Folate Deficiency: Symptoms, causes and treatment | Kin Fertility (2023)

Pregnancy can take a huge toll on your body (that little baby is taking up a lot of your energy to grow!) and one of the things that can happen during those nine months is becoming deficient in certain nutrients and vitamins.

This isn’t typically something to worry about and there are pretty easy fixes to make sure you’re getting all of those vitamins and minerals that you (and your baby) need.

One of the vitamins that is vital during those first few weeks (literally — we're talking the first one to four weeks, but more on that later) is folate.

Folate is responsible for the very early development of your baby so is something (nearly — there are a few exceptions) every expectant mother should take.

Read on to get all of the insight into exactly what folate is, signs of folate deficiency, why it’s so important during pregnancy and everything you need to know about folate supplementation.

What is folate?

Folate is a form of vitamin B9 and is naturally found in a lot of foods. There is also a synthetic version of folate called folic acid, which is added to food and supplements.

We know, it can be a little confusing! There are actually a few forms of vitamin B9, which include folic acid, folinic acid and methylfolate.

Folate is naturally occurring in foods like leafy green vegetables, beans, whole grains, seafood and fresh fruit.

Unlike folate, folic acid doesn’t occur naturally. It's used for food fortification and is commonly added to bread, pasta, rice and breakfast cereals in the US and all bread-making flour (except for organic) in Australia.It's also used for supplements.

Folate helps your body build healthy red blood cells. If you’re pregnant, it’s especially important to help your baby develop those cells — more on that to come.

What is folate deficiency?

A folate deficiency — also known as folate deficiency anaemia — occurs when a lack of folate in the body causes anaemia, which means you have too few red blood cells.

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It’s not common to have a folate deficiency if you have a well-balanced diet, but there are some who are more prone to it than others, including pregnant people — more on that to come.

Symptoms of folate deficiency

There are a variety of symptoms of folate deficiency, the most common being extreme tiredness and a lack of energy. Other symptoms of folate deficiency include:

  • Mouth sores and ulcers
  • Weakness
  • Diarrhoea
  • Weight loss
  • Reduced sense of taste and smell
  • Headache and dizziness

If left untreated, you may develop folate deficiency anaemia, which can lead to complications.

Causes of folate deficiency

It's actually not super common to have a folate deficiency thankfully, and it mostly presents in those aged 65 and over. There are a few things that can cause folate deficiency in everyday life, though.

These include:

Unbalanced diet

The folate your body naturally produces only lasts around four weeks, which is why it’s so important to supplement it through your diet.

And, in general, a folate deficiency is largely caused by not having a balanced diet that includes lots of leafy green vegetables (think: spinach, asparagus, broccoli), fresh fruit, whole grains and eggs.

Malabsorption

Malabsorption conditions such as inflammatory bowel disease, coeliac disease, and pancreatitis can interfere with the absorption of nutrients leading to a folate deficiency.

Cancer

Certain types of cancer can cause the body’s need for folate to increase, leading to a deficiency.

Alcoholism

You can be at greater risk if you have a high alcohol intake or have alcoholism. This is because the digestive system can become damaged and can impair the absorption of nutrients.

It also increases the amount of folate excreted in urine due to changes in liver function. A 2011 study suggests that up to 80 per cent of people with alcoholism can have a folate deficiency.

Pregnancy

During pregnancy, you can become deficient because your body is working overtime so you need more than your usual amount. Your body is working to create a whole human, after all!

(Video) Avoid Folic Acid and Take Folate (as methylfolate) – Folic Acid vs. Folate – Dr.Berg

Most pregnancy supplements contain folic acid as the key ingredient, however, studies have shown that roughly one in three people struggle to convert folic acid due to a common gene variant (the MTHFR-gene).

What happens if you are deficient in folate?

If you have a folate deficiency, you can experience one or multiple of the symptoms listed above, which can make daily life a challenge. If these symptoms go untreated, they can cause further health problems.

However, many of these are easily treated with a visit to your doctor to get advice on your specific circumstances and how much folate you should take to combat the deficiency.

A folate deficiency can also lead to folate deficiency anaemia, which can cause a whole host of other symptoms as your body's red blood cells are unable to function properly.

Folate is incredibly important during pregnancy to ensure the proper development of the foetus and the health of the mother.

Why is folate important for pregnancy?

As previously mentioned, folate has been proven to be incredibly important during the early stages of pregnancy. It’s been widely proven and recommended to take folate during pregnancy to help form the neural tube.

The first studies started in the 1960s, with results published in the 1980s, showing significant enough evidence between folic acid and supporting a healthy pregnancy. Since the '90s, it's been recommended that pregnant people take folate or folic acid supplements.

