Many otherwise healthy people, unknown to them, have low iron levels. Why do low iron and ferritin levels happen? Dr Suranjit Chatterjee, senior consultant, internal medicine, Indraprastha Apollo Hospital, Delhi, says: “Low iron and ferritin levels occur when the body’s iron balance is disrupted either due to inadequate intake, poor absorption, increased demand, or ongoing loss.
Ferritin reflects the body’s iron stores, so it drops when these stores are being steadily used up faster than they are replenished. Common reasons include heavy menstrual bleeding, gastrointestinal blood loss, growth phases in children and adolescents, pregnancy, endurance training, and conditions that reduce absorption from the gut such as gastritis, H. pylori infection, celiac disease, or long-term use of acid-suppressing medicines. In many cases, it is not a single cause but a combination of small contributing factors over time.”
Why do many otherwise healthy individuals with a good diet, and no other disease or symptom, also depict negligible ferritin levels?
This is a frequent scenario. A “good diet” does not always translate into adequate iron absorption or retention. Iron from plant-based foods, for example, is less efficiently absorbed compared to heme iron from animal sources. Everyday factors like tea and coffee consumption around meals, calcium intake, or irregular meal patterns can significantly reduce absorption.Iron deficiency also often develops silently. Ferritin levels may fall for months before symptoms like fatigue, hair fall, or breathlessness become noticeable. Some individuals also have subtle but chronic losses such as unnoticed heavy menstrual flow or low-grade gastrointestinal bleeding that are not immediately obvious. So, a person may appear healthy and asymptomatic while iron stores are depleted.
Is genetics a factor?
Yes, genetics can play a role, although it is not the most common cause in routine cases. Certain inherited conditions affect how the body absorbs or regulates iron. For example, rare disorders involving iron regulation pathways, such as iron-refractory iron deficiency anaemia, can lead to persistently low iron despite adequate intake and supplementation. More commonly, genetic variation may influence baseline iron stores or how efficiently iron is recycled and utilised in the body, making some more prone to deficiency than others. However, in most patients, lifestyle, absorption, or blood loss factors are more significant than genetics.
How to restore iron levels and ensure permanently stable levels?
Restoring iron levels requires both correction and investigation. The first step is identifying the underlying cause whether it is dietary insufficiency, poor absorption, or ongoing blood loss. Without this, ferritin levels often drop again after treatment.
Treatment usually involves oral iron supplementation as first-line therapy, taken in a way that improves absorption often away from tea, coffee, and calcium, and sometimes with vitamin C to enhance uptake.
In cases where oral iron is not tolerated or absorption is impaired, intravenous iron may be recommended. Diet alone is supportive but rarely sufficient to correct moderate or severe deficiency. A balanced intake of iron-rich foods, combined with improved absorption practices, is important.
Long-term stability depends on monitoring and prevention. This includes periodic blood tests in at-risk individuals, managing menstrual health where relevant, treating gastrointestinal conditions if present, and maintaining dietary habits that support absorption. In many patients, iron deficiency is a recurring tendency unless the root cause is identified and managed proactively.