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Last Updated on November 17, 2025 by Ugurkan Demir
Folic acid is essential for making blood cells and absorbing nutrients like vitamin B12. A lack of folic acid can lead to serious health issues. Understanding folic acid deficiency causes helps prevent complications such as birth defects, nerve damage, and metabolic problems.
At Liv Hospital, we focus on identifying and treating folic acid deficiency early, especially in individuals at higher risk. Our teams use advanced diagnostic tools and personalized care plans to manage and prevent deficiencies. By knowing the folic acid deficiency causes and how they affect vitamin B12 levels, we can provide patients with targeted, effective care.
Folate is a key nutrient for our bodies. It helps with DNA synthesis, repair, and methylation. It also aids in homocysteine metabolism.
Folate acts as a coenzyme in one-carbon metabolism. It helps make purines and pyrimidines for DNA and RNA. This is key for cell division and growth.
It’s most important during fast cell growth, like in pregnancy and infancy.
The biochemical functions of folate include:
These roles show how vital folate is for genomic stability and cell function.
The amount of folate we need changes as we age. The recommended dietary allowance (RDA) is given in dietary folate equivalents (DFE). DFE considers how different types of folate are absorbed by the body.
The RDAs for folate are as follows:
| Life Stage | Age | DFE (mcg/day) |
| Infants | 0-6 months | 65 |
| Infants | 7-12 months | 80 |
| Children | 1-3 years | 150 |
| Children | 4-8 years | 200 |
| Males | 9 years and older | 300-400 |
| Females | 9 years and older | 300-400 |
| Pregnant women | All ages | 600 |
| Lactating women | All ages | 500 |
These guidelines show we need more folate when pregnant or breastfeeding. It’s vital for the health of both mother and baby.
Folate and vitamin B12 work together in many body functions, like the methylation cycle. They need each other, so a lack in one can hurt the other.
The methylation cycle is key for our body’s health. It moves methyl groups to DNA, proteins, and lipids. Folate and B12 are essential here.
Folate turns into tetrahydrofolate (THF), helping make methionine from homocysteine. Vitamin B12, as methylcobalamin, helps the enzyme methionine synthase do this job.
Key dependencies in the methylation cycle include:
Not having enough B12 can cause a “folate trap.” This makes folate less available for DNA making. This can lead to megaloblastic anemia, with big red blood cells.
On the other hand, not enough folate messes with the methylation cycle. It can stop methionine making and raise homocysteine levels. High homocysteine is bad for health.
The interdependence of folate and B12 shows why we must find and fix both nutrient shortages.
Some big problems from not having enough include:
Folic acid is key for many body functions. Its lack can come from several main causes. Knowing these causes helps spot who’s at risk and how to prevent it. We’ll cover the main reasons and how to check if someone might not have enough folic acid.
Not getting enough folic acid can happen for many reasons. These include not eating enough folic acid, needing more during pregnancy, not absorbing it well due to stomach issues, drinking too much alcohol, taking certain medicines, and other factors. Each reason has its own way of leading to a lack of folic acid.
The 8 main reasons for folic acid deficiency are:
For more details on how folate works in the body, check out NCBI’s book on folate deficiency.
To figure out who might not have enough folic acid, doctors should look at a few things:
| Risk Factor | Description | Level of Risk |
| Dietary Intake | Not eating enough foods with folate | High |
| Pregnancy and Lactation | Body needs more folate | High |
| Gastrointestinal Diseases | Stomach problems making it hard to absorb | Moderate to High |
| Chronic Alcohol Consumption | Alcohol affects how the body uses folate | High |
Understanding these risk factors helps doctors find who’s at risk. They can then take steps to help them.
Folate deficiency often comes from not eating enough foods rich in this nutrient. Foods like leafy greens, legumes, and some fruits are packed with folate. They are key to keeping folate levels up.
People who don’t eat these foods often face a higher risk of folate deficiency. This is more common in those on strict diets or with limited access to fresh produce.
Several diets can lead to not getting enough folate. These include:
How we prepare food is key to keeping folate in it. Steaming or lightly cooking veggies helps keep their folate. But boiling or frying can cause big losses.
Some groups are more likely to lack folate due to their diet or lifestyle. These include:
Knowing who’s at risk helps us find ways to stop folate deficiency. By encouraging diets rich in folate, we can help keep everyone’s folate levels up and their health good.
Pregnancy makes the body need more folate. This is because the fetus grows fast and needs lots of cells. The body’s folate needs go up a lot to help the mom and the baby.
As the pregnancy goes on, the fetus grows even faster. This means the body needs even more folate. This is very important to avoid problems like neural tube defects (NTDs).
Getting enough folate during pregnancy is very important. Pregnant women need 600-800 micrograms of folate every day. This is more than the 400 micrograms non-pregnant women need.
