Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-28T05:44:17.656Z Has data issue: false hasContentIssue false

Medicine Beneath Your Feet: A Biocultural Examination of the Risks and Benefits of Geophagy

Published online by Cambridge University Press:  01 January 2024

Sera L. Young*
Affiliation:
Northwestern University, Evanston, IL, USA
Joshua D. Miller
Affiliation:
Northwestern University, Evanston, IL, USA

Abstract

Geophagy is the intentional consumption of earth. Although widely documented among vulnerable populations, including children and pregnant women, the causes and consequences of geophagy remain poorly understood. Relevant literature was, therefore, reviewed to describe geophagy across species, geographies, life stages, and disease states. After a brief consideration of hypothesized etiologies, the potential harmful and beneficial consequences of geophagy are described, considering current evidence for each. Data available to date suggest that the greatest potential risks of geophagy include toxicity or heavy metal poisoning, and diseases resulting from consumed clays binding nutrients and beneficial pharmaceuticals in the gut. Evidence also suggests that geophagy may be beneficial by protecting against harmful pathogens and toxins through two distinct physiological pathways. Future research should explore causal relationships between geophagy and iron deficiency, as well as investigate the biological and psychosocial conditions that govern geophagy.

Type
Research Article
Copyright
Copyright © Clay Minerals Society 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrahams, P.W. (2013). Geophagy and the involuntary ingestion of soil. Pp. 433454 in: Essentials of Medical Geology (Selinus, O., editor). Springer, Dordrecht, The Netherlands. https://doi.org/10.1007/978-94-007-4375-5_18.CrossRefGoogle Scholar
Abrahams, P.W., & Parsons, J.A. (1996). Geophagy in the tropics: a literature review. The Geographical Journal, 162, 6372. https://doi.org/10.2307/3060216.CrossRefGoogle Scholar
Abrahams, P.W., Follansbee, M.H., Hunt, A., Smith, B., & Wragg, J. (2006). Iron nutrition and possible lead toxicity: an appraisal of geophagy undertaken by pregnant women of UK Asian communities. Applied Geochemistry, 21, 98108. https://doi.org/10.1016/j.apgeochem.2005.09.015.CrossRefGoogle Scholar
Aloni, M.N., Lecerf, P., , P.-Q., Heijmans, C., Huybrechts, S., Devalck, C., Azzi, N., Ngalula-Mujinga, M., & Ferster, A. (2015). Is pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort. Hematology, 20, 429432. https://doi.org/10.1179/1607845414Y.0000000219.CrossRefGoogle Scholar
Al-Rmalli, S.W., Jenkins, R.O., Watts, M.J., & Haris, P.I. (2010). Risk of human exposure to arsenic and other toxic elements from geophagy: trace element analysis of baked clay using inductively coupled plasma mass spectrometry. Environmental Health: A Global Access Science Source 9 (December), 79. https://doi.org/10.1186/1476-069X-9-79.CrossRefGoogle ScholarPubMed
Arhin, E., & Zango, M.S. (2017). Determination of trace elements and their concentrations in clay balls: problem of geophagia practice in Ghana. Environmental Geochemistry and Health, https://doi.org/10.1007/s10653-016-9801-9.CrossRefGoogle Scholar
Atay, I. (2014). A pica case associated with suicide-bereavement. Anatolian Journal of Psychiatry, 15, 1. https://doi.org/10.5455/apd.149941.CrossRefGoogle Scholar
