A number of people in my extended family across generations have low serum ferritin unless they supplement with iron. And feel horrible and weak until they raise their numbers. Mine was at 3 at one point even though other blood tests for iron were completely normal.
I'm seeing many clients present with iron issues (ferritin alone is near useless). Most notable are the links to B9 and B12 deficiencies, yet these discrepancies on a full iron panel are not well understood or taught. I'm regularly seeing flareups of autoimmune thyroid from folate deficiency (MTHFR) and high ferritin/inflammation from B12 deficiency... yet doctors simply increase thyroid meds in the former (and usually ignore the high ferritin in the latter).
Sublingual. I take half of oneBen Lynch's Seeking Health Combined Hydrocobalmin (sp?) Follinic Acid (non-methyl) . I once megadosed methyl B12/B9 and it caused me to overmethylate and I barely slept for a month until I flushed it out. I may go back to taking it in small doses because if I get the overmethylation symptoms now I know to take 50mg of Niacin B3 until they subside.
Wow, you gave me the hint to the only B12 / B9 supplement that I can tolerate without getting insomnia, irritation and anger. Thank you so much for sharing!
My B12 was over 1400 but it has come down to the 800s now. Ferritin was 25 in late January but this week is up to 61 so much more energy but will get it up to 100.
So what do you believe has made the improvement in your ferritin? Does the increase correlate with your supplementation regimen?
There are other factors to consider, of course. I'm sure you're aware of copper deficiency being a cause of anemia and malabsorption from digestive conditions like Celiac, Crohn's or ulcerative colitis...
This comment is so valuable. I've never seen a clearer summary that explains my health problems as good, before, i.e. autoimmune thyroid (Hasimoto), linked to too low folate (MTFHR) and high ferritin/inflammation from too low B12.
You have helped me so much with this information, thank you!
Well, I don’t understand ferritin either, but I try. I have spent most of my adult life taking added iron every day because when I don’t cannot make it through the day, I am pale and exhausted and depressed. So I’ve learned to watch all the numbers around iron. When my ferritin level is 80, I’m OK but Lackluster. When it’s over 100 I come alive. When it’s 30 or under I feel like I’m dying. I had parasites two years ago and my ferritin level dropped from 120 down to 20 in one month even though there was no bleeding anywhere. It took me a year to get those iron levels back up. I also have celiac which I’m sure tells part of the story but it is under excellent control. I’ve only had one doctor look at a low ferritin level and understand that it is devastating for me. They say “well it’s just a little low.” So this is something I take in my own hands and have had to draw my own conclusions. I am 70 right now and rock climber and I would say that is my most important power mineral.
You definitely sound chronically anemic, and that combined with the fact that you supplement with iron regularly, driving variation in ferritin, makes the 59% correlation between ferritin and iron stores in the general population become a much higher correlation for you.
My ferritin is always on the low side and I have to take iron too. I feel pretty good when it is in the 50s. One weird thing I noticed is that when my ferritin drops my AST and ALT increase above the normal range slightly. I tried digging in the littérature but it should be the opposite happening. So I’m clueless.
When I have low ferritin my iron is normal but % saturation always high (maybe it’s trying to catch up). I do have a MTHFR deficiency. I also tried everything (methylfolate, créatine, betaine, glycine) That does not resolve the liver marker only higher ferritin does! But it’s hard to keep up as I don’t like taking iron. Thanks for asking!
Yes, I did see my ferritin drop from 95 to 20 after several blood donations! But still feel great! I just finished a 350-mile bike ride going west against headwinds and finished in four days. I felt I could have done it in three days but my companions could not sustain the pace.
According to this article with 450 citations, Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells.
Awesome read. I knew literally none of this regarding ferritin. As an endurance athlete, I use it along with iron and transferrin saturation for iron status, and I've found even if iron and TS are not low but ferritin has decreased from the last test, I feel and perform much worse. I've been very low (in the 20s) and high (>100) and there are remarkable differences in how I feel with ferritin at 40 vs. 60 vs. >100.
