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Folate deficiency

Definition

Folate deficiency means you have a lower than normal amount of folic acid, a type of B vitamin, in your blood.

Alternative Names

Deficiency - folic acid, Folic acid deficiency

Causes

Folic acid works with vitamin B12 and vitamin C to help the body break down, use, and make new proteins. The vitamin helps form red blood cells. It also helps produce DNA, the building block of the human body, which carries genetic information.

Folic acid is water-soluble type of B vitamin. This means it is not stored in the fat tissues of the body. Leftover amounts of the vitamin leave the body through the urine.

Because folate is not stored in the body in large amounts, your blood levels will get low after only a few weeks of eating a diet low in folate. Folate is found in green leafy vegetables and liver.

Causes of folate deficiency are:

  • Diseases in which folic acid is not well absorbed in the digestive system (such as celiac disease or Crohn's disease)
  • Drinking too much alcohol
  • Eating overcooked vegetables
  • Hemolytic anemia
  • Certain medicines (such as phenytoin, sulfasalazine, or trimethoprim-sulfamethoxazole)
  • Eating an unhealthy diet that not include enough fruits and vegetables

Symptoms

Folic acid deficiency may cause:

  • Fatigue
  • Gray hair
  • Mouth sores (ulcers)
  • Poor growth
  • Swollen tongue

Exams and Tests

Folate deficiency can be diagnosed with a blood test. Pregnant women commonly have this blood test at prenatal checkups.

Possible Complications

Complications include:

  • Anemia (low red blood cell count)
  • Low levels of white blood cells and platelets (in severe cases)

In folate-deficiency anemia, the red blood cells are abnormally large (megaloblastic).

Pregnant women need to get enough folic acid. The vitamin is important to the growth of the fetus’ spinal cord and brain. Folic acid deficiency can cause severe birth defects known as neural tube defects.

Prevention

The best way to get vitamins your body needs is to eat a balanced diet. Most people in the United States eat enough folic acid because it is plentiful in the food supply.

Folate occurs naturally in the following foods:

  • Beans and legumes
  • Citrus fruits and juices
  • Dark green leafy vegetables
  • Liver
  • Poultry, pork, and shellfish
  • Wheat bran and other whole grains

The Institute of Medicine's Food and Nutrition Board recommends that adults get 400 micrograms of folate daily. Women who could become pregnant should take folic acid supplements to ensure that they get enough each day.

Specific recommendations depend on a person's age, gender, and other factors (such as pregnancy). Many foods now have extra folic acid added to help prevent birth defects.

References

Antony AC. Megaloblastic anemias. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 167.

Antony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 37.


Review Date: 9/20/2013
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, Bethanne Black, and the A.D.A.M. Editorial team.
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