Barker, D. (2005). Tooth wear as a result of pica. British Dental Journal, 199, 271273. https://doi.org/10.1038/sj.bdj.4812651.CrossRefGoogle ScholarPubMed
Barr, M. (2006). Adsorption studies on clays II. The adsorption of bacteria by activated attapulgite, halloysite, and kaolin. Journal of the American Pharmaceutical Association, 46, 490492. https://doi.org/10.1002/jps.3030460810.CrossRefGoogle Scholar
Bearer, C.F. (1995). Environmental health hazards: how children are different from adults. 1 1126.Google Scholar
Binder, H.J., & Powell, D.W. (1970). Bacterial enterotoxins and diarrhea. The American Journal of Clinical Nutrition, 23, 15821587. https://doi.org/10.1093/ajcn/23.12.1582.CrossRefGoogle ScholarPubMed
Bonglaisin, J.N., Chelea, M., Tsafack, T.J.J., Djiele, P.N., Lantum, D.N., & Ngondé, E.M.C. (2017). Assessment ofhaemoglobin status and transplacental transport of lead and calcium during geophagy. Journal of Nutritional Disorders & Therapy, 7. https://doi.org/10.4172/2161-0509.1000204.CrossRefGoogle Scholar
Brightsmith, D.J., Hobson, E.A., & Martinez, G. (2018). Food availability and breeding season as predictors of geophagy inAmazonian parrots. Ibis, 160, 112129. https://doi.org/10.1111/ibi.12515.CrossRefGoogle Scholar
Campbell, L., Dixon, D.G., & Hecky, R.E. (2003). A Review of mercury in Lake Victoria, East Africa: implications for human and ecosystem health. Journal of Toxicology and Environmental Health. Part B, Critical Reviews, 6, 325356. https://doi.org/10.1080/10937400306474.CrossRefGoogle Scholar
Cavdar, A.O., & Arcasoy, A. (1972). Hematologic and biochemical studies of Turkish children with pica. A presumptive explanation for the syndrome of geophagia, iron deficiency anemia, hepatosplenomegaly and hypogonadism. Clinical Pediatrics, 11, 215223.CrossRefGoogle Scholar
Clark, J.D. (2001). Kalambo Falls Prehistoric Site. Cambridge University Press, London.Google Scholar
Cragin, F.W.M.D. (1836). Observations on cachexia africana or dirteating. Journal of the Medical Sciences, 17, 356364.Google Scholar
De Jonghe, B.C., Lawler, M.P., Horn, C.C., & Tordoff, M.G. (2009). Pica as an adaptive response: Kaolin consumption helps rats recover from chemotherapy-induced illness. Physiology & Behavior, 97, 8790. https://doi.org/10.1016/j.physbeh.2009.02.009.CrossRefGoogle ScholarPubMed
Diko, M.L., & Siewe épse Diko, C.N. (2014). Physico-chemistry of geophagic soils ingested to relief nausea and vomiting during pregnancy. African Journal of Traditional, Complementary, and Alternative Medicines: AJTCAM, 11, 2124.CrossRefGoogle ScholarPubMed
Douglas, M. (1978). Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. Routledge, London.Google Scholar
Fawcett, E.J., Fawcett, J.M., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 133, 277283. https://doi.org/10.1016/j.ijgo.2015.10.012.CrossRefGoogle ScholarPubMed
Fessler, D.M.T. (2002). Reproductive immunosuppression and diet: an evolutionary perspective on pregnancy sickness and meat consumption. Current Anthropology, 43, 1961. https://doi.org/10.1086/324128.CrossRefGoogle ScholarPubMed
Fowler, J.S., Volkow, N.D., Kassed, C.A., & Chang, L. (2007). Imaging the addicted human brain. Science & Practice Perspectives, 3, 416.CrossRefGoogle ScholarPubMed
Geissler, P.W., Mwaniki, D.L., Thiong'o, F., & Friis, H. (1997). Geophagy among school children in western Kenya. Tropical Medicine & International Health, 2, 624630.CrossRefGoogle ScholarPubMed