I think you're definitely seeing the 59% side of ferritin that correlates with iron stores, and the fact that it correlates with your performance and how you feel shows that and is what makes it valuable for you.
Linking to the Research Gate bibliography for the late Eugene Weinberg, Ph.D. After retirement his research and writing on iron issues, including ferritin, was extensive.
Very interesting article with 450 citations concludes Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells.
I started feeling really fatigued last October and more anxious. It kept getting worse and I had a hard time sleeping. My blood panel (no ferritin tested) showed I was in the normal range but on the lower end. I did a B vitamin test that included ferritin and it was low. I had been supplementing with over 50-70mg of Zn daily since COVID and avoiding copper. My theory is that the high Zn lowered my Copper and thus my Cerruloplasmin even lower which is needed to move Iron to storage and away from our soft tissues plus Zn also blocks Iron absorption. On top of this I also have low stomach acid that I treat with Betaine HCL now but I think I was not absorbing minerals well including Iron (not to mention magnesium, etc.) I take Copper now in the AM with 20mg Heme iron and Zn in the evening. My ferritin is now 61 and my energy is much better as well as my sleep and anxiety. What do you think of my theory?
You don’t mention the role of copper in iron metabolism and distribution; have you looked into the rot cause protocol of Morley M. Robbins? he brings some pretty novel and interesting insight.
My copper was low from overdosing Zn (used a RBC Copper test). Copper is needed for Cerruloplasmin that moves Iron from where it can cause problems and into storage as Ferritin.
My Father recently died of Anemia - which was a actually Leukemia. He was 85. He lived in confusion of this issue as the Doctor’s recommended Iron for the 60 years. Sometimes Doctors would suggest to stop the Iron. His issue was a roller coaster of highs and lows.
My Sister has the same issue and almost died when her Iron was extremely low and her blood count was in the category of Death. She took Blood and Plasma transfusions at a Cancer Center and survived but is now needing more Blood Transfusions. I, personally cannot recover from Donating Blood, my whole body hurts and I have to rest for 2-3 weeks. When my Father passed, the Doctor’s told him that he only one blood/plasma treatment to live with out the Biopsy of his Hip. He was exhausted and died within that one week. I appreciate this information. I think there must be studies of DNA and better definitions of differentiation of Cellular activity that is unique. There must be a subset of Humans that have an inability to process Iron and Ferritin that is beneficial.
Hi, this is interesting to me - I also just heard a podcast about the risks of giving blood and ferritin levels. Per my health coach’s advice, I was just getting ready and excited to donate in hopes of feeling better (I have high blood sugar symptoms/pre diabetic, positive for ANA, vitamin B deficient, low T3 or T4 can’t remember which and I’m compound heterozygous for MTHFR (positive for both mutations A1298C /C677T). The correlations that you noted are interesting and now I’m wondering if I should hold off on giving blood. Also, I know I’m B deficient and have been confused about whether to take methylated versions or not. I’d love any insights or feedback!
Health coaches that are influenced by Ray Peat or use a pro-metabolic approach are very anti-iron, to the point where they are probably causing harm. Yes, many do have iron excess, even without it being obvious using lab ranges. But plenty are probably low in iron ....
Dear Chris, first of all, thank you for the article! Do you have information that those who absorb more iron do they also absorb more zinc as well? Does an increased ferritin mean that the person is likely storing more zinc as well? Thank you very much in advance for the answer!!
Btw I have only one C282Y gene, but have increased ferritin which gets lower every time I donate blood. At the same time I have normal serum zinc levels, but feel really crap even after supplementing 5mg of zinc. (although a lot of other supplement can make me feel crap, I completely ditched multivitamins for this reason)
Have anyone (you, Chris, too😉) heard or come across a link between parasites and low ferritin? I have dientamoeba fragilis that loves me so much that won't leave no matter what antibiotics I take and my advicor think that nasty bastard could be the reason (and reason for me being unable to gain weight no matter what 🙄).
