Key Takeaways:

  1. Ferritin is an essential biomarker for iron storage, indicating iron sufficiency or deficiency.
  2. High ferritin levels are linked to various health issues, including heart disease, diabetes, and certain cancers.
  3. Strategies to manage ferritin levels include blood donation, dietary adjustments, and careful use of supplements.
  4.  Monitoring and understanding ferritin levels are crucial for proactive health management and reducing disease risk.

Life was designed to exist at the very interface between iron sufficiency and deficiency.

- Dr James R. Connor

Iron is an essential nutrient, and low levels in the diet, improper absorption, or excessive bleeding can lead to iron deficiency, which can result in anemia, cognitive problems, and immune dysfunction. It is essential to a number of metabolic processes, including respiration, the metabolism of proteins, lipids, or ribosomes, DNA biosynthesis and repair, and others.

Iron is a vital component of several proteins responsible for oxygen transport and metabolism. It must be transported throughout the body, stored, and made available to synthesize iron proteins.

Iron deficiency, which has historically been more prevalent than iron excess, has been the subject of extensive research, resulting in a high level of awareness among medical professionals of the resulting adverse health conditions.

Additionally, ferritin is an effective iron deficiency biomarker. It provides an accurate guide for individuals who may be iron deficient.

In contrast, excess iron is far less studied, and its adverse health effects are far less well-known. And clinical laboratories provide upper limits of ferritin “normal ranges” that are too high for optimal future disease-risk reduction and longevity.

Although anemia (iron deficiency) is well-known, iron overload is a more common and dangerous problem. Most adult men and women after menopause are at risk for iron excess.

Lowering ferritin levels may be beneficial until close to the point that iron deficiency occurs. In the absence of a deficiency, it seems that the lower the ferritin level, the greater the health benefits.

Because of the absence of systematic iron elimination mechanisms, most organisms, including humans, tend to accumulate excess iron with age.

It is unclear whether the lack of disposal methods for excess iron was due to a scarcity of iron in the evolutionary environment or the rarity of iron’s detrimental effects in an environment where few organisms died of natural causes. As a result, the body cannot rid itself of excess iron, leaving us with an age-related accumulation.

In the natural world, iron reacts with oxygen to form rust. Within the body, it has a similar effect, causing elevated levels of oxidative stress.

Iron’s capacity to undergo cyclic oxidation and reduction is crucial to its function. However, this redox activity can lead to the production of free radicals and other highly oxidizing substances that have the potential to cause various biological injuries.

More specifically, iron’s ability to accept or donate electrons is what makes it useful but also capable of biological damage. When iron reacts with hydrogen peroxide via the Fenton reaction, it can create a highly reactive and toxic free radical called hydroxyl.

This can lead to severe mitochondrial dysfunction, which may be the root cause of most chronic degenerative diseases.

Numerous health issues, including cancer, heart disease, diabetes, stroke, neurodegenerative diseases, gouty arthritis, hepatitis C, Alzheimer’s disease, and liver disease, have been linked to elevated iron levels.

High ferritin levels have been associated with dysfunctional glucose metabolism, which can increase the risk of diabetes in both men and women. In fact, men may experience a fivefold increase in diabetes risk, while women may experience a fourfold increase, similar to the risk associated with obesity.

Additionally, high ferritin levels may double the risk of metabolic syndrome, a condition that is linked to an increased risk of high blood pressure, liver disease, and heart disease. Those practicing proactive health must manage ferritin levels to reduce the future risk of these health issues.

Although many people routinely check their cholesterol levels, which have a limited impact on heart health, few think to check their ferritin (stored iron) levels. Iron is the new cholesterol.

How to Lower Ferritin Levels

Donating blood is generally the recommended solution to iron overload. However, a three-pronged approach is even better: phlebotomy, detoxification, and reducing dietary iron.

Blood donation

Donating blood twice or thrice yearly is the simplest method to reduce iron load significantly. However, you may need to perform phlebotomies more frequently if you have a severe overload. Blood loss is the primary way to lower excess iron.

Because hemoglobin is the primary iron store in the body, its replacement demands the use of iron stores and depletes them. Several studies have found that blood donors have a lower mortality rate, even when the healthy donor effect of donors being healthier than others prior to donation is accounted for.

When examining blood donors only as a distinct group, a negative correlation has been observed between the frequency of blood donation and mortality. In fact, each additional yearly donation is linked to a 7.5% decrease in the mortality rate. Blood donation is also linked to a significant reduction in body iron levels in adult men. Depleted ferritin levels (<15 μg/L) in male donors are approximately eight times more prevalent than in non-donors.

