Everything You Need to Know About Folic Acid Deficiency
Folic acid, or folate in its natural form, is a crucial B vitamin that supports many essential functions in the body, from red blood cell production to DNA synthesis. Despite its importance, folic acid deficiency is surprisingly common, and when left untreated, it can lead to serious health complications. In this blog, we’ll explore the causes of folic acid deficiency, the notable symptoms, and what can be done to treat and prevent it.
What is Folic Acid?
Folic acid is the synthetic form of folate, a water-soluble vitamin found naturally in foods like green leafy vegetables, citrus fruits, and liver. It’s essential for DNA and RNA production, cell division, and the formation of new cells. Folic acid is also added to certain fortified foods, like cereals and grains, to help prevent birth defects such as neural tube defects (NTDs) in newborns.
What Causes Folic Acid Deficiency?
Folic acid deficiency can arise from several factors, including:
Inadequate Dietary Intake: A diet low in folate-rich foods, like fruits, vegetables, and whole grains, can lead to deficiency.
Malabsorption: Conditions such as celiac disease, gastric bypass surgery, or digestive disorders can impair folate absorption.
Medications: Drugs like methotrexate (used in cancer and autoimmune diseases), phenytoin (for epilepsy), and sulfasalazine can interfere with folate metabolism or absorption.
Alcohol Use: Chronic alcohol consumption impairs folate absorption and increases its excretion.
How Do You Know if You Have Folic Acid Deficiency?
The symptoms of folic acid deficiency can be subtle and overlap with other conditions, making it difficult to diagnose. Common signs include:
Fatigue and Weakness: Folic acid is vital for red blood cell production, so a deficiency can lead to anemia, causing fatigue.
Pale Skin: Anemia from folic acid deficiency can make the skin appear pale.
Mental Health Symptoms: Deficiency may cause depression, irritability, mood swings, and cognitive issues like memory problems.
Glossitis and Mouth Sores: A swollen, red, sore tongue and mouth ulcers are common symptoms.
Digestive Issues: Nausea, loss of appetite, and weight loss can also occur.
Since some of these symptoms are similar to vitamin B12 deficiency, a proper diagnosis is crucial.
How is Folic Acid Deficiency Diagnosed?
To diagnose folic acid deficiency, healthcare providers may perform several tests, including:
Complete Blood Count (CBC): To detect anemia, which may show up as macrocytic (larger-than-normal) red blood cells.
Serum Folate Levels: A blood test to check for folate deficiency (levels below 2 ng/mL are considered deficient).
RBC Folate Levels: Measures folate in red blood cells to determine the duration of the deficiency.
Since folate and vitamin B12 deficiencies share symptoms, doctors may also check homocysteine levels, which tend to be elevated in both deficiencies.
How is Folic Acid Deficiency Treated?
Folic acid deficiency is treatable with supplements and dietary changes. Here's what you can expect:
Folic Acid Supplements: The primary treatment is folic acid supplementation, typically 1 to 5 mg per day, depending on the severity of the deficiency.
Dietary Changes: Eating folate-rich foods is essential. Include more green leafy vegetables (like spinach and kale), citrus fruits, legumes, and fortified grains in your diet.
Addressing Underlying Causes: If the deficiency is due to an underlying condition (e.g., malabsorption or alcohol use), treating the cause is crucial for preventing future deficiencies.
How Can Women Increase Folate Absorption Through Food?
For women, ensuring optimal folate absorption is crucial, especially during pregnancy. While supplements are important, the right dietary choices can help maximize folate absorption. Here are some tips on how women can increase their absorption of folic acid through food:
Pair Folate-Rich Foods with Vitamin C: Vitamin C helps improve the absorption of folate. Including vitamin C-rich foods, like citrus fruits, strawberries, bell peppers, and broccoli, with folate-rich meals can enhance absorption.
Cook Carefully: Folate is sensitive to heat and can be destroyed by overcooking. To preserve its nutrients, lightly steam or sauté folate-rich vegetables like spinach, kale, and broccoli, rather than boiling them. Opt for cooking methods that minimize nutrient loss.
Avoid Alcohol: Alcohol inhibits folate absorption, so women at risk of folic acid deficiency should limit their alcohol consumption to ensure proper absorption and utilization of folate.
Consume Fortified Foods: Many foods, such as breakfast cereals, pasta, and bread, are fortified with folic acid. These can help boost folate intake, especially for those who may have difficulty meeting their needs through whole foods alone.
Eat a Variety of Folate-Rich Foods: Include a wide variety of folate-rich foods in your diet to optimize intake. Some excellent sources include:
Leafy greens: Spinach, kale, and romaine lettuce.
Citrus fruits: Oranges, grapefruits, lemons, and limes.
Legumes: Lentils, chickpeas, beans, and peas.
Fortified grains: Breakfast cereals, rice, and pasta.
Citation:
Theisler, C. (2022) ‘Folic acid deficiency’, Adjuvant Medical Care, pp. 132–132. doi:10.1201/b22898-142.
