Folate, also known as vitamin B9, is a water-soluble vitamin required for synthesizing DNA and RNA, the genetic material directing all cellular activities. This function is important for the production and maintenance of new cells, especially red blood cells. Since the human body cannot produce folate, it must be obtained through diet for health and development.
Symptoms and Health Implications of Low Folate
The initial signs of a folate deficiency can be subtle, including persistent fatigue, weakness, and a general lack of energy. Some individuals may also experience pale skin, shortness of breath, irritability, or a sore, red tongue and mouth ulcers.
A sustained lack of folate disrupts the body’s ability to produce healthy red blood cells, leading to megaloblastic anemia. In this condition, the bone marrow produces red blood cells that are abnormally large, structurally unsound, and immature. These oversized cells, called megaloblasts, cannot function properly or carry oxygen efficiently.
Adequate folate intake is important before and during pregnancy due to its role in fetal development. Low folate levels in the earliest stages of pregnancy increase the risk of neural tube defects (NTDs). The neural tube is the embryonic structure that becomes the brain and spinal cord, and its proper closure within the first 28 days of pregnancy depends on sufficient folate.
Failure of the neural tube to close correctly can result in serious birth defects. The two most common NTDs are spina bifida, where the spinal column does not form properly, and anencephaly, a severe and typically fatal defect where major parts of the brain and skull are absent. Folic acid supplementation before and during early pregnancy can reduce the incidence of these conditions.
Causes of Folate Deficiency
Insufficient dietary intake is a primary cause of low folate. A diet lacking in fresh fruits, leafy green vegetables, and fortified foods can lead to a deficiency in a few weeks, as the body stores only small amounts. Overcooking foods can also destroy naturally occurring folate, reducing its availability.
Certain medical conditions can interfere with the body’s ability to absorb folate from food. Diseases affecting the gastrointestinal tract, such as celiac disease and Crohn’s disease, can impair nutrient absorption in the small intestine where folate is processed.
The body’s demand for folate increases during pregnancy and breastfeeding. During pregnancy, rapid cell growth in the fetus requires a significantly higher amount of folate. If a pregnant person’s intake does not meet this heightened need, a deficiency can develop.
Lifestyle choices and medications can contribute to low folate levels. Excessive alcohol consumption interferes with folate absorption and can displace nutrient-rich foods. Certain prescription medications, including some anti-seizure drugs and treatments for rheumatoid arthritis, can also affect how the body metabolizes folate.
Diagnosis and Management
A healthcare provider can diagnose a folate deficiency with a blood test that measures folate concentration in the blood serum or red blood cells. In some cases, a provider might also test for elevated levels of an amino acid called homocysteine, as high levels can suggest a deficiency.
The primary treatment is supplementation with folic acid, the synthetic form of vitamin B9. Doctors prescribe folic acid tablets to restore the body’s folate levels. Folic acid is used in supplements and for fortifying foods because it is more stable than folate, which occurs naturally in food.
Before starting treatment, a healthcare provider will check vitamin B12 levels, as taking folic acid can mask the symptoms of a vitamin B12 deficiency. If a B12 deficiency is present and left untreated, it can lead to nerve-related problems. Effective management combines supplementation with dietary improvements.
Folate-Rich Foods
Leafy green vegetables are among the best natural sources of folate; spinach, kale, and romaine lettuce are excellent choices. One cup of raw spinach, for example, provides a significant portion of the daily recommended intake. Legumes are another potent source of this B vitamin.
A single cup of cooked lentils can supply nearly all of the daily requirement for an adult. Other beneficial legumes include chickpeas, black beans, and kidney beans. Many fruits also contain folate, with citrus fruits like oranges, as well as avocados and bananas, being good options.
Many countries require food manufacturers to add folic acid to certain products, a process known as fortification. Common fortified foods include breakfast cereals, breads, pastas, and rice. Checking the nutrition label on packaged foods can help you identify products that have been enriched with folic acid.