Low ferritin levels, signalling iron deficiency, result from insufficient absorption or increased demand for iron in the body. Treatment focuses on dietary changes, sometimes supplementation, and addressing additional underlying conditions.

Causes of low Ferritin

Low ferritin levels reliably indicate iron deficiency in otherwise healthy individuals (1). Iron deficiency occurs when the absorption of iron into the body cannot meet the demands for iron by the cells, and stores of iron (ferritin) become significantly depleted. This may occur during periods of rapid growth, or with excessive blood loss (2).

There are two types of iron deficiency that a low ferritin test can indicate:

1) Latent Iron Deficiency: the term for someone at risk of developing iron deficiency anemia (also called Hypoferritinemia). The ferritin levels (iron stores) are low, but hemoglobin levels have not yet been affected (3). Individuals with latent iron deficiency may experience the milder symptoms of iron deficiency such as fatigue, weakness and depressed moods. It is critical to address low iron levels at this stage to prevent further progression towards clinical iron deficiency anemia.

2) Iron Deficiency Anemia: the stage of iron deficiency where iron stores are exhausted, and the number of red blood cells is no longer sufficient to meet the body’s needs. The systemic symptoms of iron deficiency intensify, with the severity of symptoms matching the degree of anemia (4). Here, medical intervention is required to address the root cause(s) of the anemia, and create a treatment plan to restore iron levels to normal before lasting damage to the organs can occur.

More rarely, low ferritin levels are seen in individuals with diseases such as Crohn's disease, celiac disease, colon cancer, ulcerative colitis, and peptic ulcers (3).

Signs and Symptoms

• Fatigue
• Weakness
• Chronic Headaches
• Shortness of breath
• Dizziness
• Ringing in your ears
• Leg Pain
• Irritability
• Glossitis (inflammation of the tongue)
• Angular Somatitis
• Pica (desire to eat non-food items)
• Koilonychia (Spoon nails)
• Blue Sclera (white of the eye)
  

Effects of Anemia in the Body

• Impaired immune function
• Impaired ability to regulate body temperature
• Impaired cognitive function
• Impaired physical performance (endurance and strength)
• Complications of pregnancy
• Increased absorption of lead and calcium
• Altered drug metabolism
• Increased insulin sensitivity

The severity of symptoms associated with iron deficiency increase as the degree of anemia increases (4).

These symptoms are not all exclusive to iron deficiency, and a diagnosis from your doctor is required before embarking on any treatment plan.

Populations at Risk for Iron Deficiency

Ferritin Levels; What is Normal?

Serum ferritin levels differ between males and females, and at different stages of life. Reference ranges vary depending on the laboratory, but generally values between 30 - 200 μg/L for adult females, and 30 - 300 μg/L for adult males are considered normal (6,7).

Treatment and Management Options

Treatment options vary greatly depending on the underlying issue that is causing your low ferritin levels (low iron stores). Unlike many other trace elements, there is no direct excretion pathway for iron, so iron levels in the body are mediated at the level of absorption (4).

Nutritional Intervention

If your low ferritin levels are caused by a nutritional iron deficiency, you may not be consuming enough iron-rich foods, or you may be consuming foods with iron that is not as bioavailable. 

*Bioavailability: describes the percentage of a micronutrient that the intestine can actually absorb and use in the body. Animal products have a higher iron bioavailability than plant products, and there are nuanced nutrient-nutrient interactions that can occur depending on what foods you eat together that can either increase or decrease iron absorption (8).

To learn more about how you can make nutritional changes to best support healthy iron levels in the body, read our article on “Foods and Their Effect on Iron” here.

Supplementation

If directed to do so by your doctor, multiple studies have shown that iron supplementation can significantly improve symptoms associated with iron deficiency, such as fatigue (9,10).

Addressing Underlying Causes

Identifying and treating the root cause of low ferritin levels is essential to prevent continuously low iron stores in the body. Though low ferritin often indicates iron deficiency, there are other conditions that can also produce this result such as anemia of chronic disease (also known as anemia of inflammation) (11). This is why consultation and proper diagnosis by your doctor is an essential part of determining which treatments will be best for you.

Disclaimer*

The reference ranges and insights presented in Chromacare Wellness Hub articles are meant to improve understanding and provide context, however you should consult with your physician for a formal interpretation of your own results. None of the information within these Chromacare blog posts are meant to be or should be taken as personal medical advice. 

References and Further Reading

1. Knovich, M. A., Storey, J. A., Coffman, L. G., & Torti, S. V. (2009). Ferritin for the Clinician. Blood Reviews, 23(3), 95–104. https://doi.org/10.1016/j.blre.2008.08.001
2. Abbaspour, N., Hurrell, R., & Kelishadi, R. (2014). Review on iron and its importance for human health. Journal of Research in Medical Sciences , 19(2), 164–174. https://doi.org/PMID: 24778671
3. Al-Jafar, H. A. (2017). Hwa: Hypoferritinemia without anemia a hidden hematology disorder. Journal of Family Medicine and Primary Care, 6(1), 69–72. https://doi.org/10.4103/2249-4863.214986
4. Beard, J. L. (2001). Iron Biology in immune function, muscle metabolism and neuronal functioning. The Journal of Nutrition, 131(2), 568S-580S. https://doi.org/10.1093/jn/131.2.568s
5. Ferreira, A., Neves, P., & Gozzelino, R. (2019). Multilevel impacts of iron in the brain: The Cross talk between neurophysiological mechanisms, cognition, and social behavior. Pharmaceuticals, 12(3), 126. https://doi.org/10.3390/ph12030126
6. DePalma, R. G., Hayes, V. W., & O’Leary, T. J. (2021). Optimal serum ferritin level range: Iron status measure and inflammatory biomarker. Metallomics, 13(6). https://doi.org/10.1093/mtomcs/mfab030
7. Ministry of Health. (2023, November 2). Iron deficiency – diagnosis and management. Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency
8. Piskin, E., Cianciosi, D., Gulec, S., Tomas, M., & Capanoglu, E. (2022). Iron absorption: Factors, limitations, and improvement methods. ACS Omega, 7(24), 20441–20456. https://doi.org/10.1021/acsomega.2c01833
9. Alvarez‐Ossorio, Kirchner, Klüter, & Schlenke. (2000). Low ferritin levels indicate the need for iron supplementation: Strategy to minimize iron‐depletion in regular blood donors. Transfusion Medicine, 10(2), 107–112. https://doi.org/10.1046/j.1365-3148.2000.00239.x
10. Vaucher, P., Druais, P.-L., Waldvogel, S., & Favrat, B. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: A randomized controlled trial. Canadian Medical Association Journal, 184(11), 1247–1254. https://doi.org/10.1503/cmaj.110950
11. Saito, H. (2014). METABOLISM OF IRON STORES. Nagoya Journal of Medical Science, 76(3–4), 235–254. PMID: 25741033