Ferritin

What is Ferritin?

Ferritin is a complex globular protein that stores iron in the body in its inactive form. Iron is essential for the normal production of red blood cells. It forms haemoglobin, the protein responsible for carrying oxygen and removing carbon dioxide from the body.

Ferritin and iron are not the same thing. Ferritin is critical for storing and releasing iron because as your iron stores are depleted, ferritin releases more iron to be used, keeping it within balance. Because iron is bound to ferritin, ferritin levels reflect how much iron is stored^[1].

Low ferritin levels can indicate iron deficiency while high ferritin levels may indicate iron overload or haemochromatosis. Elevated levels are also used as a surrogate marker for inflammation, as they increase when white blood cells are activated, releasing ferritin in the bloodstream. Persistently high ferritin levels are linked to atherosclerosis^[2], and high blood pressure, and can be an early warning sign for cancer.

What are Normal Ferritin Levels?

The reference range for ferritin can vary according to the testing laboratory, as well as your age and sex. Below are the healthy ferritin ranges for our laboratory and the NHS:

	Forth	NHS
Women	13 – 150µg/L	100 – 310µg/L
Men	30 – 400µg/L	100 – 340µg/L[3]

Our data shows that the ferritin levels of Forth customers are within the normal reference range. Interestingly, women of menstruating age, 18 to 49, had the lowest ferritin levels of all age groups. Because of menstrual blood loss and the demands of pregnancy, this age group are at risk of developing iron deficiency^[4]. While after menopause, iron levels rise^[5].

Causes & Symptoms of Low Ferritin

A common cause of low ferritin levels is iron deficiency anaemia. It is the most common type of anaemia. The most common cause of iron deficiency anaemia is a poor diet with a high intake of ultra-processed foods and a poor micronutrient intake. Other causes include:

• Women of reproductive age: heavy menstrual periods and pregnancy

• Men and post-menopausal women: bleeding in the stomach or intestines such as stomach ulcers or stomach

Other causes are:

• High levels of exercise

• Chronic kidney disease

• Inflammatory bowel disease

• Blood donation

• Trauma or blood loss

• Malabsorption

• Lack of dietary iron^[6]

Symptoms of low ferritin levels include:

• Shortness of breath

• Low energy and tiredness

• Paler skin than usual

• Headaches

• Heart palpitations^[7]

Further symptoms:

• Poor hair health

  Low ferritin levels can weaken your hair and in some cases contribute to hair loss. Because ferritin is stored in hair follicles, when levels are low, the body can use the follicle ferritin stores, causing weak and damaged hair^[8].

• Restless leg syndrome and poor sleep

  Restless leg syndrome can be caused and made worse by low ferritin levels^[9]. It can affect sleep quality by making it difficult to fall or stay asleep because of the urge to continuously move your legs. By improving iron levels with iron supplements, research has shown that restless leg syndrome can be improved.

Improving Ferritin Levels

If you have low ferritin levels, this suggests your iron stores are also low which means the production of haemoglobin will be reduced. Haemoglobin transports oxygen around the body and is essential for your cells and tissues to function normally. So, if your iron levels are low, then you may experience symptoms that are associated with low energy and reduced oxygen capacity.

Generally, you should be able to increase your iron levels with diet, unless a doctor has advised otherwise. Meat and fish are good sources of ‘haem’ iron. Non-animal sources are available providing ‘non-haem iron’. However, this isn’t absorbed as well as haem iron. It is possible to still get all the iron you need if you follow a vegan or vegetarian diet, as long as it is balanced. You can improve the absorption of non-haem iron by pairing it with vitamin C such as lemon or orange juice^[10].

Good sources of iron are:

Haem iron	Non-haem iron
Offal Beef Pork Lamb Poultry Sardines Mackerel Herring	Beans Lentils Quinoa Dark green leafy vegetables (watercress, kale, spinach) Dried fruit Fortified bread and cereals Nuts and seeds

You can also support your iron levels by avoiding:

• drinks containing tannins and phosphates with meals, as these can disrupt iron absorption. These drinks include tea, coffee, beer, wine, and cider.

• bran with every meal as it can impair iron absorption.

• over-cooking vegetables to retain their vitamin C content.

How long does it take to recover from low ferritin levels?

If you need iron supplements to treat iron deficiency anaemia (and low ferritin levels), you’ll need to take them for about six months. You may feel better after taking iron tablets after a week, but they can take four weeks to work fully^[11].

Causes & Symptoms of High Ferritin

High ferritin levels can be high because of iron overload. Haemochromatosis is a condition that can cause a build-up of iron, leading to organ damage. It is a genetic disorder and means the body is unable to get rid of iron causing an accumulation^[12].

Raised ferritin levels may be caused by other medical conditions and is an important biomarker for inflammation. Therefore, your ferritin levels may be raised if you have an inflammatory condition or an infection^[13].

Other causes of elevated ferritin levels are:

• Excessive alcohol intake

• Autoimmune conditions

• Diabetes

• Some cancers

• Liver disease

• An overactive thyroid (hyperthyroidism)

• Obesity

How do you feel if your ferritin is too high?

The symptoms you might experience if your ferritin levels will depend on the underlying cause. If elevated levels are the result of haemochromatosis, you might experience:

• Tiredness

• Weight loss

• Weakness

• Joint pain

• Erectile dysfunction

• Irregular or absent periods

• Low libido

• Tummy pain

• Extreme thirst and needing to pee more often

• Shortness of breath

• Chest pain^[14]

Decreasing Ferritin Levels

If your raised ferritin levels are linked to iron overload, your doctor will provide appropriate advice and treatment to help bring your iron and ferritin levels back to within a normal range.

In some cases, high ferritin levels may be temporary. For example, if you have an infection or inflammation, ferritin levels are likely to return to normal once this has been treated or you feel better.

You may be able to help lower your ferritin levels through your diet. You can try:

• Cutting down your intake of iron-rich foods such as offal or red meat. You do not need to cut it out completely as your body will need iron to make haemoglobin and ensure the proper production of red blood cells. Some research shows it takes three years of a severely iron-deficient diet to deplete iron stores^[15].

• Avoiding iron and vitamin C supplements as these will increase iron levels.

• Limiting your alcohol intake as this can increase iron levels and put extra strain on your liver.

• Donating blood can lower ferritin levels and reduce excess iron in the body^[16].

Written by Leanne Edermaniger

Based in the UK, Leanne specialises in writing about health, medicine, nutrition, and fitness.

She has over 5 years of experience in writing about health and lifestyle and has a BSc (hons) Biomedical Science and an MSc Science, Communication and Society.