Geissler, P.W., Mwaniki, D., Thiong'o, F., & Friis, H. (1998a). Geophagy as a risk factor for geohelminth infections: a longitudinal study of Kenyan primary schoolchildren. Transactions of the Royal Society of Tropical Medicine and Hygiene, 92, 711. https://doi.org/10.1016/S0035-9203(98)90934-8.CrossRefGoogle ScholarPubMed
Geissler, P.W., Shulman, C.E., Prince, R.J., Mutemi, W., Mnazi, C., Friis, H., & Lowe, B. (1998b). Geophagy, iron status and anaemia among pregnant women on the coast of Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 92, 549553.CrossRefGoogle ScholarPubMed
George, G., & Ndip, E. (2011). Prevalence of geophagia and its possible implications to health – A study in rural South Africa. International Proceedings of Chemical, Biological and Environmental Engineering, 4.Google Scholar
Gilardi, J.D., Duffey, S.S., Munn, C.A., & Tell, L.A. (1999). Biochemical functions of geophagy in parrots: detoxification of dietary toxins and cytoprotective effects. Journal of Chemical Ecology, 25, 897922.CrossRefGoogle Scholar
Glickman, L.T., Camara, A.O., Glickman, N.W., & McCabe, G.P. (1999). Nematode intestinal parasites of children in rural Guinea, Africa: prevalence and relationship to geophagia. International Journal of Epidemiology, 28, 169174.CrossRefGoogle ScholarPubMed
González, R., Sánchez de Medina, F., Martínez-Augustin, O., Nieto, A., Gálvez, J., Risco, S., & Zarzuelo, A. (2004). Anti-inflammatory effect of diosmectite in hapten-induced colitis in the rat. British Journal of Pharmacology, 141, 951960. https://doi.org/10.1038/sj.bjp.0705710.CrossRefGoogle ScholarPubMed
Gordon, H.W. (2016). Laterality of brain activation for risk factors of addiction. Current Drug Abuse Reviews, 9, 118.CrossRefGoogle ScholarPubMed
Hamilton, S., Rothenberg, S.J., Khan, F.A., Manalo, M., & Norris, K.C. (2001). Neonatal lead poisoning from maternal pica behavior during pregnancy. Journal of the National Medical Association, 93, 317319.Google ScholarPubMed
Hennigar, S.R., & McClung, J.P. (2016). Nutritional immunity: starving pathogens of trace minerals. American Journal of Lifestyle Medicine, 10, 170173. https://doi.org/10.1177/1559827616629117.CrossRefGoogle ScholarPubMed
Hippocrates and Francis Adams (1849). The Genuine Works of Hippocrates. Sydenham Society, London.Google Scholar
Hooda, P.S., Henry, C.J.K., Seyoum, T.A., Armstrong, L.D.M., & Fowler, M.B. (2002). The potential impact of geophagia on the bioavailability of iron, zinc and calcium in human nutrition. Environmental Geochemistry and Health, 24, 305–219.CrossRefGoogle Scholar
Hooda, P.S., Henry, C.J., Seyoum, T.A., Armstrong, L.D., & Fowler, M.B. (2004). The potential impact of soil ingestion on human mineral nutrition. The Science of the Total Environment, 333, 7587. https://doi.org/10.1016/j.scitotenv.2004.04.023.CrossRefGoogle ScholarPubMed
Huebl, L., Leick, S., Guettl, L., Akello, G., & Kutalek, R. (2016). Geophagy in northern Uganda: perspectives from consumers and clinicians. The American Journal of Tropical Medicine and Hygiene, 95, 14401449. https://doi.org/10.4269/ajtmh.15-0579.CrossRefGoogle ScholarPubMed
Hui, Y.H. (editor). (2001). Foodborne Disease Handbook: volume 3: Plant Toxicants. Second edition. Marcel Dekker, New York.Google Scholar
Hunter-Adams, J. (2016). Interpreting habits in a new place: migrants' descriptions of geophagia during pregnancy. Appetite, 105: 557561. https://doi.org/10.1016/j.appet.2016.06.033.CrossRefGoogle Scholar
