Ferritin: An Important Marker of Iron Storage

Feeling tired and run down all the time? Although there are many causes of low energy, one important reason to test for could be low iron storage, or iron deficiency. When you think of iron deficiency, you might think of anemia, but those two conditions are not the same!

Anemia is a condition that is diagnosed with a blood test called a complete blood count (CBC), but only checking a CBC may be missing an important piece of information. That test is called ferritin, and it’s a marker of iron storage in the body. The most common type of anemia is called iron deficiency anemia, but there is another diagnosis called iron deficiency without anemia that is just as important to test for and treat. Iron deficiency without anemia is diagnosed with low ferritin levels, but normal amounts of hemoglobin, hematocrit, and red blood cells on a CBC blood test. Many times, women may have signs and symptoms of low iron, but are not offered proper treatment until anemia is diagnosed. There are normal and optimal levels of ferritin that can help improve symptoms and support your overall health, pregnancy, and beyond.

In medicine we strive for prevention, so why not test for low iron storage before there are clinical signs of anemia! Here are the basics around ferritin including symptoms, populations and medical conditions that can impact ferritin levels, and tips on how to take and increase your ferritin levels:

SYMPTOMS OF LOW FERRITIN MAY INCLUDE:

• Fatigue

• Hair loss

• Dizziness

• Headaches

• Muscle pain or weakness

• Ear ringing

• Digestive upset or low stomach acid production

• Easy bruising

*An important note about high ferritin levels:

• When ferritin levels are above the optimal range, there are a few important considerations. First, iron overload is possible with conditions like hemochromatosis.  

• Elevated ferritin can also be a sign of acute inflammation in the body.

• It’s important to re-check your elevated ferritin with your healthcare provider to better determine if additional tests are needed to diagnose iron overload.

WHO IS MORE AT RISK FOR HAVING LOW FERRITIN LEVELS?

• Athletes

  • Due to increased demand on the body

• Those who are pregnant or breastfeeding

  • Due to increased blood volume and demand

• People in perimenopause

  • Due to irregular, heavy, or more frequent cycles

• People with heavy menstrual periods

  • Due to excess blood loss

• Those who follow vegetarian or vegan diets

  • Due to dietary deficiency of iron

CONDITIONS ASSOCIATED WITH IRON ABSORPTION ISSUES:

• Inflammatory Bowel Disease (IBD)

• Celiac disease

• Chronic use of heartburn medications

• If you have or suspect any of these conditions, talk to your healthcare provider about close monitoring of ferritin levels

OPTIMAL FERRITIN LEVELS FOR WOMEN:

• Standard reference ranges often say 15NG/mL is the cut off for low ferritin levels for the general population, but many patients are feeling symptoms at levels above 15NG/mL.

• In pregnancy, ferritin levels less than 30NG/mL is considered deficient

• Ferritin levels of 50-70NG/mL are often considered optimal, especially for those trying to become pregnant or already pregnant.

IRON SUPPLEMENTATION ABSORPTION TIPS:

• A study from 2019 found that 40-80mg of elemental iron taken on an empty stomach increased absorption.

• Take it every other day to increase absorption

• Consistent smaller doses are better for decreasing side effects and increasing absorption

  • Side effects to watch for include constipation, nausea, and stomach irritation

• Take at least 1 hour away from other supplements or 3 hours away from other medications

• Avoid with calcium, coffee, or tea because it impairs iron absorption 

• Absorption is increased with vitamin C or citrus

• Try cooking food in a cast iron pan to increase iron intake 

OPTIONS FOR INCREASING FERRITIN LEVELS:

• Oral supplementation. Preferred forms of iron supplements include bisglycinate, which can be gentler to digest.  

• IV iron infusions. Insurance will often cover infusions if ferritin levels are low, even without signs of anemia on CBC.  

  • A referral from your healthcare provider is often needed to facilitate iron infusion.

• Increased dietary consumption of iron

  • Red meat and organ meats

  • Green leafy vegetables like spinach

  • Beans and legumes

  • Pumpkin seeds

  • Dark chocolate (yay!)

If you are struggling with symptoms of low ferritin or wondering what your ferritin levels are, let’s work together! Click here to schedule an appointment.

Reference: Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):819-830. doi:10.1111/bjh.16221