“Dear Dr. Vliet,

I have a ferritin now of 483, but when my problem was first found a year or so ago, my ferritin was seriously high at 1,768. My doctor recommended therapeutic phlebotomy (giving blood).   I’ve had 7 pints of blood drawn, but now I am having symptoms of chronic fatigue, blurred vision, eyes burning, headaches and some problems focusing my thinking. I don’t have normal erections now either. I have seen several specialists: an Optometrist, an Ophthalmologist, a Neurologist, and an E.N.T. physician. I have had an MRI, blood tests, eye tests, sinus tests and none of my doctors have been able to give m an answer as to the cause of my problems. My question is could all of this be caused by the ferritin being so high for so long?”

Optimal ferritin levels are in the range of 90 to about 120. Ferritin levels as high as this patient had are commonly caused by a genetic disorder called hereditary hemochromatosis. Hemachromatosis is also called “Iron Overload Disorder” and it occurs when the daily absorption of iron from the intestines is greater than the amount needed to replace losses. Our body cannot increase iron excretion, so this means that if more is absorbed from our diet or supplements, it will accumulate in body tissues over time.

Excess iron deposits build up in various organs – the brain, joints, liver, testicles, ovaries, heart and other tissues. Over time these deposits cause damage to the organs, leading to a variety of symptoms. Women with hemochromatosis typically develop symptoms about ten years later than men do, since women lose iron in menstrual blood each month and not build up iron in body organs as rapidly as men do. Erectile dysfunction in men can be caused by high ferritin and iron deposits damaging blood vessels.

Iron deposits in the heart damage the heart muscle and lead to heart failure, palpitations, or irregular rhythms. In the pancreas, iron deposits interfere with insulin production, leading to a decrease in insulin that can lead to Diabetes.   Iron deposits in the liver cause liver damage (cirrhosis) and an increased risk of liver cancer.

Iron deposits in the pituitary gland, testicles in men, or the ovaries in women lead to decrease in hormone products that we call hypogonadism (low testosterone in men, low estradiol and lack of ovulation in women) that can cause fertility problems and other health risks due to the loss of these critical metabolic hormones affecting hundreds of functions in our bodies.

Based on the reader’s symptoms, I think there are several causes for the problems he is having:

1. Even though his ferritin is still too high, a very rapid decrease in ferritin from a very high level can cause fatigue, headaches, and vision changes.
2. The extremely high levels he had earlier can certainly have caused damage to various organs
3. The high ferritin also likely caused damage to the pancreas, which means some of his symptoms may be related to insulin resistance (pre-diabetes), or full blown diabetes. Both diabetes and pre-diabetes lead to blood sugar “swings” that can cause headaches, vision changes, mood changes, dizziness, irregular heartbeats, and other symptoms. Blood sugar problems can be checked with fasting glucose, fasting insulin, a glucose and insulin drawn two hours after eating a normal meal (called post prandial blood test) and a hemoglobin A1C.
4. Fatigue, headaches, difficulty thinking clearly may also be caused by low testosterone due to iron overload affecting testicular production of this critical hormone. Testosterone is often overlooked in men as well as women, so it would wise to check blood testosterone levels (saliva tests aren’t reliable for this) to determine whether low levels are causing some of his current problems. Testosterone for men should be checked in the early morning for most reliable readings. I will talk in future columns about the benefits…and pitfalls or risks…of various testosterone replacement options for men….and women too!

The key to accurate diagnosis is getting the right tests done. I find that these hormone and metabolic factors are often not checked in standard annual blood tests – for men and women! I have booklets on my website, www.herplace.com, to provide more information on what tests should be done to answer questions about the possible causes of puzzling or complex symptoms.

Remember, this column is for educational purposes only, and is not a substitute for careful evaluation by your personal physician. If you would like more help on this problem, contact our office for a Second Opinion consult by phone for Dr. Vliet to review your symptoms, medical history, lab tests and help you with recommendations for treatment to pursue with your own physician.

@ElizabethLee Vliet MD