Anemia Prevention: Nutrition, Testing, Iron, Vitamin B12, and Risk Groups

Anemia is a condition in which the blood's ability to carry oxygen to tissues is reduced, most often due to a lack of hemoglobin or normal red blood cells. The World Health Organization notes that anemia can cause fatigue, weakness, dizziness, shortness of breath, increased heart rate, decreased performance, and adverse effects on children and pregnant women. Therefore, anemia prevention is not a cosmetic concern for a "blush," but a way to protect the brain, heart, muscles, pregnancy, and child development. [1]

Preventing anemia isn't just about "eat more iron." Anemia can be caused by iron deficiency, vitamin B12 deficiency, folate deficiency, chronic inflammation, chronic kidney disease, blood loss, hemolysis, stomach and intestinal diseases, medications, and bone marrow failure. Therefore, prevention should consider age, gender, diet, menstruation, pregnancy, chronic diseases, stomach and intestinal surgeries, medications, and family history. [2]

The most common preventable cause of anemia worldwide is iron deficiency. Iron is needed for hemoglobin synthesis, and iron stores can be depleted due to inadequate intake, increased demand, poor absorption, or chronic blood loss. In practice, this means that prevention should combine adequate nutrition, timely monitoring of ferritin levels in at-risk groups, appropriate treatment of blood loss, and the cautious use of iron supplements when indicated. [3]

Preventing vitamin B12 and folic acid deficiencies is especially important. Vitamin B12 is found in animal products and fortified foods, and deficiency can develop with a strict plant-based diet without supplements, autoimmune gastritis, stomach and intestinal surgery, long-term use of certain medications, and malabsorption. Folic acid is especially important before and during early pregnancy because it helps reduce the risk of neural tube defects in the fetus. [4]

The main principle of prevention is not to take iron, vitamin B12, or folic acid "just in case" indefinitely, but to understand the risk and monitor the levels. Excess iron can be harmful, folic acid can partially mask vitamin B12 deficiency, and normal hemoglobin does not always rule out early iron deficiency. Therefore, prevention must be sensible: nutrition for everyone, testing for at-risk groups, supplements as needed, and a mandatory investigation of the cause if anemia has already developed. [5]

The purpose of prevention	What we prevent	Main tool
Maintain normal hemoglobin	Decreased oxygen delivery to tissues	Complete blood count in risk groups
Prevent iron depletion	Iron deficiency and low ferritin	Nutrition, ferritin, treatment of blood loss
Protect the nervous system	Vitamin B12 deficiency	Nutrition, supplements at risk, absorption diagnostics
Support pregnancy	Maternal anemia and fetal risks	Screening, iron and folic acid as recommended
Don't miss a hidden disease	Blood loss, gastritis, celiac disease, kidney disease	Finding the cause, not just the additive

Nutrition as a basis for prevention

Preventing iron deficiency anemia begins with adequate dietary iron intake. Heme iron from meat, fish, and poultry is better absorbed than nonheme iron from plant foods, but a balanced diet can include both sources. For people who eat few animal products, legumes, whole grains, nuts, seeds, leafy greens, fortified foods, and proper combinations with vitamin C are especially important. [6]

Vitamin C improves the absorption of non-heme iron, so it's beneficial to combine plant-based iron sources with vegetables, fruits, and berries. For example, legumes or grains work better in the diet if they are accompanied by bell peppers, citrus fruits, kiwi, berries, cabbage, or other sources of ascorbic acid. This is especially important for children, adolescents, menstruating women, pregnant women, and people on a predominantly plant-based diet. [7]

Certain foods and drinks can reduce iron absorption when consumed simultaneously with iron-containing foods or iron supplements. Calcium can interfere with iron absorption, so it's best to take calcium and iron supplements at different times. Coffee and tea can also reduce the absorption of non-heme iron, so if you have low ferritin and are taking iron supplements, it's wise to limit your consumption of these foods to between meals and avoid taking them with iron supplements. [8]

