What happens if folate is too low?
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Folate deficiency is common. Because the body stores only a small amount of folate, a diet lacking in folate leads to a deficiency within a few months. Not eating enough raw leafy vegetables and citrus fruits can cause folate deficiency. Anemia can develop, causing fatigue, paleness, irritability, shortness of breath, and dizziness. A severe deficiency may result in a red and sore tongue, diarrhea, a reduced sense of taste, depression, confusion, and dementia. If a pregnant woman has folate deficiency, the risk of having an infant with a birth defect of the spinal cord or brain is increased. The diagnosis is based on blood tests. Folate supplements taken by mouth usually correct the deficiency. Good sources of folate include raw green leafy vegetables, asparagus, broccoli, fruits (especially citrus), liver, other organ meats, dried yeast, and enriched breads, pastas, and cereals. Extensive cooking destroys 50 to 95% of the folate in food. In the United States and Canada, folate is added to enrich foods made from grains. Folate in supplements or in enriched foods is easier for the body to absorb than the folate that occurs naturally in food. Women who are pregnant or who could become pregnant should take folate supplements to reduce the risk of having an infant with a birth defect, mainly neural tube defects. Women who have had a baby with a neural tube defect are often prescribed higher doses of folate. Women who are taking both oral contraceptives and antiseizure drugs may need to take folate supplements. Antiseizure drugs can make oral contraceptives less effective. Folate supplements can help maintain the effectiveness of oral contraceptives. Folate supplements do not protect against coronary artery disease or stroke. There is no evidence that folate supplements reduce or increase the risk of various cancers. Folate supplements do not seem to improve cognitive function in older adults. Folate is generally not toxic. Folate deficiency may result from
People who drink large amounts of alcohol do not consume enough folate because they often substitute alcohol for food. Such people are often generally undernourished. Alcohol consumed in large amounts also interferes with the absorption and processing (metabolism) of folate. Women who are pregnant or breastfeeding and people undergoing dialysis may develop this deficiency because their need for folate is increased. Some drugs decrease the absorption of this vitamin. They include Other drugs interfere with the metabolism of folate. They include
In addition to the general symptoms of anemia (such as paleness, irritability, shortness of breath, and dizziness), folate deficiency, if severe, may result in a red and sore tongue, diarrhea, a reduced sense of taste, weight loss, and depression.
To help prevent folate deficiency, people who are taking drugs that interfere with the absorption or metabolism of folate should take a folate supplement. Taking daily doses of a folate supplement by mouth effectively treats the deficiency. CLICK HERE FOR THE PROFESSIONAL VERSION  Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid. Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.
This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.
Blood is comprised of red blood cells, platelets, and various white blood cells.
Do you feel tired and listless? Do you find your mind drifting during the day? Do you get dizzy or short of breath whenever you climb the stairs? There are a few possible reasons for the way you feel, but you could have anemia. You could even have anemia without noticing any symptoms at all. Anemia is a problem with hemoglobin, a substance in red blood cells that carries oxygen throughout your body. Without enough hemoglobin, your heart and other organs can't get the oxygen they need to work. When your organs slow down, you slow down and you start feeling tired and listless. Many different health conditions can cause anemia, from heavy blood loss during a woman's period, to pregnancy, to an underactive thyroid gland. Healthy red blood cells are made in your bone marrow, the soft tissue in the middle of your bones. Any disease that damages blood marrow, such as lymphoma or leukemia, can also affect your red blood cell production. Anemia can also be caused by an immune system problem that damages red blood cells, or surgery to the stomach or intestines. How do you know if you have anemia? You may feel tired, dizzy, and have trouble concentrating. You may get sick more often. People with anemia often complain of chest pain, headaches, or shortness of breath. Your skin might look pale, like you haven't seen the sun for months. Because these can also be symptoms of other conditions, your doctor will confirm that you have anemia by taking a blood test to check your red blood cell count and hemoglobin level. Blood tests can also look for problems that may be causing your anemia, such as a vitamin or iron deficiency. If you are anemic, it's very important to treat it. When your body isn't getting enough oxygen, it can starve vital organs like your heart. This can lead to a heart attack. How you treat anemia really depends on the cause. If the problem is with your bone marrow, you may take a medicine called erythropoietin, which will help your bone marrow make more red blood cells. If the problem is a vitamin or mineral deficiency, your doctor may prescribe iron, vitamin B12, or folic acid supplements. Or, you may need a blood transfusion to replace damaged red blood cells with healthy ones. How well you do really depends on what's causing your anemia. Call your doctor if you have any symptoms like fatigue or shortness of breath. Once your doctor can find and treat the cause of your anemia, you should have more energy and start feeling like your old self again. CausesFolate (folic acid) is needed for red blood cells to form and grow. You can get folate by eating green leafy vegetables and liver. However, your body does not store folate in large amounts. So, you need to eat plenty of folate-rich foods to maintain normal levels of this vitamin. In folate-deficiency anemia, the red blood cells are abnormally large. Such cells are called macrocytes. They are also called megaloblasts, when they are seen in the bone marrow. That is why this anemia is also called megaloblastic anemia. Causes of this type of anemia include:
The following raise your risk for this type of anemia:
Folic acid is needed to help a baby in the womb grow properly. Too little folic acid during pregnancy may lead to birth defects in a baby. SymptomsSymptoms may include:
Exams and TestsThe health care provider will perform a physical exam. Tests that may be done include:
In rare cases, a bone marrow examination may be done. TreatmentThe goal is to identify and treat the cause of the folate deficiency. You may receive folic acid supplements by mouth, injected into muscle, or through a vein (in rare cases). If you have low folate levels because of a problem with your intestines, you may need treatment for the rest of your life. Diet changes can help boost your folate level. Eat more green, leafy vegetables and citrus fruits. Outlook (Prognosis)Folate-deficiency anemia most often responds well to treatment within 3 to 6 months. It will likely get better when the underlying cause of the deficiency is treated. Possible Complications
Symptoms of anemia can cause discomfort. In pregnant women, folate deficiency has been associated with neural tube or spinal defects (such as spina bifida) in the infant. Other more severe complications may include:
When to Contact a Medical ProfessionalContact your provider if you have symptoms of folate deficiency anemia. PreventionEating plenty of folate-rich foods can help prevent this condition. Experts recommend that women take 400 micrograms (mcg) of folic acid every day before they get pregnant and through the first 3 months of their pregnancy. ReferencesAntony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 39. Kumar V, Abbas AK, Aster JC. Hematopoietic and lymphoid systems. In: Kumar V, Abbas AK, Aster JC, eds. Robbins Basic Pathology. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 12. Version InfoLast reviewed on: 1/25/2022 Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. What are the symptoms of low folate levels?Symptoms of vitamin B12 or folate deficiency. extreme tiredness.. a lack of energy.. pins and needles (paraesthesia). a sore and red tongue.. mouth ulcers.. muscle weakness.. disturbed vision.. psychological problems, which may include depression and confusion.. What causes folate levels to drop?Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a fad diet that does not involve eating good sources of folate.
How can I raise my folate levels quickly?Food Sources. Dark green leafy vegetables (turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli). Beans.. Peanuts.. Sunflower seeds.. Fresh fruits, fruit juices.. Whole grains.. Liver.. Seafood.. |
