Why You Need a Full Iron Panel
- Dr. Francesca Medina, ND
- Sep 17
- 7 min read
Updated: Sep 24
It's Important to Test More than Just Iron Levels
Iron deficiency is one of the most common nutrient deficiencies worldwide, yet it’s often missed or misdiagnosed. Why? Because most people only get a basic iron test—and while it can look “normal,” it doesn’t actually tell us if your body has enough stored iron to function optimally.
That’s why a full iron panel that includes ferritin is so important. Ferritin is the key marker that reveals whether you’re running on empty—or storing too much iron. Without it, you might go years with symptoms like fatigue, brain fog, and hair loss without answers.
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What Is Ferritin, and Why Does It Matter?
Ferritin is a protein that stores iron inside your cells. You can think of it as your iron savings account, while serum iron is your “checking account” (what’s circulating in your bloodstream right now).
The body uses stored iron for critical functions like:
Building hemoglobin (which carries oxygen in your red blood cells)
Supporting thyroid hormone conversion
Maintaining healthy hair, skin, and nails
Fueling cellular energy production
When ferritin is too low, your body doesn’t have reserves to fall back on. When it’s too high, it may indicate inflammation or iron overload that can damage organs.
Why a Full Iron Panel Matters
A complete iron panel usually includes:
Serum Iron – how much iron is circulating in the blood right now.
TIBC (Total Iron-Binding Capacity) – how much room transferrin proteins have to bind iron.
Transferrin Saturation – the percentage of transferrin carrying iron.
Ferritin – your iron storage reserves.
If you only check serum iron, you’re getting a snapshot in time—but not the whole picture. Serum iron levels fluctuate daily depending on diet, stress, or even the time of day. Ferritin shows your long-term iron status, which is far more reliable.
Patient Case A: The “Normal Iron” That Wasn’t
One of my patients, a 34-year-old woman, came in exhausted. She had thinning hair, restless legs at night, and felt breathless climbing stairs. Her primary care doctor told her, “Your iron is fine.”
When I ran a full panel, her serum iron looked normal—but her ferritin was only 12 ng/mL (optimal for women is typically 50–100). She was already dipping into depletion, which explained her symptoms.
By supporting her with dietary iron, targeted supplementation, and checking for hidden blood loss, her energy improved dramatically within months. Without ferritin testing, she might have gone years untreated.
Symptoms of Low Ferritin (Iron Deficiency)
Low ferritin often shows up before hemoglobin or serum iron dip.
Common signs include:
Chronic fatigue or feeling “wired but tired”
Brain fog and poor memory
Pale skin or brittle nails
Thinning hair or hair shedding
Feeling cold all the time
Restless legs, especially at night
Shortness of breath during workouts
Increased anxiety or mood changes
Iron deficiency is especially common in:
Women with heavy menstrual cycles (monthly blood loss adds up fast)
Vegans and vegetarians (plant-based iron isn’t absorbed as easily)
Athletes (higher iron turnover from training)
People with gut issues (celiac, Crohn’s, low stomach acid)
Patient Case B: When Ferritin Is Too High
On the flipside, I had another patient in her 50s who came in for fatigue and joint stiffness. Her labs showed high serum iron and ferritin over 500 ng/mL. We suspected, and later confirmed, hemochromatosis, a genetic condition where the body absorbs too much iron.
Catching this was crucial, because iron overload can silently damage the liver, heart, and joints if left untreated. Her treatment plan included therapeutic phlebotomy (supervised blood donation) to bring levels down.
If we had only run serum iron, we might have missed the bigger picture.
Symptoms of High Ferritin (Iron Overload)
Elevated ferritin can be a red flag for iron overload, inflammation, or chronic disease.
Symptoms may include:
Joint pain or stiffness
Liver dysfunction (elevated liver enzymes)
Chronic fatigue
Abdominal pain
Skin bronzing or hyperpigmentation (in severe cases)
Increased risk of diabetes and heart issues
Causes of high ferritin can include:
Genetic hemochromatosis (iron overload disorder)
Chronic inflammation (ferritin rises as an inflammatory marker)
Liver disease
Metabolic syndrome
What to Do If Your Ferritin or Iron Is Off
The next step always depends on the root cause—which is why running a full panel is so important.
