Folic Acid Deficiency

Written by Jacquelyn Cafasso
Medically Reviewed by Jennifer Wider, MD

What Is Folic Acid Deficiency?

Folic acid, or folate, is a type of B vitamin. It helps to:

  • repair DNA
  • make DNA
  • produce red blood cells (RBCs)

If you don’t have enough folic acid in your diet, you may end up with a folic acid deficiency. Certain foods, like citrus juices and dark green vegetables, are particularly good sources of folate. Not eating enough folic acid can lead to a deficiency in just a few weeks. Deficiency may also occur if you have a disease that prevents your body from absorbing folate.

Folic acid deficiency can cause anemia. Anemia is a condition where you have too few RBCs. Anemia can deprive your tissues of oxygen it needs, because red blood cells carry the oxygen. This may affect their function.

Folic acid is particularly important in women of childbearing age. A deficiency during pregnancy can lead to birth defects. Most people get enough folic acid from food. Many foods now have additional folic acid added to prevent deficiency. Nevertheless, supplements are recommended for women who may become pregnant.

What Causes Folic Acid Deficiency?

Folic acid is a water-soluble vitamin. It dissolves in water and is not stored in your fat cells. This means that you need to keep taking folate as your body cannot develop a reserve.

People release excess amounts of water-soluble vitamins in their urine.

Causes of folic acid deficiency include:

Diet

A diet low in fresh fruits, vegetables, and fortified cereals is the main cause of folic acid deficiency. In addition, overcooking your food can sometimes destroy the vitamins. Folic acid levels in your body can become low in just a few weeks, if you don’t eat enough folate-rich foods.

Disease

Diseases that affect absorption in the gastrointestinal tract can cause folic acid deficiencies. Such diseases include:

  • Crohn’s disease
  • celiac disease

certain types of cancers people with severe kidney problems that require dialysis

Medication Side Effects

Certain medications can cause folic acid deficiency. These include:

  • phenytoin (Dilantin)
  • trimethoprim-sulfamethoxazole
  • sulfasalazine

Excessive Alcohol Intake

Alcohol interferes with folic acid absorption. It also increases folate excretion through the urine.

What Are The Symptoms of Folic Acid Deficiency?

Symptoms of folic acid deficiency are often subtle. They include:

  • fatigue
  • grey hair
  • mouth sores
  • tongue swelling
  • growth problems

Symptoms of anemia caused by folic acid deficiency include:

  • persistent fatigue
  • lethargy
  • pale skin
  • tender tongue
  • irritability
  • diarrhea

How Is Folic Acid Deficiency Diagnosed?

Folic acid deficiency is diagnosed with a blood test.

Pregnant women will often have folate levels tested during a prenatal checkup.

What Are The Complications of Folic Acid Deficiency?

Folic acid is required for the normal production of RBCs. Complications of a deficiency may include:

  • megaloblastic anemia, where RBCs are larger than normal and not fully developed
  • low white blood cells (WBCs) and platelets
  • serious birth defects in the spinal cord and brain of a developing fetus. These are called neural tube defects.

Prevention and Treatment of Folic Acid Deficiency

Treatment involves increasing dietary intake of folate. You can also take a folic acid supplement. Folic acid is frequently combined with other B vitamins in supplements. These may be called vitamin B complexes. Alcohol intake should be decreased, and completely eliminated for pregnant women.

To prevent folic acid deficiency, eat a proper nutritious diet. Foods that contain high amounts of folate include:

  • leafy green vegetables, such as broccoli and spinach
  • brussel sprouts
  • peas
  • citrus
  • fruit such as bananas and melons
  • tomato juice
  • eggs
  • beans and legumes
  • mushrooms
  • asparagus
  • kidney and liver meat
  • poultry
  • pork
  • shellfish
  • wheat bran
  • fortified cereals

The recommended folate dose is 400 micrograms per day. Women who may become pregnant should take a folate supplement. Folate is critical for normal fetal growth.

People who take medications known to cause folic acid deficiency should take a supplement as well, but it is important to check with your doctor first

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