Exploring the Serious Health Risks: What Happens if Folate Deficiency Anemia is Left Untreated?

October 8, 2025 •

4 min read

Studies have shown that untreated folate deficiency can lead to a host of severe health issues, including megaloblastic anemia and increased cardiovascular risk. So, what happens if folate deficiency anemia is left untreated? The potential consequences are extensive and range from permanent neurological damage to critical pregnancy complications.

Quick Summary

Left untreated, folate deficiency anemia can cause progressive, serious complications affecting multiple bodily systems, including heart conditions, cognitive decline, infertility, and birth defects.

Key Points

Permanent Neurological Damage: Untreated folate deficiency can cause progressive and sometimes permanent nerve damage, leading to cognitive decline, depression, and tingling sensations.
Serious Pregnancy Complications: A lack of folate during pregnancy dramatically increases the risk of severe birth defects, particularly neural tube defects like spina bifida and anencephaly.
Increased Heart Disease Risk: Low folate leads to high homocysteine levels, a major risk factor for cardiovascular disease and, in severe cases, can contribute to heart failure.
Risk of Underlying B12 Masking: Treating with folic acid before checking B12 levels can hide a B12 deficiency, allowing severe neurological damage to progress undetected.
Effective and Simple Treatment: Folate deficiency anemia is usually easily treated with folic acid supplements and dietary changes, provided it is diagnosed and addressed in a timely manner.

The Critical Role of Folate

Folate, or vitamin B9, is an essential water-soluble vitamin required for proper bodily function. It plays a crucial role in the synthesis of DNA and RNA, processes vital for cell division and growth. Without sufficient folate, the body cannot produce enough healthy red blood cells, leading to a condition known as folate deficiency anemia. While the initial symptoms might seem mild, the repercussions of leaving this condition untreated can be severe and far-reaching.

The Unfolding Risks of Untreated Folate Deficiency Anemia

Progressive Neurological Damage

One of the most alarming consequences of untreated folate deficiency is its impact on the nervous system. Folate is vital for maintaining proper neurological function at all ages. When levels are critically low, it can lead to a variety of neuropsychiatric symptoms, some of which may become permanent even with treatment.

Cognitive decline: This can manifest as memory loss, confusion, and problems with judgment and concentration.
Depression and psychological issues: Folate deficiency has been consistently linked to mood disorders and psychological problems.
Peripheral neuropathy: Patients may experience a sensation of pins and needles, numbness, or tingling in their hands and feet.
Other neurological symptoms: In severe cases, muscle weakness and vision problems can occur.

Severe Pregnancy and Fetal Complications

Adequate folate is non-negotiable for a healthy pregnancy, especially during the earliest stages of fetal development. If a pregnant person has an untreated deficiency, the risks for both the mother and baby are substantial and potentially life-threatening.

Neural Tube Defects (NTDs): Folate deficiency is a well-established cause of severe birth defects like spina bifida and anencephaly, which affect the brain and spinal cord. Widespread folic acid fortification has been implemented to combat this risk.
Placental abruption: This serious condition involves the premature separation of the placenta from the uterine wall.
Preterm birth and low birth weight: The deficiency can lead to premature delivery or result in a baby with a low birth weight.
Increased risk of autism: Some studies have suggested a potential link between low folate during pregnancy and the development of autism in children.

Escalating Cardiovascular Health Issues

Folate plays a direct role in breaking down homocysteine, an amino acid found in the blood. Without enough folate, homocysteine levels rise, a condition known as hyperhomocysteinemia, which poses a significant risk to heart health.

Risk of heart disease: High homocysteine levels have been identified as an independent risk factor for atherosclerotic cardiovascular disease.
Heart failure: Severe anemia of any kind, including folate deficiency anemia, forces the heart to work harder to pump oxygen to the body's tissues. This extra strain can lead to an abnormally fast heart rate (tachycardia) and eventually congestive heart failure.

Other Systemic Ramifications

Beyond the cardiovascular and neurological systems, a persistent folate deficiency can disrupt many other vital functions and increase the risk of other health issues.

