00:04
Hey everyone, it's Mikki here. You're listening to Mini Mikkipedia. This week I wanna chat a little bit about high ferritin. So last week I sort of went into a little bit of depth in and around the hypothesis or health consequences of low versus high ferritin as two different, I'd say theories would sort of posit it. This week I wanna talk about what actually happens if you do have high ferritin.

00:33
as in the ferritin that is high enough to increase your risk of certain things and we'll work through that. And then what to do about it because of course the cause of the high ferritin is going to dictate first steps and the trajectory of what you're actually going to do to help resolve it. first of all, course, ferritin matters. It's a storage marker of iron. And so it isn't just a marker of deficiency.

01:01
or excess because there are things like inflammation that can bind and store your iron but you can't necessarily use it. High ferritin, however, is increasingly common in metabolically unhealthy individuals. So these are people who may have high blood sugar, be diagnosed with type 2 diabetes, have markers that reflect insulin resistance, high triglycerides, etc. Can also be an issue with

01:30
people taking supplements, both athletes and non-athletes, or high ferritin is increasingly common and is aligned with people who have inflammation. There is a difference between high ferritin from an overload of iron and iron storage versus high ferritin from inflammation. When you've got high ferritin, which just for context, what is considered high ferritin in women, anything above 150 to about 200

01:59
micrograms per litre is often flagged as elevated in the functional doctor space. don't necessarily think this is the case in just general sort of practice. Over 300 is considered high, particularly if a woman is menstruating, but certainly even if she is not menstruating. And over 500 micrograms per litre does suggest potential iron overload or significant inflammation. Similarly with men,

02:25
Over 300 micrograms per litre is considered borderline high, albeit in my practice I would suggest that that is quite high. Between 400 micrograms per litre is considered high. That's 400 to 500. And then over 800 to 1,000 is strongly suspicious for iron overload or chronic inflammatory state. So when you are considering your ferritin level,

02:53
you want to assess it against different markers to understand better where the high ferritin is coming from. And if you have high ferritin from inflammation, you're also likely to see this in your C-reactive protein, which is a systemic marker of inflammation, but also liver enzymes as well. So liver enzymes are commonly elevated with high ferritin when it is a marker of inflammation. And the first one is ALT.

03:20
alanine aminotransferase, and this is the most sensitive marker for liver injury actually. And it is often elevated in metabolic associated fatty liver disease. And elevations are usually mild to moderate, but if you have an elevated ALT plus high ferritin, this is a red flag for metabolic inflammation. If you look at AST, which is aspartate aminotransferase, this is less liver

03:46
specific than ALT because it's also found in muscle and other tissues and it can be elevated alongside ALT. If AST is greater than ALT, it may indicate more advanced liver disease or alcohol related damage. If you have elevated GGT, which is gamma glutamyl transferase, this is a sensitive marker of oxidative stress and liver congestion.

04:12
It's often elevated before ALT or AST, especially in early metabolic liver dysfunction. And it can often go up with excess alcohol, high iron, or xenobiotic overload. And what I mean by that is just a poor detox capacity. And then just to sort of close this loop, ALP, alkaline phosphatase, is less commonly associated with ferritin related inflammation.

04:37
and it's more reflective of say bile duct issues or bone turnover, though it can be mildly elevated in fatty liver. But a key pattern to watch as it relates to ferritin is if ferritin is high, you want to consider high CRP or you may sometimes see this as HSCRP, which is high sensitive CRP. And if you've got elevated LLT that might be equal to a high AST and

05:06
potentially a high GGT as well. So this pattern suggests that ferritin is elevated due to inflammation and not an iron overload. And this is particularly if your iron saturation is low or normal. So check whether is CRP in these other inflammatory markers elevated. If yes, ferritin might be artificially elevated as an acute phase reactant. And you do want to check the transferrin saturation, serum iron,

05:34
and total iron binding capacity to clarify that iron status. If you've got an iron saturation below 20%, this does suggest a functional iron deficiency despite high ferritin, which is where we sort of look at what else is occurring with regards to inflammation. And also in menstruating women, ferritin above 150 micrograms per liter can still be high, especially if paired with inflammatory symptoms or

06:02
or a condition such as endometriosis, which I'll talk about in a while. And if you see a ferritin of about 150 to 250, particularly with low iron markers, that does suggest an inflammatory driven sequestration. So that iron is being sequestered and you're not able to use it. So there is a little bit to sort of go in there, but you don't necessarily have to understand this. You just need a practitioner to sort of help you through it.

