Maybe its the flavor? Have you tried any other flavor besides vanilla? I have tasted it in the past and I have to agree. NASTY stuff. I would be gagging too. I hope you find the answer you are looking for and that she starts keeping it down better. The only time we gag with it is when Amanda is constipated and full. Then she starts gagging. But she is tube fed and has a nissan. So she really can't get much up anymore.