Dear Mark: Iron Followup

Dear Mark: Iron Followup

Last week’s post
on iron levels
got a big response and garnered a ton of
questions from you guys. Today, I’m going to clarify a few things
and answer as many questions as I can. First, do iron and ferritin
levels mean different things for men and women? If so, how do those
differences manifest? What about premenopausal women vs
postmenopausal women? Second, what do we make of the fact that
ferritin is also increased in times of inflammation? Is there a way
to distinguish between elevated ferritin caused by inflammation and
elevated ferritin caused by high iron? Third, is desiccated liver a
good option for liver haters? And finally, I share some exciting
plague news.

Let’s go:

Emma wrote:

I’d love to see more info on iron levels as they relate to men
and women differently. I recently had an iron infusion for low
ferretin, not thinking much would change I actually experienced so
many positive effects I didn’t even know were coming my way.
I’m less cold, no more afternoon fatigue, less hair falling out,
no more random palpitations, improved restless leg syndrome and the
number one big change is it improved anxiety levels – in fact my
anxiety is now gone. The last two are due to a connection between
iron and dopamine. I learnt that children with mental health issues
are often treated for low ferretin where possible, elevating levels
to around 100 showing positive results (would love to see
literature on this), for me my ferretin went from 20 to 130 and its
changed my life, at 31 I haven’t felt this good in years. Yay

That’s awesome to hear. Yes, it’s important to stress the
very basic essentiality of iron. Without it, we truly cannot
produce energy. And since energy is the currency for everything
that happens in the body, an iron deficiency makes everything start
to fall apart.

As for gender and iron, there’s a lot to discuss.

A good portion of women with hemochromatosis never actually
express it phenotypically, meaning their lab tests don’t show
evidence of dysregulated iron metabolism or storage.
According to one study of
hemochromatosis homozygotes (people who inherited the mutation from
both of their parents), being a woman makes it 16x more likely that
your hereditary hemochromatosis won’t actually present as iron

Another study
found that among mostly-age-matched men (42 years) and women (39
years) with hemochromatosis, 78% of the men had iron overload while
just 36% of the women had it. Iron overload was defined as
transferrin saturation over 52% combined with ferritin levels of
300 ng/mL for men and 200 ng/mL for women.

High iron levels are more of an issue for postmenopausal
women than premenopausal women.
The latter group regularly
sheds blood through menstruation, and if anything, they’re at a
higher risk of low iron. Plus, estrogen is a key regulator of
iron metabolism
. As menopause sets in and estrogen diminishes,
that regulation suffers.

For instance:

In postmenopausal
Korean women
, high ferritin levels predict metabolic syndrome
and subclinical atherosclerosis.

High ferritin predicts metabolic syndrome in postmenopausal but
not premenopausal women

In premenopausal Korean women, higher ferritin
levels predict better bone mineral density
; menopause nullifies
this relationship.

Remember that ferritin is actually a measurable protein bound to
iron, so testing a ferritin level is technically an indirect way to
measure iron. Why is this important? Another characteristic of
ferritin (the protein) is that it is an ACUTE PHASE REACTANT. This
means that ferritin levels can fluctuate with illnesses and other
inflammatory states in the body that drive up a ferritin value that
is not related to an actual iron level fluctuation. Don’t get
ferritin checked when you are sick with a cold or other

This is a great point.

Ferritin is marker of long term iron storage, but it’s
also an acute phase reactant that up regulates in response to
inflammation or oxidative stress.

If you want to be really careful, you should get a HS-CRP
test—that measures your overall inflammatory status. If CRP is
elevated, ferritin
can be elevated without saying anything about your iron

Come to think of it, if elevated ferritin can be a marker of
inflammation and oxidative stress, the inflammation could be
responsible for some of the negative health effects linked to high
ferritin. Or, if having too much iron in the body can increase
oxidative damage, it may be that high iron levels are increasing
inflammation which in turn increases ferritin even further. Biology
gets messy. Lots of feedback loops. However, the fact that many
studies cited in the previous iron post that use blood donation to
treat high ferritin have positive results indicates that for most
people, ferritin can be, in most situations, an accurate estimation
of your iron status.

To make sure it’s an iron problem, get a transferrin
saturation test as well.
That indicates the amount of iron
you’re absorbing, with below 20% being low and over 45% being
high. People with high ferritin and high transferrin saturation do
have high iron levels. People whose ferritin is artificially
enhanced by inflammation will have normal transferrin saturation

I have one last question on this. You say “Don’t stop eating
liver every week.” If you can’t stand the taste of liver, what
do you think about taking liver capsules made from grass-fed New
Zealand beef every day instead?

That’s a great option. Go for it.

People should generally aim for 4-8 ounces of fresh liver a
week. Note the amount of desiccated liver in your capsules and
multiply by 3 to get the fresh liver equivalent, then take enough
each day (or all at once) to hit 4-8 ounces over the week. I hear
good things about
this one

Thank you for your article on HH. I carry the gene but have been
managing my iron levels through phlebotomies. I am full Keto, meat
and all and have found my iron levels have not been effected by
going Keto. Early detection is the key and ongoing monitoring.
Bring on the plague!!!

You joke about that now, but there’s a startup that’s
breeding heritage rat fleas that produce a mild strain of the
plague that evades the attention of the immune system and
proliferates throughout the body to keep iron levels in check
without killing you. I’m an early investor, have a couple swarms
installed in my condo, and (knock on wood) so far have avoided
anything worse than a sore throat and maybe a mild open sore or
two. There’s actually a big rift forming between the techs who
want to keep the fleas heritage and those who want to go ahead with
CRISPR and engineer them. One variant has had a deer tick gene
inserted that adds an anesthetic compound to the flea’s saliva.
That way you can have a personal swarm on you and never feel any
bites or itches.

I’m not sure about CRISPR
just yet, but I gotta say it’s
pretty nice to be covered in fleas and not feel the bites. Time
will tell.

Ok, I’m joking.

That’s it for today, folks. I hope I’ve answered some of
your concerns, and if not, let me know down below. Thanks for


Lainé F, Jouannolle AM, Morcet J, et al. Phenotypic
expression in detected C282Y homozygous women depends on body mass
. J Hepatol. 2005;43(6):1055-9.

Qian Y, Yin C, Chen Y, et al. Estrogen contributes
to regulating iron metabolism through governing ferroportin
signaling via an estrogen response element
. Cell Signal.

Seo SK, Yun BH, Chon SJ, et al. Association of serum
ferritin levels with metabolic syndrome and subclinical coronary
atherosclerosis in postmenopausal Korean women
. Clin Chim Acta.

Cho GJ, Shin JH, Yi KW, et al. Serum ferritin
levels are associated with metabolic syndrome in postmenopausal
women but not in premenopausal women
. Menopause.

Chon SJ, Choi YR, Roh YH, et al. Association between
levels of serum ferritin and bone mineral density in Korean
premenopausal and postmenopausal women: KNHANES 2008-2010
. PLoS
ONE. 2014;9(12):e114972.

The post Dear Mark: Iron
appeared first on Mark’s Daily Apple.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s