Why Low Ferritin Doesn’t Mean Low Iron

To further the iron discussion from my previous blog, I want to discuss low ferritin and what it means.  I’ve had many clients come to me with concerns of low ferritin levels that, no matter what, they can’t seem to increase. With everything I was taught in school, I wondered why increasing iron intake wasn’t helping ferritin, and if ferritin did increase, their symptoms didn’t get better. The question then became, what else impacts ferritin and iron? This led me to copper, an essential mineral that affects many health areas, but especially iron levels and balance within the body. Before we dig in, let’s first get into what ferritin is. 

What Is Ferritin?

Ferritin is a protein that’s made inside our cells to help store iron. It releases iron when the body needs it.  There are two types of ferritin: heavy chain (HC) and light chain (LC). HC Ferritin is loaded with iron using a copper-dependent enzyme. When inflammation is present, LC ferritin discharges iron in the cell and gets excreted into the blood–this is what we are looking at when we see “serum ferritin” on a blood test. Ferritin is often measured and referred to as stored iron, but as you can see, that’s only part of the story. Ferritin does store iron; however, it keeps it INSIDE the cells. When we measure ferritin in blood, we are looking at ferritin OUTSIDE the cells. Ferritin levels outside the cells should be lower.  Ferritin leaves the cells when the body signals that it’s time to make more red blood cells.

If you want to look at iron status, look at hemoglobin. 70% of our iron is in hemoglobin. It’s also important to look at copper levels since copper helps attach iron to hemoglobin and loads ferritin with iron.

Why Is My Ferritin Low?

When iron appears low, but inflammation is involved and stored in our tissues, the body releases more pro-inflammatory and anti-inflammatory cytokines. Inflammation and iron increase hepcidin production–this means more iron storage, decreased iron on blood work, iron gets stored in the tissues, copper metabolism is compromised, and iron metabolism is compromised. 

This is happening because the body is trying to protect itself. Our bodies are smart. When exposed to too much iron, our immune system reacts, and an inflammatory response occurs, and we store it in our tissues to protect from potential infection. True iron deficiency occurs when there is extreme blood loss. The majority of the population being treated for iron deficiency is actually a copper issue and likely vitamin A deficiency. 

This is an excellent research article that discusses the controversy of iron fortification for infants. It shows that iron negatively impacts the gut microbiome because it can feed pathogens and increase intestinal inflammation. 

Another factor affecting ferritin levels is hepcidin.  Hepcidin is a hormone that regulates iron balance and is in charge of suppressing iron absorption when too much is iron is store.  When ferritin is low, the amount of iron stored in cells is high; therefore, hepcidin will increase to reduce the amount of iron being absorbed.  On the other hand, when ferritin is high, the iron stores are low, which will cause a decrease in hepcidin so that iron absorption will increase.

Why Is Iron Deficiency So Unlikely?

36% of the planet is made of iron, making it the fourth most common element, and eight different types of iron-fortified into the foods we eat. So how is it possible to be deficient in iron? 

Most of the research says that anemia’s common reason is a vegetarian diet that doesn’t include iron-rich meat. The interesting thing is that about 20% of the population is anemic, and only 8% is considered vegetarian. And the majority of these people would be eating iron-fortified foods like grains, cereal, and flour. So why do we still have such a high percentage of iron deficiency? I think it’s because iron isn’t the problem. Copper is, but our soil in the US has been deficient in copper for many years. This has led to lower copper levels in plants and animals. 

 What’s the Concern with Iron?

You might be connecting the dots between iron and copper and understanding that copper is essential for healthy iron levels. That’s great! I share this information with you because taking excess iron can cause a lot more harm than most people talk about or even know. Of course, we want to get to the deeper issue, usually copper and other nutrient deficiencies. Still, we also want to avoid causing more harm by supplementing with iron. 

There’s a lot of research showing concern about excess amounts of iron and how this impacts inflammation, long term vitality, and heart health. Not only is taking iron to raise ferritin not getting to the root of your problems, but it could be leading to more dysfunction in the body as a whole. Excessive iron intake can lead to iron toxicity, which is why a tolerable upper intake level (UL) has been set.  Any adult female supplementing 45+ mg/day may start to experience toxicity side effects, including abdominal pain, nausea, vomiting, diarrhea, liver and brain failure, coma, and possible death.

Many minerals are influenced by each other, and ferritin is no different.  Despite popular belief, low ferritin levels may not be caused by a lack of iron; instead, the culprit could very well be copper.  Supplementing iron, when not necessary, can lead to toxicity resulting in other health issues.  In case you missed my blog on iron, you can find it here. We go a lot deeper into iron balance and how it impacts hormone health in our new online course, Master Your Minerals. Make sure to check it out, especially if you’ve been told you have an iron deficiency!

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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