A reader writes:
This was the chief complaint of a 45-year old female. She’s been doing this for several months, but worse over the past several days. She would go into the freezer and nibble on ice cubes and ice chips constantly throughout the day. No other complaints, and does not have any other abnormal food cravings. She does report more fatigued than usual, but denies nausea, vomiting, shortness of breath, chest pain, fevers or chills. No blood in the stools nor any menstrual irregularities.Past medical history non-contributory, and does not take any medications. Physical exam unremarkable. She’s simply concerned about her “ice cravings”.
Pica is defined as an appetite for substances not fit for food, such as clay or paper products. Pagophagia is specifically pica for ice, and studies show this to be a specific indicator for iron deficiency anemia. The latter study studied 55 patients with iron-deficiency anemia. Thirty two (58%) had pica, and in 28 (88%) it manifested as pagophagia.
A blood count and iron studies were performed. Hemoglobin was slightly low, serum iron 35 (low), iron binding capacity 490 (high), ferritin 6 (low).
In patients without a concurrent inflammatory state, a ferritin level of less than 10 to 15 ng/dL is diagnostic of iron deficiency with a specificity of 99%. Thus, the findings are consistent with iron deficiency anemia.
Possible causes were discussed with the patient, including heavy menstrual bleeding – which the patient denied. Iron supplementation was started, and a colonoscopy was scheduled.
In the absence of a gynecological cause, the focus should then shift to a source of GI bleeding. A stool guaiac test would have been reasonable, but given the fact the patient was close to 50-years old (where colon cancer screening would have been initiated anyways), colonoscopy was chosen as an initial workup. If negative, an upper endoscopy can be considered to evaluate for sources of upper GI bleeding (i.e. ulcers or inflammation of the stomach, small bowel, or esophagus).
A study evaluating patients with iron deficiency anemia with upper and lower endoscopy showed 25% with a lower GI lesion, and 36% with an upper GI lesion. Peptic ulcer disease were the primary abnormalities found in the upper gastrointestinal tract, while cancer (detected in 11% of patients), was the most common finding on colonoscopy.
It’s always interesting to see what I’ve only read about in medical school.
(Disclaimer: Any pictures shown are not of the patient. All identifying features, including race, age, gender and ethnicity have been modified significantly or fictionalized.)
Similar Posts:
- Virtual colonoscopy and the message President Obama sent
- How women can benefit from oral contraceptive pills
- Poll: Is easy patient access to the medical record a good idea?
{ 363 comments }
← Previous Comments
My office mate chews ice from morning to night and I am about over the edge with it. I can’t concentrate and I don’t want to hurt her feelings. I have told her that it bothers me and she hasn’t changed her behavior. I don’t want to take away her ice because she obviously really enjoys it and maybe is addicted, but I can’t keep listening to this or I’m going to lose it. I’ve talked to my supervisor who told me to just take it away from her and tell her “it’s time to wean you now”. I know that if someone did that to me I would hate them.
Anyone who has this ice craving – what would you recommend I do to help myself and be compassionate toward her?
Perhaps you should tell her what you found on the internet. Maybe she could see her doctor about possibly being aenemic. In the meantime perhaps you could find her some crushed ice to cut down on the crunching noise.
I have been eating ice for over 5 years (since I was about 11 or 12) I am 17 1/2 and It seems to have skyrocketed, I can’t stop going into the freezer for it, my mom buys the big bags. she used to chew it when I started, now she doesn’t, but I am so addicted, it seems to also relieve my stress, I eat the round ice cubes with the holes through them, and I like when they’re white. I’m glad I’m not alone.
Cool! I’m not as wacky as I thought, thank God other people eat ice like I do. I also have fibroids & constipation, but, I had never thought about having my iron checked.
Thanks!!
I cannot believe that there are so many people with the same habit as me! This is amazing. But yea, I’m 19 yrs old and have been eating ice for 3 years. I eat a cup of crush ice everyday, but since I’m in college i have to get the big cubes and let them melt in some water then chew away. Everywhere I go I have to have a cup by my side. My family, fiends, and roommates say it’s a shame that I eat ice soo much. I have bad cravings which my mouth waters when I can’t get to ice, I also make trips to Zaxby’s (20min away) to get a cup of the small square crush ice. Those are my favorite. I am scared that I may have anemia or maybe something more serious. I know it may affect my teeth but I just can’t stop. What to do???
