Optimal Ferritin Levels May Surprise You

Optimal Ferritin Levels Blog Image

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

Ferritin is a large protein molecule, and while its role is complex and still unclear, ferritin is generally considered a surrogate marker for total iron storage in the body and often acts as a biomarker of health. Optimal ferritin levels and reference ranges are not currently well defined, but what are considered “normal levels” may actually be too high, and some researchers are advocating for a change in what is considered normal. While we still don’t know the “optimal” numbers, aiming for below the 50 percentile is most likely healthier (20-40 for women, 50-70 for men). Ferritin specialist William R. Ware, PhD, suggests that we should aim even lower for some patient populations (those with cardiometabolic disease, non-alcoholic fatty liver, etc.).

Elevated ferritin has been linked with a number of physiologic processes, the most notable inflammation. Clinical studies that aim to reduce ferritin levels have documented improvement in outcomes. This reinforces the idea that iron may be a causal factor in various disease processes, based on the following:

  • Iron is highly reactive and can produce oxidative stress, damaging DNA, organs, and vasculature.
  • High levels of iron are associated with chronic diseases, such as diabetes, cardiovascular disease, metabolic syndrome, chronic kidney disease, aging and neurologic disease, and even some cancers.
  • Iron levels gradually increase if in dietary (or supplemental) excess, as humans do not have regulatory mechanisms – other than blood loss – to rid of excess iron.

Elevated Ferritin and Iron are Linked to a Number of Brain, Heart, and Gut Diseases

BRAINdementia, neurodegenerative disorders
CARDIOMETABOLICdiabetes, hypertension, high cholesterol, heart disease, kidney disease, obesity, non-alcoholic fatty liver disease
GUT liver and colon cancer

While iron deficiency anemia is a concern worldwide, it is most common in children, premenopausal women, and those who are pregnant and lactating. I urge patients to be cautious with iron supplements, especially men and post-menopausal women. For those with low ferritin levels, ask your physician to check iron levels, as only those with documented iron deficiency and anemia should take iron, and then just to sufficient, but not high, levels of iron. For those with high ferritin levels look for an underlying cause, have your iron levels checked, and consider blood donation and a low iron diet.

Worth Reading

Adams MD, Paul, Management of Elevated Serum Ferritin Levels, NCBI/2008

Bregy, A., Trueb, R.M., No Association between Serum Ferritin Levels >10 μg/l and Hair Loss Activity in Women, Karger/2008

Fan, Yong-Gang, Guo, Chuang, Liu, Jun-Lin, et al., Iron and Alzheimer’s Disease: From Pathogenesis to Therapeutic Implications, NCBI/2018

Ware, William R., PhD, The Risk of Too Much Iron: Normal Serum Ferritin Levels May Represent Significant Health Issues, International Society of Orthomolecular Medicine/2013

Preventive Integrative Medicine, the Ideal Approach to Care

How could this have been prevented? This is a question I have been asked hundreds of times throughout my training and over the course of my career. As a resident learning about surgical procedure as pertains to obstetrics and gynecology, I clearly recall thinking beyond the surgery to how the need for the surgery may have been prevented. It was during this time that I decided to switch my concentration to family medicine, which would allow me to further focus on prevention.

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Gardening a Healthy Hobby


As a lifelong and passionate gardener, it pleases me that my hobby provides not only joy, but substantial health benefits.

My love of gardening started when I was young and continues today. I have fond memories of my father taking me to the garden store as a child and letting me choose plants for our yard. Throughout my college years and medical school, when I began studying the benefits of herbs, I always kept a garden and even extended it to the roof of my apartment when I ran out of room! I thought I would share with you some of the many ways gardening affects our health and connects to the brain, heart, and gut.


Gardening can improve our mood and reduce the risk of dementia. In fact, a study in the Netherlands cited by CNN suggests that gardening is more effective at reducing stress than other hobbies. Participants completed a stressful task and were then told to either read indoors or go outside and garden. After 30 minutes, the gardening group reported better moods, and their blood tests showed lower levels of the stress hormone cortisol. In addition, the microbiome in soil has been shown to act as an antidepressant and its effects have been used to study cancer patients, resulting in heightened happiness, vitality and “significantly improved quality of life.”


