Tomatophagia Caused by Iron Deficiency Anaemia: A Case Report

[helvella]

Posting because of a combination of interest and the outside possibility that a few members might identify with this issue.

Note: This was under the NHS in Northampton.

Tomatophagia Caused by Iron Deficiency Anaemia: A Case Report.

Abstract

Iron deficiency anaemia is a common condition that can present with a variety of symptoms, including pica, which is an uncommon but notable manifestation. Pica involves the craving and consumption of non-nutritive substances and can sometimes lead to unusual dietary habits. We report an unusual case of tomatophagia, a rare form of pica, associated with iron deficiency anaemia. A Caucasian female in her forties was referred to the hospital with severe microcytic anaemia and a two-year history of excessive cherry tomato consumption. She exhibited a notably yellowish discolouration of her skin. Based on the history and clinical findings, the diagnosis of iron deficiency anaemia and carotenemia was made. The patient's condition improved significantly following a blood transfusion and treatment with ferric carboxymaltose (ferinject).

Full paper accessible on EuropePMC

europepmc.org/article/MED/3...

[greygoose]

I wonder how many cherry tomatoes you have to eat for it to be considered excessive. What is normal cherry tomato consumption?

[helvella in reply to greygoose]

There will be a graph somewhere which shows 2.5% of us are under-consumers and 2.5% are excessive consumers of cherry tomatoes.

And if you change your consumption by just one cherry tomato, that could shift you to or from "normal".

But they probably don't rate consumption by anything as simple as numbers (or weight) of actual cherry tomatoes. They'll find something else which, sometimes, correlates with cherry tomato consumption and use that. Like count of cherry tomato packets in the waste bin. Or number of cucumbers because everyone who eats cherry tomatoes also eats cucumber...

[BootsOn in reply to helvella]

I'm just eating my lunch... cherry tomatoes and cucumber are part of it. That has made me laugh 😂

[greygoose in reply to helvella]

🤣 Well, actually, I don't. I don't eat many cherry tomatoes these days, but I used to eat something like one packet a week with pasta and cream, no cucumber. And in France they're mostly eaten as aperitif nibbles, with not a cucumber in sight!

[TSH110 in reply to helvella]

I can’t find them!

[TSH110 in reply to greygoose]

One serving is supposed to be 6 cherry tomatoes (eqivalent to one big non cherry tomato). We eat 500,000 tonnes of tomatoes a year and on average in the U.K. we eat about 160g worth a week ie 2 big ones a week and 100 a year or that’s 12 cherries a week and 600 in a year . Can’t find any breakdown of the types. 75% like cherry tomatoes according to surveys so they are popular and a bit too popular in this case. 🍅

[helvella in reply to TSH110]

I think your phrasing "a bit too popular in this case" rather plays down her consumption which is reported as:

Significantly, she had a two-year history of consuming excessive amounts of cherry tomatoes (about 1 kg a day), describing a craving for their ‘earthy taste’ and being unable to resist eating them during various activities such as driving, resting, and daily chores.

I like tomatoes. I can eat lots of tomatoes - fresh and cooked. But that is far more than I could manage whether cherry, big, fresh, tinned, as ketchup or any other form. And even if I could for one day, I cannot see myself repeating that day after day!

[greygoose in reply to helvella]

That does sound excessive, doesn't it. I wonder if she managed to eat anything else. 1 kg of tomatoes must be quite filling. She must have been deficient in other nutrients, too. Poor lady!

[Jingley in reply to greygoose]

Not to mention deficiency of the bank account 😮

[greygoose in reply to Jingley]

Are they expensive, then?

[Jingley in reply to greygoose]

I don't know but am assuming the costs must have mounted up at 1 kilo per day for two whole years.

[greygoose in reply to Jingley]

Depends what else she ate. Although I don't see how she would have had the time to eat anything else. Must be a full-time job eating that many tomatoes!

[Jingley in reply to greygoose]

🤣

[TSH110 in reply to greygoose]

She’d have about 16 minutes an hour to eat other things over 18 hours of eating a day! But would there be any room left to fill?

[helvella in reply to Jingley]

The cheapest from a major UK supermarket, the ones that haven't ripened fully and probably have little taste, are currently £2.76/kg.

The nice ones are much, much more expensive.

[Jingley in reply to helvella]

Good god. That's more than 2 grand!! On tomatoes!!

[helvella in reply to Jingley]

365 * £2.76 is only £1007.40.

"Only" to be taken relatively!

And it could be very much more if she was buying the nice ones.

[Jingley in reply to helvella]

Multiplied by 2 for the two years she was eating them 😉

[helvella in reply to Jingley]

True!

[greygoose in reply to helvella]

If eating them was a compulsion, she probably didn't even notice the taste, so the cheapest would probably have been OK.

[Angel_of_the_North in reply to Jingley]

Perhaps she was growing them. Seeds are cheap.

