Maintaining optimal levels is important for your health
By Heidi Moawad, MD
Medically reviewed by Jeffrey S. Lander, MD
If your red blood cell count is low, there are things you can do to increase it, like boosting your nutrition, taking supplements, and getting medical treatment for underlying health conditions.
Your healthcare provider will recommend lifestyle changes and possibly medical treatments if you have a low red blood cell count. Getting your red blood cell count up can help with symptoms of low red blood cells like fatigue.
This article will cover why your red blood cell count might be low and how to increase red blood cells.
Symptoms of Low Red Blood Cell Count
Anemia is the medical word for when your red blood cell count is low. It can also mean that your red blood cells are the wrong size (too small or too big) or they are otherwise not healthy and working as they should be.
The signs and symptoms of low red blood cell count can be mild to severe. They may come on quickly or slowly over time, depending on how low your numbers are and your overall health.
Common symptoms of low red blood cell count include:
Lack of energy
Sleepiness
Pale skin
Headaches
Dizziness
Irritability
Trouble concentrating
Tachycardia (rapid heart rate)
Hypotension (low blood pressure)
Severe anemia can cause fainting, shortness of breath, heart failure, and organ damage. If it goes on without treatment (e.g., because they have an undiagnosed condition that affects the red blood cells) or a person loses a lot of blood very fast (e.g., because they were badly hurt in an accident), not having enough red blood cells can lead to organ failure and death.1
Causes of Low Red Blood Cell Count
There are many causes of a low red blood cell count. In most cases, the condition happens when your body is not making enough red blood cells or your red blood cells are getting used up or damaged.
Common causes of low red blood cell count include:
Vitamin B12 deficiency
Iron deficiency
Chronic bleeding (e.g., stomach and intestinal bleeding)
Gastrointestinal problems that affect nutrient absorption2
Chemotherapy (a medicine used to kill cancer cells)
Bone marrow disorders (e.g., aplastic anemia, a condition where your body stops producing enough red blood cells)
Cancer (e.g., bone marrow cancer)
Kidney disease
Severe malnutrition
Hemolysis (breakdown of red blood cells) in conditions like malaria (a parasitic blood infection)
Acute bleeding (e.g., injury, trauma)
Blood loss from surgery
How to Get Your Red Blood Cell Count Checked
You can find out if you have a low red blood cell count by having a blood test. Your provider can do a complete blood count (CBC) to look at:
Red blood cell count (the number of red blood cells)
Hemoglobin (a protein in the red blood cells that carries oxygen)
Hematocrit (the percentage of blood that is composed of red blood cells)
Characteristics of the red blood cells (including mean corpuscular hemoglobin concentration [MCHC], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and red cell distribution width [RDW])
Increasing Red Blood Cells With Nutrition
One of the most common reasons for having a low red blood cell count is that you’re not getting proper nutrition.
You might be able to raise your red blood cells back to normal by eating enough of the nutrients that you’re missing or taking a supplement.
Vitamin B9 (Folic Acid)
Folic acid helps your body make red blood cells.
Dietary sources of folic acid include leafy green vegetables (like kale and spinach), beans, peanuts, liver, and seafood.
Iron
Iron is an important part of hemoglobin.
Some dietary sources of iron are red meat, seafood, leafy green vegetables, and beans.
Vitamin B12
Vitamin B12 helps the body make red blood cells.
Some dietary sources of vitamin B12 are beef, chicken, fish, dairy, and eggs.
Vegetarians and vegans may need to take a vitamin B12 supplement.
Copper
Copper helps the body make hemoglobin.
Dietary sources of copper include leafy green vegetables, nuts, mushrooms, organ meat (e.g., liver), and oysters.
Vitamin A
Vitamin A helps the body make red blood cells.
Some dietary sources of vitamin A are carrots, potatoes, fish, liver, and leafy green vegetables.
Vitamin C
Vitamin C helps with iron metabolism, which is necessary for making hemoglobin.
Some dietary sources of vitamin C include tomatoes, citrus fruit (e.g., oranges), strawberries, broccoli, and leafy green vegetables.
Vitamin E
Vitamin E helps protect the red blood cells.
Some dietary sources of vitamin E are almonds, pine nuts, avocado, and bell pepper.
What Happens When I Eat Extra Nutrients?
Eating more than the recommended amounts of key nutrients will not increase your red blood cell count higher than optimal levels. Your body will usually get rid of the excess nutrients it does not need or cannot use.
