A low ferritin level can be caused by iron deficiency anemia, hypothyroidism, or heavy menstrual bleeding. These conditions can lead to symptoms such as fatigue, weakness, pale skin, loss of appetite, hair loss, headaches, or dizziness.
Ferritin is a protein that stores iron in the body. Iron is an essential mineral that forms part of hemoglobin and myoglobin, which transport oxygen from the lungs to the tissues and muscles.
Treatment for a low ferritin level is prescribed by a hematologist, primary care provider, gastroenterologist, or endocrinologist. Treatment depends on the underlying cause and may include iron supplements, levothyroxine, hormone therapy, or dietary changes.
Main symptoms
The most common symptoms of a low ferritin level include:
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Weakness;
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Excessive tiredness;
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Pale skin;
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Dizziness;
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Headaches;
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Shortness of breath;
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Brittle nails;
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Hair loss.
A low ferritin level may also cause pagophagia, which is a strong craving to eat or chew ice or drink very cold beverages. It can also lead to restless legs and a constant urge to move the legs.
If you experience symptoms of a low ferritin level, it’s important to see your primary care provider or a hematologist in order to determine the cause and begin the most appropriate treatment.
Can a low ferritin level be a sign of cancer?
A low ferritin level may indicate iron deficiency anemia, which can result from blood loss caused by hidden gastrointestinal cancer.
However, in most cases, a low ferritin level does not mean cancer. When gastrointestinal bleeding is suspected, the doctor may order further testing, such as a colonoscopy, to investigate the cause.
How to know if ferritin is low
A blood test is used to measure the amount of ferritin circulating in the blood. A low ferritin level is defined as less than 30 mcg/L in men and less than 10 mcg/L in women.
The results should be interpreted by a healthcare provider along with other tests, such as a complete blood count, serum iron levels, and transferrin saturation index, as well as a physical exam and review of symptoms.
Main causes
The main causes of a low ferritin level include:
1. Iron deficiency anemia
Iron deficiency anemia develops when the body lacks enough iron to produce hemoglobin and red blood cells, which transport oxygen throughout the body.
The most common causes are a diet low in iron, poor iron absorption, prolonged or continuous blood loss in the digestive tract, and pregnancy.
What to do: Treatment should be prescribed by a primary care provider or a hematologist and typically includes iron supplementation and a diet that includes iron-rich foods such as lentils, parsley, beans, and red meat.
2. Hypothyroidism
A low ferritin level can be linked to hypothyroidism because ferritin stores iron, which is a cofactor needed for thyroid hormone production. When ferritin is low, thyroid hormone levels can also decrease.
Hypothyroidism occurs when the thyroid produces less T3 and T4 hormones, leading to symptoms like fatigue, weakness, dry or rough skin, and weight gain.
What to do: Treatment should be managed by a primary care provider or an endocrinologist and usually involves taking levothyroxine to replace thyroid hormones.
3. Heavy menstrual bleeding
Heavy menstrual bleeding, also known as menorrhagia, can cause anemia due to excessive red blood cell loss, which reduces ferritin levels in the blood.
What to do: A gynecologist should be consulted to identify the cause and recommend the most appropriate treatment. Management may include anti-inflammatory medication, hormone therapy, and iron supplements if anemia is present.
4. Gastrointestinal bleeding
Gastrointestinal bleeding can also cause anemia and a low ferritin level.
It may result from stomach ulcers, hemorrhoids, or hidden gastrointestinal cancer.
What to do: A gastroenterologist should be consulted to perform tests such as an endoscopy or colonoscopy to determine the cause and recommend the best treatment. Depending on the diagnosis, treatment may include antibiotics for stomach ulcers, anti-inflammatory creams for hemorrhoids, surgery, or chemotherapy for gastrointestinal cancer.
5. Poor iron absorption
Poor absorption of iron in the intestines can lead to iron deficiency anemia and low ferritin levels.
This can be caused by conditions such as celiac disease, Crohn's disease, excessive use of antacids, calcium supplements, or as a consequence of bariatric surgery.
What to do: Treatment should be directed by a gastroenterologist and will depend on the cause. It may include iron supplementation, a gluten-free diet, medication, or adjusting the dose or frequency of antacids and calcium supplements.
6. Diet low in iron and vitamin C
A diet low in iron is one of the main causes of iron deficiency anemia and low ferritin levels.
In addition to low iron intake, insufficient vitamin C can worsen the problem, as this vitamin helps the body absorb iron more efficiently.
What to do: A nutritionist can recommend an iron-rich diet that includes foods like red meat, chicken liver, beans, and pumpkin seeds.
To improve iron absorption, it’s also helpful to include vitamin C–rich foods such as guava, acerola, and lemon in your diet.
Is a low ferritin level serious?
A low ferritin level can become serious if the underlying cause is not treated, leading to severe iron deficiency anemia and complications such as heart problems.
In people who are pregnant, severe anemia can cause premature birth or low birth weight, while in children, it may lead to delayed growth, developmental issues, and a higher risk of infections.