Understanding Folic Acid Deficiency: Causes, Symptoms, and Treatment

Key takeaways

• A balanced diet, which is rich in leafy greens, legumes, citrus fruits, and fortified grains, is very important to prevent folate deficiency or folic acid deficiency anaemia. Early detection of low folic acid symptoms like headaches, fatigue, hair loss etc., can help reverse Vitamin B9 deficiency before it has a long-term effect on health.

• Certain health conditions or medications can also cause low folate levels by interfering with nutrient absorption. Maintaining the recommended daily folate intake can reduce risks linked to low folic acid.

Key takeaways

Introduction

Folic Acid Deficiency Causes

Folic Acid Deficiency Symptoms

Folic Acid Deficiency Treatment

How Much Folate Do You Really Need?

Conclusion

FAQs on Folate Deficiency

Introduction

Folate, also referred to as vitamin B-9, helps the body to create red blood cells and further cell growth. A folate deficiency, if not checked in time, can have serious consequences. The effects can impact our overall health, from chronic weakness to brain fog, patchy memory, or folic acid deficiency anemia. However, with a well-balanced diet and a healthy lifestyle, one can maintain good folate levels. In this blog, we explore the causes, symptoms, and treatments that should be taken in case of folic acid deficiency.  

Note: Folate (vitamin B9) refers to the natural form in foods; folic acid is the synthetic form used in supplements/fortified foods. We use ‘folate’ for dietary sources and ‘folic acid’ for supplements.

Folic Acid Deficiency Causes

Folate deficiency can happen for many reasons. Here are the major ones. 

1. Poor Diet

Diet plays a key role in maintaining the folic acid levels in our body. Folate levels can drop within a few days if folate-rich foods are not taken consistently. Here are some essential sources of folate:

• Vegetables: green leafy vegetables like spinach and asparagus, avocado, peas, cauliflower, and broccoli. 

• Fruits: especially citrus like oranges, kiwi, grapes

• Fortified cereals and grains: enriched breads, pasta.

• Lentils, chickpeas, beans, and eggs are also extremely beneficial.  

Another important factor is to eat fresh, lightly cooked meals instead of over-cooked foods. Extensive cooking destroys the folate in our food. Additionally, including zinc-rich foods in your diet can support overall nutrient absorption, including folate. For a comprehensive list of these beneficial foods, check out our blog on Best 20 Zinc-Rich Foods.

2. Malabsorption

At times, even if a person is taking a balanced diet, folate deficiency symptoms may arise. This could be because of an impaired absorption in the gastrointestinal tract, which could be due to certain underlying health conditions. These are health issues like Crohn’s disease, celiac disease, short bowel syndrome, amyloidosis, or mesenteric vascular insufficiency. Due to pre-existing health conditions, folate absorption may not occur from the food intake, leading to a deficiency. 

3. Increased Need

An increased need for folate occurs during pregnancy or in women who are planning to conceive. During pregnancy, the daily requirement for folate has been recommended at 600 mcg, instead of the usual 400 mcg. Breastfeeding mothers are also advised to ensure adequate folate intake to avoid folic acid deficiency symptoms. 

In certain cases, patients undergoing dialysis due to diabetes may also have an increased need for folate. If an expecting mother does not meet the folate requirement, there is a higher chance of development issues in the baby.  

4. Medications

Certain medicines may interfere with folic absorption in the body, such as:

• Medicines used to treat ulcerative colitis 

• Methotrexate: used for cancer treatment and rheumatoid arthritis

• Metformin: used in case of diabetic patients

• Trimethoprim-sulfamethoxazole, an antibiotic.

• Antiseizure medication such as phenytoin, phenobarbital

These drugs can inhibit folate utilisation, or its conversion, leading to a folate deficiency. 

5. Genetic Factors

Genetic factors can also contribute to folic acid deficiency symptoms. These are:

• MTHFR gene mutations: This gene gives instructions to the body for making an enzyme for folate metabolism. However, variations in this gene can inhibit the body from converting folate into an active form.   

• Hereditary Folate Malabsorption: This is a rare genetic condition. In this case, the body does not have the ability to absorb folate from food, leading to folate deficiency.   

