There are 14 conditions associated with higher ferritin and 11 with lower ferritin.  Some have honestly surprised me.

Read this ferritin post to know more about ferritin.

Optimal and Normal Reference Ranges for Ferritin

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Blood ferritin is an indirect indicator of the total amount of iron stored in the body. Therefore, blood ferritin is used as a diagnostic test for iron-deficiency anemia (R).

Ferritin is normally high at birth. Ferritin levels rise during the first two months of age and then fall until the end of the first year of life, i.e. later infancy. At about one year of age, ferritin levels begin to rise again (R).

Reference (not optimal) ferritin blood levels:

  • Men: 18-270 or 30-300 nanograms per milliliter (ng/mL)*
  • Women: 18-160 or 10-200 ng/mL*
  • Children (6 months to 15 years): 7-140 ng/mL
  • Infants (1-5 months): 50-200 ng/mL
  • Newborns: 25-200 ng/mL

Reference ranges for blood ferritin vary across laboratories, but generally levels of 30 to 300 ng/ml are considered normal for men, and 10–200 ng/ml for women (R).

However, ferritin ranges for optimal health are between 60-200 ng/ml.

Note that ferritin has been shown to increase in response to stressors, such as inflammation or infection. These conditions may change what would otherwise be low ferritin indicating a lack of iron, into a value in the normal range.

Summary of Diseases Associated With Higher Ferritin

  • Inflammatory conditions (R)
  • Chronic kidney disease (R)
  • Rheumatoid arthritis (R)
  • Autoimmune disorders (R)
  • Acute infections (R)
  • Cancer (R,R,R)
  • Anemia of Chronic Disease (R)
  • Type 2 diabetes (R)
  • Metabolic syndrome (R)
  • Atherosclerosis (R)
  • Fatty liver disease patients (R)
  • Anorexia (R)
  • Graves’ disease (R)
  • Arrhythmias (R)
  • Chronic Hepatitis C infection (R)
  • Hemochromatosis (R)
  • Hemophagocytic syndrome (R)
  • Still’s disease (R)
  • Sideroblastic anemia (R)

Summary of Diseases Associated With Lower Ferritin

  • Anemia (R)
  • Fatigue (R)
  • Hair loss (RR, R, R)
  • Fibromyalgia (R)
  • IBD (R)
  • Hypothyroidism (R)
  • Depression (R)
  • Anxiety (R)
  • ADHD (R)
  • Celiac disease (RR)
  • Parkinson’s (R)
  • Restless leg syndrome (R)

Symptoms of Low Ferritin

Your doctor may order a ferritin test if you have some of the following symptoms associated with low ferritin levels:

  • Anemia
  • Unexplained fatigue
  • Hairloss
  • IBD and Celiac’s
  • Fibromyalgia
  • Depression
  • Anxiety
  • Hypothyroidism
  • Attention issues/ADHD
  • Parkinson’s and Restless Leg Syndrome
  • Dizziness
  • Chronic headaches
  • Unexplained weakness
  • Ringing in your ears
  • Irritability
  • Leg pains
  • Shortness of breath

Diseases Associated With Higher Ferritin

Circulating ferritin is widely recognized as an acute phase reactant and a marker of acute and chronic inflammation. It is elevated in a wide range of inflammatory conditions, including chronic kidney disease, rheumatoid arthritis and other autoimmune disorders, acute infections, and malignancy (R).

Common causes of elevated ferritin levels also include obesity, diabetes, metabolic syndrome and daily alcohol consumption (R,R).

The elevated ferritin in these states reflects increased total body iron storage, but paradoxically, these stores are sequestered and not available for red blood cell production.  This contributes to the widely recognized anemia of chronic disease (ACD) (R).

Note that although ferritin levels generally increase in infection, some infections can also result in decreased ferritin (R).

1) Ferritin is Elevated in Anemia of Chronic Disease (ACD)

Anemia of Chronic Disease is the most frequent anemia in hospitalized patients. It develops in subjects suffering from diseases that are associated with chronic activation of cell mediated immunity, such as chronic infections, immune mediated inflammatory disorders, or malignancy (R).

