Symptoms and Causes of Folic Acid Deficiency

General Symptoms of Folic Acid Deficiency

Folic acid deficiency can manifest differently from anemia caused by folate deficiency. Often, symptoms are subtle or go unnoticed. Common signs may include:

• Fatigue
• Irritability
• Diarrhea
• Premature graying of hair
• Impaired growth
• Swollen tongue and mouth ulcers

Symptoms of Folate Deficiency Anemia

When folate deficiency leads to anemia, additional symptoms may appear, such as:

• Persistent fatigue
• Weakness and lethargy
• Pale skin
• Irritability
• Shortness of breath

Causes of Folic Acid Deficiency

1. Inadequate Dietary Intake

Low folate levels can develop within weeks due to a diet lacking in folate-rich foods like fresh fruits, vegetables, and fortified grains. Overcooking food at high temperatures can also destroy folate content.

2. Genetic Mutations

Some individuals have genetic mutations that hinder their ability to convert folate into its active form, methylfolate, which the body can use efficiently.

3. Alcohol Consumption

Alcohol interferes with the absorption and increases the excretion of folic acid, leading to deficiency.

4. Medical Conditions

Certain digestive disorders, such as Crohn's disease and celiac disease, impair the body's ability to absorb folate.

5. Medications

Some drugs can reduce folic acid absorption or block its activity, including:

• Anticonvulsants
• Nitrofurantoin
• Colestyramine
• Sulfasalazine
• Methotrexate
• Trimethoprim (may worsen existing deficiency)

6. Increased Demand

Higher folic acid needs occur during:

• Pregnancy and breastfeeding
• Premature birth and infancy
• Certain cancers (e.g., leukemia, lymphoma)
• Blood disorders (e.g., sickle cell anemia, thalassemia)
• Chronic infections (e.g., tuberculosis, malaria)
• Metabolic disorders (e.g., homocystinuria)
• Dialysis treatments

Complications of Folic Acid Deficiency

Untreated folate deficiency may lead to several health issues, including:

• Birth defects in newborns
• Increased risk of depression
• Memory and cognitive issues
• Higher allergy susceptibility
• Bone density loss over time
• Severe forms of anemia affecting red, white blood cells, and platelets

Diagnosing Folic Acid Deficiency

Diagnosis typically involves several tests:

• Complete blood count (CBC): Detects megaloblastic anemia.
• Vitamin B12 test: Differentiates from B12 deficiency.
• Serum folate test: Levels below 3 mcg/L may indicate deficiency.
• Homocysteine levels: Elevated in folate deficiency but influenced by B12, B6, and kidney function.
• Methylmalonic acid (MMA) test: Elevated only in B12 deficiency, not folate deficiency.

Treatment Options

Treatment depends on the underlying cause. For example, managing celiac disease can improve folate absorption. In some cases, lifelong supplementation may be required, delivered via oral supplements, intramuscular, or rarely, intravenous injections. A folate-rich diet can also help restore healthy levels.

Folic Acid and Pregnancy

Pregnant women need significantly more folic acid to support DNA synthesis and fetal development. The CDC recommends 400 mcg daily for women of childbearing age. Deficiency during pregnancy may cause:

• Poor fetal growth and low birth weight
• Neural tube defects, including:
  • Spina bifida: Incomplete spinal closure causing nerve damage and physical disabilities.
  • Anencephaly: Missing parts of the brain and skull, often fatal before or shortly after birth.

To reduce these risks, women should take folic acid for at least three months before and during pregnancy. The recommended intake during pregnancy is 600 mcg per day. Always consult a healthcare provider before starting supplements.

Recommended Daily Intake of Folate

Overview of Folic Acid

Folic acid, or vitamin B9, is a water-soluble B-vitamin essential for numerous bodily functions. It supports the metabolism of proteins, synthesis of DNA, and formation of red and white blood cells. Because the body cannot store large amounts, daily intake through diet or supplements is necessary.

Folic acid is naturally found in leafy green vegetables, liver, legumes, and fortified foods. Deficiency can cause megaloblastic anemia, a condition where red blood cells are abnormally large and inefficient in oxygen transport.