Nutritional-deficiency anemia: Causes, symptoms, and treatment

Feeling tired all the time, short of breath after climbing one flight of stairs, and
constantly cold even when everyone else is fine? It’s easy to blame “getting older”
or a busy life, but your body might be trying to tell you something more specific:
you could have nutritional-deficiency anemia.

Anemia is incredibly common worldwide, and a large portion of cases are caused by a
lack of key nutrientsespecially iron, vitamin B₁₂, and folate (vitamin B₉).
The good news? Once you know what’s going on, nutritional-deficiency anemia is often
very treatable with the right mix of diet changes, supplements, and medical follow-up.

Let’s break down what nutritional-deficiency anemia is, what causes it, how it shows up in
your body, and what you can doworking with your healthcare teamto feel like yourself again.

What is nutritional-deficiency anemia?

Anemia means your blood doesn’t have enough healthy red blood cells or enough hemoglobin
(the protein in red blood cells that carries oxygen). When you don’t have enough oxygen
moving around your body, you feel tired, weak, and generally not at your best.

Nutritional-deficiency anemia happens when your body can’t make healthy red blood
cells because it doesn’t have the nutrients it needs. The most common culprits are:

• Iron deficiency
• Vitamin B₁₂ deficiency
• Folate (vitamin B₉) deficiency

Other nutrientslike vitamin A, vitamin B₂ (riboflavin), and vitamin Calso play supporting
roles in red blood cell production, but iron, B₁₂, and folate are the big three that doctors
look at first.

Main types of nutritional-deficiency anemia

Iron-deficiency anemia

Iron-deficiency anemia is the most common type of anemia worldwide. Iron is a core building block
of hemoglobin. Without enough iron, your body makes fewer and smaller red blood cells that carry
less oxygen. You can think of it as trying to run a delivery service with fewer trucks and half-full
gas tanks: everything slows down.

Iron-deficiency anemia often develops gradually. Many people don’t realize how bad they feel until
they start treatment and suddenly notice they’re no longer exhausted all day.

Vitamin B₁₂–deficiency anemia

Vitamin B₁₂ helps your body make DNA and supports healthy red blood cells and nerve cells.
When you’re low on B₁₂, your bone marrow produces fewer red blood cells, and the ones
it does make are often larger than normal and don’t work properly (this is called megaloblastic anemia).

B₁₂-deficiency anemia isn’t just about low energy. Because B₁₂ is so important
for the nervous system, people may also develop numbness, tingling, balance problems, mood changes, or
memory issues if deficiency goes untreated.

Folate-deficiency anemia

Folate (vitamin B₉) is another key player in DNA synthesis and red blood cell production.
Like B₁₂ deficiency, folate deficiency can cause megaloblastic anemia, where red blood cells
are big, immature, and not very efficient at carrying oxygen.

Folate deficiency is especially concerning in people who are pregnant or may become pregnant, because
low folate levels are linked to neural tube defects in developing babies. That’s one reason why folic
acid is added to many grain products in the United States.

Common causes and risk factors

Nutritional-deficiency anemia can happen for more than one reason at a time. Sometimes diet is the main
problem; other times, the real issue is that your body can’t absorb nutrients properly or your needs are
higher than usual.

Dietary causes

• Low iron intake: Diets low in red meat, poultry, fish, beans, lentils, fortified cereals, and leafy
  greens can lead to iron deficiency, especially if your body’s iron needs are high.
• Vegan or strict vegetarian diets without planning: Vitamin B₁₂ is found almost entirely
  in animal products (meat, fish, eggs, dairy). People who avoid these foods and don’t use fortified foods
  or supplements are at higher risk of B₁₂ deficiency.
• Limited intake of fruits, vegetables, and fortified grains: These foods provide folate. A diet
  low in these can increase the risk of folate-deficiency anemia.
• Alcohol use: Heavy or long-term alcohol use can interfere with folate and B₁₂ absorption
  and also affect the bone marrow.

Absorption problems

Even if you’re technically “eating the right things,” your body might not be able to absorb nutrients well.
Common issues include:

• Celiac disease, inflammatory bowel disease, or other gut conditions that damage the intestinal lining.
• Stomach or intestinal surgery (for example, gastric bypass) that removes or bypasses areas where
  nutrients are normally absorbed.
• Pernicious anemia: an autoimmune condition where your body doesn’t make enough intrinsic factor,
  a protein needed to absorb vitamin B₁₂.
• Low stomach acid or long-term use of acid-reducing medications, which can interfere with B₁₂ absorption.

Increased needs or losses

Sometimes your body simply needs more nutrients than usualor you’re losing them faster than you can
replace them. For example:

• Pregnancy: Iron and folate needs go up significantly to support the growing baby and increased blood volume.
• Heavy menstrual bleeding: People with frequent, heavy periods lose blood (and therefore iron) every month.
• Rapid growth in infants, children, and teens: Growing bodies need extra iron, B₁₂, and folate.
• Chronic bleeding: From ulcers, colon polyps, cancers, or other conditions that cause slow blood loss.

