What to do if the ferritin is too low?
If you encountered the term "ferritin" at your last doctor's visit, it probably sounded like jargon. In fact, it is the medical term for the body's iron storage molecule. If it's within your normal range, you don't have to worry. But if it's not, it could be a sign of health problems. In this article you will learn why ferritin sometimes falls below the normal range and what you can do about it.
When is the ferritin value too low?
The normal amount of ferritin in the blood depends on both your age and your gender. While babies have a lot of ferritin, the concentration of the iron storage molecule drops sharply as they grow. For example, in babies up to six months old, levels below 37 μg/ l are already a cause for concern. In children up to the age of 15, a ferritin value below 7 μg/ l is suspicious.
On average, adult women have less ferritin than men, although the ratio shifts somewhat towards old age. For example, ferritin values below 22 μg/ l are considered too low in women up to 50 years of age and below 13 μg/ l in women over 50 years of age. For men, the lower limits for the same age groups are 34 μg/ l and 4 μg/ l, respectively.
Slightly different limits apply depending on how the respective laboratory determines the ferritin value. These are indicated on the result sheet or your doctor can give you information about them.
It is important to know that an acute inflammation causes the ferritin value to rise temporarily. So if you have your blood drawn to determine your ferritin level during a bout of flu, the acute increase could mask a deficiency.
Why is the ferritin too low?
As a rule, a low ferritin value is associated with iron deficiency anaemia. It is therefore important to identify the cause of this deficiency and the anaemia that often accompanies it. The special thing about ferritin as an iron storage molecule is that it can even indicate a future deficit. Because when the stores are almost empty, there can still be sufficient iron ions in circulation. Only if there is no replenishment now can the situation become precarious.
Broadly speaking, two causes of iron deficiency can be distinguished:
- (severe) blood loss
- insufficient absorption of iron
Cause 1: Blood loss
Blood loss can be obvious, as in major surgery or a serious injury. However, chronic internal bleeding, such as that caused by a stomach ulcer, is also conceivable. Even minor but recurrent bleeding can deplete depot iron. This includes, for example, menstruation in women or chronic inflammatory bowel diseases.
Cause 2: Iron deficiency
If your intake of iron is insufficient, the problem may simply be that there is not enough iron in your food. This problem affects many people who eat an unbalanced diet. However, it can also be that your intestines do not manage to absorb the iron from your food. This is the case, for example, with coeliac disease (gluten intolerance). Ultimately, iron deficiency tends to occur when there is an increased need for it. This is especially the case during growth as well as during pregnancy and breastfeeding. For this reason, expectant and young mothers are usually prescribed iron supplements as a prophylactic measure.
Finally, we would like to address a rather specific reason for a too low ferritin value: the lack of transferrin. This is a protein that is responsible for the transport of iron in the blood. If for some reason, for example because of a severe burn, there is not enough transferrin in the blood, the iron cannot reach the stores, i.e. the ferritin molecules. In this case, there is also a form of iron deficiency.
What are the consequences of a ferritin deficiency?
The lack of ferritin therefore generally indicates an undersupply of iron. Thus, at this point we are primarily concerned with the problems our body has when too few iron ions are available. In this context, doctors also speak of "iron deficiency anaemia", i.e. anaemia due to too little iron. Symptoms that are visible from the outside are, for example, paleness, torn corners of the mouth and chapped skin. Those affected usually feel dull and tired. The immune system also suffers. If you are deficient in iron, you automatically become more susceptible to infections.
Ultimately, all the cells in your body suffer from a lack of iron. The blood can no longer transport as much oxygen if the red blood cells lack iron ions. As a result, your cells get less oxygen.
How can the ferritin value be increased?
The best way to achieve a ferritin level within the normal range for your gender and age depends very much on the cause of the deficiency. If blood loss is the cause, you will need to address it first and foremost. If you have a serious bleeding injury or surgery, doctors will probably give you a blood transfusion. This will compensate for some of the blood loss. If you have a stomach ulcer or intestinal bleeding, you will probably have to change your diet and lifestyle. There is little you can do about heavy menstruation. Some women take hormonal contraceptives like the pill all the time to stop menstruating. If this is not an option for you, you can at least try the following solutions for increased iron requirements.
First, let's briefly clarify how high your iron needs actually are: adult men need about 10 mg of iron daily. Women up to the menopause need 15 mg of iron per day and after the menopause also 10 mg. That probably sounds very abstract now. Expressed in food, 10 mg of iron is equivalent to about 150 g of veal liver sausage, 2 raw egg yolks, 200 g of seeded oatmeal or 120 g of lentils. This is where the solution to the problem is hidden: if you have a ferritin deficiency, it is best to change your diet to iron-rich foods. In addition to the foods already mentioned, these include beef, liver, chickpeas, spinach, tofu and pumpkin seeds. Tea and coffee inhibit iron absorption, while vitamin C improves it. If in doubt, your doctor will probably recommend iron supplements.
A ferritin deficiency is usually caused by an iron deficit. You can counteract this with a varied and iron-rich diet. For example, red meat, liver and egg yolks contain a lot of iron. Vegetable products such as oats, millet, lentils, chickpeas, spinach, tofu and kibble seeds are at the top of the list. Drink a juice rich in vitamin C with your meal. This supports the absorption of iron.
Avoid coffee or black tea. If in doubt, you can take iron tablets temporarily if you can tolerate them. If your iron deficiency is caused by a hidden bleeding problem, such as a stomach ulcer, your doctor should treat it.
A ferritin value that is below the normal range is in most cases due to an iron deficiency. This can be caused by severe or repeated blood loss. A serious injury or chronic inflammatory bowel disease may be responsible. Other causes of iron deficiency are a mismatch between iron requirements and absorption from food. The foods consumed do not contain enough iron or there is a problem with digestion. An enormously high need for iron, for example during growth or pregnancy, can temporarily exacerbate the problem.
The body cannot absorb ferritin per se from food. Although this iron storage molecule actually occurs in animals and plants in the same and similar forms as in humans, each organism must produce it itself. How much ferritin is formed depends, among other things, on the iron supply situation. So if you have too low a ferritin level, your diet should include iron-rich foods such as beef, liver, lentils, spinach, tofu, wheat bran and oats.
If the ferritin indicates an iron deficiency but the serum iron does not, this can have various reasons. In general, ferritin is the more stable marker. Unlike serum iron, it does not fluctuate as much over a short period of time. Serum iron can easily triple its value in the course of a day. The paradoxical result may therefore be due to the time of measurement alone. In addition, it is conceivable that there has been an iron deficiency up to now and that the ferritin is therefore too low. If the iron stores slowly fill up again, the serum iron reacts faster than the ferritin. A repeated measurement at a later time is informative in this case.
The signs of a ferritin deficiency are basically the same as those of an iron deficiency. In addition to pale and cracked skin, the corners of the mouth can be a sign of this deficiency. The frequent occurrence of infections is also a sign. The organs suffer from the iron deficiency in a more hidden way. They are less well supplied with oxygen. Problems at this level come to light primarily during medical examinations.
Conclusion
As a rough rule of thumb, people over the age of 50 should be alert when their ferritin value is in the single digits. You will find precise information on the classification of your individual value in the laboratory results. A low ferritin value is usually caused by an iron deficiency. This can be caused by heavy or regular blood loss or by the fact that you get less iron from your diet than you need. Iron deficiency manifests itself, for example, in fatigue, susceptibility to infections or pale skin. To counteract this, you either need to combat blood loss and/or increase your intake of iron from food.
