Alaine Mills, a registered sports dietitian with MUSC Health’s Dietitian Services, had an instant reaction when she saw posts about “ferritin face” on social media. “Sounds like the new cortisol face,” she said, referring to older posts about the “fight-or-flight” hormone that had a strong run on social media.
Ferritin is a blood protein that contains iron, storing it for the body to use when it’s needed. A lot of social media posts are saying that low ferritin levels can cause obvious issues such as under-eye circles and pale skin.
“This seems like fear-mongering,” Mills said. “But there’s a kernel of truth because it could cause you to look pale if you had iron deficiency.”
Mills, whose education and experience make her an expert on nutrition, said iron deficiency can cause other symptoms as well. “If you have low iron, it can lead to making you cold, making you dizzy, shortness of breath, heart palpitations. And it can lead to bruising. All of that is true.”
But Mills said it’s not a good idea to start taking supplements without consulting a doctor or dietitian and getting bloodwork to screen for low iron.
“Iron supplements can be very harsh on the system. The number one side effect would be constipation. It can also cause bloating and stomach distention. Taking too much iron from supplements can cause a toxic buildup in the body, affecting the vital organs, for example, the pancreas, which can lead to issues with insulin.”
Iron is important
Iron helps hemoglobin transport oxygen to cells throughout the body to produce energy. This is why having enough iron is essential, Mills said. “When stores are low, fatigue occurs, which can lead to poor athletic performance and energy throughout the day.”
Research has found that nearly one in three adults in the U.S. is iron-deficient. Traditional iron-deficiency tests check hemoglobin levels. Mills said checking ferritin levels as well can give doctors and patients a heads-up about how much stored iron a person has. That can catch low iron before it becomes a more serious problem.
“Especially for athletes or people who exercise a lot, ferritin is a really important number,” Mills said. They need higher levels of ferritin than nonathletes because of the demands that exercise places on the body.
“If you have celiac disease or another GI condition, such as IBS, IBD or Crohn’s, all of those conditions would put you more at risk for iron deficiency,” Mills added.
“And for women who are menstruating, the ferritin level is a really important number to look at because of extra iron losses.”
Increasing iron levels – boosting ferritin in the process
So if bloodwork shows that a person has low ferritin, it’s important to address the issue, Mills said. “The first line of defense, most likely, depending on where your numbers are, would be to eat more iron-rich foods. Animal meats, like steak, chicken and shellfish, are the sources that are going to be absorbed the best.”
People who don’t eat meat have other options as well. “You can get iron from plant foods like lentils or beans, nuts and seeds, but that’s not absorbed quite as readily. What helps plant-based iron sources absorb better is vitamin C. So if you pair it with something high in vitamin C, like oranges or strawberries or even potatoes, that can help.”
Supplements can help people with low ferritin as well, Mills said, if they’re used under expert supervision. “Iron bisgycinate is one of the supplements that’s a little bit easier on the system. A lower dose of that is usually what I recommend. People tolerate it better.”
Speak up if you think you may be iron-deficient
“It’s something that I pay attention to,” Mills said. “When a patient comes to meet with me, I ask what they’re eating. Iron is a nutrient that I listen for.”
You can ask your doctor about it as well. “If you went to your doctor and you said, ‘I’ve been feeling really dizzy. I’ve been feeling really cold. I’m very pale. I’m feeling these heart palpitations,’ that would cause them to order a more comprehensive iron panel. Or if you told them, ‘My periods are extremely heavy,’ that would be another reason to have a more comprehensive panel,” she said.
New ferritin guidelines
Mills’ comments come as the American Society of Hematology issues new guidance on thresholds for iron-deficiency.
-Adults and women who are menstruating or pregnant and have 30 nanograms/milliliters or less of ferritin are now considered iron-deficient. The previous threshold was less than 15 nanograms/milliliters.
-High-risk groups, such as women who have heavy periods or who are pregnant while suffering from anemia, are iron-deficient if they have 50 nanograms/milliliters of ferritin or less.
-Adults with cancer, inflammation, inflammatory bowel disease or infection who have 100 nanograms/milliliters or less are now considered iron-deficient.
“This is a step in the right direction toward acknowledging the importance of ferritin for overall health and performance,” Mills said.