Physical examination revealed moderate pallor and chipped and abraded teeth due to eating her pica substances. She often developed abdominal pain after eating large amounts of uncooked basmati rice. She reported having pica for uncooked milled basmati rice (the most popular rice in Karachi and her usual rice in the USA), drying cement, and dirt. A 44-year-old woman, a native of Karachi, Pakistan, presented with fatigue, dizziness, cold intolerance, hair loss, and decreased growth and thinning of nails. Laboratory results in two women at diagnosis of iron deficiency 1. Other manifestations (except tooth damage) resolved after completion of iron dextran therapy. Pica resolved after the first infusion of 500 mg of iron. She was intolerant of oral iron supplements and thus was treated with intravenous iron (1500 mg Fe, total). Her iron deficiency and microcytic anemia (Table 1) were attributed to menorrhagia and multiparity.
Physical examination revealed moderate pallor and several teeth chipped by eating uncooked rice. She reported that her mother, grandmother, and other women in Mumbai also craved uncooked basmati rice. She often developed abdominal pain after eating large quantities of uncooked rice. This manifestation had occurred for many years and was more intense during pregnancy. She reported pica for uncooked milled basmati rice, the predominant local rice in Mumbai and her usual rice in the USA. A 39-year-old woman, a native of Mumbai, India, presented with severe fatigue and hair loss. We discuss particular aspects of basmati ryzophagia in the context of the two present women and review ryzophagia in adults of European and non-European ancestry and its relationships to iron deficiency, pregnancy, race/ethnicity, local traditions, geographic origin, and other conditions. We report the evaluation and treatment of two women with iron deficiency, one from India and the other from Pakistan, who developed pica for uncooked basmati rice. Although pica for uncooked rice (ryzophagia) has been reported in nonpregnant adolescents and adults with iron deficiency and in pregnancy, other aspects of ryzophagia are undescribed. Pica items in adults with iron deficiency are diverse, typically contain little or no absorbable iron, and vary according to personal choice, race/ethnicity, culture, item availability and convenience, and geographic location. In adults, pica for items not part of one’s habitual diet or preferences is a common but incompletely understood accompaniment of iron deficiency and pregnancy. Pica is the compulsive, repetitive eating of nonfood substances or large amounts of specific foods or condiments daily for more than one month. We conclude that adults with ryzophagia in European and derivative countries are likely to be non-Europeans.
We review and discuss other reports of ryzophagia associated with iron deficiency, pregnancy, race/ethnicity, geographic origin, and local traditions.
Ryzophagia and other manifestations (except tooth damage) resolved after iron dextran therapy. Both women had tooth damage due to eating uncooked rice and iron deficiency with microcytic anemia attributed to menorrhagia and multiparity. Basmati was the local rice in their native countries and their usual rice in the USA. One woman was from India and the other was from Pakistan. Both women reported fatigue, abdominal discomfort after consuming large quantities of uncooked basmati rice, and hair loss. We evaluated and treated two nonpregnant women with pica for uncooked basmati rice. Reports of pica for uncooked rice (ryzophagia) in adults who reside in European and derivative countries are uncommon.
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