Can stress cause anemia?

Did you know that every breath you take delivers oxygen to your bloodstream? Red blood cells contain a protein called hemoglobin that carries oxygen throughout your body. “With anemia, the structure of the red blood cells is compromised and can’t provide enough oxygen to the body’s tissues,” says Elena Garcia, MD, a healthcare provider at Concierge Wellness Center in Las Vegas, Nevada. Like the low oxygen levels at high altitudes, anemia can make you feel dizzy and weak. Causes of anemia include genetic factors, blood loss, damaged bone marrow, nutritional deficiencies (iron, vitamin B12, and folic acid), and health conditions that cause chronic infection or inflammation. Stress alone does not cause anemia, but chronic stress negatively impacts health in ways that increase your risk of anemia.

Does stress cause anemia?

“I don’t think we can say anemia is caused by stress,” says Dr. Garcia. Instead, stress triggers a domino effect of poor health outcomes that may lead to certain types of anemia, such as:

• Nutritional deficiencies: “When you’re feeling stressed, it can be challenging to eat well-balanced meals,” explains Kaytee Hadley, RDN, a functional medicine dietitian and founder of Holistic Health and Wellness. If you eat a poor diet for a long period of time, it can lead to vitamin and mineral deficiencies. Iron, folate, vitamin B12, and magnesium are important for preventing anemia.
• Impaired gut health: The body’s brain-gut connection may also link stress and anemia. Severe stress can trigger gastrointestinal issues like ulcers or gastritis. Left unchecked, GI problems may cause blood loss that leads to iron deficiency.
• Decreased immune function: Chronic stress also suppresses immune function. Infections and inflammation from stress-related sickness may impede your body’s ability to absorb or store iron, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

In other words, stress does not cause anemia. However, someone who is perpetually stressed may have poor eating habits that lead to a nutritional deficiency. Chronic stress can also have a negative impact on gut health and immune system function which can interfere with your body’s ability to store or conserve iron—all of which can raise a person’s risk for developing anemia.

Which anemia symptoms are associated with stress?

Common symptoms of anemia include:

• Weakness
• Tiredness
• Lethargy
• Restless legs
• Shortness of breath
• Pale skin
• Heart palpitations or irregular heartbeat

Anemia symptoms are easy to confuse with exhaustion, chronic stress, or even anxiety or depression. If you think you have anemia, it’s important to talk to your healthcare provider about getting a blood test. You may have low hemoglobin levels, but you may also have unmanaged stress or another medical condition.

It’s also possible that you are experiencing signs of both stress and anemia. Even if stress alone can’t cause anemia, it can cause a cascade of issues that raise your risk of anemia. 

The importance of diet with stress and anemia

“It’s important to fuel your body with iron, vitamin B12, and folate to prevent and alleviate anemia,” explains Hadley. Eating a well-balanced diet can also help improve your mental health in stressful times.

People with iron deficiency anemia should eat iron-rich foods. Hadley says pairing iron-rich foods with vitamin C—such as topping spinach with lemon juice—promotes iron absorption. 

Iron-rich foods include:

• Red meat
• Liver
• Spinach
• Legumes
• Tofu
• Iron-fortified cereals, breads, and oatmeal

Diet is also crucial for people with B12-deficiency anemia. “B12 is primarily found in meat such as chicken, turkey, beef, and fish as well as enriched foods such as cereal and nutritional yeast,” says Hadley.

There are no specific off-limits foods for people with anemia. However, processed foods, processed vegetable oils, sugar, and artificial sweeteners do not promote physical or mental health. Avoiding so-called “junk food” and sweets is a good idea when you’re already feeling unwell.

Tips for managing stress and anemia

Dealing with stress and anemia can be exhausting. But the good news is that both these conditions are treatable. Stress management is more than just a one-and-done ordeal. You’ll need to work on managing external stressors and the way you respond to stress. As for anemia, once you start getting enough iron through food or supplements, it typically takes three to six months to correct iron-deficiency anemia, according to the NIH.

There are several ways to help manage stress and anemia symptoms:

• See a healthcare provider. If stress or anemia are interfering with your daily functioning, the first step is to talk to your healthcare provider. Fatigue and lethargy are symptoms of stress and anemia, but they could also be signs that something else is wrong.
• Take the supplements recommended by your provider. “Supplements can be beneficial if you consistently are not able to get enough of these nutrients through foods or if you need to get your levels up quickly,” says Hadley. Iron supplements are commonly prescribed for iron deficiency anemia.
• Practice deep breathing. Deep breathing relieves stress, while shallow breathing may worsen stress or anxiety. Plus, taking deep breaths helps oxygenate your blood.
• Move your body gently. Exercise is part of a healthy lifestyle and helps reduce stress and anxiety, says Hadley. That’s true even for anemic people, though it’s a good idea to ask your healthcare provider which exercises they recommend based on the severity of your anemia.

Ultimately, different types of anemia may require different types of treatment. “Depending on your situation, you either correct it nutritionally or focus on correcting the condition behind the anemia,” says Dr. Garcia.