Preventing anemia through nutrition doesn't mean eating only liver or red meat. The diet should be safe and sustainable: sources of protein, iron, folate, vitamin B12, vitamin C, and adequate energy. In people with chronic inflammation, kidney disease, gastrointestinal disease, or blood loss, even an ideal diet may not completely prevent anemia, so testing is necessary if symptoms and risk factors are present. [9]

Fortifying foods with iron and folic acid is an important public health measure for preventing anemia. The World Health Organization considers food fortification a strategy for preventing micronutrient deficiencies, including iron, vitamin A, iodine, and folic acid. For an individual patient, this means that fortified cereals, flour, breakfast cereals, or plant-based drinks can be a useful part of the diet, but they do not replace diagnosis in cases of established anemia. [10]

Food factor	How does it affect the prevention of anemia?	Practical advice
Meat, fish, poultry	A source of highly absorbable heme iron	Use if tolerated and there are no contraindications.
Legumes, cereals, greens	Sources of non-heme iron and folate	Combine with vitamin C
Vitamin C	Improves the absorption of non-heme iron	Add vegetables, fruits, berries
Calcium	May interfere with iron absorption	Distribute calcium and iron supplements
Coffee and tea	May reduce iron absorption	Do not take with iron supplements.
Fortified foods	Helps reduce the risk of deficiencies	Useful as part of a diet, but not as a treatment for anemia.

Prevention in children and adolescents

In children, anemia is especially important because iron is involved not only in the formation of hemoglobin but also in the development of the brain, muscles, and immune system. The World Health Organization emphasizes that children are one of the most vulnerable groups, and iron deficiency anemia can impair physical and cognitive development. Therefore, prevention in children begins not with pills, but with nutrition, assessment of growth, development, and risk factors. [11]

In early childhood, breastfeeding, timely introduction of complementary foods, and iron-rich foods are important. After six months, iron requirements increase, and prenatal stores alone are often insufficient. Iron-rich foods should be included in a child's diet: pureed meats, age-appropriate fish, legumes, cereals, and fortified foods, if they are age-appropriate and recommended by a pediatrician. [12]

In adolescents, the risk of iron deficiency increases due to rapid growth, menstruation, athletic activity, restrictive diets, and inadequate iron intake. Girls with heavy menstrual bleeding, adolescents on vegetarian or vegan diets, endurance athletes, and children with chronic gastrointestinal symptoms require closer monitoring. In this group, prevention involves not only diet but also timely discussion of menstrual blood loss and ferritin levels. [13]

Pica—a craving for ice, chalk, earth, plaster, or other non-food substances—shouldn't be ignored. In children, this can be a sign of iron deficiency, but it also carries the risk of toxic exposure, including lead, especially from ingesting paint, dust, or building materials. These symptoms require a complete blood count, ferritin, and an environmental safety assessment. [14]

Preventative iron supplements are not prescribed to all children, but rather based on age, diet, risk, and examination results. Self-administering iron to a child is dangerous due to the risk of overdose, gastrointestinal side effects, and missing another cause of anemia. It's best to follow a simple rule: discuss diet and age-specific preventative measures with a pediatrician. Testing is necessary for symptoms of pallor, weakness, poor appetite, developmental delays, frequent infections, or pica. [15]

A group of children	The main risk	Preventive action
Babies after 6 months	Rapid growth and depletion of iron stores	Timely feeding with iron
Children on restricted diets	Deficiency of iron, vitamin B12 and folate	Dietary assessment and supplementation according to indications
Teenagers	Growth, sports, diets	Monitoring nutrition and symptoms
Girls with heavy periods	Chronic iron loss	Complete blood count and ferritin
Children with pica	Iron deficiency and toxic risks	Testing for iron and possible lead

Women of reproductive age and menstrual blood loss

Women of reproductive age are at increased risk of iron deficiency due to regular menstrual blood loss. The World Health Organization notes that iron and folic acid supplementation programs can reduce the risk of anemia in menstruating women in populations where the prevalence of anemia among non-pregnant women of reproductive age is 20% or higher. [16]

