Ever wondered why you wake up tired despite getting eight hours of sleep? Or why your usual workout suddenly feels twice as difficult? Perhaps you find yourself reaching for another cup of coffee just to get through the afternoon.
While these experiences can have several explanations, one possibility worth investigating is low ferritin.
Ferritin is a protein that stores iron in the body and releases it when needed. Your serum ferritin level is therefore an important indicator of your body's iron reserves. When these reserves run low, you can experience symptoms even before developing anaemia.
In fact, iron deficiency affects approximately 2 billion people worldwide, making it one of the most common nutritional deficiencies. [NIH]
What Happens When Your Ferritin Levels Are Low?
Think of ferritin as your body's iron savings account. Your body draws on these reserves to support essential functions, including haemoglobin production, oxygen transport and cellular energy metabolism.
When iron stores become depleted, these functions can be affected. Eventually, if the deficiency progresses, haemoglobin production may also decline, resulting in iron-deficiency anaemia.
Here's something important: you can have low ferritin levels without having anaemia. This means your haemoglobin may still fall within the normal range while your iron reserves are already running low. [NIH]
8 Low Ferritin Symptoms You Should Know About
Low ferritin symptoms are not always obvious. Sometimes, they show up as small changes in your everyday energy, physical performance and overall wellbeing.
1. Constant fatigue, even after sleeping
If getting through your workday feels exhausting despite adequate sleep, low iron stores could be worth investigating. Iron supports cellular energy metabolism, and iron deficiency can contribute to persistent fatigue and reduced energy. [NIH]
2. Getting breathless during everyday activities
Climbing a flight of stairs, walking uphill or completing your usual workout suddenly leaves you unusually breathless. Iron deficiency can affect oxygen transport, particularly when it progresses to anaemia, making physical activities feel more demanding. [NIH]
3. Brain fog and difficulty concentrating
Finding it harder to focus during meetings? Reading the same paragraph repeatedly? Iron plays a role in normal brain function, and iron deficiency has been associated with impaired attention, concentration and cognitive performance. [NIH]
4. Increased hair shedding and brittle nails
If you are noticing more hair strands on your pillow or in your shower drain, iron deficiency may be one contributing factor. Changes in nail strength and, in more advanced cases, spoon-shaped nails can also occur.
However, hair shedding is multifactorial, so low ferritin should not automatically be assumed to be the cause. [NIH]
5. Feeling unusually cold
Do your hands and feet always feel cold, even when everyone else is comfortable? Cold intolerance can accompany iron deficiency, particularly when anaemia develops, as reduced haemoglobin can affect oxygen delivery to tissues. [NIH]
6. Restless legs at night
An uncomfortable crawling, tingling or pulling sensation in your legs that makes you feel compelled to move them could be restless legs syndrome. Low iron stores are associated with this condition and can contribute to disturbed sleep. [NIH]
7. Unusual cravings for ice
Do you find yourself constantly wanting to chew ice? This unusual craving, known as pagophagia, is a form of pica associated with iron deficiency. It is one of the less commonly recognised signs worth discussing with your healthcare professional. [NIH]
Why Are Women More Prone to Low Ferritin?
Women of reproductive age are particularly vulnerable to iron deficiency because menstruation involves regular blood loss, and therefore iron loss.
The risk can be higher if you experience heavy periods, follow a diet low in bioavailable iron, are pregnant or have recently given birth.
Other causes of low ferritin levels include:
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Inadequate dietary iron intake, particularly with restrictive diets.
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Poor iron absorption due to conditions such as coeliac disease or certain gastrointestinal disorders.
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Gastrointestinal blood loss.
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Increased iron requirements during pregnancy and periods of growth.
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Frequent blood donation.
Symptoms alone cannot confirm iron deficiency. A blood test is the most reliable way to investigate it.
Ask your healthcare professional whether you need:
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Serum ferritin: Helps assess your body's stored iron.
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Complete blood count (CBC): Checks haemoglobin and other red blood cell parameters.
