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.
Thank you Trudy. This article was so helpful. This is exactly what’s happening with my son. I can’t get him to try the amino acids. I will try the cream idea.
Diane
So glad to hear it was so helpful. Please do let us know who it goes with your son with the cream idea. If you feel comfortable doing so, please share more about his ARFID struggles, his age, how long he has struggled, his fears and his safe food list. This will help me and more parents understand this disorder.
I think it is important to note that ARFID can exist for multiple reasons beyond what was mentioned in this article. My child and many others I know who suffer from ARFID have not seen a change to the ARFID by taking 5HTP, GABA, Pharma GABA, L- Theanine or Tryptophan. Oftentimes, ARFID is more complex than that.
I do encourage people to try the supplements listed to see if they help, but I don’t want people to have unrealistic expectations or feel like a failure if it doesn’t work.
ARFID is a very frustrating and difficult issue to treat.
Kathy
Thanks for adding to the discussion and yes this blog post is very specific to a subset of those with ARFID. I did include this in the blog for this reason: “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.”
I acknowledge it’s a very challenging condition. If you feel comfortable doing so, please share more about the ARFID struggles of your son or daughter in order to help me and other parents understand this disorder better – their age, how long they have struggled, their fears and their safe food list, and what has helped.
If you’d be willing to share how you used 5-HTP, GABA, PharmaGABA, L-Theanine and Tryptophan that would be helpful too – were they swallowed/used sublingually (and how willing were they to use these supplements this way?) or were they used topically?
I recall the incredible success you have had with your teen daughter with tryptophan so I know you know how effective the amino acids can be. Sharing a link to that blog for other blog readers: “Tryptophan for my teenager: she laughs and smiles, her OCD and anxiety has lessened, and she is more goal oriented and focused on school.” https://www.everywomanover29.com/blog/tryptophan-for-my-teenager-she-laughs-and-smiles-her-ocd-and-anxiety-has-lessened-and-she-is-more-goal-oriented-and-focused-on-school/
Hi Trudy,
Thank you for discussing the this. It can be very hard for parents who read about all the supplements that can possibly help their child with anxiety but can not be administered (without force) due to restrictive eating disorders. We have reuined many of the few meals he once ate by trying to hide supplements recommended for ASD by his health practitioners.
Any positive feedback from homemade transdermal GABA usage? I have spoken with a lot of chemist who told me that only a strong pharmaceutical carrier/base cream would needed for there to be any chance of making the bloodstream.
Steven
I don’t have feedback yet on homemade transdermal GABA usage but will be sharing via a blog when I do. I am curious to hear more about what the chemist shared – did he provide any specifics in terms of what is meant by a strong pharmaceutical carrier/base cream?
I can share that the Somnium GABA Cream is very effective. I have used it personally and have had positive client feedback – more here https://www.everywomanover29.com/blog/somnium-nighttime-gaba-cream-insomnia-anxiety-bloated-belly-muscle-spasms-ms-arfid-anorexia-alzheimers-and-autism/ They state that the chondroitin sulfate helps absorption. They recommend using it on the temple but I preferred using it on the palm of my hand and forearm. Unfortunately something in the product gave me headaches and I suspect it’s the benzoic acid.
If you feel comfortable doing so, please share more about the ARFID struggles of your son (or anxiety/ASD if ARFID is not his issue) in order to help me and other parents understand – his age, how long he has struggled, his fears and safe food list, and what you have found to help.
I’m an occupational therapist and know that a lot of how a child responds to food at the table is affected by their arousal state immediately prior to coming to the table. It can be quite helpful to do a fun gross motor activity before dinner, especially one in which there is a “power reversal” where the child fills more powerful and confident than their “stumbling, bumbling, goofy” parent. A great book on anxiety is The Opposite of Worry by Lawrence Cohen.
Lynne
Thanks for sharing. I’d love to hear an example or two of what you refer to here – a fun gross motor activity – and if you’ve seen this help specifically for kids with ARFID
Hi Trudy,
Thank you so much for your time. If you could recommend a transdermal dosage of pure GABA powder to start with for my 6year old 20kg boy, i would be happy to share my results with everyone. I may use just the shea butter/coconut oil as a carrier with a few drops of peppermint/eucalyptus oil to possibly enhance absorbtion. Yes, i obtained the ingredients lists for the pharmaceutical transdermal base creams from the different compounding chemists. They are probably to big for this blog but i am happy to email the pdf files to you.
The somnium sounds encourging but i am still concerned about the ingredients and the headaches you experienced as my son is extremely sensitive but cannot often communicate his discomfort. Ultimately, i would like to try homemade first.
