Health Talk: Pica

Michel Lotito, a French entertainer, is famous for consuming nonfood items, and is known as Monsieur Mangetout (Mister Eat Everything).
His performances include the consumption of metal, glass, and rubber parts of items such as bicycles and televisions, as well as a Cessna 150 aircraft that he disassembled, cut up, and swallowed.

The Cessna 150 took roughly two years to be “eaten,” from 1978 to 1980. Lotito began eating unusual materials as a child and has been performing this publicly since 1966. Although it has brought him fame, Lotito’s seemingly unusual talent is known as a disorder called pica.
Pica is an eating disorder where the patient craves and eats nonfood substances such as paper, chalk, ashes, hair, starch, dirt, cigarette butts, and even feces.

According to The Diagnostic and Statistical Manual of Mental Disorders, pica is classified as a childhood disorder, although it is known to affect pregnant women as well. Pica can be diagnosed after a person shows symptoms for more than one month at an age where eating such objects is considered developmentally inappropriate.

Infants and toddlers are typically excluded from this diagnosis since mouthing nonfood substances is a normal developmental behavior at that age. Individuals with mental retardation who function at or below an approximate cognitive level of 18 months may also be excluded.
Pica can be diagnosed with a direct report from the patient or from another individual, usually a parent. There are also a few tools that can help assess symptoms of pica.

For example, imaging studies can reveal intestinal blockage with solid substances that cannot be digested or dissolved, such as nuts and bolts.
Additionally, a biopsy of intestinal contents can reveal a parasitic infection, and a blood test can reveal abnormal levels of minerals or chemicals in the blood.

The condition’s name comes from the Latin word for the magpie, a bird which is reputed to eat almost anything.
Evidence suggests that there may be several causes of pica. Several reports have described pica in individuals with iron deficiency, but there is some uncertainty as to which comes first: the pica or the iron deficiency.

Some substances like clay are believed to block the absorption of iron into the bloodstream; it was once thought that low blood levels of iron could be the direct result of pica.

However, some studies have shown that pica cravings in individuals with iron deficiencies stop once iron is given to correct the deficiency. Another study compared the rate of iron absorption in a pica patient’s body to that in the body of a person with normal dietary behavior. The study showed that iron absorption was not decreased by pica.

In addition, low blood levels of iron commonly occur in pregnant women and those with poor nutrition, two populations at higher risk for pica. Such findings offer strong support that iron deficiency is a cause, rather than a result of pica. Other reports suggest that pica may have a psychological basis and may even fall into the category of obsessive compulsive disorder.Pica is also common among populations with impaired mental functioning.

These conditions include psychiatric disorders like schizophrenia, developmental disorders including autism, and mental retardation. These conditions are not characterized by iron deficiency, which supports a psychological component in the cause of pica. Cultural and religious traditions may also play a role in pica behavior. In some cultures, nonfood substances are believed to have positive health or spiritual effects.

Regardless of the cause, patients suffering from pica often do not present their condition publicly. Complications that can arise from pica include constipation, cramping, pain, obstruction caused by formation of an indigestible mass, perforation from sharp objects like rocks or gravel, and contamination and infection from soil-dwelling parasites.

Most cases of pica do not have an obvious medical cause, so many medical professionals prefer to treat patients with counseling, education, and nutritional management rather than medication. And, more often then not, such alternative treatments are more successful and more appropriate than treatment with medication.

Some alternative treatments include training that helps patients differentiate between edible and non-edible items, in addition to self-protection devices that prohibit placement of objects in the mouth.

Others include making negative associations with the consumption of non-food items, like altering an item’s taste with lemon, smell with ammonia, or touch with water mist.

By using such unpleasant or punishing stimuli, patients often modify their behavior. According to Lotito, certain foods like eggs and bananas make him sick, and therefore he sticks to his metal and glass diet.
Fun fact: Lotito ate around nine tons of metal from 1959 to 1997.