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Transferrin saturation (TSAT): Helps assess how much circulating iron is available.
A ferritin level below 30 ng/mL is commonly used as an indicator of iron deficiency in otherwise healthy adults. However, inflammation can increase ferritin, making interpretation more complex. [NIH]
How to Improve Your Iron Levels: Food First
If your iron stores are low, improving your dietary iron intake is a practical starting point. The key is to include both iron-rich foods and foods that help your body absorb iron.
A simple absorption tip: Pair plant-based iron sources with vitamin C-rich foods such as amla, guava, oranges, tomatoes or lemon. Vitamin C improves the absorption of non-heme iron. Tea and coffee, on the other hand, can reduce iron absorption when consumed alongside iron-rich meals. [NIH]
When Is Iron Supplementation Needed?
Sometimes, dietary changes alone may not be enough to replenish depleted iron stores, particularly when there is ongoing blood loss, increased demand or impaired absorption.
Your healthcare professional may recommend iron supplementation depending on your ferritin, haemoglobin levels and the underlying cause of deficiency.
Different formulations are available, including conventional oral iron, liposomal iron supplements and convenient formats such as iron melts. Liposomal delivery is one approach being studied to improve iron delivery and absorption, although the effectiveness depends on the specific formulation.
The important thing is to choose an appropriate dose of elemental iron and formulation based on your requirements, rather than supplementing without testing. Excess iron can also be harmful.
Key Takeaways
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Low ferritin means your body's iron reserves are running low, even if haemoglobin is normal.
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Persistent fatigue, brain fog, hair shedding and restless legs can be associated with iron deficiency.
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Menstruating women, particularly those with heavy periods, are at increased risk.
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A serum ferritin test, alongside other relevant blood tests, helps identify iron deficiency.
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Iron-rich foods, vitamin C and appropriate supplementation can help restore iron levels.
The Bottom Line
Feeling tired all the time should not automatically become your normal. If you are experiencing persistent fatigue, declining exercise performance, unexplained hair shedding or other changes, it may be worth checking your iron status.
Pay attention to your body's signals, investigate the underlying cause and address low iron stores before they progress to iron-deficiency anaemia.
FAQs
1. What is a normal ferritin level?
Ferritin reference ranges vary by laboratory, age and sex. In otherwise healthy adults, levels below 30 ng/mL commonly indicate iron deficiency.
2. Can you have low ferritin but normal haemoglobin?
Yes. This is known as iron deficiency without anaemia, where iron stores are depleted but haemoglobin has not yet fallen below the normal range.
3. What causes low ferritin levels in women?
Common causes include menstrual blood loss, heavy periods, inadequate dietary iron, pregnancy and poor iron absorption.
4. How can I increase ferritin levels naturally?
Include iron-rich foods such as lentils, chickpeas, meat, seafood, tofu and seeds. Pair plant-based sources with vitamin C-rich foods to improve absorption.
5. How long does it take to restore ferritin levels?
It depends on the severity of deficiency, treatment and whether ongoing iron loss is present. Replenishing iron stores can take several months.
6. Does low ferritin cause hair loss?
Iron deficiency is associated with hair shedding, but the relationship is not straightforward. Hair loss can have several nutritional, hormonal and medical causes.
7. What is the difference between iron and ferritin?
Iron is an essential mineral used in several bodily functions, while ferritin is the protein that stores iron and helps indicate the body's iron reserves.
8. Can low ferritin cause weight gain?
There is no established evidence that low ferritin directly causes weight gain. However, fatigue associated with iron deficiency may affect physical activity and exercise capacity.
9. Which foods should I avoid when taking iron supplements?
Tea, coffee and calcium-rich foods or supplements can interfere with iron absorption when taken at the same time. Follow your healthcare professional's advice on supplement timing.
10. Is it safe to take iron supplements every day?
Daily supplementation may be appropriate when prescribed, but the dose and duration should depend on your iron status and individual requirements. Unnecessary iron supplementation can cause adverse effects and iron overload.
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