The ferritin test may be the most important blood test you ever get, especially if you have a thyroid problem.
When I began my training in the diagnosis and management of internal disorders immediately after graduation, one of the first things we studied heavily was blood chemistry analysis. My teachers always stressed the importance of taking a careful look at iron levels in the blood and a rare test known as the ferritin test.
What is ferritin?
Ferritin is an iron-containing protein and is the primary form of iron stored inside your cells. Even though there is a small amount of ferritin released into your bloodstream, it is an accurate marker of how much iron is actually stored in your body. Iron is primarily stored in your liver, muscles, spleen and bone marrow but if you have too much it can accumulate in your organs and the brain.
You either have too much iron, too little or just the right balance in your body and the ferritin test can give us an excellent picture of how much iron is actually stored in your body. Iron is found in your red blood cells but it also accumulates in your organs and tissues.
Iron is important for healthy oxygen transport throughout your body so you can see how vital it really is for your health. Too little iron will result in anemia which basically means that your red blood cells cannot carry enough oxygen to your cells and you start to develop signs of oxygen deficiency. Signs of anemia include:
- Pale skin
- Low body temperature
- Memory loss
- Hair loss
- Poor brain function
- Adrenal fatigue
- Spoon-shaped finger and toenails
- Smooth tongue
- Burning sensation in the tongue
- Sores at the corners of the mouth
- Dry skin
- Shortness of breath
- Ringing in the ears (tinnitus)
- Leg pains
- Chest pain
- Pica (cravings for specific substances, such as licorice, chalk, dirt, or clay)
Too much iron can have the opposite effect because iron creates a lot of oxidative stress which is basically too many free radicals that create inflammation. These free radicals eat up your antioxidants like vitamin C and E creating deficiencies.
Menstruating females lose a small amount of iron every month during their cycle so they tend not to build up too much iron in their bodies. However, iron levels can get too low when your diet is deficient in iron and you have absorption issues due to things like gluten and gut infections. I tend to see low ferritin levels quite a bit in chronically-ill women who are still cycling but it is also common in postmenopausal women who never restored their iron levels before entering menopause.
Since men do not have a menstrual cycle, we are the most at risk for accumulating iron. As iron builds-up in a man’s body he may develop the following symptoms as it accumulates in the brain and other body tissues (most of these also apply to women):
- Brain fog
- Low sex drive and erectile dysfunction (iron accumulates in the testicles)
- Mood swings, especially anger
- Digestive problems as iron builds-up in the gut
- Fatigue after meals (insulin resistance)
- Memory loss
- Joint pain
- Weight loss
- Abdominal pain
- Hair loss
- Congestive heart failure
Iron is extremely “heavy” in the bloodstream so it forces the heart to work harder as it pumps this heavy metal through your blood vessels resulting in blood pressure changes and more inflammation in your arteries.
This is where the ferritin test is so important because it can tell us if there is too much or too little iron in your body. It’s a simple blood test but rarely ordered during general check-ups and standard blood panels however I believe it is one of the most important and overlooked tests in medicine today. This is why I include it in every patient’s blood panel even if it was normal within the last year.
What should you do if your iron levels are too low?
One extremely important fact to note is that your iron levels can become depleted due to internal bleeding from serious diseases such as cancer or an ulcer in your gut. If you or your doctor suspect serious disease then you should be evaluated by a gastroenterologist, internist or hematologist to rule out something more serious.
If your iron is simply low due to insufficient dietary intake or absorption problems then you can begin to take the following steps to restore your levels:
- Iron supplementation. Iron is best taken in a chelated form with food for the best absorption. Combining iron with vitamin C will help it’s absorption.
- You may require intravenous or iron injections by a hematologist if your ferritin levels are extremely low.
- Indentify food sensitivities such as gluten which can create absorption problems.
- Get your thyroid checked since low thyroid function results in low stomach acid which will negatively affect absorption of vitamins and minerals.
- A stool analysis may be in order to identify infections such as parasites, bacteria or yeasts that can also create poor absorption. In fact, some parasites such as worms feed on iron and b-vitamins resulting in deficiencies.
- Increase your consumption of iron-rich foods.
Additionally, you may want to limit your consumption of the following which inhibit the absorption of iron (these can be used if your iron is too high as a treatment strategy):
- Calcium supplements and calcium-rich foods
- Phytates: Reduce iron absorption about 50% (nuts, seeds, legumes, cereals, whole grains). Proper preparation of these foods such as soaking and sprouting significantly reduces the phytate content.
