Folate Deficiency

Overview

What is folate deficiency?

Folate deficiency is when your blood lacks the amount of vitamin B9 (folate) it needs to function properly. Folate deficiency can cause a wide range of symptoms and complications.

What is folate?

Folate is a B vitamin found naturally in many of the foods you eat. These foods include leafy greens, citrus fruits, nuts, beans, peas, seafood, eggs, dairy, meat, poultry and grains. Your body needs folate to make new red blood cells and DNA, the genetic material in your cells. Folate is especially important for people who are pregnant. Folate helps in the growth and development of the fetus and can help prevent birth defects.

What is folic acid?

Folic acid is a manmade (synthetic) form of folate. Your body can’t store large amounts of natural folate. But your body can easily absorb folic acid. As a result, it’s added to some of the foods you eat. Grains such as rice, bread, pasta and some cereals are enriched (fortified) with folic acid. Folic acid is also available as a dietary supplement.

What complications can occur due to folate deficiency?

When you don’t get enough folate, several complications can occur.

Folate deficiency during pregnancy

Folate deficiency during pregnancy can cause severe complications. Folate is important for the growth of the fetus's brain and spinal cord. Folate deficiency can cause severe birth defects called neural tube defects. Neural tube defects include spina bifida and anencephaly.

Folate deficiency can also increase your chances of placental abruption, a condition where your placenta separates from your uterus. In addition, your baby may be premature (preterm birth) and/or have a low birth weight. Studies have also shown low folate during pregnancy could lead to the development of autism in your child.

Folate deficiency anemia

Folate deficiency can also lead to folate deficiency anemia. Anemia can happen when your body doesn’t have enough healthy red blood cells. Your body needs red blood cells to carry oxygen to your body tissues. Folate deficiency anemia can also cause your body to produce abnormally large red blood cells that don’t function properly.

Other complications of folate deficiency can include:

Symptoms and Causes

What are the symptoms of folate deficiency?

One of the first symptoms of folate deficiency is extreme tiredness (fatigue). Other symptoms may include:

Anemia symptoms

Oral symptoms

Neurological symptoms

  • Memory loss.
  • Difficulty concentrating.
  • Confusion.
  • Problems with judgment.

Additional symptoms of folate deficiency may include:

What causes folate deficiency?

One of the most common causes of folate deficiency is not eating a healthy, balanced diet. A healthy diet includes foods that naturally contain folate or are enriched with folic acid. Other causes of folate deficiency can include:

  • Digestive system diseases: Your digestive system doesn’t absorb folic acid well if you have a disease such as Crohn’s disease or celiac disease.
  • Excessive alcohol use: People who drink large amounts of alcohol sometimes substitute alcohol for food. As a result, they don’t get enough folate.
  • Overcooking your fruits and vegetables: When you overcook, the heat can destroy the naturally occurring folate in your produce.
  • Hemolytic anemia: A blood disorder that occurs when your red blood cells are destroyed and can’t be replaced fast enough.
  • Certain medications: Some anti-seizure drugs and ulcerative colitis drugs interfere with the proper absorption of folate.
  • Kidney dialysis: A treatment for people with kidney failure.

Diagnosis and Tests

How is folate deficiency diagnosed?

Your healthcare provider will ask about your medical history and your symptoms. They can diagnose folate deficiency through a blood test. The blood test measures the amount of folate in your blood. A low level of folate indicates a folate deficiency.

Management and Treatment

How is folate deficiency treated?

Your healthcare provider will treat your folate deficiency with a folic acid supplement. Most adults need 400 micrograms (mcg) of folic acid each day. Your healthcare provider will let you know how much you should take.

Your healthcare provider will also advise you to eat a healthy, balanced diet. A balanced diet includes fruits, vegetables and other foods that contain folate or are enriched with folic acid.

Prevention

How can I prevent folate deficiency?

The best way to prevent folate deficiency is to eat a healthy diet that includes foods that contain folate or folic acid. Folate can be found naturally in:

  • Peas, beans and legumes.
  • Citrus fruits.
  • Dark green leafy vegetables.
  • Liver.
  • Seafood.
  • Eggs and dairy.
  • Meat and poultry.

