She happened to mention, “he has pica” – so, all sorts of non-food things have to be kept out of his reach lest he eat them or chew them. Well, he can’t chew, she explained. He doesn’t have teeth, so all his food is pureed.
No teeth at all. Why no teeth, I asked. Did they all rot? Did he lack access to dental care at some point? Does he have poor immune function? My friend wasn’t sure because the teeth were gone when she began working with this man, but she implied his teeth were removed because of his pica “behavior”.
Somewhere along the way, apparently, it was decided that the best solution to this behavior was to remove all this man’s teeth.
I hope this isn’t true. I’m hoping there is a reasonable explanation for why this individual no longer has any teeth other than ignorance on the part of a physician or dental surgeon somewhere – but my friend confirms that this disabled man’s primary care doctor has told them that pica is purely a behavior.
Not exactly. Pica is a well-known clinical sign of iron deficiency anemia. It can also indicate other mineral imbalances or deficiencies – like zinc or magnesium deficiency, or copper or lead toxicity. Mouthing or chewing objects is expected for teething babies, or during the developmental phase when oral exploration is key. Beyond that, persistently eating things that aren’t food – erasers, dirt, sand, rocks, clay, metal objects, plastic, wood, ice - should be regarded as a flag for iron deficiency anemia, zinc deficiency, or mineral imbalances for magnesium, copper, lead, cadmium, or manganese. Could it be in this day and age that such a fundamental tenet of nutrition was overlooked? Or even more crazy, that it might have cost a developmentally disabled adult who can’t speak for himself every tooth in his head?
Was this man’s suffering avoidable? Well, it’s simple to screen for mineral imbalances by checking clinical signs and lab studies. My friend tells me she has no idea if anyone ever did this for this man. It can be relatively straightforward to correct them with the right nutrition measures. When this is done, pica “behavior” can resolve or improve – as can other behaviors that attend mineral deficits or toxicities, like aggression, attention deficits, criminality, or even schizophrenia.
Pica can mean that minerals necessary for learning, growth, behavior modulation, and development are not fully on board, or that they have been displaced by toxic minerals instead. It’s most common in people with developmental disabilities, including autism – not a coincidence, in my opinion. Neurotoxic effects of excessive lead, cadmium, copper, or mercury are well known; costs of deficiency for essential minerals in utero or early in life are old news too. Stunting, learning delays, behavior problems, attention deficits, and lower IQ have all been linked to pica and/or mineral imbalances. Pica can also predispose people to greater lead exposure, for two reasons: They may ingest objects containing lead; and, the lower one’s iron status is, the easier it is to absorb more lead, with any exposure.
Before it’s assumed that eating weird stuff is just a behavior – especially in a developmentally or learning disabled person – a doctor should do a full iron study. Blood work should assess ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin, and hematocrit. Your doctor might look at red blood cell shape, size, and number to fully rule out anemia or pre-anemia. Reference ranges for iron parameters are wide.
Children should fall solidly in the middle of the ranges for ferritin and serum iron. Teetering at either edge of the range, high or low – at least for me as a nutritionist – would prompt me to do more looking at the problem. Marginal iron markers often go hand in hand with inattention, insomnia, picky appetites, or behavior and learning deficits. It is also wise to check serum copper, serum zinc, and ceruloplasmin (a copper transport protein in the blood), to rule out toxic levels of copper. Copper circulating unbound in serum can become neurotoxic, while ceruloplasmin will safely transport this mineral for us. Adequate zinc status can keep copper levels in check.
Clinically, pica with iron deficiency can present as craving and eating pebbles, ice, sand, dirt, clay or metal objects, while pica with zinc deficiency might lean toward a child chewing fabric, clothing, erasers, wood, or pencils, and clenching and grinding teeth often, in sleep or when awake. This has been my own clinical observation in children, at least.
One caveat: If iron supplementation is warranted per your provider’s advice, make sure your child is not ill, febrile, or has active infections, including gut candida infections. Microbes love iron, and will thrive when it is supplemented – which can make your child feel some GI discomfort at the least, or worsen a fever, trigger pain, and worsen behavior outbursts. Iron is also poisonous at the wrong dose, so only use supplements with professional guidance.
For more signs of how mineral deficiencies present clinically, see Special Needs Kids Eat Right. This is a potentially easy nutrition fix that is worth the effort. Check status of all essential minerals and rule toxic mineral exposures, to really know if pica has a physiological underpinning. Toxic minerals don’t remain in whole blood for long, so a knowledgeable practitioner may want to check hair or packed red blood cell elements to more accurately assess presence of toxic metals. Optimal mineral balance means optimizing many metabolic and neurotransmitter pathways in the brain for learning, processing, and emotional regulation – something that will benefit any person with a developmental disability.
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