Anemia & Alcohol: Can Alcohol Cause Anemia?

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Anemia is a hematologic condition (blood disorder) in which the body is unable to produce enough red blood cells, or the blood cells are unable to function correctly. It is the most common blood disorder in the US, with approximately 3,000,000 Americans diagnosed. Heavy or chronic alcohol use cannot only worsen pre-existing anemia; it can also induce low blood counts in previously healthy individuals.

If you or someone you love is dealing with anemia and alcohol use disorder (AUD), Guardian Recovery can help. Our expert clinical care services utilize a holistic treatment approach to focus on your mind and body. From initial medical detox to nutrition therapy, a team of knowledgeable, experienced clinicians will navigate you through each step of your recovery. Contact us today to speak with a treatment advisor 24/7 who can give you more information about our comprehensive, individualized services. Read on to find out more about the relationship between alcohol and anemia.


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How Does Alcohol Cause Anemia?

Red blood cells are responsible for internal oxygen transport. During respiration, small vessels in your lungs carry blood prepared to exchange old carbon dioxide for fresh oxygen. Hemoglobin is the protein found within red blood cells to bind and carry these oxygen molecules from your lungs to the rest of your system. When your body cannot produce enough healthy red blood cells, hemoglobin’s ability to transport adequate oxygen to your tissues is compromised.

Anemia can be acute or chronic, depending on the origin. It has several causes, such as vitamin and mineral deficiencies, red blood cell destruction, excessive bleeding, chronic disease, or changes in red blood cell size and shape.

Alcohol Causes Anemia in Several Ways: 

  • It can hinder the hematopoietic (blood-making) process.
  • Long-term alcohol misuse disrupts the balance of vitamins and minerals necessary to keep red blood cells functioning properly.
  • Excessive drinking leads to tissue and organ injury, resulting in excessive or chronic bleeding.

Alcohol’s Effect on Red Blood Cells

While the exact impact of alcohol on the red blood cell-producing system is not fully understood, several theories point to toxic effects on cell production and changes to the functional shape of red blood cells. Such effects are more common for individuals who drink more than 60-80 grams of alcohol daily.

Bone Marrow Suppression

Red blood cell production begins in the red marrow of bones. Stem cells within marrow differentiate into various components of blood: red blood cells, white blood cells, and platelets (clotting cells). Stem cells transitioning to red blood cells go through stages of development where they mature and form their structure. Mistakes in this process will lead to malfunctioning or nonfunctional cells.

Alcohol not only decreases blood production; it also causes the bone marrow to produce immature, malformed red blood cells. Five to seven days after heavy alcohol consumption, iron deposits or fluid-filled cavities will form in developing cells. Such cells cannot adequately transport oxygen to the rest of the system. However, these abnormalities disappear after one to two weeks of abstinence, and regular blood production resumes.

Vitamin and Mineral Deficiencies

Folate, B12, and phosphate are three vitamins and minerals most often implicated in alcohol-induced anemia. People with AUD often receive insufficient folate and B12 from their diets, and drinking impairs the body’s ability to extract these nutrients from food. In the case of folic acid and B12 deficiency, your bone marrow produces red blood cell precursors that do not grow and divide properly, resulting in extremely large, nonfunctional megaloblasts. These cells may enter the bloodstream and take the place of some functional red blood cells, leading to symptoms of anemia.

On the other hand, low phosphate levels give way to hemolytic anemia. This form of anemia is the result of red blood cell destruction. While rare in the general population, low phosphate levels are more common in heavy drinkers, because alcohol forces extra phosphate to be lost in the urine. Depletion of this mineral causes rigidity in the red blood cell membrane, which damages the cell and marks it for destruction by the spleen.

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Alcohol’s Effect on the Liver

Although bone marrow is primarily responsible for blood production, the liver produces most coagulation factors necessary for proper blood clotting. Alcohol is broken down through the liver and impacts the organ’s ability to metabolize other substances. Excessive drinking leads to a more significant number of fat deposits in healthy liver tissue. These deposits promote inflammation, which alters the chemical process necessary to break down scar tissue in the liver over time. Scar tissue then replaces healthy liver cells in a condition known as cirrhosis. A cirrhotic liver cannot produce clotting factors efficiently. Internal bleeding may result, particularly in the gastrointestinal (GI) tract.

Alcohol’s Effect on the Gastrointestinal System

The GI system breaks down food and extracts vital nutrients in digestion. Alcohol use inhibits proper nutritional absorption and promotes bleeding along the GI tract.


As previously mentioned, alcohol impairs your body’s ability to take specific essential vitamins and minerals from the food you eat. Drinking not only produces red blood cells that are too large to function as the result of folate and B12 deficiency, but alcoholic fatty liver disease also prevents the necessary intestinal absorption and liver uptake of these vitamins.

Gastrointestinal Bleeding

Apart from an overall increased risk of bleeding due to a lack of clotting factors produced by the liver, individuals with AUD are at an exceptionally high risk of GI bleeding. Alcohol stimulates stomach acid production and reduces the protective gastric mucus layer, making stomach tissue susceptible to gastritis, erosions, and ulcerations. Such conditions may ultimately reach the blood vessels of the stomach, causing them to rupture and bleed. Chronic GI bleeding over time will lead to iron deficiency and associated anemia.

Symptoms of Alcohol-Induced Anemia

Whether anemia is due to improper red blood cell formation, nutrient deficiencies, or long-term bleeding, anemia has multiple physical and mental effects. Depending on the nature of your alcohol use and how it has impacted your body, the impacts may be short-term or chronic.

Common Symptoms of Anemia Include:

  • Pale skin and mucosa (inner eyelids, mouth, inner lip).
  • Weakness and fatigue.
  • Dizziness.
  • Brittle hair and nails.
  • Cold extremities.
  • Shortness of breath after minimal exertion.
  • Chest pain.
  • Heart palpitations.
  • Headache.
  • Black or tarry bowel movements (if anemia due to GI bleeding).

Is Anemia From Alcohol Misuse Preventable or Reversible?

Alcohol-induced anemia is preventable and reversible. Recovery speed depends on your commitment to abstinence and the nature of the anemia. Most anemias caused by bone marrow suppression or nutrient deficiencies will resolve within two weeks. In the case of a GI bleed, you may require surgery to repair torn vessels.

Prevention is the best course of action for alcohol-induced anemia. If you have a history of blood disorders, liver dysfunction, or GI disease, it is best to abstain from alcohol entirely. People without these health conditions may drink up to the recommended amount of fewer than two drinks per day for men or one drink per day for women. When consuming alcohol, you should also avoid concurrent use of blood thinners, NSAIDs (e.g., ibuprofen or aspirin), and cigarettes to prevent bleeding. Conditions such as GERD, gastritis, stomach ulcers, hepatitis, and blood disorders should be treated by your healthcare provider to avoid disease-related anemia.

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Managing the combination of alcohol use and anemia can seem frightening. Sobriety is a crucial factor in allowing your body to heal. At Guardian Recovery, our goal is to address substance use in a whole-body approach, taking into account your health history, current medications, and ongoing treatment needs. Our evidence-based programs utilize 12-Step Immersion and Relapse Prevention Training to guide you toward recovery and total wellness.

Our admission process is simple: Once you reach out, we will provide a free, no-obligation health insurance benefit check and complimentary assessment. The entire process takes just 15 minutes at one of our local facilities. Contact Guardian Recovery today for more information about how we can help you heal.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.


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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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