06:31
So why is high ferritin an issue? Well, high ferritin can increase oxidative stress and a higher reactive oxidative stress situation in your cells increases the aging of our cells. It can break down endothelial tissue. Obviously you get that increased inflammation and increased tissue damage and mitochondrial damage. And I mentioned quite a few of these last week. It also links to metabolic syndrome, insulin resistance,

07:00
metabolic associated fatty liver disease, and also higher risk of cardiovascular disease. And it is linked to fatigue, joint pain, hormone disruption. These are often overlooked signs. And I think I mentioned last week as well that sometimes high ferritin can make you feel as fatigued as what low ferritin or an iron deficient state can make you feel. But there are things that you can do with regards to your diet to really help reduce

07:30
your ferritin load. So the first and possibly quite obvious one is to limit red meat and organ meats and mussels and oysters. The heme iron is highly absorbable. These are the best places to get iron in the diet. So if you do have high iron, you want to avoid these foods. You also want to avoid any iron fortified cereals and breads. And this is a fairly common thing, particularly in cereals.

07:58
And fortification just means that they add in a nutrient or something that is not naturally occurring in that food. And another thing to do is to eat more plant-based proteins such as beans, tofu, and lentils. Any iron that you get in here is really poorly absorbed. So to sort of base your protein sources around the white meats, chicken, fish, and also plant-based proteins,

08:28
can go a long way to help lower your overall sort of ferritin load of your diet. Also, you can inhibit the iron that you do eat. So if you drink coffee or tea with meals, this will reduce your iron absorption because of the polyphenols in coffee or tea. So for someone who requires more iron, they're often recommended to take their iron supplements away from coffee and tea. So the obvious reverse of that is to drink coffee and tea with meals.

08:58
Increase your calcium rich foods because calcium competes with iron and absorption sites. So if you're consuming any sort of dairy, mean, kale's high in calcium. It's not as well absorbed as calcium from dairy products, but it certainly still contains calcium. Salmon with the bones, they have some calcium in there as well. So these calcium rich foods can compete with iron and absorption sites. So you just won't absorb as much iron.

09:27
You can also use more turmeric, curcumin, cocoa, and berries in your meals if you include these alongside any iron-rich foods or even that you're just including them in your diet. And I'll go through some specifics with supplementing on some other stuff in a minute. But these are all polyphenols and they're anti-inflammatory. So that will reduce your absorption and also can help reduce that oxidative stress that occurs through high iron and high ferritin.

09:55
and also avoid cooking in cast iron pans. So these are something to really consider, and particularly if you are a woman who has just gone through menopause and you start having sort of adequate iron stores, but you do actually want to be mindful of your ferritin levels as just as you continue along and you might want to get these checked every six months or every 12 months.

10:20
because you might naturally just start storing more iron because you're just not losing it the same extent. And do check your cookware because those cast iron pans are a great way to get more iron in the diet. And if you've got a high ferritin, that is not what you want. And the timing of your meals matter as well. So iron absorption is highest when you're low in iron or when you're pairing it with vitamin C. So avoid things like, for example, steak and orange juice if you're trying to reduce your ferritin.

10:48
I say orange juice, but even like broccoli is super high in vitamin C as well, if you haven't cooked the bejesus out of it. So you do want to be mindful of those sort of bearings. And just actually, if you've got a high iron that you're worried about, avoid steak. Your lifestyle and exercise obviously can also make a difference. So endurance training can increase iron turnover via the sweat and also potentially red cell breakdown.

11:13
There is something called foot strike hemolysis in runners where they can lose red blood cells and people often think this is one of the contributors to a low iron state in an endurance athlete. Now in practice or reality, you probably have to be doing quite a bit of this training for it to be a factor, but it all counts. Sweating through exercise and also in the sauna can result in more iron losses through the sweat.