In individual practice, the main question is not only "how much iron is in the diet" but also "how much iron is lost." Heavy menstruation, bleeding between periods, uterine fibroids, endometriosis, intrauterine bleeding, postpartum blood loss, and frequent blood donations can gradually deplete ferritin. If a woman regularly experiences weakness, drowsiness, shortness of breath during exertion, hair loss, brittle nails, or a craving for ice, it's worth checking her complete blood count and ferritin. [17]

Preventing iron deficiency in women involves diet, monitoring menstrual blood loss, and promptly treating gynecological causes. If the cause is heavy menstrual flow, iron tablets alone will temporarily replenish iron stores, but the deficiency will return. Therefore, preventing recurrence requires collaboration between a physician, gynecologist, and, if necessary, a gastroenterologist or hematologist. [18]

Taking iron supplements without testing is not the best preventative measure for all women. In some people, weakness is not related to iron, but to vitamin B12 deficiency, thyroid disease, chronic inflammation, depression, sleep disturbances, or other causes. Furthermore, iron supplements can cause constipation, nausea, abdominal pain, and dark stools, so they are best prescribed only for confirmed deficiency or a clear risk. [19]

For women who follow a vegetarian or vegan diet, prevention should include separate monitoring of vitamin B12 levels. Plant foods do not naturally contain vitamin B12 unless they are fortified, so people on a strict plant-based diet often require fortified foods or supplements. This is important because vitamin B12 deficiency can lead not only to anemia but also to neurological symptoms. [20]

Risk factor in women	Why does it increase the risk of anemia?	What to do
Heavy menstruation	Regular iron loss	Check ferritin and treat the cause of blood loss
Pregnancy is in the near future	The need for iron and folate increases	Discuss folic acid and testing
Vegan nutrition	Risk of vitamin B12 deficiency	Fortified foods or vitamin B12 supplements
Frequent donation	Loss of red blood cells and iron	Ferritin control
Hair loss and brittle nails	Possible iron deficiency	Don't treat blindly, do tests first

Pregnancy and preparation for it

Preventing anemia during pregnancy begins even before conception, as iron and folate stores are important already in the first weeks of fetal development. Folic acid is especially important before and during pregnancy: the US National Institutes of Health recommends that women who are able to become pregnant should get 400 micrograms of folic acid per day from supplements and fortified foods in addition to folate from regular food. [21]

During pregnancy, iron requirements increase dramatically due to increased blood volume, placental development, and fetal growth. The World Health Organization recommends daily iron and folic acid supplementation during pregnancy to reduce the risk of maternal anemia, iron deficiency, and low birth weight; typical preventive doses in international guidelines are 30–60 milligrams of elemental iron and 400 micrograms of folic acid per day. [22]

Preventive care for pregnant women should not be limited to supplementation. Screening for anemia early in pregnancy and reassessment later are necessary, as even good nutrition does not always cover the growing need. The U.S. Preventive Services Task Force states that the American College of Obstetricians and Gynecologists recommends screening all pregnant women at their first prenatal visit and repeat screening at 24-28 weeks of pregnancy. [23]

If anemia has already been diagnosed, the preventative approach shifts to a therapeutic one: it's necessary to determine the type of anemia and eliminate the cause. Iron deficiency is treated with iron supplementation, vitamin B12 deficiency requires vitamin B12 supplementation, and in cases of bleeding, inflammation, chronic illness, or poor tolerance to pills, the approach should be individualized. The International Federation of Gynecology and Obstetrics, in its 2025 recommendations, emphasizes the need for screening and prophylactic iron supplementation in pregnant women, and more active management in cases of anemia. [24]

Increasing iron doses during pregnancy on your own is not recommended. Excess can worsen nausea, constipation, and abdominal pain, and improper treatment can miss vitamin B12 deficiency, blood loss, or other underlying conditions. Ideally, check for risk factors before pregnancy, start folic acid supplementation as recommended, follow the screening plan during pregnancy, and take supplements only as directed by your doctor. [25]

