While folate is found in many foods, not everyone gets enough of it in their diets. Even if they do, not everyone can absorb it due to issues like poor digestion (specifically malabsorption disorders) or genetic concerns that make it harder to convert dietary folate and supplemental folic acid into a usable form.
Read on to learn more about the signs of folate deficiency, the health benefits of folate, common causes of folate deficiency, top folate-containing whole foods, and recommended doses of folic acid supplements.
Signs of Folate Deficiency
There are several common folate deficiency symptoms:
Fatigue & Low Energy
Do you ever feel tired or weak or have unexplained fatigue? Maybe you feel like your get-up-and-go has got up and went away. Whatever the case, your energy reserves are low, and you’re not sure why. While there are many causes of low energy, it’s possible folate deficiency is to blame. That’s because fatigue is a common concern with anemia, and folate deficiency can cause anemia.
Hearing Loss
A 2010 study found that age-related hearing loss is associated with significantly lower levels of folate in the blood. If you’re over the age of 60 and experiencing hearing loss without a clear medical diagnosis, it could be from a folate deficiency, which is common in older people.
Anemia
Anemia is a shortage of red blood cells in your body. Because red blood cells are responsible for transporting oxygen and energy to the cells throughout your body, anemia can make you feel tired and weak. Without sufficient red blood cells to carry oxygen through your body, you may feel short of breath – and your heart rate may go up as it tries to get more oxygen to your cells. Your hands and feet may feel cold, and your skin may be paler than normal.
Anemia can have many different causes. Internal bleeding, heavy menstruation, serious illnesses, and genetic diseases (such as sickle cell anemia) are all factors. But anemia is more commonly caused by nutritional deficiencies, particularly low iron, low B12, and low folate.
Shortness of Breath
If you have trouble catching your breath, or if you feel winded after even mild exertion, the cause may be a folate deficiency. That’s because anemia, an aforementioned common concern in people with folate deficiencies, can lead to shortness of breath.
Memory Loss
Cognitive impairment, including poor memory and dementia, is associated with lower levels of folate in the blood, especially in older adults that need special care. A couple of small studies have indicated that folic acid supplementation can lead to improvement in cognitive function for some patients.
Pale Skin
If your skin looks significantly paler than normal, you may have a folate deficiency. That’s because pale skin is a symptom of anemia, and anemia can be caused by folate deficiency.
If you are experiencing symptoms of folate deficiency, make sure you are getting adequate folate in your diet and consider taking a folic acid supplement to get the U.S. Recommended Daily Allowance (RDA) for this vitamin. If your symptoms persist, see your doctor.
Folate vs. Folic Acid
You may hear people talk about folate and folic acid. So what’s the difference? While folate and folic acid are both forms of the water-soluble vitamin B9, the difference is their source. Folate is the natural form of this vitamin. You get it by eating natural foods, especially nuts, green leafy vegetables (such as kale and spinach), and other fruits and vegetables.
By contrast, folic acid, also known as folacin, is the synthetic form of vitamin B9. Since 1998, the FDA has required food producers to fortify enriched cereal and flour with folic acid. Many brands of nutritional yeast are also fortified with folic acid. Food manufacturers use synthetic folic acid rather than the natural form of this vitamin, folate, because folic acid is less expensive and folate is not shelf-stable.
It is not necessary to eat fortified foods or take folic acid supplements to get enough vitamin B9. You can get enough folate through your regular diet alone, provided you follow a healthy, whole-food diet rich in fruit, vegetables, beans, and nuts.
Folate and Folic Acid Benefits
There are many health benefits to consuming sufficient folate and folic acid. Adequate amounts of this water-soluble B vitamin help your body produce new blood cells and reduce the risk of stroke in people with high blood pressure. Folic acid can also help promote bone health. During pregnancy, getting enough folate through a healthy diet or enough folic acid through supplements and fortified foods helps to protect your developing baby’s health and prevent certain birth defects.
Facilitates New Cell Production
Adequate folate doesn’t just enable your body to build more red blood cells, it’s also important for producing and maintaining all new cells in the body. That’s because folate is required for DNA replication (to copy DNA for new cells) and for the DNA within each cell to be used to create new proteins.
Promotes Normal Blood Pressure
In people with high blood pressure, adequate folic acid intake may help prevent strokes. A 2015 study published in the Journal of the American Medical Association followed more than 20,000 adults with high blood pressure in China over 4.5 years. Those participants who received folic acid supplements, rather than a placebo, were less likely to have a stroke during that time.
Keep in mind, China doesn’t require folate fortification of grains the way the U.S. does, so it’s likely that the China-based study saw a more dramatic benefit due to the lower folate levels of people in the study. But these findings may be relevant to people in the U.S. who do not consume a lot of fortified grains, either because their main source of dietary carbohydrates is corn masa (which isn’t fortified) or because they are on a gluten-free diet due to celiac or other health issues.
Helps Healthy Development of Fetus During Pregnancy
Getting enough folic acid in pregnancy is critical to protecting the developing fetus from neural tube defects (NTDs). One type of NTD is spina bifida, where the neural tube of the spine doesn’t close completely. With the more severe forms of spina bifida, part of the infant’s spine is exposed at birth, and the child will experience minor to major disabilities. Other types of NTD affect the developing fetus’s brain and can lead to stillbirth (due to the failure of the brain to develop) or part of the infant’s brain being exposed at birth.
The good news is that women can help protect their developing babies by consuming enough folic acid before and during pregnancy. According to the CDC, since mandatory folic acid fortification of cereals and flours began, the percentage of infants in the U.S. who were born with a neural tube defect has fallen by 35 percent.
While getting enough folic acid is important throughout a woman’s entire pregnancy, it’s especially critical during the early weeks, since NTDs can occur as early as three to four weeks into pregnancy. That’s why the CDC recommends that women of childbearing age consume at least 400 micrograms of folic acid, even when they’re not pregnant. By the time a woman finds out she’s pregnant and starts taking prenatal supplements, she may already be six weeks pregnant – or more.
At the very least, folic acid supplementation should begin at least one month before conception, to ensure that blood levels are adequate before conception.
Encourages a Healthy Heart
One marker for heart disease risk is the level of the amino acid homocysteine in the blood. Elevated levels of homocysteine can cause inflammation of the blood vessels, which can lead to a buildup of plaque in the arteries of the heart.
The body needs sufficient amounts of B vitamins – specifically, B6, B9 (folic acid) and B12 – to convert homocysteine into methionine, an essential amino acid. While studies of those who already have heart disease showed no benefit from B vitamin supplementation, the Nurses’ Health Study found that women with no history of heart disease and high levels of dietary B6 and folate had a lower risk of heart disease.
Helps Protect Your Bones
Folate deficiency can lead to higher levels of the amino acid homocysteine. Elevated homocysteine levels can increase the rate of bone fractures. Ensuring you get adequate folic acid through diet and supplements can bring down homocysteine levels, potentially protecting your bones.