Hi….I live in california and I am a 2 year breast cancer survivor…if that wasn’t enough….I have this ice fixation….gotta have it…found out I was anemic….well that is great but the dr. also said you are a special case though…I said oh really why is that…well you have porhyria cutanea tarda…which means you can’t have alot of iron in your system or your lesions will get worse…oh lucky lucky me….so I am wondering what can I do….one dr. put me on iron supplements which yes…you guessed it…made the lesions worse….so went back to my oncologist…he says…we have to do blood draws to get your iron level back down so your lesions can heal…and stay out of the sun…oh boy…lucky me…I have to become a nite owl now. So the first blood draw was done..they took a pint…you talk about tired….man…and then I started to eat more ice of course…but I can’t take iron…any one have any ideas ?????
Hi my fellow ice craving junkies. During my 3rd, 4th, and 5th pregnancy, I had to have crushed ice constantly. My 5th child is now 5 and I still crave ice. I have gone through 3 ice shavers and ordering another one today. Those that like the shaved ice will love this idea. I will be ordering my 4th from the site listed below. A 16 ounce styrofoam cup (which helps keep the ice freezing cold and powdery like snow) also fits perfectly under the ice shaver. I always keep 4-6 cups in the freezer. When I get down to two cups, I start replacing my supply. I have a cup with me always and can’t even estimate how many cups I go through in a day.
http://www.hawaiianshavedice.com/snowconmac.html
I eat ice and know that it is a symptom of anemia. When I take my iron supplements, my craving for ice goes away. The only problem is taking the iron. Iron tablets are nasty little things that make all other foods taste horrible, so taking them means you know you are going to have a horrible taste in your mouth.
Not only that, I have reflux and have to take Prilosec for that. The instructions say not to take iron and Prilosec at the same time or within 1 hour before or one hour after taking any antafcid or eating egss, whole grain breads or cereal, milk, milk products, coffee or tea. So… what’s a girl to do? The only thing I can figure out to do is to take the Prilosec in the moring so I can eat my whole wheat toast, eggs, and drink my coffee, then take the iron at night before I go to bed. I hate taking the iron. I hate pills of any kind.
I go to my doctor next month and plan to ask if I can have iron injections. He told me once that we could do that as a last resort, but it was dangerous.
Wishing everyone all the best with figuring out what causes this strange eating habit. Oh… and now I’ve developed this additional strange habit of wanting to eat soda crackers. I think I could live on soda crackers, diet coke and ice for the rest of my life. That’s not a good thing.
oh my god, i eat ice all the time. I want it badly all of the time, sick part of all this is that i think it tastes delicious. i’m going to the doctor cuz i think i have pica. WOW!!
Wow! I am also an ice cruncher, I had a blood transfusion a year ago I was eating ice so bad that I would wake up in the middle of the night to eat ice, sometimes my tongue was numb and I would get little cuts on my tongue but I could not stop as soon as they gave me some blood it was not that bad, but guess what I’m back to my old habit there has to be some kind of bleeding going on mine is due to heavy periods I don’t get one from 3 to 4 months and then I get hit hard I’m weak, sleepy, fatigue and for all my friends that LOVE ICE!!! Sonic has the best ice to bad their not open 24/7 galee, we are really bad well to all take care and don’t forget to take your iron pill.
p.s
at least we won’t be attracted to vampires. lol just kidding we do have to have a little sense of humor. but please do take care it is very serious I was in the hospital for 6 days and i think the nureses don’t like it when you want ice every hour take care!
hi ,i have just read your page on ice eating ,i am simply amazed at what i have .
i too eat alot of ice ,most of my family eat ice so i thought i got it from them,i am happy to know there is a reason for this, just resently i went to the doctor ,and he said i might be anemic ,but i did not take him on ,he also sent me for a blood test witch i have not gotten as yet.
when i go to work it is realy bad ,i cannot pass by the fridge without gatting some ice ,this goes on for the whole day,somtimes i cannot wait for the ice to form i takk it also i full the tray with very little water so it will be easy to eat.all day long .i would walk the baby in the pram and i will have ice cubes in a napkin on the traay of the pram so no one will see.the frighting thing is that iaam feeling tightnest in my chest when i eat too much and this very bad,my tongue gets numb but when it cools of i am at it again,when i am home alone i put the tray on the table and take every time i pass,i too crush ice with a hammer ,so thanks form the article
Wow, and I thought I was the only one who craved ice. I’m 30 and my ice cravings started about 7 mos ago while I was pregnant. I had an anemia test done but the doc said I was “borderline” anemic, whatever that means. I LOVE ICE and even though my baby is almost 5 mos now, I still eat it constantly. I bring it with me if I can, and love to let it sit in the glass and get a little “melty” lol. Also I ate it so much the ice maker broke (oh no!) and now we have to buy bags, and the last 20lb bag we bought I ate it all and my husband went to get some ice and it was gone, and he got irritated. I told him, at least I’m not munching on chips or something!
Any comments on how to stop? Does it mess up your teeth?
