Why Men Must Check Their Iron for Good Health

iron causes atherosclerosis

I’ve written a lot about the dangers of excess iron. But what constitutes an “excess” amount of iron is key here.

Ferritin is the most important measure of iron, but the normal range that accompanies your test result is next to worthless. The Mayo Clinic, the most often cited reference for this, states that a normal ferritin for a man is from 24 to 336.

But many studies show that the damaging effects of excess iron begin at a much lower level, above around 80 – and even lower than that can result in better health.

A friend discovered he had high iron

A friend of mine who is in his mid-thirties recently told me that he had a ferritin test for the first time, and his result was just under 400. This is too high, and even most laboratories would flag it as such, and most doctors would agree.

The point here is that he didn’t know it was so high. The only way to tell is via a ferritin test, since there are no symptoms of excess iron as such.

My friend asked me how his ferritin could have got to that level, and here one can only take some educated guesses.

In men, body iron begins to rise after the age of 18 or so, when growth and development have been completed. Before that age, the body uses iron to make the body’s components, such as blood and muscle. Women typically do not see a rise of iron stores until after menopause, since the menstrual cyscle means enough blood loss to keep iron levels low and safe.

The average fertile woman has a ferritin of around 35, while the average middle-aged man has a ferritin closer to 150.

But clearly my friend’s ferritin was way above even average.

As to the educated guesses as to why his ferritin was so high at about 400, here are a few:

  • age — he could be expected to have higher levels than a younger man
  • alcohol intake — increases iron absorption from food, though I don’t believe my friend drinks to excess
  • red meat consumption — red meat is loaded with easily absorbed heme iron
  • hemochromatosis gene — it’s possible to be heterozygous for one of these genes, which results in greater iron absorption

If this man had been homozygous for the hemochromatosis gene, he would likely have even higher ferritin levels.

Unfortunately, due to residence in Europe and the U.K., this man is unable to donate blood due to concerns about mad cow disease. I’m in the same boat.

Therapeutic phlebotomy

Fortunately, his doctor readily agreed to a therapeutic phlebotomy. This procedure is essentially the same as a blood donation, with a few minor differences. One is that the blood is discarded rather than given to a recipient; the other is that there are fewer restrictions on who can be given this procedure. For example, the donor need not be in good health.

Another difference is that a therapeutic phlebotomy can be repeated often, with less wait time. While a blood donor must wait a minimum of 2 months between donations, a therapeutic phlebotomy can be done as often as once a week.

My friend will need a number of therapeutic phlebotomies to achieve a normal ferritin level. The rule of thumb for a blood donation is that each one lowers the ferritin level from 30 to 50 points. Therefore, he may need 7 to 10 of these procedures to get his ferritin down to 50 or so, a safe level.

Insurance reimbursements to doctors for a therapeutic phlebotomy are low, I understand, so that may be a reason that doctors don’t order more of them. And of course, without the right diagnosis, insurance may not pay anything.

So, just as with raising testosterone with an aromatase inhibitor, finding a doctor willing to do the procedue may be important. Recently, when I gave my doctor a copy of my iron book, he told me that he has done therapeutic phlebotomies on patients whose ferritin levels were not sky-high. Other doctors may not be so willing and do so only with a diagnosis of hemochromatosis or some other indication, such as transfusion-related iron overload.

The effect of blood donation on iron

Another man, a reader of this site and correspondent of mine, recently wrote me the following:

Here is some empirical data for your website if you want to post it.

I’ve donated blood quarterly for the last few years. The last time I donated was on Feb 16, 2016 (Hemoglobin level 15.7). About three weeks after on 3/10 I had a Serum Ferritin blood test at Labcorp via Life Extension Foundation. The result was 17 ng/mL (Ref Int. 30-400). A little low, but I felt fine. Also I’ve never had a low hemoglobin count in the pre-donation screening. I decided to skip the next quarterly donation and get another Ferritin test to see how fast it rises over time.

On 6/15, 97 days later, I had another Serum Ferritin blood test. The result this time was 53 ng/mL. This is a rise of about 2.6 ng/mL per week.

