I've seen two different patients recently who admitted to eating flour right out of the bag with a spoon. One young lady said that she was consuming two pounds of flour every day, eating little else. That was her chief complaint...."I need help to stop eating flour."
Sometimes it would make her stomach cramp up, but she had no other complaints. She seemed like an otherwise normal person, but she was embarrassed about her addiction.
Some things they don't teach us in medical school or residency. Or if they did, the specifics have been long forgotten by your humble narrator. I remember the pica lecture, of course, but I don't recall the management part. So as with many situations that present to the ER, I found myself shooting from the hip.
Is she in danger from eating flour? Of course not...it's flour. Maybe it could cause a doughy bowel obstruction if she didn't drink enough water, or perhaps some vitamin/mineral deficiencies in the long-term, but it wasn't really an emergency. But since I am the caring, compassionate type of physician who always tries to help patients in need, I came up with the best plan that I could think of.
Her examination, lab tests, and X-rays were normal, so I recommended that she take a vitamin every day and try to taper off the flour (setting aside a limited and greatly decreased amount each day for her pleasure) while trying to introduce a more balanced diet. I recommended that she follow up with a Dietitian and a Psychiatrist.
I suspect this is a more common addiction than we realize, but less harmful than many.