Why do I have high iron saturation and low ferritin?

The number one question I receive in regards to iron is this:

My iron and/or my iron saturation is high but my ferritin is low and I have all the symptoms of iron deficiency. What should I do?

Should I just discount the high iron and keep pumping iron supplements until my ferritin comes into optimal range?

Should I stop my iron supplements because I am becoming iron toxic?

Do I have hemochromatosis?

Lab markers to get checked:

Serum iron
Iron saturation
TIBC
Ferritin

Rarely does zeroing in on one marker paint a complete picture of iron status and metabolism.

Factors that may contribute to high serum iron:

Low B12
Elevated lead
Oral contraceptives
Estrogen therapy
Cortisone therapy
Estrogen dominance
Liver or kidney issues

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*The information, including but not limited to, text, graphics, images and other material contained in the video are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

[DrWholeness]

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[robeeenz]

I went to 12 doctors that didn’t know what ferritin was in 2021. 12. I was dying and begging them to test it. They refused. I lost faith in western medicine and study on my own to stay healthy. I am so happy there are people like you talking about it.

[tamaraish]

Wow! I have had severe B12 deficiency going on eight years now and no one has ever been able to figure out my high levels of saturated serum ( iron)and low ferritin. What a blessing this has been to find your video.🙏🏼🙏🏼🙏🏼😂

[feather]

My ferritin is 10. This video didnt really answer how to transfer serum iron into ferritin stores. Please advise.

[shinola]

I just donated blood and did not know I need B6 and B12 to replace my hemoglobin. So thanks for making this video. The donation center should put this on their discharge paper.

[Akabane]

I am in extreme fatigue since months now. Had my doctor check my blood. My ferritin was very low but because my iron was high my doctor said "oh you have too much iron actually!"

Now after your video I finally know what's wrong and can treat myself. It's 2024 and my doctor didn't even consider mentioning my ferritin being 13. And in addition I have fatigue symptoms.

I am so so thankful for your video. It's so hard to find a good doctor sometimes. So many don't know anything I have learnt sadly

Thank you so much for helping me

[stanlevox]

For the kiddo, I take 4oz of liver and blend it with 4 pasture raised eggs. Turn it into an omlet, about 4 times per week for about a year now. Sometimes I'll also add in additional cow honeycomb tripe with organic apple peel powder and/or lions mane mushroom powder to make it more solid of an omlet, texture-wise. I know that eggs can inhibit iron absorbtion a bit and this lowers once cooked, but I'll still supplement with a tiny bit of iron glycinate. With the iron glycinate I'll usually give that every other day as the ferritin hormone(s) spikes for awhile.

Otherwise methylated bcomplex. A bottle last forever for a child because you don't need anywhere near a whole capsule. About 1mg of copper as it's a cofactor for iron utilization in the body. Also used some asorbate (not ascorbic acid) couple times a week which seemed to make a big difference. Though I know with C its kinda a careful balance to avoid too much, so I base it off how much liquid consumption it being a water soluble vitamin. Also you can take an 4-8oz steak and blend it right up into an omlet works bout the same as liver, I reccomend starting off small and working up over the course of 2 months if they're a picky eater and getting a magic bullet or a vaccume blender.

Un related iron stuff:
Since at least I find it difficult to get the youngster to eat seafood. With milk, I'll add 3 grams of taurine at night along with nordic naturals fish oil and magnesium glycinate at night. Also I include 40mg pqq, and 24mg of astaxanthin and a table spoon of organic sunflower lecthin liquid to provide the Phosphidyl Choline and Phosphidyl serine. 3mg of boron. DIM (Diindolymethane) about 10mg-20mg so once again a bottle last forever, this is to prevent estrogen spikes which estrogen will start to fuse bone structure so less is more with DIM because we don't want the bones to fuse and end up short statured. If urine is dark like dehydration then dose is a bit too high for the kiddo. Also supplement with rhodiola and a tiny bit of l theanine to off set stress hormone cortisol.

The macros are always important so 1/2 cup of Pistachios per day, less lectins in these types of nuts and less falates that will potentially bind to iron. Lots of grass fed butter and real olive oil. Beta carotene rich foods to increase iron absorbtion even if it's just simply carrots and aliced bell peppers. Anyway, my 2 cents.

[lisaeccles]

This is clear as mud.
Ferritin 2 for over 2 months.
Iron dropped from 38 to 17.
The binding increased to above normal.

[Winterheart]

Wow, soooo amazing explanation. Doctors dont say anything. It's just yes or no. It is good to educate patients like this. I want to be able to take care of myself too.

[vimalneha]

Very good information.
Hardly any doctor in Munich knows any of points you raised. That is why i am investigating this for my daughter...

[CloD]

I suffer from hemochromatosis and I have a carrier gene . I control how much iron I take specially red meat . My recent blood test came back as 239 Tibc and 52 total iron saturation …. My b12 was very low that I needed b12 injections 4-6 weeks and vitamin d . I had a skin infection which was causing my levels off also . Great video and info … you hit the spot and makes me see you really know what you’re talking 👏👏.

[daviddavid]

How can that be that my hemoglobin is high - 16.5 and feritin is low - 35! I often feel exhausted and sleepy, especially after a meal! What can I do about it? (I am on trt) Thanks in advance!👍🏻

[LM-clys]

What are your thoughts on lactoferrin supplements?

[VikingsFan-iukq]

what causes low iron saturation and normal Ferritin levels ?

[ferminromero]

No mention of copper and Vitamin A (retinol ) deficiency impact on iron metabolism and recycling. Modern food supply delivers toxic levels of iron filings. No mention of iron biology and chemistry. Naive, narrow look into this subject.

