Folate Deficiency

Definition

Folate deficiency is a low level of folate (vitamin B9) in the body. This vitamin is found in many foods. A form of folate, called folic acid, is also added to foods and in supplements. The body uses this vitamin to build proteins, make DNA, and help form red blood cells.

Scanning Electron Micrograph of Red Blood Cells.

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Causes

Folate deficiency may be caused by:

• Not getting enough folate from food
• Not absorbing enough folate from the digestive tract
• Needing more folate than normal, such as during pregnancy
• Procedures or medicine that block absorption or raises the need for folate

Risk Factors

Things that may raise the risk of folate deficiency are:

• Not getting enough folate in the diet due to:
  • Poor nutrition
  • A long term need of IV nutrition
  • Alcohol use disorder
• Having conditions and procedures that affect the body's ability to absorb folate from the digestive tract, such as:
  • Inflammatory bowel disease
  • Celiac disease or other malabsorption disorders
  • Taking certain medicines, such as antiseizure medicines and oral contraceptives
  • Weight loss surgery that changes the digestive system
• Needing more folate than normal due to:
  • Pregnancy or breastfeeding
  • Growth in infants
  • Cancer
• Liver disease
• Chronic hemolytic anemia
• Kidney dialysis
• Taking certain medicines, such as methotrexate

Symptoms

Symptoms of folate deficiency may be:

• Feeling very tired
• Lack of hunger
• Headache
• Pale skin
• A red, irritated, swollen, and sometimes shiny tongue
• Mouth sores
• Shortness of breath and lightheadedness
• Change in bowel patterns, such as loose stools (poop)

Folate deficiency can lead to problems such as:

• Megaloblastic anemia—larger than normal red blood cells
• Elevated homocysteine levels in the blood—a risk factor for heart disease
• Neural tube defects that affect fetal spinal cord, brain, and skull development

Diagnosis

The doctor will ask about symptoms, past health, and diet. A physical exam will be done.

Blood tests will be done to check vitamin B levels. Red blood cell folate levels will also need to be tested.

Treatment

Any underlying causes will be treated.

The goal of treatment is to increase folate levels. This can be done with a folic acid supplement.

Prevention

The risk of this problem may be lowered by eating foods that contain folate, such as grains, spinach, and lentils.

Some people at risk for deficiency need to take folate supplements. For example, pregnant women need to take vitamins with additional folic acid in them to prevent birth defects.