Pagophagia

Pagophagia (pronounced pag-off-faghia)

(1) The excessive and constant eating of ice, often as part of extreme dieting.

(2) A craving to eat ice, sometimes associated with iron-deficiency anemia.

Pre 900: A compound word, the construct being págo(s) + -phagia.  Págos is from the Byzantine Greek, the perfective stem of ἔφαγον (éphagon) (I ate; I devoured), singular first-person aorist active indicative form (by suppletion) of ἐσθίω (esthíō) (I eat; I devour).  Phagia is from the Ancient Greek πάγος- (phag-) (stiff mass; frost; ice) from pēnunai, (to stick, stiffen), from the primitive Indo-European root pag.  It was used also in a derogatory, figurative sense to describe a cold, unfriendly person (in the sense of one metaphorically cold like ice).

Ice, diet and the DSM

Pagophagia (the excessive consumption of ice or iced drinks), is often regarded as a recent phenomenon and a novel manifestation of pica (a disorder characterized by craving and appetite for non-edible substances, such as ice, clay, chalk, dirt, or sand and named for the jay or magpie (pīca in Latin), based on the idea the birds will eat almost anything) but in texts from Classical Greece are warnings in the writings of both the physician Hippocrates (circa 460–circa 370 BC) and the polymath Aristotle (384–322 BC) concerning the dangers of the excessive intake of cold or iced water.  The cause of the death of Theophilus (Byzantine (Eastern Roman) Emperor 829-842) was officially dysentery but, based on the original texts of Byzantine historians and chroniclers of the era, modern researchers speculate the cause of death may have been related to Theophilus' pagophagia (snow eating), a long-time habit he indulged to relieve the symptoms of gastric inflammation.  In the medical literature, from the sixteenth century on, there are discussions and illustrative case histories about the detrimental effect of immoderate usage of cold water, ice and snow, frequently in the context of eating disorders, another range of conditions with a long history.

A noted feature of the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (2013)), was the more systematic approach taken to eating disorders, variable definitional criteria being defined for the range of behaviours within that general rubric.  What may have appeared strange was including the ice-eaters within the psychological disorder Pica which is characterized by the manifestation of appetite for non-nutritive substances including sharp objects (acuphagia), purified starch (amylophagia), burnt matches (cautopyreiophagia), dust (coniophagia), feces (coprophagia), sick (emetophagia), raw potatoes (geomelophagia), soil, clay or chalk (geophagia), glass (hyalophagia), stones (lithophagia), metal (metallophagia), musus (mucophagia), ice (pagophagia), lead (plumbophagia), hair, wool, and other fibres (trichophagia), urine (urophagia), blood (hematophagia (sometimes called vampirism)) and wood or derivates such as paper & cardboard (xylophagia).  DSM-5 also codified the criteria for behaviour to be classified pica.  They must (1) last beyond one (1) month beyond an age in infancy when eating such objects is not unusual, (2) not be culturally sanctioned practice and (3), in quantity or consequence, be of sufficient severity to demand clinical intervention.  Interestingly, when the text revision of DSM-5 (DSM-5-TR, 2022) was released, the sentence “individuals with atypical anorexia nervosa may experience many of the physiological complications associated with anorexia nervosa” was added to the description of the atypical anorexia nervosa example to clarify that the presence of physiological consequences during presentation does not mean that the diagnosis is the (typical) anorexia.

However, it must be remembered the DSM is a tool for the clinician and, while it can be a useful source document for the lay-reader, there are other publications better suited to those self-diagnosing or informally assessing others.  An individual for whom the only symptom of pica is abnormally high and persistent ice consumption doesn’t of necessity need to be subject to the treatment regime imposed on more undiscriminating consumers.

The pro-ana community does recommend the eating of ice, not merely as a food substitute but because the body needs to burn energy both to melt the ice and subsequently restore the body to its correcting operating temperature.  With frozen water, this effect is greatest in negative calorie terms but the discount effect applies even to iced confections.  If a frozen confection is listed as containing a calorie content of 100 (25 grams of carbohydrate @ 4 calories per gram), this does not include the energy the body expends to melt the ice and the net consumption is actually around 72 calories.

All things in moderation: Lindsay Lohan enjoying ice-cream and (an allegedly virgin) iced mojito, Monaco 2015.

Pro-ana does NOT however approve of frozen confections, the preferred one litre of frozen water containing zero calories yet demanding of the body a burn of around 160 calories to process, the energy equivalent of running one mile (1.6 km).  The practical upper limit per day appears to be between 3-5 litres (.8-1.3 gallons) depending on the individual and it’s speculated a daily intake much over eight litres may approach toxicity, essentially because the localized symptoms would be similar to hypothermia and some organs fail optimally to work when body temperature drops too much.  Paradoxically, pro-ana also notes, ice shouldn’t be eaten when one is too hot.  After running, the body actually exerts energy through the active effort of dissipating excess heat and if one were to ingest large amounts of ice as one was cooling off, some of the heat generated would be neutralized by the coolness of the ice, minimizing some of the energy burning benefits.  There’s also the need to avoid dental damage; pro-ana recommending it be allowed to melt in the mouth or consumed as shaved ice.