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 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:
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.
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.
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.
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.
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.