While most gardening falls under the category of moderate physical exercise, studies show that the activity can cause reductions in cardiovascular disease and cancer mortality rates. And, when in addition to regular exercise, gardening or DIY activities can cut the risk of a heart attack or stroke and prolong life by as much as 30% among those ages 60+, according to a study of almost 4,000 participants in Stockholm.


Research shows that the human gut and soil contain about the same number of active microorganisms and that there is a connection between microbes in the soil and the environment and our own microbiome. Exposure to these microbes affects our health in a number of ways, including balancing our microbes and even improving our mood. We’ve learned through studies that growing up in a microbe-rich environment, such as a farm, can have positive health effects on children. However, these effects may change due to urbanization and conventional foods.

Additional Benefits of Healthy Gardening

Gardening offers a bounty of additional benefits as well, including spending time in nature, exposure to the sun and Vitamin D, exercise, the opportunity to grow and eat organic, nutritious food and herbs, and an ongoing hobby that requires attention. It has also been shown to lower the risk of dementia, boost mood and combat loneliness.

Also, digging in and breathing in dirt not only nourishes and protects plants and plays a role in stabilizing the climate, but some research suggests a relationship between increased autoimmune disease and a disruption in the symbiotic relationships of soil microorganisms, so caring for a garden can be a conduit to increased microbial interactions.

For me, planning and tending to my garden has always been a source of healing and rejuvenation. I encourage you to explore this healthy hobby or, at the very least, take the time to begin composting your kitchen scraps.

Worth Reading

Allyn, Bruce, Amaranthus, Mike, Healthy Soil Microbes, Healthy People: The microbial community in the ground is as important as the one in our guts, The Atlantic/2013

Blum, Winfried E.H., Keiblinger, Katharina M., Zechmeister-Boltenstern, Sophie, Does Soil Contribute to the Human Gut Microbiome?, NCBI/2019

Donner, Nina C., Fox, James H., Fuchsl, Andrea M., et al., Immunization with a heat-killed preparation of the environmental bacterium Mycobacterium vaccae promotes stress resilience in mice, PNAS/2016

Gaston, Kevin J., Soga, Masashi, Yamaurac, Yuichi, Gardening is beneficial for health: A meta-analysis, ScienceDirect/March 2017

Goldman, Bruce, Gut bust: Intestinal microbes in peril, Stanford Magazine/2016 Hayes, Kim, 5 Secret Health Benefits of Gardening, AARP/2017

Ochoa-Hueso, Raul, Global Change and the Soil Microbiome: A Human-Health Perspective, Frontiers in Ecology and Evolution/2017

Staff, Three Ways Gardening is Good for Your Gut, Hyperbiotics.com

Fertility and Preconception Planning

If you’re a woman thinking about starting a family or actively trying, it can be a strange time. After spending your whole adult life trying not to get pregnant, it can seem as if once you start trying things will go off without a hitch-and they often do. But when it comes to optimizing your and your future baby’s health, it can be a bit more complicated than ditching the birth control and taking a prenatal.

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7 Ways to Make Seasonal Allergies Less Annoying

Stinging Nettle


Many of us will be spending time outdoors with our families this summer, but the beautiful blooming flowers and trees producing airborne pollen may put a damper on our plans, as they cause sniffing and sneezing. While seasonal allergies are a reality and affect about 35 million Americans, there are proactive and integrative approaches you can take to lessen your symptoms and fully appreciate summer’s splendor.

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Racism, Public Health, and My Commitment

Systemic racism and oppression are public health crises

I would like to begin this message by apologizing for the delay in formulating my thoughts and words for my patients, colleagues and the community. It was never my intention to appear uncaring by remaining silent during this monumental time in our lives and our history, and I assure you that I continue listening, learning and taking action to serve the community as a whole.

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Considering Running? Now’s the Time!

The Rewards Of Running

If you’re considering a new exercise regimen during this time of sheltering, I’d like to put in a plug for running. In completing research recently on longevity and healthy aging, I came across “The Runner’s Study,” which prompted me to want to convey the rewards of running, something I started in elementary school, continued throughout college and medical school and today still find beneficial for both the body and mind.

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