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. 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.
Although some investigators 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.
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.
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.
Psychological and physiological distress
In several cases, pagophagia has been associated with certain psychological conditions such as compulsive behavior or depressive disorder where pagophagia was used as a coping mechanism to deal with psychological stress. Some suggestions for other causes of pagophagia include hunger and gastrointestinal distress related to ways the body attempts to ease the stress.
Other known risk factors for pica include "stress, cultural factors, learned behavior, low socioeconomic status, underlying mental health disorder, nutritional deficiency, child neglect, pregnancy, epilepsy, [and] familial psychopathology."
In one case report, a 42-year-old woman presented with complaints of freezer frost and eating ice. She developed a habit of eating 10 to 12 ice cubes and freezer frost each day, and eventually increased her consumption to 25 to 30 ice cubes each day. Her medical assessment revealed no past or family history of any chronic psychiatric disorder or physical disorder. Her hemoglobin, serum calcium, and stool examination were normal. One suspected cause of her pagophagia was psychological stress, the stressor being her son's annual examinations. The woman was previously prescribed venlafaxine 50mg and vitamin B-complex for two to six weeks but with no improvement. The doctor initiated fluoxetine 20mg daily for her and the venlafaxine was tapered off. The dose was increased to 30mg after three weeks and counseling and behavioral treatment was given. Her pagophagia resolved after four months. Along with this case, previous reports have shown selective serotonin reuptake inhibitors effective in treating pagophagia. Counseling and behavioral strategies such as positive and negative reinforcement should be utilized for people with psychiatric conditions.
Due to the relation between pagophagia and iron deficiency anemia, diagnosis begins with obtaining a medical history, a physical exam as well as blood tests that includes a complete blood count and additional tests to determine levels of hemoglobin, hematocrit, serum iron, and ferritin, a protein that helps the body store iron. In individuals that are anemic, the tests would show results with lower than normal levels which would then confirm the diagnosis. If a blood slide is ordered by the doctor, it may show red blood cells that are smaller and paler than normal cells. In the case of severe iron deficiency, white blood cell count may also be low. A case series of pagophagia in men with iron-deficiency anemia concluded "that pagophagia occurred in 34% of men with iron-deficiency anemia." Men who were older and had higher platelet counts were less likely to have pagophagia compared to younger men and those with lower platelet counts.
Pregnancy
In women, pica is "most often seen during pregnancy," with estimates of 27.8% of pregnant women experiencing pica, but pica prevalence and manifestation is culturally and geographically heterogenous. A study of pica in pregnant Mexican-born women living in either the United States or Mexico found differing rates of pagophagy between the two groups.
Children
A meta-analysis of the prevalence of pica in German children found that 12.3% of German children "have engaged with a pica behavior at some point in their lives," but did not specify the types of pica observed.