What Causes Low Ferritin?

Ferritin is an iron-containing storage protein and the main form of iron stored in your body. The amount of ferritin in your blood can give your doctor clues about the amount of iron your body has in reserve. If you have low ferritin levels, it may indicate that you have an iron deficiency, or that you're on your way to developing one.

Low ferritin levels can also show up as a result of certain medications, like antacids and nonsteroidal anti-inflammatory drugs (NSAIDs). If you suspect that you have low ferritin levels, your doctor can confirm this or rule it out through a simple blood test. If that blood test confirms that your ferritin is low, he or she will dig deeper to find the underlying cause of the deficiency.

Low ferritin levels are associated with low levels of iron, but in the early stages, you might not have iron deficiency yet. When you're not taking in enough iron through your diet or you're losing iron from heavy menstrual bleeding or other blood loss like complications from ulcerative colitis or Crohn's disease, your body turns somewhere else to get what it needs.

In the absence of dietary iron, your body pulls ferritin out of your tissues and blood and uses the iron contained within it to replenish its iron stores. If you quickly correct this by taking in adequate amounts of iron, either through food or supplements, the process likely won't lead to a true iron deficiency.

However, if it's not corrected, your body will continue to use the iron in ferritin until all of the stored ferritin, and the iron it contains, is depleted. At first, this might not have a noticeable effect on you, but over time, it results in a reduced blood cell count, or what is medically referred to as iron-deficiency anemia.

The first symptoms that show up with low ferritin levels typically include fatigue and weakness. If your levels continue to drop, taking your red blood cell count with them, you may experience:

• Dizziness
  
• Headache
  
• Pale skin
  
• Shortness of breath
• Brittle nails
• Hair loss
• Pounding in your ears

If you have any of these signs and symptoms, or you have suspected blood loss, your doctor may recommend a blood test. Iron levels and total iron-binding capacity, or TIBC, tests are usually ordered in conjunction with a ferritin test, although a report published in Clinical Case Reports in April 2018 describes the ferritin test as the most sensitive and specific test for iron deficiency. Your doctor may also order a complete blood count (CBC), hemoglobin, hematocrit and an HFE gene test.

Together, these tests can detect the amount of ferritin and iron in the blood as well as the severity of the condition. When it comes to ferritin, normal range depends on your age and sex and other factors like your health history. For adult males, a normal ferritin level falls anywhere between 20 to 250 ng/mL (nanograms per milliliter). For adult females, the numbers are different based on your age.

Adult women between the ages of 18 and 39 should have a ferritin level of 10 to 120 ng/mL. Once a woman hits 40, the normal ferritin range for her changes to 12 to 263 ng/mL.

If your results show ferritin levels that are lower than normal, your doctor may recommend a combination of treatments, like iron supplementation and a specialized high-iron diet. He or she will also work to figure out what's causing your ferritin levels to be too low.

Your body starts pulling ferritin from your blood and tissues when you're low in iron, either from not eating enough of the mineral or losing too much of it due to an underlying medical condition that's causing blood loss or malabsorption. Some circumstances and conditions commonly associated with iron deficiency include:

• Heavy menstrual periods
  
• Peptic ulcer
• Hiatal hernia
• Colon polyps or colon cancer
• Excessive use of aspirin
• Celiac disease
• Ulcerative colitis
• Crohn's disease
• Surgical removal of all or part of the small intestine
• Pregnancy

According to the Mayo Clinic, women have a greater risk of developing iron deficiency and low ferritin levels than men due to the regular loss of blood during menstruation. Vegans and vegetarians also have a greater risk because animal foods contain the most bioavailable forms of iron in the diet.

If your doctor recommends that you increase your consumption of iron, there are a variety of different foods you can eat. The richest animal sources of iron are beef, oysters, chicken and turkey. You can also get iron from plant foods, like:

• Beans
• Lentils
• Potatoes
• Cashews
• Dark green leafy vegetables (spinach, kale, Swiss chard)

The Academy of Nutrition and Dietetics notes that your body absorbs two to three times more iron from animal foods than it does from plant foods. However, you can increase the amount of iron you absorb from plant foods by combining them with a rich source of vitamin C, like oranges, orange juice, bell peppers, tomatoes or broccoli.

If your doctor recommends a supplement as part of your treatment plan, there are several options available to you. Ferrous sulfate, ferrous gluconate, ferrous fumarate, ferric citrate and ferric sulfate are some forms of iron that can help boost both iron and ferritin levels.

All of these forms of iron are commonly added to over-the-counter supplements, but the National Institutes of Health Office of Dietary Supplements notes that your body tends to absorb the ferrous varieties better.

Each form also contains different amounts of the active ingredient, called ‌elemental iron‌. Ferrous fumarate typically contains the highest amount at 33 percent, while ferrous sulfate and ferrous gluconate contain 20 percent and 12 percent, respectively. When taking a supplement, follow your doctor's recommendations for type and dosage carefully.