Cancer risk: Research indicates that long-term folate deficiency may increase the risk of certain cancers, such as colon cancer.
Temporary infertility: A deficiency can temporarily impair fertility in both men and women, though this condition is often reversible with treatment.
Gastrointestinal distress: Symptoms can include diarrhea, loss of appetite, and a sore, red tongue (glossitis).
Other physical symptoms: Patients may experience extreme fatigue, weakness, dizziness, and paleness.

Untreated Folate Deficiency vs. Healthy Folate Status


Characteristic	Untreated Folate Deficiency Anemia	Healthy Folate Status
Red Blood Cells	Abnormally large (megaloblastic), improperly formed, and fewer in number.	Properly sized and shaped, allowing for efficient oxygen transport.
Homocysteine Levels	Elevated, increasing the risk of cardiovascular disease.	Kept in check, supporting healthy cardiovascular function.
Neurological Health	At risk for memory loss, confusion, depression, and permanent nerve damage.	Supports optimal cognitive function, mood, and nervous system health.
Pregnancy Outcomes	Significantly higher risk of neural tube defects, preterm birth, and low birth weight.	Crucial for normal fetal development, reducing the risk of birth defects.
General Symptoms	Chronic fatigue, weakness, mouth sores, and paleness.	Adequate energy levels, mental clarity, and overall well-being.

The Urgency of Proper Diagnosis and Treatment

Given the serious nature of these potential complications, accurate diagnosis and prompt treatment are essential. Folate deficiency is often managed with daily folic acid supplements, with the duration of treatment dependent on the underlying cause. In many cases, improving one's diet with folate-rich foods is also part of the recovery and prevention strategy.

However, a critical step before beginning folate therapy is to rule out a concurrent vitamin B12 deficiency. This is because folic acid can sometimes mask the megaloblastic anemia caused by a B12 deficiency, while allowing the associated neurological damage to continue unchecked and worsen. A healthcare provider will typically perform blood tests to check both folate and vitamin B12 levels simultaneously.

Rich Sources of Folate

For prevention and recovery, incorporating folate-rich foods into your diet is highly beneficial. Here are some excellent sources:

Green leafy vegetables like spinach, broccoli, and asparagus
Legumes such as lentils, chickpeas, and peas
Citrus fruits and juices
Fortified foods, including many cereals, bread, and pasta
Beef liver
Nuts, such as peanuts and walnuts

Conclusion: Don't Ignore the Symptoms

The message is clear: leaving folate deficiency anemia untreated is a gamble with potentially devastating consequences. What begins as general fatigue and weakness can spiral into serious, and sometimes irreversible, damage to the nervous and cardiovascular systems. For pregnant individuals, the stakes are even higher, with the risk of severe congenital disabilities in their unborn child. Fortunately, diagnosis is straightforward through a simple blood test, and treatment with oral supplements and dietary adjustments is typically highly effective. Never ignore the signs of a potential vitamin deficiency and consult a healthcare professional for proper evaluation and care.

For more in-depth information, you can consult authoritative health sources like the National Institutes of Health.

Frequently Asked Questions

Folate deficiency anemia is a condition where a lack of vitamin B9 (folate) leads to a reduced number of healthy red blood cells. The red blood cells that are produced are often abnormally large and cannot function properly, leading to symptoms of anemia.

Early symptoms can be general and easily overlooked, but typically include fatigue, weakness, headaches, a sore mouth and tongue, and changes in skin or hair color.

Folate is essential for the health of the nervous system. A deficiency can lead to various neurological symptoms, including memory loss, depression, confusion, and pins and needles in the hands and feet.

While many symptoms, such as anemia, are reversible with treatment, some complications, particularly neurological damage from a long-term deficiency, can become permanent.

Folate is vital during pregnancy because it is essential for the development of the fetus's spinal cord and brain. A deficiency during this period can lead to serious birth defects known as neural tube defects, including spina bifida.

Yes, oral folic acid supplements are the main treatment for folate deficiency. However, it is crucial to consult a doctor to ensure there is no co-existing vitamin B12 deficiency before beginning treatment.

Folate is necessary to metabolize homocysteine into other substances. When folate is deficient, homocysteine levels rise, which is a known risk factor for cardiovascular disease.