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
|BRAIN||dementia, neurodegenerative disorders|
|CARDIOMETABOLIC||diabetes, 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.
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