What should you avoid if you have polycythemia?

September 27, 2025 •

4 min read

According to the MPN Research Foundation, polycythemia vera is a rare blood cancer that causes the bone marrow to produce too many red blood cells, thickening the blood. Understanding what should you avoid if you have polycythemia? is crucial for managing symptoms and preventing serious complications like blood clots.

Quick Summary

Individuals with polycythemia should avoid dehydration, smoking, and high-altitude environments, which can further thicken blood and increase health risks. Dietarily, limiting excessive iron, high-purine, high-oxalate, and processed foods is recommended to help manage symptoms and prevent complications such as gout and kidney stones.

Key Points

Restrict High-Purine and High-Oxalate Foods: Minimize red meat, organ meats, alcohol, spinach, and peanuts to reduce the risk of gout and kidney stones.
Avoid Excessive Iron Intake: Do not take iron supplements and limit high-heme iron foods like red meat unless directed by a doctor.
Eliminate Smoking: Tobacco narrows blood vessels and dramatically increases the risk of blood clots, heart attack, and stroke.
Stay Hydrated and Avoid Dehydration: Drinking plenty of water helps keep blood thinner, reducing the risk of clots and kidney stones.
Avoid Extreme Temperatures: Protect yourself from both extreme cold and heat. Be cautious with hot baths or saunas if they trigger itching.
Exercise with Caution: Engage in moderate, low-impact exercise like walking but avoid high-contact sports, especially if you have an enlarged spleen.
Limit Processed Foods and Unhealthy Fats: Reduce intake of high-sodium, sugary, and saturated-fat foods to promote cardiovascular health.

Understanding Polycythemia and Its Risks

Polycythemia vera (PV) is a myeloproliferative neoplasm where the bone marrow produces an overabundance of red blood cells, and sometimes white blood cells and platelets. This excess cellular volume makes the blood thicker and slower-moving, significantly increasing the risk of dangerous blood clots, which can lead to a stroke or heart attack. While the condition is managed with medical treatments like phlebotomy, lifestyle and dietary choices play a vital role in mitigating risks and managing symptoms. Patients who follow their doctor's guidance regarding what to avoid can significantly improve their quality of life.

Dietary Restrictions for Polycythemia

Adopting a mindful diet is a cornerstone of managing polycythemia. The goal is not to 'cure' the condition through diet but to minimize complications by reducing inflammation, managing uric acid levels, and controlling cardiovascular risk factors.

Limiting High-Purine and High-Oxalate Foods

One of the complications of PV is an elevated risk of gout, a painful form of arthritis caused by excess uric acid. Another is the formation of kidney stones from high oxalate levels. To address these, limiting certain foods is often recommended:

High-Purine Foods: Reduce intake of red meat (especially organ meats like liver), some seafood (sardines, anchovies, shellfish), and limit alcohol consumption.
High-Oxalate Foods: Limit foods high in oxalates, including spinach, rhubarb, beets, sweet potatoes, peanuts, and soy products. While some berries are also high in oxalates, consulting a dietitian can help balance nutrient intake. Drinking plenty of water is essential to help flush out excess uric acid and oxalates.

Reducing Saturated and Trans Fats

High-fat foods can increase inflammation and raise the risk of blood clots, which is a primary concern for those with PV. It is wise to limit:

Saturated fats from red meat, chicken skin, cheese, and heavy cream.
Trans fats, which are often found in processed and fried foods.
Instead, focus on lean proteins and healthy fats, such as those found in olive oil, fish, nuts, and avocados.

Controlling Excess Iron and Sodium

Patients with PV must be cautious about their iron intake, as iron is a building block for red blood cells. Increasing iron can exacerbate the condition. Therefore, it's critical to:

Avoid taking iron supplements unless specifically instructed by a hematologist.
Limit high-heme iron sources like excessive red meat.
Minimize highly processed foods and those high in sodium, which can contribute to high blood pressure and fluid retention, placing added strain on the cardiovascular system.

Lifestyle and Environmental Factors to Avoid

Beyond diet, certain lifestyle choices and environmental conditions can worsen the symptoms and risks associated with polycythemia.

Avoiding Smoking and Low-Oxygen Environments

Smoking is one of the most detrimental habits for someone with PV. It constricts blood vessels, further increasing the risk of blood clots, heart attack, and stroke. Just as dangerous are low-oxygen environments, as the body may respond by producing even more red blood cells in an attempt to compensate. Patients should avoid:

Smoking or using any tobacco products.
Living, skiing, or climbing at high altitudes, as these conditions reduce blood oxygen levels.

