Nutritional deficiency anemia: Causes, symptoms, and treatment

By Yvette Brazier. Last updated Thu 10 August 2017

Anemia is a common condition that results from a lack of certain vitamins and minerals. Not consuming a balanced diet can lead to a deficiency, or malnutrition.

Anemia affects over 30 percent of the world’s population. It is most severe among pregnant women and in children.

A range of health problems can arise from nutritional deficiencies. Nutritional deficiency anemia can lead to a low red blood cell count, low hemoglobin in the red blood cells, or red blood cells that do not function as they should.

Nutritional deficiency anemia mainly results from a lack of iron, but a lack of folate or vitamin B12 can also cause anemia, and a low vitamin C intake can contribute.

Nutritional deficiency anemia can happen because of a lack of nutrients in the diet or because of an illness or medical condition that make it hard to absorb nutrients.

Contents of this article:

  • Iron-deficiency anemia
  • Vitamin-deficiency anemia
  • Causes of deficiency anemia
  • Treatment

Fast facts on nutritional deficiency anemia:

Here are some key points about nutritional deficiency anemia. More detail is in the main article.

  • Iron-deficiency anemia can happen when a person does not have enough iron in the diet, or if they have a condition that makes it hard to absorb nutrients.
  • It can lead to a low level of red blood cells.
  • Vitamin-deficiency anemia happens when a person does not consume or absorb enough vitamin B12, or B9, also known as folate.
  • It can cause red blood cells to be an unusual shape, so that they cannot function properly.
  • Nutritional deficiency anemia can affect a wide range of bodily functions.
  • The main way to treat or prevent it is through a healthful diet.

Iron-deficiency anemia

Anemia resulting from iron deficiency is considered one of the top 10 contributors to the global burden of disease. The World Health Organization (WHO) describe iron-deficiency anemia as “the most common and widespread nutritional deficiency in the world.”

In 2011, the WHO estimated that, globally, anemia affects 43 percent children up to the age of 5 years, 38 percent of women during pregnancy, and 29 percent of women who are not pregnant.

In iron-deficiency anemia, the red cells appear abnormal and are unusually small (microcytic) and pale (hypochromic). The pallor of the red cells reflects their low hemoglobin content.

A person with iron-deficiency anemia often has:

  • pale skin
  • fatigue and lack of energy
  • shortness of breath
  • heart palpitations, or irregular heart beat

Other symptoms include:

  • headache
  • tinnitus
  • changes to the sense of taste
  • feeling itchy
  • a desire to eat ice, known as pica
  • sores or ulcers at the corner of the mouth
  • sore tongue
  • hair loss
  • spoon-shaped fingernails and toenails
  • difficulty swallowing
  • depression
  • missed menstruation in women during their reproductive years

Iron-deficiency anemia is common in people who:

  • consume little iron in their diet
  • have a condition that prevents the body from absorbing nutrients
  • have a stomach ulcer, heavy menstruation, or another cause of bleeding
  • have a genetic disorder, such as sickle cell anemia or another health condition, such as malaria

Iron deficiency and diet

Iron-deficiency anemia can result from a lack of iron in the diet. During pregnancy, for example, women need more iron to supply the fetus. If they do not take in enough, this may lead to a dietary deficiency anemia.

Heme iron is the most bioavailable form of iron and is found only in meat. Non-heme iron is found in plant based foods and is not as easily absorbed. Vegetarians and vegans need to be mindful of their iron intake to ensure they are meeting their needs.

A lack of vitamin C in the diet can reduce the body’s ability to absorb iron, leading to anemia.

Iron-deficiency anemia can affect a person’s overall health and their ability to function at work and in their daily routine.

Vitamin-deficiency anemia

Vitamin-deficiency anemias can result from deficiencies in folate (vitamin B9) or vitamin B12.

When the intake of these nutrients is low, or if the body is not absorbing them properly, red blood cells may become too large or adequate amounts of red blood cells are not produced.

This is called megaloblastic anemia.

