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Folate (vitamin B9) is a nutrient found in certain foods that are part of a healthy diet. (A list of some foods that are good sources of folate is included later in this article.) Folic acid is the synthetic form of folate. Folic acid is added to certain fortified foods, and it can be taken orally in pill and liquid form as a dietary supplement, or it can be given as an injection. Folic acid is often prescribed for people who are not getting enough folate from their diet alone.

The recommended daily amount of folate for adults is 400 micrograms (mcg). A pregnant woman will require from 400 to 800 mcg of folate each day.

Folate is essential to maintaining healthy functioning bodies. It helps to:

  • Produce healthy red blood cells that carry oxygen to all parts of the body
  • Make and repair DNA, which provides the building blocks for the body
  • Split cells for healthy cell reproduction and growth
  • Prevent birth defects of the brain and spinal cord

There is also some evidence that folate helps to:

  • Prevent heart disease and stroke
  • Treat depression
  • Reduce the risk of some cancers

What is folate (folic acid) deficiency?

Folate (folic acid) deficiency occurs when a person is not getting enough natural folate in their diet, and the amount of folate in the blood falls below a healthy level. It is not a condition that will correct itself or go away on its own. A diagnosis of folate (folic acid) deficiency requires immediate intervention before complications set in and permanent damage to the person’s health result.

What are folate (folic acid) deficiency symptoms in adults?

The symptoms of folate (folic acid) deficiency in adults may be subtle. Often, the early symptoms are simply ignored until complications have already occurred. The symptoms can include:

  • Lack of energy/tiring easily
  • Weakness
  • Gray hair
  • Mouth sores
  • Tongue swelling /smoothness/sores
  • Irritability
  • Diarrhea
  • Headaches
  • Pale skin
  • Decreased appetite
  • Weight loss
  • Shortness of breath
  • Racing heartbeat

What causes folate (folic acid) deficiency?

Causes of folate (folic acid) deficiency may be dietary, behavioral or genetic in nature.  A deficiency may also by caused by taking certain medications or related to other medical conditions. Causes may include:

1. Poor diet

For most people, eating a balanced diet will provide all the folate their body’s need. A balanced diet must include foods that are good sources of folate. The body is not able to store unused folate, so folate-rich foods should be eaten daily. Without getting enough folate in the diet, a person can become folate deficient within a few weeks. Folate-rich foods that are commonly available include:

  • Legumes (like beans, peas or lentils)
  • Dark green leafy vegetables (like spinach, kale or arugula)
  • Eggs
  • Asparagus
  • Brussel sprouts
  • Broccoli
  • Mushrooms
  • Citrus fruits and juice
  • Tomato juice
  • Bananas
  • Avocados
  • Beef liver (only one serving contains over half of the folate needed in a day)
  • Meats (like chicken, pork or shellfish)
  • Nuts and seeds
  • White rice
  • Whole grains
  • Vitamin fortified foods (like certain breakfast cereals, pastas and breads)

2. Over-cooked food

Folate is extremely sensitive to heat. Cooking vegetables, fruits and other folate-rich foods too long can limit their benefit.

3. Excessive alcohol use

Drinking excessive amounts of alcohol inhibits the body’s ability to absorb folate. Alcohol use can also cause the body to flush out too much unabsorbed folate through urination.

4. Genetics

Some people are born with bodies that are unable to normally absorb folate from food or folic acid from supplements. This genetic trait can be passed from generation to generation. When infants are diagnosed with this genetic trait, they must begin treatments right away in order to avoid long-term health risks.

5. Medication

Certain medications can affect the body’s ability to absorb and use folate. Some of those medications are:

  • Phenytoin (Dilantin)
  • Methotrexate
  • Sulfasalazine
  • Triamterene
  • Pyrimethamine
  • Trimethoprim-sulfamethoxazole
  • Barbiturates (medications that depress the nervous system)

It is also important to note that taking folic acid supplements to treat a folate deficiency can counteract certain medications, making these medications less effective. Always discuss every medication and supplement you are taking with your primary care doctor or your pharmacist.

6. Disease

Some diseases affect the absorption of nutrients in the stomach and intestines. The following diseases can limit the absorption of folate and result in a deficiency:

  • Crohn’s disease
  • Celiac disease
  • Some cancers
  • Liver disease
  • Kidney disease that requires dialysis

7. Pregnancy

A pregnant woman’s body will absorb folate more slowly, and the developing fetus will absorb the folate that she intakes. This increases the amount of folate the woman needs during pregnancy. If you are planning to become pregnant, it is best to inform your primary care doctor so that steps are taken to increase your intake of folate and folic acid even before becoming pregnant.

How is a folate (folic acid) deficiency diagnosed?

A folate (folic acid) deficiency can be diagnosed by a blood test that is commonly done with a physical exam and a medical history. A pregnant woman will often have this blood test during prenatal checkups.

If the blood test results indicate a deficiency, other tests may be ordered to confirm the result and to check for evidence of related complications.

Complications of folate (folic acid) deficiency

Complications resulting from folate (folic acid) deficiency can be severe and permanent. If a deficiency goes untreated, it will eventually lead to anemia. Remember that folate helps the body to produce red blood cells. The purpose of red blood cells is to carry oxygen to every organ and to all tissues throughout the entire body. Without enough oxygen, the organs and tissues are damaged and die. Anemia is a condition in which the blood doesn’t contain enough red blood cells to carry an adequate supply of oxygen to all parts of the body.

