Low Ferritin Levels - What does that really mean ?

Hello dear ATS friends,

To make the description of my problem short: I have made two blood tests this year, and both shows very low ferritin levels.

May / 2014 - Results 25 ng/mL (normal range: from 30 to 400)
Nov / 2014 - Result 24 ng/mL (normal range: from 30 to 400)
(male, caucasian, 35 years old, slightly overweighted [not much really, but still not the ideal, absolutely sedentary])

Now I am a Dentist myself and I have knowledge of these results, but it seems strangely difficult finding some answers to what causes low ferritin when everything else seems to be fine.

So, what are other results and my medical history ?

- According to the endocrinologist, my exams are all good, including the one from May/2014, with the exception of Cortisol that was high (I suffer from GAD - Generalized Anxiety Disorder, also possibly depression), Cortisol results were 12,9 back in May with a normal range of 6,2 to 19,4 - but remember that Cortisol levels change rapidly from, let's say when you wake up worried with children and work to a Friday night, when you're relaxed.) This result was from a Saturday morning, when I was supposed to be very relaxed, as I don't even work Saturdays. I didn't know I had GAD but I was always very anxious, after this result I was put on Lyrica (75mg twice a day) and it did help me. Unfortunately, the endocrinologist didn't ask Cortisol this last time.

- Thyroid levels are very good according to the doc
- Complete blood test (hemogram) results are all but normal, including red cells levels
- My medical history shows a lot of anxiety since I was a kid to now I am 35 years old now (male, caucasian) and I had gastritis in the past, I made endoscopy and colonoscopy, nothing serious was found, not even ulcers, but I was put on pantoprazole "for life", even though I don't take it everyday at this point.
- Meds I'm on: Klonopil 2mg at night (for some 8 years now, can't sleep without it, before that I used to take similar meds), Lyrica 75mg (twice a day, this was prescribed by the endocrinologist in May/2014, it helped a lot with anxiety), Pantoprazole 20mg (took everyday for years, now only eventually). Nothing else important to mention that I remember.

From May to November, I have changed my diet adding more iron rich foods, I have taken iron tablets for a month (that was in May), and I couldn't believe my ferritin levels are virtually the same now. I am very worried.

Ferritin is a macro-protein that carry and storage iron, specially in the liver, it also protect human body from excessive free iron in the blood (iron is toxic), it also releases iron in a controlled way . So what I have is low storage of Iron, but still normal red cells levels.

My doubts are:

1. Can low ferritin levels be called anemia already ? Even when red cells are OK ? (this is the big question... it's such a complicated field of science, how can red blood levels be OK when ferritin is so low ???), what is the meaning of this ?

2. What are the symptoms of low ferritin ?

3. Between these symptoms, is lack of motivation, low sex drive and tiredness amongst them ?

4. What about depression, very low ferritin levels like mine could cause depression, or some kind of tiredness-like symptom that can be mistaken by depression ? Or is it the other way around, depression caused me not to eat well, and other ill-related behaviour that could have caused this ?

5. How to increase ferritin to normal levels ?

Endocrinologist now wants me to go see a hematologist, which made me even more worried... he said it was not a big deal, just that it wasn't his exact field of work, I am worried anyway.

Any other thoughts are more than welcome.

Thank you very much, sorry for the long text.


All the best,

(for the record, I do understand ATS is not a medical clinic and can't be used as one, so all information here is for educational purposes only)

a reply to: Speotyto

If it was me...

That's a complex chemistry experiment you are doing on yourself. Going to different specialists will get you deeper into the chemical spiral.

If you really want to understand your body chemistry baseline, ditch all the meds and do nothing else but some yoga and meditation for a 3-4 weeks, then retest. If you really can't sleep, a couple of glasses of red wine at least 2 hours before bed.

After that, get a trainer to work your body out of the massive slump you're in. Pay attention. Trick your body into thinking it's useful for physical work. It will respond in kind and prepare chemically for the physical stress. It will eventually overshoot and you'll get more that you put in at some point.

I sincerely believe that your body will start killing you if it senses you are physically "useless". Evolution is your best friend if you harness it.

Then again, It might be genetic

Good heath to you.

I'm trying to write this without sounding funny....here goes....

Did you try Google?

It took me 2 seconds to determine that what I think (very important, as I probably am very well wrong), you might have is a chronic Read this Linky anaemia deficiency thingymadoodle, there is a distinction between yours and typical aneamia, my suggestion is to Google low ferritin levels normal heamaglobin, it worked for me.

From the site...

The tests used most often to detect iron deficiency include hemoglobin (the iron-containing protein in the blood that carries iron and oxygen to cells), hematocrit which provides the percentage measures of of red blood cells in the blood, serum ferritin, which indicates the amount of iron stored in the body, and serum iron and iron-binding capacity (IBC, UIBC or TIBC). The latter measures are used to calculate transferrin-iron saturation percentage (TS%), a measure of iron in transit in the serum. Serum ferritin is a very important test because it helps distinguish between iron deficiency anemia and anemia of chronic disease (also called anemia of inflammatory response). In cases of iron deficiency anemia, iron supplements can be helpful; but in cases of anemia of chronic disease, iron supplements could be harmful.

