Ferritin stores iron and transports it to where it is required. However, it also participates in infections, inflammation, and malignancies. Elevated ferritin is often found in chronic inflammatory states such as obesity, metabolic syndrome, and diabetes. Find out why it is important to keep this protein in balance, and which factors increase or decrease ferritin levels.
What Is Ferritin?
Ferritin is a protein complex that stores iron in a soluble, non-toxic form, and transports it to areas where it is required [1].
Iron has many important roles in our bodies: it helps make red blood cells and is needed for muscle and heart cells to produce energy. But iron can also be toxic to cells because of its capacity to generate reactive species, which can damage DNA and proteins. Ferritin captures and buffers the iron within cells and is very important for good health [1].
Low ferritin levels signal that the body’s iron stores are low. Higher levels, on the other hand, may indicate that you have a condition that causes the body to store too much iron [2].
High Ferritin Levels
Interpretation
If ferritin is high, there is iron in excess or else there is an acute inflammatory reaction in which ferritin is mobilized without iron excess.
Ferritin is increased under oxidative stress. It is increased by the antioxidant-responsive element (ARE) [3].
Ferritin, in turn, can increase the liver proinflammatory mediators IL-1b, iNOS, RANTES, IkappaBα, and ICAM1 [4].
Ferritin is used as an indicator of iron overload disorders, such as hemochromatosis or hemosiderosis.
As ferritin is also an acute-phase reactant (a part of the body’s response to inflammation), it is often elevated in various diseases. A normal C-reactive protein (CRP) can be used to exclude elevated ferritin caused by acute phase reactions.
Ferritin levels of greater than 1,000 ng/ml are a nonspecific marker of illness, including infections and cancer [2].
However, ferritin over 300 can indicate some inflammation.
Diseases Associated with Higher Ferritin
At a Glance
The most common causes of elevated ferritin levels are obesity, inflammation, and daily alcohol intake. The most common cause of genetic-related elevated ferritin levels is the condition hemochromatosis. Additional causes include diabetes and metabolic syndrome [5, 6].
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 [2].
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) [2].
Note that although ferritin levels generally increase in infection, some infections also result in decreased ferritin [7].
- Inflammatory conditions [2]
- Chronic kidney disease [2]
- Rheumatoid arthritis [2]
- Autoimmune disorders [2]
- Acute infections [2]
- Cancer [2, 2, 2]
- Anemia of Chronic Disease [8]
- Type 2 diabetes [9]
- Metabolic syndrome [6]
- Atherosclerosis [10]
- Fatty liver disease [10]
- Anorexia [11]
- Graves’ disease [12]
- Arrhythmias [13]
- Chronic Hepatitis C infection [2]
- Hemochromatosis [5]
- Hemophagocytic syndrome [1]
- Still’s disease [2]
- Sideroblastic anemia [1]
Potential Causes of Higher Ferritin
High ferritin levels can point to many health conditions, some of which are listed below. If your ferritin is high, talk to your physician as soon as possible. He or she should diagnose and treat the underlying condition that may be increasing your ferritin levels.
Hemochromatosis
Ferritin is used as an indicator of iron overload disorders, such as hemochromatosis or hemosiderosis.
A number of conditions can cause iron overload, including:
- Rheumatoid arthritis
- Metabolic syndrome
- Type 2 diabetes
- Other inflammatory diseases
- Hyperthyroidism
- Iron poisoning
- Cancer, such as leukemia, lymphoma, or breast carcinoma
- Liver disease
- Recent blood transfusion
Additionally, pro-inflammatory cytokines stimulate the production of ferritin, which, in relation to inflammation/infection, acts as an acute phase reactant [10].
Circulating ferritin production is increased by the cytokines interleukin-1-β (IL-1) and tumor necrosis factor-α (TNF-α) [2].
Other
Alcohol
Alcohol enhances the absorption of iron. Alcohol consumption is significantly associated with high ferritin levels [14].
