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The Importance of Comprehensive Iron Testing for Health

Ferritin is a frequently assessed blood marker for iron levels, yet its scope of information is limited in assessing overall health. Continue reading to explore additional markers that are essential for obtaining a comprehensive evaluation of your iron metabolism and deficiency status.



As a Registered Nutritional Therapist, my clients frequently present me with GP blood test results containing ferritin. They might express concerns about enduring fatigue, hormonal disruptions, autoimmune conditions, or gastrointestinal problems. Although ferritin serves as a useful indicator of iron reserves, it does not provide a comprehensive understanding of how your body utilises iron.




What is iron, and why are adequate levels so important?


Iron is an essential mineral that plays a crucial role in various bodily functions. It is a key component of haemoglobin, the protein in red blood cells that carries oxygen from the lungs to the rest of the body.


Adequate iron levels are important for:


  • maintaining energy levels

  • synthesising hormones

  • a proper functioning immune system

  • producing enzymes for digestion

  • synthesising DNA

  • detoxification



Is ferritin different from iron?


Ferritin is not an iron molecule, but rather a protein that stores iron in various tissues, such as the liver, spleen, and bone marrow, and releases it when necessary. Elevated levels of ferritin usually indicate a surplus of stored iron, while low levels suggest a deficiency.


However, ferritin also acts as an acute-phase reactant, meaning its concentrations can increase in response to inflammation or infection, regardless of iron levels. This variability can make ferritin levels unreliable in certain situations. For instance, individuals with anemia caused by chronic disease may exhibit normal or high ferritin levels, despite low iron levels. Conversely, high ferritin levels can be observed in individuals combating an active infection, even though their overall iron levels may be low due to other factors.


Ferritin alone therefore offers a limited view of the body's overall iron metabolism and regulation. To gain a more complete understanding of iron dynamics, it’s essential to look at serum iron, total iron-binding capacity (TIBC), and transferrin saturation (%) as well.






Which iron markers should I request?


Serum iron

When it comes to serum iron levels, it is crucial to understand the delicate balance required for optimal health. Iron plays a fundamental role in various physiological processes, such as oxygen transport, energy production, and DNA synthesis. Therefore, monitoring serum iron levels provides valuable insights into the body's iron status.


Low serum iron levels can be indicative of iron deficiency, a common nutritional disorder that can lead to symptoms such as fatigue, weakness, and impaired cognitive function. On the other hand, elevated serum iron levels may signal underlying health conditions like iron overload or haemolytic anaemia, which can have serious implications if left unaddressed.


Excess iron in the body can have detrimental effects on cellular function. Just like a rusty pan, where iron oxidises upon exposure to oxygen, excess iron in the body can lead to the production of harmful free radicals. These free radicals can wreak havoc on cellular components, causing oxidative damage to proteins, fats, and even DNA. It is therefore equally important to understand what might be causing elevated iron.


Total iron binding capacity (TIBC)

When evaluating total iron-binding capacity (TIBC), we delve into the intricate mechanisms of how your body binds and transports iron. This process is crucial for maintaining optimal iron levels in the body, as iron plays a vital role in various physiological functions.


High TIBC levels can be indicative of iron deficiency, a condition that can lead to fatigue, weakness, and other health issues. On the other hand, low TIBC levels may signal iron overload, which can have its own set of complications.


Transferrin Saturation (%)

Transferrin saturation reflects the amount of iron bound to the transport protein transferrin in the blood. Low transferrin saturation levels can indicate iron deficiency, even in the presence of normal ferritin levels.


By considering a combination of these markers alongside ferritin, we can gain a more comprehensive understanding of your iron metabolism and deficiency status.


"I am so happy I scheduled a consultation with Nicola. From beginning to end she was so helpful informative friendly and really interested in how she could help me." - Fatigue client


What are some typical iron imbalance patterns?


Iron-Deficiency Anaemia:


  • Low ferritin, reflecting depleted iron stores

  • Low serum iron, as there’s insufficient iron in circulation

  • Elevated TIBC, as the body increases transferrin to enhance iron binding

  • Low transferrin saturation, indicating a deficiency in available iron


Anaemia of Chronic Disease:


  • Normal or elevated ferritin, despite low iron stores, due to inflammation

  • Low serum iron, as iron is sequestered and unavailable for use

  • Normal or low TIBC, as transferrin production decreases during the acute-phase response

  • Low transferrin saturation, similar to iron-deficiency anaemia, but driven by inflammation rather than a lack of iron


An Acute Phase Response:

  • Elevated ferritin, due to inflammation

  • Low serum iron, as iron absoprtion (via hepcidin) is reduced

  • Low TIBC, as transferrin production decreased

  • Low transferrin saturation, similar to iron-deficiency anaemia, but driven by inflammation rather than a lack of iron


Iron Overload Conditions (e.g., Hemochromatosis):


  • High ferritin, reflecting excess iron stores

  • Elevated serum iron, due to excessive absorption or release from stores

  • Low TIBC, as the body down-regulates transferrin production

  • High transferrin saturation, as there’s more iron than the body can handle




What are some possible reasons for iron imbalances?


Iron imbalances can occur due to a variety of factors, both related to dietary intake and internal bodily processes. One common reason for iron imbalance is inadequate dietary intake of iron-rich foods, such as red meat, poultry, fish, and leafy green vegetables. Vegetarians and vegans may be at a higher risk of deficiency due to the lack of heme iron found in animal products. On the other hand, excessive consumption of iron supplements or fortified foods can lead to iron overload, potentially causing toxicity in the body.


Certain medical conditions can also contribute to iron imbalances. Chronic diseases like inflammatory bowel disease (IBD) or coeliac disease can impair the absorption of iron in the intestines, leading to deficiencies. Menstruating and pregnant women also have higher iron requirements, and if these needs are not met through diet or supplementation, they may develop iron deficiency anemia.


Genetic factors can also play a role, and conditions like haemochromatosis, a hereditary disorder that causes the body to absorb too much iron from the diet, can result in excess iron accumulation in organs like the liver, heart, and pancreas.


Finally, it is possible that without adequate vitamins B6, folate and B12 then the haemoglobin in red blood cells is not formed correctly, and this can lead to serum iron being elevated. To determine if that is the case, I review Red Blood Cell markers as well to provide the complete picture.


Overall, understanding the various reasons for iron imbalances is crucial in maintaining optimal iron levels for overall health and well-being. Regular monitoring of iron status through blood tests can help identify and address any imbalances effectively.


"I have worked with many nutritionists over the years and Nic is the best! She's so knowledgeable, provides clear advice and easy to understand explanations and has really gone above and beyond to support me and my entire family. Highly recommend! - Perimenopause client



Did you find this helpful? Leave a comment below and let me know what you think. Comprehensive blood testing is the only way to really assess your iron levels, I use Functional DX Ultra in my practice in order to comprehensively assess health to include iron, liver, digestive and immune function as well as a Complete Blood Count.



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1 Comment


nic.simon.vaughan
Oct 08

Added by Nicola Vaughan... Post note, if serum iron is elevated but also there are irregularities in complete blood count (decreased RBC, decreased HGB or HCT), then consider that there may be an IRON CONVERSION problem, i.e. an issue with taking inorganic iron found in serum, and putting it into the haem molecule in RBCs. So then, consider that there may be an additional need for B12, folic acid, B6 and perhaps also copper.

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