A hallmark of ACD is a decrease in available iron, limiting the production of red blood cells. Meanwhile, iron is taken up by macrophages and dendritic cells. Thus ACD can be easily diagnosed by the presence of low iron, but increased blood levels of ferritin (R).

Pure iron deficiency is recognized by low ferritin and transferrin saturation but increased transferrin concentrations. Patients with “classical” ACD present with increased ferritin levels while transferrin concentrations as well as transferrin saturation are reduced. In contrast, all of these parameters are decreased in ACD patients with iron deficiency (R).

Combined treatment of ACD in subjects with active rheumatoid arthritis with iron and erythropoietin (Epo) significantly reduced disease activity (R).

2) Higher Ferritin is Associated With Diabetes

Elevated levels of ferritin may help identify individuals at high risk of type 2 diabetes (R).

In one study, subjects with elevated ferritin had a 2.4-fold higher risk of developing type 2 diabetes (R).

High ferritin was associated with elevated fasting blood glucose, hemoglobin A1c (HbA1C), CRP, and the SAD (Standard American Diet) diet in diabetic patients (R).

3) Higher Ferritin is Associated with Metabolic Syndrome

In certain situations, elevated ferritin levels are found in patients with metabolic syndrome (R).

This elevated ferritin in subjects with metabolic syndrome is associated with insulin resistance and fatty liver but not with iron overload (R,R,R).

Elevated ferritin levels were also associated with central obesity, high blood pressure, and high cholesterol/triglycerides, all manifestations of the metabolic syndrome (R).

Significant correlations were found between ferritin concentration and metabolic syndrome parameters (HDL cholesterol, triglycerides, and fasting glucose) as well as an increase in the ferritin value with the number of risk factors of metabolic syndrome in healthy men (R).

Also, oxidative stress markers (carbonyl groups, AOPP, and glycated hemoglobin), liver damage markers (GGT, SGOT), and parameters related to insulin resistance (HOMA, blood insulin, and blood glucose) correlate significantly with ferritin (R).

4) High Ferritin is Associated With Atherosclerosis

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Ferritin is not only a marker of insulin resistance but also one of the strongest risk factors for the progression of hardening of the arteries (atherosclerosis) (R).

It was linked with artery stiffness in apparently healthy Korean women (R).

Ferritin was also associated with clogged arteries in a large group of NAFLD patients (R).

5) Ferritin is Elevated in Anorexia

Ferritin can be elevated in anorexia, during periods of acute malnourishment. In anorexia patients, elevated ferritin decreases as patients gain weight and improve their BMI (R).

6) Ferritin is Higher in Grave’s

In patients with thyrotoxic Graves’ disease, ferritin is higher and decreases back to normal when normal thyroid function is achieved by antithyroid drug therapy (R).

7) High Ferritin May Contribute to Heart Arrhythmia

Ferritin and iron levels are associated with electrocardiogram findings in acutely ill patients. High ferritin contributes to abnormal heart electrical activity in a variety of medical conditions, and possibly contributes to the emergence of fatal heart arrhythmias (R).

8) Higher Ferritin is Associated With Cancer (most of the time)

Ferritin is elevated in many malignancies (R,R,R).

Although ferritin is elevated in these states, iron stores are not available for producing red blood cells, causing anemia of chronic disease (ACD) (R).

This relative iron deficiency in inflammation and malignancy is presumed to have developed as a defense mechanism to restrict iron utilization by tumors/pathogens (R).

However, some cancers are also associated with low levels of ferritin, such as colon cancer (R).

9) Ferritin is High in Sideroblastic Anemia

Sideroblastic anemia is a disorder in which there is a failure to produce healthy red blood cells. A common manifestation of sideroblastic anemia is iron overload and elevated ferritin (R).

10) Higher Ferritin is Associated With Fatty Liver (NAFLD)

Elevated ferritin and mildly increased iron stores are frequently observed in patients with non-alcoholic fatty liver disease (NAFLD), where ferritin increase can reflect oxidative stress, inflammation, and liver tissue death (R).

Growing evidence proposes a correlation between ferritin, insulin resistance, and NAFLD (R).

Ferritin levels were shown to predict NAFLD incidence in healthy Korean men (R).

11) Higher Ferritin is Associated With Liver Damage in Hepatitis C

Higher ferritin has been shown to predict severe liver tissue damage in patients with chronic Hepatitis C infection (R).

