Definition

Folic acid deficiency means that there is a lower than normal amount of folic acid in your blood. Folic acid is a water-soluble B vitamin, which means it cannot be stored in the body. You must get a continual supply of it.

This B vitamin plays a role in:

• Building proteins in the body
• Producing DNA
• Helping to form red blood cells

Causes

There are several causes of folic acid deficiency, including the following:

• Inadequate dietary intake of folic acid due to:
  • Limited consumption of fresh, minimally cooked food
  • Chronic alcoholism
  • Long-term need for IV nutrition (total parenteral nutrition)
• Inadequate absorption of folic acid due to:
  • Malabsorption syndromes, such as celiac disease
  • Inflammatory bowel disease
  • Drug interactions, such as anticonvulsant medicines and oral contraceptives
  • Bariatric surgery
• Increased need for folic acid due to:
  • Pregnancy
  • Lactation
  • Infancy
  • Malignancy, such as cancer
• Increased loss that can occur from hemodialysis
• Impaired use that can occur from certain medications, such as methotrexate

Risk Factors

Factors that may increase your risk of developing folic acid deficiency include:

• Pregnancy or breastfeeding
• Malignancy
• Liver disease
• Alcoholism
• Chronic hemolytic anemia
• Kidney dialysis treatment
• Celiac disease or other malabsorption disorders
• Need for certain medications, such as anticonvulsants and oral contraceptives
• Elevated homocysteine levels in the blood

Symptoms

Folic acid deficiency may cause:

• Fatigue
• Poor appetite
• Headache
• Pale skin
• Grey hair
• Red, irritated, swollen, and sometimes shiny tongue
• Mouth ulcers
• Shortness of breath and lightheadedness
• Change in bowel patterns, usually diarrhea

Complications from folic acid deficiency include:

• Megaloblastic anemia—a blood disorder characterized by larger than normal red blood cells
• Elevated homocysteine levels in the blood—a risk factor for heart disease
• Neural tube defects that affect fetal spinal cord, brain, and skull development

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. A blood test can help confirm a diagnosis of low folate levels and megaloblastic anemia.

It is difficult to distinguish between folic acid deficiency and vitamin B12 deficiency. However, folic acid deficiency is confirmed only by measuring red blood cell (RBC) folate levels in the blood.

It is especially important to confirm a diagnosis of folic acid deficiency before treatment with supplemental folic acid begins. Mistreating an actual vitamin B12 deficiency with supplemental folic acid will mask the vitamin B12 deficiency, meaning the anemia will be corrected, but the neurological damage associated with vitamin B12 deficiency will progress.

Treatment

Folic acid deficiency is usually treated with 1,000 micrograms of supplemental folic acid, given once a day until folic acid levels are replenished. The anemia usually is corrected within 2 months.

Prevention

It is possible to consume enough folic acid by eating a balanced, varied diet including rich sources of folate, the food form of folic acid. The recommended dietary allowance (RDA) for folic acid is 400 micrograms per day for most adults.

To get enough folate, consume plenty of the following foods:

• Fortified grains, cereals, and bread products
• Dried beans and legumes
• Poultry, pork, liver, and shellfish
• A variety of fresh fruits and vegetables, especially dark, leafy green vegetables, and citrus fruits and juices

Office of Dietary Supplements—National Institutes of Health http://ods.od.nih.gov

Healthy U http://www.healthyalberta.com

Dietary supplement fact sheet: folate. Office of Dietary Supplements website.Available at:
http://ods.od.nih.gov/factsheets/Folate-HealthProfessional
Updated December 14, 2012. Accessed December 22, 2014.

Folate deficiency. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated November 13, 2014. Accessed December 22, 2014.