Do you have iron deficiency and not know it? Fatigue, weakness, and cold intolerance are common symptoms of low iron. Standard blood tests may not reflect early iron deficiency. There is, however, a special lab test that tells you how good your iron stores are even before extensive changes occur. This lab test is called serum ferritin. Serum ferritin levels reflect the actual amount of iron stores in the body. A depletion of iron stores indicates a functional deficiency and early iron deficiency, which can cause a variety of health disorders. There is more to low serum ferritin and iron deficiency than meets the eye.
Symptoms of Iron Deficiency
When ferritin levels are low, there is inadequate iron transported in the red blood cells which then compromises oxygen transport. This can cause a number of symptoms related to iron deficiency. These include fatigue, weakness, headaches, dizziness/lightheadedness, rapid or irregular heartbeat, hearing the heartbeat in the ear, chest pain, feeling short of breath with simple tasks, feeling faint or fainting, cold sensitivity or unable to get and stay warm, cold hands and feet, pale skin and pale mucous membranes, yellowing or graying of the skin, hair loss, nails with ridges or depressed areas, irritability, depression, anxiety, and craving ice or non-food items like dirt, sand, clay, starch, and paint.
Our bodies must maintain an adequate supply of iron in the body. Everyday bodily processes like sweating, urination, bowel movements, and sloughing off skin cause daily trace losses of iron. Heavy menstrual cycles, bleeding and poor absorption in the digestive tract, interference from acid blocking medications (Tums and Zantac), high bran/fiber intake (phytates), black tea and wines rich in tannins, inadequate iron intake and vegetarian diets compromise iron levels. Athletes, especially runners, individuals with inflammatory bowel disease and gluten intolerance, chronic kidney disease patients, and expectant mothers are at high risk for insufficient iron and low serum ferritin levels. The adult recommended dietary intake to compensate for these daily basic needs is 18-20 milligrams of iron per day.
Low Ferritin Increases Disease Risk
Knowing what your serum ferritin levels are may just help save your life or prevent a major problem. Red blood cell, hemoglobin, hematocrit, serum iron and iron binding capacity tests may be measured and not completely reflect iron status, but serum ferritin does. Several health risks and disorders may not be properly diagnosed if serum ferritin is not evaluated. Elevated ferritin levels are problematic too, but for different reasons.
The serum ferritin lab reference range for men is 12-300 ng/mL and women is 12-150 ng/mL. Optimal levels are generally between 50 – 100 ng/mL. Menstruating women often do better with levels closer to 100 ng/mL.
Sleep Disorders and Low Ferritin
Restless Legs Syndrome (RLS) may reflect low iron and ferritin levels. In RLS, muscle twitching and legs feeling jumpy occurs as a person is drifting off to sleep. Replenishing iron stores often resolves this nuisance, sleep interfering problem. Pregnant women are especially prone to RLS.
If you suffer from periodic limb movement disorder (PLMD), check your ferritin levels. This sleep movement disorder (PLMD) causes repetitive movements usually in the legs during sleep. This is different than RLS, which occurs prior to sleep onset. You or your family member may recognize PLMD as brief muscle twitches, jerking movements as a person is sleeping. The PLMD sufferer will kick in the middle of the night and not remember the activity, but they will wake up exhausted despite a full night’s sleep. Research published in Sleep Medicine November 2015 studied a random selection of 801 adults. In the study, they found a significant correlation with serum ferritin stores at 50 ng/mL or lower and PLMD. The lower the serum ferritin level, the bigger the problem with PLMD.
Elevated Lactic Acid, Fibromyalgia, and Low Ferritin
Another difficulty that occurs with low serum ferritin is elevated lactic acid. Iron deficiency, even in early stages of iron deficiency anemia, causes muscle stress. An animal study demonstrated that animals with low ferritin placed on a treadmill developed significantly higher amounts of lactic acid in their muscles causing exercise activity to prematurely stop. In the healthy animals, lactic acid plateaued at moderate levels but did not interfere with exercise capacity. The iron deficiency caused excess production of lactic acid because of insufficient oxygen transported to muscle tissue. This forced muscle tissue into anaerobic activity sooner than normal. The end result is muscles end up working harder. Performance and endurance suffers, and muscle pain occurs.
