Folate Deficiency

Folate Deficiency

Medically reviewed by Avi Varma, MD, MPH, AAHIVS, FAAFP — By Jacquelyn Cafasso — Updated on March 10, 2022


Risk factors
Folic acid deficiency in pregnancy
What is folate deficiency?
Folate, or folic acid, is a type of B vitamin. It helps to:

make DNA
repair DNA
produce red blood cells (RBCs)
If you don’t have enough folate in your diet, you may end up with a folate deficiency. Certain drinks and foods, such as citrus juices and dark green vegetables, are particularly good sources of folate.

Not eating enough folate can lead to a deficiency in just a few weeks. Deficiency may also occur if you have a condition or genetic mutation that prevents your body from absorbing or converting folate to its usable form.

Folate deficiency can cause anemia. Anemia is a condition in which you have too few RBCs. Anemia can deprive your tissues of oxygen it needs because RBCs carry the oxygen. This may affect their function.

Folate is particularly important in people with uteruses of childbearing age. A folate deficiency during pregnancy can lead to birth irregularities.

Most people get enough folate from food. Many foods now have additional folateTrusted Source in the form of folic acid, a synthetic version of folate, to prevent deficiency. Nevertheless, supplements are recommended for women who may become pregnant.

What are the symptoms of folate deficiency?
The symptoms of folate deficiency are often subtle. They include:

gray hair
mouth sores
tongue swelling
growth problems
peripheral neuropathy (the result of damage to one or more groups of nerves)
The symptoms of anemia that occur due to folate deficiency include:

persistent fatigue
pale skin
shortness of breath
What causes folate deficiency?
Folate is a water-soluble vitamin. It dissolves in water and isn’t stored in your fat cells. This means that you need to keep taking folate, as your body can’t develop a reserve.

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

The causes of folate deficiency include:


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


Conditions that affect absorption in the gastrointestinal tract can cause folate deficiencies. They include:

Crohn’s disease
celiac disease
certain types of cancers
severe kidney problems that require dialysis

Some people have a genetic mutation that hinders their body from properly and efficiently converting dietary or supplemental folate to its usable form, methylfolate.

Medication side effects

Certain medications can cause folate deficiency. These include:

phenytoin (Dilantin)
trimethoprim-sulfamethoxazoleTrusted Source
Excessive alcohol intake

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

Risk factors for folate deficiency
Factors that may increase the likelihood of having a folate deficiency include:

heavy alcohol abuse
being of childbearing age
eating overcooked foods
consuming a vitamin-poor diet
medical conditions, such as sickle cell disease
low socioeconomic status
elderly people living in institutions
a genetic polymorphism in the MTHFR gene
malabsorption syndromes, such as celiac disease and inflammatory bowel disease
certain medications

Folic acid deficiency in pregnancy: What are the risks?
Folic acid is especially important in pregnancy. Folic acid can help prevent certain birth irregularities called neural tube defects in babies. Neural tube defects are serious as they affect the spinal cord or brain. They include:

Spina bifida. This a condition that occurs when a baby’s spinal cord or brain don’t fully develop in the womb. Babies born with spina bifida may require surgery, and often have paralysis and other physical disabilities.
Anencephaly. This is a condition where a baby’s brain and skull don’t completely form in the womb. In most cases, babies with anencephaly are stillborn or die shortly after birth.
All people of childbearing age should get enough folic acid
These birth irregularities occur very early in a pregnancy, usually before a person knows they’re pregnant. Since many pregnancies aren’t planned, experts recommend that all people of childbearing age get adequate amounts of folic acid even if they aren’t trying to get pregnant.
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What are the complications of folate deficiency?
Folate is required for the normal production of RBCs. Complications of a deficiency may include:

megaloblastic anemia, which means the RBCs are larger than normal and not fully developed
low levels of white blood cells and platelets
serious birth irregularities in the spinal cord and brain of a developing fetus, which are called neural tube defects
peripheral neuropathy
How is a folate deficiency diagnosed?
Folate deficiency is diagnosed with a blood test. Doctors will often test the folate levels of pregnant people during their prenatal checkups.

At-home testing kits are also available.

Treatment of folate deficiency
Treatment involves increasing the dietary intake of folate. You can also take a folate or folic acid supplement.

Those with a genetic mutation that affects folate absorption, known as MTHFR, need to take methylated folate in order to avoid deficiency.

Folate is frequently combined with other B vitamins in supplements. These are sometimes called B complex vitamins.

Pregnant people should completely avoid alcohol, and everyone else with a folate deficiency should decrease their alcohol intake.

Prevention of folate deficiency
Eat a nutritious diet to prevent folate deficiency. Foods that contain high amounts of folate include:

leafy, green vegetables, such as broccoli and spinach
Brussels sprouts
fruits, such as bananas and melons
tomato juice
liver meat
wheat bran
fortified cereals
The recommended folate dose is 400 micrograms per day. People who may become pregnant should take a folate supplement. Folate is critical for normal fetal growth.

If you have MTHFR, you should avoid foods that are fortified with folic acid. Certain variants of this genetic mutation prevent the breakdown of folic acid to methylfolate.

People who take medications known to cause folate deficiency should take a supplement as well, but it’s important to check with a doctor first.

Last medically reviewed on March 10, 2022

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version
Mar 10, 2022
Written By
Jacquelyn Cafasso
Edited By
Roman Gokhman
Medically Reviewed By
Copy Edited By
Suan Pineda
Aug 3, 2020
Written By
Jacquelyn Cafasso

Link to original article below.

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