Stage	The main goal	Practical action
Before pregnancy	Build folate reserves and assess risks	Folic acid 400 micrograms per day, tests as indicated
1st trimester	Early detection of anemia	Complete blood count at the first visit
2nd trimester	Don't miss the growing deficit	Repeat screening at 24-28 weeks
The whole pregnancy	Prevent iron deficiency	Iron and folic acid as recommended
If anemia is detected	Treat the cause, not just the symptom	Ferritin, vitamin B12 and individual therapy

Vitamin B12 and folic acid: prevention of megaloblastic anemia

Preventing vitamin B12 deficiency is especially important for people who do not consume animal products or who poorly absorb the vitamin. The U.S. National Institutes of Health notes that vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, and dairy products, while plant foods contain it only when fortified. Therefore, a strict plant-based diet without supplements is a real risk factor. [26]

Vitamin B12 deficiency can be related to more than just diet. It develops with autoimmune gastritis, intrinsic factor deficiency, gastric and intestinal surgery, ileal diseases, and, in some patients, long-term use of metformin or proton pump inhibitors. NICE, in its 2024 guidelines, emphasizes the need to recognize and treat vitamin B12 deficiency in people over 16 years of age, including cases associated with autoimmune gastritis. [27]

Preventing vitamin B12 deficiency not only prevents anemia but also protects the nervous system. Deficiency can cause numbness, tingling, gait disturbances, weakness, cognitive changes, a burning sensation in the tongue, visual complaints, and depressive symptoms. Therefore, if neurological symptoms occur, severe anemia should not be anticipated: vitamin B12 levels should be tested and treated according to the clinical situation. [28]

Folic acid is necessary for the synthesis of deoxyribonucleic acid and normal cell division, so its deficiency can lead to macrocytic anemia. Prevention of folate deficiency is especially important in women of potential pregnancy, as neural tube defects develop very early, often before a woman knows she's pregnant. Therefore, folic acid recommendations apply not only to those already pregnant but also to those who may become pregnant. [29]

A major preventative measure is taking folic acid for macrocytic anemia without checking vitamin B12 levels. Folic acid may improve some of the blood changes, but it will not correct the neurological damage associated with vitamin B12 deficiency. Therefore, if large red blood cells, numbness, gait disturbance, burning tongue, or a long-term risk of malabsorption are present, vitamin B12 levels should be assessed first. [30]

Deficit	Who is particularly at risk?	Prevention
Vitamin B12	Vegans, the elderly, patients with autoimmune gastritis, after gastric surgery	Fortified foods, supplements, or treatment as indicated
Folic acid	Women of pregnancy potential, people with poor nutrition or malabsorption	400 micrograms of folic acid per day when planning a pregnancy
Mixed deficit	People with stomach and intestinal diseases	Check iron, vitamin B12, and folate levels.
Drug risks	Metformin, proton pump inhibitors in some patients	Monitoring vitamin B12 levels as indicated
Neurological symptoms	Numbness, unsteadiness, memory problems	Don't delay vitamin B12 testing

Prevention in the elderly and patients with chronic diseases

In older adults, anemia often has multiple causes: iron deficiency, vitamin B12 deficiency, chronic inflammation, chronic kidney disease, drug-induced factors, occult blood loss, and cancer. Therefore, prevention in this group involves not only diet but also regular assessment of complete blood counts, kidney function, medications, symptoms of blood loss, and nutritional status. [31]

Chronic kidney disease is a common cause of anemia because the kidneys are involved in the production of erythropoietin, which stimulates red blood cell production. The Kidney Disease: Improving Global Outcomes 2026 guideline emphasizes that anemia in chronic kidney disease is multifactorial: iron deficiency, inflammation, erythropoietin signaling deficiency, dialysis losses, and other causes are all involved. Therefore, prevention of deterioration involves monitoring hemoglobin, iron, and kidney function. [32]

