What is Folate Deficiency?

Folate is also known as Vitamin B9. It is one of a group of important vitamins involved in cell metabolism. Folate plays a critical role in synthesizing DNA, RNA, and proteins. Therefore, deficiency can cause impairment of cell division and an accumulation of possibly toxic metabolites, e.g., homocysteine. Along with Vitamin B12, folate is essential for regulating the manufacture of red blood cells.^[1]

The synthetic form of folate is folic acid, which converts to folate in the body. Because the body more easily absorbs folic acid, it is most commonly used in supplements and fortified foods.

Many plants, mainly green leafy vegetables and animal products, contain folate. Thus, most healthy people absorb sufficient folate from their diets to avoid deficiency, but the body may increase demand in some cases. If supplementation doesn’t occur, this may lead to deficiency.

Folate deficiency is most commonly found in pregnant and lactating women, people with chronic gastrointestinal tract conditions, people following restricted diets due to weight-loss regimes or medical conditions, people with alcohol dependence, and people over 65 years of age.^[2]

Folate deficiency will not go away on its own. Treatment is required and may involve dietary changes and/or oral supplements and treatment of underlying causes if any are present. If left untreated, folate deficiency may result in folate deficiency anemia, which can cause severe complications.^[3]

Signs and symptoms of folate deficiency

Common symptoms of folate deficiency can include:^[2][4]

• Tiredness, fatigue and lethargy
• Muscle weakness
• Neurological signs, such as a feeling of pins and needles, tingling, or burning, or peripheral neuropathy, i.e. a numbness in the extremities
• Psychological problems, such as depression, confusion, memory problems, problems of judgement and understanding
• Gastrointestinal signs, such as nausea, vomiting, abdominal pain, weight loss and diarrhea
• Headache and dizziness
• Pallor
• Shortness of breath

Headache, dizziness, pallor, and shortness of breath are also symptoms of anemia. Anemia, particularly megaloblastic anemia, is often the first sign of an underlying folate deficiency, and doctors will usually test for folate and Vitamin B12 deficiencies when they encounter anemia.

Less common symptoms of folate deficiency are:^[2]

• Fast heartbeat (tachycardia)
• Fast breathing (tachypnoea)
• Exfoliative dermatitis, a condition which makes the skin red and scaly
• Heart murmur
• Painful swallowing
• A sore tongue (glossitis) and mouth ulcers
• Petechiae
• Angular stomatitis (fissures in the corners of the mouth)

In children with rare congenital malabsorption disorders, neurological problems might also be present.

Diagnosis of folate deficiency

Diagnosis is based on the evaluation of symptoms and blood tests. Although there is no official medical consensus of what folate level in blood serum indicates a deficiency, most practitioners agree that a level of fewer than seven nanomoles per liter (7nmol/L) is problematic. Below that level, the risk of megaloblastic anemia is much higher.[3] A blood test reveals anemia, which will lead to further evaluation of the possible causes, including analyzing serum folate levels. Elevated homocysteine levels can also indicate a folate deficiency and, therefore, be part of laboratory testing.

The process of diagnosing a folate deficiency involves excluding other possible causes of the symptoms. In cases where anemia is suspected, other possible causes of anemia, for example, iron deficiency, vitamin B12 deficiency, chronic disease, and others, must be excluded.

Physicians will evaluate the affected person’s diet for signs of insufficient intakes, such as might accompany vegan diets, poor diets, or “fad” diets. Often, people with this condition present with a history of alcohol intake, which contributes to a poor diet. Other affected people may be pregnant or lactating. Certain drugs, such as anticonvulsants, can also cause this type of deficiency.

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Causes of folate deficiency

Folate deficiency has several potential causes. Most healthy people absorb sufficient folate from their diets to avoid deficiency, but the body may increase demand in some cases, leading to deficiency if supplementation doesn’t occur. In other cases, the body may not absorb enough folate due to low intake or excessive excretion.

