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What is ARFID and what experts want you to know

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(CNN) — When Hannah was 7 years old, she told her parents she didn’t want to be afraid of food anymore.

She had stopped wanting to go to Girl Scouts, birthday parties, restaurants, family celebrations and even the dinner table. Food was everywhere, and it gave her a lot of anxiety, said her mom, Michelle, who is not sharing their last name for Hannah’s safety.

Michelle first saw it when she tried to switch baby Hannah from formula to milk and solids— but Hannah refused. Often, she would pucker her lips shut or spit out the food she was given.

As she got older, Hannah had a list of about five foods she would eat, and they were specific. Like the green sour cream and onion Pringles, but only the small packs, not the big container, Michelle said.

Now 8 years old, Hannah is being treated for Avoidant/Restrictive Food Intake Disorder, or ARFID. Unlike eating disorders like anorexia or bulimia nervosa, this diagnosis isn’t concerned with body shape or size, said Kate Dansie, clinical director of the Eating Disorder Center in Rockville, Maryland.

Instead, people with ARFID are very limited in the foods they feel safe and comfortable eating, Dansie said. Unlike just being “picky,” this disorder can be debilitating and cause long-term health problems.

The diagnosis is new and was only added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, in 2013. (The DSM is the handbook health care professionals use as the authoritative guide in diagnosing mental disorders.)

While an estimated 9% of the US population will have an eating disorder at some point, studies suggest that somewhere between 0.5% and 5% of the population has ARFID, according to the National Eating Disorders Association.

“I would call this the silent eating disorder because it’s very prevalent, but it’s the least studied, and it’s the least talked about, and it’s the least funded at a federal research level,” said Dr. Stuart Murray, associate professor of psychiatry and behavioral sciences at the University of Southern California and director of the Translational Research in Eating Disorders Laboratory.

Here is what experts want you to know about ARFID.

 

What is ARFID?

Rather than restricting their calories or nutritional content, people with ARFID often limit their food by sensory or textural preferences, Murray said.

“This is where a person will usually restrict the variety and volume of food because they have incredibly debilitating beliefs about the composition of the food,” he added. “Examples can be not eating any foods that are a certain texture, a certain smell, a certain flavor, even a certain brand of a food.”

In some cases, people with ARFID have had a traumatic experience with food, like choking, which induces a greater vigilance with eating, Murray said. Other times, people with this condition seem to have a low drive to eat and high anxiety around food, he said.

A rigid or fearful of change personality type may also contribute to ARFID symptoms, Murray said.

 

Is it like picky eating?

Many kids are picky and try to get out of eating some vegetables or other food, but that is not the same as ARFID, Dansie said.

One way to spot the difference is the level of impairment and anxiety that comes with facing a new food, Murray said.

“A picky eater might be able to eat around a certain food on their plate, or they might be able to have a little bit of it,” he said. “Somebody with ARFID might not be able to eat anything on the plate if a food that’s deemed to be unacceptable is on the plate.”

And it isn’t just a handful of foods that people with ARFID won’t eat, Dansie said. Often, people with this condition will have a list of as few as five or 10 foods that they feel comfortable eating, she added.

A greater vigilance around tasting may also come with ARFID, and many people with the condition can tell small differences, like if the brand of pasta sauce has been changed, Murray added.

“That in itself can be quite debilitating and crippling for parents,” he said.

 

A good relationship with food is fundamental

The condition often starts in childhood, but ARFID can impact people of all ages, Murray said. And people can experience consequences throughout their life.

“Kids can really fall off their growth curve quite quickly,” he said. “They can become metabolically, nutritively imbalanced very quickly, so the medical effects are quite profound.”

Hannah experienced this before she began working with an ARFID specialist. She had been keeping pace with the expected growth and weight gain for her age. But with not enough food in her system, her growth stopped, Michelle said.

In some cases, the restriction around eating can lead to weight loss or hospitalization, Murray said.

“With any kind of psychological or psychiatric issue, the (indicator of a problem) is always when it’s affecting the child and the family,” Dansie said. “When the impact is significant, that that’s when we get worried.”

There can be social impacts as well.

“This can be very isolating for people,” Murray said. “Kids become super anxious about going to parties or any type of social event where they think they might not know what the food is going to be.”

Often, issues around food and eating impact many areas of a person’s life, Dansie said.

“What I’ve found is that if you can look at a person’s relationship with food, you can look at their relationship with everything,” she said. “It’s so fundamental to well-being to have a good relationship with food.”

ARFID isn’t something kids just grow out of, so it is important to approach it with as much sympathy and compassion as possible, he added.

 

What you can do

Although there is much researchers still need to learn about ARFID, there are resources available, Murray said.

“The first thing we should know is early intervention is better because the list of avoided foods can grow exponentially,” he said.

There isn’t much data on if medication is helpful, but therapy – including cognitive behavioral therapy or CBT – has helped many people.

Therapy for ARFID “usually involves a guided exposure to foods so that one can relearn associations with those foods and ultimately not avoid them,” Murray said.

At home, there are things families can do to better support a child with ARFID, like prioritizing making sure the child gets enough calories before focusing on expanding variety, said Dr. Nicole Stettler, clinical executive director of Eating Disorder Recovery Services at Rogers Behavioral Health.

You can also give your child tools like timers or visual reminders to eat, and try “food chaining,” which is a strategy that combines new foods with ones they already know they like, she said.

As family and caretakers of someone with ARFID, it is important to remember that they aren’t trying to be difficult – although it can be frustrating to feel like the stars have to align for a mealtime to go smoothly, Murray added.

“It’s really, really frustrating, because most of the time the stars don’t align, and I don’t know the formula to get him or her to eat,” he said.  However, it is “really damaging for any child with any psychiatric disorder if they feel punished because of it, so it’s really important to not punish and adopt a supportive stance among parents.”

Five months into her treatment, Hannah pushing herself to try new things often and to take three bites to give it a full chance, Michelle said.

Her confidence has grown, she is getting more curious, and her list of “safe foods” has increased by 11, she said.

“Our goal is to get her to a good place … so that as she gets older, she’ll have the tools that she needs,” Michelle said.

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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