Folate deficiency

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 15, 2016
StartDiseasesFolate deficiency

Folate is a type of vitamin B. A folate deficiency can lead to some serious complications, such as folate-deficiency anemia and birth defects. Fortunately, once folate deficiency is diagnosed, it is easy to treat. Folate deficiency is a less-than-normal amount of folate in the body.


Definition & Facts

Folate is the term used for both the folate naturally found in food as well as folic acid, which is the oxidized monoglutamate form of the vitamin that is found in fortified foods and dietary supplements. Folate is a water-soluble B vitamin (vitamin B9). It is available as a dietary supplement, naturally found in some foods, and added to other foods. Because folate is a water-soluble vitamin, the body excretes excess folic acid through urine daily. Some people need a daily dose of folic acid. 

All B vitamins, including folate, aid the body in converting carbohydrates (food) into glucose (fuel) which is then used to make energy. Folate also helps the body utilize proteins and fats. B vitamins are important for healthy skin, hair, eyes, and liver. They are also essential for nervous system functioning.

Folic acid is important for proper brain functioning, and it plays a significant role in mental and emotional health. Folate also helps in producing the body's genetic material, DNA and RNA. Vitamin B9 works with vitamin B12 to create red blood cells and help iron work in the body.

Folate is also important when tissues are rapidly growing, such as during pregnancy, infancy, and adolescence. Taking folate during pregnancy helps prevent birth defects, such as spina bifida and cleft lip and cleft palate. Additionally, taking folate supplements before pregnancy and during the first trimester may lower the chance of miscarriage

Symptoms & Complaints

It can lead to several symptoms and complications. Folate deficiency symptoms are often subtle. They may include mouth ulcers, fatigue, gray hair, growth problems, loss of appetite, tongue inflammation and swelling, diarrhea, lethargy, irritability, gingivitis, and shortness of breath. Folate deficiency may also lead to depression, dementia, and cognitive difficulties.

People who have folate deficiency may also have hyperpigmentation. Hyperpigmentation is darkening of the skin, and people with folate deficiency may notice darker skin at the creases of their soles and palms and the dorsal surfaces of their fingers and toes. Hyperpigmentation can usually be reversed after several weeks or months of treatment.

People who are deficient in vitamin B9 may also have fevers. Folate deficiency can also lead to folate-deficiency anemia in which red blood cells are abnormally large. Low levels of platelets and low levels of white blood cells may also be seen in individuals with folate deficiency. 

Folate deficiency during pregnancy may lead to birth defects of the neural tube, a structure that eventually becomes a baby's spinal cord and brain. Neural tube birth defects that may occur as a result of folate deficiency during pregnancy include brain damage, cleft palate, and spina bifida. 

A cleft palate may affect one or both sides of the mouth and may go the entire length of the palate. Children with a cleft palate may also have a differently-shaped nose and poorly aligned teeth. A cleft palate may lead to feeding problems, recurrent ear infections, failure to gain weight, poor growth, and difficulties with speech

Spina bifida occurs when the neural tube fails to properly develop or close. Spina bifida ranges in severity. In its most severe form, spina bifida is associated with neurological symptoms, such as muscle weakness or paralysis in the legs, seizures, bowel problems like fecal incontinence and bladder problems like urinary incontinence.


There are several possible causes of folate deficiency. A diet low in folate is the most common cause of the condition. Eating a diet low in fresh vegetables, fruits, and fortified cereals can lead to folate deficiency. Additionally, overcooking food can destroy the vitamins in it. Folate levels in the blood can drop within just a few weeks if folate-rich foods are not part of a person's diet. Because folate is not stored in the blood, a person must consume folate daily in order to maintain healthy folic acid levels. 

Conditions that affect absorption in the digestive tract can also lead to folate deficiency. These disorders include certain types of cancers, Crohn's disease, celiac disease, and kidney problems that require dialysis. Certain medications, such as sulfasalazine, phenytoin, methotrexate, and trimethoprim-sulfamethoxazole may also lead to deficient levels of folate in the blood.

Alcohol abuse can lead someone to become folate deficient as well. Alcohol interferes with the absorption of folate and increases the excretion of folate through urination. Some individuals possess a genetic mutation that prevents their bodies from efficiently and properly converting supplemental or dietary folate to a useful form. Hemolytic anemia can also lead to folate deficiency. Hemolytic anemia occurs when a person's dying red blood cells outpaces the bone marrow's ability to produce more. 

Diagnosis & Tests

When a patient presents with symptoms of folate deficiency, a physician will perform a physical examination and take a detailed medical history. A diagnosis of folate deficiency can be made with a simple blood test. Pregnant women often have their folate levels tested at prenatal examinations. A diagnosis is made when an individual has a lower-than-normal folate level in the blood. 

Treatment & Therapy

Treatment for folate deficiency involves increasing the amount of folate an individual consumes either through food or with a supplement. Some folate-rich foods one can add to his diet include kale, romaine lettuce, turnip greens, spinach, collard greens, broccoli, papayas, raspberries, oranges, strawberries, grapefruits, asparagus, lima beans, split peas, green beans, green peas, garbanzo beans, lentils, kidney beans, pinto beans, navy beans, okra, flax seeds, sunflower seeds, almonds, peanuts, avocados, corn, beets, celery, cauliflower, squash, carrots, fortified cereals, eggs, poultry, pork, shellfish, wheat bran, tomato juice, and mushrooms. 

Prevention & Prophylaxis

Someone can prevent folate deficiency by eating a nutritious diet containing folate-rich foods. Alternatively, someone can prevent the condition by taking a daily supplement. 

Folate is important for many bodily functions. Serious complications, such as folate-deficiency anemia, birth defects, and low levels of platelets and white blood cells can occur when someone is deficient in folate. If one's folate deficiency is due to consuming an inefficient amount of folate in one's diet, it is easily treated once a proper diagnosis has been made.