High ferritin: what it means and what to do

A high ferritin usually does not mean you have too much iron. More often the reason is a fatty liver, inflammation or alcohol. A few more tests help tell which.

What high ferritin means

Ferritin is your iron store. But it also rises for other reasons, for example with inflammation or a fatty liver.

To tell whether you really have too much iron, you need another test: transferrin saturation. If it is normal, too much iron is unlikely.

What causes high ferritin

The first two are the most common.

• Fatty liver: Very common. It often comes with high triglycerides or glucose and a few extra kilos.
• Inflammation or infection: Even a flu can raise it for a few weeks.
• Alcohol: Drinking often can push it up.
• Iron supplements: Taking them when you do not need them pushes ferritin up.
• Haemochromatosis: An inherited condition in which the body holds on to too much iron. It is rarer, but important to find.
• Other, rarer causes: Other liver diseases, blood disorders or cancers. That is why a very high level should always be seen by a doctor.

Symptoms

Usually none. It is almost always found by chance, on a blood test.

If there are symptoms, they come from the cause. With too much iron, for example, there can be tiredness and joint pain.

High ferritin and fatty liver

This is one of the most common combinations. Fat in the liver causes a small inflammation that pushes ferritin up, even without too much iron. It can come down when you lose a few kilos and eat better.

Which tests to read alongside it

These tests help find the cause.

What your result means

The upper end of the scale, in ng/mL.

• 30 up to your report’s limit, Usually 150 for women, 400 for men: Normal. Usually the store is enough, but inflammation can hide a low one. In the Rosa report you also see whether you are in your optimal range.
• Above your report’s limit, up to 500: High. Usually a fatty liver or inflammation is behind it, more rarely too much iron. Read it with CRP and the liver tests (GGT and ALT), and talk to your doctor.
• Above 500: Very high. It can come from serious inflammation, liver disease or too much iron. Talk to a doctor.

How to lower high ferritin

It comes down when the cause goes away. Where to start:

• After an infection, repeat the test a few weeks later.
• Drink less alcohol: it helps bring it down.
• If a fatty liver is involved, losing a few kilos and moving every day helps a lot.
• Do not take iron supplements unless your doctor gave them to you.
• What to eat: you usually do not need to cut out red meat. If there really is too much iron, your doctor will tell you what to limit.
• With haemochromatosis the treatment is decided by a doctor: usually a little blood is taken at regular intervals.

When to worry

Talk to a doctor if:

• Your ferritin is above 500.
• Your transferrin saturation is high too.
• It stays high at the next check.
• You feel very tired, have joint pain or lose weight for no reason.

With Rosa, a ferritin above 500 is always flagged to a doctor.

Frequently asked questions

Slightly high ferritin: should I worry? Usually not. It often comes from alcohol, weight or a recent infection. Repeat the test once you have dealt with the cause.

Ferritin at 500: what does it mean? It does not have to mean anything serious, but you need to find out why. With Rosa, above 500 the result is always flagged to a doctor.

Is high ferritin dangerous? Not by itself: it is a signal. What matters is the cause. If there really is too much iron for years, it can damage the liver, heart and joints.

Can I eat bananas, pasta and bread with high ferritin? Yes. They have little iron and they are not the problem. What helps is less sugar and alcohol, and more vegetables, legumes and fish.

Does giving blood lower it? Yes, but it only helps if there really is too much iron, and a doctor decides. If the cause is a fatty liver or inflammation, it does not solve anything.

Sources

• British Society of Gastroenterology, guidelines for iron deficiency anaemia in adults. Gut, 2021. PMID 34497146
• EASL clinical practice guidelines on haemochromatosis. Journal of Hepatology, 2022. PMID 35662478
• World Health Organization, guideline on the use of ferritin to assess iron status. Geneva, 2020. ISBN 978-92-4-000012-4