What Is Folate Deficiency?
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Medically reviewed by Jamie Johnson, RDN
Folate, also known as vitamin B9, is naturally found in certain foods. Folic acid is the synthetic form of folate that's added to some foods to fortify them, such as breads and cereals. Folate deficiency occurs when you have very low amounts of vitamin B9 in your body.
Folic acid plays an important role in many of your body’s key functions, such as building new proteins, producing DNA, forming red and white blood cells, and boosting tissue growth and cell production.
People with folate deficiency can experience symptoms like fatigue, irritability, diarrhea, and a rapid heart rate, as well as complications like anemia (low red blood cells) and ulcers. Pregnant people with folate deficiency may increase the risk of certain birth defects.
Folate Deficiency Symptoms
Symptoms of folate deficiency may include:
Fatigue; weakness; paleness
Irritability; brain fog
Diarrhea
Smooth, painful tongue or mouth
Swollen tongue (glossitis)
Prematurely gray hair
Headache
Shortness of breath
Skin, hair, or nail changes
What Causes Folate Deficiency?
Folate is found in many different foods, such as beef liver, dark green leafy vegetables (like broccoli and spinach), eggs, beans, peas, and certain fruits (such as bananas and avocado). Other foods—especially grains like bread, rice, cereal, and pasta—are fortified with folic acid.
If you don’t eat enough foods that are rich in folate or folic acid, or if your body doesn’t absorb it well, you may develop a folate deficiency. This can happen for many different reasons. Certain digestive disorders, excessive alcohol use, dietary changes, and the side effects of medications like Dilantin (phenytoin) and Azulfidine (sulfasalazine) can all inhibit your intake or absorption of nutrients. Pregnant people need more folic acid than usual, so they are more likely to develop a folate deficiency.
Risk Factors
Several factors may increase your likelihood of developing folate deficiency, including:
Eating a diet low in fruits and vegetables
Frequently eating overcooked produce
Conditions that affect your ability to absorb nutrients, such as celiac disease and inflammatory bowel disease (IBD)
Alcohol use disorder (AUD)
Kidney disorders that require dialysis
Hemolytic anemia (increased destruction of red blood cells, causing a lack)
Pregnancy
Certain mutations in the methylenetetrahydrofolate reductase (MTHFR) gene
Older age
How Is Folate Deficiency Diagnosed?
Folate deficiency is diagnosed with a simple serum (blood) test. Your healthcare provider may order a blood test for folate deficiency if you present with related symptoms. During pregnancy, you may be given a folate deficiency test during a routine prenatal appointment.
If your healthcare provider suspects you’ve developed folate deficiency anemia, they may also recommend measuring your complete blood count (CBC) or even conducting a bone marrow examination.
Treatments for Folate Deficiency
The main treatment for folate deficiency is supplementation with folic acid. You may take them orally or receive injections if necessary. If your symptoms are severe, you may need to receive supplemental folic acid intravenously (through an IV).
If there is an underlying cause for your folate deficiency, such as Crohn’s disease, it’s important to follow your healthcare provider’s recommendations to treat the underlying condition effectively.
How to Prevent Folate Deficiency
The best way to prevent folate deficiency is to consume enough folate in your diet or through dietary supplements that contain folic acid. Foods like beef liver, spinach, mustard greens, asparagus, brussels sprouts, oranges, black-eyed peas, and kidney beans are especially rich in folate.
You can find folate in many different multivitamins in the form of folic acid. If you are pregnant, your healthcare provider will most likely recommend a prenatal vitamin that contains folic acid.
The recommended daily amount of folate changes based on your age and whether you are pregnant or breastfeeding. The amounts you should consume each day, listed in micrograms (mcg) of dietary folate equivalents (DFEs), are as follows:
Birth to 6 months: 65 mcg DFE
Infants up to 12 months: 80 mcg DFE
Children ages 1-3: 150 mcg DFE
Children ages 4-8: 200 mcg DFE
Children ages 9-13: 300 mcg DFE
Teens ages 14-18: 400 mcg DFE
Adults over 19: 400 mcg DFE
During pregnancy: 600 mcg DFE
While breastfeeding: 500 mcg DFE
Complications
If left untreated, folate deficiency can lead to several health complications. These include:
Low counts of red blood cells, white blood cells, or platelets
Megaloblastic anemia, which enlarges the red blood cells
Ulcers, especially in the mouth and tongue
Depression
Higher risk of strokes and heart disease due to elevated levels of an amino acid called homocysteine
Dementia
When a pregnant person experiences folate deficiency anemia, they have a higher risk of fetal birth defects and birth complications, including:
Premature labor
Neural tube defects, such as spina bifida
Restricted fetal growth
Low birth weight
A Quick Review
Folate, or vitamin B9, is also called folic acid. It’s found in foods like liver, leafy vegetables, eggs, legumes, fruits, and fortified grains. When you don’t get enough folate in your diet or aren’t able to absorb it properly, you might develop folate deficiency. This can lead to folate deficiency anemia, which causes symptoms like fatigue, irritability, a swollen tongue, a rapid heartbeat, and more.
If you think you may have a folate deficiency, talk to your healthcare provider about taking supplements that contain folic acid.
Frequently Asked Questions
How long does it take to fix a folate deficiency?
One study found that red blood cell counts among people with folate deficiency anemia increased significantly after four weeks of folic acid supplementation. Full recovery may take three to six months. However, your results may vary widely, depending on the underlying reason for your folate deficiency, the severity of your anemia, and the dosage of your supplement.
What should I eat if I have low folate?
Fruits and vegetables—such as avocado, lettuce, spinach, mustard greens, broccoli, asparagus, peas, and oranges—are especially high in folate. Nuts, beans, dairy products, and eggs are also good sources, as well as certain meats (such as beef liver and poultry). You can also eat foods that have been enriched with folic acid, including certain breakfast cereals, pastas, breads, and rice.
Is vitamin B and folate the same thing?
There are many different types of B vitamins. Folic acid, or folate, is one type—vitamin B9. Other B vitamins include B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B7 (biotin), and B12.
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