However, there are risks of getting too much of certain nutrients, whether through diet or supplements. In some cases, your body cannot get rid of the extra amounts, so a nutrient will build up to unsafe levels. For example, if you're trying to increase your iron intake to fend off anemia, you should know that getting too much iron can actually be dangerous.
You should talk to your provider about how much of each nutrient you should be getting each day, and what the best way to get them is for you.
Lifestyle Changes to Increase Your Red Blood Cell Count
Once you’ve made some changes to your diet and you're getting enough nutrition, there are some other lifestyle strategies you can use to increase your red blood cell count and keep it at a healthy level.
However, these strategies will only be effective if you are getting the nutrients that your body needs to make enough healthy red blood cells. That's why it's key to get your diet sorted out first.
Exercise
Exercise encourages your body to make more red blood cells (erythropoiesis).
Your body normally breaks down red blood cells every three to four months, but it's also constantly making new ones that replace the ones that are lost.
Exercising may cause older red blood cells to break down and get recycled faster.
However, the new red blood cells will be better able to carry oxygen than the older ones, so the natural process improves your health overall.3
Reduce Alcohol
Drinking alcohol contributes to low red blood cells in a couple of ways:
Alcohol affects your body’s absorption of nutrients and can also affect red blood cell production.4
Drinking a lot of alcohol for a long time can damage the liver and kidneys—two organs that need to be healthy for your body to make enough red blood cells.
Supplements and Medications That Increase Your Red Blood Cell Count
There are some supplements and medications that can help raise red blood cell counts.
For example, people who are low in iron, vitamin B12, or another key nutrient may need to take supplements, especially if the nutritional deficiency is caused by an absorption problem or they can't get these nutrients through the foods they eat.2
If you have an underlying health disorder that’s causing your red blood cells to be low, you will need to have it treated.
For example, if you have a condition that causes bleeding (like an ulcer), making sure it heals so the bleeding stops can help keep your red blood cells from getting too low.
If you have kidney disease, you might be prescribed a medication called erythropoietin—a natural hormone made by the kidneys that stimulate red blood cell production.
In more serious cases, a blood transfusion is needed to get the red blood cells back up to levels high enough that a person can survive.
When to See a Provider
You should see your healthcare provider if you have any symptoms of low red blood cells. It may take some time for your provider to figure out what is causing your red blood cells to be low.
Sometimes, anemia is caused by medical problems that can become more serious and less treatable if they progress without treatment (like kidney disease or cancer).
You can get treatment to raise low red blood cells, and you can also get effective treatment for the underlying problem.
Summary
Low red blood cells can be a sign of medical conditions that need treatment or lifestyle factors that need adjusting.
You can raise your red blood cells back up to a normal, healthy level by making sure you’re getting enough of the nutrients that your body needs for healthy red blood cell production, exercising regularly, taking a supplement if your provider recommends it, and avoiding excess alcohol.4
Additionally, if you have a health condition that’s lowering your red blood cells, you may need medical treatment to correct the problem. Managing the condition can help make sure your red blood cell count doesn’t drop too low again.
A low red blood cell count is one of the signs of an underlying health problem. There are many causes and solutions. If you have a medical illness that’s causing you to have a reduced number of red blood cells, you will need treatment.
It’s also very important that you incorporate lifestyle habits that will help you maintain a healthy amount of red blood cells and that you keep up these habits for the long term to avoid a recurrence of anemia.
Sources
Sun H, Weaver CM. Decreased iron intake parallels rising iron deficiency anemia and related mortality rates in the US population. J Nutr. 2021 Jul 1;151(7):1947-1955. doi:10.1093/jn/nxab064
Głąbska D, Guzek D, Kanarek B, Lech G. Analysis of association between dietary intake and red blood cell count results in remission ulcerative colitis individuals. Medicina (Kaunas). 2019;55(4):96. doi:10.3390/medicina55040096
Mairbäurl H. Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells. Front Physiol. 2013;4:332. doi:10.3389/fphys.2013.00332
Cylwik B, Naklicki M, Gruszewska E, Szmitkowski M, Chrostek L. The distribution of serum folate concentration and red blood cell indices in alcoholics. J Nutr Sci Vitaminol (Tokyo). 2013;59(1):1-8. doi:10.3177/jnsv.59.1
By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.
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