(The next logical TOTALLY off topic question is how to get rid of that little bastard when Flagyl or metronizale didn't help. also tried grape seed, wormwood, acv, garlic... that guy is tough as an ox! My own fat percentage as s female is somewhere around 5 percent, when more than 3000 calories go to the parasite's food)
Some microbes that are considered parasites are actually commensals. For example, Blastocystis has many subtypes and in research, its presence signifies a healthy microbiome. There is not enough evidence that some of what are known as parasites are to blame for various symptoms or conditions. There's probably a reason you can't kill it!!!
that's a great perspective you give Allison. Unfortunately, it would seem that dientamoeba is the reason why I cannot gain weight, even though I am severely underweight and underfat. In addition, the absorption of nutrients is really weak (just like ferritin). Another reason forme could be cadmium, which I have in toxic amounts.
But that was a valuable perspective on being parasites, that is, they can and may be just for us (like my "dietmoeba" protecting me from cadmium).
I think that is why your ferritin goes up with infections and inflammation. Your body keeps the Iron from circulating to avoid feeding the bad microbes.
I recommend Heme iron to raise it up fast. It is more absorbable than non-heme and you only have to worry about 300mg of calcium or more blocking it while non-Heme has a long list. I only take 20mg a day and in 4 months I have gone from 25 ng/ml to 61 ng/ml. Feel so much better but need to get to 100 ng/ml for optimal.
My naturopath is starting me on a protocol that's supposed to break down the biofilm protecting the overgrown bacteria first, while also supporting friendly bacteria. Once the bad bacteria is more exposed and weak, then we will hit it with more potent stuff to kill it.
Hi Chris, Thank you for this article. I’m opposite of most. 13 years ago in doing a full blood panel, I was elevated in Iron, ferritin, AST ALT. I also have hypothyroidism, which I treat with levothyroxine, that’s the only pharmaceutical I take. I was also tested and I am a Hemochromatosis CARRIER-
After being told I have a fatty liver for many years, and having difficulty bringing my numbers down, I succumbed to a liver biopsy. Results No fatty liver, but mild to moderate iron overload. I’m 58
Currently my AST is normal, ALT just slightly over normal range, total iron 164, just slightly over range, It’s the ferritin that stays elevated at about 360-402. I am healthy and exercise 5-6 days a week- I would be very interested in hearing your thoughts.
A number of people in my extended family across generations have low serum ferritin unless they supplement with iron. And feel horrible and weak until they raise their numbers. Mine was at 3 at one point even though other blood tests for iron were completely normal.
Same with me
I'm seeing many clients present with iron issues (ferritin alone is near useless). Most notable are the links to B9 and B12 deficiencies, yet these discrepancies on a full iron panel are not well understood or taught. I'm regularly seeing flareups of autoimmune thyroid from folate deficiency (MTHFR) and high ferritin/inflammation from B12 deficiency... yet doctors simply increase thyroid meds in the former (and usually ignore the high ferritin in the latter).
LOL, I had low ferritin but very high B12 and Folate.
Were you supplementing with B12, and if so was it a tablet/capsule or sublingual/oral?
Sublingual. I take half of oneBen Lynch's Seeking Health Combined Hydrocobalmin (sp?) Follinic Acid (non-methyl) . I once megadosed methyl B12/B9 and it caused me to overmethylate and I barely slept for a month until I flushed it out. I may go back to taking it in small doses because if I get the overmethylation symptoms now I know to take 50mg of Niacin B3 until they subside.
It is around 500mcg of B12. I also get 25 mcg in the Seeking Health non-methyl multivitamin too.
Wow, you gave me the hint to the only B12 / B9 supplement that I can tolerate without getting insomnia, irritation and anger. Thank you so much for sharing!
