This episode is about Avoidant Restrictive Food Intake Disorder (ARFID) in IBS, highlighting its prevalence and overlap with functional gut disorders for Eating Disorder Awareness week.

• Identification and symptoms: ARFID is common in IBS, often leading to restrictive diets based on fear of digestive consequences.
• Distinguishing ARFID from picky eating: ARFID involves heightened sensitivity to food and fear of digestive consequences, perpetuating avoidance behaviours.
• Extreme food avoidance in ARFID worsens IBS symptoms, driven by anxiety and disgust around food.
• Identifying ARFID: Questions help assess avoidance behaviours and physical signs like unintentional weight loss, indicating ARFID.
• When to seek medical and mental health support for ARFID diagnosis
• Non-food interventions to support gut health.

Support with eating disorders

Beat - https://www.beateatingdisorders.org.uk/

NHS - https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

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Would you like to try and eat

more foods, but your fear of the

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digestive consequences of vomiting

or choking or just bloating is

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so strong you cannot try them?

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Maybe you are Are you scared to eat

new foods or foods that you haven't

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prepared yourself in your own home?

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It could be that you've got sensory

issues with texture, taste or

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smells, just finding certain foods

overwhelming and maybe even disgusting.

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In this episode of the Inside

Knowledge podcast, I'm talking

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about ARFID, Avoidant Restrictive

Feeding Intake Disorder, in IBS.

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You'll learn how to identify signs

that you could benefit from some

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extra help with managing this type

of eating and what you can do next.

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Welcome to episode 43 of the

Inside Knowledge podcast.

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I'm Anna Mapson.

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Today I'm talking about ARFID.

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It's Avoidant Restrictive

Feeding Intake Disorder in IBS.

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This week is Eating

Disorder Awareness Week.

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So I thought I would focus on ARFID

in IBS because it's probably It's one

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of the least known types of eating

disorders and there is a big overlap in

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functional gut disorders and IBS and these

kind of restrictive eating practices.

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In fact, people with IBS are twice as

likely to have ARFID as people who don't.

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I'm going to talk a little bit about what

it is, what it would look like, and then

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a little bit about what you could do next.

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Most people with IBS and almost everyone

I work with Has had some sort of dietary

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Recommendation maybe from another

nutritionist a doctor or just on dr.

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Google and Commonly avoiding food groups

like dairy, maybe they've gone low carb,

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maybe you've gone on a low histamine

diet, you've tried the low FODMAP diet,

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like, it's a really normal reaction to

try to modify your diet because you've

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got digestive symptoms, because, after

all, the digestive system is dealing with

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the food that you eat, so surely it would

make sense to modify what you're eating.

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In some ways, That makes complete sense.

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But we also know that IBS is a

disorder of the gut brain connection.

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And it's not only about food.

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And there are other things that

influence the way in which we digest.

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Most people report some

sort of issues after eating.

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So they notice a change.

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Maybe you get more bloated

after eating certain foods.

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Or that you get pain three hours

after eating a certain meal.

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This is really common, also to

notice it, to monitor it, and

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to find these associations.

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So it seems natural to want to cut

more and more foods out of our diet

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in order to manage those symptoms.

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What is not so clear, I suppose,

is at what point do these efforts

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to keep your digestive symptoms

in check become disordered.

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At what point is it not okay

to keep going with them?

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So that's what I'm going

to explore a little bit.

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I just wanted to be really clear

up front that although I said

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at the beginning of this episode

that ARFID is an eating disorder.

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and it is classified as such.

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People who have ARFID aren't necessarily

focused on their body size . It's not

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about trying to lose weight, where

you are focused on eating less food in

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order to change the shape of your body.

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Of course, not everyone who has IBS

and is on a restrictive diet has ARFID.

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This is a particular set of symptoms

and there is a classification for ARFID.

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They use something called the DSM, which

is the way they classify mental health

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conditions and eating disorders, have

their own categorization within that.

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And ARFID is defined by an eating or

feeding disturbance as manifested by a

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persistent failure to meet appropriate

nutrition and or energy needs

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associated with significant weight loss,

significant nutritional deficiency, a

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dependence on feeding tubes or a marked

interference in psychosocial functioning.

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So whilst in this episode I am talking

about people who have very restrictive

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IBS diet, and particularly how

ARFID affects people who've got IBS.

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That is the way that they classify

the eating disorder, and that is

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how people get diagnosed with ARFID.

