Food Intolerance, Food Avoidance or Eating Disorder?
Eating can become difficult for many different reasons.
Physical symptoms, sensory sensitivity, fear after previous reactions, low appetite, executive function difficulties and eating disorders can sometimes look surprisingly similar from the outside.
- Not every restricted diet is an eating disorder.
- Not every food reaction is a food allergy or intolerance.
- Sometimes several factors are present at the same time.
- Physical symptoms can understandably lead to fear or avoidance.
- Sensory differences can make particular foods genuinely difficult.
- A very limited diet can create nutritional problems whatever originally caused it.
- The aim is to understand what is driving the difficulty rather than assigning blame.
Eating difficulties do not all start in the same place
Someone may avoid a food because it repeatedly causes unpleasant symptoms.
Another person may struggle with its texture, smell or temperature.
Someone who has experienced frightening symptoms after eating may begin to feel anxious about trying foods again.
Another person may have an eating disorder.
And for some people, several of these things may overlap.
It does not, by itself, tell us why.
Several different patterns can sit underneath food avoidance
Physical reactions
A person may notice repeated digestive symptoms, migraine, flushing or other symptoms associated with particular foods. These deserve appropriate medical assessment.
Sensory difficulty
Smell, texture, temperature, appearance or mixed textures may make some foods very difficult to tolerate.
Fear of consequences
Previous vomiting, pain, choking, allergic reactions or other frightening experiences can make eating feel unsafe.
Eating disorder
Eating disorders can involve significant restriction or other disturbances in eating and require appropriate professional support.
Food intolerance is not the same as food allergy
The words are sometimes used interchangeably, but they do not mean the same thing.
Food allergy involves the immune system.
Food intolerance is a broader term used for adverse reactions to food that are not typical allergic reactions.
Symptoms may be real even when standard allergy testing does not identify an allergy.
At the same time, symptoms such as bloating, pain, headache or fatigue can have many possible causes.
That is one reason it can be useful to investigate rather than continually removing more foods.
The next question is not whether the person is imagining it. It is how to work out what is contributing without unnecessarily making the diet smaller and smaller.
What about coeliac disease or food allergy?
Some conditions require genuine dietary avoidance.
Coeliac disease, diagnosed food allergy and certain other medical conditions are different from simply deciding that a food does not agree with you.
Where food allergy is possible, medical assessment is particularly important because allergic reactions can sometimes be serious.
Physical symptoms can change the relationship with food
Imagine becoming unwell several times after eating.
Even if the exact trigger is unclear, the brain begins learning:
Food might make me feel bad.
It is understandable that caution may follow.
A person may start with one or two foods they avoid.
Then another food seems suspicious. Then another.
Before long, the safe-food list may be much smaller.
A real physical problem can also create understandable fear, vigilance and avoidance around eating.
Sensory needs can also affect eating
Food is an unusually sensory activity.
It involves smell, taste, texture, temperature, appearance and sensations inside the mouth and body.
For someone with significant sensory sensitivity, these experiences can be intense.
A person may manage:
- crunchy foods but not soft foods
- separate foods but not mixed foods
- one brand but not another
- foods at one temperature but not another
- familiar foods but struggle with unfamiliar ones
From the outside this may look unnecessarily particular.
From the person’s perspective, the sensory difference can be substantial.
What about ARFID?
ARFID stands for Avoidant/Restrictive Food Intake Disorder.
Unlike some other eating disorders, the restriction is not necessarily driven by concerns about body shape or weight.
People may have difficulty eating enough or enough variety because of factors such as sensory sensitivity, low interest in food or fear of unpleasant consequences from eating.
ARFID is a clinical diagnosis.
Having food sensitivities, sensory preferences or a limited diet does not automatically mean somebody has ARFID.
That is why understanding the reason for restriction matters.
What seems to make eating difficult?
This is not a diagnostic test.
It is simply a way to notice what may be contributing. Choose as many as fit.
Food is harder because of:
You do not have to decide whether the problem is “physical” or “psychological” before asking for help.
A useful next step may be to describe what happens: the symptoms, sensory experiences, fears, food rules, practical barriers and how limited eating has become.
Sometimes practical capacity is the missing piece
Not every eating problem is mainly about food.
A person may know what they would like to eat but struggle with:
- shopping
- planning
- standing to cook
- remembering meals
- deciding what to eat
- cleaning afterwards
- using food before it spoils
When energy or executive function is low, the range of foods eaten may gradually become smaller simply because familiar foods are easier.
Sometimes eating improves when the practical cost of getting food onto the plate becomes smaller.
The difficulty with elimination diets
Sometimes removing a food is useful as part of a properly planned assessment.
But removing foods repeatedly without a clear process can create new problems.
The diet can become increasingly narrow.
It can become difficult to get enough nutrition.
Shopping and cooking may become much harder.
Food can also begin to feel increasingly dangerous.
When possible, food restriction is best approached as a process of investigation rather than an ever-growing list of foods that must never be eaten.
When several explanations may be true
People often want one answer.
But eating difficulties can be layered.
Someone may have a genuine gastrointestinal condition and become anxious about symptoms.
Someone may have sensory sensitivity and poor appetite.
Someone may have food intolerance and develop increasingly rigid food rules.
Someone may have an eating disorder and also have a genuine medical condition.
Good support can hold several possibilities in mind at the same time.
Some questions that may help
Rather than asking only:
“Which foods should I avoid?”
it may help to ask:
- What actually happens when I eat this food?
- How consistent is the reaction?
- Has another medical explanation been considered?
- Is sensory discomfort part of the problem?
- Am I avoiding food because I am frightened of symptoms?
- Has my safe-food list become much smaller?
- Am I able to eat enough overall?
- Are food rules taking over a large part of my day?
- Is preparing food simply too difficult at my current capacity?
When getting some help is particularly useful
Professional support becomes increasingly important when eating has become very restricted, when nutrition is difficult to maintain, when food fears are expanding or when thoughts and rules around food are taking up a large part of daily life.
Depending on the situation, useful support might involve a GP, accredited practising dietitian, allergy specialist, gastroenterology team or eating-disorder professional.
The right combination depends on what appears to be driving the difficulty.
You do not have to prove what is causing it before asking for help.
A useful starting description might simply be:
“Eating has become difficult and my food range is getting smaller. I have physical symptoms / sensory difficulty / fear around foods and I would like help working out what is contributing.”
Urgent symptoms are different
Possible severe allergic reactions require urgent medical care.
Likewise, severe restriction, dehydration, fainting, significant physical deterioration or being unable to maintain adequate food or fluid intake needs prompt medical assessment.
Start with curiosity rather than blame.
Food avoidance can develop for many reasons.
There may be genuine symptoms. There may be sensory difficulty. There may be fear. There may be an eating disorder. There may be practical barriers.
Sometimes several are present at once.
The aim is not to force food or dismiss symptoms.
It is to understand what is making eating difficult, protect nutrition and gradually make eating feel more manageable.
Reliable information
ASCIA — Food Intolerance
Information from the Australasian Society of Clinical Immunology
and Allergy.
Healthdirect — Food Intolerance & Testing
Australian information about assessment, testing and exclusion diets.
Healthdirect — Eating Disorders
Information about eating disorders, signs and getting support.