A person with vitamin-deficiency anemia may experience:

  • fatigue and lack of energy
  • tingling, or pins and needles
  • muscle weakness
  • a sore, red tongue
  • mouth ulcers
  • visual disturbance
  • depression and confusion
  • problems with concentration, thinking, and memory

Long-term complications include:

  • nervous system disorders, which may be permanent
  • infertility, which is usually reversible
  • heart problems, and possible heart failure
  • complications during pregnancy
  • congenital disorders in newborns

Causes of deficiency anemia

Some people have low levels of the necessary nutrients because of:

  • a low dietary intake of iron, vitamin B12, or folate, due, for example, to a vegan diet or a “monotonous, plant-based diet”
  • a low dietary intake of Vitamin C
  • a lack of intrinsic factor, a protein secreted by the stomach that aids in the absorption of vitamin B12
  • a health condition that makes it hard to absorb nutrients, such as celiac disease
  • a health conditions that makes it harder for the body to make enough red blood cells
  • medications, such as proton pump inhibitors (PPI), which affect the way the body absorbs vitamins

Riboflavin, and copper are also needed for the body to make red blood cells. If these are missing from the diet or if a person cannot absorb them, there is a higher risk of anemia.
Other risk factors for anemia

Factors that increase the risk of anemia include:

  • problems with the hormone erythropoietin, which stimulates the bone marrow to make red blood cells
  • conditions such as kidney disease and cancer, which make it hard for the body to produce enough red blood cells
  • some cancer treatments that may damage the bone marrow or reduce the red blood cells’ ability to carry oxygen
  • damaged bone marrow, which cannot make red blood cells fast enough to replace the ones that die or are destroyed

Other factors that increase the risk of anemia include:

HIV or AIDS: Infections or medicines used to treat these diseases can lead to anemia.
Pregnancy: During the first 6 months of pregnancy, the fluid portion of a woman’s blood, or plasma, increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia.
Alcohol consumption: This can affect the absorption of folate and vitamin B12, potentially leading to anemia.
Aplastic anemia: Some people are unable to make enough red blood cells from birth. Infants and children with aplastic anemia often need blood transfusions to increase the number of red blood cells in their blood. Certain medicines, toxins, and infectious diseases, also can cause aplastic anemia.


Treatment for nutritional deficiency anemia is through a varied diet, including mineral-rich and fortified foods, and vitamin and mineral supplements, if appropriate.

The Dietary Guidelines for Americans 2015-2020 recommend the following daily intake of iron, folate, and B12.

  Iron (mg) B12 (mcg) Folate mcg DFE
Men 19-30 years 8 2.4 400
Women 19-30 years 18 2.4 400
Men 31-50 years 8 2.4 400
Women 31-50 years 18 2.4 400

DFE means dietary folate equivalent. This is used because folic acid and folate are absorbed differently in the body.

Food sources of iron, B12, and folate

Here are some food sources of iron:

Food item Amount of iron
Dark chocolate, 3 ounces 7 mg
Fried beef liver, 3 ounces   5 mg
Braised beef, 3 ounces 2 mg
1 hard-boiled egg 1 mg
Tofu, firm, half a cup 3 mg
Spinach, boiled and drained, half a cup 3 mg

Food sources of B12 include:

Food item Amount of B12
Beef liver, 3 ounces 84.1 mcg
Salmon, 3 ounces 4.8 mcg
Broiled beef, 3 ounces 1.4 mcg
1 hard-boiled egg 0.6 mcg
Swiss cheese, 1 ounce 0.9 mcg

Good food sources of folate are:

Food item Amount of folate
Beef liver, 3 ounces 215 mcg DFE
Boiled spinach, 1 cup 131 mcg DFE
White rice, half a cup 90 mcg DFE
Avocado 59 mcg DFE
1 medium banana 24 mcg DFE
Low-fat milk, 1 cup 12 mcg DFE

Fortified cereals are a good source of nutrients. The amount depends on the product and the manufacturer.

Vitamin C enhances iron absorption, while tannin, found in tea, reduces it. Consuming more vitamin C and reducing intake of tannin, therefore, can also help prevent anemia. Good sources of vitamin C include red peppers, oranges, strawberries, and broccoli.

While some causes of anemia require medical treatment, such as transfusions, the WHO estimated that in 2011, half of all cases of anemia in women could be solved through supplementation.

Medical treatment

People who are at risk can take supplements orally or by injection. Those with severe deficiencies may need hospitalization, where they may receive the nutrients intravenously.

A person with B12 anemia may need injections of the vitamin once a month, or they may use a nose spray, a tablet under the tongue, or a tablet that is swallowed.

People with folate deficiency may need to take folate tablets.

If deficiencies result from an inability to absorb nutrients, supplements may be a life-long treatment.

During pregnancy, women may need to take supplemental iron and folic acid. A health care professional can advise about use of these supplements.

However, for most people living in developed countries, a healthful diet that meets the dietary guidelines for nutrients will normally provide enough iron, folate, and vitamin B12 to prevent anemia.

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