A teenager and his parents were arguing
about his diet full of junk food, again.
As a picky eater, he didn’t like a lot of home cooked
meals, and thought that he should get to eat what he
enjoyed if he was going to eat at all—fries, and Pringles.
His mother and father said he was too picky, and his meals
weren’t providing enough nutrition for a growing teenager.
But the boy adamantly refused to eat other
options, so the parents eventually had to give in.
After all, eating unhealthy food was
still better than eating nothing, right?
Things were fine for a while, but then the son’s eyesight
started getting worse and worse… until one day, he became blind.
Eating nothing but fries, chips, and junk
food might sound like a guilty pleasure dream.
But what would happen if someone really did survive off these foods?
One case of an extreme poor diet was published by a group
of researchers from the University of Bristol in the UK.
The patient was a boy who was 17 at the time, and who remains unnamed.
The teenager was a “fussy eater” according to his parents,
who first took him to see a doctor when he was 14.
He suffered from fatigue, but other than picky eating
he was healthy, with no history of medications.
But blood tests showed he had anemia and low levels of vitamin B12.
The doctor treated him with B12 injections and instructions for
a healthier diet, but it seems like this advice wasn’t followed.
A year later, at age 15, the boy was experiencing issues with his sight
and his hearing, and was referred to an ear, nose and throat specialist.
But doctors couldn’t pinpoint a cause.
The teenager’s MRI results and an eye exam both seemed
normal, but over the next two years, his condition got worse.
By 17, his vision was testing at 20/200 in both eyes, which made
him legally blind in the United Kingdom and the United States.
A closer examination revealed that the patient had damage to his
optic nerve, which connects the back of the eye to the brain.
The medical team asked him about his lifestyle habits.
He told them that he didn’t use alcohol, tobacco or drugs.
But then, he admitted that he had had issues with food from a young age.
Doctors discovered that he had low levels of B12,
deficiencies of copper, selenium, and vitamin D,
high levels of zinc, and reduced bone density.
Since he was a child, the boy refused to eat certain textures of food.
Every day, he had fries from a local fish
and chips shop, chips—specifically, Pringles—
white bread, processed ham slices, and sausage.
The doctors ruled out other possible causes of his vision
loss, then diagnosed him with nutritional optic neuropathy.
This means that the teenager’s poor diet led to nutritional
deficiencies that damaged his optic nerve to the point of blindness.
Medical malnourishment can be caused by drugs, issues absorbing food,
poor diet, gastrointestinal surgery, an eating disorder, strict veganism
or vegetarianism that isn’t supplemented appropriately, or alcoholism.
If the teenager’s vision loss from nutritional optic
neuropathy had been caught earlier, it might have been
possible to turn things around and restore his loss.
The patient had a poor diet since age 10,
but only started to show symptoms at age 14.
Dr Denize Atan, a neuro-ophthalmologist who treated the
patient at Bristol Eye Hospital, says it takes a very long
time to use up your body’s stores of certain vitamins.
But by the time the teenager was diagnosed, his blindness was permanent.
Even wearing glasses wasn’t an option, because it isn’t possible
to correct damage to the optic nerve using lenses, according
to the lead author of the study at the University of Bristol.
To prevent his vision from getting any worse, the teenager was
prescribed nutritional supplements and referred to mental health
services to address his dietary habits, which were considered extreme
enough to be categorized as an eating disorder, according to the report.
This disorder used to be known as “Selective Eating Disorder,” but
is now called “Avoidant-Restrictive Food Intake Disorder,” or ARFID.
It’s a relatively new diagnosis that is uncommon
because it isn’t driven by a concern for body image.
Instead, the condition is characterized by a lack of interest in food
or avoidance of foods with certain textures, colors, or other factors.
Bob Krause, a 63-year-old man with ARFID, describes his
diet as “a four-year old’s dream.” He enjoys peanut butter,
crackers, grilled cheese sandwiches, and that’s about it.
Bob says that, to him, any other meals just look like a plate of barf.
But he doesn’t enjoy living like this, saying that he
wished he could simply snap his fingers and change.
His picky eating was extreme enough to help end two marriages,
hurt his work opportunities, and make social gatherings stressful.
As he explains it, most foods just don’t look like food to his brain.
Researchers at the Duke Center for Eating Disorders believe that
Bob might be just one of thousands of people affected by ARFID.
Most people have a couple of foods they feel strongly about
and won’t eat, but people with this disorder experience the
opposite—there are only a handful of things that they will eat.
And they aren’t doing this out of a desire to be difficult or stubborn,
they seem to simply experience food differently than most people do.
At the Duke Center, many adults come seeking help because their
selective eating is affecting their job, social life, or the
way their kids perceive food and affect their eating habits.
A lot of sufferers are embarrassed by their limited diet
and will put in a lot of effort to hide it from people’s
judgment—by avoiding social events that revolve around
food and drinks or making up excuses for not eating.
The Duke Center attempted to get an idea of how many people might have
ARFID in America and launched an online registry with a thorough survey.
In less than five months, 7500 adults had fully registered.
The center offers treatment options and resources for people with
ARFID and parents with children that struggle with selective eating.
Selective eaters tend to like similar foods across their tastes,
with a preference for bland and/or processed food, and salty foods.
