72. ARFID Explained: Insights from ARFID Dietitian Lauren Sharifi

Written By Brittyn Coleman, MS, RDN/LD

In this episode of the Nourishing Autism Podcast, Brittyn welcomes Lauren Sharifi, a registered dietitian specializing in ARFID (Avoidant Restrictive Food Intake Disorder). They discuss the complexities of ARFID, its differences from picky eating, and the importance of specialized care.

Lauren shares her journey into the field, the different subtypes of ARFID, and its strong correlation with neurodiversity, especially autism. They also talk about the challenges faced by those with ARFID, including food anxiety and the necessity of a supportive community. Listen to learn about the need for personalized care and the importance of understanding and normalizing the experiences of those with ARFID.

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TRANSCRIPT

Hi, I'm Brittyn, a Registered Dietitian and autism sibling. I have a passion for helping parents of neurodivergent kids navigate nutrition and wellness for their child, one small step at a time. Here we'll explore practical nutrition tips, learn from top autism experts, break down the newest research, and share inspirational stories that will empower you to utilize nutrition to help your child feel their best and thrive.

Listen in while picking kids up from school, sitting in a therapy waiting room, taking a quick walk or wherever you find yourself, looking for some inspiration and a friend to guide you along this journey. This is Nourishing Autism.

Lauren: [00:00:00] I have had parents who come and say we tried

all the things and nothing works, and it's very true, picky eating stuff doesn't often work for those with ARFID because they really do have a lot of anxiety around food, even their safe foods sometimes aren't safe.

And so, it's way more, they're not being difficult, you'll see that like "just being difficult" and yeah, it's not that, they're really, they are truly struggling to be able to put food into their body.

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Hi, everyone. Welcome back to the Nourishing Autism Podcast. I am so excited to be [00:02:00] sitting here with Lauren Sharifi, who is the ARFID dietitian. Lauren, thanks for being here. Thanks for having me, Brittyn. Yeah, we've connected for a while now on Instagram, so it's really great to be able to collaborate and sit down for an actual conversation.

And kind of like we were saying right before this podcast episode started recording is that the

information and awareness around ARFID has just really been booming this past like few years and I feel like especially

recently a lot of my audience has been asking so much more about ARFID resources so I was really excited to be

able to bring you on and yeah, tell us who you are and what you do and who you help.

Lauren: Yeah, so yeah, my name is Lauren Sharifi. I'm a registered dietitian. And I work with adults with ARFID. I also work with caregivers of those with ARFID or suspected ARFID. And then I work with some teens as well. So I provide one on one support as well as I run a couple memberships. One for caregivers with ARFID,

like [00:03:00] loved ones with ARFID, and then also for adults with ARFID. So those two groups have been really cool to connect people because there's people like, I don't even know, I don't know anyone with ARFID, I didn't even know this was a thing, right? So really to be able to connect people has been a cool, cool experience as a provider.

Brittyn: It makes it so much more, it just to have a community while you're working through something like ARFID is just really, really special. And to be able to have a practitioner who actually really understands. So before we get into what is ARFID and all of those really important things we're going to be touching on today.

I am curious how you got into this field of nutrition because that's not something that we learn in school.

Lauren: Yeah. No, no. Yeah. I graduated back in 2010 and it wasn't even a diagnosis then. So yeah, after I had my first child, who is now eight years old, I started up in a gym, I just wanted to do more private practice work.

So I worked there. I was getting a lot of people with eating disorders. And then I was having my own kids and really [00:04:00] interested in feeding, nutrition, that kind of stuff. So I had these two interests, which ultimately kind of started bringing me these ARFID clients. And at that time, I didn't even know what it was.

I had to do a lot of learning on my own from my clients, whatever resources I could find, which honestly wasn't a lot at the time and really just started to grow an interest in it and wanting to kind of fill that gap because there just was nothing for providers. There was nothing for my clients.

So after I had my last child, I was like, I'm going to go off, do my own thing. So it was over two years, like two and a half years ago at this point, I left that practice, started my own thing and decided I'm just going to fully go into ARFID because it's so, so specific. And I really wanted to you know, really get good at this and know this and really support people as best as I could.

So that's kind of how it all evolved.

Brittyn: Yeah. Which is amazing because, and I tell other practitioners this all the time. ARFID is not something that we just want to guess at, that [00:05:00] we want to just use the traditional quote unquote picky eating approaches because you're going to do a lot more harm than good.

