A storage protein called ferritin both transports iron throughout our bodies and helps moderate our iron levels. Low ferritin symptoms can indicate a number of conditions, including anemia, restless leg syndrome and celiac disease.

Low serum ferritin is a common problem in people with gluten intolerance. In celiac disease, antibodies first target the proximal small intestine (the earlier part of your small intestine), which is the part of your small intestine responsible for absorbing iron. Some forms of non-celiac gluten sensitivity (NCGS) also trigger antibodies that do damage to this part of your intestine, while other forms of NCGS trigger systemic inflammation, which may impede iron absorption. Low ferritin is most common and most severe in celiac disease patients.

• What Is Ferritin?
• Low Ferritin Symptoms
• Low Ferritin Causes
• Celiac Disease and Low Serum Ferritin
• Low Ferritin Symptoms In Runners and Athletes
• Low Ferritin Treatment
• Take the Quiz

What Is Ferritin?

Ferritin is an intracellular, globular protein complex (in simpler terms, it is a soluble protein complex rather than an insoluble protein complex like fibrous proteins) that performs two critical roles: it transports iron to all the tissues of your body and it helps moderate your iron levels from being too low or too high. When ferritin isn’t bound with iron, it is called apoferritin.

Iron is a key element of healthy hemoglobin, the molecule carrying oxygen to tissues all over your body. If you don’t have enough iron, various cells and tissues all over your body may not get the oxygen they need to perform at optimum levels or to remain healthy. Iron plays a critical role in your body’s ability to generate energy, experience cellular respiration and maintain a healthy immune system. Ferritin performs transportation and moderation of this critical element throughout your body.

Serum ferritin levels are tested to detect either low or high iron, but conditions associated with either low or high iron often require additional examination because ferritin levels can be raised when infections or a sources of chronic inflammation are present. In other words, if you have an infection or some other inflammation, you could have borderline low iron but a serum ferritin test could still indicate a normal ferritin level.

Low Ferritin Symptoms

Early signs of low ferritin levels are easy to miss because they may seem mild or they may seem like a natural part of the ebb and flow of how you feel day in and day out. These earlier symptoms include:

• Body aches
• Fatigue
• Irritability
• Low libido

As your ferritin stays low or goes lower, the following ferritin deficiency symptoms may occur:

• Confusion
• Long, heavy menstrual cycle in women
• Palpitations
• Restless Leg Syndrome
• Tingling or numbness in fingers or toes (neuropathy)
• Weakness

If you fail to raise your ferritin, you may become anemic or begin experiencing the following low serum ferritin and low iron symptoms:

• Pale skin or eyes
• Brittle nails
• Bruising easily

Chronic iron deficiency can lead to organ failure, so you should see a doctor if these last symptoms of low ferritin levels seem familiar to you. Very low ferritin levels can be critical.

Low serum ferritin is also associated with hypothyroid disease, so if you either suspect thyroid problems or are diagnosed with a thyroid problem, you might want to discuss an iron supplement with your doctor.

A woman’s menstruation may also cause reduced serum ferritin levels, but don’t let that mask a real case of low ferritin. Unfortunately, there have been cases where doctors passed off low ferritin or low iron as being caused by a woman’s period, when later it was discovered that celiac disease was the real cause.

Note that low ferritin is not the same thing as anemia but rather a precursor to anemia.

Low Ferritin Causes

The most common causes of low ferritin are:

• Poor Diet (not consuming enough high-iron foods or enough foods with the nutrients required to help absorb iron)
• Blood loss (can be internal or external, from injury or from giving blood)
• Intestinal disease (like celiac disease, Crohn’s Disease, ulcerative colitis or gluten sensitivity)
• Intestinal medical procedures (intestine surgery, and in some rare cases colonoscopy or sigmoidoscopy)

When you examine reasons for low ferritin, you should be able to narrow the cause down to one of those primary reasons fairly quickly. However, within each of these primary reasons you may find difficulty narrowing down your particular situation.

Poor Diet

There are two parts to the diet cause of low ferritin. First, you need to make sure you are consuming enough foods that contain iron.

There are two forms of iron: Heme Iron and Non-heme iron. The human body more readily absorbs heme iron (as it is more “bioavailable”), which only occurs in animal products, but high-iron vegetables often contain far more non-heme iron per 100 calories than heme iron sources, so you can still address your low ferritin or anemia by eating generous portions of foods like spinach, kale and lentils if you’re trying to avoid red meat. For example, 100 calories of cooked spinach contains about 15 milligrams of iron, while 100 calories of choice sirloin steak contains less than 1 milligram of iron.

The second part to the diet equation involves consuming enough of the nutrients required to help you absorb the iron you eat. The most important nutrients you need to integrate into your diet to help you better absorb iron are folic acid (folate) and vitamin C (especially vitamin C). Fortified whole grains, citrus fruits, eggs and leafy green vegetables are all good sources of these nutrients.

See the section below on Low Ferritin Treatment for more dietary suggestions to raise your ferritin levels.

Blood Loss

Another common cause of low ferritin is blood loss. This can result from an internal or external injury, so don’t assume that just because you’re not overtly bleeding after an injury that you’re not suffering from some form of blood loss.

