You Eat What?!
Think an insatiable yen for potato chips is hard to live with? Imagine craving chalk, paper, even ashes. Inside the strange world of the dietary disorder known as pica.
Every week, there’s a meal waiting inside Caitlin Woodruff’s mailbox. She’s not mail ordering fruit baskets or Maine lobsters. This treat is stuffed inside Woodruff’s copy of The New Yorker.
“I eat paper,” says the 35-years-old San Francisco consumer-electronics marketer. “I eat one New Yorker subscription card a week. I like the white parts without ink the best. I call it the white meat. Mmm.”
Most people would find Woodruff’s taste for card stock bizarre, but those driven by similar strange cravings know where she’s coming form. Woodruff has a disorder called pica, the compulsion to eat nonfood products like dirt, clay or hair.
Because many people are ashamed of their habit, solid numbers are hard to come by, but researchers are discovering that pica may be more prevalent than once thought according to one study in The American Journal of Maternal/Child Nursing, and affects more (mostly young) women than men.
A curious compulsion
Woodruff’s passion for paper is typical of pica suffers, who also yearn for ice, cornstarch or chalk. (Pica is the Latin word for “magpie,” a bird known for its odd eating habits.) Some people eat even less palatable things, such as cigarette buttes, sponges and rocks. Most have a hankering for one item, as does Lenna Martyak, a 31-year-old medical resident in Los Abgeles, who hungered for chalk throughout high school. “I was very aware that it was white chalk I needed,” she says.
In some instances, pica starts in childhood. Woodruff’s desire for paper began when she learned to read. “I’d tear off the corners of pages and eat them,” she says. Eventually, she moved on to magazines, “My family would joke, Caitlin got the TV Guide again you can’t tell what’s on television tonight.”
Woodruff is an anomaly in that, unlike most people known to have pica, she doesn’t live in a rural or poor area. Among women in these groups, myths, about dirt and clay improving fertility persist, which may encourage the behavior. Nor did Woodruff’s disorder worsen during a pregnancy. (Pregnancy often triggers pica.) One study of expectant mothers in groups at high risk for pica found that 38 per cents had the disorder. Researchers suspect there’s also a genetic predisposition: Statistics show women who have a sister or aunt with the disorder are more at risk of developing it themselves.
An elusive cause
The explanations for pica are as numerous and varied as the substances victims long for. The leading idea is that pica is set off by a mineral deficiency. Heath issues that affect women pregnancy, breast feeding, menstruation can sap the body of nutrients such as iron and zinc. Research suggests that up to 50 per cent of sufferers don’t get enough iron and that supplements may relieve cravings. Some experts think this is the reason people with Crohn’s disease are also at risk; the chronic inflammatory bowel condition causes victims to lose blood (and nutrients). A flaw in this theory, however, is that the substances these individuals desire usually do not contain the needed nutrients.
Supplements don’t always relieve the urges, either. This fact has led to other theories, such as that pica is behaviorally based, possibly form of obsessive compulsive disorder. Those affected say they’re unaware of what they’re doing, and they’re caompelled by a strong psychological need. Martyak says eating chalk wasn’t about the flavor. “It was bland,” she says. “I feel better because I’d given into the craving.”
Perhaps most strange is the extremely small group of people who way be purposefully consuming indigestible things, which has led some experts to believe the condition could be linked to eating disorders. These individuals may consume wood or pebbles to feel full without gaining weight, explains. Dr. Rose, an associate residency director at the North Oakland Medical Centers in Pontiac, Michigan. That’s part of the motivation for Sara, a 20-year-old homemaker in Orlando, Florida. “I don’t eat a lot of food,” says Sara, who at 5 feet 5 inches weighs less than 100 pounds. And just tasting things like baking soda or chalk can settle the food craving yet keep my stomach empty so I lose weight.”
In most cases, however, pica results in weight gain. Pica substances can be very high in calories: Cornstarch has 480 per cup. What’s more, those with the condition are also at risk for malnutrition because they consume dirt or chalk in place of healthy, nutrient rich foods, Dr. Rose says.
Secrecy and shame
Most people who suffer from pica never seek help. But while eating small amounts of digestible, nontoxic substances such as chalk or paper is mostly harmless, pica is most individuals with pica don’t see it as a problem.” Dr. Rose says. The habit is potentially deadly, however. “I also eat cigarette ashes and dirt,” Sara admits.
Carcinogens in cigarettes could increase the risk for cervical and colon cancers when ingested. Soil is loaded with pesticides and parasites, which can be toxic, while eating hair may case blockages in the intestines or bowels, says Jeff Hampl, PhD., a dietitian in Mesa. Arizona, who have pica. Even less harmful substances can be risky: people can suffer heartburn and indigestion form substances such as dust or break their teeth chewing on pebbles.
Still, for many, one of the biggest side effects is emotional. Until now. Sara has kept her pica a secret. “I’m so ashamed,” she says.
“I’m like a child sneaking batter from the bowl when no one’s looking.” It’s not surprising that more than 90 per cent of sufferers go undiagnosed.
Some of the others just get lucky; they’re found out or cured accidentally, like Martyak, whose urge for chalk eased when she was treated for iron-deficiency anemia related to Crohn’s.
“Doctors think to ask about it when people have other complications, like lead poisoning from eating paint.” Says Dr. Rose who has learned to play detective, gently pressing patients to confide in him. “I start out asking about eating ice because people will admit to that,” he says. It’s worth telling you physician if you eat odd items, Dr. Rose adds, because pica can be treated. Doctors typically suggest nutritional supplements and behavior therapy. In severe cases, antidepressants such as Prozac may be recommended to rectify an imbalance in brain chemicals, which in turn helps relieve cravings.
The disorder may also go away on its own, as it often does for pregnant women after they’ve given birth and for some who developed the condition in childhood. Woodruff used to eat up to a page a day, but “I don’t do it as much anymore,” she reports.
“I’m horrified of ruining books.” But she isn’t giving up her New York subscription just yet.