In chronic inflammatory diseases, anemia can develop even with normal or elevated ferritin. Inflammation increases hepcidin, impairing iron release from iron stores and making it less accessible to the bone marrow. Therefore, prevention involves monitoring the activity of the underlying disease, assessing transferrin iron saturation, not just ferritin, and avoiding self-administering iron without understanding the mechanism of anemia. [33]

Patients with gastrointestinal diseases require special prevention of deficiency. Atrophic gastritis, Helicobacter pylori, celiac disease, inflammatory bowel disease, and gastric and intestinal surgery can impair the absorption of iron and vitamin B12. If there is a poor response to iron tablets, consideration should be given not only to the dose but also to absorption, ongoing blood loss, and the need for intravenous iron, if indicated. [34]

Drug prophylaxis of anemia in chronically ill patients requires caution. Anticoagulants and nonsteroidal anti-inflammatory drugs may increase the risk of bleeding, metformin and acid-reducing drugs are associated with a risk of vitamin B12 deficiency in some patients, and iron supplements may interact with calcium and cause side effects. Therefore, prevention should include periodic review of medications and safety considerations. [35]

Risk group	Possible mechanism of anemia	Preventive control
Elderly people	Deficiencies, inflammation, kidneys, blood loss	Complete blood count, ferritin, vitamin B12, kidney function
Chronic kidney disease	Erythropoietin deficiency, iron deficiency, inflammation	Hemoglobin, ferritin, transferrin iron saturation
Bowel diseases	Malabsorption and blood loss	Iron, vitamin B12, folate, disease activity
Atrophic gastritis	Iron and vitamin B12 deficiency	Vitamin B12, ferritin, gastroenterological monitoring
Drug risks	Bleeding or malabsorption	Review of medications and symptoms

Tests and screening: who should be tested and when

The basic test for detecting anemia is a complete blood count (CBC) with hemoglobin, red blood cells, hematocrit, mean corpuscular volume, white blood cells, and platelets. The World Health Organization, in its 2024 guidelines, emphasizes that hemoglobin is used as one of the key markers for diagnosing anemia in individuals and populations, but its thresholds depend on age, gender, pregnancy, and other factors. [36]

Hemoglobin alone is often insufficient to prevent iron deficiency anemia. Ferritin can decline earlier than hemoglobin, so it is useful to assess iron stores in people with risk factors. Ferritin can be normal or elevated during inflammation, so transferrin saturation and clinical context are also used. [37]

Pregnant women are among those in whom screening is particularly important. According to the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the U.S. Centers for Disease Control and Prevention recommend screening all pregnant women for anemia at their first prenatal visit, and the American College of Obstetricians and Gynecologists also recommends repeat screening at 24–28 weeks. [38]

Vitamin B12 testing is recommended for people with a vegan diet, autoimmune gastritis, stomach or intestinal surgery, ileal diseases, long-term use of metformin or acid-reducing medications, as well as macrocytosis, burning tongue, numbness, gait disturbance, and cognitive symptoms. NICE emphasizes that vitamin B12 deficiency should be recognized and treated as an independent problem, including cases without typical severe anaemia. [39]

Screening should not degenerate into a pointless, pointless series of tests. A rational set of tests is usually based on risk: a complete blood count, ferritin, and transferrin saturation if iron deficiency is suspected; vitamin B12 and folic acid if macrocytosis or neurological symptoms are present; creatinine if a renal cause is suspected; and a gastrointestinal examination if iron deficiency anemia has no obvious explanation. [40]

Who should be tested?	What tests are needed most often?	For what
Pregnant women	Complete blood count, ferritin as indicated	Early detection of anemia
Women with heavy menstrual periods	Complete blood count, ferritin	Prevent iron depletion
Vegans	Vitamin B12, complete blood count	Prevent megaloblastic anemia and neurological complications
Elderly people	Complete blood count, vitamin B12, kidney function, iron	Find multifactorial anemia
Patients with kidney disease	Hemoglobin, ferritin, transferrin iron saturation	Control renal anemia
Men and postmenopausal women with iron deficiency	Gastrointestinal examination as indicated	Exclude hidden blood loss