To meet these needs, pregnant women should eat foods high in folate. These include leafy greens, legumes, and fortified cereals. Sometimes, they might also need to take supplements.
| Life Stage | Recommended Folate Intake (mcg/day) |
| Pregnancy | 600-800 |
| Lactation | 500 |
| Non-Pregnant Women | 400 |
Not having enough folate during pregnancy can harm the fetus. One big risk is neural tube defects (NTDs). These include spina bifida and anencephaly.
Neural tube defects are common and can be very serious. It’s very important for pregnant women to get enough folate early on to prevent these problems.
Folate deficiency can also lead to preterm labor and low birth weight. So, keeping folate levels up is key for the health of both the mom and the baby during pregnancy.
Gastrointestinal diseases can make it hard for our bodies to absorb important nutrients like folate. Conditions like celiac disease and inflammatory bowel disease (IBD) can cause malabsorption. This leads to a lack of essential nutrients.
We will look at how these diseases affect folate absorption. We will also explore the reasons behind this.
Celiac disease is an autoimmune disorder. It makes the immune system react to gluten, damaging the small intestine. This damage can stop nutrients, including folate, from being absorbed properly.
The main effects of celiac disease on nutrient absorption are:
A study on patients with celiac disease found many had folate deficiency at diagnosis. This shows how important it is to consider gastrointestinal diseases when checking folate levels.
IBD, which includes Crohn’s disease and ulcerative colitis, can also affect folate absorption. The inflammation in IBD can make the small intestine less effective at absorbing nutrients.
The impact of IBD on folate status can be seen in several ways:
| Disease Aspect | Effect on Folate Absorption |
| Inflammation | Reduces the ability of the intestine to absorb folate |
| Surgical Resection | Can lead to a reduction in the absorptive surface area |
| Medication | Some medications used in IBD treatment can interfere with folate metabolism |
It’s important to understand how gastrointestinal diseases affect folate absorption. This knowledge helps in managing deficiencies. We need to consider these conditions when checking folate levels and planning treatments.
Drinking alcohol for a long time can harm how the body uses folate and vitamin B12. It makes it hard for the body to absorb, store, and use folate. This can lead to a folate deficiency, which is bad for health.
Alcohol messes with folate metabolism in several ways. It lowers the amount of folate transport proteins in the gut, making it harder to absorb folate. It also blocks the enzyme methionine synthase, which is key for turning homocysteine into methionine. This affects how folate and methionine are used in the body.
Chronic alcohol use also affects vitamin B12. Folate and B12 work together in the methylation cycle. A folate deficiency can make a B12 deficiency worse. This can raise homocysteine levels, increasing the risk of heart disease and brain problems.
Knowing how alcohol affects folate and B12 can help doctors treat alcohol use disorders. This can reduce the risk of nutrient deficiencies in these important vitamins.
Some prescription drugs can cause folate deficiency. This happens when certain drugs affect how our body uses folate. This can lead to a lack of folate.
We look at how drugs like anticonvulsants and methotrexate can cause folate deficiency. We explain how these drugs affect folate levels.
Anticonvulsants help control seizures. But some, like phenytoin, carbamazepine, and valproate, can mess with folate. They can stop folate from being absorbed or used properly.
Mechanisms of Action:
This can lower folate levels. This might lead to a deficiency.
Methotrexate is used to treat cancer and other conditions. It blocks an enzyme needed for DNA repair. This is how it works.
Impact on Folate Status:
| Drug | Mechanism | Effect on Folate |
| Methotrexate | Inhibition of DHFR | Reduced folate utilization |
| Trimethoprim | Inhibition of DHFR | Reduced folate utilization |
| Pyrimethamine | Inhibition of DHFR | Reduced folate utilization |
Other drugs like trimethoprim and pyrimethamine also block DHFR. But they do it in different ways.
It’s important to know how these drugs affect folate levels. This helps doctors manage patients on long-term treatment.
Doctors should watch for folate deficiency in patients on these drugs. They should check folate levels in those at risk.
Vitamin B12 absorption happens mainly in the ileum, the last part of the small intestine. This process is key for using vitamin B12 in the body. It helps make red blood cells and keeps the nervous system working right.
The ileum is made for absorbing vitamin B12. Its special design and function help it grab this important nutrient well. The process involves a few important parts:
Intrinsic factor is very important for vitamin B12 absorption. Without it, the body can’t get vitamin B12 from food. The vitamin B12 binds to intrinsic factor, which is a key step for absorption in the ileum. For more info on vitamin B12 absorption, check out this resource.
Intrinsic factor’s role is clear in conditions like pernicious anemia. This condition happens when the stomach cells that make intrinsic factor get destroyed. It shows how vital intrinsic factor is for vitamin B12 absorption and what happens when it’s missing.
