Pica is highly prevalent among men in Madagascar

Turns out pregnant women aren’t the only ones who eat dirt. A new study reveals a surprising incidence of picacraving and consuming nonfood substancesamong men.

Conducted in Madagascar, where pica is common, the research is the first to identify a population where the practice is highly prevalent among men, the scientists say. In fact, the men in the study ate nonfood items at least as much as pregnant women and adolescents, whom previous case studies had shown to be the main pica practitioners.

So why this sudden appearance of pica-practicing men?

“My guess, which is not substantiated, is that prior research study designs may have ignored men in their study samples as an artifact of studying pregnant women,” said study author Christopher Golden, an eco-epidemiologist and National Geographic Society Conservation Trust grantee.

Pica researcher Laura Beatriz López, nutrition director at the University of Buenos Aires, agreed.

“Traditionally studies of geophagy [eating earth] and pica have focused on describing the prevalence in children and pregnant women,” López wrote in an email, which has been translated from Spanish.

“Personally, I think the work is pioneering,” she said, because it reveals “such a high prevalence of pica in men and also found no significant differences with women.”

Golden and colleagues—advised by Cornell nutritional anthropologist Sera Young—surveyed pica behaviors in a random sample of 760 people in 16 villages of Madagascar’s Makira Protected Area in 2009. (See Madagascar pictures from National Geographic magazine.)

The study subjects—male and female—identified eating 13 nonfood substances, including sand, soil, chicken feces, uncooked rice, raw cassava root, charcoal, salt, and ash, according to the new report, which appeared Wednesday in the journal PLOS ONE.

More than 53 percent of the survey respondents reported engaging in pica. For adult men alone, that number was 63 percent.

Bucking the stereotype, less than one percent of nonpregnant women said they ate any nonfoods only during pregnancy.

Many people reported eating nonfoods for their healing powers, especially for stomach troubles, Golden said. And many believed that pica would bring good luck for better overall health.

Previously, scientists had suggested people practice pica for two reasons: to fulfill a deficiency of trace minerals in their diet and to cleanse and deworm the intestinal tract.

The nutrition theory would make sense for pregnant women and children, whose dietary needs are greater those of the rest of the population.

Even so, there’s no evidence that the human body can actually absorb trace minerals from soil, said Golden, adding that pica “may not serve any health purpose.”

The University of Buenos Aires’s López added that the cultural norms of Madagascar contribute to the high rate of eating inedible substances. For instance, many Malagasy don’t consider eating raw starches, such as uncooked rice, to be a form of pica.

Pica, study co-author Golden emphasized, “is not exclusive to rural populations in developing countries.”

For example, many Americans do it, Golden said, and he speaks from experience. “A close college friend of mine,” he said, “is a frequent consumer of chalk.

“It is very prevalent, yet stigmatized, and thus underreported.”

Added Cleveland Clinic psychologist Susan Albers by email: “Pica is an eating disorder that gets far less attention and research than other eating disorders such as anorexia and bulimia, yet it is important, as it can lead to significant health consequences, due to the possibility of consuming toxic substances.

“We’ve seen more attention on men and eating disorders over the last few years,” Albers said. “This study notes the importance of further research on men and pica and making sure they are adequately represented in the sample.”

Study co-author Golden said he isn’t quite ready to label pica an eating disorder, since it’s not yet clear whether the practice is harmful. But he agreed that more pica research is needed, especially among men.

The new Madagascar study may be a big step in that direction. To Golden, the discovery “opens up this whole field of research, to have fellow researchers acknowledge both men and women in their studies.”

More: “Why People Eat Dirt”—interview with Christopher Golden >>


PICA: Woman Eats 4,000 Sponges


A DENTAL nurse told yesterday how she has EATEN 4,000 washing-up sponges due to a rare disorder.

Kerry Trebilcock, 21, has also munched more than 100 bars of SOAP.

She suffers from pica, which causes victims to crave objects that are not food.

Kerry, of Mylor, Cornwall, said: “One day I will beat this and be able to have a shower or do the washing-up without feeling hungry.”

Sponge eater Kerry said she likes to spice up her bizarre snacks with hot sauce or mustard.

Sometimes, she dips them in tea or hot chocolate like biscuits.

She also chomps on chunks of soap — but only organic fruit-flavoured varieties, with lemon and lime her favourite.

Kerry said: “I have been very particular about the type of sponges and soaps I’d eat and how I’d prepare them.

“If I went out for the day I’d carry a small plastic bag of cut-up pieces of sponge with some tomato and BBQ sauce in Tupperware. I was never without a ‘snack’.”

Other pica sufferers eat metal, coal, sand, chalk — or even lightbulbs and furniture.

Petite Kerry, who weighs just 8st, has endured shocking stomach cramps, constipation and diarrhoea.

And although she has cut down on her sponge munching, she has been unable to totally shake the condition.

At one point Kerry was eating five a day topped with hot relish, BBQ sauce, ketchup, mustard, jam or honey.

She said: “The sauces and dipping the sponges in drinks softened them — and I’d chew them until the flavour was gone. Then I would swallow the sponge.”

Sponges are commonly made from cellulose wood fibres or foamed plastic polymers.

Organic soap contains olive or palm oil, glycerin and plant scents, plus oatmeal to lift off dead skin.

Kerry’s eating habits changed after a holiday to Morocco in 2008, during which she picked up an infection of hookworm, a parasite that lives in the small intestine.

At first, she began craving junk food. But then something strange happened.

She said: “After one dinner where I ate a double helping of lasagne and a tub of ice cream, I still felt hungry.

“To distract myself, I decided to wash the dishes. I took out a new sponge from a packet and had an overwhelming desire to eat it.

“I sat down with a glass of water and chewed the sponge until it was gone.

“It tasted of nothing but I found eating it enjoyable.

“Finally my hunger was gone and my stomach felt satisfied.”

Afterwards, though, she felt embarrassed and scared — and cried herself to sleep.

But the next morning, as she washed herself with lemon and lime soap, she had an urge to eat some and swallowed a chunk.

She said: “I knew something was very wrong with me but I didn’t want to tell anyone as I felt like a freak. But after a week I’d eaten nine sponges and over a pound of organic soap.”

Her hookworm infection was diagnosed by her GP but she kept quiet about her cravings in case he thought she was mad.

She said: “I would go to the supermarket and buy over 40 sponges and different types of organic soap.

“It made me hungry just smelling all the different soap products in the cleaning aisle. The cashiers joked that I must love cleaning!”

Kerry, who also eats normal food, finally confided to a friend in 2009.

And after seeing the doctor again, she was told she had pica and could seriously damage her digestive system.

A programme of counselling and vitamins has set her on the road to recovery. And she is determined to succeed. But it is a slow and arduous process.

Kerry said: “I still have a one-inch square of sponge and three teaspoons of organic soap with each meal.

“But I am making progress and speak to other sufferers of pica on internet forums, which helps.

“There are some out there far worse than me who eat car tyres, spoons and even sofas.”

Kerry is trying to curb her pangs with Floral Gum sweets.

She said: “They taste like soap so they help me get the flavour I desire without doing any damage. I know one day I will beat this.”

Kerry’s student sister Jody, 20, told how the family initially found her sponge munching hard to understand.

She said: “Watching her eat a sponge or soap was extremely weird. But Kerry has educated us all about pica.

“I’m so proud she has worked hard to fight this condition and is recovering through counselling.

“She is really brave to talk about it so openly.”