Ferritin in Serum

The most sensitive marker of iron storage and also an indicator of inflammation.

Also known as:

S-ferritin

Do not confuse with serum Iron (Fe).

Video explainer of this page

Ferritin ranges for

Interpret your result

"Normal" lab range for Ferritin is between 22 and 500 µg/L for males:

500

According to Peter Attia, Ferritin should be between 30 and 400 µg/L:

400

According to OptimalDX, Ferritin should be between 45 and 79 µg/L:

According to American Gastroenterological Association, Ferritin should be above 45 µg/L:

Symptomatic hemochromatosis was associated with Ferritin above 500 µg/L:

500

Unexplained fatigue and weakness was associated with Ferritin below 50 µg/L:

Hair loss was associated with Ferritin below 40 µg/L:

Restless Legs Syndrome was associated with Ferritin below 75 µg/L:

Increased all cause mortality was associated with Ferritin above 194 µg/L in males:

194

Optimal range

Optimal range for Ferritin appears to be between 60 and 110 µg/L:

110

200

600

Why this optimal range?

Both observational and interventional data suggest that ferritin levels below 60 µg/L may be associated with symptoms.

Longitudinal studies indicate that both high and low ferritin levels are linked to increased all-cause mortality. But GWAS studies suggest that lower ferritin levels are preferable, so I am inclined to keep ferritin levels relatively low, yet above the level associated with symptoms.

Your interpretation

For low

For high

Common reasons for low Ferritin:

Dietary iron deficiency
Iron deficiency is one of the most prevalent nutritional deficiencies according to the WHO. In both the developed and developing countries.
77.5% of young females are considered iron deficient when using a 50-μg/L cutoff
Adult vegetarians have significantly lower serum ferritin levels (-29.71 µg/L) than their non-vegetarian controls. (meta analysis of 27 cross-sectional studies)
Impaired iron absorption
GI diseases, such as celiac disease, IBD, H. pylori, atrophic or autoimmune gastritis, Crohn's disease...
Tea consumption with a meal inhibits iron absorption by 37%. Waiting one hour after the meal reduces this inhibition to only 18%.
Coffee inhibits iron absorption from a supplement by 54%.
Calcium supplementation (1200 mg/day) significantly reduces daily non-heme iron absorption from 15.8% to 4.7%.
Blood loss,
Heavy menstrual bleeding, blood donations, accidents, or surgery.
Drugs that decrease iron absorption or cause gastrointestinal bleeding,,
Proton Pump Inhibitors, Antacids and H2-Receptor Antagonists, Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Certain Antimicrobials like tetracycline and ciprofloxacin ...
Hypothyroidism,
Serum ferritin levels appear to increase when even subclinical hypothyroidism is treated. However, a combination of levothyroxine and iron salts is more effective than using either one alone.
Colon cancer in older adults
Up to 60% of patients with colon cancer have iron deficiency at diagnosis, probably due to chronic blood loss. Peter Attia says: "In fact, if a person is 50 years of age or older and they have low ferritin, they have colon cancer until proven otherwise"
Running - footstrike hemolysis
Athletes such as marathoners with high training volumes would be particularly at high risk.

Possible consequences from low Ferritin:

Unexplained fatigue and weakness
Both intravenous and oral iron supplementation have improved fatigue in iron-deficient, non-anemic women of childbearing age.,
Having a serum ferritin level <50 ng/ml caused a 6.5-fold increased risk for fibromyalgia syndrome.
Hair loss
In a meta-analysis of 36 observational studies, the average ferritin levels in patients with hair loss were 20.65 ng/dL lower than those in controls (childbearing age women). The meta-analysis concludes "Women with hair loss can benefit from higher ferritin levels."
In a smaller study involving 210 patients with hair loss and 210 healthy controls, females with hair loss had an average ferritin level of 49.27 µg/L, while healthy women had an average of 77.89 µg/L. Additionally, 22.7% of males with hair loss had a serum ferritin level lower than 70 µg/L, compared to healthy males, where non of them had ferritin levels below 70 µg/L.
In a smaller randomized controlled trial, iron supplementation improved hair density by 16% over six months, nearly double the improvement seen in the 2% Minoxidil group.
Restless Legs Syndrome
Meta-analysis: For patients with RLS who are iron deficient, iron supplements can not only relieve their fundamental RLS symptoms but also lower the risk of RLS augmentation.
Mayo clinic: All RLS patients with serum ferritin concentration of 75 mg/L or less and transferrin saturation below 45% should receive a trial of oral iron therapy.
Being pale or having yellow "sallow" skin
Shortness of breath or chest pain, especially with activity
Unexplained generalized weakness
Rapid heartbeat
Pounding or "whooshing" in the ears
Headache, especially with activity
Craving for ice or clay - "picophagia"
Brittle nails

How to increase Ferritin:

Rule out serious diseases via Bidirectional endoscopy
American Gastroenterological Association recommends the following for patients with anemia and ferritin below 45 ng/mL:

- Adult men and postmenopausal women: Strongly recommends bidirectional endoscopy before initiating iron supplementation.
- Premenopausal women, vegetarians and frequent blood donors: Prefers bidirectional endoscopy, but allows for non-invasive testing for H. pylori and celiac disease.
Iron supplementation
Calculate your Iron Stores and personalized supplementation plan.
Read the American Society of Hematology guideline for Management of iron deficiency
Consider the "gentle iron" supplement. Compared with other iron supplements, supplementation with ferrous bisglycinate for 4-20 weeks resulted in higher hemoglobin concentrations and fewer reported GI adverse events.
Adding 500 mg of vitamin C doubles the iron absorption from FeAC (15% vs 34%) and is dose dependent. Vitamin C has to be taken at the same time as the iron supplement.,
Liquid iron might not be the best first option, as it can stain the teeth.
Lab check ferritin at least twice a year, since high values are dangerous.
"Slow-release" or "enteric-coated" Iron supplements are ineffective. Iron absorption primarily occurs in the duodenum, meaning there is only a limited window for efficient uptake.

Images:

Ferritin was associated with all cause mortality

Model 5 is the fully adjusted model. Significant results in bold

5,471 participants

Community dwellers aged ≥52 years from England.

Dataset: English Longitudinal Study of Ageing

Longitudinal study

Kadoglou et al. (2017)

High ferritin was associated with moderate rise in mortality

Plasma ferritin cannot be reliably converted to serum ferritin.

8,988 participants

Randomly selected Danish population 20 to 80 years old followed up for 23 years.

Dataset: The Copenhagen City Heart Study

Longitudinal study

Ellervik et al. (2014)

High ferritin was associated with moderate rise in mortality

257,953 participants

GWAS Mendelian randomization study

Moksnes et al. (2022)

Ferritin was not associated with all-cause mortality

However, all-cause mortality was inversely associated with transferrin saturation (%) in men.

5,695 participants

50 years or older men and postmenopausal women.

Longitudinal study

Kim et al. (2012)

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