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The guide

Ferritin not rising? Work down the list.

Updated 2 min readWaiting for medical review

The short answer

The most common reasons are missed doses and timing: iron taken near coffee, tea or dairy. After that come hidden inflammation, low stomach acid, ongoing blood loss, coeliac disease, thyroid and vitamin D, and too little protein. The later ones need your doctor.

  1. 1Adherence. Count the doses you actually took and the meals that followed the rules.
  2. 2Timing. Coffee, tea or dairy close to your iron undo a lot of work.
  3. 3Hidden inflammation. A sore tooth, a lingering infection or chronic stress keeps hepcidin high. See inflammation and ferritin.
  4. 4Stomach acid. Acid blockers, H. pylori, gastritis and stress all lower the acid you need to absorb iron.
  5. 5Coeliac disease. It damages the gut lining where iron gets in. A simple blood test is the first step.
  6. 6Blood loss. Heavy periods are the usual one. Quiet bleeding in the gut is the one not to miss.
  7. 7Thyroid and vitamin D. Both form loops with iron that keep each other low.
  8. 8Protein and cofactors. Without enough protein, copper and B vitamins, your body cannot build ferritin.
Do

Change one thing at a time, then recheck.

Don’t

Raise your iron dose on your own.

DON’T BRIGHT LIGHT OVERHEADDO LOW, WARM LIGHT FROM THE SIDE
Stress and sleep count. Stress raises hepcidin just as inflammation does, and dim evening light helps sleep.

If ferritin stays low despite good adherence, ask your doctor about coeliac testing, H. pylori and checking for blood loss. Low ferritin in a man or after menopause always deserves a look for the cause.

A real page from The Iron GuideThe whole guide on one page: ten rules that work together.See more pages

Questions

How long before I can say it is not working?

After a full course, usually 8 to 12 weeks of regular doses, with a recheck at the same lab and with the same preparation.

Should I switch to an iron infusion?

Infusions make sense when tablets cannot work, for example with poor absorption, large ongoing losses or tablets you cannot tolerate. Your doctor decides.

Sources

  1. 1.NIH Office of Dietary Supplements. Iron: fact sheet for health professionals
  2. 2.Ganz T. Hepcidin and iron regulation, 10 years later. Blood, 2011
  3. 3.The Iron Guide, part 8: When ferritin is stuck

This page has not been reviewed by a clinician yet. Read it as general education, and take your own results to your doctor.

Educational, not medical advice. ferritin.ai does not diagnose or treat any condition, and it never sets a dose. Talk to your doctor about your own results.

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