[TSH110 in reply to helvella]

Blimey I make that around 750 a day, 5250 a week & 273,750 a year. 41 an hour if she ate them for 18 hours a day that’s almost one a minute 😳

[greygoose in reply to TSH110]

Perhaps she ate two at a time.

[TSH110 in reply to greygoose]

More manageable I’d say

[Angel_of_the_North in reply to greygoose]

Oh dear, I eat "loads" as I grow them

[Jingley]

Hubby (diabetic but not the usual type) used to eat 4 or 5 cherry tomatoes a day along with a banana so he easily reached his "5 a day" target - as per his diabetes nurse instructions.

His GP wondered why his potassium levels shot through the roof. He now only eats tomatoes as part of a pasta dish.

[greygoose in reply to Jingley]

You do know that 'five a day' is not a real thing, don't you?

[Jingley in reply to greygoose]

Yep. But you know what these medical 'professionals' are like 😉

[greygoose in reply to Jingley]

Oh indeed! Know nothing about nutrition - get their information from TV commercials!

[alchemilla12 in reply to Jingley]

4 or 5 cherry tomatoes would only count as 1 serving!

[Jingley in reply to alchemilla12]

Crossed wires 🙃 I meant that the tomatoes counted as one portion, not five. They were on top of other fruits and veg.Shame really, would be so easy to hit targets otherwise.

[alchemilla12 in reply to Jingley]

yes indeed! I once knew a chap who thought each strawberry and grape he ate was 1 of his 5 a day 😂

[Angel_of_the_North in reply to alchemilla12]

Like donuts. Flour comes from a plant, sugar comes from a plant and so does jam, so at least 3 of your 5 a day

[helvella in reply to Angel_of_the_North]

So does the oil they are fried in. Up to four.

[alchemilla12 in reply to Angel_of_the_North]

🤣🤣

[RedApple]

'she had a two-year history of consuming excessive amounts of cherry tomatoes (about 1 kg a day), '

I just weighed some cherry tomatoes I have in my kitchen, and going by those, 1kg would be about 70 cherry tomatoes a day!

[helvella in reply to RedApple]

That helps with perception.

It's some sort of evidence that tomatoes do not, cannot, provide enough iron to overcome iron deficiency even in those vast quantities.

[TSH110 in reply to helvella]

c. 0.27mg iron per 100 grams of cherry tomatoes - better than ice or dirt?

[helvella in reply to TSH110]

The full kilogram would be 2.7 milligrams.

Which, in a bit of arithmetic luck, is 10% of the 27 milligrams daily requirement in pregnancy.

ods.od.nih.gov/factsheets/I...

[TSH110 in reply to helvella]

Oh dear a fruitless exercise eating all those for iron. Poor lady it must have been awful for her

[TSH110 in reply to RedApple]

My maths must be wrong I made it 750!

[helvella in reply to RedApple]

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[Jingley in reply to helvella]

Stop! I'm starting to feel sick 🤢 😄

[arTistapple]

I thought it was the 1st of April. I had to do a double check.

[Thrumplover]

when I was very anaemia I would eat packets of rice cakes. I would even go out at night to buy them. I liked the texture and the snapping sound also. My doctor kept telling my tiredness was menopausal.I very nearly died. I hate rice cakes now.

[TSH110 in reply to Thrumplover]

I’ve had serious obsessions with papaya, carrots and pineapple juice in the past. I’ve discovered I have rock bottom basement ferritin but no pica at the mo as far as I can determine - now pass me that kilo of cherry tomatoes I feel a bit peckish

oh yes my thyroid disorder was just the menopause according to the white coats till it ended and I was still very ill and l I nearly croaked with the thyroid shrivelled to a useless crisp 🙄 it was grim.

[CarpaBob]

Interestingly I recently learned that depending on how they are grown (organic, soil quality etc) there can be 10 times the amount of iron in a farm grown organic tomato compared to a supermarket mass produced one!

[RedApple in reply to CarpaBob]

I'm currently growing cherry tomatoes in my kitchen, hydroponically, which means no soil whatsoever. My tomato plants receive their nourishment from liquid feed. As I understand it, lot of tomatoes that we buy in the shops now are grown in a similar way.

[helvella in reply to RedApple]

How big a kitchen do you need to grow one kilogram a day, on a rolling basis?

[tattybogle in reply to RedApple]

have you got grow lights on them ?

bbc.co.uk/news/articles/cm2....

[RedApple in reply to tattybogle]

Oh yes, I recall seeing that news item! 🤣

My set-up is a little more modest. I have six little plants in all. I might get one kilo in total. I will try to remember to weight them when I pick them!

hydroponic tomatoes

[RedApple]

'herbs etc' Hmm, I'm not going to ask whichich type of, ahem, herbs you were growing in those days! 🤣😉

[samaja]

I must say what interests me here is whether she also had other deficiencies, B12 in particular, and thyroid issues as they are so common with iron deficiency.