According to The National Eating Disorders Association /NEDA, “Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.”
As you can read on this page:
- “Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders”
- There are also “fears of choking or vomiting” and
- There is a “dramatic restriction in types or amount of food eaten” and they will often “only eat certain textures of food”
What we seldom see addressed is the biochemical causes of anxiety and fears which can show up as phobias and ongoing worrying and obsessing about ingesting certain foods. These are all typical low serotonin symptoms.
With low serotonin (you can see all the symptoms here) we use the amino acids tryptophan or 5-HTP to raise serotonin and alleviate these symptoms (often within a few minutes).
However, what do we do when a child (or adult) with ARFID has low serotonin and is too terrified to even consider a trial of tryptophan or 5-HTP? This may be because of fear of choking or vomiting and/or because of an aversion to the taste/texture and/or the fact that they are being offered something new that is not on their “safe foods” list.
There is a similar issue with low GABA which can show up as physical anxiety and tummy issues like “constipation, abdominal pain, upset stomach.” Intrusive thoughts are a common sign of low GABA too and this can manifest as a debilitating fear of choking and dying.
There is the same issue with not being able to have the individual use sublingual GABA as a supplement in order to alleviate these symptoms.
It’s for this reason, we have to be creative and find other ways to support serotonin and GABA.
Other ways to boost serotonin and GABA
The traditional ways that tryptophan/5-HTP and GABA are used is opened onto the tongue or swallowed or chewed. However, there are other ways to boost serotonin and GABA in these kids with ARFID, without further adding to their distress:
- Experiment with using tryptophan or 5-HTP topically. I’m not aware of a commercial topical product but I recently mixed 500mg tryptophan powder (only tryptophan with no fillers) into a base cream (I used Primal Derma beef tallow) and used it topically with success.
- Experiment in a similar way with using GABA topically. It could be made at home too (with a GABA only powder) or a product such as Somnium GABA cream is an excellent option (I have used this product with success). I suspect the liposomal GABA/theanine products may also work topically (but have yet to experiment with this option).
- If tolerated, GABA powder swished in the mouth but not swallowed, may be an option once some of the anxiety and fears have been reduced. GABA powder doesn’t taste bad (it’s slightly sweet) and mixes well in water. By swishing some in the mouth it can help reduce the fear of choking and esophageal spasms (if they are present). It may also help with the sensation of a lump-in-the-throat (called globus pharyngeus) that some kids with ARFID describe.
- Liquid zinc (zinc sulfate) tastes like water when zinc levels are low and may be tolerated. This 2021 paper, Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder, lists low vitamin B1, vitamin B2, vitamin C, vitamin K, zinc, iron, and potassium in kids with ARFID. Zinc, iron and the B vitamins are all needed to make serotonin and GABA, and low zinc can reduce appetite. It’s also possible these children had low levels of some of these nutrients beforehand and that this contributed to their fears and restrictive eating.
- Magnesium spray or other forms of topical magnesium creams can be used. Magnesium itself is calming and is a cofactor for making serotonin and GABA. An Epsom salts bath also provides magnesium and a warm bath with Epsom salts and an essential oil such as lavender is very calming.
Other less direct but equally effective approaches to include are:
- gentle yoga (it supports GABA production and is calming)
- swinging on an outdoor swing (reduces stress, cortisol and anxiety)
- full spectrum light therapy (boosts serotonin)
- vagus nerve support “This modern world can lead to overstimulation of the nervous system and you can become desensitized to chronic stress. Over time, this can lead to low vagal tone, which has been linked to a variety of mental and physical health issues.”
- full spectrum infrared sauna (low heat and of short duration to simulate light exercise)
- a weighted blanket is calming and improves mood and sleep and
- essential oils such as orange (topically or diffused) can help with fear and anxiety.
Once serotonin and GABA levels have improved with some of the above measures, and more and more of the fear of choking and vomiting dissipates and food texture and taste aversion is reduced, the amino acids can then hopefully be introduced in the ways they are typically used (more on that below). This will further speed up the anxiety and fear reduction, allowing more and more foods to be slowly introduced.
If you are new to Avoidant Restrictive Food Intake Disorder (ARFID)
Be sure to read more about ARFID on The National Eating Disorders Association /NEDA site: diagnostic criteria, risk factors, warning signs and symptoms (behavioral and psychological, and physical).
As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms.
Resources if you are new to using tryptophan/5-HTP and GABA as supplements
If you are new to using the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the low serotonin and low GABA symptoms).
If you suspect low levels of GABA or any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.
There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, blood sugar control, sugar cravings, self-medicating with alcohol and more.
The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.
If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program. This is a paid online/virtual group program where you get my guidance and community support. There are many moms in the program who are having much success with their kids.
If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.
If you feel comfortable doing so, please share more about the ARFID struggles of your son or daughter in order to help more parents understand this disorder – their age, how long they have struggled, their fears and their safe food list.
Do let us know if you have found success with any of these approaches with your loved one with ARFID (or yourself)? And what other approaches have also helped?
If you are a practitioner are you seeing results with approaches like these with your ARFID clients/patients?
If you have questions please share them here too.