What Symptoms Do You Have if Your Folic Acid is Low?

According to the CDC, mandatory fortification of grain products has significantly reduced folic acid deficiency in countries like the United States. However, deficiency remains a concern for many people, especially those with certain health conditions, diets, or lifestyles. Recognizing the symptoms is the first step toward correcting this issue and improving your overall health.

Quick Summary

Low folic acid, or folate deficiency, can cause a variety of symptoms ranging from fatigue and weakness to oral sores and cognitive issues. A deficiency can lead to megaloblastic anemia, where red blood cells become abnormally large and are less effective at carrying oxygen. Symptoms often develop gradually, making them easy to overlook.

Key Points

• Fatigue and Weakness: Persistent tiredness that does not improve with rest is a primary symptom of low folic acid due to insufficient red blood cell production.

• Oral Symptoms: A smooth, tender, red tongue (glossitis), along with mouth ulcers and a reduced sense of taste, are specific indicators of deficiency.

• Cognitive and Mood Changes: Low folate can impair brain function, leading to symptoms like poor memory, difficulty concentrating, irritability, and depression.

• Megaloblastic Anemia: A severe deficiency can cause anemia, where red blood cells are abnormally large and less efficient at carrying oxygen, exacerbating symptoms like paleness and shortness of breath.

• Causes of Deficiency: Risk factors include a poor diet, heavy alcohol consumption, certain medications, malabsorption issues, and increased needs during pregnancy.

• Pregnancy Complications: Low folate during pregnancy significantly increases the risk of birth defects, particularly neural tube defects like spina bifida.

• Distinguishing from B12: Folic acid and B12 deficiencies can present similarly, but B12 is more often associated with permanent nerve damage. Proper diagnosis requires testing both levels.

Understanding Folic Acid and Its Importance

Folic acid, the synthetic form of Vitamin B9, and folate, its naturally occurring counterpart, are essential B vitamins vital for numerous bodily functions. They play a crucial role in DNA synthesis, cell growth, and the production of red blood cells. A deficiency arises when your body doesn't receive or absorb enough of this vital nutrient, leading to potential health complications. Because the body doesn't store folate for long periods, regular intake through diet or supplements is necessary. The resulting symptoms, particularly those associated with folate deficiency anemia, can severely impact one's quality of life.

Common Symptoms of Low Folic Acid

The symptoms of low folic acid often develop gradually and can be subtle initially. While many of the signs overlap with other conditions, especially vitamin B12 deficiency, a pattern of these symptoms warrants further investigation. The most common symptoms are typically linked to the development of megaloblastic anemia, a condition where red blood cells are abnormally large and inefficient.

Physical Symptoms Associated with Anemia

• Persistent fatigue and weakness: Feeling unusually tired and lacking energy is often the first and most noticeable sign. This happens because there aren't enough healthy red blood cells to carry oxygen throughout the body.
• Pale skin (pallor): A lack of oxygen-rich blood can cause the skin to appear paler than usual, which may be more visible in nail beds and inner eyelids.
• Shortness of breath: Even mild physical exertion can lead to feeling winded or out of breath due to the reduced oxygen-carrying capacity of the blood.
• Dizziness or lightheadedness: Inadequate oxygen supply to the brain can cause feelings of faintness.
• Heart palpitations: The heart may beat faster or irregularly to compensate for the lack of oxygen, leading to palpitations or a pounding sensation.

Oral Symptoms

• Sore and red tongue (glossitis): This is a specific and common symptom, where the tongue may feel smooth, tender, and look inflamed.
• Mouth ulcers or sores: Painful sores can develop inside the mouth and on the tongue.
• Reduced sense of taste: Some individuals report a diminished or altered sense of taste.

Neurological and Cognitive Symptoms

• Memory problems and difficulty concentrating: Folate is essential for brain function. A deficiency can impair cognitive abilities, leading to forgetfulness and a lack of focus.
• Irritability and mood changes: Psychological symptoms, such as irritability, anxiety, and depression, are common.
• Pins and needles (paresthesia): While more characteristic of vitamin B12 deficiency, some people with folate deficiency can experience a tingling sensation in the hands, feet, or limbs.
• Confusion and impaired judgment: In severe cases, particularly in older adults, cognitive function can decline, causing confusion and problems with judgment.

