When examining what is known about anemia and stress, it’s important to note that “stress” is spoken about in many different contexts. For example, there is emotional stress, oxidative stress caused by free radicals, the traumatic stress of an injury, the stress of childbearing, and so on.
Stress can be acute (intense, short-term) or chronic (persistent, long-term).
Along with all these manifestations and durations of stress, there are lots of different biological indicators used to evaluate stress levels in a lab setting. For instance, markers in the saliva or urine, heart rate variability, and even eye movements can measure how stressed you are.
So, if it sounds like establishing the relationship between stress and anemia is not so simple, you’re correct.
In addition, many types of anemia exist — iron deficiency anemia is a well-known and common form, but it’s certainly not the only type of anemia.
Ultimately, it’s difficult to pin down a clear yes or no answer to whether stress can cause anemia.
However, particularly in the case of iron-deficiency anemia, some findings suggest that a connection is quite possible.
Interestingly, in 2017, molecular biologists discovered a cellular process demonstrating that stress is necessary for hemoglobin production. (Hemoglobin is the iron-carrying protein in red blood cells).¹
Keep reading to learn what form of stress they studied and more about the connection between anemia and stress.
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Anemia is a blood disorder characterized by causing a reduced number of functioning red blood cells. This results in a lack of oxygen in the bloodstream, which can cause various symptoms and complications.
Being anemic is not a definitive disease diagnosis. Rather, it is a condition that indicates an underlying health issue.
Anemia can be a symptom of certain genetic conditions, advanced kidney disease, cancer, or insufficient dietary iron, among other things.² ³
While there is strong evidence that stress can cause nutritional deficiencies (such as a lack of iron or vitamin B12), there is still more to learn about exactly how stress impacts or depletes nutrient levels.⁴
(Again, keep in mind that not all anemia forms have an iron or B12 deficiency as their cause).
Here are several types of anemia, from common to rare⁵
Iron-deficiency anemia is the most common form of anemia, in which the body can’t keep up with its need for iron to help manufacture new red blood cells. This anemia is associated with a lack of dietary iron, poor iron absorption, or blood loss (such as experiencing heavy menstruation or after childbirth).⁶
Pernicious anemia This type also involves a lack of essential nutrients, in this case vitamin B12, necessary to produce red blood cells. (pernicious means harmful).
Aplastic anemia Having this rare bone condition means the tissue responsible for producing blood cells (bone marrow) is damaged and not producing enough cells, white blood cells, or platelets. The cause could be genetic or result from certain medications, radiation treatment, or chemotherapy.
Hemolytic anemia Red blood cells have a finite lifespan of roughly 120 days. However, a condition called acquired hemolytic anemia can trigger them to be destroyed early, even when they’re still viable. There is also inherited hemolytic anemia, a genetic condition that interferes with the body’s messengers that control red blood cells. In either form of anemia, not enough red blood cells are made.
Some of the established causes for anemia include but are not necessarily limited to⁷
Nutritional deficiencies, such as insufficient dietary iron
Blood loss from internal bleeding, birthing, or frequent heavy menstruation
Autoimmune disorders, such as type 1 diabetes or vitiligo
Medication side effects
Alcohol use disorder
If you have mild anemia, you may not have noticeable symptoms.
However, some of the more common symptoms to be aware of include
Shortness of breath
Cravings to eat non-food substances (pica)⁸
Cold hands and feet
Rapid breathing rate
Low blood pressure when moving from sitting or lying down to standing up
Iron deficiency is usually the biggest risk factor for anemia, followed by folate and vitamin B12 deficiencies.
Other risk factors for anemia include:
Lifestyle and diet
Inflammation due to infections
Chronic kidney disease
Certain medications or chemotherapy
Women of reproductive age are frequently found to have iron deficiency due to menstrual blood loss.
Moderate to severe anemia is of particular concern for pregnant women, as it can raise the chances of premature labor, having a newborn with low birth weight, and increased blood loss during labor.
In addition, older adults are also at greater risk of anemia. According to the World Health Organization, 50–60% of individuals in nursing homes are affected.⁹
Complications of anemia among older adults can also be more severe due to other diseases, especially cardiovascular conditions.