Use the Right Kitchenware

Cooking acidic foods (e.g., tomatoes) in iron pots or pans can lead to higher levels of iron absorption. This is because the acid in the food reacts with the iron in the cookware, causing small amounts of iron to leach into the food. Instead, cook acidic foods with other cookware, such as stainless steel.

Read Supplement Labels

Vitamins and mineral supplements frequently include iron. Read the labels and check – particularly the multi-vitamin and mineral products. For example, “meal replacements and nutritional supplements” must have iron added in Canada.

Sauna

According to research, sauna use increases sweating, which can help remove iron through the skin. 

In addition, saunas have been shown to increase the production of erythropoietin, a hormone that stimulates red blood cell production and increases the body’s iron demand. 

This increased iron demand can help reduce the amount of excess iron in the body.

Limit Alcohol Consumption

Avoid regular alcohol consumption because it enhances dietary iron absorption. For example, consuming wine with your steak may result in absorbing more iron than you need.

Alcohol inhibits the production of hepcidin, the hormone that controls iron metabolism. Hepcidin regulates the quantity of dietary iron that is absorbed and released from storage in the body. It has been demonstrated that alcohol reduces hepcidin production, which can increase iron absorption and accumulation.

Avoid Fortified Foods

The United States and Canada mandate that many food and drink items are fortified with iron, including flour, pre-cooked rice, and fruit-flavoured drinks. Avoid regularly eating processed foods such as cereals and white bread. 

Two servings of fortified breakfast cereal alone can provide as much as 44 milligrams (mg) of iron, perilously close to the recommended maximum daily iron intake.

Food and Drink that Inhibits Iron Absorption

You can alter your diet and beverages to reduce the amount of iron you absorb. The following may inhibit iron absorption:

  • Dairy products
  • Eggs
  • Chocolate
  • Tea and coffee
  • Vegetables
  • Phytate-rich foods including hazelnuts, almonds, and legumes (beans, peas, lentils)

The consumption of eggs and dairy products along with meals may hinder iron absorption by as much as 50%. Calcium found in dairy products competes with iron for absorption, which can inhibit it. Similarly, eggs contain a substance that tightly binds iron and prevents its absorption. This substance also helps to protect eggs from bacterial invasion by denying iron to potential invaders.

Tea and coffee greatly lower the amount of iron that’s absorbed from a meal. To inhibit iron, coffee or tea must be drunk with or shortly after a meal and not before.

Coffee can reduce iron absorption by as much as 80% when consumed with a meal. Black or green tea appears to be the most effective iron inhibitor. As much as 94% of iron absorption is inhibited when black tea is drunk with a meal.

Dietary Tea

By inhibiting iron absorption, Camellia sinensis extracts increase the lifespan of Drosophila (“small fruit flies”) by up to 21.4%.

Camellia sinensis is more commonly known as tea plant. White tea, yellow tea, green tea, oolong, dark tea, and black tea are all harvested from one of two major varieties grown today. Different processing methods yield the various types of tea.

Studies have also shown that catechins can act as antioxidants, reducing oxidative damage and inflammation in cells.

The active compounds that are responsible are the catechins, which are a type of flavonoid. Flavonoids are a group of polyphenols. Catechins can bind to dietary iron, preventing it from being absorbed by the body. 

Consider Supplements

A number of geroprotectors increase lifespan in model organisms, and many of these either block dietary iron absorption or chelate iron and remove it.

A geroprotector is an agent that helps protect against aging. It works by targeting the underlying mechanisms involved in aging and helping to maintain youthful cellular and tissue functions. Geroprotectors can come in many forms, such as supplements, medications, and lifestyle modifications.

Chelating agents are compounds with multiple sites capable of binding to metal ions, such as iron. When a chelating agent binds to iron, it forms a complex in which the iron is no longer free to participate in chemical reactions. These compounds help to remove metal ions from the body.

Curcumin

Mice-fed diets supplemented 0.2% with curcumin became iron deficient; levels of zinc and copper were not affected, suggesting that curcumin is a potent iron chelator. Curcumin (and its metabolite tetrahydrocurcumin) extended the average lifespan of three model organisms: C. elegans, Drosophila, and mice.

Curcumin is known to have a wide range of benefits, including antioxidant, antiviral, anti-inflammatory, improving digestion and cognitive function, relieving joint pain, aiding in weight loss, antiangiogenic and antitumorigenic (preventing cancer), and more.