Symptoms of nutritional-deficiency anemia

The symptoms of nutritional-deficiency anemia can be sneaky. Many people shrug them off as “just stress”
or “getting older,” but your blood work might tell a different story.

General anemia symptoms

Regardless of whether the cause is iron, B₁₂, or folate, many symptoms overlap because they’re driven
by low oxygen delivery to tissues. Common signs include:

• Persistent fatigue or exhaustion, even after rest
• Weakness and low stamina
• Shortness of breath with mild activity
• Dizziness or lightheadedness
• Pale or sallow skin
• Rapid or irregular heartbeat, especially with exertion
• Headaches
• Cold hands and feet

Iron-deficiency anemia symptoms

Iron deficiency can cause some extra clues, including:

• Brittle nails or hair loss
• Craving non-food items like ice, dirt, or paper (a symptom called pica)
• Sore or smooth tongue
• Restless legs, especially at night, in some people

Vitamin B₁₂ and folate-deficiency symptoms

Symptoms of B₁₂ or folate deficiency can overlap with iron deficiency, but there are some extra
red flags, especially when nerves are affected:

• Numbness, tingling, or “pins and needles” in hands and feet
• Balance problems or trouble walking
• Memory issues, trouble concentrating, or confusion
• Mood changes such as irritability or depression
• Sore, red, or swollen tongue; mouth ulcers

These symptoms can become permanent if B₁₂ deficiency goes untreated for too long, so early diagnosis
really matters.

How nutritional-deficiency anemia is diagnosed

If you or your healthcare provider suspects anemia, the evaluation usually starts with a
complete blood count (CBC). This test checks:

• Hemoglobin and hematocrit (measures of red blood cells)
• Red blood cell size and shape
• Number of white blood cells and platelets

If the CBC suggests anemia, additional tests can help figure out which nutrients are low and why:

• Serum iron, ferritin, transferrin, or total iron-binding capacity (for iron deficiency)
• Vitamin B₁₂ and folate levels
• Methylmalonic acid and homocysteine (can help clarify B₁₂ vs. folate deficiency)
• Tests for blood loss (such as stool tests for hidden blood)
• Evaluation for conditions affecting the stomach or intestines when malabsorption is suspected

Your provider will also ask about your diet, menstrual history, medications, and any digestive symptoms.
This detective work is key to choosing the right treatment plan.

Treatment for nutritional-deficiency anemia

Treatment focuses on two things:

1. Replacing the missing nutrient(s)
2. Addressing the underlying cause so the problem doesn’t just come back

Diet changes

Nutrition is the foundation. Your provider or a registered dietitian may suggest:

• For iron: More lean red meat, poultry, fish, beans, lentils, tofu, fortified cereals, and
  dark leafy greens. Pair plant-based iron sources with vitamin C–rich foods (like citrus, strawberries,
  or bell peppers) to boost absorption.
• For vitamin B₁₂: More meat, poultry, fish, eggs, and dairy products if you eat them.
  If you’re vegetarian or vegan, fortified plant milks, cereals, and nutritional yeast can provide B₁₂,
  often along with supplements.
• For folate: Leafy greens (spinach, kale), beans, peas, lentils, avocados, citrus fruits, and
  fortified grain products.

A balanced eating pattern that includes a variety of whole foods is more sustainable (and more enjoyable) than
trying to fix everything with one “superfood.”

Supplements

Many people with nutritional-deficiency anemia also need supplements, at least for a while. Common options include:

• Oral iron supplements: Often taken once or several times a day. They may cause constipation,
  dark stools, or stomach upset, so your provider may adjust the dose or type. It can take several months to
  fully rebuild iron stores, even after blood counts normalize.
• Vitamin B₁₂ supplements: May be taken as pills, sublingual tablets, or liquids. For people
  with absorption problems or pernicious anemia, regular B₁₂ injections or high-dose tablets that
  don’t rely on normal absorption may be needed long-term.
• Folic acid supplements: Often used to correct folate deficiency and are especially important before
  and during pregnancy.

It’s important not to self-diagnose or start high-dose supplements without guidance. For example, taking large
amounts of folic acid can mask a B₁₂ deficiency, which can delay diagnosis and increase the risk of
nerve damage.

IV infusions and injections

In more serious cases, or when oral supplements aren’t tolerated or absorbed, your provider may recommend:

• Intravenous (IV) iron infusions for moderate to severe iron deficiency or when quick correction is needed.
• Vitamin B₁₂ injections on a regular schedule for pernicious anemia or severe B₁₂ deficiency.

These treatments are usually given in a clinic setting and monitored carefully for side effects.

Can nutritional-deficiency anemia be prevented?

You can’t control everything in life (if only!), but there are practical steps that can lower your risk:

• Build a nutrient-dense plate: Include sources of iron, B₁₂, and folate regularly, especially
  if you’re in a higher-risk group like people who menstruate heavily, are pregnant, or follow a restricted diet.
• Don’t skip routine checkups: Regular blood work can catch mild anemia before it becomes severe.
• Talk with your provider before and during pregnancy: Prenatal vitamins with iron and folic acid are
  standard for good reason.
• Ask about medications: If you’re taking acid-reducing drugs, metformin, or other medications that can
  affect nutrient absorption, ask your provider whether monitoring or supplementation is recommended.
• Limit heavy alcohol use: This protects both your nutrient absorption and your bone marrow.