And so I'm sure it's really assuring to families and individuals to be able to say, okay, I'm going to someone, and this is the same reason I specialize in autism, be able to go to someone and say, I really trust you. I know that you're the expert in this field and that the work that we're going to do together is going to move me forward because it's really scary whenever you have a child or you're an individual with just a few foods, you know, you don't have a lot of flexibility, I guess, to be able to take the wrong path.

We really have to move forward. So I think that's so great. And I was just double checking ARFID did become a diagnosis, it was in 2013. I couldn't remember.

Lauren: Yeah. So yeah. Yeah. Three years after I had graduated, it was a thing, but at that point, I don't even, yeah, it was later on that I even knew what it was.

Brittyn: Yeah, well, if you could educate all of us on ARFID and share more about what that is, [00:06:00] and I think more and more people are understanding what it is, but how it differs from just the quote unquote picky eating.

Lauren: Right. Yeah, so ARFID stands for Avoidant Restrictive Food Intake Disorder, and so like we said, it wasn't an actual diagnosis until 2013, but it's been around forever.

It's been a thing forever. And yeah, there's actually three different subtypes. So people with ARFID can have, I have not had one client that is like another. It can present very differently. So they kind of group them three different ways. So there's avoidant, which is more sensory based.

So I see a lot with autism that connection very often, especially amongst children. They often fit into that category. The sensory taste, texture, smell, visual input from food can be just very overwhelming and make it difficult to try new foods or even certain foods because the smell is too much.

And then the second subtype is [00:07:00] aversive or fear based. So there might be some fear that a negative health event is going to happen. So it might be an allergy or choking, vomiting, GI, so even just negative sensations in the body that can present, and I, again, I see that too among children and a lot of adults as well.

And then the third subtype is low interest or restrictive. So those individuals have hunger cues may be different. So they struggle to even know when they're hungry. They may not have an appetite. They get full very quickly just really disgust or disinterest in just eating in general.

I have so many clients are like, I wish I could just be like a plant and get my nutrients from the ground and from the sun. That would be great. So, those are the three subtypes and I often see most people kind of fit into more than one. So maybe all three or a couple.

And then there's even, you know, some individuals who might experience both ARFID and another eating disorder, like anorexia, and often it kind of can go back and forth, so [00:08:00] it's like anorexia might be more present, ARFID might be more present, it's, yeah so there's, like I said, so many different faces

in individuals with

ARFID.

Their experiences are very different.

Brittyn: And I think some people are surprised to find out that ARFID is a mental health diagnosis. It is an eating disorder. And so I think a lot of people, when they think of eating disorders, they also think about the way that people feel about their body and ARFID doesn't take into account

your feelings about the size of your body or how your body is. And so you did a really great job of explaining that. And I do see a lot of my clients yes, fall into that avoidant area, but I also see a lot of anxiety and fear around food. And then I also see kids who have a hard time with the interoception piece, being able to recognize that they're hungry.

And so then, you know, start to fall into that low interest or low hunger group. And so I really see it as a spectrum as well. And so you kind of can fit into [00:09:00] these multiple categories and then bringing in kids too, I see pediatric feeding disorder. Also being another diagnosis that often coexists with ARFID, and it's hard to necessarily tell them apart..

Yeah. Yeah. So it can be confusing for parents who are like, okay, there's multiple, or I mean, individuals too, being able to try and tease these apart and understand how to best support your child or yourself through this, to be able to help yourself feel the best you can and have the best, most positive relationship with food possible.

Lauren: Yeah. Yeah. It's yeah. It can be definitely tricky too. Yeah. Yep.

Brittyn: What have you seen? Oh, sorry to cut you off.

Lauren: So, I was just gonna talk about the picky eating too. I know you had asked that question about how it differs from picky eating. And often I say for, I guess what, like quote unquote, picky eating is often something that we see individuals will as they get older, they kind of grow out of versus ARFID,

it's often not something that [00:10:00] they'll grow out of. And often, any picky eating advice that we see out there, like, I have had parents who come and say we tried

all the things and nothing works, and it's very true, picky eating stuff doesn't often work for those with ARFID because they really do have a lot of anxiety around food, even their safe foods sometimes aren't safe.

And so, it's way more, they're not being difficult, you'll see that like "just being difficult" and yeah, it's not that, they're really, they are truly struggling to be able to put food into their body.

Brittyn: Exactly, I think that's an important differentiation. You know, social media is a hard place and so a lot of times I don't know, your page seems relatively positive though.

