Can Smoking Cause Anemia?

Although some research has linked smoking and anemia, smoking is much more likely to cause diseases associated with elevated hemoglobin and red blood cell levels.

It’s well known how harmful smoking is to the human body. Cigarette chemicals like tar, carbon monoxide, and nicotine can lead to serious health conditions like lung cancer and heart disease.

When it comes to the relationship between smoking and anemia, it’s not as well understood.

Some research suggests smoking may increase the risk of developing anemia, but overall, smoking is much more likely to cause other hemoglobin-related diseases.

Some research indicates a relationship between smoking and iron-deficiency anemia (IDA). The relationship between smoking and anemia is complicated, and research findings are mixed.

IDA is a type of anemia that occurs when the body does not have enough iron to produce a steady supply of hemoglobin, a protein in red blood cells responsible for delivering oxygen to the body.

Preventable medical errors kill about 22,000 patients a year, according to research from the Yale School of Medicine. That’s much less than a previously reported number of 250,000 deaths a year where medical error is to blame.

The relationship between smoking and IDA is not intuitive because while IDA indicates lower hemoglobin levels, research suggests smoking increases hemoglobin levels.

For this reason, the increase in hemoglobin levels from smoking is more commonly associated with:

• secondary polycythemia
• chronic obstructive pulmonary disease (COPD)
• cardiovascular disease

Despite this seemingly paradoxical relationship between smoking and anemia, smoking may still cause anemia. For instance, a study from 2022 found a strong correlation between tobacco smoking and iron-deficiency anemia.

Although the study found the longer a person smoked, the more likely they were to develop anemia, the study also showed that it was the lighter smokers compared with the heavier smokers who were more likely to develop anemia. Results indicated that the full relationship between smoking and anemia is not fully understood.

There are several theories for why smoking may contribute to anemia:

• Smoking reduces the body’s vitamin C level, which plays a major role in iron absorption. Evidence consistently shows that smokers have lower blood levels of vitamin C. The more cigarettes smoked per day, the lower the vitamin C.
• Smoking damages the lining of the stomach and intestines, leading to chronic blood loss.
• Smoking decreases the body’s ability to absorb iron from food.
• Smoking leads to other nutrient deficiencies, including vitamins B12 and folate, which are important for red blood cell production.

Smoking also contributes to several conditions and diseases that can worsen anemia like ulcers and various types of cancer.

How does cigarette smoking affect hemoglobin levels?

Research from 2017 found that smokers have significantly higher levels of hemoglobin — the protein found in red blood cells that carries oxygen to the body’s organs — than nonsmokers. Research from 2020 concluded that in addition to hemoglobin, smoking increases both red and white blood cell counts.

Although increases in hemoglobin, red blood cells, and white blood cells can have significant health consequences, these are not associated with anemia since anemia is associated with lower hemoglobin, red blood cells, and white blood cells.

If you smoke, it’s recommended that you see a healthcare professional for an evaluation and get a blood test to check for any medical conditions, including anemia. If your results suggest you have anemia, treatment will likely include iron supplementation.

It’s important not to take any iron pills without first talking with a doctor or nurse. Taking too much iron can be harmful and cause damage to your liver and other organs.

Vaping is a relatively new phenomenon, and so its long-term effects are not yet fully understood. Research has not yet found a strong relationship between vaping and iron levels.

Instead, one smaller study found that even one vaping session may trigger oxidative stress, which is associated with cancer, Alzheimer’s, cardiac disease , diabetes, and more.

If you have anemia, or think you might have it, here are a few things you can consider doing:

• Eat more foods containing iron. Beef, pork, and poultry are good sources of heme iron, which is the most easily absorbed form of iron. Other foods with iron include seafood, legumes, fortified cereals, and dark leafy greens.
• Eat more foods with vitamin C. Vitamin C helps your body absorb iron. Good sources include citrus as well as other fruits and vegetables.
• Avoid drinking coffee or tea with meals. Coffee and tea can inhibit iron absorption.
• Take an iron supplement. Only do this if you’ve received a doctor’s recommendation and approval. Remember, too much iron can cause health problems.
• Treat any conditions responsible for blood loss. If you have anemia due to heavy menstrual periods or digestive problems, be sure to talk with your doctor about proper treatment.

Although some research has found a relationship between smoking and anemia, there is not sufficient evidence to link the two.

Instead, researchers indicate that smoking is much more likely to lead to an increased hemoglobin count, which can lead to diseases like secondary polycythemia.

Nevertheless, if you smoke and think you might have anemia, consider reaching out to a healthcare professional to take a blood test. With proper treatment, anemia can be reversed.

Last medically reviewed on March 20, 2023