There was a positive relationship between wine intake and concentrations of both ferritin and iron in the blood [15].
In alcohol abuse, ferritin levels are elevated and rapidly decrease with alcohol abstinence [16].
Smoking
Women who smoke have higher ferritin and higher body iron compared to nonsmoking women. However, when women smoke during pregnancy, their newborn infants have lower iron stores than those of non-smoking mothers [17].
Tobacco smoking was associated with elevated ferritin concentrations in Parkinson’s disease patients (in this setting smoking had a beneficial effect) [18].
Ways to Decrease Ferritin
It’s important to speak with your doctor if your ferritin is high. Your doctor should diagnose and treat any underlying conditions causing your high ferritin levels.
You may try the additional strategies listed below if you and your doctor determine that they could be appropriate for lowering your iron. Discuss the strategies listed here with your doctor. Remember that none of them should ever be done in place of what your doctor recommends or prescribes.
1) Hemochromatosis Diet (Foods Low in Iron)
Hemochromatosis is a common cause of high ferritin. People with this condition absorb too much iron from food, which excessively raises blood iron levels.
Generally, the optimal diet for people with hemochromatosis is low in iron.
Additionally, various factors can affect the amount of iron people absorb, such as:
- Dietary iron forms: heme (from meat, poultry, and fish) vs. non-heme (mostly from plants) iron. Hem iron is absorbed better [8].
- Stomach acid and vitamin C, which increase non-heme iron absorption [8].
- Phytic acid and polyphenols (in vegetables), which reduce non-heme absorption [8].
Having these factors in mind, in addition to lowering the intake of iron-rich foods, additionally affects iron balance and absorption in the body.
For example, you can and should still eat green, leafy vegetables, as they only contain non-heme iron. This type of iron is much harder to absorb.
Many fresh vegetables also contain polyphenols, which act as antioxidants and lower iron absorption.
You can also consume more legumes and grains, which contain compounds that reduce iron absorption (phytic acid). The ways in which you may modify a healthy hemochromatosis diet is explained in more detail below.
2) Green Tea & Coffee
Both tea and coffee contain tannins and polyphenols, which inhibit the absorption of iron. However, tea does not seem to impact ferritin levels in healthy adults. It may only lower ferritin in those with iron deficiency or iron overload.
Ferritin concentrations were not related to black, green, or herbal tea consumption in healthy adults [19].
However, ferritin displayed a negative correlation with the consumption of tea in the elderly [20].
Tea consumption was associated with lower ferritin in groups with a high prevalence of iron deficiency [21].
In those at risk for iron overload, tea consumption may lower ferritin concentrations [21].
EGCG found in tea markedly inhibits intestinal heme iron absorption (by reducing iron export in Caco-2 cells) [22].
Additionally, coffee interferes with the utilization of supplemental iron [23].
Pregnant women with a high frequency of coffee consumption had lower values of body iron [24, 25].
3) Fiber
Fiber impairs the absorption of iron.
Intake of fiber-poor fruits, vegetables, and juices was associated with higher ferritin concentrations in premenopausal women [26].
4) Whole Grains (Phytic Acid)
Phytic acid is common in pretty much all plant-based foods, including whole grains, beans, nuts, and seeds.
Phytic acid is a potent inhibitor of native and fortification iron absorption [27].
In people, there is a dose-dependent inhibitory effect of phytate on iron absorption [28].
Iron absorption increased four- to fivefold in humans when phytic acid was reduced from its normal amount in soy [29].
5) Exercise
Ferritin increases acutely immediately after exercise but returns to baseline a few hours later [30].
On the other hand, long-term, routine exercise lowers ferritin along with other acute phase reactants [31].
Regular physical activity, especially extensive running, increases iron loss. Mild iron deficiency (abnormal blood ferritin and normal hemoglobin concentration) and sometimes true iron deficiency anemia can occur, especially when nutritional iron intake is insufficient and iron demand is increased because of growth (children, adolescents) or additional iron loss (by menstruation) [32].
