Folic Acid Deficiency: Causes, Symptoms & Treatment

What Is A Folic Acid Deficiency?

A folic acid deficiency occurs when your body absorbs too little folic acid or folate. A lack of folic acid can have far-reaching adverse effects on your health, from reduced energy and performance to serious cardiovascular risks or fetal malformations during pregnancy. [1]

Folic acid, also known as vitamin B9, vitamin M, or folate, is a water-soluble vitamin from the vitamin B group essential for cell division and blood formation. [1]

While folate includes all-natural folate-active compounds found in plants and foods, “folic acid” refers to the synthetic form of the B vitamin with a glutamate residue [1]

Why Is Folic Acid Important?

Folic acid supports cell growth, the healthy development of an unborn child during pregnancy, heart health, and it ensures that the body is adequately oxygenated since it helps form red blood cells. [1]

All of these functions are essential for an active and healthy life.

Consequently, we will go into more detail about the importance of folic acid for the various biological processes in your body and what happens when there is a folic acid deficiency.

Without Folic Acid, Your Cells Can't Divide Properly

At a basic level, folic acid helps to produce and repair the DNA and RNA in your cells. These genetic materials are critical to the function and structure of every cell in your body. [1]

Without sufficient folic acid, your cells cannot grow or divide properly (cell division).

A folic acid deficiency can lead to serious problems at this point, such as delayed wound healing, increased susceptibility to infection, and, in the long term, a general weakening of your immune system — mainly due to compromised white blood cell production. [2]

Folic Acid Deficiency Impairs Pregnancy

Folic acid deficiency becomes particularly problematic if you want to have children or are pregnant, as folic acid supports the development of the neural tube in the fetus — a process in which even minor deficiencies can have serious consequences such as neural tube defects (malformations of the brain or spine). [1]

A folic acid deficiency during pregnancy can also increase the risk of premature birth and low birth weight.

Folic Acid Deficiency Disrupts Blood Formation

However, folic acid is not only essential for expectant mothers. It also plays a crucial role in blood formation and the production of red blood cells.

These cells ensure that oxygen is transported efficiently throughout your body. A lack of folic acid here can lead to a form of anemia known as megaloblastic anemia. [1] [2]

This anemia can make you tired, weak, and unfocused, significantly impairing your performance in everyday life.

You may also experience symptoms such as pale skin, shortness of breath, and palpitations because your body is not getting enough oxygen.

Folic Acid Deficiency Puts Your Heart Health At Risk

Folic acid also helps to regulate homocysteine levels in the blood. A folic acid deficiency can, therefore, lead to heightened homocysteine in the blood, which can put your heart health at risk in the long term.

This is because elevated homocysteine levels are associated with a higher risk of cardiovascular disease, including heart attack and stroke.

It is, therefore, vital that you make sure you get enough folic acid, whether through your diet or supplements, to prevent a deficiency and its potentially serious consequences.

What Are The Symptoms Of Folic Acid Deficiency?

A folic acid deficiency can cause symptoms such as fatigue, paleness, diarrhea, irritability, and concentration problems. More severe symptoms include megaloblastic anemia, developmental disorders during pregnancy, and increased risk of cardiovascular disease. [1] [3]

We would now like to take a closer look at the individual symptoms of folic acid deficiency:

1. Fatigue and weakness: a lack of folic acid can lead to reduced red blood cell production, which affects the body's oxygen supply and can lead to persistent fatigue and general weakness. [2]
2. Paleness: A reduced number of red blood cells can make your skin appear pale as less oxygen is transported in the blood. [3]
3. Irritability and concentration problems: Folic acid deficiency can affect your nervous system, leading to irritability, mood swings, and difficulty concentrating. [3]
4. Megaloblastic anemia: One of the more serious consequences is megaloblastic anemia, in which your red blood cells are enlarged and misshapen, significantly reducing oxygen-carrying capacity and causing you to experience symptoms such as shortness of breath and palpitations.
5. Developmental disorders during pregnancy: In pregnant women, folic acid deficiency increases the risk of neural tube defects in the fetus, such as spina bifida, which is a high-risk developmental disorder.
6. Elevated homocysteine levels: A vitamin deficiency of folic acid can increase the homocysteine level in your blood, which increases the risk of cardiovascular diseases such as heart attack and stroke.
7. Indigestion & diarrhea: Symptoms such as diarrhea, loss of appetite, and weight loss can also occur as folic acid deficiency affects gastrointestinal function.
8. Glossitis and mouth ulcers: Inflammation of the tongue (glossitis) and painful ulcers in the mouth can also be signs of folic acid deficiency. [2] [3]

What Are The Causes Of Folic Acid Deficiency?

