The Normal Value for Iron and Why It Matters

Iron is stored in the body in the protein ferritin, which is considered the best measure of body iron stores. One of the most important aspects of my book Dumping Iron is that the laboratory normal ranges for ferritin are wrong, particularly the upper limits. Let’s take a look at the normal value for iron and why it matters.

Normal lab values

Clinical laboratories calculate a normal range for any given substance of interest by running tests on a large number of apparently healthy people and constructing a range, from high to low, such that the values of 95% of these people fall within the range.

For example, the normal range for fasting blood glucose is 72 to 108 mg/dL. (Ranges may vary somewhat between labs.)

“Apparently healthy” is the key here, since lab values are calculated for fat, sick people. Over 70% of the population is overweight or obese, and a large fraction of them have pre-diabetes or undiagnosed diabetes.

If you care about your health, you shouldn’t just accept what the lab – and the doctor – say is normal.

Personally, I don’t want to be normal. The norm is overweight/obese, out-of-shape, depressed, sugar-addicted. (Not to mention in front of the TV for 8 hours a day.)

For ferritin (iron), here’s what mainstream medicine (the Mayo Clinic) says is normal:

 

For men (the main audience of this website), the Mayo Clinic deems up to 500 ng/ml ferritin to be normal. In practice, that means if you’re tested, have up to 500 ng/ml, your doctor will tell you that you’re fine, no cause for worry.

Yet a ferritin that high puts your health at risk.

Healthy ferritin values

In my book, I stated that a healthy ferritin level for men may be around 50 to 80 ng/ml. I based that range on many scientific studies, both epidemiological and clinical, that showed that health risks rise when ferritin is higher. As for the lower limit, below that may cause iron deficiency, although usually the value would be well below that in deficiency.

How can we better calculate a healthy ferritin range?

One way to do that is to look at ranges associated with hemoglobin, the blood molecule that carries oxygen. The body tightly regulates hemoglobin and uses available iron to make a sufficient amount; when it reaches a sufficient amount, the body stops adding to it (though it still makes enough to satisfy normal turnover of red blood cells), and excess iron is stored as ferritin.

Leo Zacharski, M.D., who wrote the preface to my book, and colleagues, just published a study looking at this issue: Ferritin and percent transferrin saturation levels predict type 2 diabetes risk and cardiovascular disease outcomes.

Hemoglobin values associated with ferritin up to 80 ng/dl of ferritin. Values for ferritin above 100 ng/ml were associated with increased risk of type 2 diabetes and cardiovascular disease.

That means that some people may need up to a ferritin level of 80 to have a full complement of hemoglobin. Beyond the level of 80 to 100, there’s no increase in hemoglobin, but there is an increase in disease risk.

Data presented in Fig. (1) suggest that ferritin levels approximating 80-100 ng/mL represent an upper normal limit of physiologic levels of body iron as related to corresponding hemoglobin levels. Ferritin levels over the 80-100 ng/mL range appear to lack physiologic correspondence with hemoglobin levels. Thus, normative values for the serum ferritin may range from the commonly accepted lower limit of less than about 15 ng/mL to an upper limit of about 80-100 ng/mL as observed in this study. This threshold ferritin level coincides with levels associated with increased T2D risk observed epidemiologically [13] as well as adverse outcomes observed in clinical trial data [17, 21]… 

The revised normal ranges for these biomarkers of iron metabolism suggested here bear striking resemblance to other estimates of disease risk in relation to increasing ferritin and %TS levels. Population mean ferritin levels vary considerably by age, race and sex while %TS levels appear to be relatively stable [20, 21, 27]. Mean ferritin levels up to approximately 60-70 ng/mL in the late teens in males and females associate with low disease risk [17, 23-25]. Population levels in males increase at a rate of about 4 to 5 ng/mL per year and plateau at a mean of about 140-150 ng/mL associated with increasing disease risk by middle-age [20]. Cross-sectional measures of ferritin decline gradually with increasing age to range at about 80-100 ng/mL suggesting that such lower levels select for greater longevity [20, 24, 25] as illustrated in CSP 410 outcomes data [17]. Low risk mean ferritin levels below about 50 ng/mL in premenopausal women rise after menopause to plateau at approximately 80-100 ng/mL about 30 years earlier in women compared to men [20]. The increase in ferritin levels above this threshold associate with increased post-menopausal disease risk in women [46]. Occurrence of ferritin levels in this range at an earlier age in women correspond to their increased risk for T2D above this threshold [13]. Higher ferritin levels relate to increasingly impaired beta cell function, insulin resistance and metabolic abnormalities characterizing diabetes [5, 47, 48].