Environmental and lifestyle factors such as alcohol consumption can also impair folate absorption. 

Folic Acid Deficiency Symptoms

Here are the folate deficiency symptoms you should keep a note of. 

1. Fatigue

A person may feel extremely tired all the time and be lacking energy. This can be despite sleeping for a sufficient number of hours.

2. Anaemia 

A poor level of healthy red blood cells causes folic acid deficiency anemia. In this condition, there may not be enough RBC for carrying oxygen to the body's tissues. This results in a low level of oxygen in the entire body, leading to issues like fatigue, weakness, and shortness of breath.   

3. Cognitive Issues 

A serious outcome of folic acid deficiency is in the form of cognitive issues like poor concentration, depression, irritability, insomnia, cognitive decline, and, in extreme cases, psychosis. Consistent poor folate levels can also cause memory loss or dementia. 

4. Mouth Sores 

Mouth ulcers may be caused by vitamin deficiencies, including low folate levels. A  severe deficiency may result in a red and sore tongue. Check out our blog on the Top 11 Vitamin-Rich Foods List

5. Tingling Or Numbness

Lack of folic acid can affect nerve function. It is responsible for the pins and needles feeling in your hands[1], feet, or legs. This symptom often gets overlooked, but it could be your body's way of telling you that you have low folate levels.

6. Changes In Hair Skin Or Nails

From brittle nails and hair thinning to pale skin; low folic acid levels can affect the cells that grow fastest. And, those cells are found in your hair, skin, and nails.

7. Digestive Issues

Folic deficiency can also cause poor appetite, weight loss, bloating, or even mouth sores [2]. At times, certain types of cancers can also lead to a folic deficit [3], so persistent gut issues should be checked by a doctor.

Growth Problems 

A lack of folate deficiency can also affect the foetus. Folate is important for the foetus’s brain development and spinal cord development. A deficiency can cause neural tube defects, like spina bifida and anencephaly in the baby. 

This can later affect learning abilities, behavior, and cognitive development. Further, the child may also suffer from stunted growth or delayed development due to inadequate folate at the initial stages. Lastly, immunity may also be impacted due to this deficiency. The child may have low resistance and get frequent infections, which would later impact his development. 

Folic Acid Deficiency Treatment

• Dietary Changes

Your diet needs an overhaul in case you are folate deficient. You should try to include foods from all major food groups in your diet to ensure they are well-balanced. The essentials which should be included are dark green, leafy vegetables (kale, spinach, broccoli, asparagus, etc) and citrus fruits like oranges, kiwi, and grapes. These foods are rich in iron, and regular consumption can increase folic acid levels. One must include fortified cereals and whole grains. Fresh, lightly cooked food should be consumed instead of deep-fried or overcooked food. 

Try Good Monk’s Family Nutrition Mix, which can be added to your meals. It is a super-food mix containing B-9, Iron, Zinc, and a host of other vitamins and minerals.  

• Supplements

One should consult a doctor before taking any supplement as a folic acid deficiency treatment. On a routine blood test, if a folate deficiency is observed, the medical practitioner will usually recommend folic acid tablets. These are usually prescribed for daily usage, up to 4 months, to build up the folate. However, only the intake of supplements is not sufficient, once one has to make dietary changes to improve their folate levels. 

• Addressing Underlying Conditions

While addressing the issue of low iron levels in the body, one must consider certain other factors as well. A poor diet, regular alcohol consumption, or the intake of drugs can severely impact the body. Further,  patients on specialized medications such as methotrexate, phenytoin, and trimethoprim can suffer from this deficiency. The doctor should also check for a B-12 deficiency, as most symptoms overlap with a folate deficiency.  The underlying issues should be sorted out before any new interventions occur.

• Medication

The doctor may recommend an oral folic acid tablet (1-5 mg) daily to treat folic acid deficiency symptoms. In case the B-12 is found to be lacking, the doctor may suggest a B-12 supplement as well.  

• Regular Monitoring 

This is essential and the doctor would suggest the time duration after which a laboratory test should be done. Parameters such as the complete blood count, folate, and vitamin B-12 levels, among others should be checked. Always check with your doctor for the required tests. 

How Much Folate Do You Really Need?