Some stats and confounding factors.

Sex: Male
Age: 57
Avid carnivore
Hemochromatosis carrier.
Take Curcumin and IP6 daily.

He has donated quarterly for a few years because of his status as a hemochromatosis carrier, but then held off when he discovered a low ferritin of 17, though he was not anemic and “felt fine”.

As a result, his ferritin shot up quickly. Whereas a typical man might see a rise in ferritin of 5 to 10 points a year, his rose that much in 2 to 4 weeks. This despite taking IP6 and curcumin, which have been shown to lower iron. Both his gene variant and being an “avid carnivore” (as I am) probably contributed to the fast rise.

But also, as ferritin gets low, as his did, the hormone hepcidin increases, which leads to greater iron absorption from food.

This man felt fine at a ferritin of 17. The suggested male normal range in my book, which is 50 to 70 for men and 20 to 40 for women, contains a generous fudge factor. The reality is that many people can get lower than this without any problems.

Another correspondent of mine also donates blood quarterly. He is on testosterone replacement therapy, one side effect of which can be a high hemoglobin. Testosterone promotes higher red cell numbers and also increases iron absorption.

This man measured his ferritin at 11, and said he felt perfectly fine.

Why men must check their iron

Every man should know his ferritin number. If you don’t, you are missing a critically important piece of health information, and you’ll be unaware of a factor that may be damaging your health.

The Life Extension Foundation offers a ferritin test for $28. No doctor’s order required and no extra cost for the blood draw.

Dr. Joseph Mercola agrees that checking your iron level is crucial for optimal health, and says about my book,

There’s also a really informative book called “Dumping Iron: How to Ditch This Secret Killer and Reclaim Your Health,” which is a well written and easy to understand resource.

PS: Check out my Supplements Buying Guide for Men.


Leave a Comment:

Erik Williams says June 19, 2016

Great article. I’m a 42 year old man in otherwise extremely good shape, but tested Ferritin levels over 400 in April after reading your book. This was flagged as over the FDA limit, and I’ve started giving blood quarterly to hopefully get my Ferritin down to normal over the next few years.

No one would have spotted this had I not read your book and paid to get myself tested. Many thanks Mangan

    P. D. Mangan says June 19, 2016

    Thanks, Erik, glad to be of help. Your situation is quite similar to that of my friend in the article.

JP says June 19, 2016

“I had a Serum Ferritin blood test at Labcorp via Life Extension Foundation.”

So the idea is that for $28 you get the blood drawn at LabCorp but LabCorp doesn’t charge you any extra?

TRT can cause production of excess red blood cells. Is it possible to have excess iron *without* having excess red blood cells?

    P. D. Mangan says June 19, 2016

    Hi JP, both are correct. Life Extension has some kind of a deal with LabCorp wherein the latter does the testing, the former pays them for it, obviously taking a cut. When you order the test, you get a form that you take to LabCorp, they draw your blood, send you the results.

    Yes, it is totally possible to have excess iron without excess red cells, in fact with excess iron that is usually the case. The body keeps red cells and hemoglobin within strict limits (in healthy states) but excess iron is stored as ferritin. Higher than normal red cells are seen in the condition called polycythemia rubra vera, which is uncommon. Most of those with iron excess, even very high such as in hemochromatosis, have normal hematological profiles, i.e. RBC, hemoglobin, hematocrit.

      JP says June 22, 2016

      Another question – how often should I check my iron level? Quarterly?

        P. D. Mangan says June 22, 2016

        Unless it’s very high and you’re getting a lot of phlebotomies, annually would be often enough.

        PS: That’s all in my book.

A says June 19, 2016

Persuaded by your posts and book on this topic, I’ve been monitoring iron for several months now. Consumption of tea/coffee/red wine during meals didn’t have a significant impact on my ferritin levels. Nor, surprisingly, did blood donation.

IP6, however, has significantly impacted my ferritin levels: taking 2000 mg daily for 7 weeks reduced my ferritin levels from around 200 mg/L to 120 mg/L. TIBC within normal range throughout. However, in the same period my serum iron level rose from 30 umol/L to 35 umol/L while transferrin saturation rocketed from 50% (within normal range) to 130% (way outside normal range).

