Pagophagia (from Greek: pagos, frost/ice, + phagō, to eat) is the compulsive consumption of ice or iced drinks. It is a form of the disorder known as pica, which in Latin refers to a magpie that eats everything indiscriminately. 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. 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." It has been shown to be associated with iron-deficiency anemia and responsive to iron supplementation, leading some investigators to postulate that some forms of pica may be the result of nutritional deficiency. 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. 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. 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. Although some investigators 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. 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.
Signs and symptoms The main symptom for pagophagia is intense cravings for chewing ice. Those with pagophagia will find themselves constantly chewing on ice cubes, shaved ice or even frost from the fridge. Since a common underlying cause of pagophagia is iron-deficiency anemia, many people with the disorder will also experience weakness, fatigue, pallor, sore tongue, dizziness, headache, and cold extremities. Other symptoms associated with iron deficiency may include brittle nails, cracking at the corner of the mouth, and restless legs syndrome. Severe cases of iron deficiency can also cause the body to make up for decreased oxygen-carrying capacity of the blood by increasing cardiac output. Thus, palpitations, angina, as well as shortness of breath may also present, specially if there is a preexisting cardiovascular disease or condition. Excess water intake from any source can lead to hyponatremia and has been noted in at least one case study.
Causes
Iron deficiency Although compulsive consumption of ice is frequently associated with a deficiency of iron, the exact etiology of this form of pica is not well-understood. There is one hypothesis that states consumption of ice activates a vasoconstrictive response which causes an increase of blood flow to the brain. Because fatigue is the most common symptom experienced in iron-deficiency anemia due to decreased levels of oxygen delivered to the brain, the increase of blood flow to the brain through consumption of ice is thought to increase alertness and improve the symptoms of fatigue. In support of this hypothesis, individuals with iron-deficient anemia were found to have improved response times on neuropsychological tests than compared to healthy controls when chewing ice. Reports have demonstrated the improvement or resolution of pagophagia when given iron supplementation. People with iron-deficiency anemia who showed symptoms of pagophagia had complete resolution of their symptoms when their iron levels were treated, suggesting the association between serum iron levels and symptoms of pagophagia. In another case, an individual who presented with pagophagia was prescribed 325mg tablets of ferrous sulfate twice daily. The individual was also administered 1000mg of low molecular weight dextran over 1 hour and their symptoms of pagophagia were immediately resolved. In another case, a woman with iron-deficiency anemia related to gynecological bleeding was admitted and her dietary screening showed consumption of about 80 ice cubes per day for the past 5 years. She was given iron supplementation and her anemia was treated along with the disappearance of pagophagia within two weeks. One study looked at the relationship between pagophagia and H. pylori infection in those with iron deficiency anemia. It was found that pagophagia does not increase the risk of H. pylori infections in that specific population. In addition, H. pylori infection and pagophagia did not have a synergistic effect on the development of iron absorption abnormalities in the intestines.
Calcium deficiency Pagophagia has been often reported with calcium deficiency but its pathophysiology is unknown.
… excerpt ends here. Continue reading the full article.