Iron Supplements: When Prevention Is Beneficial and When It's Harmful

Iron supplements are useful when there is an increased need, a proven deficiency, or a population recommendation for a specific group, such as pregnant women in antenatal care systems. However, iron is not a universal vitamin for fatigue: taking it without a prescription can lead to side effects and miss the true cause of symptoms. [41]

In 2024, the American Gastroenterological Association recommended giving oral iron no more than once daily for the treatment of iron deficiency anemia, although an alternate-day regimen may be better tolerated in some patients. It also notes that vitamin C may improve the absorption of oral iron, and intravenous iron is considered in cases of poor tolerance, ineffectiveness, or impaired absorption. [42]

For prevention, it's important to take iron correctly. It shouldn't be taken with coffee, tea, or milk, or with calcium, as this can reduce absorption. If the medication causes nausea, constipation, abdominal pain, or diarrhea, discuss the form, dosage, and regimen with your doctor, rather than discontinuing treatment or changing medications haphazardly. [43]

Self-prophylactic iron supplementation is particularly undesirable for men, postmenopausal women, and older adults with newly diagnosed iron deficiency. In these groups, deficiency often requires investigation of underlying gastrointestinal bleeding, including ulcers, polyps, inflammatory bowel disease, and tumors. Simply taking iron without testing can temporarily raise hemoglobin levels and delay diagnosis. [44]

Iron excess can also be a problem. People with inherited iron metabolism disorders, repeated transfusions, liver disease, or improper, uncontrolled supplementation may develop iron accumulation. Therefore, prevention should be individualized: supplements are prescribed based on risk and blood tests, and the duration of administration is monitored by ferritin, hemoglobin, and the cause of the deficiency. [45]

Situation	Iron as a preventative measure	Comment
Pregnancy	Often recommended as part of prenatal care	The dosage depends on recommendations and tests.
Low ferritin	Usually useful when prescribed by a doctor	We need to look for the cause of the deficit.
Fatigue without tests	Not desirable	The reason may not be in the hardware
A man with iron deficiency	You can't limit yourself to just one supplement	The source of blood loss must be found.
Poor tolerance of tablets	The scheme can be adjusted	Sometimes intravenous iron is needed
Normal iron stores	Usually not necessary	Harm from excess is possible

Frequently asked questions

Can anemia be completely prevented by diet alone? Not always. Diet helps prevent some deficiencies, especially iron, folate, and vitamin B12, but anemia can develop due to blood loss, chronic inflammation, kidney disease, malabsorption, hemolysis, or bone marrow disease. Therefore, testing is necessary for those with symptoms and in risk groups. [46]

What foods are best for preventing iron deficiency? Heme iron from meat, fish, and poultry is best absorbed, but plant sources are also important: legumes, cereals, nuts, seeds, greens, and fortified foods. Plant-based iron is best combined with vitamin C, as it improves the absorption of non-heme iron. [47]

Should all women take iron supplements for prevention? No. Women with heavy menstrual flow, low ferritin, pregnancy, frequent blood donation, or a restricted diet are at increased risk, but supplementation is best prescribed based on testing and clinical circumstances. In populations with a high prevalence of anemia, the World Health Organization recommends intermittent iron and folic acid supplementation programs for menstruating women. [48]

Why is ferritin important if hemoglobin is still normal? Ferritin reflects iron stores, and it can decrease to the point of anemia. Therefore, a person may already have symptoms of iron deficiency, such as hair loss, weakness, or a craving for ice, while their hemoglobin remains within normal limits. [49]

How can I prevent vitamin B12 deficiency on a vegan diet? It's important to regularly get vitamin B12 from fortified foods or supplements, as regular plant foods don't naturally contain it. When following a strict plant-based diet for a long time, it's helpful to periodically check your vitamin B12 levels and complete blood counts, especially if you experience weakness, numbness, a burning tongue, or gait disturbances. [50]

Should I take folic acid before pregnancy? Yes, women who are able to conceive are recommended to get 400 micrograms of folic acid per day from supplements or fortified foods in addition to folate from the diet. This is important before conception and during early pregnancy, when the neural tube is forming. [51]