Iron deficiency is common in athletes involved in endurance sports. In female marathon runners, the prevalence is as high as 28%, compared to 11% in the general female population [33].
Endurance athletes need more iron because their training causes an expansion in the number of red blood cells. This means that their hemoglobin levels may seem normal but their ferritin levels (a marker of the iron reserves stored in the body) may be low.
Low ferritin with hemoglobin in the mid-to-upper normal range and low ferritin with hemoglobin in the low normal range are relative indications for iron supplementation in athletes [34].
6) Calcium
Calcium-rich foods, such as dairy products, may decrease the absorption of iron.
Ferritin levels were negatively associated with the amount of cow’s milk consumed and calcium intake in 18-month old children [35].
Pregnant women who had consumed cow’s milk at least 3 times a week had lower levels of ferritin and body iron [24].
A diet rich in milk and yogurt increased the risk of low iron status by 50% in women in New Zealand [36].
However, although some short-term effects have been observed, long-term calcium supplementation was not observed to negatively impact iron status and ferritin concentration [37].
7) Zinc
Zinc is an essential mineral commonly found in multi-mineral supplements. Zinc is important for immune function.
Zinc may interfere with iron absorption because of similar chemical properties and shared absorption pathways.
In human trials, zinc supplementation alone does not appear to have a clinically important negative effect on iron status. However, when zinc is given with iron, iron indicators do not improve as greatly as when iron is given alone [38].
8) Manganese
Manganese is an essential mineral commonly found in multi-mineral supplements.
Manganese may interfere with iron absorption because of similar chemical properties and shared absorption pathways.
In humans, manganese inhibited iron absorption dose-dependently both in solutions and in a hamburger meal. Manganese has a strong direct competitive inhibition of iron absorption [39].
9) Magnesium
Some types of common magnesium supplements, such as magnesium oxide, can impair iron absorption in cellular studies [40].
10) Curcumin
Curcumin, a polyphenol found in turmeric, binds to iron and can cause iron deficiency in rats [41].
It can also help rats with iron overload [42].
In a model of borderline iron deficiency, rats fed curcumin had an induced full-blown deficiency [43].
11, 12, & 13) Peppermint, Cocoa, and Chamomile
Compared with humans who just drank water [44]:
- Beverages containing 20 to 50 mg total polyphenols/serving reduced iron absorption from the bread meal by 50 to 70%
- Beverages containing 100 to 400 mg total polyphenols/serving reduced iron absorption by 60 to 90%
Inhibition of iron by teas (same concentration of polyphenols) [44]:
- Black tea = 79 to 94%
- Peppermint tea = 84%
- Pennyroyal = 73%
- Cocoa = 71%
- Vervain = 59%
- Lime flower = 52%
- Chamomile = 47%
14) Eggs
Egg yolks decrease the absorption of iron [45].
15) Grapeseed Extract (and Anthocyanins)
Grape seed extract (GSE) markedly inhibits intestinal heme iron absorption (by reducing iron export in Caco-2 cells) [22].
Regular consumption of dietary vitamin C can easily counteract the inhibitory effects of low concentrations of dietary polyphenols on heme iron absorption, but cannot counteract the inhibitory actions of high concentrations of polyphenols [22].
16) Chili
Chili is capable of inhibiting iron absorption in a study performed on young women [46].
Takeaway
Ferritin is a protein that stores and transports iron in the blood. High ferritin levels usually point to excess iron and acute or chronic inflammation.
Common causes of high ferritin are obesity, heavy drinking, and inflammation. The main genetic cause is hemochromatosis. It’s key to get adequate diagnosis and treatment since many other conditions can raise or lower ferritin.
A complementary strategy that may help lower ferritin levels in people with hemochromatosis is following a diet lower in iron but high enough in nutritious foods.
Fiber, green tea, and coffee might also lower iron absorption in people with iron overload. Regular, moderate exercise may help lower high ferritin and inflammation in the long-run.