12) Ferritin is High in Still’s Disease

Adult onset Still’s disease is a systemic inflammatory disorder characterized by fever, arthritis, and rash, that typically affects young women. Elevated ferritin levels were seen in 89% of these patients, nearly half of whom had levels greater than five times normal (R).

An exaggerated ferritin response with levels above 5 times the normal upper level predicted chronic Still’s disease with 100% accuracy. Ferritin was useful in distinguishing these patients from clinically similar rheumatoid arthritis patients (R).

13) Ferritin is High in Hemochromatosis

Genetic mutations in the hemochromatosis gene (HFE) make up the most common genetic cause of elevated ferritin levels and are usually seen in patients with northern European ancestors (R).

High ferritin robustly predicts the risk of cirrhosis, the main clinical manifestation of hemochromatosis. Several studies have shown that cirrhosis of the liver rarely occurs in hemochromatosis patients with ferritin levels below that of 1000 micrograms/liter (R).

14) Ferritin is Extremely High in Hemophagocytic Syndrome

Hemophagocytic syndrome (also known as macrophage activation syndrome or lymphohistiocytic syndrome) is a group of disorders with a final common pathway consisting of elevated triglycerides, elevated ferritin, deficiency of all blood cells, and multiple organ failure. The syndrome is strongly associated with autoimmune disorders, particularly systemic lupus erythematosus and Still’s disease, and viral infections, particularly Epstein-Barr virus (R).

Ferritin in hemophagocytic syndrome is classically elevated above 10,000 ng/L (R).

Diseases Associated With Lower Ferritin

Patients with iron deficiency, as measured by ferritin, have an increased risk of unipolar depressive disorder (OR = 2.34), bipolar disorder (OR = 5.78), anxiety disorder (OR = 2.17), autism spectrum disorder (OR = 3.08), attention deficit hyperactivity disorder (OR = 1.67), tic disorder (OR = 1.70), developmental delay (OR = 2.45), and mental retardation (OR = 2.70) (R).

1) Low Ferritin Indicates Anemia

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Low blood ferritin indicates depletion of iron stores and is a diagnostic criterion for iron deficiency and anemia (R).

Anaemia can manifest as fatigue, headache, dizziness, shortness of breath, or elevated heart rate (tachycardia), and generally lowers the overall quality of life. Motility disorder, nausea, anorexia, and even malabsorption have also been attributed to this condition (R).

A common finding in anemia is irregularity or absence of menstrual periods in women, while men may suffer from impotence. Loss of libido may contribute to impaired quality of life in both sexes (R).

Several studies have confirmed that treatment of anaemia improves cognitive function. That is because iron is a component of many essential enzymes, and therefore iron deficiency alone may impair cognitive function. Indeed, correction of iron-deficiency in non-anaemic girls was shown to improve verbal learning and memory (R).

2) Low Ferritin is Associated With Fatigue

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Ferritin and iron depletion can be found in some fatigue patients.

Intravenous administration of iron improved fatigue in iron-deficient, nonanemic women (R). Over 80 percent had reduced fatigue after receiving iron.

A couple of studies recommend iron supplementation for women with unexplained fatigue who have ferritin levels below 50 μg/L (R).

3) Ferritin is Lower in Fibromyalgia

Iron is a necessary for serotonin and dopamine production and may have a role in causing fibromyalgia.

The spinal fluid in fibromyalgia syndrome (FMS) has shown a reduction in the concentration of dopamine, norepinephrine, and serotonin.

The average serum ferritin levels in the fibromyalgia 27.3 and 43.8 ng/ml in a healthy group.

Statistical analyses show that ferritin levels below 50 ng/ml caused a 6.5-fold increased risk for Fibromyalgia.

4) Ferritin is Lower in IBD

Chronic intestinal bleeding in inflammatory bowel disease (IBD) may exceed the amount of iron that can be absorbed from the diet, resulting in a negative iron balance (R).

In fact, anemia is a common complication associated with inflammatory bowel disease (IBD). The World Health Organization estimates that more than 30% of the population have iron deficiency anemia yet it remains an under-managed feature of many gastrointestinal conditions. Also, one-third of inflammatory bowel disease (IBD) patients suffer from recurrent anemia (R).