Folic acid can be found in enriched or fortified:

  • Bread.
  • Flour.
  • Pasta.
  • Rice.
  • Cereal.

The amount of folate you need every day depends on your age and other factors. Most adults should get 400 micrograms (mcg) of folate daily. People who are pregnant should take a folic acid supplement to make sure they’re getting enough folate each day. The average daily recommended amount of folate you need are:

Age/Life StageRecommended Amount of Dietary Folate Equivalents (DFEs)
Birth to age 6 months65 mcg DFE
Infants ages 7 to 12 months80 mcg DFE
Children ages 1 to 3 years150 mcg DFE
Children ages 4 to 8 years200 mcg DFE
Children ages 9 to 13 years300 mcg DFE
Teenagers ages 14 to 18 years400 mcg DFE
Adults ages 19 years and up400 mcg DFE
Pregnant people600 mcg DFE
Breastfeeding (chestfeeding) people500 mcg DFE

If you’re taking any medication that interferes with folate absorption, you should also take a folic acid supplement.

Outlook / Prognosis

What can I expect if I have folate deficiency?

If you increase your folate intake, the effects of folate deficiency should start to reverse. It’s important to eat enough foods that contain folate or are enriched with folic acid. In addition, take a folic acid supplement. If you don’t get enough folate, complications such as anemia will be ongoing.

Frequently Asked Questions

What is cerebral folate deficiency?

Cerebral folate deficiency is a very rare disorder that occurs when there’s a shortage of folate in the fetus's brain. Babies born with cerebral folate deficiency develop normally during infancy. Then, they begin to slowly lose their mental skills and movement abilities about age 2. Intellectual disabilities, speech difficulties, seizures and difficulty coordinating movements (ataxia) can be severe. Cerebral folate deficiency is caused by a gene change (mutation).

What’s the difference between B12 and folate deficiency?

Vitamin B12 and folate are both important for the formation of your red blood cells and DNA. A deficiency in either vitamin can lead to fatigue, weakness and anemia. Unlike folate, B12 isn’t found in plants. B12 is mainly found in meat, eggs and dairy products. Vegetarians and vegans are at a high risk of B12 deficiency. Severe vitamin B12 deficiency can lead to complications such as depression, paranoia, delusions, memory loss, incontinence and loss of taste and smell.

What is MTHFR polymorphism?

MTHFR stands for methylenetetrahydrofolate reductase. Some people have a genetic change (mutation) in their MTHFR gene. If you have this mutation, you aren’t able to convert folate to its active form, 5-MTHF. This genetic mutation affects about 25% of Hispanic people, 10% of white people, 10% of Asian people and 1% of Black people. If you have this genetic mutation, you may benefit from using a folate supplement that contains 5-methyl-THF, the active form of folic acid.

A note from Cleveland Clinic

Folate is a vitamin that helps your body make red blood cells and DNA. Folate is especially important for people who are pregnant, as it aids in fetal development. While folate deficiency is rare, it can cause severe complications such as birth defects and anemia. So it’s important to eat a diet rich in fruits, vegetables and other foods that contain folate or folic acid. In addition, you can take a folic acid supplement. Your healthcare provider can advise you on the amount of folate you should be getting each day.

Last reviewed by a Cleveland Clinic medical professional on 12/14/2021.

References

  • Centers for Disease Control and Prevention. Folic Acid. (https://www.cdc.gov/ncbddd/folicacid/index.html) Accessed 12/14/2021.
  • Merck Manual. Folate Deficiency. (https://www.merckmanuals.com/home/disorders-of-nutrition/vitamins/folate-deficiency) Accessed 12/14/2021.
  • National Health Service. Vitamin B12 or folate deficiency anaemia. (https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/) Accessed 12/14/2021.
  • National Institutes of Health. Folate. (https://ods.od.nih.gov/factsheets/Folate-Consumer/) Accessed 12/14/2021.
  • National Library of Medicine. Folate deficiency. (https://medlineplus.gov/ency/article/000354.htm) Accessed 12/14/2021.

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