Nonpregnant patients in New York city had iron deficiency anemia and ate laundry starch or clay. Although this form of pica is common in the southern and western United States, it is less frequently considered in the northeast. Starch and clay ingestion varied from 250 to 1,300 gm/ day and average hemoglobin value was 6.2 gm/ 100 ml. All patients received iron but lack of cooperation allowed only three of ten patients to be followed up. They had normal hemoglobin values while continuing the ingestion of clay or starch. This suggests that the iron deficiency anemia in these adults was not a cause of pica but an effect. Cultural tradition or habit is probably another mechanism for this form of pica. Anemic, nonpregnant individuals should be questioned about pica, particularly clay or laundry starch ingestion.
Roselle HA. Association of Laundry Starch and Clay Ingestion With Anemia in New York City. Arch Intern Med. 1970;125(1):57–61. doi:https://doi.org/10.1001/archinte.1970.00310010059003
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