top of page
Search

Ferritin, Inflammation, and Root Cause Red Flags

“What’s the difference between ferritin and iron in a blood test? “


Understanding this distinction is key to appropriately guide next steps- as is pattern recognition in both labs and biofeedback 


This blog was inspired by conversations inside our group mentorship.


It’s not just a matter of reading labs; it’s understanding those results in context.

Meaning - connecting the dots between biofeedback, labs, and the root cause of the issue.


Mentorship traditionally promises all the answers. Which is silly because we know for a fact that especially in this space, if you think you know it all- you know nothing. Part of being a good coach is asking better questions in order to connect the dots between your clients biofeedback, labs, history and help them to create a roadmap towards their goals. 


Our approach is to help you ask better questions, to come to evidence led conclusions.


For a review on iron, iron metabolism and reasons for LOW iron check out- “Iron Supplements Aren’t Always the Solution for Low Iron”


Quick Recap: Iron vs. Ferritin 


Serum Iron is showing the mineral circulating in the blood. Iron is crucial for oxygen transport, ATP production and energy metabolism . 


Ferritin is the body’s iron storage protein, acting as a reservoir when iron levels drop. Low ferritin suggests depleted iron stores and will often dip before iron or hemoglobin drop low enough to diagnose anemia. 


**Optimal will always be individual, but 50 - 100 ng/mL is generally an ideal range for ferritin


Testing ferritin is crucial for catching deficiencies early, as well as if someone is taking an iron supplement - we want to ensure they aren’t storing too much. Which brings us to the other role of ferritin… 


Ferritin As an Inflammatory Marker  


Ferritin is considered an acute phase reactant (APR), meaning it rises in response to inflammation,  like C-reactive protein (CRP) or  Erythrocyte sedimentation rate (ESR).


So when ferritin is high, it doesn’t always mean there’s too much iron. It could be a signal the body is inflamed.


Remember our friend hepcidin?

During stressful periods (which encompasses a lot of things…) or  in the presence of inflammation, the liver produces more hepcidin, the hormone that blocks iron absorption and increases ferritin to limit iron availability.


High ferritin can also indicate excess iron intake or hemochromatosis 


Iron and Ferritin Patterns 


Low iron + Low ferritin- true depletion and indicative of anemia 


Normal iron + Low ferritin- Mild deficiency or depleted iron stores.


Normal and/or Low iron + High ferritin? Likely inflammation. 

  • This is a very common pattern in anemia of chronic disease . Clients who have digestive inflammation or an autoimmune disorder like IBD, joint pain or metabolic syndrome may fall into this category  . For these folks, ferritin may fluctuate high and low with flareups. 


High Iron + High Ferritin- Possible iron overload or hemochromatosis; and/or inflammation


Common Causes of Elevated Ferritin (Inflammatory, Not Iron Overload)


So you now know ferritin rises in response to inflammation. Triaging where that inflammation is stemming from is the real question, and why more questions and assessment is needed. Reviewing history, current symptoms and presentation and labs work (serum and otherwise) can help determine the root.


Nutrition Lifestyle & Training Factors:

  • Acute or chronic stress (mental, physical, or both)

    • This can include hard training blocks or phases 

  • Overtraining or recent strenuous training (ferritin can stay elevated for days after)

  • Micronutrient deficiencies ( a lack of micros is a state of inflammation at a cellular level!)

  • Under-eating or prolonged low-carb/low-calorie intake (via hepcidin up-regulation)

  • Over eating and high body fat level, obesity 


Health Conditions:

  • Infections (chronic or acute)

  • Poor gut health or GI inflammation

  • Post infection recovery phase 

    • For example, I worked with a client post-SIBO protocol whose ferritin remained high initially in serum labs as she was recovering, but came down as we supported immune system and gut lining  

  • Autoimmune Conditions such as IBD, arthritis 

  • Metabolic syndrome 

  • Liver dysfunction (remember, the liver is a major site of iron metabolism) 

  • PCOS or other hormonal dysregulation


Environmental & Exogenous Factors:

  • Environmental toxins or mold exposure

  • Iron supplements or high-dose vitamin C

  • Diets heavy in iron-fortified foods like cereals and highly processed foods


A Smarter Way to Assess Iron & Inflammation:


Review the Full Iron Panel: serum iron, ferritin, transferrin saturation, total iron-binding capacity (TIBC) 


 Check Inflammation Markers - 

  • Ferritin 

  •  Hs-CRP

  •  Neutrophil to lymphocyte ratios (NLR)

  •  and Sed Rate (ESR): 


If ferritin is high with normal iron, and you also see shifts or elevations in other inflammatory markers, this may indicate various stages of inflammation. At that point, return to screening for the source of the inflammation.


Reminder: Don’t draw labs immediately post-training. Wait 24–48 hours and show up fasted and well-hydrated for the most accurate lab results 


Actionable Coaching: Next Steps for High Ferritin and Inflammation 


Ask Questions and Direct to Appropriate Referrals

  • Refer out when needed (PCP or GI, especially if ferritin remains persistently high)

  • Consider rechecking labs if they were drawn the day after hard training or during a demanding athletic season

    • Consider whether pulling back on training intensity long-term is warranted

  • Ask about family history or past screening for hemochromatosis

  • Take note if of the PCOS and iron overload connection and review hormonal health


Diet and Lifestyle Inflammation Support Strategies

  • Address mental and emotional stress

  • Prioritize sleep and balanced nutrient-dense meals for blood sugar regulation

  • Decrease processed foods to make room for a nutrient-dense, whole food diet

  • Support liver health (the liver major site of iron recycling and detox)

  • Review use of high-dose vitamin C or vitamin C injections (can increase iron absorption)

  • Screen for iron-fortified foods or iron supplements

  • Rebuild gut function to support nutrient absorption and reduce inflammation

  • Consider high-dose fish oil as omega-3 fatty acids may help reduce inflammation

    • Code FORD to save on Legion Triton

  • Ensure regular movement and consistent exercise

    • Consider activities that strengthen the mind–body connection (e.g., yoga)




Ferritin can be a gold mine of insight when viewed in context. But only if you look at the full picture: labs, biofeedback, symptoms, history, and habits.


Don’t just “fix” a number. Ask why the body might be holding onto ferritin. Then reverse-engineer the support from there.



bottom of page