Folic acid, or folate in its natural form, is an essential nutrient involved in cell division and blood formation. A long-term deficiency due to inadequate dietary intake can result in a clinically significant folic acid deficiency. This can lead to anaemia, with symptoms such as fatigue, pallor, and inflamed mucous membranes. Supplementation with folic acid tablets may be necessary to correct the deficiency.
Folic acid deficiency at a glance
- Folic acid deficiency can be caused by malnutrition, gastrointestinal diseases, and certain medications.
- Pregnant and breastfeeding women are more vulnerable due to their increased folic acid requirements.
- Symptoms of deficiency may include fatigue, shortness of breath, and loss of appetite.
- Treatment typically involves high-dose folic acid supplements.
- In some cases, long-term supplementation may be needed to prevent recurrence.
What causes folic acid deficiency?
A folic acid deficiency can have various causes. It can result from consistently low dietary intake or from medical conditions that impair absorption.
Common causes include:
Excessive alcohol consumption
Prolonged malnutrition
Gastrointestinal disorders such as Crohn’s disease
Certain medications
Oral contraceptive pills
Folic acid deficiency due to genetic defects
Rare genetic mutations, such as those causing hereditary folate malabsorption, can significantly impair the absorption and utilisation of folate. This very rare inherited disorder, known as hereditary folate malabsorption, is inherited in an autosomal recessive manner. Its primary consequences include intellectual disability and epileptic seizures. To prevent permanent neurological damage, affected children must be treated early with folic acid supplements.
Folic acid deficiency in women trying to conceive
The recommended daily intake for adults is 300 micrograms of folate equivalents, according to the German Nutrition Society (DGE). However, pregnant and breastfeeding women require significantly higher amounts. During pregnancy, the recommended daily intake is 550 micrograms, and during breastfeeding, it is 450 micrograms.1 Due to this increased demand, the risk of deficiency is higher, which can have serious health consequences for both mother and baby.
How does folic acid deficiency develop?
The body can store around five to ten milligrams of folic acid, primarily in the liver. If intake stops, it may take around four months for these stores to be depleted and symptoms to appear.
Folic acid is essential for red blood cell production (erythropoiesis). A deficiency can lead to anaemia and enlarged red blood cells. Anaemia may cause symptoms such as fatigue, shortness of breath, and pallor.
Additional symptoms of folic acid deficiency include:
Loss of appetite
Weight loss
Diarrhoea
Inflammation of mucous membranes
Cardiovascular diseases
Depressive moods
Irritability
What are the risks of folic acid deficiency during pregnancy?
Folic acid is crucial for the healthy development of the foetus, contributing to cell division and the normal development of the nervous system. A folic acid deficiency during pregnancy significantly increases the risk of neural tube defects and can also contribute to premature birth and other complications.
To prevent neural tube defects, women trying to conceive are advised to take a daily supplement of 400 micrograms of folic acid. This supplementation should begin at least four weeks before pregnancy and continue throughout the first trimester.23
How is folic acid deficiency diagnosed?
If folic acid deficiency is suspected, a blood test is performed to check for anaemia and enlarged red blood cells. If these indicators are present, the next step is usually to measure folic acid levels in the blood. A low folic acid level confirms the deficiency.
Before treating folic acid deficiency, it is essential to rule out vitamin B12 deficiency, as both deficiencies can cause macrocytic anaemia. If vitamin B12 deficiency is mistakenly treated with folic acid alone, anaemia symptoms may improve, but irreversible neurological damage could occur.
How is folic acid deficiency treated?
Treatment usually involves oral folic acid supplements. The dosage depends on the severity of the deficiency. In some cases, 400 to 1,000 micrograms per day may be sufficient, while in more severe cases, five milligrams per day may be necessary.
Alongside supplementation, addressing the underlying cause of the deficiency is crucial. The appropriate approach depends on the specific cause of the deficiency.
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How long does it take to restore folic acid levels?
Replenishing folic acid stores takes time. Depending on the severity of the deficiency and the dosage of supplementation, symptoms may improve within four weeks. However, full treatment may take up to four months. Supplements should be taken until blood tests confirm that folic acid levels have returned to normal.
When should folic acid be taken long term?
In some cases, eliminating the root cause of folic acid deficiency is not possible, or there is a high likelihood of recurrence. In such situations, long-term folic acid supplementation may be necessary.
Which foods help prevent folic acid deficiency?
Severe deficiencies typically require supplements, but a diet rich in folate can help maintain adequate levels.
Folate-rich foods include:
- Pulses (e.g., lentils, beans)
- Leafy green vegetables
- Wheat germ
- Bran
- Pork liver
- Eggs
- SpeisesalzFortified table salt
How can folic acid deficiency be prevented?
For healthy individuals, a balanced diet generally provides sufficient folic acid to prevent deficiency. Since folic acid is mainly found in plant-based foods, vegans can also meet their requirements through diet. However, supplementation may be beneficial in some cases, particularly for:
Women trying to conceive
Individuals with specific medical conditions or eating disorders
Patients taking medications that impair folic acid absorption
For those at risk, supplementing with folic acid can be an effective preventive measure. A maximum daily dose of 200 micrograms is generally recommended for routine supplementation.4
Are vitamin B12 and folic acid the same?
Vitamin B12 and folic acid are not the same. Both belong to the B-vitamin group and have some overlapping functions, but they are distinct nutrients. Folic acid is also known as vitamin B9 or folate, while vitamin B12 is called cobalamin.
Unlike folic acid, vitamin B12 is primarily found in animal-based foods. Therefore, vegans need to take a vitamin B12 supplement to prevent deficiency.
- 1 Deutsche Gesellschaft für Ernährung e.V.: Empfohlene Folatzufuhr (Stand: 2015). URL: https://www.dge.de/wissenschaft/referenzwerte/folat/ (zuletzt aufgerufen am: 25.10.2024).
- 2 Bundesinstitut für Risikobewertung: Schwanger werden? – Aber nicht ohne Folsäure! (Stand: 2022). URL: https://www.bfr.bund.de/cm/350/schwanger-werden-aber-nicht-ohne-folsaeure.pdf (zuletzt aufgerufen am: 25.10.2024).
- 3 Deutsche Gesellschaft für Ernährung e.V.: Ausgewählte Fragen und Antworten zu Folat (Stand: Dezember 2018). URL: https://www.dge.de/gesunde-ernaehrung/faq/folat/ (zuletzt aufgerufen: 25.10.2024).
- 4 Bundesinstitut für Risikobewertung: Aktualisierung (2024): Höchstmengenvorschläge für Folsäure in Lebensmitteln inklusive Nahrungsergänzungsmitteln (Veröffentlichung: 22.02.2024). URL: https://www.bfr.bund.de/cm/343/aktualisierung-2024-hoechstmengenvorschlaege-fuer-folsaeure-in-lebensmitteln-inklusive-nahrungsergaenzungsmitteln.pdf (zuletzt aufgerufen am: 25.10.2024).
Important to know
If you are not a medical specialist and have complaints, specific health conditions, or suspect deficiencies, please make sure to consult a doctor to discuss this.
