Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis that was introduced into the DSM-V in 2013. Since then, eating and digestive disorders have increased as a result of the pandemic and lockdown restrictions. So, it’s more important than ever to learn about these disorders.
Unlike other eating disorders, ARFID isn’t caused by a negative body image or a desire to lose weight. Although it can begin in childhood, with many parents thinking it’s just “picky eating,” the recent rise in ARFID has been driven by a person’s desire to avoid triggering gastrointestinal symptoms.
What is ARFID?
ARFID is defined as limiting the quantity and variety of foods consumed. It can lead to nutritional deficiency, weight loss, dependence on elemental formulas, and interference with psychosocial function. It can co-exist with depression, anxiety, ADHD, and autism spectrum disorders. This type of disorder has also increased with the recent rise in people with autoimmune conditions, Lyme disease, and digestive disorders.
Initially, it’s understandable and rational. Those living with chronic digestive problems attempt to figure out which foods trigger their symptoms and may go for years without competent nutritional and medical guidance. They often rely on the advice of friends, online information, and their own experience. Unfortunately for some, they end up avoiding so many different foods or eating only a few food items to the point that they become seriously undernourished and sometimes emotionally affected.
“Some patients have eliminated so many things that they’re basically living on 4 or 5 foods. Their diets are super restricted. They rely on liquid formulas like Ensure. This becomes problematic because their nutrient intake can be very low.” Bethany Doerfler, Clinical Research Dietician, 2023 Integrative Healthcare Symposium
Identifying and eliminating trigger foods makes sense and is essential for treating digestive conditions. However, in an attempt to minimize uncomfortable symptoms, people can compromise their physical and mental health in the process. ARFID is different from other eating disorders because it starts as a rational response to a difficult situation. But negative health consequences emerge as someone’s list of “safe” foods becomes too narrow.
This can trigger a vicious cycle where the restricted diet contributes to the condition it is trying to address. Restricted eating can negatively affect the beneficial digestive tract microbes (microbiome). A healthy and diverse microbiome is critical for improving the overall health of the brain and body. And a key to excellent microbiome health is eating a wide variety of foods.
Some Therapeutic Diets Can Be Harmful
An excellent example of a well-known diet for specific digestive conditions is the Low FODMAP diet. This diet is sometimes indicated for patients with Irritable Bowel Syndrome (IBS), Small Intestinal Bacterial Overgrowth (SIBO), and other digestive disorders. But this diet eliminates many nutrient-rich fruits and vegetables, so it’s often only used as a short-term solution for reducing symptoms and should only be followed for a limited period. Without proper nutritional and medical guidance, many of these people end up becoming malnourished and begin to feel anxiety and fear surrounding food.
With the proper guidance from knowledgeable nutrition and medical professionals, those who completely eliminated high FODMAP foods discover they can tolerate small amounts without digestive problems. In fact, FODMAP-friendly grains such as oats, quinoa, sourdough cornmeal, and small amounts of the foods they previously thought they couldn’t eat, can be beneficial. Sadly, if someone starts believing that “all grains are bad” from reading internet sources, it can create unnecessary food fear. This underlines the importance of professional guidance.
Who Gets ARFID?
According to a recent study, 54% of participants with chronic digestive disorders met the criteria for ARFID. This study included patients with digestive issues such as celiac, irritable bowel disease, and eosinophilic esophagitis. Others who are at risk for ARFID include those with chronic illnesses such as Lyme disease, mycotoxicity (mold illness), Long COVID, and certain autoimmune conditions. ARFID can affect anyone who begins restricting too many foods to avoid digestive symptoms like constant diarrhea, flatulence, and abdominal pain. In some cases, the person may not even have a medical diagnosis.
Gastrointestinal disorders can cause intense emotional and social stress. Eating becomes a highly stressful experience instead of a joyful and pleasurable one. Successful management of ARFID requires a combination of nutritionally-focused guidance and psychological counseling, including cognitive-behavioral therapy. The person needs to learn new behaviors, unlearn old behavior patterns, and manage the fear and anxiety surrounding food. It’s also essential to improve the person’s nutritional status.
Sanoviv is an excellent place to start on the road to healthy management of digestive issues, especially since doctors, nutritionists, and psychologists are available in-house to contribute to overall healing. Also, since we use foods from clean sources, there is no better environment to expand food choices and find the best diet for you.