So, why is it crucial? Folate in pregnancy helps prevent birth defects that affect the baby’s brain (anencephaly) and spine (spina bifida). A neural tube defect can cause serious damage and in some cases, also lead to death.

The neural tube develops very early during pregnancy, closing around four weeks after conception — before most people realise they are pregnant. This is why it’s recommended to take the supplement for around three months before trying to conceive.

How much folate is needed during pregnancy?

The typical recommended amount for pregnant women (or those trying to conceive) is 400 micrograms (0.4mg), according to the Australian Dietary Guidelines.

You may also be advised to take a higher dose of folic acid than normal, which may be the case if:

  • You’ve previously been affected by a neural tube defect
  • You or the baby’s biological father has neural tube defects or have a family history of it
  • You have diabetes
  • You have a malabsorption issue (for example, inflammatory bowel disease)
  • You take medication for epilepsy
  • You take certain medications that can interfere with folate (for example, sulfonamides or methotrexate — you can ask your doctor for advice on this)

You should always seek advice from your GP to make sure you’re getting the correct dose of folate for your circumstances.

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Can low folate be dangerous?

Low folate levels and a folate deficiency can lead to complications for everyone, though this is rare. However, pregnant people are at risk of complications caused by low folate levels.

As discussed, it can cause serious birth defects during early pregnancy (typically four weeks after conception).

Low folate can also cause issues during birth and premature birth. In fact, higher folate levels in the mother were associated with a 28 per cent reduction in the risk of premature birth.

Severe anaemia (regardless of the cause, including folate deficiency anaemia) can cause complications.

In some cases, folate deficiency anaemia can lead to heart and lung complications, as well as neurological symptoms, like memory loss, vision problems and pins and needles, which can become irreversible.

Severe complications include being at risk of developing heart failure. However, in the majority of cases, low folate and anaemia have straightforward treatments and avoiding long-lasting complications is possible.

What's the best way to consume folate?

It’s always important to make sure you’re consuming a well-balanced diet to avoid various deficiencies, folate being one of them.

However, not everyone can get their recommended intake of folate through diet alone, particularly pregnant people.

If you’re pregnant, it’s recommended that you take 400 micrograms of folate every day.

Ideally, you should start supplementation prior to conceiving but you can also start taking a supplement as soon as you discover you're pregnant.

Who shouldn’t take folic acid?

Although folic acid is recommended to most mothers, there are a few people who shouldn’t take it (your doctor can help guide you if you’re unsure).

The main people who should avoid folic acid (or who should consult their doctor first) are:

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  • Those who have ever had an allergic reaction to folic acid
  • Those who have cancer (though this really varies so absolutely take the advice from your doctor)
  • Those who have low vitamin B12 levels.

Are folate and B12 the same thing?

Both vitamin B12 and folate are important for your body's ability to carry red blood cells, and both can cause the symptoms above, but they are not the same thing.

They do, however, work together to make these cells and iron work correctly in the body.

Folate and vitamin B12 work together to produce something called S-adenosylmethionine (SAMe), which is naturally occurring in the body.

This helps to produce and regulate hormone function as well as maintain cell membranes.

Difference between vitamin B12 deficiency and folate deficiency?

B12 deficiency symptoms tend to develop at a slower rate than folate, sometimes over years.

This is because your body stores B12 for two to five years, whereas folate for only four months, leading to folate deficiency quicker. 'You may also experience neurological symptoms such as problems with your vision, coordination and memory loss — with or without anaemia.

Pernicious anaemia (an autoimmune condition affecting the stomach and its ability to absorb vitamin B12) is one of the most common causes of vitamin B12 deficiency.

Vitamin B12 is found in meat and dairy products and eggs, unlike folate which is found in plant foods.

The main symptoms of folate deficiency are fatigue, muscle weakness and many others listed above.

If you are deficient in folate, you will likely notice it within weeks or months. Folate deficiency anemia can present with these symptoms, plus classic anaemia symptoms that include impaired cognitive function.

Both deficiencies can be diagnosed with a blood test. A low level of either B12 or folate indicates a deficiency.

How is folate deficiency treated?

The good news is that it’s relatively straightforward to get your folate levels regulated again if you have a folate deficiency.

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Upon consultation with your doctor, you will most likely be instructed to take a folate or folic acid supplement, while also trying to increase your intake of folate through foods like green leafy vegetables.

If you're unsure of what supplement is best for you, be sure to consult your doctor.