If Ferritin Is Low (Iron Deficiency):
Boost iron-rich foods: grass-fed red meat, lentils, beans, spinach, pumpkin seeds, quinoa.
Pair plant iron with vitamin C: (e.g., spinach + lemon juice, beans + bell peppers).
Address absorption issues: low stomach acid, celiac, gut dysbiosis can all impair iron uptake.
Check for hidden blood loss: heavy cycles, GI bleeding, ulcers.
Consider supplementation: gentle forms like iron bisglycinate are often better tolerated. Always test and retest—iron supplements should never be taken blindly.
If Ferritin Is High (Iron Overload):
Avoid iron supplements unless prescribed.
Cut back on iron-rich and fortified foods.
Limit alcohol, which stresses the liver.
Get genetic testing if hemochromatosis is suspected.
Therapeutic phlebotomy or regular blood donation may be prescribed under supervision.
Optimal vs. “Normal” Ranges
Another reason ferritin is so helpful: lab ranges can be misleading.
Conventional ranges often list ferritin as “normal” anywhere between 15–150 ng/mL for women.
Functional/optimal ranges are typically higher: most women feel best between 50–100 ng/mL, and men between 100–150 ng/mL.
FAQs About Ferritin and Iron Testing
1. Can ferritin be high from inflammation, not iron overload?
Yes. Ferritin is an acute phase reactant, meaning it rises in response to inflammation, infection, or even recent illness. That’s why we always interpret it alongside other iron markers.
2. How often should ferritin be tested?
If you’re supplementing or treating a deficiency, retest in 8–12 weeks. For general health, once a year is usually enough.
3. Can you test ferritin at home?
Yes, there are now at-home kits that measure ferritin via finger-prick blood tests. However, I recommend a full panel through your doctor for the most accurate picture.
4. What’s the difference between ferritin and hemoglobin?
Hemoglobin measures oxygen-carrying red blood cells, while ferritin shows whether your body has the raw material (iron) needed to keep making them. You can have “normal” hemoglobin but still be low in ferritin.
If you’ve ever been told “your iron looks fine” but you still struggle with fatigue, hair loss, or brain fog, it’s time to dig deeper. A full iron panel that includes ferritin gives a much more accurate picture than serum iron alone.
Ferritin is your body’s iron savings account, and checking it can help catch deficiencies or overloads early, before they cause long-term damage.
Next time you ask your doctor for testing, specifically request a complete iron panel with ferritin. That one extra marker can be life-changing. Don’t settle for a “normal” iron result without ferritin. Advocate for yourself. It could explain years of unexplained fatigue, hair thinning, or restless legs.
🧰 Resources for Supporting Healthy Iron Levels
If you’re looking to explore testing or natural ways to support your iron, here are some helpful resources I often share with patients:
Order a Complete Iron/Anemia Panel: You can order a full anemia assessment panel (including ferritin) directly through my Rupa Health shop to get a deeper look at your iron status.
Gentle Iron Supplements: I often recommend iron bisglycinate as it’s typically better tolerated than standard forms of iron. Shop my preferred option here.
Vitamin C Support: Since vitamin C boosts iron absorption, pairing your iron-rich meals with a supplement can make a big difference. This is my go-to vitamin C.
Cook With Cast Iron: Cooking in cast iron pans naturally increases the iron content of food, especially acidic dishes like tomato sauce. Find my favorite cast iron pan here.
The Lucky Iron Fish™: A simple tool for adding a safe, consistent boost of iron to soups, stews, or boiling water. Great for vegans and vegetarians. Check it out here.
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*Dr. Francesca works only with patients physically located in California.*
*Disclaimer: Although I am a doctor, I may not be your doctor. The information contained within the pages of this site is for educational purposes only and should not be used to treat conditions. Please consult with your doctor, or make an appointment with me, before implementing any of the treatments, diets, supplements, etc. mentioned in this article.*
