How do you treat low folic acid levels?

January 6, 2026 •

4 min read

The human body stores only a small amount of folate, making a dietary deficiency possible within just a few months if intake is insufficient. This article explains how do you treat low folic acid levels through targeted interventions, including supplementation, diet, and addressing the underlying medical causes.

Quick Summary

Treatment for low folate involves prescribing oral folic acid supplements to restore levels, often in conjunction with dietary counseling to increase folate-rich foods. Underlying medical conditions causing malabsorption must also be addressed for full recovery. Vitamin B12 levels are checked prior to starting treatment to avoid masking a deficiency.

Key Points

Supplements are the primary treatment: Prescribed oral folic acid supplements are the fastest way to raise low folate levels.
Dietary changes are crucial: Incorporating a diet rich in natural folate from leafy greens, legumes, and fortified cereals is essential for maintenance.
Check Vitamin B12 first: It is vital to rule out a concurrent B12 deficiency before starting folic acid treatment to prevent neurological complications.
Address underlying causes: Treat conditions like celiac disease, chronic alcohol use, or medication interactions that may be causing the deficiency.
Monitor progress: Blood tests are used to track folate levels and confirm recovery, with most individuals seeing improvement within a few months.
Pregnancy requires special attention: Women who are pregnant or planning to become pregnant need specific doses of folic acid to prevent birth defects.
Consider genetic factors: Individuals with MTHFR gene variations may need the active form of folate (5-methyl-THF) for proper absorption.

What is Low Folic Acid?

Folic acid, or folate in its natural form, is vitamin B9, a critical nutrient for DNA synthesis, red blood cell formation, and overall cellular metabolism. A deficiency, also known as folate deficiency, can lead to megaloblastic anemia, which causes the body to produce abnormally large and dysfunctional red blood cells. Symptoms may include fatigue, weakness, pale skin, shortness of breath, and a sore or red tongue. Diagnosis is confirmed through a simple blood test measuring serum folate levels.

The Primary Treatment: Oral Folic Acid Supplements

For most adults with a diagnosed deficiency, oral folic acid supplementation is the cornerstone of treatment. The dosage and duration depend on the severity of the deficiency and its cause. A typical prescription involves a daily dose of 1 to 5 mg for approximately four months, or until blood test results confirm that folate levels have returned to a healthy range. It is critical that a healthcare provider checks for a concurrent vitamin B12 deficiency before initiating folic acid therapy, as treating folate deficiency alone can mask a B12 deficiency and allow related neurological damage to progress.

The Importance of Dietary Adjustments

While supplements are crucial for rapid repletion, long-term maintenance of healthy folate levels requires dietary changes. A diet rich in natural folate sources is key for prevention and continued health. Folate is a water-soluble vitamin, so cooking methods should be considered to minimize nutrient loss; steaming or microwaving vegetables is preferable to boiling.

Foods High in Folate

Dark Green Leafy Vegetables: Spinach, kale, romaine lettuce, broccoli, and turnip greens.
Legumes: Lentils, black-eyed peas, chickpeas, and various beans.
Citrus Fruits: Oranges, grapefruit, and their juices.
Fortified Grains: Many countries, including the U.S. and Canada, mandate folic acid fortification in grain products like bread, pasta, and cereals.
Animal Products: Beef liver, eggs, and poultry.
Other Vegetables: Asparagus, Brussels sprouts, and avocado.

Addressing Underlying Causes

In some cases, a poor diet is not the sole cause of low folic acid. Treatment must also address the root problem to ensure long-term success. This may involve:

Malabsorption Issues: Conditions such as celiac disease or Crohn's disease can impair the body's ability to absorb folate from food. Treating the underlying gastrointestinal disease is necessary. In severe malabsorption cases, higher-dose or parenteral (injections) folic acid may be required.
Excessive Alcohol Use: Chronic alcohol consumption interferes with folate absorption and metabolism. Reducing alcohol intake is a vital step in treatment.
Certain Medications: Some drugs, including certain anti-seizure medications and methotrexate (used for rheumatoid arthritis), can inhibit folate absorption or metabolism. A doctor may need to adjust medication or prescribe a supplement specifically to counteract this effect.
Increased Demand: Pregnancy and lactation, chronic hemolytic anemia, or other conditions with rapid cell turnover increase the body’s need for folate. Prophylactic supplementation is often recommended in these situations.

Comparison of Folate vs. Folic Acid


Feature	Folate (Natural)	Folic Acid (Synthetic)
Source	Found naturally in foods like leafy greens, citrus, and legumes.	Added to supplements and fortified foods like cereals and pasta.
Absorption	Can be less stable and easily destroyed by cooking.	More easily absorbed and bioavailable to the body.
Usage	Best for maintaining healthy levels through diet.	The primary treatment for correcting a diagnosed deficiency.
Standardization	Content can vary based on food preparation.	Consistent and reliable dosage in supplements and fortified products.

Special Considerations for High-Risk Groups

Pregnancy: All women of childbearing age are advised to take a daily folic acid supplement to prevent neural tube defects. A higher dose of 5 mg daily may be recommended for women with a history of neural tube defects or other risk factors.
Genetic Factors: Individuals with MTHFR polymorphism have a genetic variation that affects their ability to convert folic acid to its active form. They may benefit from a supplement containing the active form, 5-methyl-THF.

Conclusion: A Multi-Pronged Approach to Recovery

Treating low folic acid levels is a straightforward process that typically involves both supplementation and dietary modifications. While daily oral folic acid supplements are the most effective way to restore levels quickly, a long-term strategy must include a diet rich in folate-containing foods and addressing any underlying medical issues. Early diagnosis and proper management lead to an excellent prognosis, with symptoms often improving within weeks. Always consult a healthcare professional to confirm diagnosis and determine the appropriate treatment plan for your specific situation. For more information on the critical role of folic acid in health, see this resource from the National Institutes of Health: Folate - Health Professional Fact Sheet.

How Do You Treat Low Folic Acid Levels?

Frequently Asked Questions

With appropriate supplementation, initial improvements in blood markers can be seen within a few weeks, with full resolution of the deficiency typically occurring within 2 to 4 months.

Foods highest in folate include dark leafy greens like spinach and kale, legumes such as lentils and chickpeas, and fortified grain products. Beef liver is also a very rich source.

For mild deficiencies, dietary changes may be sufficient, but for a diagnosed deficiency, supplements are almost always required to restore levels effectively. For high-risk groups like pregnant women, supplementation is necessary regardless of diet.

Yes, folate is the naturally occurring form of vitamin B9 found in foods, while folic acid is the synthetic form used in supplements and fortified products. Folic acid is generally better absorbed by the body.

Folic acid treatment can correct the anemia caused by a vitamin B12 deficiency, but it will not address the underlying B12 problem. This can mask the true deficiency and allow neurological damage to worsen.

Untreated low folic acid can lead to megaloblastic anemia, severe fatigue, and other symptoms. During pregnancy, it significantly increases the risk of neural tube birth defects like spina bifida.

Folic acid is generally safe when taken in recommended doses. However, very high doses may cause side effects like upset stomach or irritability. It is important to follow a doctor's prescribed dosage.