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June 29, 2023

Optimal Guide to Anemia: Red Blood Cell Support


Anemia occurs when blood cells (RBCs) or hemoglobin decrease to an unhealthy level. Hemoglobin carries oxygen through the bloodstream so any reduction can lead to weakness and fatigue.

Blood loss, nutrient deficiencies, chronic disease, inflammation, RBC destruction, or RBC shape or size changes may cause anemia. The most common cause of anemia is reduced production of healthy RBCs caused by nutrient deficiency.

Common nutrient deficiencies associated with anemia include iron, folate, and B12. However, other nutrients are involved in maintaining healthy red blood cells, and any deficiency can contribute to anemia. These include vitamins A, C, E, K2, B1, B2, B6, B12, pantothenic acid, copper, zinc, magnesium, and selenium.

The cause of anemia must be identified to resolve it.


  • Consume a healthy, well-balanced diet.
  • Minimize oxidative stress from pollution, toxins, and excessive exercise.
  • Minimize inflammation, especially chronic inflammation.
  • Minimize or address infections, including hookworm, malaria, tuberculosis, and HIV.
  • Address chronic blood loss.
  • Consider anemia a contraindication to donating blood until resolved.


  • Address issues with maldigestion or malabsorption.
  • Consume
    • Adequate protein and iron for hemoglobin production.
    • Adequate antioxidants to protect RBCs, including vitamin C, vitamin E, selenium, and phytonutrients found in plant-based foods, including citrus, blueberries, acai, goji berries, acerola, leafy greens, and nuts.
    • Adequate amounts of the nutrients involved in RBC maintenance:
      • Iron, B12, folate, and vitamins A, C, E, K2, B1, B2, B6, pantothenic acid, copper, zinc, magnesium, and selenium.
    • Use targeted nutrition support to replete nutrients specific to the type of anemia diagnosed.
    • Although iron deficiency is a common cause of anemia, supplementation should be done carefully, as excess iron can be harmful.
    • Iron and RBC biomarkers in the blood should be monitored closely.

Optimal Takeaways

Pay close attention to the nutrients that are vital to healthy red blood cells, especially:


  • Foods high in iron include organ meats, clams, oysters, beef, chicken, dried beans, greens, and blackstrap molasses.
  • Iron from animal-based sources is better absorbed than from plant-based sources; vitamin C can help absorb plant-based iron.
  • If iron supplements are indicated, ferrous glycinate or pyrophosphate is preferred.


  • The usable form of vitamin B12 is found in animal-based foods, including organ meats, eggs, seafood, cheese, and meat. MethylB12 or adenosylB12 are the preferred supplement forms.
  • If absorption of B12 is impaired, then oral/sublingual or intramuscular forms may be needed.
  • B12 should be supplemented along with folate as they work closely together.


  • Good sources of folate include dark leafy greens, asparagus, whole grains, dried beans, brewer’s yeast, and liver.
  • Folate, or 5-MTHF, is the preferred form of supplemental folate. The synthetic folic acid form may not be tolerated well by some individual

Multivitamin mineral supplement

  • A well-balanced well-formulated multi should provide desirable amounts of B vitamins, vitamin D, trace minerals, and antioxidants. This can be used as a foundation accompanied by additional targeted nutrition support as needed.


Chang, Sui Kiat et al. “Superfruits: Phytochemicals, antioxidant efficacies, and health effects - A comprehensive review.” Critical reviews in food science and nutrition vol. 59,10 (2019): 1580-1604. doi:10.1080/10408398.2017.1422111

da Silva Lopes, Katharina et al. “Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews.” The Cochrane database of systematic reviews vol. 9,9 CD013092. 26 Sep. 2021, doi:10.1002/14651858.CD013092.pub2

Food sources of select nutrients. Appendix B 2005 DGA.

Gaby, Alan R. Nutritional Medicine. Fritz Perlberg Publishing, 2017.

Kim, Yong Chul et al. “The low number of red blood cells is an important risk factor for all-cause mortality in the general population.” The Tohoku journal of experimental medicine vol. 227,2 (2012): 149-59. doi:10.1620/tjem.227.149

Murray, Michael T., and Joseph Pizzorno. The encyclopedia of natural medicine third edition. Simon and Schuster, 2012.

Noland, Diana, Jeanne A. Drisko, and Leigh Wagner, eds. Integrative and functional medical nutrition therapy: principles and practices. Springer Nature, 2020.

Pagana, Kathleen Deska; Pagana, Timothy J.; Pagana, Theresa N. Mosby's Diagnostic and Laboratory Test Reference. Elsevier Health Sciences. 2019.

Scaglione, Francesco, and Giscardo Panzavolta. “Folate, folic acid, and 5-methyltetrahydrofolate are not the same.” Xenobiotica; the fate of foreign compounds in biological systems vol. 44,5 (2014): 480-8. doi:10.3109/00498254.2013.845705

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