FAQs

How does folate deficiency cause infertility? ›

Folate levels measured in semen have been associated with sperm count and health. One study found that low folate levels in semen were associated with poor sperm DNA stability. From this, we may learn that folate plays an important role in sperm health.

What causes a folate deficiency? ›

Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a fad diet that does not involve eating good sources of folate.

What are deficiency signs and symptoms of folate? ›

Symptoms of folate deficiency
  • symptoms related to anaemia.
  • reduced sense of taste.
  • diarrhoea.
  • numbness and tingling in the feet and hands.
  • muscle weakness.
  • depression.

Can you get pregnant with folate deficiency? ›

Folate deficiency can affect your fertility, so taking a supplement before trying can help you get pregnant if you have stopped using contraception. Taking a folic acid supplement can lower the chance of your baby having a low birthweight or being born prematurely (before 37 weeks).

Does folate increase fertility? ›

Taking folic acid can not only improve your chances of conceiving, but it also reduces the risk of serious birth defects that can occur in the first month of pregnancy.

How does folate help you get pregnant? ›

Studies suggest that folic acid may also increase fertility. Women who take multivitamins with folic acid are more likely to ovulate (produce eggs). Previous studies found that women trying to conceive had somewhat higher pregnancy rates when taking folic acid supplements.

How do you stop folate deficiency? ›

To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake. Good sources of folate include: broccoli.

Who is most at risk for folate deficiency? ›

Women of childbearing age, patients with malabsorption syndromes, or those with bowel resections are at increased risks of developing a folic acid deficiency and should be provided with folic acid supplements. The outcomes are excellent for most patients with folic acid deficiency if it is corrected.

Can low folate cause anxiety? ›

“Problems with folate metabolism have been associated with depression and/or anxiety.

Can a folate deficiency cause hair loss? ›

Only riboflavin, biotin, folate, and vitamin B12 deficiencies have been associated with hair loss.

How much folate do you need for fertility? ›

CDC recommends that women of reproductive age who could become pregnant consume at least 400 micrograms (mcg) of folic acid every day. However, it's difficult to get 400 mcg of folic acid through diet alone.

How long does it take to recover from folate deficiency? ›

Folic acid tablets are used to restore folate levels. These usually need to be taken for four months. In some cases, improving your diet can help treat the condition and prevent it recurring.

Should I take folate when trying to conceive? ›

Take a folic acid supplement

It's recommended that you should take a daily supplement of folic acid when you're pregnant, or there's a chance you might get pregnant. You should take a 400 microgram supplement of folic acid every day before you get pregnant, and every day afterwards, up until you're 12 weeks pregnant.

How can I improve fertility? ›

Here are some expert-backed ways to boost fertility:
  1. Maintain a Healthy Weight. ...
  2. Moderate Exercise. ...
  3. Avoid Tobacco and Too Much Alcohol. ...
  4. Consider Taking a Multivitamin. ...
  5. Work on Managing Your Stress. ...
  6. Be Aware of Environmental Toxins.
12 Sept 2022

Can folic acid affect periods? ›

A. Yes, folic acid regulates periods. It restores the levels of red blood cells in your body and prevents the symptoms of anaemia.

How long should you take folate before getting pregnant? ›

You should take a supplement with 400 micrograms of folic acid per day from 12 weeks before you become pregnant through to the first 12 weeks of pregnancy. Folic acid supplements are available over the counter from pharmacies at varying doses.

Is a folate deficiency serious? ›

Although it's uncommon, vitamin B12 or folate deficiency (with or without anaemia) can lead to complications, particularly if you have been deficient in vitamin B12 or folate for some time. Potential complications can include: problems with the nervous system. temporary infertility.

What foods destroy folate? ›

Eating overcooked fruits and vegetables. Folate can be easily destroyed by heat.

Is low folate life threatening? ›

It can cause pain and increased bleeding. Your fetus could die. Your unborn child can also be harmed by too little folate. They may have a low birth weight or be born before their due date.

What is the richest source of folate? ›

Spinach, liver, asparagus, and brussels sprouts are among the foods with the highest folate levels.

What cancers cause folic acid deficiency? ›

Folic acid deficiency in humans has been linked with megaloblastic anaemia, neural tube defects in the neonate, and heart disease. Folate has also been implicated in the development of cancer, especially cancer of the colorectum.

What cancers are low in folate? ›

In fact, laboratory studies have found that too little or too much folate may contribute to cancer. In humans, there is some evidence that foods containing folate protect against pancreatic, esophageal and colorectal cancer.

How does low folate affect the brain? ›

Folate deficiency impairs cognitive function and nerve signaling in the brain, potentially elevating risks of dementia and death. Researchers found that low serum folate levels may increase the risk of dementia by 68%.

