"Do you look like ferritin?" asks a young woman on TikTok, pointing to dark circles, dull skin and brittle hair, showing before and after photos. The content creator attributes these characteristics to the iron levels in her body.
The video is part of a growing number of publications on the social networks TikTok and Instagram that claim that low levels of ferritin, the protein responsible for storing iron in the body, can leave visible signs on the face.
Users point out signs such as pale or grayish skin, dark circles under the eyes, dry or cracked lips, hair loss and brittle nails. Others share photos that they say show marked differences in appearance.
The expression ferritin face ("ferritin face", in free translation) has spread across social media, with videos accumulating millions of views.
But doctors say it's not possible to diagnose iron deficiency by appearance alone.
“Ferritin face is not a medical diagnosis,” said Aziza Sesay, a family doctor practicing in the West Midlands region of England. "However, it may be an indication that something is not right."
According to Sesay, paleness, hair loss and brittle nails can be associated with low iron levels, but they can also be signs of other health problems.
What is ferritin?
Ferritin levels indicate the amount of iron stored in the body. Hemoglobin, in turn, is a protein present in red blood cells responsible for transporting oxygen throughout the body. When hemoglobin levels are low, the blood carries less oxygen, a condition known as anemia — about half of all cases of anemia are caused by iron deficiency.
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But iron stores may be depleted before this happens. This means that a person can be iron deficient and experience symptoms even without being anemic.
"You no longer have iron stores, but your hemoglobin levels remain normal. That's the big difference," said hematologist Drew Provan.
According to the Brazilian Ministry of Health, iron deficiency occurs when the body loses more iron than it can absorb. Possible causes include: pregnancy, heavy menstruation, accelerated growth, diet poor in iron and absorption difficulties. Bleeding, illnesses, use of certain medications and gastrointestinal surgeries can also cause the problem.
Hematologist Sue Pavord said iron deficiency is common and often goes undiagnosed in women.
According to guidelines from the British Society of Gastroenterology, ferritin levels of less than 15 micrograms per liter indicate that iron stores are depleted, while values below 30 micrograms per liter generally indicate low iron stores.
Lack of iron is the most common micronutrient deficiency in the world today. It affects around 1 in 3 people, mainly children and women of reproductive age, including pregnant women. And it can cause several consequences.
Lack of adequate iron stores in pregnant women, for example, can affect fetal brain development and increases the risk of low birth weight, premature birth, miscarriage and stillbirth. For babies and younger children, a lack of iron can harm long-term development.
Lucy M., 32, who shares content about hair loss on Instagram and TikTok, on the profile @marvluceskin, said that the expression "ferritin face" seemed to describe changes she had noticed in her own appearance.
In 2021, she began to experience heart palpitations, fatigue and hair loss. After being told his blood tests were normal and receiving a diagnosis of generalized anxiety disorder, a new test revealed his ferritin level was 12 micrograms per liter.
Lucy said her skin was "grey" and her hair had become dull and brittle.
She shared with the BBC photos taken when her ferritin levels were low and others when they had recovered. According to Lucy, the difference in both her appearance and the way she felt was "overnight."
Can a lack of iron change the appearance of your face?
Videos about "ferritin face" often encourage users to look for physical signs, such as dark circles under the eyes, pale skin, dry lips, thinning hair and brittle nails, and compare them to their own appearance.
"You're not ugly, your ferritin is low," says a content creator, pointing to the camera.
But hematologist Drew Provan says it's "impossible" to determine a person's ferritin levels just by the appearance of their face.
He explains that people with severe anemia may appear pale and that fatigue can contribute to the appearance of dark circles. However, these visible signs are "subjective and unreliable."
Sesay added that changes in skin color may be less noticeable in people with darker skin. Therefore, those who only look for the signs described on social media may not realize that they have an iron deficiency.
Awareness or misinformation?
According to experts, symptoms and the way a person feels are more important than appearance.
For Provan and Sesay, blood tests are essential not only to confirm iron deficiency, but also to identify its cause and guide treatment.
Both stated that treatment must also combat the cause of the problem. Heavy menstruation, a diet poor in iron, blood loss from the gastrointestinal tract and difficulties in absorbing iron from the intestine are among the possible factors.
Iron deficiency is often treated with oral iron supplements. Hematologist Pavord explained that the pills should preferably be taken on an empty stomach, first thing in the morning. Pavord also recommended avoiding tea and coffee close to medication time, because these drinks can impair iron absorption.
Iron can also be obtained naturally through foods such as meat, beans, lentils, dark leafy greens and enriched cereals.
Taking iron supplements without a diagnosis can be harmful to your health. Additionally, self-medication may delay investigation of a health problem that is causing the disability.
Lucy said, however, that social media has helped women take their symptoms more seriously and given some women the confidence to ask questions when they realize something is not right.
"There are a lot of women saying, 'Oh my God, this happens to me,'" she said. She emphasized that she is not a doctor and that her content is based on her own experiences.
For Lucy, sharing this information has been a way to give women more knowledge and confidence to advocate for their own health interests.
The doctor, Sesay, described social media as a "double-edged sword": it can encourage people to seek medical help, but also lead them to make incorrect diagnoses based on short videos.
For Lucy, the most important thing is not trying to identify a health problem by appearance, but recognizing when something is not right and knowing when to seek clarification.
Balanced diet
In an ideal world, people should get enough iron from a balanced diet that includes iron-rich foods to prevent deficiency. But this is not always possible.
There are two types of iron: heme and non-heme. Heme iron comes from animal sources — and is more easily absorbed by the body. You find it in the following foods:
And there are good sources of iron in dark green leafy vegetables, such as kale and spinach, and legumes, such as beans, peas and lentils. The problem is that these are non-heme, which means you don't absorb as much iron from plant sources as you do from red meat.
Then there's also the iron you can get from breads and breakfast cereals fortified with the mineral — although, again, it's not always in a highly absorbable form.
But the way you prepare your food and what you drink during meals can also change how much iron you absorb.
To demonstrate this, the BBC asked nutrition scientist Paul Sharp, from King's College London University, in the United Kingdom, to carry out some experiments to simulate human digestion.
The tests reproduced the effect of enzymes involved in food digestion and the chemical reaction that occurs in human intestinal cells to show how much iron would be absorbed.
Sharp showed that if you drink orange juice with your iron-fortified breakfast cereal, you absorb much more iron than when you eat the cereal alone, because orange juice contains vitamin C, which makes it easier to absorb iron from food.
But unfortunately, if you drink coffee with your bowl of cereal, you will absorb significantly less iron.
But why does this happen? According to Sharp, coffee contains chemicals called polyphenols that are very efficient at binding to iron and making it less soluble.
So, if you like eating fortified cereal for breakfast, drinking a small glass of orange juice or even sucking on an orange will help increase your iron absorption.
You may also consider delaying coffee for at least 30 minutes after your meal.
Additional reporting Amanda Ruggeri
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