Same here, ferritin is 16, but b12 is near 1000 and folate is superhigh aswell...
Had you been supplementing with B12 and folate?
Yes but only non-methyl hydroxocobalmin and follinic acid.
My B12 was over 1400 but it has come down to the 800s now. Ferritin was 25 in late January but this week is up to 61 so much more energy but will get it up to 100.
So what do you believe has made the improvement in your ferritin? Does the increase correlate with your supplementation regimen?
There are other factors to consider, of course. I'm sure you're aware of copper deficiency being a cause of anemia and malabsorption from digestive conditions like Celiac, Crohn's or ulcerative colitis...
This comment is so valuable. I've never seen a clearer summary that explains my health problems as good, before, i.e. autoimmune thyroid (Hasimoto), linked to too low folate (MTFHR) and high ferritin/inflammation from too low B12.
You have helped me so much with this information, thank you!
My pleasure, I'm so glad it's been helpful! Have you noticed any improvements in the last month?
Well, I don’t understand ferritin either, but I try. I have spent most of my adult life taking added iron every day because when I don’t cannot make it through the day, I am pale and exhausted and depressed. So I’ve learned to watch all the numbers around iron. When my ferritin level is 80, I’m OK but Lackluster. When it’s over 100 I come alive. When it’s 30 or under I feel like I’m dying. I had parasites two years ago and my ferritin level dropped from 120 down to 20 in one month even though there was no bleeding anywhere. It took me a year to get those iron levels back up. I also have celiac which I’m sure tells part of the story but it is under excellent control. I’ve only had one doctor look at a low ferritin level and understand that it is devastating for me. They say “well it’s just a little low.” So this is something I take in my own hands and have had to draw my own conclusions. I am 70 right now and rock climber and I would say that is my most important power mineral.
You definitely sound chronically anemic, and that combined with the fact that you supplement with iron regularly, driving variation in ferritin, makes the 59% correlation between ferritin and iron stores in the general population become a much higher correlation for you.
My ferritin is always on the low side and I have to take iron too. I feel pretty good when it is in the 50s. One weird thing I noticed is that when my ferritin drops my AST and ALT increase above the normal range slightly. I tried digging in the littérature but it should be the opposite happening. So I’m clueless.
What are your other iron markers doing when your ferritin drops? Have you been tested for MTHFR?
When I have low ferritin my iron is normal but % saturation always high (maybe it’s trying to catch up). I do have a MTHFR deficiency. I also tried everything (methylfolate, créatine, betaine, glycine) That does not resolve the liver marker only higher ferritin does! But it’s hard to keep up as I don’t like taking iron. Thanks for asking!
Could be a riboflavin deficiency
Yes, I did see my ferritin drop from 95 to 20 after several blood donations! But still feel great! I just finished a 350-mile bike ride going west against headwinds and finished in four days. I felt I could have done it in three days but my companions could not sustain the pace.
Everybody is different.
According to this article with 450 citations, Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells.
https://pubs.rsc.org/en/content/articlehtml/2014/mt/c3mt00347g?fbclid=IwAR0YJPQQAvJ5f9YHP2v6rkUgOZjh_TgWZP3XLwEn6rupJ2a1ojXeJjT7OUc
Agreed, high ferritin is a symptom of high inflammation
Yes, hence my comment!
Awesome read. I knew literally none of this regarding ferritin. As an endurance athlete, I use it along with iron and transferrin saturation for iron status, and I've found even if iron and TS are not low but ferritin has decreased from the last test, I feel and perform much worse. I've been very low (in the 20s) and high (>100) and there are remarkable differences in how I feel with ferritin at 40 vs. 60 vs. >100.
I think you're definitely seeing the 59% side of ferritin that correlates with iron stores, and the fact that it correlates with your performance and how you feel shows that and is what makes it valuable for you.
Austen! Pleased to meet you! We must have been writing similar posts at the same time.