11:40
And you know, high intensity exercise can actually help bind the ferritin as well. And so we have an enzyme called hepsidine, and this increases across the course of a day. And it is an enzyme that's released from the gut that helps bind iron. And it increases more, as I understand it, through this high intensity training also. So high intensity training is one of the recommendations for

12:08
reducing the ferritin or the available iron. And of course, blood donation. So actually giving blood is one of the easiest and safest ways to reduce your ferritin load in the body. And you know, if you are someone who's carrying any excess body weight or body fat, then weight loss can help lower ferritin in insulin resistant individuals, particularly because fat cells in someone who is metabolically unhealthy does contribute to

12:37
chronic inflammation and ferritin elevation. So there are a few nutraceuticals and natural support that can also help. The first one that I'm sure you're familiar with is curcumin. So it's an anti-inflammatory that lowers ferritin indirectly by reducing inflammation. And it may also affect Kepsidin, which is that iron regulating hormone. And so if you're having dietary tumouric, which is where curcumin comes from, you do have to have

13:06
quite a load in order to see an impact on your ferritin. However, about 500 to 1500 micrograms per day, having it with black pepper or biopurine for absorption. It's an iron chelator, which means it binds iron. It's anti-inflammatory and it supports the liver. And you'd want to be taking it with meals ideally. So that is something else which can be helpful.

13:35
There is also phytic acid and phytic acid or IP6, inositol hexaphosphate. It's found in whole grains, it's found in legumes, but also it's available as a supplement form. And taking it, taking about 500 to a thousand micrograms per day, and you want to take it away from any other minerals that you might be taking, it binds iron in the gut and it does reduce ferritin. You also might want to consider taking it with iron rich meals to inhibit the absorption.

14:05
Green tea extract or EGCG is a strong iron chelator and it's an antioxidant and it inhibits intestinal iron absorption. So you want about 250 to 500 micrograms per day. Milk thistle is another one. It's liver protective. It supports our detox pathways and it helps with bio flow. And around 200 to 400 milligrams per day is recommended.

14:32
Quercetin is another supplement. It's a polyphenol with iron chelating properties and it can potentially down-regulate iron transporters. So the typical dose for quercetin is 500 to 1,000 micrograms per day divided into one to two doses. It's a natural iron chelator, down-regulates these inflammatory cytokines, can modulate hepsidine, which is that iron regulating hormone, and it may also support the gut barrier.

14:59
and this is often paired with bromelain to enhance the absorption. We've also got NAC, N-acetylcysteine, 600 to 1800 micrograms per day, split into one to three doses. It boosts sclerothione, which is our own antioxidant. It reduces oxidative stress and inflammation. And if ferritin is elevated alongside insulin resistance or metabolic associated fatty liver disease, berberine is another consideration.

15:29
And this is about 500 micrograms, milligrams, I'm sorry, two to three times a day. So around 1000 to 1500 milligrams per day is considered effective. And it does act a bit like the drug metformin. So it can help improve insulin sensitivity, reduces liver fat, supports gut microbiota, and reduces inflammation. And it can also lower ferritin in individuals with elevated CRP, fatty liver, or insulin resistance.

15:58
The thing is though with all of these supplements is that you don't want to just go overboard and do all the things. I really do think it's important to work with a practitioner who can help guide you through that and make some sort of basic suggestions where to start and then maybe lay out one or the other on top of what you're already doing. Particularly because if the ferritin is actually iron overload, then a lot of what we've discussed is pretty appropriate for that.

16:27
There is a nuance as well, is that there are a lot of people that assume that a high ferritin just means high iron, but in reality, it absolutely, as I mentioned, coexists with other low iron, other iron markers being low, such as transferrin saturation or low serum iron. And as I mentioned, that is what we see with inflammation and chronic inflammatory conditions such as endometriosis, MCAS, which is mast cell disorder,

16:57
autoimmunity, insulin resistance, even post-viral states or overtraining. So as I mentioned, ferritin is an acute phase reactant, so it goes up in response to inflammation or cellular stress and not just iron overload. So the body might be trapping iron inside the cells to protect against pathogens or further damage. And this, for example, is common in endometriosis where you've got chronic inflammation and oxidative stress, which pushes ferritin up

17:27
but circulating iron is low. Also, some of the endometrial lesions are often found with iron inside them, which can be problematic, clearly, for anyone with this condition. So iron is being sequestered, it's not mobilized, and you can functionally be iron deficient while still having elevated ferritin. Inflammatory ferritin equals oxidative stress and can lead to tissue damage.

