How to Fix Folate Levels: Your Guide to Diet, Supplements, and Health

Did you know that in many low-income countries, the prevalence of folate deficiency among women of reproductive age exceeds 20%? Fixing folate levels is crucial for preventing anemia, supporting neurological function, and promoting overall well-being, whether through dietary changes, supplements, or lifestyle adjustments.

Quick Summary

Correcting low folate levels involves increasing your intake of natural folate and fortified foods, along with using folic acid supplements as advised by a doctor, while addressing underlying medical issues.

Key Points

• Dietary Intake is Key: Increase your consumption of folate-rich foods like leafy greens, legumes, and fortified grains to help restore your levels naturally.

• Consider Supplements: For diagnosed deficiencies, a doctor may prescribe folic acid tablets, often for a period of several months.

• Check B12 Levels First: Always have your vitamin B12 levels tested before starting folic acid supplements, as high folate intake can mask a B12 deficiency and worsen neurological symptoms.

• Address Underlying Causes: Conditions like celiac disease, malabsorption disorders, or excessive alcohol use must be treated to fully correct a folate deficiency.

• Understand Your Folate: Know the difference between natural folate, synthetic folic acid, and the active form, methylfolate, especially if you have an MTHFR gene mutation.

• Consult a Professional: Work with a healthcare provider for a proper diagnosis and to create a safe and effective treatment and monitoring plan.

The Importance of Folate

Folate, or vitamin B9, is a water-soluble vitamin essential for numerous bodily functions. It plays a critical role in DNA synthesis, repair, and methylation, and is vital for producing red blood cells. A deficiency can impact rapidly dividing cells, potentially leading to significant health complications, including a specific type of anemia known as megaloblastic anemia. The body does not store large amounts of folate, so consistent daily intake is necessary to prevent a drop in levels. The good news is that for most people, low folate levels can be effectively corrected and managed.

Understanding the Causes of Low Folate

Identifying the root cause of your folate deficiency is the first step toward a lasting solution. While poor diet is a common factor, several other issues can interfere with your body’s ability to absorb or utilize this crucial nutrient.

Common causes include:

• Inadequate Dietary Intake: Not eating enough folate-rich foods is a primary cause. Folate is easily destroyed by heat, so overcooking fruits and vegetables can significantly reduce their content.
• Medical Conditions: Certain digestive system diseases, such as celiac disease and inflammatory bowel disease, can hinder folate absorption in the small intestine. Some forms of cancer and chronic kidney problems requiring dialysis also increase risk.
• Increased Bodily Demands: During periods of rapid cell division, such as pregnancy, lactation, and infancy, the body's need for folate increases dramatically. Conditions like chronic hemolytic anemia also increase folate requirements.
• Certain Medications: Some drugs, including anti-seizure medications (like phenytoin) and those used for ulcerative colitis and psoriasis (like sulfasalazine and methotrexate), can interfere with folate absorption and metabolism.
• Excessive Alcohol Use: Chronic, heavy alcohol consumption impairs the absorption and metabolism of folate.
• MTHFR Gene Mutation: A genetic variant in the MTHFR gene can affect some individuals' ability to convert folate into its active, usable form, 5-MTHF.

Dietary Strategies to Restore Folate

Incorporating more folate-rich foods into your daily diet is a cornerstone of correcting low levels. Focusing on a balanced and diverse nutritional plan is key.

Prioritize Folate-Rich Foods

Dietary sources of folate are abundant and include a variety of plant and animal products. To maximize intake, opt for low-heat cooking methods like steaming to preserve the nutrient content.

• Leafy Green Vegetables: Spinach, kale, romaine lettuce, broccoli, and asparagus are excellent sources.
• Legumes: Lentils, chickpeas, black-eyed peas, and kidney beans are packed with folate.
• Fruits: Oranges, bananas, and citrus juices provide a healthy dose.
• Fortified Grains: Many breakfast cereals, bread, and pasta are enriched with the synthetic form of folate, folic acid, to combat deficiency.
• Other Sources: Beef liver, eggs, peanuts, and sunflower seeds also contain significant amounts of folate.

Folate Versus Folic Acid: A Key Distinction

When addressing a deficiency, it's important to understand the different forms of Vitamin B9. Folate, folic acid, and methylfolate are all related but processed differently by the body.