Johns, T. (1996). The origins of human diet and medicine: chemical ecology. Arizona Studies in Human Ecology. Tucson: University of Arizona Press.Google Scholar
Johns, T., & Duquette, M. (1991a). Detoxification and mineral supplementation as functions of geophagy. The American Journal of Clinical Nutrition, 53, 448456. https://doi.org/10.1093/ajcn/53.2.448.CrossRefGoogle ScholarPubMed
Johns, T., & Duquette, M. (1991b). Traditional detoxification of acorn bread with clay. Ecology of Food and Nutrition, 25, 221228. https://doi.org/10.1080/03670244.1991.9991170.CrossRefGoogle Scholar
Katsoufis, C.P., Kertis, M., McCullough, J., Pereira, T., Seeherunvong, W., Chandar, J., Zilleruelo, G., & Abitbol, C. (2012). Pica: an important and unrecognized problem in pediatric dialysis patients. Journal of Renal Nutrition: The Official Journal of the Council on Renal Nutrition of the National Kidney Foundation, 22, 567571. https://doi.org/10.1053/j.jrn.2011.10.038.CrossRefGoogle ScholarPubMed
Kawai, K., Saathoff, E., Antelman, G., Msamanga, G., & Fawzi, W.W. (2009). Geophagy (soil-eating) in relation to anemia and helminth infection among HIV-infected pregnant women in Tanzania. The American Journal of Tropical Medicine and Hygiene, 80, 3643.CrossRefGoogle ScholarPubMed
Kmiec, I., Nguyen, Y., Rouger, C., Berger, J.L., Lambert, D., Hentzien, M., Lebrun, D., Robbins, A., Drame, M., & Bani-Sadr, F. (2017). Factors associated with geophagy and knowledge about its harmful effects among native sub-Saharan African, Caribbean and French Guiana HIV patients living in northern France. AIDS and Behavior, 21, 36303635. https://doi.org/10.1007/s10461-016-1661-x.CrossRefGoogle ScholarPubMed
Koeppen-Geiger climate zones: dataset (2018). Portland State University. Accessed April 16. https://www.pdx.edu/econ/countrygeography-data.Google Scholar
Krishnamani, R., & Mahaney, W.C. (2000). Geophagy among primates: adaptive significance and ecological consequences. Animal Behaviour, 59, 899915. https://doi.org/10.1006/anbe.1999.1376.CrossRefGoogle ScholarPubMed
Kutalek, R., Wewalka, G., Gundacker, C., Auer, H., Wilson, J., Haluza, D., Huhulescu, S., Hillier, S., Sager, M., & Prinz, A. (2010). Geophagy and potential health implications: geohelminths, microbes and heavy metals. Transactions of the Royal Society of Tropical Medicine and Hygiene, 104, 787795. https://doi.org/10.1016/j.trstmh.2010.09.002.CrossRefGoogle ScholarPubMed
Lar, U.A., Agene, J.I., & Umar, A.I. (2014). Geophagic clay materials from Nigeria: a potential source of heavy metals and human health implications in mostly women and children who practice it. Environmental Geochemistry and Health, November. https://doi.org/10.1007/s10653-014-9653-0.CrossRefGoogle Scholar
Lin, J.W., Temple, L., Trujillo, C., Mejia-Rodriquez, F., Goldman Rosas, L., Fernald, L., & Young, S.L. (2015). Pica during pregnancy among Mexican-born women: a formative study. Maternal & Child Nutrition, 11, 550558. https://doi.org/10.1111/mcn.12120.CrossRefGoogle ScholarPubMed
Lipson, S.M., & Stotzky, G. (1983). Adsorption of reovirus to clay minerals: effects of cation-exchange capacity, cation saturation, and surface area. Applied and Environmental Microbiology, 46, 673682.CrossRefGoogle ScholarPubMed
Lowry, L.K., Cherry, D.C., Brady, C.F., Huggins, B., D'Sa, A.M., & Levin, J.L. (2004). An unexplained case of elevated blood lead in a Hispanic child. Environmental Health Perspectives, 112, 222225.CrossRefGoogle Scholar
