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    Tomato craving tied to iron deficiency

By Suzanne Rostler

NEW YORK, Jun 30 (Reuters Health) -- Iron-deficiency anemia has long been associated with pica, a phenomenon in which people crave unusual food and nonfood substances such as dirt and clay. Now, an Ohio-based physician has linked the deficiency with a craving for tomatoes.

"The take-home point is that it is not a bad idea to check the hemoglobin (an indicator of iron status) of patients who report any unusual cravings," Dr. Mark A. Marinella, a physician with Wright State University School of Medicine in Dayton, Ohio, told Reuters Health.

Marinella said tomatoes are not presently included in the list of foods that are associated with pica. Pica occurs in up to 60% of patients with iron-deficiency anemia, when it typically manifests as pagophagia -- a craving for ice. The physician dubs this new craving "tomatophagia."

While he could not explain the link between iron-deficiency anemia and tomatoes, he suggests that "there may be something about iron-deficiency anemia that does not relate to the iron deficiency that causes the craving."

In a letter published in the July 1st issue of The New England Journal of Medicine, Marinella describes a 66-year-old woman who consumed 6 to 10 whole tomatoes daily over a 2-month period. The patient also was taking nonsteroidal anti-inflammatory drugs for arthritis, drugs associated with risk of stomach ulcers. Tests showed that the woman had irritation of her stomach and esophagus that may have caused her to lose blood, leading to anemia.

The patient was taken off her painkillers, given a blood transfusion and prescribed iron supplements. After several weeks of taking iron, the patient's anemia resolved, and her craving for tomatoes disappeared -- "a result that is diagnostic of pica," he writes in the letter.

Marinella notes that previous reports of cravings for crunchy or salty foods have also been linked to iron-deficiency anemia. "Patients with food pica typically ingest large amounts of crunchy food such as celery, carrots, peanuts, seeds, crackers, and pretzels," he writes.

SOURCE: The New England Journal of Medicine 1999;341:60-61.

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