Ferritin and iron deficiency in a nutshell
1. Ferritin stores iron in your body
2. You may be iron deficient without anaemia
3. It’s worth checking for iron deficiency if your iron level is less than 30 µg/l
Ferritin is the primary test to find out iron deficiency. Iron deficiency and anaemia has been traditionally diagnosed with testing haemoglobin levels, where a low result is also indicative of anaemia. Together they are a fairly common and reliable indicator of either iron depletion or iron depletion anaemia.
Iron is one of the most recycled particles in your body. It’s also one of the most important dietary minerals. It transfers oxygen to your organs. A lot of it is lost in production of red blood cells and other important cellular structures.
80% of the iron in your body is functional (70% in haemoglobin, 10% in myoglobin and less than 1% in enzymes). Storage iron makes up for about 20% of your body’s iron needs (ferritin and haemosiderin).
Testing for ferritin will help to determine the state of your body’s iron stores. You may find that the stores are low before ever developing anaemia – correcting depleted iron stores before it develops into iron deficiency anaemia is better for you!
Stages of iron deficiency
Your body holds normal haemoglobin level, but only has a small amount of stored iron, which will soon run out. Usually this stage has no obvious symptoms.
Iron deficiency is one of the most common deficiencies in the world. Throwing the scientific explanation aside, it means that your body is losing iron in your bodily functions faster than new iron is absorbed from your diet. The stored and blood-borne iron levels are low and your haemoglobin has dropped below normal. You also start to experience symptoms, including tiredness and hair loss. This is common for menstruating women, those who’ve recently suffered a great blood loss (due to accident, childbirth, surgery…), and to those who suffer form pre-existing conditions that affect iron absorption (coeliac disease pops to mind).
Iron deficiency anaemia
We mentioned haemoglobin already – in short, anaemia is just another word for low haemoglobin. Most commonly anaemia occurs due to iron deficiency, and it presents most commonly with tiredness and impaired physical performance. In short, you suffer from iron deficiency anaemia when your haemoglobin level is so low that your blood is unable to deliver enough oxygen to your cells.
It’s estimated that 25-40% of women suffer from iron deficiency anaemia during their lifetime. Technically anyone can be anaemic, but like many things, this one is primarily for the women. It’s rare to see anaemic men or children. Note, that people with iron deficiency anaemia may also have reduced immune function, so they are more vulnerable to infection.
Haemochromatosis is not an iron deficiency. It is the opposite; an inherited condition where iron levels in the body slowly build up over many years due to the body absorbing much more iron from foods than necessary. In other words, while most women suffer from low ferritin level, some have inherited the opposite issue: they get too much iron. This build-up of iron, known as iron overload, can cause unpleasant symptoms. If it is not treated, this can damage parts of the body such as the liver, joints, pancreas and heart.
Symptoms of iron deficiency anaemia
- Impaired physical performance and loss of general condition'
- Shortness of breath
- Pallor, pale gums
- Hair loss and thinning, poor nails and skin
- Restless legs
- Sleeping disorders
- Depression-like symptoms
- …and more
As you can see, the list is fairly exhaustive. If you’ve been feeling poorly, no matter your situation, it’s a good idea to get this checked!
Who are in higher risk of developing iron deficiency?
Well, women in reproductive age were mentioned earlier, but also the elderly, athletes, and those who suffer from blood loss or donate blood may experience iron deficiency. In short:
- Women with heavy monthly bleed (over 2-3 days of excessive bleeding)
- Those with a disorder related to nutrient absorption or intestinal disease like coeliac
- Those with IBS or similar
- Those with heavy blood loss related to accidents, surgeries, childbirth or other means of bleeding for an extended period of time (such as haemorrhoids)
- Those who’ve donated blood repeatedly
- The elderly (due to illness or poor nutrition)
- Athletes (when you need more oxygen in your body, you need more iron)
- Pregnant women, as pregnancy increases the amount of fluids in the body and baby’s growth requires more oxygen as well
Primarily ferritin stores iron. It also transfers iron in your body.
- Ferritin stores iron in your body. If there’s a depletion of this storage protein, iron levels are low too.
- Iron does not circulate in the body as it’s own component. Instead it is transferred by ferritin and transferrin, which deliver iron to where it’s needed. 10% of iron in your body travels with ferritin and 90% with transferrin.
- When your body is under an acute infection, ferritin levels may be elevated so it’s not worth measuring if you are sick.
- Low ferritin often indicates iron deficiency.
What affects my body’s iron stores?
If you can believe it, things like the time of day have an effect to your iron levels. Your body’s iron content is not constant. It changes according to other factors such as your monthly cycle. It doesn’t really disappear from your body through other means than blood loss and cellular development. You do loose some through skin, but this accounts for barely anything.
A heavy cycle is the number 1 reason for iron deficiency anaemia. But like we pointed out earlier, iron stores are affected by all blood loss.
Diagnosis and Treatment
Make an appointment with your doctor if you think you may be iron deficient. Diagnosis aims to exclude other illnesses that can have similar symptoms, such as coeliac disease.
