The Reason for Low Ferritin

The Reason for Low Ferritin

(Addendum: As a kind reader pointed out (thank you Patricia), in the last newsletter I neglected to mention that there are omega-3 options that are not derived from fish. For those who do not consume fish, for either ethical or environmental reasons, or who may be allergic to seafood, there are now plenty of algae-derived omega-3 products on the market. Such products can be found wherever one purchases their vitamins. Unlike flax oil (which only provides precursors to omega-3 fatty acids, and must be converted into DHA and EPA within our bodies), the products made from algae contain preformed DHA and EPA, in amounts comparable to fish oil. As with fish oil products, one should endeavour to obtain at least 1000 mg of mixed DHA and EPA daily, more for therapeutic purposes.)

Iron Levels

In my work as a nutritional consultant, I often comment to co-workers that our job can be like an episode of “House, M.D.” We are presented with unusual symptoms, usually ones that the doctors cannot figure out (or can’t be bothered to research), and we are often the last hope that these people have to solve their medical mystery.

For example, a woman came to talk to me about her chronically low iron levels. After some discussion it was revealed that her blood work revealed a high white blood cell count. This is something any good doctor should have picked up on: high white blood cell count indicates infection in the body, and when infection is present, the body will pull iron out of circulation because iron feeds bacteria.

Therefore, never take an iron supplement if you know you have an infection. Unfortunately, it is possible to have a low grade infection, and not even know it. This is one reason why I regularly ask people with chronically low iron levels if they have root canals. A root canal has had the nerves removed and thus, when one goes bad and gets infected, there is no pain signal to let us know that infection is present.

The point is, over the years it has become apparent to me that there is a plague of low ferritin levels, and until now I could not figure out why this deficiency was so prevalent.

What is Ferritin?

Put simply, ferritin is a blood protein that contains stored iron, and if a test shows that one’s levels of ferritin are low, it indicates chronic iron deficiency.

Put less simply: “Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals.” (Source)
For all us creatures, ferritin stores iron in a non-toxic and soluble form, acting as a buffer against both iron deficiency and iron overload.

The Answer

Well, the answer finally appeared to me when I stumbled across a study on PubMed, while doing research on another subject. The answer is vitamin A deficiency.

Those of you familiar with my writings know that I have devoted a lot of space to defending and encouraging the use of vitamin A as a supplement (see blogs, newsletters, and my books). I believe vitamin A deficiency to be widespread (like ferritin deficiency), as it is only found in appreciable amounts in animal liver. Which few people eat anymore (at least in the West), and which, surprise, is one of the richest sources of iron available in food. So right there, we can see a link between vitamin A and iron.  Now let’s take a look at the science available on the subject.

The Science

It is well known in the world-wide medical community, that both vitamin A and iron deficiencies are serious nutritional problems affecting many pregnant and lactating women, as well as preschool children.

A review of the scientific research on this subject covering the years from 1992 to 2013, was released in 2013, becoming the first study I could find that really linked the two deficiencies. This review was designed to assess “the influence of vitamin A supplementation on iron status”.

While the authors noted that some of the studies reviewed did not include a placebo group, and some did not include an assessment of baseline vitamin A status on the subjects, they nonetheless came to this conclusion: “Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone.” (Study)

Then, in 2019, the clincher came through. This study first acknowledges the conclusions of the preceding study: that anemia is a worldwide public health problem, and that it can be related to vitamin A deficiency.

The authors then define their aim: “to assess and estimate the effect of vitamin A supplementation (VAS) on iron status biomarkers and anemia in humans. Six databases, including Cochrane, EMBASE, LILACS, Pubmed, Scopus and Web of Science, were searched for clinical trials and cohort studies that investigated the effect of vitamin A supplementation alone on iron status and anemia.”

This meta-analysis of clinical trials found that supplementing with vitamin A reduced the risk of anemia by 26% and raised hemoglobin levels (hemoglobin are the iron-containing, oxygen-transporting red cells), in most groups. As well, “a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women”.

The study concluded with this: “Therefore, vitamin A supplementation alone may reduce the risk of anemia, by improving hemoglobin and ferritin levels in individuals with low serum retinol levels.” (Study)

Supplementing With Vitamin A

For those unfamiliar with my suggested regimen for using vitamin A, I suggest checking out this blog, How 3 Nutrients Can Heal Most Ailments, which will provide recommendations for dosage levels at the end of the article.

Basically, I believe we all should get a minimum of 50,000 IU of vitamin A per week (if not deficient), as that is roughly the amount found in one fair sized serving of cow’s liver. Thus it is within the range of normal human food intake.

As I have discussed elsewhere (here), natural beta carotene (from food or supplements) is not a viable alternative to vitamin A, and eating liver is the only way, outside of supplementation, of getting enough vitamin A to meet our nutritional requirements.

For those repulsed by the idea of eating liver, natural vitamin A is commonly available in supplement form, derived from molecularly-distilled cod or halibut liver oil. (Molecular-distillation is a process that removes toxins from the fish liver oils.) And, fortunately for vegans, synthetic vitamin A is a viable, effective option (unlike synthetic beta carotene, which should be avoided).