Rena Bronson of Macon comes home from work and makes a pot of coffee before sneaking off to the bathroom to feed her habit. She pulls out a plastic baggie full of hard, crumbling white chunks and then pops a piece in her mouth.
"I eat dirt with the door closed," she said, laughing and a little embarrassed because she is a nurse at the Bibb County Health Department. "I just call it eating dirt. That's what I do. Every day that God sends that's what I do. Technically, I guess I'm supposed to be crazy for eating this stuff?"
The "dirt" in question is kaolin, a white clay mined in Georgia and South Carolina that is used for everything from making ceramics and textiles to diarrhea medicine. For decades, it has also been a folk medicine that pregnant women, particularly black women in the rural South, have used to combat cravings during pregnancy. A recent study published in the Southern Medical Journal argues that kaolin-eating should be classed as a particular kind of problem known as a "culture-bound syndrome," that is not connected to any other psychiatric problem, said the study's lead author, R. Kevin Grigsby, a social worker and professor of psychiatry and health behavior at Medical College of Georgia.
Eating things like kaolin, however, can be harmful to the pregnant women and is something doctors need to talk to their patients about, said Lawrence Devoe, chairman of obstetrics and gynecology at MCG. In fact, the clay eating may be a factor in the rate of low-birth weight babies and more research is needed to see how widespread the practice is, Dr. Grigsby said.
Persistently eating non-food items is a psychiatric disorder called pica, and eating dirt is a specific disorder known as geophagia, Dr. Grigsby said.
"Pica exists all over the world, there are so many types of it, eating match heads and ice and earth," Dr. Grigsby said. Geophagia is usually found in children and is often linked with mental retardation, Dr. Grigsby said.
With the 21 clay eaters Dr. Grigsby and his colleagues reviewed in Middle Georgia, however, there was no other sign of mental or physical illness. It seemed to be most prevalent among black women in rural areas, who had been introduced to it by a relative, usually their mother, Dr. Grigsby said.
"This may be a collective family habit," Dr. Grigsby said.
The oldest of 13 children, Ms. Bronson remembers as a little girl watching her mother eat chunks of kaolin while she was pregnant. Her mother would send her to get the clay from neighbors or friends who worked in "the chalk mine" nearby.
"Mama would give us like 15 cents and say, `Go on up to Mrs. So-and-So's house and get me some chalk,'^" said Ms. Bronson, 51. "You'd give Mrs. So-and-So 15 cents and she'd just take a bag and put some chalk in it. Naturally, we'd sneak some out of the bag and eat it."
The researchers have reports of people eating dirt from Mississippi to North Carolina and Virginia, Dr. Grigsby said. "What we don't know is whether they're eating kaolin or not," he said.
While there is a great deal of information on geophagia, no one has systematically looked at kaolin-eating, Dr. Grigsby said. He first noticed the practice 25 years ago driving across a rural area when he saw people digging the clay out of ditches on the side of the road. He can document that it goes back at least three generations, but no one seems to know where it began.
"The fundamental question I have is, who started this?" Dr. Grigsby said. "Were they just so hungry they decided to eat dirt?"
The answer may have more to do with pregnancy. It has long been known that pregnant women may suddenly develop cravings for non-food items, such as dirt or laundry starch, Dr. Devoe said. It may come from changes in the brain itself, in the areas that control taste and smell, from the hormonal changes of pregnancy, Dr. Devoe said.
"It can make things a patient normally wouldn't ever think of partaking of in a non-pregnant state suddenly palatable," and desirable, Dr. Devoe said. The craving itself may be shaped by the culture around them, he said. While nationally perhaps 5-10 percent of pregnant women would develop some form of pica, it is much more prevalent in the South, Dr. Devoe said.
And it can become a danger to the mother's health because it can keep the mother from getting enough calories or the right nutrients, Dr. Devoe said. The dirt or clay can also sap the body of iron and other minerals and create anemia, Dr. Devoe said. As part of standard prenatal care, doctors are already screening patients for eating disorders and paying close attention to the mother's diet, Dr. Devoe said.
Dr. Grigsby believes there should be further research on whether kaolin-eating is adding to the number of low-birth-weight babies. While Dr. Devoe said he's not convinced it plays a major role, in 40-50 percent of premature or low-birth-weight babies there is not a known risk factor that can be identified.
For most patients, the cravings end when the pregnancy does, Dr. Devoe said. But for Ms. Bronson, it actually began with a seizure she had in 1992. After her doctor started her on seizure medication, she found herself wanting something.
"I hadn't had any chalk since I was a little girl at home," she said. But when she went to visit her mother, she saw a piece of it drying out on a heater and tried a taste. Later, when she was visiting her sister, she had an upset stomach and her sister gave her two chalky antacid tablets. Ahhhhh, she thought to herself.
"When I chewed those, that gave me that satisfied feeling that I needed inside," Ms. Bronson said.
Then she was surprised to find the kaolin was being sold in her grocery store in Macon.
"They got it right back there in the area where the fruit and vegetables are," she said, though it is labeled "not for human consumption."
It's the creamy consistency that the chalk turns in the mouth that Ms. Bronson enjoys. To describe the taste, she harkens back to sudden summer rainstorms that break up the heat of the day.
"If you can remember how the earth smells just after that shower hits the ground, it tastes like that," she said.
But she has paid a price for her habit. In addition to "severe constipation," she also has gained more than 20 pounds in the years she has been chewing chalk. But try as she might, she just can't kick it.
"I have tried so hard to stop eating that stuff," Ms. Bronson said. "I think they put something in it to addict you, really."
It is small relief that at least her habit doesn't mean she is crazy, though she has found herself rushing through the rain trying to get to the store before it closes to replenish her stash.
"I don't know, it might be a habit but it's definitely a very true yearning," she said.