Ferritin levels below about 80-100 ng/mL relate to minimal disease and maximum longevity observed in other studies [17, 20, 22-25]. Individuals in the elderly Framingham Heart Study cohort having a mean age of 75 (age range 68- 93) but lacking a clinical disease diagnosis had mean ferritin levels of 86 ng/mL whereas members of the same elderly cohort having a clinical disease diagnosis had a slightly higher mean ferritin level of 94 ng/mL [22]. … Data from a cohort of males from the Mediterranean region of Europe over age 80 having relatively low morbidity and mortality had mean ferritin levels of 68 ng/mL [23]. These levels were significantly lower than levels found in a male population of similar age from The Netherlands having significantly greater morbidity associated with mean ferritin levels of 137 ng/mL….  Residents of the Mediterranean region are known to have a lower risk of T2D [49], vascular disease and malignancy [23]. These estimates resemble NHANES III data showing a similar pattern for ferritin levels in freeliving older age individuals [20].[My emphases.]

Conclusion

Ferritin (iron) values above the level of 80 to 100 are associated with disease. Healthy individuals and populations have ferritin values below this level.

Laboratory normal values for ferritin include many people either at risk to their health or with hidden illnesses. If you want to be as healthy as possible, your ferritin should not be in the triple digits (100 and up), but below that.

PS: For the complete guide to controlling iron for health, see my book, Dumping Iron. While you’re at it, check out my latest book, Best Supplements for Men.

PPS: Check out my Supplements Buying Guide for Men.

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Leave a Comment:

29 comments
Randall Parker says May 20, 2017

Do you know anything about the rate of ferritin drop per milligram level of daily aspirin?

Reply
    P. D. Mangan says May 20, 2017

    No, I don’t think that’s known and would vary a lot depending on the individual and other circumstances. What is known is that long-term aspirin users have lower ferritin, from 20 to 50% lower.

    Reply
James says May 20, 2017

High serum ferritin correlates with suboptimal health outcomes.

But is serum ferritin the cause of poor health … or the consequence of poor health?

If the former, reducing serum ferritin is key to good health (assuming reductions in serum ferritin also reflect reductions in overall body stores – another issue to think about further).

If the latter, reducing serum ferritin levels will not improve health.

I’m betting on the former … but do you have any research at hand that points more towards a causal relation between serum ferritin and poor health (rather than just an association)?

Reply
    P. D. Mangan says May 20, 2017

    Yes, I noted that research in my book. Phlebotomy improves insulin resistance, decreases cancer risk, and decreases gout attacks. Also, prospective studies of blood donors found they have better health, even when factoring in the healthy donor effect.

    Reply
al becker says May 20, 2017

Thanks. I will keep this in mind.
I donate blood regularly, about 4 times a year, and they test for iron levels before each donation. I am slightly above the minimum required to donate, so I guess that’s fairly healthy.
Especially considering what you wrote about “normal” ranges.
All best regards, Al

Reply
    P. D. Mangan says May 21, 2017

    Hi Al – just one thing: keep in mind that blood banks do not measure iron or ferritin levels of donors. They measure hemoglobin, and then always say that it’s iron. When they say that, it’s false, and I think they have to know it’s false. The nurses or assistants either don’t know the difference or think that donors won’t understand, so they “simplify” by making up a story. Hemoglobin and ferritin are completely different.

    Reply
Bill says May 20, 2017

Hi PD, I was talking with my son & his girlfriend a couple of nights ago. She is a clinical pharmacist working with cardiologists and heart transplant surgeons at the Alfred Hospital in Melbourne. One of the largest public hospitals in Melbourne. We got around to talking about ferritin blood levels. Even at that level of expertise there is an unawareness of this issue and the leading edge research by people like Zacharski..

And so I forwarded a link to a search of your website, re Iron levels in the blood to her by email. Maybe she will check out what you have written and the scientific research on which these articles are based.

And today you have published this article ! Great work !

