Does sugar make anemia worse?

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Having anemia can make you feel tired and weak. There are many types of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

What is anemia?

Anemia develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen.

There are several types of anemia. All of them cause similar symptoms. The most common are:

• Iron deficiency anemia. This most common type of anemia is caused by a lack of iron in your body.
• Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production.
• Anemia of chronic disease. Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other chronic inflammatory diseases — can interfere with the production of red blood cells.
• Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn’t produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.
• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life.

What causes anemia?

Anemia has three main causes:

1. Blood loss. Losing blood through heavy menstrual periods or wounds can cause anemia.
2. Lack of certain nutrients in your diet. Not getting enough iron, folate or vitamin B-12 can cause decreased red blood cell production.
3. Inability of the bone marrow to produce enough red blood cells. Some conditions and diseases can prevent your body from making enough red blood cells.

Many common causes of anemia are preventable, especially those caused by deficiencies in iron, folate and vitamin B-12:

• Iron deficiency. Not getting enough iron in your diet can happen when you don’t eat foods that are rich in iron — including meat and other foods from animals — or if you don’t consume enough fruits, vegetables and grains that provide iron.
• Vitamin deficiency. In addition to iron, having a diet low in folate or vitamin B-12 can cause anemia. Folate and vitamin B-12 help create new red blood cells.
• Pregnancy. Red blood cell volume expands during pregnancy to supply oxygen for the developing baby. This temporarily lowers the red blood cell count in expectant mothers.
• Internal bleeding. Some medical conditions can cause internal bleeding, leading to iron deficiency anemia. These include ulcers, polyps, diverticulosis and colon cancer.
• Diseases. Certain inherited diseases affect the proper functioning of hemoglobin and other components of red blood cells. These diseases can lead to anemia.

Does sugar consumption affect anemia?

There is some evidence that high sugar intake may exacerbate or worsen anemia in certain ways:

1. Sugar can inhibit iron absorption

Iron deficiency is the most common cause of anemia globally. Consuming too much sugar may make it more difficult for your body to absorb iron from food:

• One study found that drinking a sugary soft drink with a hamburger meal reduced iron absorption by 39% compared to drinking water. The researchers attributed this to the acidic environment caused by the sugar-sweetened beverage.
• Another study found that consuming 50 grams of fructose (about 12 teaspoons of sugar) reduced iron absorption by 36% in iron-deficient young women.
• Excess sugar consumption is also linked to reduced absorption of zinc, another nutrient important for red blood cell production.

This research suggests that a high intake of added sugars and sugary foods and beverages may inhibit iron absorption, worsening iron deficiency anemia.

2. Sugar causes inflammation

Chronic inflammation appears to play a role in some types of anemia, including anemia of chronic disease and aplastic anemia.

Research shows that frequently consuming sugar-sweetened beverages and foods contributes to chronic, low-grade inflammation in the body. This type of diet-induced inflammation may worsen anemia in certain individuals.

3. Sugar provides empty calories

Foods and drinks high in added sugars like candy, soft drinks and baked goods are typically low in nutrients. Filling up on these empty calories may lead to an inadequate intake of iron and other important nutrients needed to produce healthy red blood cells.

This effect may be particularly problematic in children. One study of children in India found that those who consumed the most added sugar had the lowest intakes of iron.

4. Sugar impacts gut health

Excessive sugar intake is linked to reduced diversity of healthy gut bacteria. An unhealthy gut microbiome is associated with inflammation and reduced absorption of key nutrients involved in red blood cell production, including iron, vitamin B-12 and folate.

Therefore, excess sugar intake may worsen anemia by disturbing the gut microbiome.

Does anemia cause sugar cravings?

While high sugar intake may exacerbate anemia, the reverse may also be true — anemia can lead to cravings for sugary foods.

There are a few reasons why anemia may cause sugar cravings:

• Fatigue. The fatigue and low energy caused by anemia can lead to cravings for a quick energy boost from sugar.
• Nutrient deficiencies. Anemia is often caused by iron, vitamin B-12 or folate deficiencies. Lacking these nutrients may trigger cravings for sugary foods.
• Altered brain chemistry. Some research indicates that iron deficiency can alter dopamine levels and activity in the brain, potentially increasing sugar cravings.

In this way, anemia and high sugar intake can become a vicious cycle — anemia can cause sugar cravings, while high sugar intake may worsen anemia.

Treatment for anemia

Treatment for anemia depends on the cause:

• Iron deficiency anemia. Your doctor may recommend iron supplements, usually taken by mouth once or several times a day. Iron supplements can cause side effects like constipation and nausea, especially if taken on an empty stomach. In serious cases that don’t respond to oral iron, iron may need to be given intravenously or by injection.
• Vitamin deficiency anemias. Increasing intake of folate and vitamin B-12 through diet or supplements will resolve these types of anemia.
• Anemia of chronic disease. There is no specific treatment for this type of anemia. Doctors focus on treating the underlying condition.
• Aplastic anemia. This serious condition requires hospitalization. Transfusions can help replace red blood cells until treatment helps restore bone marrow function.
• Hemolytic anemias. Treatment depends on the cause and can include avoiding medications and chemicals that cause hemolysis, treating related infections or conditions, and frequent blood transfusions.

In addition to specific medical treatments, a healthy diet rich in iron, folate and vitamin B-12 is important for overcoming all types of anemia.

Tips for preventing and managing anemia

If you have anemia, you can take steps to reduce symptoms and help get your red blood cell counts back to normal:

• Eat iron-rich foods like meat, poultry, seafood, beans, lentils, tofu, spinach, raisins and iron-fortified cereals and breads.
• Consume folate-rich foods like dark leafy greens, asparagus, broccoli, citrus fruits, legumes and nuts.
• Include vitamin B-12 sources like meat, fish, eggs, dairy products and fortified plant-based milk and cereals.
• Consider taking iron, folic acid and vitamin B-12 supplements if diet alone isn’t helping.
• Reduce sugar intake from candy, baked goods, and sugary beverages.
• Limit refined grains, which contain less iron than whole grains.
• Avoid drinking coffee and tea with meals, as they make it harder to absorb iron.
• Treat underlying medical conditions that may cause anemia, such as ulcers or heavy menstrual bleeding.
• Stop smoking cigarettes, which can worsen anemia.

Making diet and lifestyle changes can go a long way in preventing and treating mild forms of anemia. However, see your doctor regularly to monitor blood cell counts while recovering from anemia.

The bottom line

Based on current evidence, a high intake of added sugars may worsen existing anemia or increase the risk of developing anemia in certain individuals by:

• Inhibiting absorption of iron and other nutrients needed to produce red blood cells
• Promoting inflammation
• Disrupting the gut microbiome
• Providing empty calories that displace nutrient-dense foods

On the flip side, anemia can also lead to increased sugar cravings due to fatigue, altered brain chemistry and nutritional deficiencies. Therefore, limiting added sugar intake should be part of an overall healthy diet and lifestyle approach to preventing and managing anemia.