Diagnosis methods include:
- Physical examination
- Medical history
- Blood tests
Like most laboratory reference values, there is no universal measure for ferritin, but there are a few generally used indicators. You’ll recognise the test from codes S-Ferrit and P-Ferrit. The first letter is a reference to the measuring method: S for serum-based test and P for plasma-based test. The method is not relevant to the quality of these tests but the reference values may vary. And that’s why you should pay attention to which test is analysed, what the reference values are, and what your treating doctor says. And keep in mind, the reference values differ from the desired value. If you are, or want to become pregnant shortly, the desired ferritin value will be higher for you.
If you have iron depletion, your doctor will give you information about including iron-rich foods in your diet. You will have another blood test in around six months to check that your iron level has improved.
If you have iron deficiency, your doctor will give you dietary advice and closely monitor your diet. They will encourage you to have iron-rich foods and discourage you from having foods and drinks (such as bran, tea and coffee) that can interfere with iron absorption with meals. They will regularly review your iron status and may prescribe supplements.
If you have iron deficiency anaemia, your doctor will prescribe iron supplements. It may take six months to one year for your body to restock its iron stores. Your iron levels will be regularly reviewed with blood tests.
If you have an underlying problem that is causing your iron deficiency, it is very important that the cause is investigated. If it is a medical cause, it is important that it be treated appropriately.
Low ferritin may decrease chances of conception
We’ve established what ferritin is, why is it important, and how to treat low ferritin. But does it affect your chances of getting pregnant? The answer is, it may.
While there is no concrete evidence of the causation, there is some data that may indicate that low ferritin may affect fertilisation of eggs in your ovaries, or the membrane of your womb. Many doctors agree that there may be some causation, and there are many ongoing studies worldwide to try to find more thorough answers.
Iron can be toxic
Iron overdose happens when you take too much iron in the form of supplements. Iron is toxic in large amounts and can be fatal at high doses. Do not take iron supplements without consulting your doctor! This is especially important for people who may suffer from haemochromatosis.
Children are especially at risk because they may mistake the red iron tablets for lollies. Always keep iron supplements tightly capped and out of children’s reach.
And let’s not forget, iron supplements can mess up your tummy quite badly! Sore belly, constipation, and nausea are common side effects of supplementary iron. For most people it feels bad well before you get to toxicity.
Preventing iron deficiency
How much iron your body absorbs can be affected by:
- How much iron you consume
- The type of iron you consume (iron from meat is more easily absorbed than iron from plant-based sources)
- Other dietary factors – for example, vitamin C can help your body absorb iron, but tea can make it harder to absorb
- Your current iron levels – when your body is low in iron, it absorbs a higher percentage of iron from your food. Absorption of iron from food is about 18% from a typical western diet (including animal foods) and about 10% from a vegetarian diet.
- Enjoying calcium from dairy will reduce iron absorption by up to 50-60% so try to eat cheese and drink milk well before or after eating iron-rich foods.
Talk to your doctor about healthy eating and getting enough iron in your diet. Some suggestions include:
- Wholegrain cereals, meat, poultry and fish are good sources of dietary iron.
- Liver is an especially rich source of iron (avoid liver if you are pregnant because of its high vitamin A content!)
- Choose iron-fortified breakfast cereals and breads.
- If you are vegetarian and have no animal tissue in your diet, you may need almost twice as much dietary iron each day as non-vegetarians. Plant-based sources of iron include: dark green leafy vegetables such as broccoli, raisins, nuts, prunes, dried apricots, seeds, dried beans and peas, and iron-fortified cereals, breads and pastas.
- Vitamin C increases iron absorption, so eat more brightly coloured fruits and vegetables.
- Cut back on the amount of tea and coffee you drink, especially around mealtimes, since the tannins in tea and coffee bind to the iron and interfere with absorption.
It’s always important to find out why your iron levels are low, and treat the primary cause as well. Ideally you can affect ferritin levels through dietary decisions and supplements when necessary. If the cause is heavy periods, that needs to be addressed to make a permanent change for the better.
Fixing iron-related issues takes time. Often supplements are prescribed to be taken for many months, all the way up to a year. Often, during longer prescriptions your doctor will talk with you about the harms of long-term iron supplement consumption (the sore belly, constipation…). Talk with your treating physician. And make sure you have follow-up tests. Haemoglobin may rise quickly, but depleted iron stores take a long time to fill up, about 6 months or so.
Iron infusion is also an option if the situation is dire or your body simply can’t handle the supplementary pills or liquid. Ask your doctor if this is an option for you!
The bottom line
Ferritin is a blood protein which stores iron and is a good indicator of how much iron is present in the body. The amount of ferritin present in the blood reflects the total amount of iron available to the body for future use. Ferritin releases iron as it is required by the body for many functions including the production of new red blood cells. Symptoms of low ferritin levels include fatigue, weakness, dizziness, shortness of breath and headaches, whereas symptoms of high levels of ferritin include fatigue, abdominal pain, unexplained weight loss, joint pain and weakness.
If there are no underlying health conditions causing low ferritin levels, then improving your diet can help improve iron levels and absorption of iron by the body. And if you are, or want to become pregnant shortly, it’s a good basic test to see where your body is currently at!