[pinkheart]

What would cause a higher red cell count but low normal hemoglobin with a ferritin of 5?

[vornamenachname]

There is also one problem not mentioned here: intracellular iron overload. (most likely due to genetic problems with converting iron into ferritin)
This is often not talked about but this "uncoupling" of iron and ferritin has been shown to be a predisposing factor or to at least correlate with migraines, schizophrenia and certain types of dementia. And the thing is that meassuring the actual amount of intracellular elemental iron (non-transferin-bound and non-ferritin-bound iron) is quite hard/expensive.
One should keep that in mind. I do suffer from migraines from time to time, have a mother with schizophrenia, am compound heterozygote for hemochromatosis and have genes for heamolytic aneamia and when I received some vitamin C injections, both times I was sick for one week with symptoms of schizoaffective disorder which I never had otherwise.
Basically, I was bumping into objects while walking, could not speak properly and had a flat affect followed by depressive mood swings and "having the urge to destroy everything around me" - which I never did. Both times, it went away after 5 days on its own without any medication but I did not take a third vitamin C injection...
So it's always good to ask for family history of diseases and read into their relation to iron metabolism before acting and taking any kind of supplement.

[gracygrace.mp]

Hi, Dr. Angove! This video really helped me. Do you know what the normal ferritin range is? I used to have H. Pylori and my ferritin was at a 1 before antibiotics and iron infusions. I was feeling a bit better for many years but began to slowly feel ill again. I went to a different doctor 2 years ago and my ferritin level was at a 12 while my iron was at 61 ug/dL and my saturation was at 16%. I was told I was fine and to keep taking iron, which I did. I switched between 65mg per day to taking multivitamins that only contained 18mg, and then alternated and didn't feel much of a difference in my energy. Their standard ferritin range was between 6 to 137. I kept feeling bad and tried many supplements to feel better but nothing worked, and I felt like I was not being heard at this doctor because my bloodwork was normal. So I tried to find solutions on my own. But it's 2 years later, and I could hardly wash my hair recently, so I went to a different doctor this week. My iron level is now at 73 mcg/dL and my saturation is at 20%, so I guess that improved? But my ferritin is now an 8. I am confused because this new clinic's standard ferritin range is 16 to 154. Why do different clinics have different standard ranges? Which is correct? I feel that at my old clinic I would have had to get more and more exhausted until I was taken seriously. Or maybe I am not understanding their process well, so I will forgive it. I am always grateful for my doctors. I have had hair loss since 13 years old and joint pain, and I wonder if this is genetic? My sister also has hair loss and anemia runs in my family, as well as hair loss. I will bring up the points in your video to my doctor this coming week and see what she thinks. She is so kind and took me seriously. I hope all goes well. Thank you for your video! I really appreciate it!

[AndreaBakacs]

Hello Dr Matt!

Complex one here! Can't wait to hear your thoughts. Here is my most recent:

Iron Total 185
Iron Binding Capacity 294
*Ferritin 22 (chronically low)
Saturation 63 (chronically high)
WBC 6.1
RBC 4.07
Hemoglobin 12.6
Hematocrit 37.4
MCV 91.9
MCH 31
MCHC 33.7
RDW 12.9%
*Platelet Count 150 (getting lower)
*MPV 14.4 (always high, always, on every test)
*B12 >2000
MMA 111
Vit D 60
Homocysteine 6
hsCRP .9

I have 12 methylation mutations, 12. Nightmare to figure out. I do supplement with hydroxycobalamin after being on super high doses of methylcobalamin as I was told by Genova on my NutrEval last year I was super overmethylated (was also taking TMG.) I also supplement with P5P. I do not have elevated lead, but I do have elevated mercury which could be displacing iron from bones?

I've watched your videos, other videos, read quite a few papers, and joined the FB group "Iron Deficiency with or without Anemia.) From everything I've gathered, it's one of 2 things: Iron deficiency without anemia (hypoferritinemia) OR early life hemochromatosis. Both have low ferritin and high saturation. In the former, when ferritin levels drop below 25, the liver will often compensate by synthesizing more transferrin which leads to a pooling of iron in the blood and increased serum iron levels in the face of iron deficiency. This occurs when there’s an iron deficiency. In the latter, the defect in hemochromatosis is that when the short-term storage, transferrin, starts getting fuller than usual, you don't notice it, so you don't stop absorbing iron from food that makes the transferrin saturation go up even further. But you don't shuttle the iron into ferritin. That makes ferritin lower. So which is it?

I have been tested for the most common HFE variant. I'm told to diagnose I'd need HFE C282Y/H63D with YY/DD. I have CY/HH. So I do have one missense copy. But I'm also told this type is not associated in any study with iron overload. It is homozygous, so the yy/dd, or two heterozygous, so cy/hd .. the HH variant I have is considered a "neutralizing agent" for the variant, meaning, if the HH is present, the other variant even if yy would not express. And my hsCRP is within normal range too. I am not on HRT.

Would absolutely love your thoughts please! Thank you so much in advance!!

[rebecagaldon]

Hi Dr.!
You keep mentioning high serum iron but don't mention iron saturation which is a different lab test and I was hoping to find some answers in this video. My ferritin in 35, serum iron 110 and iron saturation is 36%. I want to supplement with iron to improve my ferritin levels, since I suffer from fatigue, hair loss, muscle/joint pain...and my other lab markers are fine. However, I am worried about my iron saturation, why would my iron saturation be high? last Spring it was over 50. I stopped my vit c supplements and it looks like it went down a little, but my ferritin keeps being low. Should I still supplement with iron?Ah ! my B12 is great, 700.