Common favourites include french fries and bacon; while
fruit, vegetables, and alcohol are mostly avoided; with
possible exceptions for light beer and raw carrots.
The root cause of extreme pickiness is not precisely known,
though it’s suspected to be a mix of nature and nurture.
It’s possible that some picky people are “supertasters,” meaning
that they taste certain flavours more strongly due to their genetics.
For example, I know lots of people hate cilantro
because they have a gene that makes it taste like soap.
I’m not sure why so many people know what
soap tastes like, but to each their own.
However, this isn’t entirely supported because
many supertasters are not fussy eaters.
Many people with ARFID dislike food because of sensory
qualities like look or smells, and not because of taste alone.
Neurodivergent people who are on the autism spectrum, or
those with ADHD, as well as some people with intellectual
disabilities are much more likely to develop ARFID.
Many children with ARFID also have an anxiety disorder.
Most adults who are picky eaters have been that way since
childhood, and often have early negative experiences with
food, like acid reflux as a baby or childhood digestive issues.
They may also have had undesirable
associations with food at the dinner table.
Since many eating habits are influenced in childhood, it’s important
for parents and caretakers to keep an eye of childrens’ diets
to prevent cases like our teenager from the UK who went blind.
Diet-related vision loss isn’t uncommon in populations
where poverty and food insecurity are prevalent issues.
It’s very rare for cases of nutritional optic neuropathy
in developed countries to be caused purely by poor diet.
According to the University of Iowa, B vitamins are
important to our body’s cellular reactions, and not having
enough of them leads to things like toxic by-products
of metabolism building up, and damage to nerve cells.
A study in the British Journal of Ophthalmology, led by Dr
Amy Millen from the University of Buffalo revealed a link
between an unhealthy diet and age-related macular degeneration.
AMD is a condition that affects the retina as people age and
blurs their central vision, which helps people see things
clearly and do ordinary behaviours like driving or reading.
The CDC reports that 1.8 million people aged 40 and
above in the US have AMD, and 7.3 million people
have drusen, a condition often progresses to AMD.
Early-stage AMD has no symptoms, so it’s hard to tell if someone has it.
Late-stage AMD can be expensive and invasive
to treat, and it comes in two types.
Neovascular AMD, also known as wet AMD, occurs when a protein called
abnormal blood vessels grow in the wrong place in the back of your eye.
Medical professionals treat this by
injecting anti vascular growth factors.
AMD is the number one cause of reading impairment
and loss of close-up vision in people 65 and older.
The study is the first one to look at diet and AMD
development over time, focusing on the development of
early and late AMD and overall diet patterns over 8 years.
It used data on 66 different food types and identified two
patterns—one healthful and called “Prudent,” with a lot of
vegetables, fruit, legumes, whole grains, and fish and other seafood.
The other was called “Western,” which had lots of
processed and red meat, fried food, dessert, eggs,
refined grains, high fat dairy, and sugary drinks.
There was no link between early AMD and either of the
eating patterns, but the rate of late AMD was three
times higher in people with a Western eating pattern.
People who had no signs of the condition at the start
of the study, but who ate an unhealthy diet, were more
likely to develop late-stage AMD around 18 years later.
The other type, dry AMD or geographic atrophy, happens
when the photoreceptor cells die and cause reduced central
vision, due to thinning of the macula—the part of the
retina responsible for clear vision in your line of sight.
Dry AMD currently has no effective treatment.
With your sight at risk, people may be wondering
how to prevent nutritional deficiencies.
The most common nutritional deficiencies are: iron, iodine,
vitamin D, vitamin B12, calcium, vitamin A, and magnesium.
A balanced diet that can give proper amounts of these nutrients
should include red meat, specifically organ meat, beans, seeds,
dark and leafy greens, fish, eggs, dairy, shellfish, whole grains,
nuts, sweet potatoes and carrots, and other fruits and vegetables.
Children, young women, older adults, vegetarians, and
vegans are at higher risk of nutrient deficiencies.
Supplements might be needed if people
can’t obtain enough from just their diet.
For children, ways to encourage a healthier relationship with food
is to include encouraging healthy eating at school, not buying
junk food in bulk, educating kids about drinks with high calories,
promoting fruits and veggies at dinner, leading by example in your
own eating, starting with small portions, preventing overeating,
sticking to a meal and snack schedule, being gently persistent with
introducing nutritious food, and not totally banning junk food.
Restricting desserts or treats as a punishment can lead to an
unhealthy relationship with food, and letting them have a small amount
prevents them from being overly tempted to what they can’t have.
And as for ARFID, if you notice a child or someone you care for
only eats certain foods, to the point that you’re worried about
their health, it’s best to be non-judgemental and consult a doctor
and/or mental health professional about selective eating disorder.
It’s better to understand the situation before it
leads to vision loss and other serious health issues.
Unfortunately, the teenager from our main case today did not regain
his vision, but treatment did prevent it from getting any worse.
Avoidant-Restrictive Food Intake Disorder is a relatively
new diagnosis, so people may not have been as aware of it
and so they didn’t have the tools to support him earlier.
As for the rest of us, if you don’t want to end up with vision loss
or other problems that can be caused by nutritional deficiencies
later in life, it might be time to get some more greens on your plate.
And the next time you get a burger, remember that your choice of side
could be the difference between keeping your vision or going blind.
Just imagine they’re asking “Would you like eyes with that?”