Ferritin is the protein responsible for storing iron within the body, which is essential for overall wellness. When a blood test reveals low ferritin, it signals that the body’s iron reserves are running low. This common situation can be managed effectively through diet, supplementation, and medical procedures. Before making significant changes, consult a healthcare provider for personalized diagnosis and treatment.
What Ferritin Is and Why Low Levels Matter
Ferritin is a protein that stores iron inside cells, primarily in the liver, spleen, and bone marrow. It acts as the body’s iron reservoir, holding iron until it is needed for processes like making red blood cells and transporting oxygen. Measuring serum ferritin provides an indirect measure of the body’s total iron stores.
Low ferritin is often the first sign of iron deficiency, occurring before the condition progresses to anemia. This state, known as non-anemic iron deficiency, can cause symptoms like unexplained fatigue, general weakness, difficulty concentrating, and restless legs syndrome. Addressing low ferritin early helps prevent the development of full-blown anemia, where the lack of iron affects hemoglobin production.
Dietary Strategies for Increasing Iron Intake
Dietary iron comes in two forms: heme iron and non-heme iron, which the body absorbs differently. Heme iron is found exclusively in animal products, such as meat, poultry, and seafood. It is the most readily absorbed form, with the body typically absorbing between 15% and 35% of the heme iron consumed.
High-iron sources of heme iron include red meat, organ meats like liver, and shellfish such as clams and oysters. Non-heme iron is present in plant-based foods, including grains, nuts, seeds, legumes, and leafy green vegetables. This form is less bioavailable, with absorption rates ranging from about 2% to 20%, but it makes up the majority of iron consumed in most diets.
To maximize non-heme iron intake, focus on foods like lentils, beans, spinach, and fortified cereals. The “meat factor” in animal protein can also enhance the absorption of non-heme iron when both are consumed in the same meal.
Choosing and Taking Iron Supplements
When diet alone is insufficient, oral iron supplements are the primary course of action. Supplements are typically made from various iron salts, with ferrous sulfate being the most common and affordable option. Other forms include ferrous gluconate and ferrous fumarate, which contain varying amounts of elemental iron available for absorption.
A major challenge with oral iron is gastrointestinal side effects, such as nausea, constipation, and stomach upset, which can lead to discontinuation of treatment. Taking the supplement with a small amount of food can help minimize these adverse effects, although iron is technically best absorbed on an empty stomach. To improve tolerance, some individuals may benefit from supplements like ferrous bisglycinate or polysaccharide iron complex, which are associated with fewer digestive issues.
The standard dose of iron is often taken daily, but research suggests that taking a lower dose every other day may improve absorption and reduce side effects. A healthcare provider must determine the correct type and dose based on the deficiency’s severity and the patient’s tolerance. Treatment typically continues for six to twelve months to ensure that the body’s iron stores are fully re-established.
Maximizing Iron Absorption
The body’s ability to absorb iron from both food and supplements is heavily influenced by what the iron is paired with. Vitamin C, or ascorbic acid, is a powerful enhancer of iron absorption, especially for non-heme iron uptake. Vitamin C works by converting the less soluble ferric iron (Fe³⁺) into the more easily absorbed ferrous iron (Fe²⁺) in the gut.
Taking an iron supplement with a glass of orange juice or a Vitamin C supplement can significantly boost the amount of iron the body utilizes. Conversely, several substances inhibit iron absorption and should be avoided in the two hours before and after taking an iron source. These inhibitors include calcium (found in dairy products and supplements), tannins in coffee and tea, and phytates found in whole grains, legumes, and nuts.
To maximize iron intake, it is advisable to consume these inhibitors at a separate time from iron-rich meals or supplements.
When Medical Intervention is Necessary
While diet and oral supplements are the first-line treatment for low ferritin, they are not always sufficient to correct the deficiency. A different approach may be required in situations like severe iron deficiency, malabsorption disorders (such as Celiac disease or Crohn’s disease), or chronic blood loss. Intolerance to the gastrointestinal side effects of oral iron can also make it difficult to sustain treatment long enough to rebuild stores.
In these cases, a healthcare provider may recommend an intravenous (IV) iron infusion. An IV iron infusion delivers iron directly into the bloodstream, bypassing the digestive system and rapidly replenishing the body’s iron stores. This method is often reserved for patients who need a quick rise in iron levels, such as those with advanced kidney disease, those late in pregnancy, or those facing imminent surgery.
Treatment of low ferritin requires ongoing monitoring, including repeat blood tests to track the rise in ferritin. It is essential to ensure the underlying cause of the deficiency is addressed for lasting health.