It seems like, but we all get the haters. Yeah, don't get many haters. Yeah. You know, it's funny because my Instagram is so positive and it's Facebook that they're the ones to get in fights with one another. And unfortunately, it's always in the comments about people saying they're just choosing to be this way.[00:11:00]

And thankfully, the whole ARFID community will come out and be like, you just don't understand. You don't know what you're talking about. But it's really crazy, because sometimes I forget that we do have to raise so much awareness around this because they are struggling.

It's not something that they're choosing to really limit the foods that they're eating. And with my clients, a lot of it is sensory based and that's not a choice either. And so really being able to educate in this space is so important because we do still have people out there who are just saying they're just spoiled and it just sends me into this rage that it's hard to educate from a place where you're like, ugh, I just wish you got it.

Lauren: Yeah. Some people are like, I wish I could eat that. it's not something that I'm choosing. I truly wish, it's just incredibly hard and I just can't.

Brittyn: Exactly. Now I'm curious if you can share more about what you've seen, kind of the intersection between ARFID and neurodiversity.

Lauren: Yeah, so, I [00:12:00] mean, I have seen very big connections, so I would say most, if not 100 percent of my clients also have

autism, ADHD, OCD, sensory processing differences, anxiety disorders, or differences in that regard, so there is a big connection between someone's neurodivergence and how their brain functions and how in eating, but obviously not everyone who is autistic has ARFID.

But I do see very commonly just how they're kind of thinking about it, like they have eating differences and how they relate to food is different. And I don't know if you know who Naureen Hunani is. So she's the RDs for neurodiversity. She does that course for

providers on like children and eating differences and adults with eating differences. And she has like a framework that she created. And that's actually the first place that kind of identified ARFID as a form of neurodiversity. Because thinking like, you know, there are different [00:13:00] ways to relate to food.

 And those with ARFID kind of relate to food in a different way than what we see as our, you know, neuro normative way to connect and eat and really accepting and understanding that, that there are different ways that we can relate to food. There's just a big layer of shame that comes with these eating differences, as like, okay, there's this level of difficulty, now we're adding shame, and that just makes it so much harder, especially a lot of the adults that I'm working with, how that interplays with their eating is so big.

Brittyn: Yeah, yeah, I think that, I mean, I exclusively work with families who have children that are autistic. And so I do see a huge uptick. I mean, again, this is like my specialty is autism, but you know, the prevalence of ARFID and I was curious looking into the stats too. And what I was seeing is that it's up to 15 percent of the general population also has ARFID, but it's up to 33 percent of [00:14:00] those within the autistic population that also have ARFID.

And so, yeah. It's something that's really prevalent. I mean, that's one in three.

Lauren: Yeah. I always like to think about too, I mean, there's so many individuals who are not diagnosed, they don't get diagnosed. So there are adults, but they've been, you know, or they don't want to be diagnosed. So that percentage is probably much bigger than all of the neurodivergence they're yeah, very high.

Brittyn: Especially, I mean, the fact that ARFID's only been a diagnosis for a little over 10 years now, we all know how long it takes

for new diagnoses and new medical information to get into medical schools and actually trickle down to the point

where we have practitioners who are educated about this, are able to send out the right referrals, help get the right diagnosis.

I mean, a lot of it right now is on parents and individuals. to learn about this and advocate for it themselves, which makes it especially hard if you're pushing against a system that [00:15:00] isn't educated on this.

Lauren: Yeah. Yeah. The number of parents that have come to me and been like, my pediatrician doesn't feel comfortable diagnosing cause they don't know about it.

Like how invalidating that is. Like, I know this is something they're experiencing and yeah, it happens far too often. So it's even hard to get some of these diagnoses. It's just privilege and being able to get that diagnosis. Yeah.

Brittyn: I mean, on that note, where would somebody go to get an ARFID diagnosis?

Because I've seen, you know, many practitioners can, but where, where would you recommend for somebody to be the most validated and get the most support?

Lauren: Yeah. So pediatricians can so if they are knowledgeable, some are, so pediatricians or primary care physicians can diagnose as well as certain therapists can, psychiatrists, psychologists, that they can also diagnose.

So that's where I have a lot of people who through their therapist, have been diagnosed with ARFID. So that's, that is the most [00:16:00] common. And there's this, ah, the organization's name has escaped my brain, but there's an organization that's actually working to help. And I think you have to be an adult though.

Maybe it's like 16 plus that they're actually doing some diagnosis, like you can call and do over the phone basically. Oh, and if I remember the name, I will send it to you. But there is an organization out there that's doing some work for the, I think it's like 16 plus and diagnosing individuals.

