Ferritin Fatigue: Boosting Your Body’s Iron Reserves

Ferritin is a protein that stores iron in your body. Measuring ferritin can therefore provide useful information about your iron reserves and help identify iron deficiency before it progresses to iron-deficiency anaemia.

Think of your body’s iron supply as having both iron available for immediate use and iron kept in reserve. Ferritin represents much of that stored iron. When ferritin levels become low, it usually means your iron stores are becoming depleted.

Contents

• Symptoms of Low Ferritin
• What Causes Low Ferritin?
• Iron Deficiency and Anaemia
• The Ferritin Blood Test
• Improving Your Iron Stores
• When to Seek Medical Advice

Symptoms of Low Ferritin

Low ferritin indicates depleted iron stores. Some people with low ferritin have no obvious symptoms, particularly in the early stages, while others may experience symptoms associated with iron deficiency.

Possible symptoms include:

• Unusual tiredness or lack of energy
• Shortness of breath
• Dizziness or light-headedness
• Headaches
• Heart palpitations
• Paler skin than usual
• Difficulty concentrating
• Increased hair shedding

These symptoms can have many causes, so they should not be assumed to result from low iron without appropriate testing.

What Causes Low Ferritin?

Low iron stores can have several causes. These include not getting enough iron from your diet, increased iron requirements, difficulty absorbing iron and ongoing blood loss.

Common or important causes include:

• Heavy menstrual bleeding
• Pregnancy and increased iron requirements
• A diet that does not provide enough iron
• Regular blood donation
• Conditions that affect absorption of nutrients, such as coeliac disease or inflammatory bowel disease
• Blood loss from the stomach or intestines

Heavy periods and pregnancy are common causes of iron-deficiency anaemia. Bleeding from the stomach or intestines is another important cause, particularly in men and postmenopausal women, and should be appropriately investigated.

More information about the causes of iron-deficiency anaemia is available from the NHS.

Iron Deficiency and Anaemia

Iron deficiency and iron-deficiency anaemia are related, but they are not quite the same thing.

Iron deficiency develops when your body’s iron stores become depleted. At this stage your ferritin may be low even though your haemoglobin level and red blood cell count are still within the normal range.

If iron deficiency progresses far enough to reduce the body’s ability to produce sufficient haemoglobin, iron-deficiency anaemia can develop. Haemoglobin is the protein in red blood cells responsible for carrying oxygen around the body.

This means it is possible to have low iron stores without yet being anaemic. Blood test results therefore need to be considered together rather than relying on a single measurement.

The Ferritin Blood Test

A ferritin blood test measures the amount of ferritin in your blood and is commonly used when iron deficiency is suspected. Ferritin testing itself does not usually require fasting, although you should always follow any instructions provided if other blood tests are being performed at the same time.

There is no single universal “normal” ferritin range. Reference intervals can vary between laboratories, so your result should be interpreted using the range supplied with your test.

Current NICE guidance states that a serum ferritin level below 30 micrograms/L confirms iron deficiency when interpreted as part of the diagnostic process. Ferritin can also rise during inflammation or illness, which means a result within the laboratory reference range does not always exclude iron deficiency in every situation.

You can read more about ferritin testing and the diagnosis of iron deficiency in the NICE guidance on iron-deficiency anaemia.

Improving Your Iron Stores

Iron-Rich Foods

If your diet is contributing to low iron levels, eating a varied range of iron-rich foods can help. Dietary iron occurs in two main forms: haem iron, which comes from animal foods, and non-haem iron, which is found mainly in plant foods.

Sources of haem iron include:

• Beef and lamb
• Pork
• Poultry
• Fish and shellfish

Sources of non-haem iron include:

• Beans, peas and lentils
• Dark-green leafy vegetables
• Iron-fortified cereals and bread
• Tofu
• Nuts and seeds
• Dried fruit

Plant-based diets can provide sufficient iron, although non-haem iron is generally less readily absorbed than haem iron. Eating foods containing vitamin C alongside plant sources of iron can help improve absorption.

Tea and coffee can reduce iron absorption when consumed around meals, so people trying to increase their iron intake may benefit from having them at a different time.

Iron Supplements

If blood tests show that you are iron deficient, a GP or other healthcare professional may recommend an iron supplement. The appropriate product and dose depend on your blood results, symptoms, the cause of the deficiency and your individual circumstances.

Iron supplements can cause side effects including constipation, nausea and stomach discomfort, and taking more iron than you need can be harmful. For this reason, avoid treating suspected iron deficiency with high-dose iron supplements without appropriate advice.

If iron deficiency has been confirmed, it is also important to identify why your iron stores have become low rather than simply replacing the missing iron.

When to Seek Medical Advice

Speak to your GP if you have persistent fatigue, shortness of breath, palpitations, unusually pale skin or other symptoms that could suggest iron-deficiency anaemia.

You should also seek medical advice if a home test suggests low ferritin, particularly if you do not know why your iron stores might be low. Further blood tests may be needed to confirm iron deficiency and determine whether anaemia is present.

Unexplained iron deficiency is particularly important to investigate in adult men and postmenopausal women because ongoing blood loss from the gastrointestinal tract is one possible cause.

Conclusion

Ferritin provides a useful indication of the amount of iron your body has in reserve. Low ferritin can occur before anaemia develops, so identifying depleted iron stores can help explain symptoms and allow the underlying cause to be investigated.

Dietary changes can help when iron intake is inadequate, while some people need iron supplements under medical guidance. If your ferritin is low, the most important step is not simply to increase your iron intake but to understand why your iron stores have fallen and address the cause where possible.

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