What Depletes Folate Levels? Causes, Symptoms, and Prevention

October 11, 2025 •

3 min read

According to the NIH, folate is a water-soluble B-vitamin that is not stored in large amounts in the body, meaning a deficient intake or other factors can quickly deplete folate levels. This article explores the various dietary, medical, and lifestyle causes behind this essential nutrient's depletion.

Quick Summary

Explore the various causes of low folate levels, including dietary choices, excessive alcohol consumption, certain medications, and underlying medical conditions. Learn to identify the risk factors and how to maintain adequate vitamin B9 intake.

Key Points

Poor Diet: Inadequate consumption of folate-rich foods like leafy greens and legumes is a common cause of depletion.
Alcohol Use: Excessive alcohol interferes with folate absorption, storage, and metabolism, making it a major risk factor for deficiency.
Medication Interference: Certain drugs, including methotrexate and some anticonvulsants, can actively block or inhibit folate utilization in the body.
Malabsorption Conditions: Gastrointestinal diseases such as celiac and Crohn's disease disrupt the body's ability to properly absorb folate from food.
Increased Demand: Pregnancy and conditions involving rapid cell turnover, like hemolytic anemia, significantly increase the body's need for folate.
Heat Sensitivity: Overcooking or boiling vegetables can destroy a large percentage of their natural folate content.

The Causes of Folate Depletion

Folate, also known as vitamin B9, is a crucial nutrient for cell growth and metabolism. Since the body does not store large reserves of this water-soluble vitamin, various factors can lead to its depletion over time. Understanding these causes is the first step toward prevention.

Dietary Insufficiency

Perhaps the most straightforward cause of folate depletion is not consuming enough foods rich in this vitamin. The body's folate stores can drop significantly in just a few weeks without adequate intake. Certain habits can further worsen this issue:

Poor diet: A diet lacking in fresh fruits, dark leafy green vegetables, and fortified grains is a primary cause of low folate. This is particularly common among the elderly, those with low socioeconomic status, and individuals with alcohol use disorder.
Overcooking: Folate is sensitive to heat and can be destroyed by prolonged cooking methods, especially when vegetables are boiled. As much as 50-90% of food folate may be lost during cooking, processing, and storage.

Factors Inhibiting Absorption and Metabolism

Even with a proper diet, certain conditions and substances can prevent the body from effectively absorbing or utilizing folate.

Excessive alcohol consumption: Chronic alcohol use is a major contributor to deficiency. It interferes with folate absorption, inhibits its proper metabolism, and increases its excretion via urine.
Gastrointestinal diseases: Conditions that cause malabsorption in the digestive tract can significantly impair folate uptake. This includes celiac disease, Crohn's disease, and tropical sprue. Surgery that removes or bypasses parts of the intestines can also have this effect.
Genetic factors: Some individuals carry a genetic mutation in the methylenetetrahydrofolate reductase (MTHFR) gene, which hinders their body's ability to convert folate into its active, usable form (5-MTHF).

Medications and Other Substances

A number of drugs can interfere with folate levels, affecting absorption, metabolism, or both. Patients on these medications should consult a doctor about supplementation.

Folate antagonists: Drugs like methotrexate, used for cancer and autoimmune diseases, deliberately block folate's action.
Anticonvulsants: Certain anti-seizure medications, such as phenytoin (Dilantin), phenobarbital, and primidone, can interfere with folate absorption and metabolism.
Antibiotics: Drugs like trimethoprim-sulfamethoxazole can reduce folate levels.
Other medications: Oral contraceptives, sulfasalazine (for inflammatory bowel disease), and some antacids may also impact folate levels.

Increased Physiological Demand

In some cases, the body's need for folate simply outpaces its intake, even in healthy individuals. Conditions that trigger rapid cell division and growth increase the demand for folate.

Pregnancy and lactation: The rapid growth of fetal and placental tissues significantly increases the body's need for folate, making pregnant women a high-risk group.
Hemolytic anemia: This blood disorder, which involves the rapid destruction of red blood cells, puts the body in a constant state of red blood cell production, increasing folate requirements.
Dialysis: Patients with kidney failure undergoing dialysis frequently lose folate during the treatment process.

Comparison of Folate Depletion Causes


Category	Examples	Primary Mechanism	Prevention/Management
Dietary	Lack of greens, overcooking	Inadequate intake, nutrient destruction	Balanced diet, steaming vegetables
Lifestyle	Excessive alcohol use	Inhibited absorption, increased excretion	Reduced alcohol intake
Medical Conditions	Celiac disease, Crohn's	Malabsorption due to intestinal issues	Managed with treatment of underlying condition
Genetic	MTHFR mutation	Impaired metabolism of folate to active form	Supplements with active folate (5-MTHF)
Medications	Methotrexate, anticonvulsants	Blocking folate's action or absorption	Doctor-monitored supplementation
Increased Need	Pregnancy, hemolytic anemia	Rapid cell division requires more folate	Increased dietary intake and supplementation

Conclusion: Maintaining Healthy Folate Levels

Folate is a vital nutrient, and its depletion can lead to serious health consequences, including a specific type of anemia and, if deficient during pregnancy, birth defects. The causes of low folate are varied, ranging from simple dietary habits to complex medical conditions and genetic factors. For most people, consuming a diet rich in folate-containing foods, such as leafy greens, legumes, and fortified grains, is sufficient. However, those with specific risk factors, including certain medical conditions, chronic alcohol use, or medication use, need to be particularly vigilant. Always consult with a healthcare provider if you suspect a folate deficiency, especially if you are pregnant or taking medications that may interfere with folate metabolism. Regular monitoring and appropriate supplementation can effectively prevent and manage folate depletion. More information on symptoms and prevention can be found at reputable sources like Healthline.

Frequently Asked Questions

The primary dietary cause is insufficient intake of foods naturally rich in folate, such as leafy greens, legumes, and citrus fruits. Overcooking these foods can also destroy a significant amount of the vitamin.

Excessive alcohol consumption significantly depletes folate levels by interfering with its absorption in the gut, hindering its metabolism in the liver, and increasing its excretion through the kidneys.

Yes, a number of medications can. These include folate antagonists like methotrexate, some anti-seizure drugs (e.g., phenytoin), and certain antibiotics (e.g., trimethoprim).

Some individuals have a genetic mutation in the MTHFR gene, which impairs the conversion of folate to its active, usable form. This can lead to low levels of active folate in the body.

Pregnancy dramatically increases the demand for folate due to the rapid growth of the fetus and placental tissues. Inadequate folate during this period increases the risk of neural tube defects in the baby.

Yes, malabsorption conditions like celiac disease, tropical sprue, and inflammatory bowel diseases impair the intestine's ability to absorb nutrients, including folate, from food.

You can prevent dietary folate depletion by eating a balanced diet rich in leafy greens, legumes, fortified grains, and citrus fruits. Minimize nutrient loss by cooking foods with lower heat methods like steaming rather than boiling.