Intestinal Surgery

Intestinal procedures, such as an appendectomy, surgeries addressing colon cancer or other intestinal disorders often cause low ferritin symptoms. Intestinal procedures may reduce your ferritin levels because of either temporary damage done to the intestinal wall where iron is absorbed or by causing temporary internal bleeding (or both). If you have had such a procedure, discuss your iron levels with your doctor. If necessary, he or she will prescribe dietary changes or temporary iron supplementation as you recover. This especially important for people with celiac disease and cancer recovering from surgery.

Intestinal Diseases

As far as this gluten intolerance site goes, the cause of low ferritin symptoms we’re most concerned with are intestinal diseases, in particular celiac disease and a non-celiac gluten sensitivity. However, ulcerative colitis and Crohn’s disease may also cause problems with iron absorption.

Celiac Disease and Low Serum Ferritin

One of the first vitamin or mineral deficiencies you may develop if you have celiac disease is an iron deficiency, or anemia. This is because minerals like calcium, magnesium and iron are absorbed in your proximal small intestine, which means the early, upper part of your small intestine. This is where the antibodies triggered by your consumption of gluten first attack, and where villous atrophy occurs the earliest for people with either celiac disease or a non-celiac gluten sensitivity.

As the villi, which are finger-like protrusions from the mucosal lining of your small intestine, slowly flatten in villous atrophy, your intestines become less and less able to absorb nutrients from your food. So if blood test results or a blood panel reveals you have low serum ferritin levels, and you don’t have another obvious explanation (like you just donated blood), you should discuss the possibility of celiac disease, including possibly a celiac disease test, with your doctor. You may need to make this suggestion as celiac disease isn’t yet a common path of diagnosis for many doctors.

Fatigue is a common symptoms of celiac disease, and some people may be frustrated when their doctor tells them they do not have anemia. It is possible to suffer from low ferritin but not yet have anemia.

A smart celiac disease diet for recently diagnosed celiacs should include increased intake of iron, Vitamin C and folic acid to help raise low ferritin levels.

Low Ferritin Symptoms In Runners and Athletes

As iron-rich ferritin is largely responsible for carrying oxygen to working muscles, endurance athletes often stress their ferritin resources much more than the average person. So it is not uncommon for endurance athletes with otherwise healthy diets and good blood panels to suffer from low ferritin symptoms. In particular, the phenomenon is more common in women endurance athletes.

If you are an athlete and you recognize some of the above symptoms of low ferritin, you might consult with a nutritionist about diet modifications you can make to compensate for the increased exhaustion of your body’s iron resources.

Low Ferritin Treatment

The first step towards treatment of any case of low ferritin is to determine why serum ferritin levels are low in the first place. Too often I see people skip over this important step by addressing their low ferritin with diet and supplements before they even know why it is low.

Once you and your doctor know the cause of your low ferritin, you may have specific changes you need to make to your diet or lifestyle.

For most people suffering from low ferritin, a change in diet will be necessary. In the western diet, we often don’t eat enough of the right combination of foods providing iron, vitamin C and folic acid to maintain healthy iron levels. Some good sources of iron include:

• Almonds
• Brazil nuts
• Cereals and foods fortified with iron
• Collard greens
• Dark chicken meat
• Dark turkey meat
• Eggs
• Fish
• Kale
• Legumes (black, kidney and pinto beans)
• Lentils
• Liver
• Quinoa
• Red meat (especially beef)
• Soybeans
• Spinach

Some dark, leafy vegetables are veritable powerhouses of iron, vitamin C and folic acid all together. These superfoods include collard greens and spinach. You’ll need to eat quite a bit more than one small salad a day to obtain your iron from these superfoods, but they’re still an excellent source of absorbable iron because of their mix of iron, vitamin C and folate all in one food.

If you are a vegan or vegetarian, you can easily manage without meat, but you do need to increase your intake of these high-iron foods and eat them with foods containing vitamin C and folic acid as often as possible.

Iron Supplements

Iron supplements are a fast and effective way to treat low ferritin levels. However, iron can be toxic if taken in too high amount for too long. I believe the toxicity of iron supplementation is often under-appreciated, so before you supplement your diet with an iron supplement discuss the amount and length of time you need to take it with your doctor before you begin an iron regiment.

Also, iron supplements are especially toxic to children, so please keep any iron pills you own well out of your child’s reach.

I don’t mean to scare you from taking an iron supplement; it can be very effective. Just be careful about hemochromatosis, a relatively common iron storage disease. Iron toxicity is possible and it can be dangerous, so I don’t recommend taking an iron supplement without having your ferritin serum levels checked and without supervision of a health professional. In some borderline cases moderate dietary changes may be all that is necessary to raise your ferritin levels.

In people with celiac disease, the most critical low ferritin treatment you can implement will be a strict gluten-free diet. It is crucial you allow your small intestine to repair itself over time by avoiding gluten and staying on a healthy diet. As your gut repairs itself, your body will slowly improve its ability to absorb iron again.

I’m not suggesting you avoid iron supplementation, but just understand if you have celiac disease or a non-celiac gluten sensitivity the most important first step is to eliminate all traces of gluten from your diet.

You should now have a better understanding of low ferritin symptoms, how they may occur, and what you can do to improve your serum ferritin levels.

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