1. Insufficient Intake Through Diet

A common cause of folic acid deficiency is insufficient intake of folate-containing foods such as green leafy vegetables, legumes, and citrus fruits.

People who eat little fresh fruit and vegetables or have an unbalanced diet are particularly at risk for folic acid deficiency. [2]

2. Increased Requirement of Folic Acid

In certain phases of life, such as pregnancy, breastfeeding, growth phases, or chronic illnesses, your folic acid needs are increased. [2]

If your increased requirement is not met, a folic acid deficiency can quickly occur.

3. Malabsorption

Diseases such as coeliac disease, Crohn's disease, ulcerative colitis, or short bowel syndrome impair the absorption of folate or folic acid in the intestine, as they damage the intestinal mucosa and cause inflammatory changes. [2]

This damage reduces the gut's ability to absorb nutrients effectively, ultimately leading to folate deficiency.

4. Medications

Medications such as anticonvulsants (used to treat seizures) or methotrexate (used as an immunosuppressant and chemotherapeutic agent), but also certain antibiotics can interfere with the absorption and metabolism of folic acid and folate, which can lead to a folic acid deficiency. [2]

5. Alcoholism

Chronic alcohol consumption and even frequent drinking of alcoholic beverages interfere with the absorption of folic acid in your gut, as alcohol damages the gut lining and reduces your body's ability to absorb nutrients. [2]

At the same time, alcohol increases your folic acid requirements because it stresses the metabolism and promotes the excretion of folic acid via the kidneys.

This combination of reduced absorption and increased need often leads to a folic acid deficiency, especially if your diet is unbalanced and low in folate.

6. Genetic Factors

Genetic variants such as the MTHFR polymorphism can impair the utilization of folic acid in the body, as these variants reduce the activity of the enzyme that converts folic acid into its active form, resulting in an increased risk of folic acid deficiency.

7. Lifestyle Choices and Environmental Factors

Smoking and chronic stress can also lower your folic acid levels as they speed up metabolism and impair the absorption of folic acid in the gut, forcing your body to use more folic acid. [2]

8. Older Age

As you age, your body's ability to absorb nutrients such as folic acid decreases as intestinal function and nutrient absorption efficiency decline.

Older people are, therefore, more likely to be deficient in folic acid. [2]

9. Renal Insufficiency and Dialysis

Chronic renal failure and dialysis can increase folic acid absorption, as dialysis removes vitamin B9 from the blood, and kidney function impairs utilization, which increases the need for folic acid. [2]

10. Liver Diseases

Liver disease can also significantly impact folic acid metabolism, as the liver plays a central role in the storage, conversion, and utilization of folic acid.

With a damaged liver, such as cirrhosis or hepatitis, your body's ability to properly store folic acid and convert it into its active form may be impaired. [2]

This results in less folic acid being available, which increases the risk of folic acid deficiency.

How Is Folic Acid Deficiency Diagnosed?

A folic acid deficiency is usually diagnosed through a blood test, which measures the folic acid concentration in the serum and the number of red blood cells.

CARE can also diagnose a folic acid deficiency through our comprehensive blood analysis that checks both folic acid and homocysteine levels to accurately determine a possible deficiency and help you optimize your health.

How Is Folic Acid Deficiency Treated?

Folic acid deficiency therapy is usually carried out by taking folic acid preparations (food supplements) and switching to a folate-rich diet. [1]

In more severe cases or for specific causes, more intensive medical care may be required to compensate for the deficiency and avoid long-term consequences.

If you would like to find out which foods are particularly rich in folic acid (folate), please read this article from us.

How can I avoid a folic acid deficiency?

To avoid a folic acid deficiency, you should start by incorporating a balanced diet with folate-rich foods such as green leafy vegetables, pulses and wholegrain products into your diet. Although dairy products do not contain much folic acid, your body can absorb folic acid from them particularly well. [4]

It can also be useful to take folic acid if you are in a phase of life with an increased requirement, such as during pregnancy or while breastfeeding. [1]

A healthy lifestyle that avoids or at least minimizes alcohol and smoking also helps to keep your folic acid levels stable. [2]

Book your health check-up with CARE today and take your health into your own hands!