Factors That Increase Your Risk

Several factors can contribute to developing a folic acid deficiency. Awareness of these risk factors is key to prevention.

• Poor diet: Inadequate intake of folate-rich foods is a primary cause. Folate is found in leafy green vegetables, citrus fruits, legumes, and fortified grains. Excessive cooking can also destroy the vitamin.
• Alcohol abuse: Chronic, heavy alcohol consumption interferes with folate absorption and metabolism.
• Certain medications: Some drugs, including certain anticonvulsants and medications for ulcerative colitis and rheumatoid arthritis, can interfere with folate absorption.
• Increased physiological demand: Pregnancy, lactation, and certain medical conditions like hemolytic anemia significantly increase the body's need for folate.
• Malabsorption disorders: Conditions affecting the digestive tract, such as Crohn's disease and celiac disease, can prevent proper absorption.

Folic Acid vs. Vitamin B12 Deficiency: A Comparison

Feature	Folic Acid Deficiency	Vitamin B12 Deficiency
Primary Cause	Often due to poor diet, malabsorption, or increased demand.	Often due to malabsorption (e.g., pernicious anemia) or vegan diet.
Common Symptoms	Fatigue, oral sores, digestive issues, mood changes.	Fatigue, memory issues, numbness/tingling, coordination problems.
Neurological Symptoms	Mood changes and cognitive issues are common, but severe neurological damage is less typical and usually reversible.	Can cause permanent nerve damage if untreated, leading to numbness, tingling, and balance problems.
Anemia Type	Megaloblastic anemia (large, immature red blood cells).	Megaloblastic anemia (large, immature red blood cells).
Diagnostic Indicator	Elevated homocysteine with normal methylmalonic acid (MMA).	Elevated homocysteine and elevated MMA.
Treatment Caution	Taking folic acid alone can mask a B12 deficiency and allow neurological damage to progress.	Needs to be treated with B12 before or simultaneously with folic acid if both are low.

Conclusion

A low folic acid level, or folate deficiency, can manifest through a wide array of symptoms, from extreme fatigue and oral sores to cognitive and mood disturbances. Because these signs are often non-specific and can overlap with other conditions like B12 deficiency, it is crucial to consult a healthcare provider for a proper diagnosis. Through a blood test, a doctor can confirm a deficiency and determine the appropriate course of action, which typically involves dietary changes, supplementation, or addressing an underlying medical condition. For women of childbearing age, ensuring sufficient folic acid intake is especially critical to prevent neural tube defects in offspring. Taking proactive steps to address a potential deficiency is vital for maintaining long-term health and well-being. Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment.

Discover more about the crucial role of B vitamins in overall health.

Frequently Asked Questions

What are the first signs of low folic acid?

The initial signs are often gradual and may be dismissed as general fatigue or lack of energy. As the deficiency progresses, other symptoms like paleness, shortness of breath, and oral issues may appear.

Can low folic acid affect your mood?

Yes, a folic acid deficiency can cause neuropsychiatric symptoms, including mood changes, irritability, anxiety, and depression. Folate is crucial for producing neurotransmitters that regulate mood.

Does a folic acid deficiency cause headaches?

Headaches are a common symptom associated with the anemia that results from a folic acid deficiency. They occur due to the reduced oxygen flow to the brain.

How can you tell the difference between a folic acid and B12 deficiency?

Both deficiencies can cause anemia and fatigue. However, a key difference is that B12 deficiency can lead to permanent nerve damage, including severe tingling and balance problems, which are less typical in an isolated folate deficiency. Blood tests measuring both folate and B12 levels are necessary for an accurate diagnosis.

What are the common oral symptoms of low folate?

Oral symptoms include a swollen, sore, or red tongue (glossitis), mouth ulcers, and a diminished sense of taste.

Which foods are good sources of folate?

Good sources of folate include leafy green vegetables (like spinach and kale), citrus fruits, legumes, beans, and fortified grains such as cereals, bread, and pasta.

How is a folic acid deficiency treated?

Treatment for a deficiency typically involves taking oral folic acid supplements and incorporating more folate-rich foods into the diet. In some cases, addressing an underlying medical condition, like a malabsorption disorder, is also necessary.

Can cooking destroy folate?

Yes, folate is sensitive to heat and can be destroyed by extensive cooking. For this reason, consuming some folate sources raw or lightly cooked is recommended to maximize intake.