Not sure I have been any help at all, but always like to try, especailly as I understood ferritin was to do with iron.

BIG DISCLAIMER: Don't listen to a word I have said, plese research for yourself, come to your own conclusions and seek professional clarification, everything I have submitted is just a starting block and may not be representative of anything relating to you.

Most sound advice I can give...seek out your primary care provider for the answers.


EDIT:
Ok, I'm a real durr brain, you want to know a potential cause....

I found this, Linky to Thyroid?????

Have a look, it may or may not apply.

Form what I gathered so far and I may well be very wrong, it sounds as though perhaps your store of iron is running on its limits, i.e you have enough in the tank to produce normal blood, but there isn't any in backstock.

a reply to: InverseLookingGlass


Dear InverseLookingGlass, I sure will take all your advice into account, thank you very much.

a reply to: solargeddon

Dear solargeddon,

I have been researching google for months now to find an answer for this situation, I couldn't find anything that would explain how all red cell levels are OK when ferritin is so low, but I did asked my doctor (endocrinologist) today and he said this was so complex to explain, that he wouldn't be able to give a proper answer and he asked me to look for a hematologist.

Thanks anyway, I appreciate your time.

Cheers,

Low ferritin is extremely common. It is often the first blood result to slip down low when your iron intake is too low. In other words, it's often the first step towards iron deficiency anemia. I don't think I've ever had my ferritin in normal range- just can't get it up even with supplements.

I am very surprised you got referred to a hematologist - are there other reasons for the referral?

Symptoms of low ferritin are usually none. Many people have low ferritin and aren't aware of it without a blood test. Some people do get symptoms, though, which are like mild anemia symptoms (fatigue for example.)

The cortisol level is actually more dependent on time of day than anything else. Cortisol peaks between 8 am and 10 am. It's lowest at night. Your level doesn't seem high. That wouldn't even be high in the afternoon, and if it was taken in the morning it is almost low. (My 8 am cortisol a often near 20). So, time of day matters.

I don't know if any of that helped. I have a history of endocrine problems (pituitary issues, thyroid cancer) so I'm all too familiar with these hormone tests.

If you are really concerned about your cortisol, request a 24 hour urine test. It is a much more accurate indicator of your cortisol levels.

Good luck!!

a reply to: Speotyto


So it isn't anything to do with there being low stocks of iron, but just enough to keep your blood oxygenated?

Bit unfair for the endochrinologist to not clue you in, after all it's your body.

a reply to: Speotyto

www.nlm.nih.gov...

Normal value range is:

Male: 12-300 ng/mL (nanograms per millilter)
Female: 12-150 ng/mL

You're on the low side but if the rest of your stats are good I wouldn't worry about it.

Edit: Also from same source, here are some causes of "low" levels:

Heavy menstrual bleeding
Intestinal conditions that cause poor absorption of iron
Iron deficiency anemia
Long-term digestive tract bleeding

Oh... Scattered right now, sorry.

Wanted to add that you might want to experiment with different iron supplements. My endo recommended ironsorbs. The only thing that bumps my ferritin levels is actually taking a lot of vitamin c. It helps in absorbing the iron.

Second... About that cortisol. If that was an 8 am blood draw, it is a bit low which could point to mild Addison's or adrenal insufficency. Strangely, people with cushings sometimes have low am cortisol because their diurnal rhythm us messed up (high overall cortisol- but low at wrong time)

Sorry gotta run - hope that helped

originally posted by: VegHead
Low ferritin is extremely common. It is often the first blood result to slip down low when your iron intake is too low. In other words, it's often the first step towards iron deficiency anemia. I don't think I've ever had my ferritin in normal range- just can't get it up even with supplements.

I am very surprised you got referred to a hematologist - are there other reasons for the referral?

Symptoms of low ferritin are usually none. Many people have low ferritin and aren't aware of it without a blood test. Some people do get symptoms, though, which are like mild anemia symptoms (fatigue for example.)

The cortisol level is actually more dependent on time of day than anything else. Cortisol peaks between 8 am and 10 am. It's lowest at night. Your level doesn't seem high. That wouldn't even be high in the afternoon, and if it was taken in the morning it is almost low. (My 8 am cortisol a often near 20). So, time of day matters.

I don't know if any of that helped. I have a history of endocrine problems (pituitary issues, thyroid cancer) so I'm all too familiar with these hormone tests.

If you are really concerned about your cortisol, request a 24 hour urine test. It is a much more accurate indicator of your cortisol levels.

Good luck!!

Dear VegHead,

Thanks a lot for your answer, if I may, remember that my ferritin is below normal for over 6 months, and that's what I know, maybe even for longer.