17:55
and high ferritin can also worsen these conditions. So the key in this instance is to reduce inflammation to unlock iron and bring ferritin down without pushing them into true iron deficiency. So we don't want to load up with iron supplements despite these other markers being low, but we want to address the fire and not just the smoke. So as I mentioned earlier, testing, you can absolutely test for this by looking at

18:23
Ferritin, so ferritin is high normal. If serum iron is low normal, if transferrin saturation is low, below 20%. If CRP is elevated, and you might also get liver enzymes that are up, those are clues that you've got high ferritin due to inflammation. so strategies for these people are to first look at an anti-inflammatory diet pattern where you have a lower intake of sugars, processed foods,

18:52
seed oils, fast foods, anything that will reduce the diet quality for these individuals. And you do want to have polyphenols and curcumin that may help down regulate that inflammation and ferritin. You want to look at that NAC or glutathione support, and I mentioned the dose already, and also look at omega-3s. So high EPA has strong anti-inflammatory effects, particularly for women's hormone-related inflammation.

19:22
And as always, you want that EPA-DHA combo. And it is suggested to have two to three grams of total omega-3s per day. And ideally, you'll have over 1.5 grams of that EPA for that anti-inflammatory effect. And try to get in a two to one ratio of EPA to DHA if possible. But equally, just try to get that 1.5 grams of EPA, regardless of that DHA dose, because as we learned in the episode with Greg Peeples,

19:51
The DHA is also really important. Take your omega-3s with food to enhance absorption and choose a triglyceride or reesterified oil. Do not rely on walnuts or chia or hemp or any sort of like omega-369 supplement to get your omegas. You do want that fish or that algae supplement if you are someone who chooses to use an algae vegetarian option. You also do might want to consider

20:21
berberine or alpha lipoic acid if insulin resistance and metabolic issues are present as well as part of that inflammation. Because these can help reduce ferritin when it's elevated due to that metabolic stress or potentially that metabolic associated fatty liver disease. I already mentioned berberine and the dose you'd want there. Alpha lipoic acid, you want 300 to 600 milligrams per day taken 30 to 60 minutes before meals and away from any other minerals. And

20:50
The R form of ALA is the more bioavailable form. It's an active form. And then also look at your gut and liver support. So digestive enzymes with ox bile, if fat digestion is poor. Probiotics to help, again, with the gut. Lactobacillus, plantarum, and bifidobacteria strains. And these are really common, actually. to 50 billion colony forming units daily. Milk thistle.

21:19
200 to 400 milligrams per day of the standard extract, as I already mentioned. An artichoke extract, dandelion root, can also be included in bitters or tea blends to support bile flow and the D-tacks. So if you are someone who's been told that your iron is low but your ferritin is high, especially if you have autoimmune stuff, ongoing fatigue, endometriosis, it's not as simple as just taking more iron.

21:46
to reverse your low iron fatigue stuff because your ferritin is high. So you really have to look more upstream at inflammation, liver health and metabolic function. And that's where ultimately the real change will happen. And I will just say that of course, conditions like autoimmune conditions and endometriosis really require like a whole system approach. It's not just, this is your ferritin, do these things here. But I did just wanna sort of make a mention of this because

22:16
I often see that it's recommended that women with endo avoid iron supplements, and this really explains why. So hopefully this just helps a little bit more of your, I mean, it's always about learning, isn't it? And certainly just gives you a few more tools in the toolbox with regards to ferritin and what to look for and whether it's an iron issue or it's just an inflammation issue. Keen to hear your thoughts.

22:45
whether or not this is helpful. I'm over on Instagram threads and X @mikkiwilliden. I'm at Facebook at mikkiwillidennutrition or head to my website, mikkiwilliden.com. And if you're interested, actually, I have a webinar coming up on the 16th of April, Wednesday, 7pm New Zealand time for anyone who is vegetarian.

23:12
who really has questions about their protein intake and how to optimize it on a vegetarian approach, particularly as it relates to either hormones or fat loss, this is a webinar for you. So we'll pop a link in the show notes. I think you're really gonna love it. All right, team, have the best week. See you later.