Folate deficiency

Folate, also known as folacin, is the natural form of vitamin B9. It is a water-soluble chemical that can be found in many foods.

It is also synthesized into folic acid and is added to foods or sold as a supplement as the folic acid is better absorbed than folate from food sources. Folate is responsible for the creation of DNA and RNA and it is involved in the metabolism of protein.

It is also needed in the production of healthy red blood cells and is vital during periods of rapid cell growth, such as in the time of pregnancy and fetal development.

Folate plays an important role in the breakdown of homocysteine, an amino acid that has deleterious effects in the body if present in high amounts.

What is Folate Deficiency?

Folate deficiency occurs when there is a low level of folate and its derivatives in the body. Since the body cannot naturally produce folate, folate deficiency may occur if there isn’t enough folate in your diet.

Folate deficiency can occur within a few weeks of not eating folate-rich foods. Deficiency may also be caused by a hereditary mutation or disease that prevents your body from absorbing or converting folate that can be synthesized by the body.

Anemia is the most common effect of folate deficiency. It is a condition where there are very few red blood cells. The illness can impair the function of tissues because the body requires red blood cells to carry oxygen.

Folate is a vital nutrient for women of childbearing age, and it can lead to birth defects during pregnancy.

Causes of Folate Deficiency

Lack of Folate in Diet

Consuming food with low levels of folic acid may lead to folate deficiency. This is a common cause of the folate deficiency for may people. Foods rich in folate include beans, leafy green vegetables, whole grains like wheat, and citrus fruits.

Excess consumption of alcohol

Drinking lots of alcohol over time can impair the body’s ability to absorb folate. Excess alcohol intake makes it harder for the intestines to absorb and utilize the nutrient.

Existing Medical Conditions

Since the small intestine absorbs folate through the jejunum, diseases of the small intestine such as celiac disease, Crohn’s disease, and entero-enteric fistula may reduce folate absorption. This makes it difficult for the body to hold as much folate as it needs.


Due to the increasing number of cells of a growing fetus, the body needs an increased amount of folate. This can lead to a decreased absorption and intake of the nutrient.

Folate deficiency is common in pregnant women, and it occurs as a result of an increasing amount of blood, and maternal hormones that regulate metabolism.

Pregnant women living in areas endemic with malaria and with sickle cell anemia require more folate.


Certain medications can interfere with the body’s ability to absorb and process folate. These include:

  • Birth control pills
  • Methotrexate (used to control inflammation like Crohn diseases and rheumatoid arthritis)
  • Anticonvulsant medications like valproate phenytoin, carbamazepine, and primidone)
  • Metformin
  • Triamterene
  • 5-fluorouracil
  • Sulfasalazine

Other conditions that may increase one’s risk for folate deficiency include:

  • Kidney dialysis
  • Tobacco smoking
  • Breastfeeding
  • Bleeding
  • Malabsorption including fructose malabsorption and celiac disease

Signs and Symptoms of Folate Deficiency

Common symptoms of folate deficiency include:

  • Loss of appetite
  • Weight loss
  • Weakness
  • Headache
  • Sore tongue
  • Irritability

In pregnant women, folate deficiency may lead to low birth weight or premature births of infants. Folate deficiency in children can lead to:

Anemia due to folate deficiency can cause problems like:

  • Pale skin
  • Fatigue
  • Ringing in the ears (Tinnitus)
  • Race heart
  • Lack of energy
  • Headaches


The condition can be diagnosed by examining folate levels and its derivatives in the blood. This is measured as methyltetrahydrofolate.

Folate can also be diagnosed according to this guideline:

  • Folate deficiency is detected if the serum folate level is less than 7 nmol/l (3 μg/l).
  • Red blood cell examination may be carried out if folate deficiency is suspected.
  • A homocysteine level above 15 μmol/l could be indicative of a folate deficiency; however, local reference ranges should be taken into account.


Complications due to folate deficiency may include:

  • Low levels of white blood cells (leucocytes) and platelets.
  • Megaloblastic anemia, a condition where the red blood cells are larger than usual and underdeveloped.
  • Severe birth defects in the brain and spinal cord of a developing fetus. This is also known as neural tube defects.
  • Placental abruption which occurs when the placenta pulls away from the uterus wall and disrupts the flow of blood to the fetus.

Treatment and Prevention of Folate Deficiency

Folate deficiency can be prevented or treated by eating a healthy diet. These include leafy green vegetables, cereals, nuts, and fruits.

Folate acid is a synthetic form of folate and can be administered daily as a supplement. Daily multivitamin supplement contains folic acid along with other vitamin B nutrients.

The supplement is available over the counter in some counties, and in others, it is available in the form of fortified wheat flour, cornmeal, and rice.