What is optimal Ferritin level?

[Blackpanther46]

Hi thyroid forum , I’ve had my ferritin levels checked and it’s now 79 range 11-311 . Is that good or should it be higher ? If so how do I get it higher?

Thankyou

[jimh111]

The average ferritin for females is around 45 but higher for males. So, your level is good. Beware the 11-311 interval because it's one of the ones where a small number of people have very high levels, the mid-point shouldn't be seen as a target.

I don't like the concept of 'optimal' because it may target unrealistic levels and is often used as a marketing tool for selling supplements or as a 'hook' to attract patients to websites that make money from advertising. Also, by focussing on a putative 'optimal' level patients may be distracted away from finding out what is really going wrong.

[humanbean in reply to jimh111]

jimh111

So you are asking Blackpanther to ignore the reference range supplied with her test? And replace it with what?

A result of 79 with a range of 11 - 311 is only 23% of the way through the range, and this isn't really enough for many people who have one or more chronic diseases such as thyroid disease.

You are suggesting that the reference range was created out of a set of subjects, some of whom had high levels of iron and thus distorted the range. Where is the evidence for that?

The average ferritin for females is around 45 but higher for males.

An average is of no use unless you know the reference range that it is an average for.

People with low iron/ferritin can develop all sorts of problems such as hair loss, extreme fatigue, cramp, restless legs syndrome, benign fasciculations, breathlessness, dizziness, tachycardia, palpitations, arrhythmia, sore and swollen tongue, depression, anxiety, increased risk of infection. For women who are still menstruating low iron/ferritin levels can increase the risk of heavy bleeding thus making the problem worse i.e. a vicious circle that causes all sorts of problems that make life miserable.

I should point out that if someone has very high levels of ferritin doctors pay little attention until ferritin is around 800+.

I don't think anyone on this forum has ever suggested taking iron and ferritin levels high in range or over the range - in fact it is always specifically advised against. Personally I always suggest taking levels to optimal or lower, never optimal or higher.

[jimh111 in reply to humanbean]

What I am saying is that reference intervals (they are not ranges) are not diagnostic nor does the mean represent the median population level. Some reference intervals e.g. calcium do indeed give a good indication of health status. Some reference intervals are very wide and most healthy people will fall in the lower part of the interval as can happen with some vitamin levels.

About half the healthy female population has a ferritin below 45 so it is unlikely that attempting to drive ferritin well above this level will show any benefit. There are cases where people are anaemic with good ferritin levels but this is a separate issue (in which case ferritin is not informative). The danger is that people are misdirected into making themselves sick trying to up their ferritin and failing to find the underlying cause of their ill health.

In short, if your ferritin is above the population average don't worry about it. If you have signs and symptoms that still suggest iron deficiency then investigate it but don't set an arbitary (high) target for ferritin. The ferritin reference interval is one of those intervals where the majority of healthy people are nowhere near the middle.

[Blackpanther46 in reply to jimh111]

Ok I’m a bit confused now as conflicting advice given here .

[jimh111 in reply to Blackpanther46]

Try to keep it simple. What matters is whether your symtoms are likely to be caused by low iron levels, it is most unlikely. Globally about a quarter of the population is anaemic who.int/vmnis/anaemia/preva... . This WHO study doesn't refer to ferritin but generally anaemia is defined as a ferritin below 15 or 20. (I know this is disputed and I would aim for a higher level but this is the accepted measure). Clearly, a quarter of the world population do not have hypothyroid symptoms.

This graph shows how most young woment have a ferritin below 40 researchgate.net/figure/Mea... . The thin standard deviation lines show where about 68% of the population lie. I think this includes subjects who may be anaemic so ignore the lower parts of the lines. There are other similar graphs that are restricted to healthy subjects.

This shows that if you are female with a ferritin of 79 your are doing very well compared to the rest of the population - particularly if you are pre-menopausal.

[humanbean in reply to jimh111]

reference intervals (they are not ranges)

Nitpicking. We all know what is being discussed with either term.

reference intervals (they are not ranges) are not diagnostic nor does the mean represent the median population level

Doctors treat ranges as diagnostic most of the time. And whether the mean represents the median population level or not, how is anyone supposed to know what the mean and the median are? And there is no guarantee that the distribution isn't highly skewed making it likely that the mean and the median could be significantly different. It is rare for people to know what the shape of the distribution of "normal" results is for anything.