Almost every anemic patient with IBD demonstrates some degree of iron deficiency as a consequence of dietary restrictions, malabsorption, or intestinal bleeding (R).

Both iron deficiency and anaemia of chronic disease (ACD) contribute to the development of anaemia in IBD (R).

Inflammation and ACD is why anemic IBD patients can have elevated ferritin. CRP can be used to exclude inflammation.

Chronic fatigue, a frequent IBD symptom itself, is commonly caused by anemia and may debilitate patients as much as abdominal pain or diarrhea (R).

In IBD, oral iron treatment is limited by poor absorption, intolerance, and induction of oxidative stress at the site of bowel inflammation. However, intravenous iron sucrose has a good safety profile and a 65–75% response rate within 4–8 weeks, which is paralleled by improvement in the quality of life. Additionally, combination therapy with erythropoietin (Epo) leads to a faster and larger hemoglobin increase (R).

When anemic Crohn’s disease patients were treated with iron sucrose and Epo, the feeling of well-being, mood, physical ability, and social activities improved. Also, individual patients reported relief of disturbed sleep and increased appetite or libido (R).

Iron deficiency may enhance the IFNgamma response in Th1 driven inflammation in immune-mediated inflammatory disorders such as Crohn’s disease (R).

High iron load lowers inflammation by decreasing TNF-a and lowering Th1 and increasing Th2 function (R).

5) Ferritin is Lower in Hypothyroidism

Alterations in thyroid status and activity result in changes in blood ferritin levels (R).

Subclinical hypothyroidism is associated with iron-deficiency anemia (R) and lower ferritin levels (R).

Blood ferritin levels increased in hypothyroid patients with Hashimoto’s disease when normal thyroid function was achieved with L-Thyroxine therapy (R).

In patients with Graves’ disease (higher thyroid hormones), ferritin is higher and decreases back to normal when normal thyroid function is achieved by antithyroid drug therapy (R).

6) Ferritin is Lower in Depression and Anxiety

The average ferritin level in students with depression was significantly lower than the healthy ones.  Low ferritin increases the odds of depression by 1.92X (R).

The study implies a possible association between depression and decreased ferritin level before the occurrence of anemia (R).

In another study, patients with iron deficiency, as measured by ferritin, have an increased risk of unipolar depressive disorder (OR = 2.34), bipolar disorder (OR = 5.78) and anxiety disorder (OR = 2.17) (R).

7) Low Ferritin Causes ADHD

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Iron is associated with dopamine metabolism and low iron levels might be associated with more significant impairment in dopamine function in subjects with ADHD (R).

Iron deficiency has been associated with attention and behavioral problems and ADHD.

Kids with lower ferritin (average of 18.4 ng/mL) had worse inattention, hyperactivity/impulsivity, and ADHD symptoms (R, R, R).

Children who were on ADHD meds showed a stronger association between ferritin and ADHD symptom severity (R).

These findings add to the growing literature implicating iron deficiency in ADHD (R).

Iron supplementation should be investigated as a potential intervention in individuals with low iron stores and ADHD (R).

8) Ferritin in Parkinson’s and Neurodegenerative Diseases

Several iron disorders that affect movement and other neurologic functions (Parkinson’s disease and restless legs syndrome) are linked to abnormalities in ferritin (R).

It could be that lower ferritin in the cell may contribute to these disorders by causing higher levels of free iron.  This may or may not be related to blood ferritin.

A rare genetic disease, neuroferritinopathy, is a result of mutations in the gene encoding a component of ferritin. It is thought that the mutations impair ferritin assembly lead to a loss of iron storage capacity within brain cells, which causes iron-mediated cell injury (R).

Mitochondrial ferritin (FtMt) has a protective role in neurodegenerative diseases (R,R). Mitochondrial ferritin lowers reactive oxygen species (ROS) accumulation and reduces cell damage in Parkinson’s and Alzheimer’s disease in animal models (R).

9) Ferritin is Lower in Celiac Disease

Iron depletion and low ferritin are frequent findings in patients with celiac disease (R,R).

