Think You’re Iron Deficient? Why Ferritin Levels Mislead and What Really Causes Anemia

Iron Deficiency vs. Iron Dysregulation

Most people do not actually have iron deficiency or true iron deficiency anemia. What they really have is iron dysregulation, which is far more common. True iron-deficiency anemia is actually rare when you look at the full picture of iron metabolism.

What Iron Actually Does in the Body

Iron carries oxygen through the blood to your cells, where it’s used by the mitochondria to make energy. Iron is not designed to sit in storage long-term. About 80% of the iron in your body lives in hemoglobin and myoglobin, bound to proteins and constantly circulating.

Iron is meant to be recycled, not accumulated.

Less than 10% of iron is stored as ferritin, and ferritin is supposed to live inside the cell — not floating around in the bloodstream.

What High Ferritin Really Means

Excess stored iron is not a good thing. Ferritin is stored in your tissues, and a blood test only measures what’s circulating at that moment.

If your ferritin level is over 100 ng/mL, this often reflects inflammation, not iron deficiency.

So if your doctor diagnosed you with iron deficiency or anemia based only on ferritin levels, that’s a red flag. It’s like diagnosing hypothyroidism by only looking at TSH — you’re missing the majority of the story. Iron homeostasis is complex, and it requires looking at multiple cofactors.

Cofactors Needed for Iron Recycling

To maintain proper iron regulation and prevent iron overload in the tissues, your body depends on several key nutrients. These are almost always ignored in conventional lab work — and many practitioners don’t know how to interpret them for iron recycling.

Bio-available Copper

Copper helps regulate iron in the body, supports iron absorption in the gut, and activates oxygen in the mitochondria (turning it into water). Copper deficiency is a known root cause of anemia, yet it is rarely checked.

Vitamin A (Retinol)

Retinol is essential for building blood, especially hemoglobin. This active form of vitamin A is only found in animal foods. While beta-carotene can convert into retinol, it requires very large amounts — and approximately 45% of people have at least one genetic variant that makes this conversion inefficient.

Magnesium

Magnesium drives thousands of enzymatic processes, including mitochondrial energy production. It’s also required for making red blood cells and hemoglobin. A magnesium deficiency can itself be a root cause of anemia.

Ceruloplasmin

Ceruloplasmin acts like an iron “taxi.” It’s a copper-dependent protein that keeps iron moving. When ceruloplasmin is low, iron becomes unbound and gets stored in tissues — especially the liver. Low ceruloplasmin = low bioavailable copper = poor iron recycling.

Recommended Lab Testing

Instead of relying only on ferritin, I recommend a complete iron panel, including:

• Serum iron

• Transferrin

• TIBC

• Iron saturation

• Ferritin

• Retinol (vitamin A)

• RBC magnesium

• Zinc

• Copper

• Ceruloplasmin

Remember: “normal range” is not the same as optimal.

Work with a functional or holistic health practitioner who understands iron regulation and how to optimize iron recycling, mineral balance, and mitochondrial function.