Can low folate make you dizzy? ›

The signs can come gradually and mimic other common symptoms such as feeling tired, irritable or dizzy. These symptoms indicate folate-deficiency anemia, a condition that happens when the body's lack of folate or folic acid limits the production of red blood cells.

What does folate do to the brain? ›

Some of the important functions folate aides in are the creation of DNA and RNA, formation of neurotransmitters, and the formation of the nervous system during pregnancy. Folate is also known to help with depression, mental fatigue, and irritability because it can be quickly broken down and supply the body with energy.

How can I get folate naturally? ›

[38,39] Good sources of folate include:
  1. Dark green leafy vegetables (turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli)
  2. Beans.
  3. Peanuts.
  4. Sunflower seeds.
  5. Fresh fruits, fruit juices.
  6. Whole grains.
  7. Liver.
  8. Seafood.

What fruit is good for folic acid? ›

Besides being delicious and full of flavor, citrus fruits like oranges, grapefruit, lemons, and limes are rich in folate. Just one large orange contains 55 mcg of folate, or about 14% of the DV ( 17 ).

Is folate or folic acid better for conceiving? ›

The body needs folate to function normally. Most children and adults get enough folate through their diet. Choose a wide variety of foods to get the best range of nutrients. Women who are planning to become pregnant or who are in the early stages of pregnancy should take a folic acid supplement.

Which vitamin deficiency is responsible for infertility? ›

In another study, vitamin D deficiency was related to 75% reduction in overall fertility (13). Vitamin D is a steroid hormone which is known for its role in calcium metabolism.

What vitamin deficiency can cause infertility? ›

Vitamin B12 deficiency, infertility and recurrent fetal loss.

What happens if folate deficiency is left untreated? ›

Folate deficiency will not go away on its own.

Treatment is required and may involve dietary changes and/or oral supplements and treatment of underlying causes, if any are present. If left untreated, folate deficiency may result in folate deficiency anemia, which can cause severe complications.

Who is most at risk of developing folate deficiency and fertility problems? ›

Pregnant women are at higher risk of developing folate deficiency because of increased requirements.

Which vitamin is best for fertility? ›

Folic acid: Most people associate folic acid as a prenatal vitamin, but it can also be a really great supplement for those who are trying to conceive. Folic acid is associated with greater chances of getting pregnant naturally and improves success for those undergoing fertility treatments.

What supplements increase fertility? ›

Folic acid.

Folic acid supplementation is often recommended for women before getting pregnant. In addition to promoting fertility, supplementing with folic acid may help protect against neural tube irregularities in a developing fetus ( 1 ).

What factors can improve fertility? ›

What can I do to promote female fertility?
  • Maintain a healthy weight. Being overweight or significantly underweight can inhibit normal ovulation.
  • Prevent sexually transmitted infections. Infections such as chlamydia and gonorrhea are a leading cause of infertility for women.
  • Avoid the night shift, if possible.

How can I solve my fertility problems? ›

Other women may need several different types of treatment to achieve pregnancy.
  1. Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. ...
  2. Intrauterine insemination (IUI). ...
  3. Surgery to restore fertility.
1 Sept 2021

Can B12 injections help fertility? ›

Research has shown that vitamin B12 plays an important role in boosting sperm motility, improving sperm concentration and helps to prevent DNA damage in sperm cells.

How do you improve infertility? ›

What are risk factors for infertility in all genders?
  1. Age (over age 35 for women or over 40 for men).
  2. Diabetes.
  3. Eating disorders, including anorexia nervosa and bulimia.
  4. Excessive alcohol use.
  5. Exposure to environmental toxins, such as lead and pesticides.
  6. Over exercising.
  7. Radiation therapy or other cancer treatments.
14 Dec 2020

How do you fix folate deficiency? ›

What's the Treatment? Folate deficiency anemia is prevented and treated by eating a healthy diet. This includes foods rich in folic acid, such as nuts, leafy green vegetables, enriched breads and cereals, and fruit. Your doctor will also likely prescribe you a daily folic acid supplement.

Can folate affect your period? ›

A. Yes, folic acid regulates periods. It restores the levels of red blood cells in your body and prevents the symptoms of anaemia.

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1. 10 HEALTHY FOODS THAT ARE HIGH IN FOLATE - Health Benefits of Folate (Vitamin B9)
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2. Vitamin B12 or folate deficiency anaemia - Complications
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3. Alcohol Use and Folate Deficiency: What's The Connection
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4. Anaemia (Vitamin B12 or folate deficiency anaemia) :: TREATMENT AND COMPLICATIONS
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