Causes of folate deficiency include:^[1][2][3][5]

• Low dietary intake due to medically restricted diets such as those followed by people with phenylketonuria or due to fad diets concentrating on foods that do not contain enough folate. Infants who are fed unfortified goat’s milk will also experience folate deficiency, as folate is not naturally present in goat’s milk.
• Malabsorption, which can be due to age, liver problems or gastrointestinal problems causing chronic diarrhoea, such as sprue, celiac disease or inflammatory bowel disease. Other causes of malabsorption are pancreatitis, bariatric surgery and extensive surgery involving the large or small intestine. Malabsorption is also a risk for people who use drugs that interfere with the absorption of folate, such as proton-pump inhibitors, some anticonvulsants such as carbamezapine, phenytoin, valproic acid, and phenobarbitol.^[6]
• Disorders such as leukaemia, carcinomas and lymphomas,, which increase the body’s demand for folate and may consequently lead to deficiency if folic acid supplements aren’t taken.
• Age, which causes changes in the gastrointestinal systems of people more than 65 years of age. These may lead to reduced absorption and reduced dietary intake.
• Alcohol-related damage to the liver, which affects the way in which folate is stored in the liver and increases the amount of folate excreted in urine. People with alcohol dependence may also have a nutritionally insufficient diet.
• Pregnancy and lactation, which raise the body’s demand for folate considerably due to the growth of new tissue in both mother and fetus. Sufficient folic acid supplementation is crucial for pregnant women, as a deficiency may cause birth defects.
• Smoking or exposure to secondhand smoke.^[7]
• Renal dialysis, which affects the amounts of homocysteine in the body and therefore increases the amount of folic acid needed.

Risks for folate deficiency

While folic acid is found in many food and fortified products, some people are more likely to develop a deficiency than others. Pregnant women, people with alcohol use addictions, and the elderly are at particular risk.^[8]

Alcohol abuse and folate deficiency

Alcoholism causes physical damage to the body, and one significant element of this is the development of nutritional deficiencies. This results from damage to the liver, which uses stored nutrients to process alcohol. Alcohol abuse causes the liver to run out of stored nutrients, causing the body to draw nutrients out of the bloodstream to make up the difference.[9] This can cause Vitamin A, calcium, Vitamin B12, and Vitamin B9, which is also called folic acid or folate.

High alcohol concentrations can also directly destroy B vitamins in the gastrointestinal tract.^[8] The body’s ability to process nutrients is further compromised as alcohol damages the liver, pancreas, and stomach. The ability of the small intestine to absorb nutrients such as folate is also reduced.^[10]

Furthermore, some people with alcoholism do not eat balanced diets, leading to low nutrient intake. Folate is one of the most essential nutrients affected by excessive alcohol use. Folate deficiency can contribute to the development of alcoholic liver disease.^[10]

Pregnancy and folate deficiency

Folic acid is vital during pregnancy, as it is required for the growth and development of the fetus.

In women, pregnancy increases the risk of folate-deficiency-related anemia because of its effect on the mother’s circulatory system. The mother’s blood volume increases during pregnancy, meaning that plasma levels and red blood cell numbers increase. Folate is needed to produce red blood cells, so pregnant women experience an increased demand for folate.^[11]

In fetuses, folate is crucial for the proper neural tube development. Folic acid also prevents oral clefts and congenital heart disease.^[11]

Ideally, women planning to have a baby should begin to supplement with folic acid before falling pregnant (see below).

Age and folate deficiency

It is well-established that folic acid levels can affect a person’s mood, social function, and cognitive function, especially among older people.[12] Depression is also common in people with folic acid deficiency. Many older people have folic acid deficiencies because of aging, poor diets linked to reduced income, or absorption problems caused by medication. Some older people also develop an increased demand for folate for unknown reasons.^[12]

Supplementation with B9 for older people may be helpful. Some studies have found that increasing folic acid supplementation in people with low folate levels leads to notable improvements in mood, cognitive function, and social functioning.

However, it is not advisable to begin taking folate supplements without consulting a physician. This is important because in older people with anemia, supplementing with B9 may cover the effects of B12 deficiencies.^[13] For more information on B12 deficiencies, see the FAQs below. If you are concerned that you or a loved one may have a folate deficiency, You can find for nearest doctor Find doctor.

Complications of folate deficiency

There are several possible health consequences of having folate deficiency. These include:

Anemia and folate deficiency

Megaloblasts are large, poorly-formed red blood cells that form in cases of anemia caused by, among others, folate or B12 deficiencies. Megaloblastic anemia is a result of folate deficiency and one of the most easily-identified symptoms: sometimes, a deficiency is only identified when anemia presents. If it results from folate deficiency, this anemia is treated by taking oral or intravenous folate supplements.^[14] For more information on folate-related anemia and B12-related anemia, see FAQs below.

Risks of folate deficiency during pregnancy

Folic acid is essential in the correct development of cells and is crucial for the correct development of fetuses. Pregnant women and women planning to become pregnant should increase their folic acid intake to 400 micrograms a day.

