What is the connection between ice and iron deficiency?

Do You Crave Ice a lot?

It’s approaching the warmest days of the year and hot drinks are making the transition to iced drinks. We may all want some cooler beverages, but have you noticed you are craving ice much more than usual? Are you chewing ice all the time? Research shows that this is possibly driven by an underlying health condition related to blood iron stores. While not dangerous itself, craving ice could be the first sign of iron-deficiency anemia which can be serious if left untreated. Treating this underlying condition is important, so becoming aware of a strong craving for ice may help you get the treatment you need.

The Connection between Ice and Iron

This ice craving is more than liking ice in your beverages. It is defined as, “an excessive compulsion for chewing ice or consuming iced drinks” and when it reaches this level, it is termed pagophagia¹. It is most commonly seen in pregnant women and children, though it can be seen at any age and in any gender². It has also commonly been observed after patients undergo certain types of gastric bypass surgery^3,4. Each of these groups who most commonly exhibit pagophagia are known to either have an increased need for iron or a difficulty in absorbing it. This suggests a mysterious link between ice craving and iron.

Since initial observations of this phenomenon, many case studies have pointed to the connection between iron-deficiency anemia and eating ice². The connection is not fully understood, but theories include the relief of inflammation in the mouth and throat caused by iron-deficiency anemia, the perturbation of appetite centers in the brainstem from low blood iron levels, and tissue enzyme deficiencies from missing iron as a cofactor^4,5. Although the connection may not be perfectly clear, strong evidence shows that excessive ice cravings are resolved when patients are treated for iron-deficiency anemia^2,5.

Iron-deficiency anemia

Anemia is simply the condition of not having enough red blood cells. The most prevalent form is iron-deficiency anemia which is caused by insufficient free and stored iron in the body². A key component of healthy red blood cells is hemoglobin, a protein responsible for the transport of oxygen from the lungs to tissues in the body. Iron is required to make hemoglobin, and so a lack of iron will interfere with the body’s ability to make enough hemoglobin and healthy red blood cells for oxygen delivery⁶.

The reasons why someone may not have enough iron to make red blood cells include:

The body is losing more blood cells and iron than it can replace with diet (ex: chronic bleeding disorders or other excessive blood loss due to chronic heavy periods).
The body is not absorbing enough iron, either because of poor iron absorption (ex: gastric bypass surgery) or by low dietary intake (ex: prolonged improper diet).
The body requires more than normal amounts of iron and is not getting enough through regular diet (ex: childhood and pregnancy).

Iron deficiency anemia is a significant health condition that can affect a person’s ability to function. Other symptoms include fatigue, low motivation, mood disturbances, shortness of breath, weakness, restless legs, dizziness, a sore tongue, headaches, hair loss, brittle nails, pale appearance and impaired immune function^{6,7, 8}. A simple way check for potential anemia is to look at the inside of your bottom eyelid: is it very pale? If it is, this could be an indication you need natural iron therapy. Check with your health care provider.

It is important to note that there are two types of iron: heme and non-heme. The difference is mainly that heme iron is found in animal products while non-heme is found in leafy greens and other plant sources. About 15-30% of heme iron from animals is absorbed in the human gut, depending on your current iron stores. Meaning, if you are low in iron, you will absorb up to almost a third of what you take in. Sound like a low absorption rate? Unfortunately non-heme iron is even lower, being absorbed only at 2-20% of what is taken in. This absorption rate is less affected by what your stores are like, and more by what other foods and beverages you have in your system at the same time (point 3 below has more information on what affects iron absorption)⁸.

How to Improve Iron Levels Naturally

The good news is that iron-deficiency anemia is treatable. Using a range of therapies, blood iron levels and body iron stores can be raised to healthy levels and restore proper cellular functioning, oxygen delivery and energy levels. A good treatment plan must also investigate and address the cause of low iron—poor absorption, poor diet, excessive bleeding, etc.

One of the easiest and most important therapy approaches is through diet. Start by increasing green leafy vegetables in your diet, also red cabbage, parsley, beets, alfalfa, watercress, wheat grass, spinach, cucumbers, tomato juice, fish, coconuts, eggs, black strap molasses, black cherry and blackberry juice. If you are not a strict vegan or vegetarian, consider consuming organic red meat especially when you know you are losing blood (for example, during menses).
An important addition for iron therapy is supplementation. There are many different forms of supplements and some are better absorbed than others so it is advised to speak with a naturopathic doctor to determine the best one for you.
Pay attention to other things that may be affecting your iron levels. Some tips⁹:

Taking iron with vitamin C helps absorption, speeding up results for iron therapy
Taking digestive enzymes may help you absorb better as well, especially if you have problems digesting dairy and protein properly
Taking antacid tablets with calcium can interfere with iron absorption and lead to iron deficiency
Coffee, tea and wine contain polyphenols can also reduce the absorption of iron in the gut
Low folic acid and B12 levels can look like iron-deficiency anemia, so it might be necessary for you to also supplement with these nutrients.
Low stomach acid levels may contribute to low iron by decreasing your ability to digest foods properly. You may want to check with your health care provider.
Minerals (calcium, zinc and copper) can affect the absorption of iron so it is best to take your iron supplement with Vitamin C and away from other supplements that contain minerals
Phytic acid found in grains, leafy greens, soy and other legumes can inhibit iron absorption
Last but not least, parasites in the body can also drastically reduce iron levels. If there is any chance you have picked up a parasite, its eradication is essential to reversing iron-deficiency anemia.

These pointers are here to help you begin to think about how many aspects of your health are connected: how diet, supplementation, and other factors can affect iron levels and therefore cause you to crave ice or have other symptoms of anemia. Be empowered and learn about your body and your habits, but also be sure to discuss with a trusted health care practitioner how you can address this. Iron-deficiency anemia is indicated by many symptoms – from eating ice to brittle nails – but once it is caught, it can be treated to help you move towards a more energetic and healthy way of living.

References

Parry-Jones, B, 1993. Pagophagia, or compulsive ice consumption: a historical perspective. Psychological Medicine(Psychol Med) 22 (3): 561–71. doi:1017/s0033291700038022.PMID 1410082.
Youssef, 2005. Craving for Ice and Iron-deficiency Anemia, a case series from Oman. Pediatric Hematology and Oncology, 22: 127–131, 2005 online DOI: 10.1080/08880010590896486
Kushner and Retelny, 2005. Emergence of Pica (Ingestion of Non-food Substances) Accompanying Iron Deficiency Anemia after Gastric Bypass Surgery. Obesity surgery. November 2005, Volume 15, Issue 10, pp 1491-1495