Can I take iron supplements with coffee or tea? It's not recommended. Coffee, tea, calcium, and dairy products can reduce iron absorption when taken simultaneously, so it's best to take iron supplements with water and space them out from these foods and drinks. [52]

When is prevention no longer sufficient and treatment is needed? If hemoglobin is low, ferritin is low, there is shortness of breath, palpitations, fainting, black stool, blood in the stool, heavy bleeding, neurological symptoms, or rapid deterioration, prevention is no longer an option. Diagnosis of the cause and treatment under medical supervision are necessary. [53]

What symptoms should alert you before testing? Fatigue, pallor, shortness of breath during exertion, palpitations, dizziness, hair loss, brittle nails, burning tongue, craving for ice or chalk, numbness, and gait disturbances may indicate anemia or deficiency. These symptoms do not confirm the diagnosis, but they are a reason to have your blood tested. [54]

Key points from experts

Sant-Rein Pasricha, a professor and researcher on anemia, iron deficiency, and global health, emphasizes that anemia is not just a laboratory indicator but also a major problem for development, performance, pregnancy, and public health. The practical conclusion: anemia prevention should combine nutrition, precise hemoglobin thresholds, work with at-risk groups, and identifying the underlying causes, rather than relying on random iron supplementation. [55]

Thomas J. DeLaffery, MD, professor of medicine, pathology, and pediatrics at Oregon Health and Science University and co-author of the 2024 American Gastroenterological Association clinical update on iron deficiency anemia, emphasizes the importance of a tolerable iron regimen and the correct choice of route of administration. The practical takeaway: Preventing recurrence of iron deficiency is impossible without understanding the cause of the deficiency and a regimen that the patient can realistically adhere to. [56]

World Health Organization experts on antenatal prophylaxis emphasize that daily iron and folic acid supplementation during pregnancy reduces the risk of iron deficiency and anemia in pregnant women. Practical conclusion: pregnancy is a period when anemia prevention should be planned and not begun only after severe weakness and low hemoglobin. [57]

NICE experts, who prepared the 2024 guidelines on vitamin B12 deficiency, emphasize that vitamin B12 deficiency should be recognized based on clinical symptoms, risk factors, and laboratory data, including cases associated with autoimmune gastritis. The practical conclusion: the prevention of anemia should take vitamin B12 into account, especially in vegans, the elderly, and patients with malabsorption. [58]

In their 2026 guideline for anemia in chronic kidney disease, experts from Kidney Disease: Improving Global Outcomes emphasize the multifactorial nature of renal anemia and the need to assess iron, inflammation, erythropoietin signaling, and treatment risks. The practical conclusion: in patients with kidney disease, prevention of worsening anemia should be part of nephrological monitoring, rather than independent iron supplementation without monitoring. [59]

Conclusion

Anemia prevention begins with understanding the cause: iron, vitamin B12, folic acid, blood loss, inflammation, kidneys, stomach, intestines, and medications can all contribute in varying degrees. Therefore, there is no universal rule that "everyone should take iron"; proper prevention combines a balanced diet, screening at-risk groups, and treatment of factors that lead to nutrient loss or poor absorption. [60]

The most important risk groups are pregnant women, young children, adolescents, women with heavy menstrual periods, people on a strictly plant-based diet, the elderly, patients with chronic kidney disease, inflammatory diseases, stomach and intestinal diseases, and people following gastrointestinal surgery. For these groups, prevention should be proactive: don't wait for severe weakness, but rather monitor hemoglobin, ferritin, vitamin B12, and other indicators as needed. [61]

The best practice approach is to eat a varied diet, consume iron and vitamin C, prevent folate deficiency before pregnancy, supplement with vitamin B12 if at risk, monitor menstrual and gastrointestinal blood loss, and avoid unnecessary supplements. This preventative approach reduces the risk of anemia while also helping to detect diseases for which anemia may be the first sign. [62]