Folate Deficiency Causes, Symptoms & More
Article Sources
- 1. Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. 'Folate Deficiency - Disorders of Nutrition.' Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency.
- 2. 'Folate-Deficiency Anemia.' Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.
- 3. 'Folate Deficiency.' Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682.
- 4. 'Folate Deficiency Anemia.' Folate Deficiency Anemia | Michigan Medicine, www.uofmhealth.org/health-library/hw152337.
- 5. Khan, Kashif M. 'Folic Acid Deficiency.' StatPearls /[Internet/]., U.S. National Library of Medicine, 30 June 2020, www.ncbi.nlm.nih.gov/books/NBK535377/.
- 6. NHS Choices, NHS, www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/.
- 7. 'Folate-Deficiency Anemia.' Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/folate-deficiency-anemia.
- 8. 'Folic Acid.' Womenshealth.gov, 1 Apr. 2019, www.womenshealth.gov/a-z-topics/folic-acid.
- 9. 'Folate (Folic Acid).' Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Feb. 2021, www.mayoclinic.org/drugs-supplements-folate/art-20364625.
Folate is one of the B vitamins. It works with vitamin B12 to help the body create normal red blood cells, which help carry oxygen throughout the body. These nutrients are also involved in DNA synthesis, the genetic material in cells. Folate plays a key role in the proper development of a fetus’s nervous system as well.
The body only stores a small amount of folate at a time, so without regular replenishment, folate levels become depleted.1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency. When this occurs, the body produces fewer red blood cells, and less oxygen is delivered to body tissues and organs, disrupting proper bodily functions.2‘Folate-Deficiency Anemia.’ Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.
1. Causes of Folate Deficiency
Folate deficiency occurs when a person fails to consume sufficient amounts of folate, which is also known as vitamin B9. Meat, leafy green vegetables, fruits, yeast and fortified cereals are good sources of folate. This nutrient is also included in many multiple vitamins and is available separately as a supplement.2‘Folate-Deficiency Anemia.’ Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.
Heavy alcohol use, medical conditions, medical procedures or medications may prevent the digestive tract from properly absorbing folate, leading to low folate levels. Women who are pregnant or breastfeeding may experience folate deficiency since their bodies need higher levels of folate to operate correctly under those conditions.3‘Folate Deficiency.’ Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682.
2. Risk Factors for Folate Deficiency
Poor diet, alcoholism and receiving nutrition via IV long-term are risk factors for developing folate deficiency. Celiac disease, inflammatory bowel disease and other diseases that impact the digestive tract’s ability to absorb folate increase the chance that folate deficiency will develop.
People with cancer, liver disease and chronic hemolytic anemia are more likely to develop folate deficiency. Those who have undergone bariatric surgery or require dialysis may also be more prone to folate deficiency.3‘Folate Deficiency.’ Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682.
3. Pregnancy and Folate Deficiency
Folate plays a key role in preventing birth defects, such as spina bifida, a condition in which the baby’s brain or spine fails to form correctly. These neural tube defects frequently occur early in pregnancy, before a woman is aware she’s pregnant, so it’s critical that women planning to become pregnant take a daily vitamin supplement containing folic acid.4‘Folate Deficiency Anemia.’ Folate Deficiency Anemia | Michigan Medicine, www.uofmhealth.org/health-library/hw152337.
Folate deficiency during pregnancy may also lead to spontaneous abortion and language deficits in the unborn child.5Khan, Kashif M. ‘Folic Acid Deficiency.’ StatPearls /[Internet/]., U.S. National Library of Medicine, 30 June 2020, www.ncbi.nlm.nih.gov/books/NBK535377/.
4. Medications and Folate Deficiency
Using certain oral contraceptives may interfere with folate absorption.3‘Folate Deficiency.’ Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682. Other medications that may reduce folate absorption include anticonvulsants, such as phenytoin and phenobarbital, and sulfasalazine, a treatment for ulcerative colitis.
People who take methotrexate for cancer and rheumatoid arthritis, triamterene to treat high blood pressure or metformin to treat diabetes may also suffer folate deficiency as a result. The antibiotic trimethoprim-sulfamethoxazole may disrupt the body’s metabolism of folate as well.1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency.
