If That Paper Towel Looks Delicious, You Might Want to Get Your Iron Levels Checked

Nearly 70 percent of pregnant women crave non-edible items like paper towels, ice, and laundry detergent. Image via Shutterstock.

Trisha Nelson, a copywriter for a technology company in Los Angeles, California, was addicted to ice. Not just any ice, the really minerally-smelling ice that forms on the inside walls of old freezers. “I would scrape the ice that had formed on the sides of our fridge. I knew exactly where all the ‘good’ ice was and I bought a snow-cone maker,” said Nelson. “I was insatiable.”

When Nelson went to her doctor to figure out what was going on, he diagnosed her with pica. Pica is the craving of non-nutritive items such as dirt, paint, or laundry detergent. Many doctors link pica to an iron deficiency, which was the case for Nelson. Nelson had developed anemia because of fibroids that were growing on her uterus. The fibroids were causing excessively heavy menstrual bleeding and that blood loss had led to anemia. After Nelson went to her doctor, he told her to take iron supplements and her cravings began to subside. Once her uterine fibroids were removed, life went back to normal.

Women are at particular risk for iron deficiency because of their menstrual cycles said Jessica Shapiro, an associate wellness dietitian at Montefiore Health System. “We lose a ton of blood every month and iron is needed to replenish that blood.”

Pica can also be common among pregnant women—by some estimates, a whopping 68 percent of pregnant women show symptoms of pica. This is because, by the second trimester of pregnancy, many women don’t have enough iron in their bodies and need to take supplements. According to the American Society of Hematology, the amount of blood in your body increases by about 20-30 percent during pregnancy. This means that your iron requirements also increase in order to make hemoglobin, which is the protein in our red blood cells responsible for transporting oxygen to different cells in our body. (Our body also needs vitamin B12 and folic acid to make hemoglobin.)

When Maria Redin, a strategist for a media company also based in Los Angeles, was 20 weeks pregnant, she started to crave brown paper towels. “I remember feeling like I needed something but it wasn’t food. I thought maybe it would be a texture and when I saw the paper towels, I thought they may be the right combination,” Redin said. “I knew it wasn’t a good idea to eat them, but I really wanted to.” Shortly after her cravings began, Redin fainted one morning while walking to work. Her doctor diagnosed her with a low iron count.

Redin’s case is not unusual. A study published in the Journal of Nutrition in 2014 linked her type of pica to women with low iron levels during pregnancy. Other studies have found that pica can be especially common among pregnant women from developing countries who are commonly at risk for nutrient deficiencies.

In some cases, doctors stretch the definition of pica to include the craving of edible substances as well. In a case study published in the journal Psychosomatics in 2014, doctors write about Mrs. A, a postmenopausal, vegetarian woman who developed such an insatiable desire for tofu that she had gained a lot of weight. Mrs. A consumed so much tofu that she had to hide her tofu eating from others, including her husband. After doing lab tests, doctors found that she was deficient in iron and began a treatment of iron supplementation. After a while, her tofu cravings subsided.

Should you be worried if you’re suddenly craving strange substances? Maybe, says Victoria Brodsky, a nutritionist in Santa Monica, California. “There are two nutrition-related problems with pica, the first being that it is likely a symptom of some kind of nutrient deficiency. The second problem is that the substances that the individual is putting in their mouth could be harmful to their health. It may be toxic, it may block absorption of nutrients, and it may cause blockage or damage in the GI tract,” Brodsky said.

What can you do if you think you might have pica? Brodsky recommends seeing a doctor if you’re experiencing pica behavior. The first thing the doctor will do is run a series of blood tests and ask for a diet recall. “With those, a medical professional will be able to pinpoint where the patient is lacking nutrients and will provide the patient with nutritional guidance along with supplementation of the nutrients they’re lacking,” said Brodksy.