- Oxalates: spinach, kale, beets, nuts, chocolate, tea, wheat bran, rhubarb, strawberries and herbs such as oregano, basil, and parsley.
- Polyphenols: cocoa, coffee, black tea, herbal teas, green tea, berries, walnuts, apples.
If you have too much iron in your body then you may have a genetic condition known as hemochromatosis. This disease basically means that your body is absorbing too much iron so it builds-up in massive quantities. It can be deadly if not found early as iron continues to build resulting in heart attack and organ failure. Hemochromatosis is handled by a gastroenterologist or hematologist who will have you do frequent therapeutic phlebotomies to reduce your iron levels. This usually works quite nicely to get iron levels down to a healthy level and then you must be monitored and prescribed a schedule for regular phlebotomies or blood donations to keep your iron levels in a healthy range.
Additionally, there are a few things you can do to keep your iron levels low and reduce the oxidative stress from the excess iron:
- Drink green tea. This will inhibit iron absorption and the antioxidants in green tea will help reduce inflammation.
- Increase consumption of the spice turmeric or supplement with curcumin. This has actually been shown to help your body get rid of excess iron.
- Stop cooking on iron cookware which can result in iron in your cooked food. I only recommend menstruating females to eat off of iron cookware. I have seen many patients over the years who use iron cookware and their iron levels have built up to an unhealthy level.
- Decrease consumption of foods that are high in iron. Red meat has the highest level of iron which is great if your iron levels are low, but not so great if they are too high.
- Be careful with vitamin C supplements since vitamin C improves absorption of iron. Some say the antioxidant effects of vitamin C cancel out the negative effect of increased iron absorption, but I recommend just not going overboard if you are going to take it.
- Avoid alcohol, sugar, nicotine, and beta-carotene which all increase the absorption of iron.
Iron and your thyroid
Too much iron can build-up in your thyroid gland creating inflammation and imbalanced hormone production. However, iron is required for thyroid hormone production, the conversion of T4 into the more active T3, and for utilization of thyroid hormone in the cell, so your ferritin levels must be healthy for optimal thyroid hormone levels. I have found that low ferritin levels have been the missing link in some patients with hypothyroidism who just can’t seem to get their thyroid levels in balance. If you have a thyroid problem, definitely have your ferritin levels checked to make sure your ferritin is not too high or too low.
Click here to read my detailed article on ferritin and hypothyroidism.
Iron at war?
Too much iron can create an internal battle among iron and the following nutrients:
As iron accumulates in your body, you may develop deficiencies in these vital nutrients which are key factors in hundreds of processes in your body. I have patients do a “Zinc Taste Test” every 30 days to check their Zinc levels. If they are low, we supplement with Zinc and a small amount of Copper for 30 days and then retest on a regular basis. Just as iron competes with these 4 nutrients, they also compete with each other so it’s a matter of finding the right balance and not taking too much of one of these for long periods of time so you don’t develop deficiencies.
What is a healthy ferritin level?
Standard lab ranges are pretty broad currently set at 15-150 ng/ml for adult women and 30-400 ng/ml for adult men. I prefer a ferritin of about 70-150 for optimal health. Some women need to have a ferritin at 100 or above just to start seeing hair regrowth, to normalize thyroid function, and to really feel better. It’s amazing how symptoms can set in when the ferritin drops below 100. One other important thing to note is that your ferritin levels can be extremely low but you may not show signs of anemia on standard blood tests.
Are there other tests you should have?
You should also have these iron values tested along with ferritin to get a more accurate picture:
- Serum iron
- % iron saturation
- TIBC (Total iron binding capacity)
If you only check ferritin without the above three markers then you’re not getting the complete picture. If the above markers are elevated along with a normal or low ferritin, then it most likely isn’t a good idea to supplement with iron. If the above three are elevated then your blood and cells are saturated with iron and it isn’t being used properly by your body. This could be due to liver dysfunction, hypothyroidism, B12, or folate deficiency. You don’t want to dump more iron into a system that is overly saturated.
If however the % iron saturation and TIBC are low and your serum iron is normal or low along with a low ferritin, then it can be safe to start supplementing with iron. Have these levels checked every 6 weeks until all your markers normalize.
The ferritin test is by far one of the most important tests you can have done on a regular basis yet it is almost never ordered by conventional doctors. Make sure you request it the next time you have a check-up. It just may be the missing link if you aren’t feeling your best.