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It's important that if you feel

like this is something that affects

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you, you do go and see a doctor.

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It does need a doctor to diagnose,

and a particular specialist,

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psychiatrist, or eating disorder.

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medical practitioner.

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So just up front, be really clear.

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It's not just about being a bit picky.

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It's not about, oh, you don't like certain

vegetables because of their texture.

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It's about where the restrictions that

you have that are around the fear of

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eating or the fear of the consequences

of eating, have led to weight loss or

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have led to a Nutrition Deficiency,

like it's affecting your body or

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that it is affecting your life, as

in it's affecting your interactions

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with others, relationships and so on.

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It's about the consequences of eating.

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and the feeling you get when you eat.

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There is, of course, though, a difference

between picky eating, like fussy eating.

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This is where It's hard to draw the

line, and some people, it can be

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quite complicated to work out where

the border is between disordered

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eating and an eating disorder.

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But, the way ARFID is broken down

is more about sensitivity, so like

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a sensory sensitivity to food.

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Maybe you struggle with a

really strong flavours, taste.

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It could be a lot about texture.

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Other people with ARFID might

just have no interest in eating.

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You have a very low appetite and

you're just not interested in food.

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There's no desire to eat.

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But the most common type of reaction that

I see is people who are afraid of what

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the digestive consequences are of eating.

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So, like I said, every time you eat

you feel bloated or every time you eat

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I don't know, apples, you, you have

really bad gas, whatever, that's going

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to stop you wanting to do it again.

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This is much more the common kind of issue

that I see with my clients is people who

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just don't want to eat certain foods or

don't want to eat anything new because

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of the worry of what it could do to you.

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You might worry about choking or vomiting

and fear of vomiting is quite common.

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And if you eat foods that make you feel

sick, give you nausea, then doesn't

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mean you're actually going to vomit,

but then you're going to avoid those

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foods because you don't want that

sensation because it drives your fear.

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And this is partly down to how we learn.

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Pain is a danger signal that

tells our body something is wrong.

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We therefore tend to get fear of

those conditions that create pain.

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Oh, I was thinking about how to try

and explain this and I was thinking

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if you were trying to fix, I don't

know, a bit of equipment in your

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home and last time you did it, you

trapped your fingers and it really

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the next time you go to repair that.

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door or whatever it is, you're going to

be really cautious and you're going to be

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quite fearful of doing the work because

you're worried about trapping your finger

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again, because it really hurt last time.

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So this time you're not going to do it.

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Maybe you're going to ask someone else to

do it for you, you're going to get someone

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in, you don't want to get that pain, and

so you're avoiding the situation where

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the pain might come, but what it's not

doing is teaching you how to do that job.

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And so actually you are avoiding it.

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And by avoiding it, you're creating

a whole load of situations, more and

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more experiences as you go through your

life with the same digestive symptoms.

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They're not going away and yet you're

adding more and more situations

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that you just can't do, places you

can't go, and all of these sort of

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maintenance behaviours are in place to

avoid feeling that horrible feeling.

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So to translate it into sort of digestive

symptoms, maybe you felt really full and

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uncomfortable after a meal and you want

to avoid that feeling in the future.

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So you start only eating half your

dinner and you try not to get too full

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because you had a horrible experience,

feeling really stuffed, really bloated,

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maybe quite distended and gassy.

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So then, because you're only getting

to the point of eating half a meal and

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you're afraid to have a full stomach,

it's negatively reinforcing this cycle.

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The problem is as well that you get the

opposite of that, so that is hunger.

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The opposite is feeling hungry is the

safe feeling, because you're less likely

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to get the bloating and the pain and

the gas and those feelings, or maybe

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the urgent diarrhea, whatever it is.

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I had a client a few years ago who

just Realized through working with me.

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I am afraid to have a full tummy and

she'd worked that out when I was trying

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to push her to eat more and more.

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I think she was on a low FODMAP

diet, but she was worried about

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having a full stomach, even of it.

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the foods which she knew would be okay.

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So when we know that hunger is the

opposite of the bad feeling and we

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feel like hunger is the safe place to

be, it's hard to move out of hunger

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and that gets you trapped in this

cycle where you don't want to eat.

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You can then get into this cycle

where you are getting fear of

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normal digestive symptoms as well.

