Geophagia- earth-eating

                                         Geophagia- earth-eating

    Geophagia is defined as deliberate consumption of earth, soil, or clay. From different viewpoints, it has been regarded as a psychiatric disease, a culturally sanctioned practice or a sequel to poverty and famine. 

   Prompted by a remarkable case in our own practice. we became increasingly aware of geophagia in contemporary urban South Africa. In view of the high prevalence of geophagia there and in many other regions of the world, we hypothesized that ancient medical texts would also contain reports of the disorder. To our surprise, geophagia was indeed reported by many authors ranging from Roman physicians to 18th-century explorers. Here we present, together with a brief description of the disorder, some of the most remarkable examples.

      From a psychiatric point of view, geophagia has been classed as a form of pica a term that comes from the Latin for magpie, a bird with indiscriminate eating habits. In its Diagnostic and Statistical Manual, the American Psychiatric Association defines pica as persistent eating of non-nutritive substances that is inappropriate to developmental level, occurs outside culturally sanctioned practice and, if observed during the course of another mental disorder, is sufficiently severe to warrant independent attention.

   Geophagia denotes the habit of eating earth, soil or clay and is not uncommon in southern parts of the United States as well as urban Africa. Fine red clay is often preferred. In particular, geophagia is observed during pregnancy or as a feature of iron-deficiency anemia. Where poverty and famine are implicated, the earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is often observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized. Finally, geophagia is encountered in people with learning disability, particularly in the context of long-term institutionalization; in this regard, geophagia and other forms of pica are associated with a high rate of complications and substantial morbidity and mortality. 

  Geophagia has also been reported to serve specific purposes, for example, young women in urban South Africa believe that earth eating will give them a lighter color and soften their skin. There is a reason to believe that geophagia often goes unrecognized by doctors because patients are reluctant to volunteer the history. Indeed, stigma plays a role, and concealment of the aberrant eating behavior is an important issue. 

   The diagnosis commonly emerges when a patient is accidentally discovered during a ‘binge’ of geophagia. Abdominal radiography can be of great help in the occasional patient who fervently denies the habit. Complications of geophagia are rare but closely linked to the amount of ingested material. They include parasitic infestation, electrolyte disturbances, and intestinal obstruction. Perforation and peritonitis are rare but the associated mortality is very high.

    Though it has been associated with the psychiatric disorder pica, whereby people crave and purposefully consume non-food items like sand, paint chips, chalk, laundry starch, and hair—geophagia is not necessarily aberrant behavior. It’s actually widespread in animals, from macaws to gorillas, and relatively common in the world’s poorest people and in tribal societies, as well as in pregnant women in many cultures.

There are several theories behind geophagia: Soil may be ingested for its minerals (such as calcium, magnesium, iron, zinc, copper, and chromium)—or just to curb hunger pangs. It may ease symptoms of morning sickness. Some research supports the idea that eating earth binds plant toxins and pathogens in the gastrointestinal tract.

   That’s not to say it’s a good practice. If the purpose is to acquire more nutrients, it can be counterproductive, since eating earth may interfere with the absorption of certain nutrients and, if done regularly, could lead to deficiencies. Also of concern, the soil may contain lead, arsenic, and other toxic metals, as well as parasitic worms, viruses, and bacteria—the very things geophagia is supposed to protect against. According to a paper in Environmental Geochemistry and Health in 2002, geophagia is associated with a range of problems, including iron-deficiency anemia, low potassium, parasitic infections, and bowel obstruction.

  All the concepts of geophagia—as psychiatric disorder, culturally sanctioned practice or sequel to famine—fall short of a satisfying explanation. The causation is certainly multifactorial, and clearly, the practice of earth-eating has existed since the first medical texts were written. The descriptions do not allow simple categorization as a psychiatric disease. Finally, geophagia is not confined to a particular cultural environment and is observed in the absence of hunger. Might it be an atavistic mode of behavior, formerly invaluable when minerals and trace elements were scarce? Its re-emergence might then be triggered by events such as famine, cultural change or psychiatric disease. A beautiful description of the latter can be found in Gabriel García Màrquez' novel, One Hundred Years of Solitude, where he describes geophagia in a woman who is madly in love.