This information is especially important for those who suffer from chronic widespread pain or disorders such as fibromyalgia. A 2014 study showed that patients with chronic widespread pain and fibromyalgia had elevated lactic acid and glutamate levels in the neck and shoulders, causing higher pain levels and pain sensitivity. A study in the European Journal of Clinical Nutrition explored this concept in a different light. In a case controlled study, fibromyalgia patients had an average serum ferritin level of 27.3 ng/mL. The control subjects had a range of ferritin of 44-73. The results of the study showed that those who had a serum ferritin of 50 ng/mL or less had a 6.5 fold increased risk for fibromyalgia.
Increased lactic acid production, diminished aerobic activity and low serum ferritin puts significant stress on the energy producing factories or mitochondria in our cells. Mitochondria function is compromised with too little iron causing substantial fatigue. In addition, animal studies show that inadequate iron causes widespread mitochondria dysfunction and DNA damage. Once iron stores are replenished, function improves and the inflammation that causes the DNA damage declines. Too much iron also compromises mitochondria function as excess iron intake is toxic to mitochondria.
Mood, Cognitive Function, and Neurodegeneration
There are other significant risks and disorders that may sneak up without warning within the brain with low serum ferritin. Iron metabolism is a very delicate, tightly regulated nutrient essential to the brain. Anything outside this delicate balance is harmful. Without adequate iron, several problems occur. This is not an all-inclusive list.
Iron is essential for the synthesis and use of the neurotransmitters dopamine, serotonin, adrenalin, and epinephrine. These major neurotransmitters help emotion, focus and attention, physical movement, pleasure and motivation, etc. Iron is essential for the fatty sheath or membrane around nerves, i.e. the myelin sheath. Without iron, nerve conduction is slowed throughout the body; even the parts of the brain that process sound and sight information are compromised. Poor coordination or clumsiness, anxiety, depression, mid-life cognitive changes, social and attention (ADD, ADHD) problems have been associated with insufficient iron.
New research shows that some cases of neurodegeneration are related with inadequate iron and low ferritin. As a result, mitochondrial function in the brain is impaired and free radical output increases. This free radical stress causes the fatty structures in the brain to become oxidized and damaged. The focus on brain health and iron has always looked at excess iron as a cause of neurodegeneration. We now know that too little iron is also detrimental to healthy brain function. Animal studies demonstrate that low ferritin can cause motor neurons to degenerate and mitochondria activity to suffer. This information has been previously unrecognized. These motor neurons are nerves that run from the brain or spinal cord to muscle creating movement and physical action. This is seen as weakness and wasting of muscles in the arms and legs. Sometimes speech, chewing, and swallowing are affected.
Increased Risk of Strokes and Clots Linked with Insufficient Iron
Stroke events and risk can markedly increase with low serum ferritin and iron levels. A study in the journal Thorax found a surprising revelation with pulmonary embolism or deep vein thrombosis (blood clots in the lungs or legs) linked with low ferritin and iron levels. They found that patients with low iron and stroke history had an elevated genetic clotting factor called factor VIII. This combination led to a 2.5 fold increase chance of having a blood clot. Blood tests called coagulation studies will measure factor VIII. This study showed that high levels of factor VIII are strong risk factors for blood clots. Low iron levels were strongly associated with higher levels of factor VIII.
Further investigation found that iron deficiency increases the platelet stickiness, which are very small blood cells. This doubled the stroke risk especially when blood vessels in the lungs were misshapen. A family history of strokes, deep vein thrombosis, and/or pulmonary embolisms along with low ferritin and iron levels creates a high risk situation. Omega-3 oils DHA/EPA, pantethine, tocotrienol vitamin E, grape seed extract, resveratrol, curcumin, bromelain, along with supplementing iron bisglycinate may help support platelet and circulatory health.