WANNA HEAR A FUNNY STORY! I love eating ice, especially crushed- love the taste, the coldness and the crunchiness. So a couple days ago I went to the freezer, got some ice and put it in the food processer to crush it. Put it in the glass and took a big mouthful, yummie, right? Heck no! What I didn’t know was that my brother used the processor a few weeks ago to chop HOT chilis for his salsa. He washed it but I guess not very well. Try crunching on chili-flavored ice. I choked it was so spicy. LOL
I hate it when I go to my in-laws and they have the worst tasting ice ever. They never replace their water filter so the ice tastes like dirt. I have to stop and get a cup before we get there! Man, it could be worse…at least we’re not craving alcohol or something like that.
Ice lovers unite! I too am an ice addict. I eat several cups and trays of ice daily. I crave it as soon as I wake up, and always after eating. I will take it anytime ! I have it down to a science I have 8 ice trays at home and I make ice “slivers” by placing small amounts of water in them so I don’t damage my teeth (I never eat whole ice cubes they are too hard on the teeth). No one else can use my 8 ice trays. I agree with the one blogger their are different grades of ice. I like the freezer burn smell. I chip the ice from my sister’s old freezer because it taste and smells the best. I call that my imported ice because I actually have to drive to her house to harvest it. I am a OR nurse and we have a deep freezer for tissue storage, and every time I open that freezer I smell that sub zero ice and I want it so bad but that would be really gross. I also search the corner stores for the finest ice, some of it just crunches easier. I also eat snow off my car-it’s fluffiness is worth it- I know that’s gross too. By the way I’m anemic too my H/H was 7.3 and 24.7. I also have fibrois and flow like a stuck pig. I flow so heavy I use bladder control pads(they work wonders!). I’m going to try iron supplements again but they make me constipated and hungry, but I will try them again. I’ve been fatigued for so long I would’nt know what to do if I had energy. But I will never be too tired to eat my ice! P.S my dog loves ice too, he waits anxiously for me to drop some or give him a sliver.
I always say I could be addicted to something worse! Ice has no calories, it’s good for you and most times it’s free, you could’nt ask for a better addiction.
The only drawback is that annoys people around you. Oh well-carry on my fellow ice lovers!
Symptoms as gleaned from several internet sites
People with iron-deficiency anemia have symptoms caused by a low level of oxygen in the blood. These include:
breathlessness
tiredness
dizziness
rapid, weak pulse or palpitations
headaches
Less common symptoms can include: tinnitus (ringing in the ears
altered taste
swallowing difficulties
reduced attention span
and in children, behavior and development problems.
People with iron deficiency may also have:
pale skin
brittle nails
cracked lips
inflamed tongue
gum infections
immune disorders
Some sites say that it’s very rare that people present with pica, which is a craving for non-food substances such as ice, but I think it’s more common than studies have shown.
I was also surprised to learn from the internet that it’s not as easy to replace iron once it is lost by just eating right. One site suggested that only 10% of iron eaten would be absorbed even with normal people. Those that are under stress, have sickness, or have bodies that are other wise compromised would absorb even less.
Since I first started trying to learn more about why I eat so much ice and finding the anemia connection, I’ve found that I have all the symptoms listed above in varying degrees as well as exema and psoriasis arthritis.
Maybe making a list of all ailments would help the doctors be able to identity what causes us to eat ice. It may be something as simple as the reason we stratch when we itch, but I sure would like to know.
Hi I am also addicted to ice. I started about 4 months ago.My sister told me how good it was. I first began thinking I might could eat ice instead of food and loose weight. Not the case I eat both. Yes, it gets on the nerves of friends and family. I will only eat Sonic ice I buy a couple of bags every other day. Once I was out of town and had to eat hotel ice yuck but desperate.No one understands I enjoy and now it is a must have.When I am looking for Sonic its like someone looking to score drugs.I can’t stop.
I crave ice just recently, last month i went to the emergency hospital because i cant take this heavy menstrual problem 3 weeks nonstop bleeding, 50 thick pads is not enough for me every month like this when suddenly i feel that is not normal anymore so i decided to consult to ob/gyn then she told me u need to under go ulra sound then they found out that i have this small fibroids, and she told me 3 days before my period i should take ibufropen to lessen the heavyness bleeding, but unfortunately one month and one week to be exact since my ultra sound done my period is not come yet then i started eating ice i thougth all the while that im pregnant only the ice is my fall back just to satisfy my needs as a pregnant but sad to say im not pregnant at all,when i decided to ask my computer why i have these kind of weird feelings to eat ice even in the middle of the night before im not even drink cold water and if ever i will ask juice i will always requested to lessen the ice but now i dont know why i have this addiction to eat and chew ice, and i gain a lot of weight and my face is getting bigger like i have an allergy everybody notice my face getting blow up so please if anybody can help me to get rid of these addiction i would appreciate youre big help.. thanks from philippines..