Luoba, A.I., Geissler, P.W., Estambale, B., Ouma, J.H., Magnussen, P., Alusala, D., Ayah, R., Mwaniki, D., & Friis, H. (2004). Geophagy among pregnant and lactating women in Bondo District, western Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 98, 734741. https://doi.org/10.1016/j.trstmh.2004.01.009.CrossRefGoogle ScholarPubMed
Madden, L.J., Seeley, R.J., & Woods, S.C. (1999). Intraventricular neuropeptide Y decreases need-induced sodium appetite and increases pica in rats. Behavioral Neuroscience, 113, 826832.CrossRefGoogle ScholarPubMed
Mahaney, W.C., Milner, M.W., Hs, M., Hancock, R.G.V., Aufreiter, S., Reich, M., & Wink, M. (2000). Mineral and chemical analyses of soils eaten by humans in Indonesia. International Journal of Environmental Health Research, 10, 93109. https://doi.org/10.1080/09603120050021100.CrossRefGoogle Scholar
Marschner, B., Welge, P., Hack, A., Wittsiepe, J., & Wilhelm, M. (2006). Comparison of soil Pb in vitro bioaccessibility and in vivo bioavailability with Pb pools from a sequential soil extraction. Environmental Science & Technology, 40, 28122818. https://doi.org/10.1021/es051617p.CrossRefGoogle ScholarPubMed
Mawell, J. (1835). Pathological inquiry into the nature of cachexia Africana. Jamaica Physical Journal, 2, 409435.Google Scholar
Mcdonald, R., & Marshall, S.R. (1964). The value of iron therapy in pica. Pediatrics, 34, 558562.CrossRefGoogle ScholarPubMed
McElroy, A. (1990). Biocultural models in studies of human health and adaptation. Medical Anthropology Quarterly, 4, 243265. https://doi.org/10.1525/maq.1990.4.3.02a00010.CrossRefGoogle Scholar
Miao, D., Young, S.L., & Golden, C.D. (2015). A meta-analysis of pica and micronutrient status: pica and micronutrient meta-analysis. American Journal of Human Biology, 27, 8493. https://doi.org/10.1002/ajhb.22598.CrossRefGoogle ScholarPubMed
Miller, J.D., Collins, S.M., Omotayo, M., Martin, S.L., Dickin, K.L., & Young, S.L. (2018). Geophagic earths consumed by women in western Kenya contain dangerous levels of lead, arsenic, and iron. American Journal of Human Biology. https://doi.org/10.1002/ajhb.23130CrossRefGoogle Scholar
Minnich, V., Okçuoğlu, A., Tarcon, Y., Arcasoy, A., Cin, S., Yörükoğlu, O., Renda, F., & Demirağ, B. (1968). Pica in Turkey. II. Effect of clay upon iron absorption. The American Journal of Clinical Nutrition, 21, 7886. https://doi.org/10.1093/ajcn/21.1.78.CrossRefGoogle ScholarPubMed
Murdock, G.P., & White, D.R. (1969). Standard cross-cultural sample. Ethnology, 8, 329. https://doi.org/10.2307/3772907.CrossRefGoogle Scholar
Nchito, M., Geissler, P.W., Mubila, L., Friis, H., & Olsen, A. (2004). Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Transactions of the Royal Society of Tropical Medicine and Hygiene, 98, 218227.CrossRefGoogle ScholarPubMed
Ngole, V.M., Ekosse, G.E., de Jager, L., & Songca, S.P. (2010). Physicochemical characteristics of geophagic clayey soils from South Africa and Swaziland 9, 59295937. https://doi.org/10.5897/AJB10.406.Google Scholar
Nyanza, E.C., Joseph, M., Premji, S.S., Thomas, D.S.K., & Mannion, C. (2014). Geophagy practices and the content of chemical elements in the soil eaten by pregnant women in artisanal and small scale gold mining communities in Tanzania. BMC Pregnancy and Childbirth, 14, 144.CrossRefGoogle Scholar