Linking to the Research Gate bibliography for the late Eugene Weinberg, Ph.D. After retirement his research and writing on iron issues, including ferritin, was extensive.
https://www.researchgate.net/profile/Eugene-Weinberg-3
Very interesting article with 450 citations concludes Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells.
https://pubs.rsc.org/en/content/articlehtml/2014/mt/c3mt00347g?fbclid=IwAR0YJPQQAvJ5f9YHP2v6rkUgOZjh_TgWZP3XLwEn6rupJ2a1ojXeJjT7OUc
I'll read it but I'm quite skeptical, and that author has been on X/Twitter responding to this in a way that does not address key pieces of evidence.
If it is dumped from damaged cells wouldn't you expect it to be the "intracellular" form of ferritin described here rather than the serum form?
I started feeling really fatigued last October and more anxious. It kept getting worse and I had a hard time sleeping. My blood panel (no ferritin tested) showed I was in the normal range but on the lower end. I did a B vitamin test that included ferritin and it was low. I had been supplementing with over 50-70mg of Zn daily since COVID and avoiding copper. My theory is that the high Zn lowered my Copper and thus my Cerruloplasmin even lower which is needed to move Iron to storage and away from our soft tissues plus Zn also blocks Iron absorption. On top of this I also have low stomach acid that I treat with Betaine HCL now but I think I was not absorbing minerals well including Iron (not to mention magnesium, etc.) I take Copper now in the AM with 20mg Heme iron and Zn in the evening. My ferritin is now 61 and my energy is much better as well as my sleep and anxiety. What do you think of my theory?
I think you're running pretty far with very little evidence. Your iron was low, you added some, you feel better. That's what I see.
LOL, you sound like my wife. Thanks as an engineer I like your scientific approach.
Forgot to mention that my hair was falling out too.
Hi Chris,
You don’t mention the role of copper in iron metabolism and distribution; have you looked into the rot cause protocol of Morley M. Robbins? he brings some pretty novel and interesting insight.
Copper does not play a role in what I was writing about here. I have read his book, we are likely to have a podcast discussion some time this year.
My copper was low from overdosing Zn (used a RBC Copper test). Copper is needed for Cerruloplasmin that moves Iron from where it can cause problems and into storage as Ferritin.
I have to point out that this is just my theory and I did not do a Zinc RBC test only serum.
My Father recently died of Anemia - which was a actually Leukemia. He was 85. He lived in confusion of this issue as the Doctor’s recommended Iron for the 60 years. Sometimes Doctors would suggest to stop the Iron. His issue was a roller coaster of highs and lows.
My Sister has the same issue and almost died when her Iron was extremely low and her blood count was in the category of Death. She took Blood and Plasma transfusions at a Cancer Center and survived but is now needing more Blood Transfusions. I, personally cannot recover from Donating Blood, my whole body hurts and I have to rest for 2-3 weeks. When my Father passed, the Doctor’s told him that he only one blood/plasma treatment to live with out the Biopsy of his Hip. He was exhausted and died within that one week. I appreciate this information. I think there must be studies of DNA and better definitions of differentiation of Cellular activity that is unique. There must be a subset of Humans that have an inability to process Iron and Ferritin that is beneficial.
That’s sad.
When there’s another condition messing with iron metabolism you have to be more sophisticated than just wanting the iron to go up or down.
Hi, this is interesting to me - I also just heard a podcast about the risks of giving blood and ferritin levels. Per my health coach’s advice, I was just getting ready and excited to donate in hopes of feeling better (I have high blood sugar symptoms/pre diabetic, positive for ANA, vitamin B deficient, low T3 or T4 can’t remember which and I’m compound heterozygous for MTHFR (positive for both mutations A1298C /C677T). The correlations that you noted are interesting and now I’m wondering if I should hold off on giving blood. Also, I know I’m B deficient and have been confused about whether to take methylated versions or not. I’d love any insights or feedback!