So you don't have to go to your primary doctor or something. So, I mean, yeah.

Brittyn: And hopefully can hook you up to the right resources as well. Yeah, exactly. Yep. Now, can you share what treatment would look like? And if that is even the right word to use? And both treatment and recovery are two words that I struggle with because I never know if they're the right terms to use, actually.

So I would love if you share more on what both of those could look like and what terms you [00:17:00] recommend using.

Lauren: Yeah. Yeah, I know. I feel the same way. Because there is, I mean, in the medical model, it's a lot of focus on let's fix, let's cure, which may not be accessible for many of these people.

Like, this might be part of their identity and how they relate to food. So I mean, obviously dietitians can support. I have

individuals who work with occupational therapists sometimes, speech language pathologists, therapists, they might have a

psychiatrist, so there might be a multitude of teams going on, depending on what the person is struggling with and

what they have access to and yeah, versus kind of like fixing or curing, it's more like, how do we, manage, accommodate, support an individual

so they kind of learn how to work with their eating differences in a way that's affirming for them to be able to nourish their body versus how do we get rid of

some of these experiences that they're having? Cause we may never be able to like processing differences as

it relates to [00:18:00] foods, but how can we learn what they might like? And how do we modify foods? How

do we set accommodations so they can get access to their safe foods? And it's really hard in our culture where people aren't so aware and how to kind of accommodate and even accommodations are hard to get access to.

You might ask for one and not be able to access it. And I'm sure you're aware of that, it's tricky. So, yeah, some of the stuff that I work on people is just really learning how to advocate for their needs, understanding what their needs are, what are their triggers that make food really difficult for them?

And how do we make it a little bit easier with what they have control over? And it's hard. I think there's, you know, in the eating disorder world too, there's a lot of systems of oppression, their neurodivergence, there's all these little factors that play into being able to access recovery.

And so that idealistic recovery is often not accessible for most people with eating disorders and definitely those with ARFID. I talk [00:19:00] about too, wait, how do you want to improve your quality of life? What does that kind of look like for you that's realistic for you within what your experience is and having individuals kind of define that for themselves versus me defining it, our society defining it.

So kind of reframing that term, which I think people are kind of working on as a society.

Brittyn: I think that's a really important question to be asking, like, what does this look like for you? And what is your best quality of life look like? Because that may be completely different than the next person. So especially, I mean, coming from, you talked about the subtypes too, and what is going into this as well.

And so that's also going to determine the services they need, but also what it realistically looks like to them to be living their best life. And so I think yeah, it's of course going to be different for everyone. Yeah. Yeah. So what is your biggest tip for someone [00:20:00] whether it's a parent or an individual who has dropped a safe food, what do you typically do in those situations?

Lauren: I guess first I try to normalize it because it is normal. I think there's a lot of apologizing of dropping foods or food jagging like, it's a problem. It's a bad thing. You avoid it. This is actually part of how you might relate to food.

You might fixate on a food, eat it a lot, and that's what's safe, and that's what's nourishing your body, and then you one

day just drop it, and that's like just kind of normalizing that experience, because it's very common and then having, I'll have

sometimes people like keep lists of things, so if they've like, if there's a food that they drop, put that on a list, and like

maybe you just need a break from it, But when you maybe drop another food, like, you can refer back to that list.

Because often, sometimes, those foods will come back into rotation. You just need a little break from it. So that's what I often see. You might eat it a long, long time. So it's like mac and cheese, mac and cheese. All the parents are like, that's all they'll eat is mac and cheese. And then one day they don't, now what do I do?

I'm like, check that list. Maybe chicken nuggets. Maybe reintroduce those [00:21:00] things that maybe they dropped before. And again, nothing is perfect, but often, I'll find that one of those new foods or old foods will come back in or somehow a new food will kind of be reintroduced into their diet.

So yeah, normalizing, keep a list and then kind of refer back to that list to help reintroduce things.

Brittyn: You know, it's interesting to hear how you work because I mean, this is the first time that we're meeting live and we've never talked about the way that we work with clients before. But I'm with you.

I mean, right when I start working with families and in my membership, we start off with a list, and we break it down into like our love it foods, our like maybe foods, our not yet foods, and then our past foods, or like our used to love foods. And so having that list, can also take off a layer of like anxiety for parents to be able to try and like come up and think of something new when an old thing comes out.

It's just easy to [00:22:00] go back to that list, make life easier for your future self. And then we also break it down into, we just do protein, fat, and fiber. And I'm like, if we can get a variety in there, let's do the best we can. And where can we work within these areas? And how can we support you and your child and their nutrition?