Reading research and reports of others posted on the internet, as well as a brief trial of IP6 earlier in the year, I expected IP6 to have this degree of impact and accordingly I was pleased. The serum iron and transferrin saturation levels, however, were a little troubling. Assuming the results are accurate, two possibilities arise, not mutually exclusive: (1) my dietary iron is too high; (2) reducing ferritin to this extent so quickly triggers counteracting mechanisms. Given what you wrote about hepcidin increasing when ferritin gets low, leading to greater dietary iron absorption, (2) is likely a factor.

I’m taking a break from IP6, in part because I want to experiment with a prolonged water fast. I’ll establish a new baseline next month or sometime thereafter and start a new trial of IP6, probably 500 mg or 1000 mg daily over a 4 month period. Hopefully a lower daily amount of IP6 will continue to reduce my ferritin levels further without significantly spiking hepcidin. I’m aiming to establish a ferritin level of 30 mg/L. Once reached, probably only a relatively small amount of IP6 will be needed to maintain that level of ferritin, perhaps 500 mg once every three days or something like that.

BTW I imagine quite a few readers of your website and books are experimenting with different interventions. Perhaps a general page/post could be created for readers to register their results and to discuss results?

    P. D. Mangan says June 19, 2016

    Thanks, A, good data to ponder.

    B says August 1, 2016

    Interesting. Did you feel any different when you started taking IP6?

Holdem17 says June 20, 2016

I had my ferritin checked 2 months ago and it came back at 195. Shortly thereafter I gave blood and had a hemoglobin number of 13.5. Last week, I donated again(double red blood cell) and my hemoglobin number was still 13.5. I assume that the ferritin number can drop over time, while the body holds the hemoglobin constant…no need to worry until there is an issue with the hemoglobin. I plan to do another double red cell donation before checking the ferritin again.

Ole says July 5, 2016

You may also want to consider adding alpha lipoic acid and acetyl-L-carnitine (ALCAR) to your daily supplements: http://www.ncbi.nlm.nih.gov/pubmed/18284845

Henry Morf says July 15, 2016

I give blood two to three times a year and my ferritin is still 112

steven says October 25, 2016

Update on Iron.
Last month, prior to reducing my animal sourced foods (Yes I know you and I do not exactly agree on this, though I believe sharing information helps everyone in the long run), I tested my Iron levels. I was eating normal meats, eggs and cheeses usually on the weekends.
Iron (ug/dl): 167 (test date 17 September 2016)

After 4 weeks, 100% plant based whole foods,
16.9 mg Iron per day average (using Cronometer, excellent site and app)
Iron: 101 (test date 19 October 2016, same clinic)

Conclusion: Iron stores can be maintained and reduced, depending on the source (plant versus animal).

    P. D. Mangan says October 26, 2016

    Steve, don’t want to rain on your parade, but are those ferritin levels? Looks like serum iron to me, and those could be expected to vary a lot more, like from your diet. But they don’t accurately reflect body iron stores.

      steven says October 26, 2016

      Spanish is Hierro Serico which google says is serum iron

Lucas says December 27, 2016

Cilantro works!!
My ferritin was 231 in the end of august, and now is 169 ng/ml!!
Serum iron was 110 ug/dl, and now is 60 ug/dl!! It is close to deficiency, since the reference range is 59 – 159 ug/dl.
Transferrin Saturation was 40%, and now is 20,7 % !! Whooo!!
What I did? Simple. 1 teaspoon of powdered Cilantro on breakfast, and 1 tablespoon at lunch and dinner, this added to the food, since I like the taste of it.
Now I will keep doing it until I reach a ferritin of 50 ng/ml. My only concern is the lower serum iron, don’t know what this mean.
So, this is my testimonial, I hope this is informative for people that have high iron to try Cilantro.
I starting chelating iron after founding this site and buying your book.
Thank you very much.

    P. D. Mangan says December 27, 2016

    Thanks for commenting, Lucas, very useful information.

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