My son was diagnosed with ASD at 2years, with GAD and ARFID his greatest challenges. Currently home schooled due to anxiety. One on one OT,psych,speech and SOS feeding therapy with moderate to no results as yet.
At 2, diary and wheat were phased out/substituted due to GI issues, which ultimately would lead to more anxiety/distress around meals and trying new foods. Safe foods include filtered water and organic rice milk served in the same bottles from infancy. Carrot and apple slices. Plain orgrans wafers. Gluten free toast with cocoa/coconut oil/hemp protein spread. His dinners rotate homemade crumbed tuna croquettes, and crumbed chicken patties. All drinks and meals delicately conceal arrange of pre/probiotics, antifungals, vitamins/minerals/ aminos (including zinc, mg, p5p, iron, methylb12, methyl folate, taurine, theanine, carnitine,glutathione and more). We would love to add GABA but he has repeatedly spat out his milk when we added only half of a 1/64 teaspoon of GABA to his milk on different non consecutive occassions. His taste is very sensitive.
He has not tried a birthday cake in years. Never tried a soda, milk shake or juice, nor pizza, McDonald’s, lollies, noodles etc. Often people assume that all fussy eaters are only doing so because theyre parents fill them up on junk food when their child protests their vegetables. A slight error in the making of his safe foods results in gagging and crying with severe anxiety and distrust in trying them next time. He has dropped countless meals since infancy.
Steven
Thanks for sharing more about your son’s ARFID, ASD and anxiety struggles. Well done on concealing all those nutrients into his safe foods. I do wonder if GABA could be concealed too and am curious which product as it’s typically bland and similar to taurine.
The dosing is very individual for sublingual GABA and I honestly don’t yet know how dosing translates with home-made topical GABA. I do plan some testing myself and follow-up blogs and will share when they are ready. I also can’t offer specifics via the blog.
I’d also confirm low GABA symptoms vs low serotonin symptoms to make sure it’s topical GABA vs topical tryptophan that is to be trialed – symptoms here https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/ My book “The Antianxiety Food Solution” is also a good resource for understanding the amino acids. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Assuming low GABA is the decision I’d start super super low. For adults 125 mg is a typical GABA starting dose (used sublingually) and for kids I have parents use 1/2 or 1/4 of that (and less for very sensitive kids.) These blogs may offer some ideas – child used 25mg sublingual GABA https://www.everywomanover29.com/blog/gaba-rescue-remedy-essential-oils-for-eliminating-dental-anxiety/ and an adult woman see benefits with 1.5 to 3mg sublingual GABA and another with 3000mg https://www.everywomanover29.com/blog/how-much-gaba-should-i-use-for-my-anxiety-it-depends-on-your-unique-needs-and-there-is-an-extremely-large-variation-in-dosing/
I like the idea of shea butter/coconut oil as a carrier oil but don’t know about peppermint/eucalyptus oil to possibly enhance absorption. Playing it safe and not using Somnium sounds wise given his extreme sensitivity.
My online GABA Quickstart group program is helpful when you have a lot of questions like this and need guidance (and moral support/encouragement). More here about the program and purchase info https://www.anxietynutritioninstitute.com/gabaquickstart/ There are a number of parents in the group.
Oh I would appreciate you emailing me the ingredients lists for the pharmaceutical transdermal base creams from the different compounding chemists
Steven
Some updates on my GABA experimenting. Mixing the GABA powder into an oil based cream like Primal Derma didn’t work to dissolve the crystals and it was like a body scrub (like Epsom salts) and I feel it would be too rough for a sensitive person (unless sensory stimulation is the goal). It did work to some extent but I had even better results when I used a bit of water on top of the visible crystals on my skin – they softened and dissolved quickly.
Over the weekend I used some on my stiff back, using another approach which worked surprisingly well! Equal parts GABA to filtered water, mixed until crystals dissolve and used topically. It was smooth, cooling and pleasant and eased the stiffness immediately. I had been planning to add the GABA/water mix to my cream with an emulsifier but have yet to try that.
The GABA I am using is by Healthwise and is crystalline. A powder product that is more like tryptophan may work like the tryptophan approach I mentioned in the blog
Thanks for the email with compounding info. Some pretty nasty ingredients in some of them! I’m sure we can do better
Great Trudy!
I will definety explore your concept this weekend. Perhaps the least amount of filtered water possible for solubility, with the challenge of finding a natural cream to suspend and spread.
Did you notice any calming effects? Perhaps if it was only muscular, i may need to look at the permeation enhancers.
Steven
To be clear I used just GABA powder (crystalline) and water with success. I had no need to mix it into a cream. I plan to try that approach next.
Right now I have no need for GABA for it’s calming effects but I use my stiff muscles and sleep as my measure.
I look forward to hearing of your results with your son.