There are 14 conditions associated with higher ferritin and 11 associated with lower ferritin. Some have honestly surprised me.
What is Ferritin?
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 .
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 .
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 .
However, ferritin ranges for optimal health are different than the normal ranges.
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 
- Chronic kidney disease 
- Rheumatoid arthritis 
- Autoimmune disorders 
- Acute infections 
- Cancer [1, 1, 1]
- Anemia of Chronic Disease 
- Type 2 diabetes 
- Metabolic syndrome 
- Atherosclerosis 
- Fatty liver disease patients 
- Anorexia 
- Graves’ disease 
- Arrhythmias 
- Chronic Hepatitis C infection 
- Hemochromatosis 
- Hemophagocytic syndrome 
- Still’s disease 
- Sideroblastic anemia 
Summary of Diseases Associated With Lower Ferritin
- Anemia 
- Fatigue 
- Hair loss [13, 14, 15, 16]
- Fibromyalgia 
- IBD 
- Hypothyroidism 
- Depression 
- Anxiety 
- ADHD 
- Celiac disease [22, 23]
- Parkinson’s 
- Restless leg syndrome 
Symptoms of Low Ferritin
Your doctor may order a ferritin test if you have some of the following symptoms associated with low ferritin levels:
- Unexplained fatigue
- Hair loss
- IBD and Celiac’s
- Attention issues/ADHD
- Parkinson’s and Restless Leg Syndrome
- Chronic headaches
- Unexplained weakness
- Ringing in your ears
- Leg pains
- Shortness of breath
Diseases Associated With Higher Ferritin Levels
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 .
The elevated ferritin in these states reflects increased total body iron stores, 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) .
Note that although ferritin levels generally increase in infection, some infections can also result in decreased ferritin .
1) 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 .
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 .
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 and transferrin saturation are reduced. In contrast, all of these parameters are decreased in ACD patients with iron deficiency .
Combined treatment of ACD in subjects with active rheumatoid arthritis with iron and erythropoietin (EPO) significantly reduced disease activity .
Elevated levels of ferritin may help identify individuals at high risk of type 2 diabetes .
In one study, subjects with elevated ferritin had a 2.4-fold higher risk of developing type 2 diabetes .
3) Metabolic Syndrome
In certain situations, elevated ferritin levels are found in patients with metabolic syndrome .
Elevated ferritin levels were also associated with central obesity, high blood pressure, and high cholesterol/triglycerides, all manifestations of the metabolic syndrome .
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 .
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 .
It was linked with artery stiffness in apparently healthy Korean women .
Ferritin was also associated with clogged arteries in a large group of NAFLD patients .
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 .
6) Grave’s disease
In patients with thyrotoxic Graves’ disease, ferritin is higher and decreases back to normal when normal thyroid function is achieved by antithyroid drug therapy .
7) 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 .
8) Cancer (most of the time)
Although ferritin is elevated in these states, iron stores are not available for producing red blood cells, causing anemia of chronic disease (ACD) .
This relative iron deficiency in inflammation and malignancy is presumed to have developed as a defense mechanism to restrict iron utilization by tumors/pathogens .
However, some cancers are also associated with low levels of ferritin, such as colon cancer .
9) 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 .
10) 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 .
Ferritin levels were shown to predict NAFLD incidence in healthy Korean men .
11) Liver Damage in Hepatitis C
Higher ferritin has been shown to predict severe liver tissue damage in patients with chronic Hepatitis C infection .
12) 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 .
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 .
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 .
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 1,000 micrograms/liter .
14) 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 .
Ferritin in hemophagocytic syndrome is classically elevated above 10,000 ng/L .
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) .
Low blood ferritin indicates depletion of iron stores and is a diagnostic criterion for iron deficiency and anemia .
Anemia 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 .
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 .
Several studies have confirmed that treatment of anemia improves cognitive function. That is because iron is a component of many essential enzymes, and therefore iron deficiency alone may impair cognitive function. Indeed, the correction of iron-deficiency in non-anemic girls was shown to improve verbal learning and memory .
Ferritin and iron depletion can be found in some fatigue patients.
Intravenous administration of iron improved fatigue in iron-deficient, nonanemic women . 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 .
Iron is 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 fibromyalgia was 27.3 ng/ml versus 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.
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 .
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 .
Almost every anemic patient with IBD demonstrates some degree of iron deficiency as a consequence of dietary restrictions, malabsorption, or intestinal bleeding .
Both iron deficiency and anemia of chronic disease (ACD) contribute to the development of anemia in IBD .
Inflammation and ACD are 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 .
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 .
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 .
Iron deficiency may enhance the IFN-gamma response in Th1 driven inflammation in immune-mediated inflammatory disorders such as Crohn’s disease .
High iron load lowers inflammation by decreasing TNF-a, lowering Th1, and increasing Th2 function .
Alterations in thyroid status and activity result in changes in blood ferritin levels .
Blood ferritin levels increased in hypothyroid patients with Hashimoto’s disease when normal thyroid function was achieved with L-Thyroxine therapy .
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 .
6) 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 .
The study implies a possible association between depression and decreased ferritin level before the occurrence of anemia .
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) .
Iron is associated with dopamine metabolism and low iron levels might be associated with more significant impairment in dopamine function in subjects with ADHD .
Iron deficiency has been associated with attention and behavioral problems and ADHD.
Children who were on ADHD meds showed a stronger association between ferritin and ADHD symptom severity .
These findings add to the growing literature implicating iron deficiency in ADHD .
Iron supplementation should be investigated as a potential intervention in individuals with low iron stores and ADHD .
8) 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 .
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 .
Mitochondrial ferritin (FtMt) has a protective role in neurodegenerative diseases [33, 34]. Mitochondrial ferritin lowers reactive oxygen species (ROS) accumulation and reduces cell damage in Parkinson’s and Alzheimer’s disease in animal models .
9) Celiac Disease
10) 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 .
It was suggested that patients with restless legs syndrome have lower ferritin levels in spinal fluid and parts of the brain .
11) Hair Loss
In women without systemic inflammation or other underlying disorders, ferritin levels below or equal to 30 ng/mL are strongly associated with hair loss .
A total of 210 patients with male and female pattern hair loss were compared to 210 healthy controls. Ferritin concentration was lower in patients with female pattern hair loss (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 hair loss had lower than 70 ng/mL .
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) was statistically significantly lower than in people without hair loss (59.5) .
Irregular Ferritin Levels?
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