Ofoefule, S.I., & Okonta, M. (1999). Adsorption studies of ciprofloxacin: evaluation of magnesium trisilicate, kaolin and starch as alternatives for the management of ciprofloxacin poisoning. Bollettino Chimico Farmaceutico, 138, 239242.Google ScholarPubMed
Pebsworth, P.A., Bardi, M., & Huffman, M.A. (2012). Geophagy in chacma baboons: patterns of soil consumption by age class, sex, and reproductive state. American Journal of Primatology, 74, 4857. https://doi.org/10.1002/ajp.21008.CrossRefGoogle ScholarPubMed
Pebsworth, P.A., Seim, G.L., Huffman, M.A., Glahn, R.P., Tako, E., & Young, S.L. (2013). Soil consumed by chacma baboons is low in bioavailable iron and high in clay. Journal of Chemical Ecology, 39, 447449. https://doi.org/10.1007/s10886-013-0258-3.CrossRefGoogle ScholarPubMed
Pebsworth, P.A., Huffman, M.A., Lambert, J.E., & Young, S.L. (2018). Geophagy among nonhuman primates: a systematic review of current knowledge and suggestions for future directions. American Journal of Physical Anthropology. https://doi.org/10.1002/ajpa.23724CrossRefGoogle Scholar
Phillips, T.D. (1999). Dietary clay in the chemoprevention of aflatoxininduced disease. Toxicological Sciences: An Official Journal of the Society of Toxicology, 52, 118126.CrossRefGoogle ScholarPubMed
Prentice, A.M., Ghattas, H., & Cox, S.E. (2007). Host-pathogen interactions: can micronutrients tip the balance? The Journal of Nutrition, 137, 13341337. https://doi.org/10.1093/jn/137.5.1334.CrossRefGoogle ScholarPubMed
Saathoff, E., Olsen, A., Kvalsvig, J.D., & Geissler, P.W. (2002). Geophagy and its association with geohelminth infection in rural schoolchildren from northern KwaZulu-Natal, South Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 96, 485490.CrossRefGoogle ScholarPubMed
Saunders, C., de Carvalho Padilha, P., Della Líbera, B., Lima Nogueira, J., Mello de Oliveira, L., & Astulla, A. (2009). Pica: epidemiology and association with pregnancy complications. Revista Brasileira de Ginecologia e Obstetricia: Revista da Federação Brasileira das Sociedades de Ginecologia e Obstetricia, 31, 440446.CrossRefGoogle ScholarPubMed
Sayers, G., Lipschitz, D.A., Sayers, M., Sefterl, H.C., Bothwell, T.H., & Charlton, R.W. (1974). Relationship between pica and iron nutrition in Johannesburg black adults. South African Medical Journal, 48: 16551660.Google ScholarPubMed
Seim, G.L., Ahn, C.I., Bodis, M.S., Luwedde, F., Miller, D.D., Hillier, S., Tako, E., Glahn, R.P., & Young, S.L. (2013). Bioavailability of iron in geophagic earths and clay minerals, and their effect on dietary iron absorption using an in vitro digestion/Caco-2 cell model. Food & Function, 4, 1263. https://doi.org/10.1039/c3fo30380b.CrossRefGoogle ScholarPubMed
Seim, G.L., Tako, E., Ahn, C., Glahn, R., & Young, S.L. (2016). A novel in vivo model for assessing the impact of geophagic earth on iron status. Nutrients, 8, 362. https://doi.org/10.3390/nu8060362.CrossRefGoogle ScholarPubMed
Simon, A.K., Hollander, G.A., & McMichael, A. (2015). Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences, 282(1821). https://doi.org/10.1098/rspb.2014.3085.Google ScholarPubMed
Solaini, L., Gardani, M., & Ragni, F. (2012). Geophagia: an extraordinary cause of perforation of the sigmoid colon. Surgery, 152, 136137. https://doi.org/10.1016/j.surg.2011.06.033.CrossRefGoogle ScholarPubMed
Soranus, of Ephesus (1991). Soranus' gynecology. Johns Hopkins University Press, Baltimore.Google Scholar
Spencer, T. (2002). Dirt-eating persists in rural South. Newhouse News Service, January 25.Google Scholar
