A deficiency of folate can occur when an increased need for folate is not matched by an increased intake, when dietary folate intake does not meet recommended needs, and when folate loss increases. Medications that interfere with the metabolism of folate may also increase the need for this vitamin and risk of deficiency.^{1 2 3 4 5 6}

Medical conditions that increase the need for folate or result in increased loss of folate include:

• pregnancy and lactation (breastfeeding)
• alcohol abuse
• malabsorption
• kidney dialysis
• liver disease
• certain anemias

Medications that interfere with folate utilization include:

• anticonvulsant medications (such as dilantin, phenytoin and primidone)
• metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
• sulfasalazine (used to control inflammation associated with Crohn's disease and ulcerative colitis)
• triamterene (a diuretic)
• methotrexate (used for cancer and other diseases such as rheumatoid arthritis)
• barbiturates (used as sedatives)

• Folate deficient women who become pregnant are at greater risk of giving birth to low birth weight, premature, and/or infants with neural tube defects.
• In infants and children, folate deficiency can slow overall growth rate.
• In adults, a particular type of anemia (Macrocytic, megaloblastic anemia) can result from long term folate deficiency.
• Other signs of folate deficiency are often subtle. Digestive disorders such as diarrhea, loss of appetite, and weight loss can occur, as can weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and behavioral disorders.^7 8 An elevated level of homocysteine in the blood, a risk factor for cardiovascular disease, also can result from folate deficiency.Many of these subtle symptoms are general and can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

Related Links: What is folate? | What are some important links between folate and my health? | What foods provide folate? | How much folate do I need? | What happens if I do not get enough folate? | Do I need extra folate? | Can folate be harmful? | What are some of the current issues and controversies about folate? | Does folate interact with any medicines or supplements?

Disclaimer

Reasonable care has been taken in preparing this document and the information provided herein is believed to be accurate. However, this information is not intended to constitute an "authoritative statement" under Food and Drug Administration rules and regulations.

About Source: ODS

The mission of the Office of Dietary Supplements (ODS) is to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and educating the public to foster an enhanced quality of life and health for the U.S. population.

General Safety Advisory

Health professionals and consumers need credible information to make thoughtful decisions about eating a healthful diet and using vitamin and mineral supplements. These Fact Sheets provide responsible information about the role of vitamins and minerals in health and disease. Each Fact Sheet in this series received extensive review by recognized experts from the academic and research communities.

The information is not intended to be a substitute for professional medical advice. It is important to seek the advice of a physician about any medical condition or symptom. It is also important to seek the advice of a physician, registered dietitian, pharmacist, or other qualified health professional about the appropriateness of taking dietary supplements and their potential interactions with medications.

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Footnotes

1. Herbert V. Folic Acid. In: Shils M, Olson J, Shike M, Ross AC, ed. Nutrition in Health and Disease. Baltimore: Williams & Wilkins, 1999. [↩]
2. McNulty H. Folate requirements for health in different population groups. Br J Biomed Sci 1995;52:110-9. PubMed abstract [↩]
3. Stolzenberg R. Possible folate deficiency with postsurgical infection. Nutr Clin Pract 1994;9:247-50. PubMed abstract [↩]
4. Cravo ML, Gloria LM, Selhub J, Nadeau MR, Camilo ME, Resende MP, Cardoso JN, Leitao CN, Mira FC. Hyperhomocysteinemia in chronic alcoholism: Correlation with folate, vitamin B-12, and vitamin B-6 status. Am J Clin Nutr 1996;63:220-4. PubMed abstract [↩]
5. Pietrzik KF and Thorand B. Folate economy in pregnancy. Nutrition 1997;13:975-7. PubMed abstract [↩]
6. Kelly GS. Folates: Supplemental forms and therapeutic applications. Altern Med Rev 1998;3:208-20. PubMed abstract [↩]
7. Herbert V. Folic Acid. In: Shils M, Olson J, Shike M, Ross AC, ed. Nutrition in Health and Disease. Baltimore: Williams & Wilkins, 1999. [↩]
8. Haslam N and Probert CS. An audit of the investigation and treatment of folic acid deficiency. J R Soc Med 1998;91:72-3. PubMed abstract [↩]