There's a lot of complications here, I guess due to a lot of different views of this situation. I also used to think that I was "almost anemic" or on the "verge of anemia", like my iron stock was running low, and that this shouldn't cause any symptom at all, but my endocrinologist says different, he says that it does cause fatigue and other related symptoms, internet says the same in so many different websites... maybe all of them - even the ones that acknowledge low ferritin is the first step before real anemia (low red cells count) - I even read somewhere on the internet that even "close to low levels of ferritin can cause anemia-like symptoms - and that my level is so low that it could mean close to zero storage available.

After my doctor telling me my ferritin level was enough to cause me tiredness, depression, etc, (even with me thinking I was just close to anemia) he said he couldn't easily explain how my ferritin could be so low when red cells are normal, told me not to worry, and asked to go see a hematologist because that was a more specific field for this problem. There's nothing special I know about my health that would explain this, I guess it's because he gave me iron tablets for a month and asked to change diet, and this approach failed. I guess this is it, he can't do better.

Thank you!

You might want to check if you have antibodies to glutein. there are many people who have celiac but doesn´t know that. Bad glutein diet lowers ferritin and storage iron.

originally posted by: dollukka
You might want to check if you have antibodies to glutein. there are many people who have celiac but doesn´t know that. Bad glutein diet lowers ferritin and storage iron.

Thank you and everyone else for your help!

Cheers,

My cousin was a PhD, MD with his doctorate in organic chemistry; he was in research for quite a while and then became an anesthesiologist; I said 'was' because he came down with an unusual blood disorder perhaps related to his exposure to chemicals and anesthetic agents, then a few years later came down with the exact *opposite* blood disorder as far as blood chemistries and died about two years after diagnosis of the second illness after undergoing chemo, which is probably the last thing he needed

Not to scare you but definitely see a hematologist and don't stop until you get a diagnosis. It could be as simple as occult intestinal blood loss related to IBS or Crohn's, which has become endemic in the last 20 years. Changing your diet to something extremely healthy with lots of green vegetables (I'm beginning to think of chlorophyll as green blood) certainly wouldn't hurt. Hire a cook or healthy shopper if you need to, to get into the habit.

I was low on this for 3 or 4 years. Apparently I was told this was more of a true indicator of aneamia. Under microscope my cells were miniscule which can indicate something more serious. I had every test done celiac, stomach ulcer, etc everything normal. Had terrible itching and sores, joint pain, depression, fatigue. Bit by bit things have improved but it has taken time. As long as you have had all tests done I would try not to worry too much as only makes depression fatigue worse.

a reply to: signalfire

Thanks for your input signalfire, I am very sorry about your cousin.

I will one day update this thread with more tests results.

Cheers

originally posted by: anxiouswens
I was low on this for 3 or 4 years. Apparently I was told this was more of a true indicator of aneamia. Under microscope my cells were miniscule which can indicate something more serious. I had every test done celiac, stomach ulcer, etc everything normal. Had terrible itching and sores, joint pain, depression, fatigue. Bit by bit things have improved but it has taken time. As long as you have had all tests done I would try not to worry too much as only makes depression fatigue worse.

Yes, that's also what the doctor told me, that this is a true indicator of anemia when critical thinking said I was only short of iron storage. Anyway, the lab that made the tests put normal range between 30 to 400 and I've read several times that being close to the "normal" minimum was already bed, and yet I'm below it, that's not good considering it's a long range...

Thanks for your kind words,

a reply to: VegHead

I take C vitamin everyday, as for my Cortisol, the doc thought it was way too hi for a Saturday morning, when I was relaxed. Combined with my history of a lifetime of anxiety, I suppose he is right.

You have helped a lot, thanks!

I think being anxious and your "pantrozonol for life", are indicators that you worry to much, in your case.
It's most likely caused by stress. The energy you spend in negative thinking ( This thread is a perfect example ), is making the stuff you worry about bigger. This causes a lot of stress, causing you to be anxious for example, stumach issues that can't be explained are also a symptom of stress.

Don't just trust my opinion, or ridicule it for that matter. I'm not trying to offend or be a troll.
If I were you, I would google for everything that can help you stop worrying.
Anything that will teach you how to invest your energy in something else, anything that can help you relax etc.

My 2 cents.

P.S.

It is worth it, even if stress isn't the cause of your complaints.

I would suggest: Get checked for ulcers, Crohns, and especially celiac.
Take Vitamin B12 and Vitamin C. They help with iron issues.
Do you take NSAIDS or aspirin? They can cause issues with bleeding.
Also do you take prilosec? It can prevent absorption of iron.
If you start taking a ferritin supplement, it will take some time to build up your reserves but it will help.

I didn't think Ferretin was low till it was around seventeen.

Iron supplements do not work for everyone. If you lack an enzyme in high enough numbers, all the iron in the world won't help. My wife and both daughters can't take iron supplements. I don't think that their condition is even close to rare.

Now being a dentist means you are in contact with chemicals. One being mercury to make fillings. Methyl mercury possibly released in grinding and making fillings can probably interfere with the proper utilization of iron in the body. There are lots of chemicals used in that field.