Deep learning-based food recognition has made significant progress in predicting food types from eating occasion images. However, two key challenges hinder real-world deployment: (1) continuously learning new food classes without forgetting previously learned ones, and (2) handling the long-tailed distribution of food images, where a few common classes and many more rare classes. To address these, food recognition methods should focus on long-tailed continual learning. In this work, We introduce a dataset that encompasses 186 American foods along with comprehensive annotations. We also introduce three new benchmark datasets, VFN186-LT, VFN186-INSULIN and VFN186-T2D, which reflect real-world food consumption for healthy populations, insulin takers and individuals with type 2 diabetes without taking insulin. We propose a novel end-to-end framework that improves the generalization ability for instance-rare food classes using a knowledge distillation-based predictor to avoid misalignment of representation during continual learning. Additionally, we introduce an augmentation technique by integrating class-activation-map (CAM) and CutMix to improve generalization on instance-rare food classes. Our method, evaluated on Food101-LT, VFN-LT, VFN186-LT, VFN186-INSULIN, and VFN186-T2DM, shows significant improvements over existing methods. An ablation study highlights further performance enhancements, demonstrating its potential for real-world food recognition applications.