Dear Alice!,

I have a very strong aversion to certain food textures such as potato (mashed, chipped, roasted, etc.), that causes me to gag violently. I am 22 years old and have a BMI of 16 which I blame in part to my very unbalanced diet. I am constantly lethargic but am eating three good portion meals a day. I was wondering if there was a way to get over this sensitivity as I am eating cereal without milk every morning, plain pasta for lunch and a pizza for dinner every day, I am looking to be a lot healthier with my life.

Dear Reader,

Being a picky eater is one trait, but having such strong aversions to certain foods that you gag violently is quite another. It’s a possibility that the symptoms such as ongoing lethargy may be associated with an unbalanced diet. It sounds as though the difficulties you experience when trying to eat certain foods may prevent you from meeting your essential nutritional needs, including calories for energy. Picky eating is also a symptom of avoidant/restrictive food intake disorder (ARFID), a diagnosis for folks who may not be meeting caloric or nutritional requirements due to restrictive eating habits, often due to being sensitive to food texture, taste, or smell. This diagnosis can only be made by a professional, so if this information resonates with you, speaking with a mental health professional or health care provider may be helpful. The good news is that select treatments for individuals who experience similar aversions to a wide variety of foods have been shown to be highly effective. Even if this condition doesn’t match your experiences, they may still be able to help you overcome your troubles with picky eating.

Parents and babysitters can attest to the fact that picky eating is very common among children and adolescents, and research backs this up. Unfortunately, there aren’t as many studies that address highly selective eating behaviors that begin in or last through adulthood. So, it’s difficult to get an accurate read on prevalence in adults. However, it’s known that food aversion in adults is linked to health risks that may interfere with a person’s daily functioning, including the presence of other mental health conditions such as anxiety, obsessive compulsive disorder (OCD), and increased shame and guilt regarding eating habits. The primary consequence of eating an unbalanced diet low in nutrients is becoming underweight. Being underweight may cause a variety of short- and long-term health consequences, including fatigue (as you mention), weakened immune system, fragile bones and osteoporosis, anemia, and, for those with ovaries, interrupted menstrual periods and fertility issues. You’re correct that one of the best ways to prevent becoming underweight is to maintain balanced eating patterns that work for you and your health.

If possible, experimenting with your current diet may be worth a try. Right now, it seems like your current diet is high in carbohydrates, which may give you a short blast of energy but fade away rather quickly. You may consider recombining ingredients in your existing diet — for example, you could try putting some cheese with tomato sauce on your pasta (almost the same as pizza!). You may also want to consider trying out other foods and textures to help sustain your energy, such as fruit smoothies, nuts, yogurt, and berries. Experimentation within the range of the foods you feel comfortable eating may help you become more open to trying new foods. Once you’re ready to try new foods, you can take small tastes and evaluate what you like and don’t like about the food. You won’t necessarily like every new food you try, and that’s okay — it’s all about being open to experimentation. Lastly, incorporating nutrient-dense foods into your current diet (such as including pureed vegetables in pasta or pizza sauce) may be helpful in getting your body the nutrients it needs. 

Given your aversion to food textures and gag response, it makes sense that maintaining a balanced diet has been extremely challenging and is easier said than done. Fortunately, if experimenting with food on your own proves difficult, there are other options that may help. For example, there’s evidence that a combination of medication, family therapy, and cognitive behavioral therapy (CBT) has been successful in helping adolescents who have been diagnosed with ARFID add nutritional variety to their diet and meet caloric requirements, along with gaining weight. It’s possible that such treatments may help adults as well. For this reason, it may be worthwhile to speak with a mental health professional, health care provider, or registered dietitian to learn more about the treatment options that may be best for your specific needs.

In addition to simply disliking the texture of certain foods, there may be emotional factors that prevent you from eating a well-balanced diet. In fact, clinical trials show that gagging, vomiting, and retching when exposed to a new food are often stress-related responses. Also, since individuals diagnosed with ARFID are more likely to be diagnosed with depression, anxiety, or OCD as well, it’s possible that mood disorder symptoms may make it a challenge to balance eating habits, too. Meditating, using breathing exercises, and experimenting with other relaxation techniques have been shown to be effective in reducing distress. Along with reaching out to a health care provider, these strategies may be worth a try as well.

Although experimenting with food and undergoing professional treatment may be challenging, the long-term health benefits of working to overcome food aversions may be well worth it. Wishing you best of luck as you work to diversify your diet!

Alice!

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