Protecting Against Temperature Extremes

Poor blood flow in PV can make individuals more sensitive to temperature extremes. Both very hot and very cold conditions can be problematic:

Avoid prolonged exposure to cold without proper protection, as it can narrow blood vessels further. Wear warm gloves and socks in cold weather.
Avoid hot tubs, heated whirlpools, and very hot showers/baths, which can trigger severe itching (pruritus) associated with PV.
In hot weather, stay hydrated and protect yourself from the sun.

Navigating Physical Activity and Injury Risk

While moderate exercise is highly recommended to improve circulation and reduce clot risk, certain activities pose a higher risk:

High-impact or contact sports like rugby, football, or martial arts should be approached with caution due to the risk of injury, especially if a patient has an enlarged spleen or a higher bleeding tendency.
Your doctor or physical therapist can help determine the safest types of physical activity for you, such as walking, swimming, or tai chi.

Comparison of Dietary Choices for Polycythemia


Food Category	Choices to Limit or Avoid	Recommended Alternatives
Protein	Red meat, organ meats, some seafood	Lean poultry, fish (like salmon), eggs, tofu, low-fat dairy
Fats	Saturated fats (butter, heavy cream), Trans fats (fried foods, processed snacks)	Olive oil, nut oils, avocados, nuts, seeds
Processed Foods	Sugary drinks, chips, cookies, high-sodium packaged foods	Fresh fruits, vegetables, whole grains, homemade low-sodium meals
High-Purine/Oxalate	Alcohol, red meat, spinach, rhubarb, beets	Water, lean meats, diverse fruits and vegetables

Medications and Supplements

Always discuss any medications or supplements with your healthcare provider to ensure they are safe for someone with polycythemia. While some over-the-counter medications like low-dose aspirin are often recommended, there are exceptions.

Iron Supplements: As noted, iron supplements are typically contraindicated because they stimulate red blood cell production.
Aspirin: While low-dose aspirin is a standard treatment for most PV patients, it should be avoided in rare cases of extreme thrombocytosis (high platelet count) due to an increased risk of bleeding.
Herbal and Other Supplements: Many supplements, including herbal remedies, can interact with medications or have blood-thinning properties. Always consult your doctor before starting any new supplement regimen.

Conclusion

Navigating life with polycythemia involves a careful and consistent approach to diet and lifestyle. By actively avoiding excessive iron and certain foods high in purines, oxalates, and saturated fats, individuals can reduce the risk of serious complications like blood clots, gout, and kidney stones. Additionally, steering clear of smoking, high altitudes, and extreme temperatures is crucial. Regular, moderate exercise can help, but high-impact sports should be avoided with caution. The most important step is to partner closely with a healthcare team to create a personalized plan. For more detailed information on managing this condition, you can refer to authoritative sources such as the Cleveland Clinic's resources on Polycythemia Vera. This proactive approach, centered on knowing what to avoid, is the key to living well with polycythemia.

Frequently Asked Questions

No, diet is a supportive measure, not a cure. While eating a healthy diet and avoiding certain foods is important for managing symptoms and reducing complication risks, it must be combined with a comprehensive medical treatment plan developed with your hematologist.

It is generally recommended to limit or avoid all types of alcohol. Alcohol can contribute to high uric acid levels, increasing the risk of gout, and can also contribute to dehydration, which thickens the blood.

It is not always necessary to completely avoid all red meat, but it should be consumed in moderation. The primary concern is the high heme iron content, which can increase red blood cell production. Talk to your doctor about what level of intake is safe for you.

Most commercial flights are safe, as the cabin is pressurized. However, flying, especially long distances, still increases the risk of blood clots. It is crucial to stay very well-hydrated, move around frequently, and discuss any travel plans with your doctor beforehand.

Many people with polycythemia experience pruritus (itching) that is triggered or worsened by contact with warm water. It is advisable to take cooler showers or baths and avoid heated whirlpools or saunas to prevent discomfort.

There are no general rules to avoid specific spices, but if you have a history of stomach ulcers, it is wise to be cautious with spicy foods. In all cases, individual tolerance can vary, so monitor your body's response.

You should never take iron supplements without explicit medical instruction. Additionally, be very cautious with over-the-counter pain relievers and supplements, and always check with your hematologist or prescribing physician before starting new medications.