What causes the urge to chew ice in individuals with anemia?

Crunching on ice does more than cool you down; it can harm your oral health. This habit can damage gums and even lead to broken or cracked teeth.

Here’s a lesser-known fact: A craving for ice might also indicate anemia.

Anemia occurs when your body has an unusually low count of red blood cells, which can happen for two main reasons: either the body isn’t producing enough red blood cells (despite their natural replacement every three months) or it’s losing or destroying them faster than normal. These cells contain hemoglobin, an iron-rich protein responsible for transporting oxygen throughout the body. Without sufficient hemoglobin, your organs and tissues receive less oxygen. While some individuals may experience no symptoms or only mild ones, anemia can lead to fatigue, dizziness, and exhaustion. Other symptoms include shortness of breath, irregular heartbeats, headaches, leg cramps, insomnia, and difficulty focusing.

There are over 400 types of anemia, each with unique causes and symptoms beyond the general ones. For instance, sickle cell anemia is a genetic blood disorder, while other forms arise from nutritional deficiencies like insufficient vitamin B12 or iron. Symptoms of vitamin B12 deficiency anemia may include clumsiness, tingling in the hands and feet (similar to pins and needles), and even depression or hallucinations. Iron is essential not only for giving blood its red color but also for producing healthy red blood cells. Adults typically have 3 to 4 grams of iron circulating in their bodies; when levels drop too low, red blood cell production halts, leading to iron-deficiency anemia. This type is associated with a sore, red tongue (glossitis), mouth inflammation (stomatitis), and cracked corners of the mouth (angular cheilitis) [source: Johnson-Wimbley]. It’s also linked to the compulsion to chew ice.

Pagophagia and Iron-deficiency Anemia

Iron-deficiency anemia, affecting approximately 7% of American women and 2% of American men, can lead to unusual cravings. A French study revealed that 44% of patients regularly consumed non-food items like clay, ashes, or starch, compared to only 9% of those without anemia [sources: Gordon, Bowerman]. Unsurprisingly, the most frequent craving was for ice.

Pica refers to the compulsive craving and consumption of non-food items for at least a month, and when the craving is specifically for ice, it’s called pagophagia. This isn’t just about chewing a few ice cubes on a hot day; pagophagia involves regularly eating significant amounts of ice.

In the late 1960s, researchers linked iron-deficiency anemia to unusual ice cravings, noting that symptoms disappeared as patients’ serum iron levels returned to normal [source: Reynolds]. While it was once thought that pica compensated for dietary deficiencies, this theory is now outdated, especially since ice contains no iron. The exact reason for ice cravings in iron-deficient individuals remains unclear, though some suggest it may provide relief from mouth inflammation or fissures caused by anemia. Others simply feel a strong urge to chew on something cold and crunchy.

Fortunately, iron-deficiency anemia is treatable. Increasing dietary iron intake and taking daily supplements can effectively reverse the condition. Once the deficiency is corrected, pagophagia typically disappears as well.