What Happens If Your B9 Is Low? Causes, Symptoms, and Treatment

According to research, folate insufficiency affects over 40% of women of reproductive age globally in regions without fortification programs. When your body's levels are inadequate, understanding what happens if your B9 is low is crucial, as it can lead to significant health problems affecting energy levels, mental health, and cellular function.

Quick Summary

Low vitamin B9 (folate) can trigger a range of health issues, including fatigue, megaloblastic anemia, and cognitive impairment. The deficiency can result from diet, malabsorption issues, or increased physiological demands like pregnancy, and is treatable with dietary changes and supplementation.

Key Points

• Megaloblastic Anemia: Low B9 is a common cause of megaloblastic anemia, where the body produces abnormally large, dysfunctional red blood cells, leading to fatigue and weakness.

• Pregnancy Complications: A critical consequence of low folate during early pregnancy is a higher risk of neural tube defects like spina bifida, along with preterm birth and low birth weight.

• Elevated Homocysteine: Folate deficiency raises homocysteine levels in the blood, which is a known risk factor for developing cardiovascular disease and stroke.

• Cognitive and Mood Changes: Insufficient folate can impair brain function, manifesting as difficulty concentrating, memory issues, irritability, and depression.

• Treatment with Supplements: Treatment for a deficiency almost always involves oral or injected folic acid supplements, along with dietary adjustments, but requires ruling out B12 deficiency first.

The Role of Vitamin B9 (Folate) in the Body

Vitamin B9, commonly known as folate in its natural form and folic acid in its synthetic form, is a water-soluble vitamin essential for numerous bodily functions. It acts as a coenzyme in one-carbon metabolism, playing a critical role in the synthesis and repair of DNA and RNA. This makes it especially important for periods of rapid cell division and growth, such as during pregnancy and infancy. Without sufficient B9, the body's ability to produce new, healthy red blood cells is impaired, which can lead to anemia and a host of other symptoms.

Immediate Signs and Symptoms of Low B9

A folate deficiency often develops gradually, and early symptoms may be subtle, but they worsen if the condition remains untreated. Many of these symptoms are related to the resulting megaloblastic anemia, where red blood cells become abnormally large and are unable to function properly.

Physical Symptoms

• Extreme Fatigue and Weakness: A hallmark symptom of anemia, this is caused by a reduced number of healthy red blood cells carrying oxygen to the body's tissues.
• Pale Skin: This pallor is another sign of anemia and reduced oxygen in the blood.
• Shortness of Breath and Palpitations: As the body struggles to get enough oxygen, the heart and lungs compensate, leading to a rapid or pounding heart rate and breathlessness.
• Oral Discomfort: A swollen, red, and painful tongue (glossitis) is a common sign, along with mouth ulcers.
• Diarrhea: Digestive issues are also frequently reported as a symptom of folate deficiency.

Cognitive and Psychological Symptoms

• Memory and Concentration Problems: Low folate levels can impact brain function, leading to difficulty concentrating, memory loss, and confusion.
• Irritability and Depression: Folate is involved in the synthesis of neurotransmitters, and its deficiency can lead to psychological problems ranging from mild depression to more severe mood changes.

Causes and Risk Factors for Low B9

A folate deficiency can arise from various factors, including inadequate dietary intake, malabsorption, increased physiological demand, and other underlying health conditions.

Common Causes of Folate Deficiency

• Dietary Insufficiency: Not consuming enough folate-rich foods like leafy greens, citrus fruits, and fortified grains is a primary cause. Overcooking vegetables can also destroy the heat-sensitive folate.
• Increased Physiological Needs: Pregnancy and breastfeeding significantly increase the body's demand for folate to support rapid cell division and fetal development.
• Alcoholism: Chronic, heavy alcohol consumption interferes with the absorption and metabolism of folate, making it a major risk factor.
• Malabsorption Disorders: Conditions such as celiac disease and Crohn's disease can impair the body's ability to absorb folate from the intestines.
• Medications: Certain drugs, including some used for seizures (phenytoin), rheumatoid arthritis (methotrexate), and ulcerative colitis (sulfasalazine), can interfere with folate utilization.
• Genetic Factors: Some individuals have a genetic mutation in the MTHFR gene, which impairs their body's ability to convert folate into its active form.

Serious Complications of Untreated Folate Deficiency

Left untreated, low B9 can lead to severe and potentially permanent health problems, impacting several major body systems.