10) Ferritin in Restless Legs Syndrome

Restless Legs Syndrome is a neurologic disorder characterized by unpleasant sensations in the legs that appear mostly at night upon retiring, including an irrepressible urge to move the limbs (R).

It was suggested that patients with restless legs syndrome have lower ferritin levels in spinal fluid and parts of the brain (R).

11) Low Ferritin and Hair Loss

Multiple studies have found low ferritin correlating with hair loss (RR, R, R).

In women without systemic inflammation or other underlying disorders, ferritin levels below or equal to 30 ng/mL are strongly associated with hair loss (R).

A total 210 patients with male and female pattern hairloss were compared to 210 healthy controls. Ferritin concentration was lower in patients with female pattern hairloss (49.27 ng/ml), compared with normal healthy women (77.89 ng/ml).

Among male patients, 22.7% of them showed lower ferritin than 70 ng/ml, while none of the men without hairloss had lower than 70 ng/mL (R).

The average ferritin level in patients with male pattern baldness (37.3 ng/ml) and an autoimmune hair loss disease called alopecia areata (24.9) were statistically significantly lower than in people without hair loss (59.5) (R).

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6 COMMENTS

  • Charla Shamhart

    Hi ferritin levels are a marker for Chronic Myeloid Leulemia that I deal with. my level runs about 385.

  • Dawn Matijevich Frizzell

    I was diagnosed with celiac in 2013 and had a ferritin level of 1. I had to have iron injections and a blood transfusion in the hospital. I have had to have iron injections about every 18 months since diagnosis. I am allergic to infed and venefor. I haven’t had any negative reactions to fereheme. I also have hashimotos hypothyroiditis. I am wondering if there is any other issue I might need to investigate with my hematologist. I would be grateful for any Information you could pass along.

  • Dirk

    Would Artemisinin, which is detailed on this blog, decrease affect ferritin?

    1. Nattha Wannissorn, PhD

      Ask your doctor or pharmacist.

      1. Mary Lambe

        Your information mixes together several issues and thus confuses the reader. I worry the writer is also confused. Ferritin is what we call an “Acute phase reactor” This means that in illnesses that have acute inflammation ferritin rises as it responds to inflammation and becomes inaccurate as a marker for iron stores. Ferritin is normally useful in looking at iron stores but we must remain alert for when it has been pushed up by inflammation. This is why it should be–when there is question–measured with Iron/iron binding capacity and sometimes with a sed rate as well. An example where ferritin can be high, but the body depleted in iron is in “Stills’ Disease” called in Modern day Juvenile Rheumatoid Arthritis. Just because the Ferritin is high in JRA (in olden days’ called Still’s Disease) has NOTHING to do with iron count truly being high–ferritin is falsely elevated as a marker of inflammation in this ailment. Indeed many children with Juvenile Rheumatoid arthritis have low iron when measured in other fashion. What is the author’s point? A high ferritin in this autoimmune disease, for example, is meaningless–it is not even a good or accurate means to measure iron and would lead to false understanding… While low ferritin is less fraught with risk because treating low iron in Restless legs, as an example WILL help decrease restless legs symptoms, does the author imagine iron helps low thyroid? As another example, celiac disease, ferritin is low because the bowel is damaged and cannot well absorb nutrients. Avoiding gluten will heal the gut and permit better iron absorbtion; I worry someone misunderstand that a treatment for celiac involves iron. Overall it completely misses the point to say ferritin is high in Hemochromatosis (yes this is real elevated iron which we diagnose via DNA) versus ferritin high in Still’s Disease (iron is NOT elevated at all. This is a false positive. It means the author doesn’t understand the test. For the same reason ferritin is High in Grave’s but not in Hypothyroidism. It is not the iron that changes it is the test which is falsely impacted by inflammation. Ferritin is NOT the same as iron. Ferritin is a test impacted by forces beyond actual iron results. That’s why we do OTHER tests to double check it. FERRITIN is a test fraught with error. You have it all backwards and I am sorry you wrote a whole book that way.

        1. Nattha Wannissorn, PhD

          We do understand what you mean, and we did say so in the post that it is a marker of inflammation. The question is to what extent is it? Inflammation also causes anemia, so one must look at both the CBC as well as ferritin and other markers to be sure. This post is not to discuss diagnosis but to link ferritin to other health conditions in context.

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