Folate is a form of B9 vitamin that helps the body grow and develop properly. While everyone needs folate, it is especially important for pregnant women. Folate deficiency during pregnancy can cause problems with the development of a baby’s brain and spinal cord, known as neural tube defects.
Folic acid is the man-made version of folate, found in supplements and fortified foods. It is absorbed by the body more easily than natural folate. In the United States, folate or folic acid is often added to grains to help prevent birth defects, especially neural tube defects.Â
This article explores the causes and risks of folate deficiency, its effects on the body, the complications of folate deficiency, and practical ways to ensure you’re getting enough, whether through diet, supplements, or fortified foods.
What does folate do?
The body needs folate to create red blood cells and build genetic material. This nutrient is especially important during pregnancy and early childhood since these are times of fast growth.
What foods are good sources of folate?
Most individuals can obtain sufficient folate through their diet, except in cases where additional folate is required, such as during pregnancy planning or pregnancy.
Folate can be found in many types of food. Green leafy vegetables like spinach, kale, broccoli, bok choy, and dark lettuce are great sources. Legumes, such as beans, peas, chickpeas, soybeans, lima beans, and lentils, are also rich in folate. Fruits like oranges, bananas, strawberries, pawpaw, and avocados provide folate as well. Other good sources include fortified wheat-based breads and cereals, tofu, and eggs.
How much folate do I need?
How much folate a person needs depends on their age and circumstance.Â
- Kids aged one to three need around 150 micrograms per day
- Kids aged four to eight need about 200 micrograms daily
- Kids aged nine to thirteen need about 300 micrograms per day
- Women in their childbearing years should aim for at least 400 micrograms daily.Â
- Pregnant women need more, about 600 micrograms daily, to support their baby’s development.Â
- Women who are breastfeeding should get 500 micrograms per day to meet their nutritional needs.Â
- Men need around 400 micrograms per day, and women past childbearing age need about the same.
These recommendations are for dietary folate, not folic acid supplements. If you’re pregnant or trying to become pregnant, it’s recommended to take a folic acid supplement in addition to getting enough dietary folate. However, it’s always best to consult with your doctor before starting any supplement regimen.
Do I need to take a folic acid supplement?
Women are advised to take a daily folic acid supplement before they get pregnant and continue eating foods rich in folate. The general recommendation is to take 400 micrograms of folic acid every day. This should start at least one month, but preferably three months, before pregnancy and continue for the first three months after becoming pregnant. Since many pregnancies happen unexpectedly, women are encouraged to eat foods high in folate during all their childbearing years.
What happens if I don’t get enough folate?
Folate deficiency happens when someone doesn’t get enough folate in their diet. Some population groups are more likely to be affected by any deficiency, including pregnant and breastfeeding women, individuals undergoing kidney dialysis, those who have a high alcohol intake, people with celiac disease or liver disease, and people taking specific medications, like those for treating seizures.
Not getting enough folate can lead to folate deficiency anemia. This condition causes the body to produce red blood cells that are too large and don’t function as they should. Folate deficiency anemia can cause symptoms like fatigue, mouth sores, and weak muscles.
When should I see my doctor?
Anyone who thinks they might have a folate deficiency should visit a doctor. Folate deficiency doesn’t go away without treatment. A blood test can check folate levels, and if the test confirms a deficiency, the doctor will likely recommend taking folic acid tablets for a few months to fix the problem.
What is the cause of folate deficiency?
Folic acid deficiency can happen for many reasons, including not eating the right foods in the right quantity. Cooking food at high temperatures can also destroy folic acid. The body absorbs folic acid in the small intestine through active and passive transport. Some health conditions, like food absorption issues, short gut syndrome, celiac disease, gastric bypass surgery, or problems with blood flow in the intestines, can interfere with this process and lead to a deficiency. High stomach pH levels, such as in achlorhydria, can also make it harder for the body to absorb folic acid.
Medications like Methotrex, Dilantin, Sulfazine, and Bactrim (Septra), can block folic acid absorption or prevent it from being converted into its usable form. Some people are born with enzyme problems that affect how their body processes folic acid, leading to a deficiency. Folic acid deficiency can also occur along with vitamin B12 deficiency because the latter affects methionine synthase, causing folic acid to get trapped in an unusable form and increasing how much folic acid is lost through urine.
Alcoholism is another major cause of folic acid deficiency. Conditions like pregnancy, hemolytic anemia (where red blood cells are destroyed), and dialysis can also lead to low folic acid levels.
The body doesn’t store folate well, so a person with a diet low in folate can develop a deficiency within weeks or months.
How is folate deficiency diagnosed?
Folate levels in the blood can help identify if a person has a deficiency. Levels below 2 ng/mL are considered deficient, while levels above 4 ng/mL are normal. If levels fall between 2 and 4 ng/mL, further testing is needed, like checking methylmalonic acid (MMA) and homocysteine levels. A folate deficiency is confirmed when B12 and MMA levels are normal, but homocysteine levels are high. Testing red blood cell folate levels can show how much folate is stored in the body and help determine how long the deficiency has lasted.
Treatment of folate deficiency
Patients with folate deficiency should be given folic acid supplements like Metanx to address the problem. For most people, taking one to five milligrams of folic acid by mouth each day is enough to treat the deficiency. If someone can’t take medicine by mouth, folic acid can be given through an injection or IV. Another option, folinic acid (also called Leucovorin), is used to help prevent side effects from the drug methotrexate.Â
How long a patient needs treatment depends on whether the cause of the deficiency is still present. For example, patients with absorption issues or conditions like short gut syndrome may need long-term treatment. With proper treatment, most of the problems caused by folic acid deficiency can be fixed, and the outlook is usually good.
Is it possible to take too much folate?
Too much folate can cause problems, especially for older adults. High levels of folate have been linked to worsening anemia and memory issues while also hiding low vitamin B levels. Folate’s role in colorectal cancer is also complicated. Some studies suggest it may help protect against the disease, while others show that folate supplements might actually increase the risk of developing it.
Frequently Asked Questions
Can low folate cause mental health problems?
Folate supports the creation of neurotransmitters like serotonin and dopamine, which help regulate mood. Studies have found that low folate levels are associated with a higher likelihood of mood disorders, including severe depression and anxiety. People with insufficient folate may face more intense depressive episodes and elevated anxiety symptoms.
How long does it take to recover from folic acid deficiency?
Treatment for folic acid deficiency usually involves a daily folic acid tablet, which can help return levels to normal within 2-3 months.
What are the most common side effects of folic acid?
Folic acid can cause side effects, but many people either don’t have any or only experience mild ones. They may include:
- Feeling sick (nausea)
- Loss of appetite
- Bloating or gas
When is the best time to take folate?
Folic acid supplements are best taken in the morning on an empty stomach with some water. Supplements should ideally be started three months before conceiving.
