Folate Deficiency: Meaning, Causes, Symptoms, Treatment & Prevention 

Introduction

Vitamins are essential substances that our body needs to stay healthy and function properly. They play a key role in a variety of functions, including, helping in energy production, immunity, growth, and tissue repair. One such important vitamin is folate (vitamin B9). Folate plays a key role in the formation of red blood cells and in the making of DNA, which is the genetic material present in all our cells¹.

When the body does not receive enough folate, it develops folate deficiency. This is a more prevalent dietary condition that can affect people of any age, including children, adults, pregnant women, and older people. Because folate is essential for healthy blood and cell formation, its deficiency can lead to a variety of health problems if not handled properly².

Understanding the causes, symptoms, treatment, and prevention of folate deficiencies is critical because it aids in the early detection and effective management of this condition, resulting in improved health and well-being. In this article, we will discuss on all these topics. 

What Is Folate Deficiency?

As mentioned earlier, folate deficiency is a condition that develops when the body does not have enough folate to meet its daily needs. It means your body is lacking an important vitamin that is necessary for making new cells and healthy red blood cells. 

When folate levels are inadequate, the body struggles to make adequate normal red blood cells. Instead, the bone marrow produces large, immature, and abnormal cells that don’t work properly. This can result in folate-deficiency anaemia, a condition in which the blood fails to transport enough oxygen to the body’s tissues. As a result, a person may experience weakness, fatigue, and a lack of energy. Low folate levels can also slow down the body’s ability to make DNA properly. 

Folate deficiency can develop gradually over time, often due to a poor diet, specific health conditions, or increased nutritional requirements, such as during pregnancy or rapid growth. If not detected and treated early, it can have a negative impact on overall health and daily functioning².

Why Is Folate Important for the Body?

Folate is an essential vitamin that the body needs to function properly. It plays a key role in several important processes such as: 

1. Red Blood Cell Production

Folate helps the body produce healthy red blood cells in the bone marrow, which carry oxygen from the lungs to all parts of the body, helping organs and tissues function properly. Inadequate folate levels lead to abnormal red blood cell formation and cause folate deficiency anaemia.

2. DNA Synthesis and Repair

Folate is essential for formation and repairing of DNA, the genetic material found in every cell of the body. It is especially important during periods of rapid cell production and growth. It works through one-carbon metabolism, a simple process that helps the body build and repair DNA properly. 

3. Cell Growth and Division

 Folate plays a key role in methylation reactions that help in gene regulation and amino acid production aiding the formation of new cells. This is particularly important during pregnancy, childhood, adolescence, and recovery from illness or injury when the body is growing or healing quickly².

4. Pregnancy and Foetal Development

Folate is crucial during early pregnancy as it helps prevent neural tube defects (such as spina bifida) in the developing baby. Adequate intake before and during early pregnancy supports proper brain and spinal cord development in baby³.

5. Brain and Mental Health

Folate plays an important role in brain function as it helps in making and managing chemicals that control mood, thinking, and memory. It also supports key body processes that keep brain cells healthy. Studies show that low folate levels can cause mood changes (depression), memory issues, and are at higher risk of age-related mental decline⁴.

6. Heart Health 

Folate helps regulate homocysteine levels in the blood. High homocysteine is a risk factor for cardiovascular diseases, so adequate folate intake can support heart health⁵.

7. Overall Health Maintenance

Folate contributes to normal growth, development of tissues and organs, and overall good health, making it essential for people of all ages².

Note: Folate supplements should not be taken without proper medical guidance as they may mask signs of vitamin B12 deficiency with nerve damage continuing to progress. 

Symptoms of Folate Deficiency

Folate deficiency can affect multiple systems in the body, leading to a range of symptoms involving the blood, brain, digestive system, and mouth. The following are some common folate deficiency symptoms. 

1. Folate Deficiency Anaemia Symptoms 

• Fatigue and weakness: Feeling unusually tired or lacking energy due to reduced red blood cells. 
• Pale skin: Caused by decreased haemoglobin levels².
• Jaundice (if present): Happens when poorly formed red blood cells break down early. 
• Shortness of breath: Especially during physical activity⁶.
• Fast heartbeats (palpitations): As the heart works harder to supply oxygen⁶.

2. Neuropsychiatric Signs 

• Irritability or mood changes: Feeling easily annoyed or emotionally unstable².
• Difficulty concentrating: Trouble focusing or thinking clearly⁶.
• Memory problems: Difficulty with memory and thinking, especially in older adults⁴.