Congestive heart failure patients must be aware of their iron status. Iron deficiency is an independent risk factor of death in heart failure. Research shows that about half of all patients with heart failure have functional iron deficiency (low ferritin) or significant, absolute iron deficiency. Without adequate iron, the heart muscle and exercise capacity changes even when there is no change to hemoglobin levels or actual iron deficiency anemia. Iron is an essential component of myoglobin, which is a protein that carries oxygen to the heart and skeletal muscles. Without adequate iron and properly functioning myoglobin, oxygenation of the heart and skeletal muscles suffer. This leads to worsening fatigue, higher lactic acid, and further compromise of the heart muscle.
Blood Sugar Values Affected
Low ferritin levels can elevate hemoglobin A1C levels. Hemoglobin A1C is a lab value used to measure long term blood sugar regulation and management. Researchers found that non-diabetics and diabetics may have a higher hemoglobin A1C level when iron deficient than if iron stores are adequate. This is due to the length of time red blood cells stay in circulation. This may skew the interpretation of how well blood sugar is managed.
H. Pylori and Low Ferritin
H. Pylori is a known cause of stomach ulcers and gastric cancer. The ulcers that develop contribute to the blood loss that causes iron deficiency. Recent research shows that individuals who had the lowest levels of serum ferritin had the most virulent strains of H. Pylori with a robust inflammation and the highest risk of gastric cancer. This evidence was found in both animal and human studies.
Prenatal Ferritin Levels and Baby’s Health
Iron deficiency anemia in infants and children is a major concern. The insufficient serum ferritin in the womb during pregnancy provides developmental challenges of a healthy baby. Low levels are defined as less than 75 ng/mL. This lab value is far from iron deficiency levels and would not be seen on a basic iron panel and red blood cell analysis. Studies have found that low ferritin levels caused adverse effects on the developing brain and the auditory system. Infants with iron deficits had trouble recognizing and remembering their mother’s voice at two months of age. The memory part of the baby’s brain, the hippocampus was dysfunctional as a result of insufficient iron intake during prenatal growth.
In the world of fast food health care and practitioners who ignore or dismiss serum ferritin for the patient, the patient must be ready to take charge of their health. Low serum ferritin status has far reaching effects and dangerous risks. Compare the developing knowledge of vitamin D to serum ferritin. It has taken decades in modern medicine with vitamin D lab testing to become acceptable and commonplace. Like vitamin D, serum ferritin evaluation needs to occur. If the serum ferritin lab values are low, the next step is to determine why iron storage levels are exhausted. If your practitioner fails to do this, then find another practitioner to help you. Identifying the true cause of low iron levels and not speculation is the standard of care. Don’t let dismissive health care practices diminish your care.
To help replenish iron levels, ensure that your diet is rich in organic, free-range, grass-fed animal proteins, especially red meats and organic beef or chicken liver, molasses, and spinach. Animal proteins provide the best iron sources far superior to plant source. The fibers in plant sources readily compete against iron absorption. Iron supplementation is imperative if your serum ferritin levels are low. Use highly absorbable iron bisglycinate for a non-irritating, easily absorbable iron supplement. Add in extra vitamin C and make sure your thyroid is healthy, as these are other direct causes of low serum ferritin.
Work on supporting healthy blood flow and reducing platelet stickiness, especially if there is a family history of blood clots. Helpful nutrient support includes omega-3 oils DHA/EPA, pantethine, tocotrienol vitamin E, grape seed extract, resveratrol, curcumin, and bromelain. Protect your mitochondria and your brain from this lack of iron and consequential changes in tissue oxygenation. Support may include PQQ, magnesium with malic acid, chlorella, and tocotrienols. There are an estimated two billion people on the planet with iron deficiency. You don’t want to be one of them!