Folic Acid Deficiency: What It Is, Causes, Symptoms, and Treatment

Folic acid deficiency refers to having lower than normal levels of folic acid in the body, caused by various factors.

Folic acid deficiency has negative effects on overall health. It is possible to prevent folic acid deficiency by consuming foods rich in folate or using dietary supplements.

What is Folic Acid Deficiency?

Folic acid, also known as folate, is a type of B vitamin. Vitamin B9, as it is also called, plays a crucial role in the body. Folic acid is necessary for DNA replication during cell division. It is also required to repair any damage that may occur in the DNA during replication. One of the most important functions of folic acid is its involvement in the production of red blood cells. Red blood cells (erythrocytes) are responsible for carrying oxygen to the body's cells. Since the average lifespan of red blood cells is 120 days, they must be constantly broken down and replaced. The production of new red blood cells requires folic acid (vitamin B9) and cobalamin (vitamin B12).

Folic acid deficiency occurs when the body does not receive the amount of folic acid it needs. In healthy individuals, the level of folic acid in the blood should be between 2.7-17.0 ng/mL. A diagnosis of folic acid deficiency is made when the level is below this ideal range. Folic acid deficiency can cause serious problems. In pregnant women, untreated and undiagnosed folic acid deficiency can lead to severe issues in the baby.

Having a folic acid level above the ideal range generally does not cause problems. However, high folic acid levels may indicate a deficiency in vitamin B12. The body requires vitamin B12 to use folic acid effectively. If there is a deficiency in vitamin B12, folic acid cannot be used adequately, which can result in higher folic acid levels. In such cases, blood tests should also measure vitamin B12 levels along with folic acid.

Symptoms of Folic Acid Deficiency

The symptoms of folic acid deficiency can be subtle and hard to detect if they are not severe. Additionally, the symptoms associated with folic acid deficiency may resemble those of other conditions, making it difficult to determine whether they are due to folic acid deficiency. Therefore, various tests are needed to distinguish whether these symptoms are caused by folic acid deficiency.

Symptoms of folic acid deficiency include:

• Fatigue
• Premature graying of hair
• Mouth sores
• Swelling of the tongue
• Growth and development issues

Causes of Folic Acid Deficiency

Folic acid is a water-soluble vitamin, meaning it cannot be stored in the body's fat tissues. Since the body has no reserves of folic acid, it needs to be consumed regularly. Any issues with the intake or absorption of folic acid can lead to a deficiency. Conditions that contribute to the development of folic acid deficiency include:

• Diet: People who do not consume enough fresh vegetables and fruits or do not eat enough folate-enriched foods (such as milk, yogurt, flour, breakfast cereals) may develop a deficiency. Folate deficiency can start within a few weeks of poor nutrition.
• Diseases: Conditions that impair nutrient absorption in the intestines, such as Crohn's disease, celiac disease, and certain types of cancer, can lead to folic acid deficiency.
• Genetics: Some individuals have a mutation in the gene that codes for the enzyme responsible for converting folic acid into its active form, methylfolate.
• Medication Side Effects: Certain medications, such as phenytoin, trimethoprim-sulfamethoxazole, methotrexate, and sulfasalazine, can cause folic acid deficiency as a side effect.

Diagnosis of Folic Acid Deficiency

If folic acid deficiency is suspected in a patient, or if the patient has a condition that may cause deficiency (e.g., celiac disease), a folic acid test is conducted.

A blood test is required to diagnose folic acid deficiency. The blood sample is examined in a laboratory to determine the level of folic acid. If the level is found to be lower than 2.7 ng/mL, it indicates a deficiency.

Since folic acid and vitamin B12 deficiencies can occur together, a B12 test may also be requested.

Symptoms Associated with Folic Acid Deficiency

Folic acid deficiency negatively affects overall health.

The most common issue caused by folic acid deficiency is megaloblastic anemia, a type of anemia in which the production of red blood cells is impaired. A deficiency in red blood cells can cause the following symptoms:

• Persistent fatigue and easy exhaustion
• Weakness
• Numbness
• Shortness of breath
• Pale skin color
• Restlessness

In cases of folate deficiency, there may also be a reduction in white blood cells and platelets (blood cells). A decrease in white blood cells makes the person more susceptible to infections and delays wound healing. A low platelet count can cause problems with blood clotting. As a result, the patient may experience redness, bruising, and difficulty forming clots even with minor injuries or small cuts.

In pregnancy, folic acid deficiency can lead to severe complications for the baby. If the mother's folic acid levels are low, the baby may be born with neural tube defects, which affect the brain and spinal cord. The neural tube is a structure in the developing embryo that eventually forms the brain and spinal cord. Folic acid deficiency during embryonic development can cause problems with the closure of the neural tube, leading to birth defects such as spina bifida and anencephaly.

Spina bifida is a condition where the spinal cord does not develop properly within the vertebral column. Anencephaly is a condition where parts of the brain and skull are missing.

The symptoms in babies born with neural tube defects can vary depending on the specific disorder. However, general issues include vision and hearing problems, intellectual disabilities, and loss of consciousness.

To prevent neural tube defects, it is advisable for women to start taking folic acid supplements as soon as they begin planning a pregnancy.

Treatment of Folate Deficiency

The treatment for folic acid deficiency is done by increasing the patient's daily folate intake or by administering folic acid supplements.

To reach the necessary daily levels of folic acid, consuming foods that are high in folate is beneficial. Foods rich in folic acid include:

• Green leafy vegetables like broccoli and spinach
• Brussels sprouts
• Peas
• Citrus fruits
• Melon
• Bananas
• Tomatoes
• Eggs
• Legumes
• Mushrooms
• Liver, white meat, red meat
• Shellfish

If the deficiency is severe, high-dose folic acid supplementation may be used to ensure rapid improvement. If the patient has other concurrent micronutrient deficiencies, multivitamin supplements may also be preferred in treatment.

If you suspect that you or someone close to you may have a folic acid deficiency, or if you are planning to become pregnant, it would be beneficial to visit a healthcare institution for necessary tests and check-ups.