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So you're getting a normal amount

of gas, a normal amount of gurgling,

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maybe some bloating, or just feeling

of general fullness that's not

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starved, but you're just full enough.

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But That sensation in your

mind is associated with

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really negative consequences.

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And so normal digestive feelings can

feel danger, can feel very scary.

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And therefore, when you're feeling

scared, you can actually then

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affect your digestion even further.

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If you go back and listen to episode 4

as well, where I talk about the gut brain

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connection, I talk about how when you're

feeling scared, stressed and anxious.

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Then your blood supply is not

majoring on your digestive system.

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It is flowing to your muscles, to your

brain and putting you on high alert.

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And if you're in constant state of

stress and anxiety and worry and

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feeling very tense, that is not

optimal for your digestive system.

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You have lower, output of

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stomach acid lower digestive enzymes,

which means you're not going to break

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down your food as effectively and

therefore It's almost gonna cause

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more gas So learning how to feel calm

when you eat is also very important.

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A small sensation in your stomach does

not necessarily predicate a massive

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flare up, and that's what you need

to start to learn to deal with, is

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like how to tolerate normal bodily

sensations, and not go into that sort

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of real distressed, cycle and mindset.

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So that's one way that the fear

of eating actually causes you

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to not digest your food as well.

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But also there's research that shows

that people who have ARFID, are only

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consuming up to like 60 or 70 percent

of the amount of fruits and only 50

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percent of the amount of vegetables that

a group of healthy controls were eating.

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So this extreme food avoidance can

also lead to problems with not eating

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enough food which can slow down gastric

motility, so slowing down the speed

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with which food goes through your body.

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which can increase bloating, constipation,

and digestive distress symptoms.

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There's also a big link of

anxiety between People who have

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IBS and people who have ARFID.

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So there's the anxiety and sometimes

disgust around food that contribute

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to avoiding food in people with ARFID.

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And that kind of heightened sensitivity

to food, texture, taste, may be linked

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to the visceral hypersensitivity.

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That people have in IBS.

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So we know people with IBS are

hypersensitive to small changes in the

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gut and other people can have the same

amount of gas as you and not experience

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the pain and the discomfort and that

sensitivity that you feel In IBS.

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So there's a heightened nervous system.

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It's like on overdrive, listening

out and really overreacting.

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But that is another kind of

link between people who have

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IBS and people who have ARFID.

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It's that heightened sensitivity and

heightened, perception of food and what's

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happening in your digestive system.

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And linked to that, thinking about the

The fear, and I was talking about the

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pain, you're, worried about pain, so

you don't do the thing that's going to

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lead to the pain, but in IBS, it's so

unpredictable, and for a lot of people.

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when it's not well managed, you

don't know what your triggers are,

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you don't know what might set it

off, and therefore, Every meal

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could be potentially quite scary.

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Some of the questions that I ask my

clients at the beginning of working

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together include things to find

out to what extent you're avoiding

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things, and what might be the drivers

behind you avoiding certain foods.

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So I ask, for example,

are you a picky eater?

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Or do you dislike most foods that

other people seem to eat okay?

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And one interesting question is,

is the list of foods you like and

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that you will eat shorter than the

list of foods that you won't eat?

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And this is quite an interesting

question to get to the bottom of

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whether people are on a really

restrictive, small amount of food.

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What people normally say is, I do like

these foods and I want to eat them.

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I just can't because of the gut symptoms.

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So those first three questions are just

about understanding like your preferences.

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And then I ask a little

bit about, your appetite.

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Do you have a very small appetite

compared to other people?

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Do you ever enjoy

eating ? That kind of thing.

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So maybe you can think about this.

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Do you have to push yourself to

really eat a normal size meal?

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And even when you're eating something

that you really enjoy, do you have

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to force yourself to eat enough?

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Or can you eat a big meal then?

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And then the next set of questions

are really about do you put off eating

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because you're afraid of gut symptoms

like bloating or choking or vomiting?

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Do you just not eat?

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Do you ever just restrict yourself to

a small subsection of foods because

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you're trying to avoid gut symptoms?

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Or do you only eat very small

portions, for example, because you're

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worried about your gut symptoms?

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The problem is with sort of trying to

screen for things like ARFID in IBS

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is that Everybody I work with says

yes They restrict their food because

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they're worried about gut symptoms

and that doesn't necessarily mean that

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you've got an eating disorder It means

that you've got a severe gut issue and

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you're taking Reasonable and moderate

steps in order to manage those symptoms.