3. Oral and Mucosal Problems

• Mouth ulcers: Painful sores inside the mouth².
• Glossitis: The tongue may appear sore, red, swollen and smooth².

4. Gastrointestinal Problems

• Loss of appetite: Reduced desire to eat. 
• Weight loss: Unintentional weight loss, often linked to poor appetite. 
• Diarrhoea or digestive discomfort: Due to effects on the intestinal lining⁷.

Causes of Folate Deficiency

Folate deficiency can be caused by a variety of reasons. The following are the most common folate deficiency causes. 

• Inadequate Dietary Intake: Inadequate consumption of folate-rich foods such as green leafy vegetables, fruits, legumes, and fortified cereals can cause low folate levels in the body over time. 
• Overcooking Food: Prolonged cooking, reheating, or boiling foods can cause significant loss of folate, mainly because it leaches (leaks) into the cooking water and also because it is a heat-sensitive vitamin. 
• Malabsorption Disorders: Conditions like Celiac disease and Crohn’s disease damage the lining of the small intestine, reducing the body’s ability to absorb folate properly. 
• Excess Alcohol Consumption: Alcohol interferes with folate absorption in the intestines, reduces its storage in the liver, and increases its excretion from the body. 
• Certain Medications: Some drugs, such as methotrexate, phenytoin, sulfasalazine, and trimethoprim can interfere with folate absorption, metabolism, or utilisation in the body. 
• Increased Requirements: Folate deficiency can develop when the body requires more folate than usual. This can occur during pregnancy, breastfeeding, and times of fast growth such as infancy, childhood, and adolescence. It can also occur in individuals undergoing haemodialysis (since folate is lost during the procedure; however, significant deficiency is uncommon with modern dialysis procedure) and in some skin disorders such as dermatitis, where rapid cell division raises folate requirements. 
• Genetic Factor: A change in certain genes (such as MTHFR) can make it harder for the body to use folate properly, even if proper diet is followed. 
• Vitamin B12 Deficiency: Vitamin B12 deficiency causes the folate to get trapped in a form that the body cannot use effectively².

Risk Factors for Folate Deficiency

Some people are more likely to develop folate deficiency than others. People who are at a higher risk of developing folate deficiency includes the following: 

• Pregnant Women: During pregnancy, the body need more folate to support the baby’s growth, particularly brain and spinal cord development. If this additional demand is not met, deficiency can occur. 
• People With Poor Diet: Those who do not eat enough folate-rich foods like green leafy vegetables, fruits, beans, and fortified cereals may not get the required amount of folate and are at risk. 
• Alcohol Users: People who drink alcohol regularly or heavily may develop folate deficiency because alcohol interferes with the absorption and storage of folate in the body. 
• People With Digestive Problems: People with conditions such as celiac disease may have a reduced ability to absorb folate properly from food. 
• People Taking Certain Medications: People who consume certain medication (methotrexate, sulfasalazine, trimethoprim, etc.) are at risk as these medicines interfere with how folate is absorbed or used in the body. 
• Those With Increased Needs: Growing children, teenagers, and individuals recovering from illness or surgery may require more folate for tissue repair and growth, increasing their risk if intake is not sufficient².
• Elderly: Older adults may have poor dietary intake and reduced ability to absorb nutrients, making them more prone to folate deficiency⁸.

Note: Many of these risk factors can also predispose to vitamin B12 deficiency, so B12 levels should be checked before treating with folate alone. 

Folate Deficiency in Pregnancy

Folate is extremely important during pregnancy as it supports the baby’s quick growth and development. It is critical in the formation of the baby’s brain, spinal cord, and other tissues, particularly in the first few weeks of pregnancy when many vital structures are growing. 

One of folate’s most significant functions is to help avoid neural tube defects, which are conditions that affect the development of the baby’s brain and spine. Consuming adequate folate before and during early pregnancy promotes healthy development and lowers the chance of these issues. 

Folate also helps the mother’s body produce extra red blood cells needed during pregnancy and supports overall health and energy levels. Because of these important roles, pregnant women are usually advised to ensure adequate folate intake through a healthy diet and recommended supplements³. 

All women planning for pregnancy are usually advised to take about 400 mcg of folic acid daily to maintain adequate folate levels in the body and support a healthy pregnancy³. Women at higher risk (for example, those who had a previous baby with a birth defect or take certain medicines) may need a higher dose (around 4-5 mg per day), but only if a doctor recommends it².