Health coaches that are influenced by Ray Peat or use a pro-metabolic approach are very anti-iron, to the point where they are probably causing harm. Yes, many do have iron excess, even without it being obvious using lab ranges. But plenty are probably low in iron ....
Dear Chris, first of all, thank you for the article! Do you have information that those who absorb more iron do they also absorb more zinc as well? Does an increased ferritin mean that the person is likely storing more zinc as well? Thank you very much in advance for the answer!!
The only study I was able to find concerning this topic: https://europepmc.org/article/med/2040101
Btw I have only one C282Y gene, but have increased ferritin which gets lower every time I donate blood. At the same time I have normal serum zinc levels, but feel really crap even after supplementing 5mg of zinc. (although a lot of other supplement can make me feel crap, I completely ditched multivitamins for this reason)
Have anyone (you, Chris, too😉) heard or come across a link between parasites and low ferritin? I have dientamoeba fragilis that loves me so much that won't leave no matter what antibiotics I take and my advicor think that nasty bastard could be the reason (and reason for me being unable to gain weight no matter what 🙄).
A parasite could be eating your iron before you get a chance to absorb it.
(The next logical TOTALLY off topic question is how to get rid of that little bastard when Flagyl or metronizale didn't help. also tried grape seed, wormwood, acv, garlic... that guy is tough as an ox! My own fat percentage as s female is somewhere around 5 percent, when more than 3000 calories go to the parasite's food)
Some microbes that are considered parasites are actually commensals. For example, Blastocystis has many subtypes and in research, its presence signifies a healthy microbiome. There is not enough evidence that some of what are known as parasites are to blame for various symptoms or conditions. There's probably a reason you can't kill it!!!
that's a great perspective you give Allison. Unfortunately, it would seem that dientamoeba is the reason why I cannot gain weight, even though I am severely underweight and underfat. In addition, the absorption of nutrients is really weak (just like ferritin). Another reason forme could be cadmium, which I have in toxic amounts.
But that was a valuable perspective on being parasites, that is, they can and may be just for us (like my "dietmoeba" protecting me from cadmium).
I know that harmful bacteria feeds off of iron.
I think that is why your ferritin goes up with infections and inflammation. Your body keeps the Iron from circulating to avoid feeding the bad microbes.
My ferritin is 16 so it's super low. Hb is 141 and transf 2,5 g/L.
I recommend Heme iron to raise it up fast. It is more absorbable than non-heme and you only have to worry about 300mg of calcium or more blocking it while non-Heme has a long list. I only take 20mg a day and in 4 months I have gone from 25 ng/ml to 61 ng/ml. Feel so much better but need to get to 100 ng/ml for optimal.
My naturopath is starting me on a protocol that's supposed to break down the biofilm protecting the overgrown bacteria first, while also supporting friendly bacteria. Once the bad bacteria is more exposed and weak, then we will hit it with more potent stuff to kill it.
Interesting. As a pregnant woman, the iron and ferritin levels change a lot in pregnancy, and follow a pattern.
Yes your blood volume is expanding and you are making blood for a growing baby.
@Chris Masterjohn: What level of ferritin has worked best for you, personally?
Hi Chris, Thank you for this article. I’m opposite of most. 13 years ago in doing a full blood panel, I was elevated in Iron, ferritin, AST ALT. I also have hypothyroidism, which I treat with levothyroxine, that’s the only pharmaceutical I take. I was also tested and I am a Hemochromatosis CARRIER-
After being told I have a fatty liver for many years, and having difficulty bringing my numbers down, I succumbed to a liver biopsy. Results No fatty liver, but mild to moderate iron overload. I’m 58
Currently my AST is normal, ALT just slightly over normal range, total iron 164, just slightly over range, It’s the ferritin that stays elevated at about 360-402. I am healthy and exercise 5-6 days a week- I would be very interested in hearing your thoughts.
Can you reformulate that into a specific question? Thanks.