Pregnancy and Infant Health

One of the most well-known complications of folate deficiency is the risk to a developing fetus. A lack of folate early in pregnancy can cause severe birth defects called neural tube defects (NTDs), such as spina bifida and anencephaly. It can also increase the risk of preterm birth and low birth weight. For this reason, folic acid supplementation is widely recommended for women of childbearing age.

Cardiovascular and Neurological Health

Folate deficiency contributes to elevated levels of homocysteine, an amino acid, in the blood. High homocysteine is associated with an increased risk of cardiovascular disease, including heart attack and stroke. While overt neurological issues are more common with B12 deficiency, untreated folate deficiency can lead to persistent neuropsychiatric symptoms like depression and cognitive decline.

Differentiating B9 and B12 Deficiencies

Because both B9 and B12 deficiencies can cause megaloblastic anemia, it is crucial to distinguish between them, as treating one can mask the symptoms of the other. Folic acid supplementation can resolve the anemia caused by a B12 deficiency without addressing the underlying B12 issue, allowing for irreversible nerve damage to occur.

Feature	Vitamin B9 Deficiency	Vitamin B12 Deficiency
Neurological Symptoms	Usually absent or mild (cognitive changes, depression)	Typically present, including numbness, pins and needles, and balance issues
Onset Speed	Can occur within weeks to months due to smaller body stores	Takes years to develop due to large liver stores of B12
Associated Substance	Elevated homocysteine levels, normal MMA	Elevated homocysteine and methylmalonic acid (MMA) levels
Risk Factors	Poor diet, alcoholism, pregnancy, malabsorption	Vegan diet, pernicious anemia, bariatric surgery

Treatment and Prevention of Low B9

Medical Treatment

For diagnosed folate deficiency, treatment typically involves oral folic acid supplements. In severe cases or with absorption issues, injections may be necessary. It is vital to test for a coexisting B12 deficiency before beginning treatment with high-dose folic acid to prevent neurological complications. A healthcare provider can determine the correct dosage and duration of treatment.

Dietary Interventions

Incorporating more folate-rich foods is key for preventing and helping to manage deficiency.

Foods Rich in Folate and Folic Acid:

• Leafy Greens: Spinach, kale, and romaine lettuce
• Legumes: Lentils, chickpeas, and black-eyed peas
• Citrus Fruits: Oranges and orange juice
• Fortified Grains: Many breads, cereals, and pastas are enriched with folic acid
• Other Sources: Beef liver, eggs, and nuts

Conclusion

Low vitamin B9 levels can have widespread and serious effects on the body, from the relatively common symptoms of anemia to major risks during pregnancy and potential long-term cardiovascular and cognitive issues. By understanding the causes, recognizing the symptoms, and knowing the proper course of treatment—often involving supplements and dietary changes—it is possible to correct a folate deficiency and mitigate its health consequences. Regular intake of folate-rich foods and addressing underlying health conditions are the best strategies for prevention and maintaining overall health.

Learn more about folate and folic acid from the Harvard T.H. Chan School of Public Health: Folate (Folic Acid) - Vitamin B9 - The Nutrition Source

Frequently Asked Questions

How quickly can a B9 deficiency develop?

Because the body only stores a small amount of folate, a deficiency can develop within a few months of insufficient intake, much faster than a vitamin B12 deficiency.

Can diet alone fix low B9 levels?

While increasing folate-rich foods is important, significant deficiencies often require folic acid supplementation as prescribed by a healthcare provider for a period of several months to fully restore levels.

Is there a difference between folate and folic acid?

Yes, folate is the natural form found in food, while folic acid is the synthetic form added to supplements and fortified foods. The body absorbs folic acid more easily.

What is the biggest risk of B9 deficiency during pregnancy?

The most significant risk is the development of neural tube defects in the baby, such as spina bifida. This is why supplementation is recommended for women of childbearing age.

How do you know if you have a B9 deficiency versus a B12 deficiency?

Diagnosis requires blood tests. While both cause anemia, a key difference is that B12 deficiency typically presents with neurological symptoms (numbness, pins and needles), which are generally absent in isolated folate deficiency.

Can too much B9 be harmful?

Taking excessive amounts of folic acid from supplements can mask the symptoms of an underlying B12 deficiency, potentially leading to irreversible neurological damage if not caught and treated.

Are certain people more at risk for low B9?

Yes, individuals with alcoholism, pregnant or breastfeeding women, people with malabsorption disorders like celiac disease, and those on certain medications are at a higher risk.