Women should increase their intake to 5mg a day if they are or wish to become pregnant and are affected by the following factors:^[15]

• If a woman is affected by diabetes or
• celiac disease or
• A BMI is more than 30 or
• Is treated with drugs that affect folate absorption

additional supplementation must be considered.

Folic acid deficiency in the mother can cause defects in the neural tube, which is the structure that eventually develops into the baby’s spinal cord. Neural tube defects (NTDs) can include spina bifida, caudal regressive (affecting the lowest part of the spine), and cleft palate. Infrequent, but severe, complications of folic acid deficiency can include anencephaly and encephaloceles, which involve the baby’s skull and brain.^[16]

Treatment of folate deficiency

In most cases, folate deficiency is relatively easy to correct. In cases where a deficiency has set in due to poor diet or age, taking a folic acid supplement or modifying the diet is sufficient. However, if there is an underlying problem, like alcoholic changes to the liver or a drug interaction or condition causing malabsorption, specialized treatment will be required. The underlying causes of folate deficiency need to be addressed to prevent the problem from recurring.

Folate deficiency is relatively easily treated in cases where the deficiency is not severe. However, where it has caused anemia, folic acid supplementation and/or correcting diet alone will not be enough. In women with megaloblastic anemia, vitamin B12 deficiency must be ruled out before any folic acid treatment can begin. If complications have occurred, or if there is an underlying condition or factor causing the folate deficiency, the affected person may have to be referred to one or more of the following kinds of doctors :^[2]

• Gastroenterologist, a doctor specialising in diseases and disorders of the esophagus, stomach, small intestine, colon and rectum, as well as the pancreas, gallbladder, bile ducts and liver
• Dietitian, a certified expert on diet and nutrition
• Hematologist, a doctor specialising in diseases and disorders of the blood

Natural sources of folic acid

Folate is readily available in many whole foods, such as:^[15]

• Leafy green vegetables such spinach, kale, broccoli, cabbage, and brussels sprouts
• Beetroot
• Citrus fruits
• Liver
• Beans and legumes such as peas, pinto, cannellini, or garbanzo beans/chickpeas

Good to know: Liver should be avoided by pregnant women, due to the high levels of Vitamin A it contains. Too much vitamin A can cause birth defects.

Supplementation with folate/folic acid

In some countries, such as the United States, South Africa, Chile, Canada, and Costa Rica, grain cereal products (bread, pasta, and breakfast cereals) are fortified with folic acid.^[17] This is a major factor in reducing the number of neural tube defects that occur, but it is still recommended that anyone who is at risk of a deficiency, such as pregnant women, should make sure to get 400 micrograms of folate a day. This is especially the case if the following risk factors are present:

• Celiac disease or other intestinal absorption disorders
• Thalassemia or sickle cell anemia; hereditary red blood cell disorders
• Clinical obesity, a BMI of 30 or more.
• Family history of, or partner with a family history of, neural tube defects. In this case, folic acid acts as “insurance.”
• Rapid cell turnover (hemolysis) occuring as a result of chronic hematological disorders^[3]

FAQs

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1. University of Maryland Medical Centre. “Vitamin B9 (Folic acid)” 5 August 2015. Accessed 8 February 2018. ↩ ↩

2. British Medical Journal Best Practice. “Folate deficiency.”. Updated November 2017. Accessed February 2018. ↩ ↩ ↩ ↩ ↩

3. Patient.info. “Folate deficiency.” 10 June 2016. Accessed 8 February 2018. ↩ ↩ ↩ ↩

4. NHS Choices. “Vitamin B12 or folate deficiency anemia.”. 16 May 2016. Accessed 8 February 2018. ↩

5. British Journal of Haematology. “Guidelines for the diagnosis and treatment of cobalamin and folate disorders”. 18 June 2014. Accessed 8 February 2018. ↩

6. Epilepsy.com. “Folic acid”. October 2013, reviewed 5 January 2018. Accessed 8 February 2018. ↩

7. Journal of Clinical Periodontology. “Relationship between smoking and folic acid, vitamin B12 and some haematological variables in patients with chronic periodontal disease.”. December 2006. Accessed 8 February 2018. ↩

8. Recovery Ranch. “Nutritional Effects of Alcohol and Alcoholism”. 16 October 2012. Accessed 1 Aug 2018. ↩ ↩

9. Polski Merkuriusz Lekarski. “Disturbances of folic acid and homocysteine metabolism in alcohol abuse”. April 2011. Accessed 1 August 2018. ↩

10. Journal of Nutrition. “Metabolic Interactions of Alcohol and Folate”. August 2002. Accessed 1 August 2018. ↩ ↩

11. Reviews in Obstetrics and Gynecology. “Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention”. 2011. Accessed 1 August 2018. ↩ ↩

