Folate Deficiency

Folate, or folic acid, is one of the groups of B vitamins that are found in many foods. It is absorbed through the upper part of the small intestine and is necessary for the formation of red blood cells. It works with vitamin C and vitamin B12 to help the body break down and use proteins, as well as help to produce DNA. Because it is an important vitamin, you should increase your intake of folate if you suffer from folate deficiency.

Causes of Folate Deficiency

Folate deficiency has a number of causes but the main reason is poor intake. There are many reasons for poor intake or absorption of folate, including:

1. Deficiency Due to Diet

There are many dietary factors for folate deficiency like:

  • Malnutrition
  • Alcoholism, which interferes with the utilization of folate
  • Poor food source intake
  • Anorexia
  • Diet and other food fads
  • Old age
  • Poor social conditions (lack of access to good food)
  • Malabsorption due to disease (like inflammatory bowel disease and coeliac disease)

2. High Requirements of the Body

Many health conditions can demand a higher level of folate, such as:

  • Malignant cancers associated with leukemia or lymphoma
  • Blood disorders such as sickle cell anemia and chronic myelosclerosis
  • Pregnancy and lactation
  • Metabolic disorders such as homocystinuria
  • Inflammatory diseases such as Crohn’s disease or tuberculosis
  • Peritoneal dialysis or haemodialysis

3. Excessive Excretion Through the Urine

A number of conditions can lead to folate being excreted excessively through urination, for example:

  • Acute liver damage
  • Dialysis of the kidneys
  • Congestive heart failure

4. Medications That Cause Malabsorption

Certain medications can cause the malabsorption or excessive excretion:

  • Anticonvulsants and nitrofurantoin, though the reasons are not known
  • Methotrexate, sulfasalazine, colestyramine can cause malabsorption
  • Trimethoprim can worsen an existing folate deficiency

 Symptoms of Folate Deficiency

There are a number of symptoms associated with folate deficiency, and these symptoms can get worse with anemia associated with the deficiency. The general symptoms include:

  • Problems with growth (in children)
  • Grey hair
  • Sores in the mouth
  • Fatigue
  • Swelling of the tongue

Symptoms of anemia that is due to a folate deficiency include:

  • Pale skin
  • Diarrhea
  • Lethargy
  • Chronic fatigue
  • Sore or tender tongue

Complications of Folate Deficiency

Folate is necessary for the production of red blood cells, so any complications can be very serious. They include:

  • Low platelets and white blood cells
  • Megaloblastic anemia where the red blood cells are not fully developed and are larger than normal
  • Neural tube defects in developing fetuses likedefects in the brain and spinal cord

Treatment for Folate Deficiency

Treatment of folate deficiency requires increasing consumption of foods containing the highest source of folate. The Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies has recommended the amountof folate intake as follows(RDA=recommended daily allowance, DFE=dietary folate equivalents, UL=tolerable upper level):

  • Adults and teens 14 to 19 years old: RDA 400 mcg DFE; UL, 1000 mcg DFE
  • Pregnant females: RDA, 600 mcg DFE; UL, 1000 mcg DFE
  • Lactating females: RDA, 500 mcg DFE; UL, 1000 mcg DFE

Because of variable absorption rates, an approximation of total folate intake in a day can be calculated as follows:

Grams of DFEs provided = grams of food folate + 1.7 X (grams of folic acid supplementation)

Prevention of Folate Deficiency

Eating a healthy, balanced diet is the best way to get the nutrients your body needs to function properly. Most people in the United States get enough folate in their diets because of the robust food supply. We have listed foods high in folate here. Add them to your diet.


Folate per Cup (DV=daily value)

Dark leafy greens:


Collard greens

Turnip greens


263 mcg (65% DV)

177 mcg (44% DV)

170 mcg (42% DV)

Citrus fruits (one whole fruit):





115 mcg (29% DV)

40 mcg (10% DV)

30 mcg (8% DV)

Beans, peas, lentils:


Pinto beans

Garbanzo beans


358 mcg (90% DV)

294 mcg (74% DV)

282 mcg (71% DV)

Seeds and nuts:

Sunflower seeds


Flax seeds


¼ cup= 82 mcg (21% DV)

¼ cup= 88 mcg (22% DV)

2 tbsp.= 54 mcg (14% DV)


Winter squash

Summer squash


57 mcg (14% DV)

36 mcg (9% DV)


262 mcg (65% DV)


136 mcg (34% DV)

Brussels sprouts

25% DV


24% DV


90 mcg (22% DV)


76 mcg (20% DV)


55 mcg (14% DV)


34 mcg (8% DV)


37 mcg (9% DV)


5% DV