Takeda, N., Hasegawa, S., Morita, M., & Matsunaga, T. (1993). Pica in rats is analogous to emesis: an animal model in emesis research. Pharmacology, Biochemistry, and Behavior, 45, 817821.CrossRefGoogle ScholarPubMed
Toker, H., Ozdemir, H., Ozan, F., Turgut, M., Goze, F., Sencan, M., & Kantarci, A. (2009). Dramatic oral findings belonging to a pica patient: a case report. International Dental Journal, 59, 2630. https://doi.org/10.1922/IDJ_2029Toker05.Google ScholarPubMed
Wilensky-Lanford, E. (2005). A corner of Kyrgyzstan has a cure-all: Let them eat clay. The New York Times, September 5, sec. Asia Pacific. https://www.nytimes.com/2005/09/05/world/asia/a-corner-of-kyrgyzstan-has-a-cureall-let-them-eat-clay.html. Accessed 15 Apr 2018.Google Scholar
Wilson, M.J. (2003). Clay mineralogical and related characteristics of geophagic materials. Journal of Chemical Ecology, 29, 15251547.CrossRefGoogle ScholarPubMed
Woywodt, A. (1999). Perforation of the sigmoid colon due to geophagia. Archives of Surgery, 134, 88. https://doi.org/10.1001/archsurg.134.1.88.CrossRefGoogle ScholarPubMed
Yamamoto, K., Takeda, N., & Yamatodani, A. (2002). Establishment of an animal model for radiation-induced vomiting in rats using pica. Journal of Radiation Research, 43, 135141.CrossRefGoogle ScholarPubMed
Youdim, M.B.H., & Iancu, T.C. (1977). Pica hypothesis. British Journal of Haematology, 36, 298. https://doi.org/10.1111/j.1365-2141.1977.tb00651.x.CrossRefGoogle Scholar
Young, S.L. (2010). Pica in pregnancy: new ideas about an old condition. Annual Review of Nutrition, 30, 403422. https://doi.org/10.1146/annurev.nutr.012809.104713.CrossRefGoogle ScholarPubMed
Young, S.L. (2012). Craving Earth: Understanding Pica: The Urge to Eat Clay, Starch, Ice, and Chalk. Columbia University Press, New York.CrossRefGoogle Scholar
Young, S.L., Goodman, D., Farag, T.H., Ali, S.M., Khatib, M.R., Khalfan, S.S., Tielsch, J.M., & Stoltzfus, R.J. (2007). Geophagia is not associated with trichuris or hookworm transmission in Zanzibar, Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101, 766772. https://doi.org/10.1016/j.trstmh.2007.04.016.CrossRefGoogle ScholarPubMed
Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. Edited by Joel Gagnier. PLoS ONE 3, e3147. https://doi.org/10.1371/journal.pone.0003147.CrossRefGoogle Scholar
Young, S.L., Khalfan, S.S., Farag, T.H., Kavle, J.A., Ali, S.M., Hajji, H., Rasmussen, K.M., & Pelto, G.H. (2010a). Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania. American Journal of Tropical Medicine and Hygiene, 83, 144151. https://doi.org/10.4269/ajtmh.2010.09-0442.CrossRefGoogle ScholarPubMed
Young, S.L., Wilson, M.J., Hillier, S., Delbos, E., Ali, S.M., & Stoltzfus, R.J. (2010b). Differences and commonalities in physical, chemical and mineralogical properties of Zanzibari geophagic soils. Journal of Chemical Ecology, 36, 129140. https://doi.org/10.1007/s10886-009-9729-y.CrossRefGoogle ScholarPubMed
Young, S.L., Sherman, P.W., Lucks, J.B., & Pelto, G.H. (2011). Why on earth?: evaluating hypotheses about the physiological functions of human geophagy. The Quarterly Review of Biology, 86, 97120. https://doi.org/10.1086/659884.CrossRefGoogle ScholarPubMed
Zganjer, V., Zganjer, M., Cizmić, A., Pajid, A., & Zupancić, B. (2011). Suicide attempt by swallowing sponge or pica disorder: a case report. Acta Medica (Hradec Kralove), 54, 9193.CrossRefGoogle ScholarPubMed