12. British Medical Journal. “Folic acid, ageing, depression, and dementia”. June 2002. Accessed 1 August 2018. ↩ ↩ ↩

13. Journal of the American Medical Association. “Vitamin B12 and Folate and the Risk of Anemia in Old Age: The Leiden 85-Plus Study”. 10 November 2008. Accessed 3 August 2018. ↩

14. Patient.info. “Macrocytosis and Macrocytic Anaemia”. 9 July 2017. Accessed 8 February 2018. ↩ ↩

15. NHS Choices. [“Why do I need folic acid in pregnancy?]”(https://www.nhs.uk/chq/pages/913.aspx?categoryid=54). Last reviewed 18 March 2015. Accessed 8 February 2018. ↩ ↩ ↩

16. Patient.info. “Neural tube defects.”. 21 July 2014. Accessed 8 February 2018. ↩

17. Nutrients. “Folic Acid Food Fortification—Its History, Effect, Concerns, and Future Directions.”. March 2011. Accessed 8 February 2018. ↩

18. British Dietitians Association. “Food Fact Sheet: Folic Acid.” August 2016. Accessed 13 February 2018. ↩

19. Centre for Disease Control and Prevention. “Folic acid: frequently asked questions.”. 16 December 2016. Accessed 13 February 2018. ↩

20. Children’s National Health System. “Pediatric Anemia (pernicious or megaloblastic)”. Accessed 13 February 2018. ↩

21. National Heart, Lung and Blood Institute. “Pernicious Anemia”. Accessed 1 August 2018. ↩ ↩ ↩

22. Medscape. “Pernicious Anemia”. 27 December 2017. Accessed 1 August 2018. ↩

23. American Society of Hematology. “For patients: anemia”. Accessed 13 February 2018. ↩

**What is ⁤Folate Deficiency?**



**What is Folate?**



Folate, also known as vitamin‍ B9, is an essential nutrient ⁤that plays a crucial role in various bodily functions, including DNA synthesis, red blood cell formation, and fetal⁢ development.‍ It is naturally found in leafy green vegetables, fruits, and fortified foods.



**Causes of Folate Deficiency:**



*‌ **Inadequate Dietary⁤ Intake:** ⁤A lack of folate-rich foods in one’s diet can lead to deficiency.

* **Malabsorption Syndromes:** Conditions like celiac disease or Crohn’s disease can impair the absorption of folate from the intestines.

* **Pregnancy and Lactation:** Increased⁤ folate requirements during these periods can deplete reserves.

* **Medications:** ⁢Certain medications, such as birth control ⁤pills and methotrexate, can interfere with folate metabolism.

* **Alcoholism:** Chronic alcohol use can impair folate absorption and utilization.



**Symptoms of Folate Deficiency:**



* **Anemia:** Megaloblastic anemia, characterized by large, immature red blood cells.

*‌ **Fatigue⁣ and Weakness:** Due to reduced oxygen delivery.

* **Gastrointestinal Issues:** Loss of ⁢appetite, ⁤nausea, and diarrhea.

* **Pale Skin and Tongue:** Reduced hemoglobin levels cause pallor.

* **Developmental Problems in Infants:** Birth defects, such as neural tube defects, can occur in folate-deficient mothers.



**Diagnosis and Treatment:**



* **Blood Tests:**⁣ Serum folate levels determine deficiency status.

* **Bone Marrow Biopsy:** Examines red blood cell⁢ morphology to diagnose megaloblastic ⁤anemia.

* **Treatment:** Includes folate supplementation, either in pill or injection ⁢form.



**Prevention:**



* **Consuming Folate-Rich Foods:** Include leafy greens, legumes, and fortified cereals in your diet.

* **Supplementation:** Consider prenatal vitamins or folate supplements, especially⁢ during pregnancy and lactation.

* **Medical Management:** Address underlying medical conditions that⁢ affect folate absorption.



**Additional Information for SEO Optimization:**



* **Folate Deficiency Diet:** Foods⁣ rich in folate, such as spinach, kidney beans, and avocado.

* **Folate Absorption:** Factors affecting absorption, such ‍as cooking methods and digestive issues.

* **Folate Metabolism:** The role of ⁢enzymes in⁢ folate utilization and conversion.

* **Neural Tube​ Defects:** ​The importance of folate during pregnancy to prevent birth defects.

* **Megaloblastic Anemia Treatment:** Options for treating this type of anemia caused by folate deficiency.