When to see a doctor

Make an appointment with your healthcare provider if you notice:

• Ongoing fatigue or weakness that doesn’t match your activity level
• Shortness of breath doing everyday tasks
• New or worsening dizziness, chest discomfort, or rapid heartbeat
• Pale skin, frequent headaches, or extremely cold hands and feet
• Numbness, tingling, or changes in balance, mood, or memory

If you have severe symptoms such as chest pain, extreme shortness of breath, or fainting, seek urgent or
emergency care. Anemia can sometimes be a sign of serious bleeding or other underlying conditions that need
prompt treatment.

Real-life experiences and practical tips for living with nutritional-deficiency anemia

Statistics and lab values tell part of the story, but day-to-day life with nutritional-deficiency anemia is
where the real challengeand real progresshappens. Here are some common experiences people share and
practical tips that can help.

The “I didn’t realize how bad I felt” moment

Many people say they didn’t understand how exhausted they were until treatment kicked in. Before diagnosis,
it’s easy to normalize symptoms: afternoon crashes, needing three cups of coffee to function, or getting
winded walking up a flight of stairs. After a few weeks of appropriate treatment, they often describe feeling
like “someone turned the lights back on.”

Tip: If your energy level has slowly slipped over months or years, it can be hard to see the
change. Keeping a simple energy log for a week or tworating your energy from 1 to 10 at different times
of daycan give you something concrete to talk about with your provider.

Learning to take supplements consistently

Iron and vitamin supplements only work if you actually take them (annoying, but true). People often struggle
with remembering doses or with side effects like nausea or constipation.

Helpful strategies include:

• Taking iron every other day if recommended, which can sometimes improve absorption and comfort.
• Pairing your supplement with a daily routinelike brushing your teeth or eating breakfast.
• Using a pill organizer or phone reminders so doses don’t disappear into the chaos of your schedule.
• Talking with your provider about changing the type of supplement if side effects are a deal-breaker.

Managing food restrictions and preferences

If you’re vegetarian, vegan, or have multiple food allergies, the phrase “just eat more steak” is not very
helpful. But that doesn’t mean you’re doomed to anemia.

People often find success by:

• Leaning into fortified foods (cereals, plant milks, nutritional yeast) for B₁₂ and folate.
• Using beans, lentils, tofu, and tempeh as regular protein and iron sources.
• Pairing iron-rich plant foods with vitamin C sourcesthink beans with salsa, spinach with citrus, or lentil soup with a side of fruit.
• Working with a dietitian for a few sessions to build a customized, realistic plan.

Balancing rest and activity

When you’re anemic, pushing through intense workouts can leave you completely wiped out. On the flip side,
doing absolutely nothing can make you feel even more sluggish.

Many people do best when they:

• Scale workouts down but don’t stop moving entirelygentle walks, stretching, or yoga can help.
• Listen to their bodies: if you’re short of breath, dizzy, or your heart is racing, that’s a sign to slow down.
• Give themselves permission to rest without guilt while treatment is starting to work.

Advocating for yourself in healthcare settings

One of the most powerful tools you have is your own voice. People with nutritional-deficiency anemia often
describe a long road of feeling “off” before getting answers. If you feel like your symptoms are being brushed
aside, it’s okay to:

• Ask specifically: “Could this be anemia or a nutrient deficiency? Should we check a CBC, iron, B12, and folate?”
• Bring a written list of symptoms and how long they’ve been happening.
• Ask for clarification on test resultsdon’t be shy about “What does that number mean for me?”
• Request a referral to a specialist (such as a hematologist or gastroenterologist) if the cause isn’t clear.

You deserve to understand what’s happening in your own body and to be an active partner in your treatment plan.

Looking ahead: life after treatment

With the right diagnosis and a tailored treatment plan, most people see significant improvement in their energy
levels and overall health. For some, treatment is short-termlike correcting iron deficiency after a period of
heavy bleeding. For others with chronic conditions or absorption problems, maintenance supplements or injections
become part of their long-term routine.

Either way, nutritional-deficiency anemia doesn’t have to define you. With good medical care, a supportive diet,
and a bit of patience, you can rebuild your nutrient stores and get back to living your lifeideally with fewer
naps required.

Final thoughts

Nutritional-deficiency anemia is common, but it isn’t something you just have to live with. If you’re dealing
with unexplained fatigue, shortness of breath, or other symptoms that just don’t feel right, it’s worth asking
whether anemiaor a nutrient deficiencymight be part of the picture.

Partnering with your healthcare team, focusing on nutrient-rich foods, and using supplements wisely can help
restore healthy red blood cells and, more importantly, help you feel like yourself again. Your body is doing
its best with what you give itsometimes it just needs a little more of the right building blocks.