I’m a GP – ferritin face is a myth, but these are the signs you need more iron

If you’ve recently found yourself staring in the mirror wondering why you look so tired, pale or washed out, TikTok may have an answer for you: “ferritin face“. The term has been spreading across social media, with people attributing everything from dull or pale skin and dark circles under the eyes to a generally exhausted-looking complexion to low ferritin – the protein that stores iron in the body. But before you start booking a private blood test based on what how your skin looks to you, “ferritin face” is not widely recognised among GPs, and not a medical term or diagnosis. What is ferritin? Ferritin is a blood protein that safely stores iron in your body’s cells and releases it when needed. “Ferritin means stored iron; it roughly equates to how much iron stores someone has; that’s an easy way to think about it”, says Dr Max Draper, GP at MyAtlas Health Clinic. Shorts “Iron is fundamental for almost every process in your body; it’s important for hormonal behaviours; it’s the foundation to life,” he adds. According to the World Health Organisation, iron is one of the most common nutrient deficiencies in the world, with approximately 30 per cent of women aged 15 to 49 suffering from anaemia, with iron deficiency being the primary underlying nutritional cause. Testing for low ferritin is currently the most common way to test if a person is iron deficient but it has limitations. “If ferritin is low that is diagnostic of iron deficiency,” says Dr Sue Pavord, a consultant haematologist at Oxford University Hospitals. “But if it’s normal on a blood test, that doesn’t exclude an iron deficiency, as it also increases with infection, inflammation, pregnancy and some cancers.” In other words, low ferritin is a strong sign that your iron stores are depleted but a normal ferritin doesn’t always mean your iron status is fine. Doctors may need to look at ferritin alongside other blood results for a wider picture. If one of Draper’s patients has low ferritin on a blood test, “it would automatically make you think they were lacking in iron and with the rest of the blood test markers you can work out whether that iron deficiency is anaemia, which has a knock-on effect on somebody’s blood count”. Visual changes Some of the changes people describe as “ferritin face” (which has racked up thousands of online views), such as paler skin and dark eye circles, can occur with iron deficiency but Draper warns it’s “certainly not diagnostic”. Pavord says she can usually tell when people are severely low in iron due to the paleness in their face but it’s not in all cases. “The quality of the skin is impacted because iron is needed for skin cells so you will get paler skin or poor-quality skin.” She believes it’s a good thing that ferritin itself is trending online as it’s drawing attention to iron deficiencies, which disproportionately impact women with heavy menstrual cycles. “The normal body will have around four grams of iron. If you take the menstrual life of a woman averaging from 12 to 51 years old, they’ll lose between nine and 10 grams. If they have heavy periods, which impacts around 18 per cent of the population, they’re going to lose twice that amount.” Dr Sue Pavord can usually tell from someone’s appearance if they’re low in iron The signs of low iron The most common symptom, according to both experts, is fatigue and tiredness but it can impact people in different ways, from aches and pains, low mood, irritability, poor concentration or a weakened immune system. “The main one is fatigue because people put that down to their busy lives or attribute it to pregnancy, or the fact they’re looking after children, or it may even be misdiagnosed as chronic fatigue syndrome or long Covid but it’s so easily treated if people get their diagnosis of iron deficiency.” Other symptoms include hair loss: “as iron is necessary for every cell, which includes the hair follicles and hair growth cells, hair will be lost if they’re not functioning properly.” And more severe symptoms include breathlessness, shortness of breath and heart palpitations. This is particularly associated with chronic anaemia. “If we think about the iron needed in the heart muscle, not getting enough iron, the heart can start racing quickly,” says Pavord. Hidden signs include spoon-shaped nails (where they become flat or break easily), cold hands and feet, and odd cravings called pagophagia – such as craving ice – and being drawn to the smell of petrol, paint or the desire to chew paper or clay. What to do Cheaper finger-prick tests are available to test iron for as little as £7.99 but Pavord questions how accurately they can measure someone’s iron status. Draper says that anyone who suspects they have an iron deficiency should speak to their GP. He warns that people shouldn’t jump to taking iron supplements. “You can become iron overloaded,” says Draper, “some supplements commonly affect people’s bowels, constipation and bloating.” If iron deficiency is confirmed, oral iron is commonly used, but some people may need alternative treatment if they cannot absorb it. At the Oxford Iron Clinic, where Pavord is a director, they treat those with IV iron infusions. Pavord says that if patients do need iron supplements, she instructs them to take elemental iron and to take it early in the morning on an empty stomach, away from multivitamins, milk, coffee and tea. “If someone is taking their tablets effectively, and their body is absorbing it well, they should start to feel better in two to three weeks.”