Curcumin is the key active ingredient in turmeric. Turmeric is a yellow powder made from the rhizome of the Curcuma longa plant. It has been used as a traditional medicine in Ayurvedic practices and as a food ingredient for thousands of years.

EGCG

Epigallocatechin gallate (EGCG) is a type of catechin, found in green tea, that is a strong iron chelator. 

EGCG has been shown to extend the lifespan of both C. elegans and Drosophila. Studies on mice have revealed that EGCG safeguards against alcoholic liver disease by decreasing iron levels in the liver.

Berberine

Berberine has been shown to extend the lifespan of mice. Berberine has been found to exhibit iron-chelating properties. In a study on rats, berberine reduced iron overload in the liver. Additionally, the study found that berberine could inhibit the expression of hepcidin, a protein involved in iron metabolism and storage. 

Studies have shown berberine to be an antioxidant, anti-inflammatory, anti-bacterial, and anti-fungal, as well as potential benefits for a range of other health conditions, including blood sugar control, cardiovascular health, weight management, and digestion.

Berberine is an active compound known as an alkaloid (an organic compound containing at least one nitrogen atom) found in certain plants, including barberry, goldenseal, Oregon grape, and tree turmeric.

Quercetin

Quercetin has been shown to extend the lifespan of C. elegans. Quercetin has demonstrated iron-chelating properties.

Studies have shown quercetin to reduce the risk of heart disease, lower blood pressure, improve blood sugar control, and support the immune system. Quercetin has also been studied for its potential benefits in treating allergies, asthma, and other respiratory illnesses.

Quercetin is a flavonoid that occurs naturally in a variety of plants, including red onions, pears, berries, and certain leafy green vegetables. It is available in supplement form.

Optimal Ferritin Levels

Often patients express worry that their ferritin levels are too low, when, in fact, I am concerned about the opposite.

- Lesley James MD

Those interested in proactive healthcare, reducing future-disease risk, and extending lifespan, must consider much tighter upper bounds than “normal ranges” would suggest. Laboratories give upper ranges that may be far too high for optimal health.

Gerry Koenig, former chairman of the Iron Disorders Institute and the Hemochromatosis Foundation, related the following ferritin values:

  • The most commonly used threshold for iron deficiency in clinical studies is 12-15 ng/mL (30-37 nmol/L).
  • You do not want to be below 20 ng/mL (50 nmol/L) or above 80 ng/mL (200 nmol/L). 
  • Adult men and non-menstruating women should aim for 30-40 ng/mL (75-100 nmol/L).

Regularly screen for iron overload with a ferritin test. Your iron status is likely far more critical than your cholesterol. 

Virtually all adult men and postmenopausal women are at risk for iron overload due to inefficient iron excretion since they do not lose blood on a regular basis.

What is ferritin

Ferritin is a protein that stores iron and releases it as needed. It helps to regulate the amount of iron in the blood and tissues, ensuring that our cells have enough to function properly. It is present in almost all living organisms, including plants, animals, and humans.

Additionally, ferritin plays an important role in maintaining healthy levels of red blood cells and preventing anemia. Anemia is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower-than-normal number of red blood cells or a reduction in hemoglobin.

Ferritin is found in many different tissues in the body, but it is most abundant in the liver, spleen, and bone marrow. The liver is the primary site of ferritin synthesis and storage.

When the body has an excess of iron, the iron is stored in the form of ferritin to prevent it from causing damage to other tissues. When the body needs more iron, ferritin releases the stored iron into the bloodstream, where it can be transported to other tissues to be used for various functions (such as the production of red blood cells).

Why measure ferritin levels

Ferritin is an important indicator of overall health that is measured to provide insight into the amount of iron stored in the body and detect any abnormalities in iron metabolism.

Low ferritin levels typically indicate low iron stores in the body, which can lead to anemia and other health problems. Iron deficiency anemia is a common type of anemia that occurs when the body does not have enough iron to produce hemoglobin, a protein in red blood cells that carries oxygen.

On the other hand, high ferritin levels can indicate an excess of stored iron, which can also have negative health effects and accelerate aging.

Measuring ferritin levels may also help detect diseases like cancer, diabetes and thyroid problems earlier on. Therefore, measuring ferritin levels is essential for maintaining good health and well-being.

What are the symptoms of low ferritin?

