Pagophagia

Pagophagia
An ice cube resting on a white surface
SymptomsCompulsive consumption of ice
ComplicationsDental injury, worsening iron deficiency or other micronutrient deficiency, hyponatremia
CausesUnknown etiology
Risk factorsIron-deficiency anemia, psychological distress, pregnancy
Diagnostic methodBased on signs and symptoms presented and blood tests such as a complete blood count
TreatmentIron supplementation

Pagophagia (from Greek: pagos, frost/ice, + phagō, to eat[1]) is the compulsive consumption of ice or iced drinks.[2] It is a form of the disorder known as pica, which in Latin refers to a magpie that eats everything indiscriminately.[3] Pica's medical definition refers to the persistent consumption of nonnutritive substances, ice in this case, for over a period of at least one month.[3] However, different studies have included alternative definitions for pagophagia, including "daily consumption of 2–11 full glasses of ice (480–2640 g)" or "the purposeful ingestion of at least one ordinary tray of ice daily for a period in excess of two months."[4] It has been shown to be associated with iron-deficiency anemia[5] and responsive to iron supplementation,[6][7] leading some investigators to postulate that some forms of pica may be the result of nutritional deficiency.[8]

Similarly, folk wisdom also maintained that pica reflected an appetite to compensate for nutritional deficiencies, such as low iron or zinc. In iron deficient pregnant women who experience symptoms of pagophagia, decreased cravings for ice have been observed after iron supplementation.[9] Later research demonstrated that the substances ingested by those who have pica generally do not provide the mineral or nutrient in which people are deficient. In the long run, as people start consuming more nonfoods compulsively, pica can also cause additional nutritional deficiencies.[9]

A hypothesis of the neurological basis of pagophagia was proposed in a 2014 study in which those with iron deficiency anemia were shown to have improved response times while performing on a neuropsychological test when given ice to chew on. As a result, the researchers hypothesized that chewing on ice causes vascular changes that allow for increased perfusion of the brain, as well as activation of the sympathetic nervous system, which also increases blood flow to the brain, allowing for increased processing speed and alertness.[10]

Although some investigators[8] also hypothesize that chewing ice may lessen pain in glossitis and stomatitis related to iron-deficiency anemia, the specific pathophysiology is still unknown and this hypothesis remains controversial.[11] The American Dental Association recommends not chewing ice as it can lead to dental injury and suggests that ice should be allowed to melt in the mouth instead.[12]

  1. ^ " pagophagia at The Free Dictionary
  2. ^ Parry-Jones, B. (1993). "Pagophagia, or compulsive ice consumption: a historical perspective". Psychol Med. 22 (3): 561–71. doi:10.1017/s0033291700038022. PMID 1410082. S2CID 40619187.
  3. ^ a b Diagnostic and Statistical Manual of Mental Disorders. Psychiatry Online: American Psychiatric Association. 2014.
  4. ^ Cite error: The named reference :4 was invoked but never defined (see the help page).
  5. ^ Borgna-Pignatti, Caterina; Zanella, Sara (2016). "Pica as a manifestation of iron deficiency". Expert Review of Hematology. 9 (11): 1075–1080. doi:10.1080/17474086.2016.1245136. ISSN 1747-4086. PMID 27701928. S2CID 19221253.
  6. ^ Ilan Brat (2008). "Chew This Over: Munchable Ice Sells Like Hot Cakes". Wall Street Journal. Retrieved 2008-01-31.
  7. ^ Osman YM, Wali YA, Osman OM (2005). "Craving for ice and iron-deficiency anemia: a case series from Oman". Pediatr Hematol Oncol. 22 (2): 127–31. doi:10.1080/08880010590896486. PMID 15804997. S2CID 34338417.
  8. ^ a b Reynolds, Ralph D. (1968). "Pagophagia and Iron Deficiency Anemia". Annals of Internal Medicine. 69 (3): 435–440. doi:10.7326/0003-4819-69-3-435. ISSN 0003-4819. PMID 5244572.
  9. ^ a b Gavin, Mary L., MD. Pica. KidsHealth for Parents. December 2007.
  10. ^ Hunt, Melissa G.; Belfer, Samuel; Atuahene, Brittany (2014). "Pagophagia improves neuropsychological processing speed in iron-deficiency anemia". Medical Hypotheses. 83 (4): 473–476. doi:10.1016/j.mehy.2014.07.016. ISSN 0306-9877. PMID 25169035.
  11. ^ Mesa, Ruben, MD. Craving and chewing ice: A sign of Anemia?, MayoClinic.com.
  12. ^ The American Dental Association. Chew on This: Crunching Ice Can Be Bad for Your Teeth. colgate.com, 2006.