Note: Anaemia in pregnancy can have multiple causes, and iron deficiency is more common; therefore, both iron and folate levels should be properly assessed and managed. Folate should not be taken on its own without checking for vitamin B12 deficiency, as it can hide blood problems while nerve damage may still continue. All supplementations should be taken under the guidance of a doctor. 

Complications of Folate Deficiency

Folate deficiency can cause several complications, such as:

1. Severe Blood Disorders 

• Megaloblastic Anaemia: The main complication of the folate deficiency, where the body produces huge, unhealthy red blood cells that don’t function properly. As a result, less oxygen is delivered to various regions of the body, causing fatigue and weakness⁹.
• Pancytopenia: In severe cases, folate deficiency causes decrease in all three types of blood cells, red blood cells, white blood cells, and platelets. This can affect immunity and cause several health problems^2,10.

2. Pregnancy and Developmental Complications

• Neural Tube Defects (NTD): Serious birth defects that can affect a baby during early pregnancy. They include problems like spina bifida (when the spinal cord doesn’t form properly) and anencephaly (when parts of the brain and skull don’t develop properly)³. 
• Pregnancy Loss & Prematurity: Increased risk of miscarriage (loss of pregnancy-spontaneous abortion), and babies being born too early (preterm birth)². 

3. Brain and Mental Health Problems

• Cognitive decline: Long-term folate deficiency can lead to memory problems, confusion, and a higher risk of conditions like dementia or Alzheimer’s disease⁴.
• Mental Health Issues: Can cause depression, irritability and difficulty falling asleep or staying asleep². 
• Neuropathy: Although rare, long-term severe folate deficiency can damage the nerves. This may cause symptoms like tingling, numbness, or weakness in the body².

4. Other Health Problems

• Heart Disease: Increased risk of heart-related problems as folate deficiency causes a rise in a substance called homocysteine in the blood. 
• Gastrointestinal Problems: Long-lasting diarrhoea, unintentional weight loss, and swelling or soreness of the tongue (glossitis), along with mouth ulcers^2,7.
• Fertility Problems: Difficulty in getting pregnant, which usually resolves by supplementation¹¹.

Diagnosis of Folate Deficiency

To identify folate deficiency, your doctor might evaluate a combination of symptoms, medical history, and laboratory test results rather than relying on a single sign. 

• Clinical Evaluation: Your doctor might look for symptoms like tiredness, weakness, pale skin, mouth ulcers, or a sore tongue. He might also ask about your diet, alcohol consumption, medication use, mood changes and any existing health problems².
• Blood Tests: Your doctor might suggest blood tests for folate deficiency, such as the following: 
  • Complete Blood Count (CBC): Helps the doctor to identify anaemia and also may show low haemoglobin levels and the presence of unusually large red blood cells (megaloblastic changes), due to faulty DNA formation, leading to ineffective red blood cell production. 
  • Serum Folate Test: Measures folate levels in the body, helping the doctor to confirm whether folate levels are low. 
  • Serum Homocysteine Levels: Measures homocysteine levels to identify the deficiency. 
  • Peripheral Blood Smear: Looks at your blood under a microscope, which helps doctor identify whether there are larger than normal red blood cells and any changes in white blood cells which shows deficiency².
  • Vitamin B12 Test: Your doctor might also suggest vitamin B12 test at the same time, because B12 deficiency can look similar to folate deficiency².  

Note: Symptoms such as tingling, numbness, or nerve damage (neuropathy) are more commonly seen in vitamin B12 deficiency. 

Treatment of Folate Deficiency

The treatment of folate deficiency mainly focuses on replacing the missing folate and treating the underlying cause. You doctor might prescribe any of the following as a folate deficiency treatment, based on your cause or condition. 

• Folate supplements: The most common treatment that might doctor prescribe. Your doctor might give you folic acid (vitamin B9) tablets (usually a dose of 1-5 mg per day), which help restore folate levels in the body. 
• Improving Diet: Your doctor might suggest a folate-rich diet (leafy greens, fruits, lentils, nuts, etc.) along with other medications, which might help maintain folate levels in the long term. 
• Treating Underlying Causes: Your doctor might initiate treatment for underlying causes like digestive problems, alcohol use, or certain medications such as: 
  • Treating gut disorders to improve absorption 
  • Reducing alcohol intake 
  • Adjusting medications if needed²
• Special Care During Pregnancy: If you are pregnant, your doctor might give you folate supplements to support the baby’s development and avoid birth defects³.