Feature	Folate	Folic Acid	Methylfolate (5-MTHF)
Source	Found naturally in foods like leafy greens, legumes, and citrus fruits.	A synthetic (man-made) form used in supplements and fortified foods.	The active, bioavailable form of folate.
Absorption	Can be less easily absorbed by the body, with some lost during cooking.	Absorbed more easily by the body than natural folate.	The most bioavailable form, as it doesn't require further conversion by the body.
Processing	Converted in the small intestine into its active form.	Must be metabolized by the liver, which can be inefficient for some individuals.	Ready for immediate use by the body's cells.
Key Consideration	Ideal for baseline nutritional intake through diet.	Effective for preventing deficiency but can mask a vitamin B12 deficiency at high doses.	Often recommended for individuals with the MTHFR gene variant.

Supplementing Your Folate Intake

For many, especially those with diagnosed deficiency, supplements are necessary to restore folate levels quickly and efficiently. Oral folic acid tablets are a common treatment, with dosages prescribed by a healthcare provider.

Important considerations for supplementation:

• Duration: Treatment with folic acid tablets may last several months. However, if the underlying cause is chronic, lifelong supplementation might be necessary.
• Check Vitamin B12 Levels: Before beginning folic acid supplements, a doctor should always check vitamin B12 levels. Taking folic acid can correct the anemia symptoms of a B12 deficiency without addressing the underlying B12 problem, which can lead to irreversible neurological damage.
• MTHFR Variant: If you have the MTHFR gene mutation, your body may not efficiently convert standard folic acid. In this case, your doctor may recommend a supplement with methylfolate (5-MTHF).

Monitoring and Medical Advice

Working with a healthcare provider is essential for diagnosing and managing low folate levels. A simple blood test can confirm a deficiency and help rule out other conditions, such as vitamin B12 deficiency. Your doctor can then recommend the appropriate treatment, whether it's dietary changes, supplements, or addressing an underlying illness. Follow-up blood tests will likely be scheduled to ensure your folate levels have returned to a healthy range.

Conclusion

Correcting low folate levels is an achievable and vital step toward improving your overall health. The process involves a combination of smart dietary choices, with a focus on nutrient-rich leafy greens, legumes, and fortified foods, alongside medically supervised supplementation if needed. By understanding the causes of deficiency and distinguishing between folate, folic acid, and methylfolate, you can take informed steps to restore your levels effectively and safely. Always consult a healthcare professional for a proper diagnosis and personalized treatment plan to ensure your approach is both safe and effective. A balanced approach to nutrition, supported by medical guidance, is the most reliable way to maintain adequate folate status for the long term.

Learn more about folate and folic acid from the NIH Office of Dietary Supplements at https://ods.od.nih.gov/factsheets/Folate-Consumer/.

Frequently Asked Questions

What foods are the best source of folate?

Excellent sources of folate include leafy greens (spinach, kale), legumes (lentils, chickpeas), fortified cereals, asparagus, broccoli, and citrus fruits like oranges.

How long does it take to fix low folate levels?

With proper supplementation, blood folate levels can begin to normalize within weeks, and anemia can resolve within four to eight weeks. The duration of treatment depends on the underlying cause.

What is the difference between folate and folic acid?

Folate is the naturally occurring form of vitamin B9 found in food. Folic acid is the synthetic, man-made version used in supplements and to fortify foods, and it is more easily absorbed by the body.

Should I take methylfolate instead of folic acid?

For individuals with an MTHFR gene mutation that impairs folate conversion, supplements containing methylfolate (5-MTHF), the active form, may be more effective. A healthcare provider can recommend the best option.

Can cooking destroy the folate in my food?

Yes, folate is sensitive to heat and water. Overcooking vegetables can destroy a significant amount of the natural folate content, so it's better to steam or lightly cook them.

What are the common symptoms of folate deficiency?

Common symptoms include extreme fatigue, pale skin, weakness, irritability, mouth sores, a sore and red tongue, and digestive problems like diarrhea.

How can I prevent a folate deficiency from recurring?

Maintaining a balanced diet rich in folate-containing and fortified foods is the best prevention. For some, especially those with malabsorption issues, ongoing supplementation might be necessary as directed by a doctor.