In 2017, at the Hebrew University of Jerusalem, a team of researchers published a breakthrough finding that stress is “not only important but also essential and may have important implications for how we understand hemoglobin expression.” And this is not the first time that researchers have highlighted certain forms of stress as necessary, and even good for us.¹⁰
Hemoglobin is a protein in your red blood cells (RBCs) that attracts oxygen — it’s made of molecular building blocks called hemes. Heme attaches to iron molecules, and iron attaches to oxygen. So, at least at the molecular level, and in this particular experiment, a functioning stress response seems to play a positive, not negative, role in having working red blood cells.
In this context, stress was studied at the cellular level, as opposed to stress perceived as emotional tension or other forms of stress. However, cellular stress can be evidence of emotional or physical stress. The research also used embryonic kidney cells rather than individual adult participants.¹¹
In this case, broader implications for iron-deficiency anemia or other types of anemia were not part of the research scope.
One of the researchers, Professor Raymond Kaempfer, said that the discovery amounts to confirmation that "[E]ven at the cellular level, stress and the ability to mount a stress response are essential to our survival. We have long known this in relation to other biological processes, and now we see that it is at play even for the tiny molecules that carry oxygen in our blood."
In terms of more established evidence, there isn’t much data to support stress as a direct cause of anemia.
It would be more accurate to say that stress can change the way you digest food, which could lead to poor absorption of nutrients, thereby heightening the risk of iron-deficiency anemia.¹²
In addition, the causes of certain other forms of anemia are well-established. For instance, hemolytic anemia is known to be genetic, while aplastic anemia is also inherited but can sometimes be caused by bone marrow injury (such as in the case of radiation treatment or chemotherapy).¹³
Iron-deficiency anemia symptoms can feel eerily similar to an episode of anxiety, including rapid breathing, or irregular heartbeat. However, anxiety itself is not known to cause anemia.¹⁴
Blood tests, medical history, and physical exams can help determine whether (and to what extent) anemia is causing the symptoms listed above.
The various blood tests a doctor may order include:
Complete blood count (CBC)
Serum iron and ferritin
Other, more advanced tests to determine blood cell shape can help identify types and causes of anemia, including molecular and cytogenetic tests.
In some cases, bone marrow tests may be needed.
Certain tests for renal disease may be ordered if poor kidney function is suspected as a risk factor.
Stress-relieving activities and thought patterns can encourage cortisol regulation. (Cortisol is a hormone that your body releases to mediate stress).
In addition to experiencing noticeable feelings of relief and relaxation, the effectiveness of stress-relieving techniques is verifiable according to cortisol levels present in saliva.
There are numerous proven ways to prevent or reduce stress, including:
In the case of mild iron-deficiency anemia, iron supplements are usually the go-to treatment. For severe cases, IV iron therapy or blood transfusions may be necessary.¹⁹
The first-line treatment for pernicious anemia is ongoing B12 injections.²⁰
In some cases of aplastic anemia, a bone marrow transplant can be curative. There are also medications that can stop the autoimmune response that destroys bone marrow stem cells.²¹
Hemolytic anemia treatment can vary from requiring blood transfusions and bone marrow transplants. Medication and surgery (spleen removal) may also be recommended.²²
Looking ahead, there is evidence suggesting that gene therapy may be a promising treatment option for hereditary forms of anemia.²³
Anemia is a condition that can leave you feeling tired, dizzy, and depressed. If you think you may be anemic, your doctor will be able to recommend appropriate diagnostic tests and, if necessary, treatment.
Iron deficiency is the most common cause of anemia — some other risk factors include age, family history, and cancer. Taking measures to reduce stress, such as eating nutritious food whenever possible and getting plenty of rest is appropriate for anyone contending with either stress or anemia.
Strictly speaking, current science indicates more of a connection between nutrition deficiencies and iron-deficient anemia, as opposed to anemia and stress in general. There are many forms of anemia, some of which have nothing to do with iron deficiency, and have confirmed causes unrelated to stress.
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How stress controls hemoglobin levels in blood | Science Daily
What is anemia? | National Heart, Lung, and Blood Institute
What is anemia? | National Heart, Lung, and Blood Institute
Pica | National Eating Disorders Association
How chronic stress is harming our DNA | American Psychological Association
Stress effects on the body | American Psychological Association
Acquired aplastic anemia | Rare Disease
Pernicious anemia (2023)
Aplastic anemia | National Heart, Lung, and Blood Institute
Hemolytic anemia | National Heart, Lung, and Blood Institute