Reply
    P. D. Mangan says May 21, 2017

    Bill, thanks for doing that, hopefully the word will spread. Usually the first reaction from people medically-educated people is incredulity – but, minds can always change!

    Reply
The Normal Value for Iron and Why It Matters says May 21, 2017

[…] post The Normal Value for Iron and Why It Matters appeared first on Rogue Health and […]

Reply
Jrm says May 21, 2017

Do blood banks track outcomes of the donated blood? Presumably, blood from frequent donors and women would be better than blood from 1st time donors and men. Because the formers have lower ferritin levels.

Reply
    P. D. Mangan says May 21, 2017

    They don’t routinely track, but it is always known which particular units of blood go to each patient. In case of a transfusion reaction for example that can’t be otherwise explained, they may want to track who the donor was, or in case of transmitted disease (rare these days). However, red blood cells have virtually the same amount of iron no matter the donor; first time donor or habitual donor makes no difference, and routine transfusions use RBCs only. The point of donation for the donor is that he (or she, of course) uses his own body iron stores to make new RBCs, hence his ferritin declines. No difference for the recipient though.

    BTW, the age of the unit of blood definitely does make a difference for the recipient. Blood older than 35 days is associated with worse outcomes for the recipient. (Blood has a theoretical outdate of 42 days.) I wrote that up here.

    Reply
Ole says May 22, 2017

I wonder what other systemic effects to expect from this mitochondrial targeted iron chelator?

https://www.ncbi.nlm.nih.gov/pubmed/27109868

Reply
    P. D. Mangan says May 22, 2017

    Very interesting paper, thanks. If that compound turned out to be systemically non-toxic, I think it could have huge potential.

    Reply
Ole says May 22, 2017

…and again the usual challenge between deficiency and overload.

Reply
Nick says May 25, 2017

Does your book cover the other iron panel values? Specifically % Trans Sat. Cheers, Nick.

Reply
    P. D. Mangan says May 25, 2017

    Hi Nick – no, it doesn’t. As Dr. Zacharski notes in his paper, transferrin saturation stays within a relatively stable range, and ferritin is considered the best measure of body iron stores. Beyond that, I feared getting too technical when writing it, so I wanted to keep things as simple as possible.

    Reply
      Nick says May 25, 2017

      Hmm, I’m trying to reconcile puzzling results from an old test: ferritin 52 and %TS 55. According to your info and Dr Z’s paper that ferritin looks good. Does the high TS override that?

      Reply
        P. D. Mangan says May 26, 2017

        A low ferritin is indicative of low/normal body iron stores, but beyond that, I don’t think I can comment on individual lab results.

        Reply
Bill says June 4, 2017

PD, I have no idea if you know this link but it has an article about the damaging effects of high iron ferritin blood levels .. Conforms all you say in your Iron book an dmore some

http://knowledgeofhealth.com/dense-iron-copper-induced-blood-clots-linked-to-brain-eye-heart-diabetic-diseases/

Reply
    P. D. Mangan says June 5, 2017

    That article discusses the work of Etherisia Pretorius, which I’ve read a lot of and is very interesting. Together with Douglas Kell, they shown how iron and bacteria could be responsible for many manifestations of disease. I’ve written about it: hypercoagulation 1, hypercoagulation 2.

    Reply
Nick says June 10, 2017

Just bought Dumping Iron the other day and am nearly through it. Great stuff. I may order print copies as gifts for my parents.

What about migraines? A cursory google suggests both high and low iron might correlate to migraine headaches. I’m not ashamed to admit I suffer from them sometimes, even though it’s commonly thought of as a woman’s affliction. (I inherited them from my dad.) I ask, because I just came down with a very slight one today.

I believe I’m going to go get my blood checked for insulin, testosterone, and ferritin. This means I have to find a doctor though. I’ve never, ever had a regular GP doctor as an adult.

Reply
    Allan Folz says June 10, 2017

    Hey Nick, I’ve never had a GP either.

    Unless you have some nice insurance through work, you can DIY blood tests for cheaper than a doctor visit if you can catch ’em on sale. Life Extension, which I think Dennis has an affiliate link somewhere, has them 50% off through this weekend, so unfortunately you have to pull the trigger fast.