When anemia results from folate (folic acid) deficiency, not only is the number of red blood cells reduced; the cells that are produced are larger than normal, misshapen and underdeveloped. This condition is called megaloblastic anemia. These abnormal red blood cells are not able to carry oxygen as well as a healthy cell, so the amount of oxygen getting to the body’s organs and tissues is decreased even more.

In addition to the risk of anemia in the mother, untreated folate (folic acid) deficiency in pregnant women can lead to severe brain and spinal cord defects in the developing fetus. These are called neural tube defects, and they can result in a baby being born with a damaged brain and nervous system. Neural tube defects can also result in a baby dying in the womb or soon after birth. It is critically important for pregnant women to have their folate levels checked and to take folic acid supplements as prescribed.

In rare cases, untreated folate (folic acid) deficiency can lead to a low white blood cell count. This is known as leukopenia. White blood cells are an important part of the body’s immune system. A decrease in the number of white blood cells leaves the body vulnerable to disease and infection.

How to treat folate (folic acid) deficiency

Simply stated, the treatment of folate (folic acid) deficiency usually involves one or a combination of the following options:

  • Eating a healthier diet
  • Taking folic acid supplements
  • Treating a condition or disease that is causing the deficiency

Deciding upon the best treatment plan requires an understanding of the specific source of the deficiency.

If a poor diet is the source of the deficiency, eating more folate-rich foods is usually enough to treat it. Not only will better food choices help to increase folate intake; healthier food preparation choices will also help. Lightly steaming vegetables, and eating more raw fruits and vegetables help preserve the folate contained in them. In some cases, folic acid supplements in the form of pills or liquid drops, or folic acid injections may be temporarily combined with a permanent change in diet to help correct a deficiency more quickly. No matter what the primary source of the deficiency is, eating a healthy diet should always be part of the treatment plan.

When the deficiency is the result of taking other medications or having medical conditions that inhibit the body’s ability to absorb and use folate, folic acid supplements are usually prescribed. The need for these supplements may be permanent if the medical conditions causing the deficiency are permanent. Folic acid supplements are often prescribed in combination with other vitamin B supplements. These are called B-complexes. When folic acid supplements are taken as directed, they are safe and they rarely produce serious side effects. Some people have allergies that prevent them from taking folic acid supplements. If you experience a skin rash, itchiness, redness or difficulty breathing after taking a folic acid supplement, you should contact your doctor immediately.

Individuals who are born with a genetic trait that prevents their body from absorbing folate or folic acid will be treated with a special supplement called methylated folate. This genetic trait is usually diagnosed when the person is an infant, and it requires the person to take methylated folate their entire life.

Women who are planning to become pregnant, are pregnant or currently breastfeeding should not wait to become folate (folic acid) deficient before they begin treatment. When it comes to deficiency resulting from pregnancy, prevention is the preferred treatment. In fact, starting folic acid supplements several months prior to becoming pregnant is a good idea.

As part of all treatment plans for folate (folic acid) deficiency, alcohol use should be reduced or avoided. Alcohol use can cause folate (folic acid) deficiency and work against the benefit of any treatment option. For pregnant women, alcohol consumption must be eliminated completely.

How to prevent folate (folic acid) deficiency

By far, the best way to prevent folate (folic acid) deficiency is by eating a diet that includes plenty of folate-rich foods. Remember that the recommended daily amount of folate for an adult who is not pregnant or breastfeeding is 400 mcg. With the amount and variety of folate-rich foods in the U.S. food supply, getting enough folate through diet is relatively easy. To see how much folate is contained in your favorite foods, you can use the USDA Food Composition Database. This online tool was created by the United States Department of Agriculture, and it will show you the amount of all nutrients contained in a serving of the food you select. As you use this and other tools, or as you check labels on the foods you purchase at the grocery store, remember that folate is also known as vitamin B9.

Seeing your doctor regularly is another important way to help prevent folate (folic acid) deficiency. Because the initial symptoms of a deficiency may be so difficult to recognize, it’s best not to wait until symptoms are noticeable. Schedule regular physicals and blood exams, and discuss all of your health concerns and possible symptoms with your doctor.

How Diversity Home Health Group can help

Medical Nutrition Therapy

The most effective way to prevent and treat folate (folic acid) deficiency is with a healthy diet. Diversity Home Health Group offers Medical Nutrition Therapy (MNT) services that can help. A Registered Dietician can help you design a nutrition program that is tailor-made for you. When helping you make a plan, we will take into account factors such as your medical history, your current health needs, your dietary restrictions, and many others. Through the MNT services offered by Diversity Home Health Group, you can make better food choices, eat healthier portions and learn delicious ways to enjoy a healthier lifestyle.

PCA Services

Personal Care Assistant (PCA) services through Diversity Home Health Group are provided by trained and caring individuals who are supervised by a Registered Nurse. PCA services are available to people who aren’t able to do all the things they once were able to do for themselves. PCA’s can help with grocery shopping, meal preparation, going to medical appointments, picking up prescription medications and many other tasks that are required for living an independent and healthy life. Diversity Home Health Group offers several PCA service options that are designed to meet your unique needs efficiently and effectively.

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