Low ferritin levels, also known as hyporferritinemia, may be the cause of one or more of the symptoms:

  1. Fatigue and weakness: Low iron levels can cause fatigue and weakness, as iron is needed to produce hemoglobin, which carries oxygen throughout the body.
  2. Shortness of breath: Low iron levels can also cause shortness of breath, particularly with physical activity.
  3. Headaches: Low iron levels can cause headaches, particularly when the body is low on oxygen.
  4. Dizziness or lightheadedness: Low iron levels can cause dizziness or lightheadedness, particularly when standing up quickly.
  5. Pale skin: Iron deficiency anemia can cause the skin to become pale or even yellowish.
  6. Cold hands and feet: Low iron levels can cause a decrease in body temperature, leading to cold hands and feet.
  7. Restless leg syndrome: Iron deficiency can cause restless leg syndrome, characterized by uncomfortable sensations in the legs and an urge to move them.
  8. Brittle nails: Low iron levels can cause the nails to become brittle and fragile.
  9. Slow healing:
    • Low iron levels can impair the body’s ability to heal wounds, as oxygen is necessary for the formation of new blood vessels and the production of collagen, a protein that helps the skin heal.
    • Additionally, iron is involved in the immune system’s response to infection, and low levels of iron can impair the immune system’s ability to fight off infections which can cause wounds to heal more slowly.
  10. Infertility: Low iron levels can lead to the ovaries producing fewer and lower-quality eggs, which can contribute to infertility. Additionally, iron deficiency anemia can cause menstrual irregularities, such as heavy or prolonged menstrual bleeding, which can also contribute to infertility.

It’s important to note that not all people with low ferritin levels will experience symptoms and that other conditions can also cause the symptoms of low ferritin.

What are the symptoms of high ferritin?

High ferritin levels, also known as hyperferritinemia, can manifest as several symptoms associated with several conditions, including iron overload disorders and certain types of inflammatory or infectious diseases:

  1. Abdominal pain: High ferritin levels can be associated with conditions such as hemochromatosis, which can cause abdominal pain and discomfort.
  2. Joint pain and swelling: Certain inflammatory conditions associated with high ferritin levels, such as rheumatoid arthritis, can cause joint pain and swelling.
  3. Skin discoloration: In some cases, high ferritin levels can cause skin discoloration, such as a bronzed appearance.
  4. Loss of libido and impotence: Iron overload disorders, such as hemochromatosis, can cause hormonal imbalances that can lead to a loss of libido and impotence.
  5. Weight gain: High ferritin levels can be a sign of liver damage or inflammation, which can be detected through elevated liver enzyme levels. High ferritin levels can be seen in certain types of liver disease, such as non-alcoholic fatty liver disease, which can cause weight gain.
  6. Metabolic syndrome: High ferritin levels are associated with an increased risk of developing metabolic syndrome, but they are not a direct cause of the condition. Metabolic syndrome is a group of conditions that occur together, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
  7. Cancer: High ferritin levels can be seen in certain types of cancer, particularly those that involve inflammation or liver damage. High ferritin levels may also be associated with an increased risk of developing certain types of cancer. For example, some studies have found that high ferritin levels are associated with an increased risk of liver cancer and colorectal cancer.
  8. Celiac disease: High ferritin levels can be associated with certain underlying medical conditions that may contribute to the development of celiac disease. For example, iron overload disorders such as hemochromatosis can cause damage to the liver and pancreas, leading to impaired pancreatic function and an increased risk of developing celiac disease. Additionally, chronic inflammation, which is associated with high ferritin levels, can also contribute to the development of celiac disease.

Some people with high ferritin levels may not experience any symptoms, while others may experience symptoms related to the underlying condition causing the high ferritin levels.

Interpretation of ferritin test results and optimal ranges

Ferritin test results are reported in nanograms of ferritin per milliliter of blood (ng/mL) or micrograms per liter (μg/L). SiPhox Health reports are expressed in ng/mL.

Here’s how to interpret your ferritin results:

  • Cleveland Clinic lists a normal range of 30.3 to 565.7 ng/ML for men, and a normal range of 14.7 to 205.1 ng/ML for women.
  • According to Oregon Health & Science University (OHSU), a ferritin value of less than 20 ng/mL is indicative of iron deficiency, while a ferritin count of 21 to 50 is indicative of a possible iron deficiency. When the ferritin level exceeds 200 ng/mL, iron overload is a possibility.
  • Generally, ferritin levels below 30 ng/mL during pregnancy are considered to be indicative of iron deficiency anemia, which is a common concern during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) lists a ferritin level of 30 to 150 ng/ML as normal in pregnancy.
  • SiPhox Health lists a normal range of 23.9 to 336.2 ng/ML for men, and a normal range of 11 to 306.8 ng/ML for women.

Optimal ferritin levels can vary depending on factors such as age, sex, and underlying health conditions. 

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Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on the SiPhox Health Hub are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis or treatment.