    FWIW, I did a bunch of reading through the fine print on all their tests and my recommendations for metabolic health markers at least (if you’re trying to diagnose headaches that’s a different deal, might try the CHECKD tab in the header-banner) are either the “Weight Loss Panel Comprehensive” for $206 or “Healthy Aging Basic” for $112.

    Good luck.

    Reply
      Nick says June 11, 2017

      Thanks Allan, but I live in Germany, so I don’t know about whether self-tests are available here…they might not be allowed. In any case, we’ve got great insurance through my wife’s work, yes. The health insurance system here is split 80/20 between public-supported and private. We’ve got private, which means we get priority in appointment-making and also going to specialists basically whenever we want, without needing a referral. It costs more, on the order of what we used to pay in the US for good insurance. I must be like the conservative govt’s wet dream: paying for premium private health insurance and then NEVER using it.

      Anyway, I will look into the online offers. There is a sports medicine clinic in town here that would probably measure all my performance stuff like VO and body fat too.

      The migraines…been having them since I was 18 or so, much less severe these days, also less often, once or twice a year at most vs. every few months back then. My dad says they got milder for him too and eventually went away.

      Reply
    P. D. Mangan says June 10, 2017

    Hi Nick, I’m not aware of any link between iron and migraines. There is one between them and low magnesium though. As for blood tests, as Allan points out, you can see them all here.

    Reply
      Nick says June 11, 2017

      Thanks for the idea on magnesium. I’ve been taking 400 mg magnesium oxide (not citrate)
      http://www.biolectra-magnesium.de/sortiment/biolectra-magnesium-400-mg-ultra-direct/
      for months now, maybe a year. I eat nuts every day too, as well as berries on non-fasting days. I suspect I was not getting anything like that much when I was younger.

      Now that I’ve gotten off Propecia, I think I’m eligible to donate blood. I cut back from the daily 1 mg tab to 3 x weekly in October, then stopped completely at the end of April. The little woman says hair growth goes through a 3 month cycle, so we think the 6 month reduced rate should have revealed if things were going to change. There’s been no change. I did not consult with the dermatologist here, who checked me once for suspicious freckles (found none) and writes my prescription.

      I got on it at about 35 when my hair suddenly started thinning all over. Propecia was new back then, and Mrs had been going to a dermatologist for her own acute hair loss problem then too (long since cured…suspected iron deficiency!). Doctor thought I was the ideal candidate, with later-onset, overall hair loss, and sure enough, it stopped the hair loss outright. But then thinking more about whether I want to be messing with my hormones, as well as my hair apparently *darkening* a bit since correcting my feeding and fitness regimens last year, that made me decide to get off it.

      Reply
        Bill says June 11, 2017

        Nick Magnesium oxide is excellent for sorting constipation ( it’s sold as milk of magnesium for this purpose ) and if that is not your ‘problem’, it tends towards causing diarohea. This is what happened to my brother here with Magnesium Oxide. Since he switched to Magnesium citrate the diarohea has stopped and so have the cramps in his legs which is what he was advised to take Magnesium oxide at a Pharmacy. !

        Reply
          Nick says June 11, 2017

          Interesting…I just got magnesium “sticks”, without knowing anything about citrate or oxide. I’ve had occasional cramping in my feet recently, come to think of it, just kind of randomly. I shall remain silent on my bowels, aside from saying I don’t need a laxative. (Heavy beer drinker.)

          I’ll go see what there is for mg citrate.

          Reply
      Nick says June 11, 2017

      Ah, here’s a German self-test for €29, postage-paid envelope to send the sample in, positive reviews report a 2-day turnaround, negative ones report a 9-day one. I may go for this.
      http://tinyurl.com/eisenblutselbertesten

      Of course, the marketing is all about determining if you suffer from the dreaded deficiency (Mangel).

      Reply
        Nick says June 18, 2017

        So I got that in the mail. It came with two little one-use lancette thingies, and using both of them…couldn’t get pricked enough to draw more than about a drop and a half of blood. So no where near enough to fill the vial. 29€ wasted.

        I had the little woman prick me with a needle, and that got a bit more, but still…I shall simply have to go to the doctor and get a proper blood test done. And I plan to give blood on Tuesday. They said on the phone that my being off Propecia for 2 months should constitute no problem.

        Could be that I just have low blood pressure. I get really cold fingers in winter, and sometimes get tingling & numbness in them.

        Reply
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