I know that TSH has a very skewed distribution because that information has been "advertised" and I happened to spot it, but most people (including most doctors) won't know this. They think mid-range for TSH is fine, but it isn't - the majority of healthy people have a TSH which is lower than mid-range.

Get a bunch of apparently healthy people, measure their ferritin, knock off the 2.5% of people at the lowest end of the scale and the 2.5% at the top end of the scale and say the middle 95% of results represents good health.

But iron deficiency is the most common nutrient deficiency in the world, suggesting that only using people who are "apparently" healthy is likely to include many people whose iron levels are lower than ideal.

According to this link :

theironmaiden.ca/how-many-a...

2 billion people are affected by anemia worldwide and 293 million of those affected are preschool age children;

56 million pregnant women are anemic (41.8% prevalence globally);

468 million non-pregnant women are anemic (30.2% prevalence globally);

The latest estimates from the World Health Organization and United Nations Children’s Fund estimates that 750 million children worldwide suffer from iron deficiency and anemia.

Picking the middle 95% of results of "apparently healthy" people implies that no condition affects more than 5% of people i.e. 2.5% of people might be low in iron and 2.5% of people might have high levels of iron. With such shocking levels of anaemia in the world today, this idea is absolutely absurd.

So, if a reference interval for ferritin is 13 - 150 the chances are that people with results in the lower part of the range are iron deficient.

I think you are asking the people on this forum to know more than doctors about a very common nutrient deficiency. And you are asking us to know where to find information that simply isn't advertised. This ain't going to happen.

Whether the reference range (interval) for menstruating women is 11 - 311 or 13 - 150 or something else we have to assume that the range is a safe one, and suggestions on this forum are always to stay well within the range. You suggested that a ferritin level of 45 is perfectly fine. If the range is 13 - 150 then a result of 45 equates to a level of 23% of the way through the range. If the range is 11 - 311 then a result of 45 is only 11% of the way through the range. Suggesting that both of these are equivalent and that they are both healthy sounds like sadism to me.

[Blackpanther46 in reply to humanbean]

That’s very interesting how many people are iron deficient. So would half way through the range be a much better result ?

[jimh111 in reply to humanbean]

I always use the term 'reference interval' to emphasise that it should not be used as a diagnostic range. It's pedantic but important so as to change attitudes.

[Blackpanther46 in reply to humanbean]

As it’s so low through the range is half way through the range better?

[humanbean]

Blackpanther46

Ferritin is a measure of your iron stores. There is more to iron than just measuring ferritin. People also have iron in their blood in the form of "free" iron.

For more info on what ferritin actually is this link is worth reading :

web.archive.org/web/2013112...

People can have all sorts of combinations of ferritin and iron :

Low iron and low ferritin

Low iron and high ferritin

High iron and low ferritin

High iron and high ferritin

Healthy iron and low or high ferritin

Low or high iron and healthy ferritin

All these different combinations can tell you different things about your health.

Your ferritin is quite low in range, but your serum iron could be extremely high, or healthy or low. If you take iron you won't know if your ferritin will rise or your serum iron will rise or if both will rise.

So, taking iron supplements if you only know ferritin is not very safe and wouldn't be recommended.

You can get an iron panel done with a finger-prick test - no doctor involved.

This is the one I use :

medichecks.com/iron-tests/i...

There is a discount code THYROIDUK10 which you can quote if you order that gets you 10% off the price. Also, Medichecks has regular special offers on one test every Thursday - the test changes each week.

If you want to use a testing company make sure to register with the company so that you get info via email on any sales they have.

How to test iron :

1) Stop taking iron supplements for 5 - 7 days before testing. Check all your supplements just in case some of them contain iron you weren't aware of.

2) Test iron under the same circumstances you would do a thyroid test. In other words, do the test first thing in the morning, fast for 10 - 12 hours before the test. You can drink water only throughout the fasting period.

Once you get your results post them in a new thread and ask for feedback.