5. Symptoms of Folate Deficiency
The onset of symptoms of folate deficiency may be gradual. The first symptom that may develop is fatigue. The tongue may become red and sore; the person may experience a reduced sense of taste, have diarrhea and lose weight. They may also develop depression.1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency.
Headaches, appetite loss and mouth sores are additional possible symptoms of folate deficiency.3‘Folate Deficiency.’ Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682. In addition, the person may experience dizziness, shortness of breath, paleness and irritability.1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency.
6. Diagnosis of Folate Deficiency
To diagnose folate deficiency, the health care provider takes symptoms into consideration and checks the person’s medical history. They also perform a physical examination and draw blood.
The blood goes to a laboratory where technicians check the number of red blood cells present and test folate levels. They also check vitamin B12 levels. Deficiencies of folate and vitamin B12 often coexist and cause similar symptoms.4‘Folate Deficiency Anemia.’ Folate Deficiency Anemia | Michigan Medicine, www.uofmhealth.org/health-library/hw152337. If the provider suspects a digestive cause, they may order a barium study and other tests.2‘Folate-Deficiency Anemia.’ Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.
7. Treatment of Folate Deficiency
The health care provider develops a treatment plan that takes into consideration the person’s age, overall health, level of folate deficiency and tolerance for various medications and therapies. The treatment plan addresses any underlying condition that may be impacting folate levels.
In most cases, improving the diet to include foods rich in folic acid and reduce alcohol intake is helpful. Folate supplements offer a simple way to boost and maintain folate levels.2‘Folate-Deficiency Anemia.’ Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia.
8. Complications of Folate Deficiency
Left untreated, folate deficiency may cause pregnancy complications, fetal defects and megaloblastic anemia.3‘Folate Deficiency.’ Winchester Hospital, www.winchesterhospital.org/health-library/article?id=96682. Heart disease, nervous system problems and temporary infertility are other possible effects of folate deficiency.
The longer the folate deficiency exists before diagnosis and treatment, the more likely it is that complications occur.6NHS Choices, NHS, www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/. Once the underlying cause of the deficiency is identified and treated, improvement normally takes place within three to six months.7‘Folate-Deficiency Anemia.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/folate-deficiency-anemia. Long-term outcomes are usually excellent.5Khan, Kashif M. ‘Folic Acid Deficiency.’ StatPearls /[Internet/]., U.S. National Library of Medicine, 30 June 2020, www.ncbi.nlm.nih.gov/books/NBK535377/.
9. Preventing Folate Deficiency
Limiting alcohol intake and consuming a diet high in folate can help prevent folate deficiency. Taking daily supplements containing 400 micrograms of folic acid prior to pregnancy and during the first trimester is especially helpful in preventing pregnancy complications and neural tube defects in the fetus.7‘Folate-Deficiency Anemia.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/folate-deficiency-anemia.
While it’s best to obtain folate through a healthy diet, folic acid supplements are effective in treating folate deficiency, especially for those who take medications that have an impact on the absorption or metabolism of folate.1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency.
10. Is Too Much Folate Problematic?
While folate is normally not toxic1Folate Deficiency (Folic Acid Deficiency) By Larry E. Johnson, et al. ‘Folate Deficiency - Disorders of Nutrition.’ Merck Manuals Consumer Version, Merck Manuals, www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency., some evidence suggests high folate levels may worsen anemia and negatively impact cognition, especially in the elderly.5Khan, Kashif M. ‘Folic Acid Deficiency.’ StatPearls /[Internet/]., U.S. National Library of Medicine, 30 June 2020, www.ncbi.nlm.nih.gov/books/NBK535377/. Excessive folate levels may also make detecting symptoms of a vitamin B12 deficiency more difficult. People should not take more than 1,000 micrograms of folic acid per day.8‘Folic Acid.’ Womenshealth.gov, 1 Apr. 2019, www.womenshealth.gov/a-z-topics/folic-acid.
Folate supplements may cause allergic reactions in some people. They may also leave a bad taste in the mouth and cause nausea, appetite loss, confusion and irritability.9‘Folate (Folic Acid).’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Feb. 2021, www.mayoclinic.org/drugs-supplements-folate/art-20364625.
