CRDAMC Homepage | CRDAMC Library Phone #: (254) 288-8366 | CRDAMC Library Fax #: (254) 288-8368

Search Health Library

Folic Acid Deficiency

(Folate Deficiency; Folacin Deficiency)

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 well 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

Scanning Electron Micrograph of Red Blood Cells

14600W
Copyright © Nucleus Medical Media, Inc.

Causes    TOP

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    TOP

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    TOP

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    TOP

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.

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    TOP

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    TOP

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
  • Eggs
  • A variety of fresh fruits and vegetables, especially dark, leafy green vegetables, and citrus fruits and juices

RESOURCES:

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

CANADIAN RESOURCES:

References:

Bariatric surgery. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T483434/Bariatric-surgery. Updated October 23, 2017. Accessed November 8, 2017.
Dietary supplement fact sheet: folate. Office of Dietary Supplements website. Available at:
...(Click grey area to select URL)
Updated April 20, 2016. Accessed November 8, 2017.
Folate deficiency. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114304/Folate-deficiency. Updated December 21, 2016. Accessed November 8, 2017.
Last reviewed November 2017 by EBSCO Medical Review BoardDianne Scheinberg Rishikof MS, RD, LDN
Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

To send comments or feedback to our Editorial Team regarding the content please email us at healthlibrarysupport@ebsco.com. Our Health Library Support team will respond to your email request within 2 business days.

Health Library: Editorial Policy | Privacy Policy | Terms and Conditions | Support
36000 Darnall Loop Fort Hood, Texas 76544-4752 | Phone: (254) 288-8000