And so I agree, lists can be really fantastic. And then I also think normalizing, just like you said, the fact that this is so normal, that there is a term that you threw out there, food jagging, I think a lot of people don't know that that word exists. And I think sometimes just knowing that a word exists for something that you're experiencing

helps you be like, okay, this is so normal that there is a word for it. I think that that in itself, being able to put a word to something that you're experiencing makes you feel not so alone. And then the anxiety around that you can kind of move forward and say, okay, there are steps forward from where we are right now.

Exactly. Yeah. [00:23:00] Well, so we were talking before we started recording, you host a membership for both individuals, so adults and caregivers. Can you share more information about that? And then where people can find you online and the best way that you can support people.

Lauren: Yeah, so for the caregiver membership that I run, it's for anyone who has a child, a loved one, even I've had some

partner spouses that join as well and they have an individual with ARFID, suspected ARFID and we meet once a month for an

hour, and you can kind of, you know, connect with other caregivers, ask questions to me, to the other caregivers that come on.

And then we also host quarterly speakers that will come on which is cool. We had last month a author Stephanie Elliott, who wrote It's about Sad Perfect. I don't know if you know that book, but it's more geared to older kids [00:24:00] teens and adults. But it's a story, a novel that she wrote about her daughter who had ARFID.

So we had some people who were like, I would love to connect with her and so we brought her on. So we're trying to bring in other people just to learn from. And then there's a bunch of resources on there, like past recordings of educational groups that we've done.

So there's just kind of like a big resource hub for all things ARFID as well as a way to connect and there's a chat so you can connect with other caregivers. So just trying to create community and connection. So that's the caregiver and then the adult one we meet more frequently.

It's once a week and it's myself and then another dietitian, Amanda, who actually has ARFID herself, who helps me kind of alternate. So I do two, she does two. We meet once a week and do support group, meal support. We always have different events, like tonight we're doing an art event with another individual, Kevin, who is an advocate in this space.

We're doing art stuff together just some fun events just to connect to the [00:25:00] community in a virtual space. And there's also resources there as well, so it's been a great way for me as a provider to learn and just support in a different way.

Brittyn: I think having additional opportunities to connect with others, sometimes when you're just not even talking about nutrition, but just being able to be with others who get it in a space in a call is really important.

We host monthly mama mingles in the Collective and we had one last night and it's like, we don't even have to talk nutrition. It comes up cause you know, it's one thing that they're struggling with, but it's just really nice to be able to be among other people who really get it and be able to actually feel so validated when just the typical role can feel really invalidating.

So...

Lauren: yeah, yes, exactly. I think that's the big takeaway. Most people are like, I'm just so glad to be here and be among people that get me and I get them.

Brittyn: So nice. Well, and you're on Instagram as well. It's @ arfid.dietitian, [00:26:00] correct?

Lauren: Yep. Yes. And then my website is laurensharifi.

com and you can get all the stuff there as well. So those are the best ways to kind of connect with me.

Brittyn: Amazing. We'll link everything in the show notes below so everyone can connect with you. So thank you so much, Lauren, for being here and for sharing all this information and also just for doing what you do.

I mean, it is so appreciated especially coming from, you know, my space, being able to see that other dietitians in this neurodiversity affirming, but also like support with ARFID and support with all of these other pieces that I often feel are just very misunderstood and just don't have the right resources in place.

It's just great to be able to chat with another dietitian in this space as well. So I'm so glad that you came on and thank you for everything that you shared. Thanks for having me. Thanks. Thanks everyone.

Transcribed by Descript

About Brittyn Coleman, MS, RDN/LD

Brittyn Coleman, MS, RDN/LD, is a distinguished Registered Dietitian and Autism Nutrition Expert, known for her innovative, sensory-friendly feeding approach to nutrition for children on the autism spectrum. As the founder of the Nourishing Autism Collective, and as an autism sibling herself, Brittyn brings both professional expertise and personal understanding to her work. She empowers families with her expert guidance, helping children receive essential nutrients for optimal health and development. Her strategies are tailored to the unique dietary needs and sensory preferences of each child.

Brittyn's influence extends beyond her membership site through her active social media presence and her popular podcast, 'Nourishing Autism'. Her educational content on Instagram, YouTube, and other platforms has established her as a leading voice in autism nutrition, providing valuable resources, practical advice, and a supportive community for parents and professionals. 

Brittyn Coleman, MS, RDN/LD https://www.autismdietitian.com
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