Folate is also known as vitamin B9 and it plays a vital role in red blood cell production, healthy cell growth and overall well-being. A deficiency of folate is known as folic acid deficiency anemia, and it can lead to a number of low folate symptoms like fatigue and weakness. 

Here is the recommended folate intake [4] based on age and life stage. When you know these numbers, it can help you prevent vitamin B9 deficiency before it becomes alarming.

Conclusion

Folate deficiency can have a deep impact on a person’s overall health. One should watch for symptoms such as unusual tiredness, pale skin, or dizziness, as these could be indicators of a folic acid deficiency. A regular, healthy diet intake is the best way to fortify oneself. Routine health checks are essential and should be done. 

Check out Good Monk Family Nutrition Mix to get your intake of iron and other important minerals. 

References

[1] https://ada.com/conditions/folate-deficiency

[2] https://www.ncbi.nlm.nih.gov/books/NBK535377/

[3] https://www.medicalnewstoday.com/articles/what-type-of-cancer-causes-folic-acid-deficiency

[4] https://ods.od.nih.gov/factsheets/Folate-Consumer/

[5] https://charlesmedicalgroup.com/general/folate-deficiency-and-hair-loss-unraveling-the-connection-for-healthier-locks/

FAQs on Folate Deficiency

1. What are the common causes of folic acid deficiency?

Poor dietary intake, malabsorption, medication, and lifestyle issues are some of the folate deficiency causes.

2. Who is at risk for folic acid deficiency?

Anyone who has below-normal folic acid levels in their body is at risk for folate deficiency. Pregnant women and diabetics who are undergoing dialysis are at high risk for folic acid deficiency. 

3. How can I prevent folic acid deficiency?

You can prevent folic acid deficiency by making sure your diet contains dark green, leafy vegetables, citrus fruits and juices, eggs, and whole grains. 

4. How long does it take to correct a folic acid deficiency? 

Most people need to intake folic acid tablets for 4 months to see any changes. This can vary depending on the person’s health situation.

5. What is the fastest way to fix folic acid deficiency?

The fastest way to address folic acid deficiency is through a combination of high quality dietary sources and folic acid supplements that are prescribed by your doctor. Eating folate-rich foods like dark green leafy vegetables, lentils, chickpeas, citrus fruits, etc. can help restore your levels naturally.

6. What type of cancer causes folic acid deficiency? 

Cancers affecting the digestive system like gastric cancer or colorectal cancer can contribute to folate deficiency as this health problem can interfere with nutrient absorption. Moreover, cancer treatments such as chemotherapy can also lower folate levels by disrupting our body's ability to process vitamin B9.

7. Can low folic acid prevent pregnancy? 

Low folic acid levels can make it more difficult for some women to conceive. This is because folate plays a crucial role in cell division and DNA synthesis which is very important for healthy pregnancy. Long-term folate deficiency can impact fertility and also increase the risk of neural tube defects in pregnancy.

8. Can low folic acid cause headaches?

Headaches can be a symptom of folic acid deficiency anemia. Low folate levels reduce healthy red blood cell production, which limits oxygen supply to the brain, and triggers fatigue, dizziness, and headaches.

9. Can folate deficiency cause hair loss?

Low folate levels can affect the fast-growing cells in your hair follicles, leading to hair thinning or increased hair fall [5]. Since folate aids red blood cell production, low levels can reduce nutrient and oxygen delivery to hair roots and weaken them over time. By taking corrective measures for balancing vitamin B9 deficiency, you will be able to see an improvement in your hair health over time. 

10. Can folate deficiency be reversed?

In most cases, folate deficiency is reversible with the right treatment. This involves increasing folate intake through diet, supplements, and taking care of any underlying cause, such as an illness or a malabsorption disorder.

Related articles:

• Top folic acid rich foods

• What is vitamin B Complex

• Nutrition-rich foods to add to your diet

• Micronutrient-rich foods to include in your diet
  

• Nutrition tips and a balanced diet

About the Author

Written by the team at Good Monk—a clean and honest nutrition brand supported by doctors and food scientists. Every product is backed by thorough clinical evidence and clinically proven ingredients and made to help families eat better, feel better, and live healthier every day.

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