Oh my goodness!! I’m not alone!! I am a vegetarian, and have been anemic off and on…more off than on I think, though…for years. I go through stages where all I want to eat all day is ice. This last rut I’ve been in has been going on for like 5+ months. I didn’t read all of the comments, but did anyone mention stress playing a factor, too? I’m a believer of that one…I just went through an amicable (kinda) divorce, but some really nasty after-stuff. I’ve been sooooo stressed, and I’ve noticed that when I’m stressed or upset my cravings are worse. But that could also be because I don’t eat well when I’m upset and stressed…that’s something for me to think about…. I do need to do better because my kids are picking up on my habit, too, and I don’t want them to have broken teeth among other health issues because of it.
Relief. I thought I was nuts, and that my strange host of symptoms indicated some rare and undiagnosable problem. But it all makes sense now. Over the summer I was out of the country, and my period started and would not stop. To have been able to say I was bleeding like a stuck pig would have been WELCOME. Well, for two weeks it went on, and the day after I got home to the US, I woke up to my heart beating so fast I was sure I was going to die. I went to the ER and they had to give me IVs to get my heart to slow down. The doctor asked me about any other problems. I mentioned the very heavy period, but it seemed not to be a concern of his. (Travel stress he said.) (I’m also a vegetarian but he never asked that either, and I didn’t think it had anything to do with anything anyway.) Nor did it even cross my mind to inquire as to why all of a sudden I had an insatiable desire to crunch ice. (I’m 38, and think I could count on one had the times in my life I have crunched ice.) But all of a sudden, it was like (as one poster said) a drug habit. Had to have it. Thankfully, for the next two months my period was normal (and in hindsight the ice cravings went away also during that time.) Then last month, the stuck pig was back, and for reasons I didn’t understand, I dug the ice trays out from under the cabinet. I made an OB appointment and found that I too, have a small fibroid, and low iron. Now two plus two equals four. The fibroid caused the bleeding, the bleeding caused the anemia, and the anemia triggered the rapid heartbeat and the ice pica. So glad to have come across this. Thank you all for sharing your stories.
Does anyone have a use for a commercial shaved ice machine. It makes about seven hundred pounds of the most lightly crunchy, tasty. melt in your mouth ice per day you can imagine. My wife too has anemia and steals the ice out my glass all the time and where ever we are. I’m starting to get use to warm ice tea when we go out for dinner. She likes the ice from our refrigerator it’s closer.
today is friday 9th december 2005.i posted my comment two weeks ago about my craving for ice ,and i was modt amazed about the reason why i eat so much ice,so on friday last 2nd december 2005 i went to the drug store and i bought viatmin b 12 with iron and i have not eaten ice the way i normally do,for this week i have not craved it.and that is the truth.i enjoyed this week alot no ice .i realy feel lively ,my joints does not feel stiff.hats off to the person who dicovered this amazing fact about ice and anemia
the time is now 12:04pm
Wow some common themes here. Just spent the last 20 min. reading over these posts. I’ve been eating ice fiendishly for about a month now…preferably finely crushed and a bit “aged” (after a bag of crushed has been in my freezer for 2 weeks it gets lighter, fluffier almost…sort of more porous and turns white like frost instead of clear.) Anyway, I have endometriosis, diagnosed at stage 4 by lap. surgery last spring. I’m also constantly tired to the extreme of sleeping sometimes 14 hours per day…straight. Guess I should have my iron levels checked. Neat website. Karenina
I was very happy to see what ice eating can do to you. I’m eating ice for the past 12 years now, my ob/gyn told me it was ok, he said it’s ice, so it’s water, no problem, but co-worker told me it was not something good I was doing. I have heavy periods each month, my periods looks like liver, you would want to eat live again if you see my periods. I’m eating a 24 ozs cup of ice at this time, typing this letter. One of my friends at work want to get me a gift for christmas, so she told me she was going to give me a bag of ice instead, but this seem to be a very serious case. I’m glad I pulled this topic on the Internet.
Can someone tell me, what kind of Iron pill to use.
HI,
I too am glad to find this site, as an avid “ice” eater it is nice to know that I am not alone. I have been anemic at least two times in the last year the first time I recieved injections of venofur, which really helped. The doctor has been reluctant to use it this time. My hbg. has been dowon to 9. which is not horrible butthat along with my diabetes and sarcoidosis is making my life miserable. Especially since fatigue goes along with all three problems. I’m not producing red blood cells at the rate that I’m supposed to so that I will stay in a normal area. I have not been normal since July. Taking ferrous sulfate doesn’t seem to help. can’t eat liver as it gives me gout. Really frustrated there is so uch that I want to get done and just have no energy.
← Previous Comments
Comments on this entry are closed.