bleak picture of treatment options for autoimmune gastritis. “Standard medicine admits defeat by saying there is nothing that can be done other than to manage the condition, no matter how severe and deadly its effects,” he writes.
Unfortunately, “the fact is that there is no good treatment for this disease,” Cornish said. Like Johnson, people take iron orally or intravenously to combat nutritional deficiencies and are monitored for stomach cancer. Patients with this condition are 13 times more likely to develop a neuroendocrine tumor. The goal is to find tumors early so they can be treated endoscopically rather than surgically. Patients with autoimmune gastritis also have an increased risk of adenocarcinoma, a serious cancer.
The reason neuroendocrine tumors are so common in patients with this condition “is due to a physiological feedback loop. When stomach acid drops, the stomach secretes gastrin to try to raise acid levels, and gastrin is supposed to raise acid levels. But when there are no parietal cells that make acid, acid levels never rise and the stomach just makes more gastrin,” Dr. Cornish said. Insufficient gastrin eventually forms neuroendocrine tumors. If detected early, the prognosis tends to be good.
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Not satisfied with these measures, Johnson said in a post that his team is considering experimental interventions including CAR-T therapy, a personalized form of gene therapy that has shown promise in a variety of autoimmune patients.
CAR-T therapy has not been well studied for this particular condition, Cornish said. “This is probably the best research direction for finding treatments for autoimmune gastritis. But it’s still in the very early stages.”
Still, he said, “It’s reassuring to know that people are exploring CAR-T for this purpose, because honestly, there’s not a lot that can be done to help these patients.”
For Johnson, the diagnosis brought a sense of relief. “I want to know if there is something wrong with my body,” he wrote on X Tuesday. “Ignoring it will not improve the situation; delaying it will only make the task more difficult, costly and risky.”
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