Note: Always check for vitamin B12 deficiency before starting folic acid, as folate may improve anaemia but can allow nerve damage to continue or worsen. This should only be done under your doctor’s guidance. 

How to Manage Folate Deficiency Naturally?

Folate deficiency can often be improved with simple lifestyle and diet changes. Here are some practical tips: 

• Eat more folate-rich foods: Include green leafy vegetables (like spinach), fruits (such as oranges and bananas), beans, lentils, nuts, etc. in your daily diet⁶.
• Choose Fresh Foods: Avoid long storage or overcooking which can cause folate loss. Eating fresh foods whenever possible can retain the folate content in food². 
• Include Fortified Foods: Consume cereals and grains that are fortified with folate. This can give enough folate needed for your body².
• Limit Alcohol Intake: Reduce alcohol consumption. This may assist your body take in and utilise folate more effectively².
• Manage Medical Conditions: Proper treatment of digestive or chronic illnesses, with the guidance of your doctor can improve nutrient absorption².

Note: These tips can help boost folate levels, but they are not a substitute for medical treatment. If you experience signs of folate deficiency or have been diagnosed with it, see a doctor for a complete diagnosis and treatment plan. In some circumstances, folic acid supplements or treatment may be required. Also, ruling out vitamin B12 deficiency before starting folate supplementation is important, as it may mask anaemia, retaining nerve damage. 

When to See a Doctor?

Consider seeing a doctor if you have persistent tiredness or weakness even after rest, pale skin or shortness of breath, mouth ulcers or a sore tongue, memory problems or confusion, numbness or tingling in the hands and feet, unexplained weight loss, or long-lasting diarrhoea, which could indicate nutrient absorption problems. 

It is especially important to seek medical guidance while pregnant or planning pregnancy, as folate is required for the baby’s development. You should also see a doctor if you eat poorly, drink excessively, have digestive difficulties or chronic conditions that affect vitamin absorption, or are taking long-term drugs that may interfere with folate levels².

Also Read: 7 Things You Need to Avoid in Anaemia!

Conclusion

Folate deficiency means a condition that occurs when the body does not have enough folate to meet its needs. It is a common, yet avoidable condition that can negatively affect overall health if left untreated. Since folate is essential for blood formation, DNA synthesis, repair and cell growth, maintaining adequate levels through a balanced diet and healthy lifestyle is important. It is especially important if you are pregnant or planning pregnancy. Early detection of any deficiency and proper treatment can help avoid complications and support good health in people of all ages. 

Frequently Asked Questions (FAQs)

References

1. Vitamins. 2025. doi: https://medlineplus.gov/ency/article/002399.htm 

2. Baddam S, Khan KM, Jialal I. Folic Acid Deficiency. 2025. doi: https://www.ncbi.nlm.nih.gov/books/NBK535377/ 

3. About Folic Acid. 2025. doi: https://www.cdc.gov/folic-acid/about/index.html 

4. Reynolds EH. Folic acid, ageing, depression, and dementia. BMJ. 2002;324(7352):1512.1-1515. doi:10.1136/bmj.324.7352.1512 https://pmc.ncbi.nlm.nih.gov/articles/PMC1123448/

5. Li Y, Huang T, Zheng Y, Muka T, Troup J, Hu FB. Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta‐Analysis of Randomized Controlled Trials. JAHA. 2016;5(8):e003768. doi:10.1161/JAHA.116.003768 https://pubmed.ncbi.nlm.nih.gov/27528407/

6. Folate Fact Sheet for Consumers. 2018. doi: https://ods.od.nih.gov/pdf/factsheets/folate-consumer.pdf 

7. Folic Acid. 2023. doi: https://www.bda.uk.com/resource/folic-acid.html 

8. Araújo JR, Martel F, Borges N, Araújo JM, Keating E. Folates and aging: Role in mild cognitive impairment, dementia and depression. Ageing Research Reviews. 2015;22:9-19. doi:10.1016/j.arr.2015.04.005 https://pubmed.ncbi.nlm.nih.gov/25939915/ 

9. Hariz A, Bhattacharya PT. Megaloblastic Anemia(Archived). 2023. doi: https://www.ncbi.nlm.nih.gov/books/NBK537254/ 

10. Chiravuri S, Jesus OD. Pancytopenia. 2023. doi: https://www.ncbi.nlm.nih.gov/books/NBK563146/ 

11. Complications. 2023. doi: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/complications/ 

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