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So just because you think oh

actually I recognize myself

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in some of those statements.

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It wouldn't necessarily diagnose

you with an eating disorder.

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However, if you feeling that

This is a problem, in that

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food is taking over your life.

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Food is becoming all you think about,

and you're anxious before every single

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meal, and you can't socialize with

people, it's becoming difficult to

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maintain relationships, and then

physically signs that You are not

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getting enough food is obviously that

you are losing weight unintentionally.

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If you're losing weight and you don't

want to be or maybe you are already

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in a small body and you can't really

lose any more weight or just that

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you don't want to be in a smaller

body size but weight is coming off

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because of the restrictive diet.

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This is another big sign

to go to your doctor.

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You might have physical signs like

Your nails are very thin and brittle.

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Your hair is dry.

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Your skin is dry.

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You are feeling very cold all the

time and finding it hard to get warm.

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Your circulation is slow.

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You could be struggling with insomnia,

so you're not sleeping well because

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your body cannot switch off at night

because it hasn't had enough food

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during the day or it's only had a

certain amount of food because you're

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eating the same foods on repeat.

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Part of the reason I wanted to cover

this topic is that people often

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think about picky eating in children

and Oh, they'll grow out of it.

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And adults don't seem to have

this problem with picky eating.

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What I find is people hide it very well,

and you might be quite embarrassed about

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the limited diet variety that you have,

and you know, logically, you know, as

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an adult that you should be eating more.

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But this is not about not having

the right knowledge or not

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understanding enough about nutrition.

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Often people are very well versed

in what they need to be doing.

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But this fear or disgust or just total

lack of interest in food is making it

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hard for you to actually get the food in.

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So this is why I wanted to do

this episode just to call out to

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people to say, it is okay to go

to your doctor about these things.

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Is not just about kids.

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And ideally your doctor will refer you

to the relevant mental health support,

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because if you actually get diagnosed with

an eating disorder, which ARFID is, then

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you should be able to access the help.

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And I know the waiting lists are

exceedingly long, the threshold

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for getting help is very high,

and so there isn't always

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the right help available but it is

important to go to your doctor and try

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and see what is available in your area.

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The other things you can think

about are non food interventions for

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supporting your gut because if your

digestion works better then You can

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tolerate a little bit more food now.

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I know it's not going to help you get

over the fear of it But if you can

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reduce the symptoms through non food

related things You've got a better chance

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of being in that place where you are

feeling more Open to trying new foods.

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The things I'm talking about when I

mention non food interventions for IBS

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include mindful eating, chewing your

food really well, sitting at a table.

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So if you go back and listen to the

first four episodes of this podcast,

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I go through a lot of the basics

of things that you can do that

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don't involve changing your diet.

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They just involve changing

how you eat, but also really

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prioritizing self care activities.

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So things that help you support and

nourish that gut brain connection so that

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you feel a little bit more resilience.

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to help you get through the challenge

of working out how to expand your diet.

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You might also be interested in episode

22, which was all about supplements

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for IBS and what would be worth taking.

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So thinking about, for example, if

you've got constipation, are there some

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things like psyllium husk, like PHGG,

that's partially hydrolyzed guar gum

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that can help you to get things moving

without necessarily changing your food.

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Maybe you can take magnesium to support.

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A looser stool.

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Psyllium husk also, by the way,

can be used in people who have

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IBSD, like diarrhoea predominant.

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So helping you to form a softer stool,

but also increasing some of those

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foods within the foods that you find

safe that would contain some soluble

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fiber helping to form a good poo.

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Now also you can think about exercise

that also brings down the stress

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levels, helps you release cortisol

and just kind of reset your body and

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exercise can also help you sleep better.

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So there are a number of

things that you can be doing.

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Even if you feel like tackling what

food you're eating is too far off

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where you are right now But I would

consider those questions that I have

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placed into this episode really think

about them Are they a problem for you?

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And then also think about what

you're prepared to do about them.

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What resources have you got within

yourself to tackle this right now and

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try to get some help so there are eating

disorder registered nutritionists and

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dietitians who specialize in this who

can give you the right kind of support

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as well as your doctor or eating disorder

trained counsellors and therapists.

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Thanks for listening this week.

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I'll be back next week.

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I hope it's been helpful.

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Thanks for getting the inside knowledge.

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Better digestion for everyone.