Chronic hemolysis affects folate use because red blood cells are constantly being replaced. This happens when red blood cells are destroyed faster than they can be made. It can be due to genetic issues, infections, or autoimmune diseases.
When red blood cells are destroyed quickly, the body needs to make more. This means it uses more folate to help make new cells.
Hemolytic conditions can be either acute or chronic. Chronic hemolysis means red blood cells are constantly being destroyed. This leads to a constant need for new cells.
It can be caused by genetic issues like sickle cell disease and thalassemia. It can also be caused by acquired conditions, such as autoimmune hemolytic anemia.
We will look at how these conditions affect folate use. Below is a table that shows some common hemolytic conditions and how they impact red blood cell turnover.
| Hemolytic Condition | Effect on Red Blood Cell Turnover | Impact on Folate Utilization |
| Sickle Cell Disease | Increased destruction of red blood cells | Higher demand for folate to support erythropoiesis |
| Thalassemia | Rapid turnover of red blood cells | Increased folate utilization for new cell production |
| Autoimmune Hemolytic Anemia | Immune-mediated destruction of red blood cells | Enhanced folate demand due to compensatory erythropoiesis |
During chronic hemolysis, the body needs more folate to make new red blood cells. Folate is key for DNA synthesis and repair. It’s vital for making new cells.
The body’s demand for folate goes up during cell turnover. If not enough folate is added through diet or supplements, stores can get low.
It’s important to understand how chronic hemolysis affects folate use and health. Knowing this can help better manage patients with these conditions.
It’s important to know how vitamin B12 is stored and used in our bodies. This is key, with a focus on the liver and how it recycles nutrients. Vitamin B12 helps make red blood cells and keeps our nervous system working right.
The liver is where vitamin B12 is mainly stored. When we eat foods with B12 or take supplements, it goes to the liver. There, it’s stored in forms like methylcobalamin and adenosylcobalamin, which are important for our metabolism.
Enterohepatic circulation is a key process that helps keep B12 levels up. It recycles B12 from the bile back into the blood. This makes sure we use what we have efficiently.
This recycling process is vital, helping us keep B12 levels steady, even when we don’t get enough from food. It helps our bodies use what they have longer, delaying when we might start to show signs of deficiency.
How long it takes for B12 levels to drop after we stop taking it varies. Our bodies can keep B12 for years because of how it’s stored and recycled. But, how fast it goes down depends on several things.
These include how much B12 we start with, any health issues that might affect how we absorb it, and our overall health. Generally, it can take 2 to 5 years or more for symptoms of B12 deficiency to show up after we stop taking it. But, if we have problems absorbing B12, it can happen sooner.
It’s important to understand these details to manage B12 levels, which is key for people at risk of deficiency. Doctors need to consider these factors when deciding if someone needs B12 supplements.
We’ve looked into how folate and vitamin B12 work together for our health. It’s clear they’re both key for staying healthy. To fix deficiencies, we need to change our diet, use supplements, and find the root cause.
Healthcare teams can use a complete plan to stop and treat these deficiencies. This plan helps patients get better. It focuses on groups at high risk, like pregnant women and those with gut problems, and gives them the right help.
Our talk shows the need for a full plan to handle folate and B12 issues. With diet advice, supplements, and fixing the underlying problems, we can avoid the bad effects. This way, we help everyone stay healthy and feel good.
Folic acid deficiency can happen for several reasons. It might be due to not getting enough from food. It can also be caused by needing more during pregnancy or growth. Other reasons include malabsorption from diseases, drinking too much alcohol, and taking certain medicines.
Folate and vitamin B12 work together in the body. If you lack one, it can make it harder to use the other. This can lead to more health problems.
Vitamin B12 is mostly absorbed in the ileum, the last part of the small intestine. This process needs intrinsic factor, a protein from the stomach lining.
Intrinsic factor is key for vitamin B12 absorption. It helps bind vitamin B12 in food. This makes it easier for the body to absorb it in the ileum.
Vitamin B12 is stored in the liver. It can last for years through a process called enterohepatic circulation. After stopping intake, it takes time for the body to use up stored vitamin B12.
Chronic hemolysis means red blood cells break down fast. This increases folate needs. If not enough folate is taken in, deficiency can occur.
Yes, some medicines can affect folate levels. This includes anticonvulsants and drugs like methotrexate. They can make it harder for the body to use folate.
Folate is vital during pregnancy. It supports the growth of the fetus. It helps prevent birth defects and keeps both mother and baby healthy.
Drinking too much alcohol can harm folate and vitamin B12 use. It can lead to deficiency in folate. It also affects vitamin B12, increasing the risk of deficiency.
Some groups are more at risk for folate deficiency. These include pregnant women, people with gut diseases, and those who don’t eat enough folate. Also, those who drink a lot of alcohol or take certain medicines are at risk.
Reference:
https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia
