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Folic Acid Deficiency


Folic acid or folate is a part of vitamin B complex. It is also known as vitamin B9. Folic acid is required to synthesize DNA, RNA, and red blood cells. A healthy adult needs at least 400 micrograms of folic acid. Deficiency of folic acid can result in a type of anemia known as megaloblastic anemia. Folic acid deficiency can occur in a short amount of time if it is not a part of your diet or you have an underlying disease that causes impaired absorption. It can be treated by taking supplements and eating a folate-rich diet. 


Folic acid belongs to the category of water-soluble vitamins. These vitamins are not stored in the body, unlike fat-soluble vitamins, and are excreted via urine. For this reason, a deficiency of these vitamins can occur much more quickly if they are not a part of your diet. Folic acid is rich in fresh fruits, green leaves, and vegetables. A lack of these food items from your diet can result in folic acid deficiency. Overcooking certain food products can also destroy this vitamin and other nutrients. Some people have underlying medical conditions that disrupt the normal absorption of folic acid. These include celiac disease, Crohn’s disease, kidney disease, certain types of cancer, and a few genetic conditions.

Excessive consumption of alcohol can also interfere with the absorption of folic acid. Some people also tend to replace nutrition-rich food substances with alcohol. This can cause further damage and deficiency of essential nutrients. Certain medications such as methotrexate, phenytoin, trimethoprim-sulfamethoxazole, and sulfasalazine may also cause folic acid deficiency. 

Risk Factors And Epidemiology

Risk of folate deficiency is higher among those who do not eat a balanced diet. Genetic conditions and malabsorption disorders can also prevent the normal uptake of folate by your digestive system. Alcohol abuse is another major factor because it disrupts absorption and increases the excretion of folic acid via urine. Women of childbearing age, pregnant women, and lactating mothers are especially at risk because they require an increased amount of folic acid. Use of certain medications, such as those mentioned above, can also increase the risk.

Folic acid deficiency can occur at any age, but it is frequently seen among people over the age of 60 and pregnant females. About 5% of the United States population is affected by folic acid deficiency every year. 

Signs And Symptoms

Since folic acid deficiency causes anemia, many signs and symptoms reflect that condition. You can experience fatigue, weakness, paleness, shortness of breath, dizziness, and irritability. Other symptoms of folic acid deficiency are subtle and may not develop in everyone. They include lethargy, muscle weakness, weight loss, diarrhea, oral ulcers, tender tongue, reduced sensation of taste, gray hair, and growth issues. Some people may also experience neurological symptoms, including confusion, memory loss, and difficulty in concentration. Folate deficiency in pregnant women can lead to neural tube defects of the fetus, which include spina bifida and anencephaly. These birth irregularities can occur at a very early stage during pregnancy. 


It is difficult to diagnose folic acid deficiency on the basis of symptoms alone as they can go unnoticed or be confused with other causes. The conformational diagnosis of folic acid deficiency is made by a blood test. This test checks the levels of folate in your blood. It is often a part of a routine examination for pregnant women. Early diagnosis of folic acid deficiency, especially during pregnancy, can help prevent the risk of neural tube defects in children.

Differential Diagnosis

Folic acid deficiency should be differentiated from other conditions that cause anemia or other similar symptoms. These conditions include vitamin B12 deficiency, hypothyroidism, alcoholic liver disease, aplastic anemia, and myelodysplasia. Differentiation can be done on the basis of diagnostic tests. 


Treatment of folic acid deficiency is done by fulfilling the required amount of this vitamin. Your doctor will prescribe you folic acid supplements based on the severity of your deficiency. Standard dosages include 1 to 5 mg of folic acid per day. Dietary modifications are also made to include fresh fruits, citruses, leafy green vegetables, and fortified folate-rich cereals. Women of childbearing age, pregnant women, and lactating mothers are recommended to take a folate-rich diet and supplements even if folic acid deficiency hasn’t been detected yet. This is to prevent early-stage birth defects during pregnancy. Use of alcohol is prohibited during pregnancy. Apart from that, everyone with folic acid deficiency is recommended to reduce alcohol intake because it can cause further damage.


Prognosis of people with folic acid deficiency is good if supplements are taken regularly and folate-rich products are made a part of the diet. With the right dosages of supplements, anemia and other related symptoms can be reversed in approximately two months. 


A diet that contains a high amount of folic acid can help prevent folate deficiency. Broccoli, spinach, Brussel sprouts, peas, citruses, eggs, beans, mushrooms, asparagus, tomatoes, bananas, and melons are rich in folate. Try to eat fruits and vegetables in the form of a salad rather than overcooking them. Women of childbearing age should take special care because unplanned pregnancies can occur, which may go unnoticed for a few weeks. Pregnant women should take folic acid supplements as recommended by their doctor at an early stage. Excessive alcohol consumption should be avoided. People who take medications that may cause folic acid deficiency should consult with their doctor for alternative options if available. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on April 27th, 2023.




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