What to take if serum folate is low? A guide to treatment

December 1, 2025 •

3 min read

According to the NHS, most cases of folate deficiency are easily treatable with tablets to replace the missing vitamins. If you have been diagnosed with low serum folate, it's essential to follow your doctor's guidance on supplementation and dietary adjustments to restore healthy levels and prevent complications.

Quick Summary

Treatment for low folate levels involves prescribed folic acid supplements and increasing dietary intake of folate-rich foods. It is critical to test for vitamin B12 deficiency concurrently, as folate can mask its symptoms. Addressing underlying causes like malabsorption is also vital for long-term recovery.

Key Points

Consult a Doctor: It is essential to get a proper diagnosis and treatment plan from a healthcare professional, who will likely prescribe folic acid supplements.
Take Folic Acid Supplements: The standard treatment involves daily folic acid tablets, with dosage and duration determined by your doctor.
Increase Folate-Rich Foods: Supplementation should be accompanied by a diet rich in green leafy vegetables, legumes, and fortified grains.
Check Vitamin B12 Levels: Always test for a vitamin B12 deficiency, as taking folic acid can mask B12-related nerve damage.
Understand Folate Types: Folic acid (synthetic) is different from natural folate and methylfolate; consult your doctor, especially if you have an MTHFR gene variation.
Address the Underlying Cause: Treat the root cause of the deficiency, which could range from poor diet to malabsorption disorders or alcohol abuse.

Primary Treatment: Folic Acid Supplements

For most individuals with a diagnosed folate deficiency, doctors will prescribe a daily dose of folic acid tablets to replenish the body's stores. This is the most direct and effective way to raise serum folate levels. Most people need to take these supplements for a few months, but the duration depends on the severity of the deficiency and its underlying cause. It is crucial to follow the prescribed dosage and duration exactly. Stopping treatment early could lead to a recurrence of the deficiency. In certain cases, such as ongoing malabsorption issues, some individuals may need to continue supplementation long-term.

The Difference Between Folate, Folic Acid, and Methylfolate

Understanding the different forms of Vitamin B9 is key to effective treatment. Folate is the naturally occurring form found in foods. Folic acid is the synthetic form used in fortified foods and most supplements. Methylfolate (or L-5-methyltetrahydrofolate) is the metabolically active form that your body uses. For most people, taking folic acid supplements is effective because their body can convert it into methylfolate.

For people with a specific genetic variation in the MTHFR gene, this conversion process is less efficient. For these individuals, supplementation with methylfolate may be more beneficial than with folic acid, as it bypasses the need for the inefficient enzyme conversion. It is important to discuss this possibility with your doctor, who can determine if testing for the MTHFR polymorphism is appropriate for you.

Dietary Changes: Boosting Folate Naturally

Alongside supplementation, increasing your intake of folate-rich foods is a powerful way to support your recovery and maintain healthy levels in the long run. Good sources include:

Dark green leafy vegetables: Spinach, kale, broccoli, asparagus, and Brussels sprouts.
Legumes: Lentils, chickpeas, and black-eyed peas.
Fruits: Oranges, bananas, and papaya.
Liver: Though rich in folate, consumption should be limited, especially during pregnancy due to high vitamin A content.
Fortified foods: Many grain products, including breakfast cereals, breads, rice, and pasta, are enriched with folic acid.

Why Vitamin B12 Status Must Be Checked

Before beginning folic acid treatment, a doctor will almost always check your vitamin B12 levels. This is a critical step because folic acid supplementation can correct the anemia symptoms associated with vitamin B12 deficiency, but it does not address the underlying B12 issue. Masking a B12 deficiency can allow its neurological damage to progress unnoticed, potentially leading to irreversible nerve problems. A balanced approach ensures that both deficiencies are addressed correctly.

Table: Comparing Folate Sources


Source	Form of B9	Absorption	Primary Benefit	Considerations
Natural Foods	Folate	Less stable, can be destroyed by cooking.	Broad nutritional benefits with other vitamins and fiber.	Needs consistent daily consumption to maintain levels.
Fortified Foods	Folic Acid	Highly stable and bioavailable.	Helps boost population-wide intake and prevent deficiency.	Does not apply to those with MTHFR polymorphism who struggle with conversion.
Folic Acid Supplements	Folic Acid	High bioavailability, especially on an empty stomach.	Effectively and quickly treats deficiency.	High doses can mask B12 deficiency; requires doctor supervision.
Methylfolate Supplements	L-5-methyltetrahydrofolate (active form)	Equal or greater bioavailability than folic acid.	Bypasses conversion issues for individuals with MTHFR gene variations.	More expensive; check with a doctor if necessary.

Addressing the Underlying Cause

For lasting recovery, addressing the root cause of the deficiency is vital. Common reasons for low folate include:

Poor diet: Inadequate intake of folate-rich foods. Excessive cooking can also destroy natural folate.
Alcohol abuse: Alcohol interferes with folate absorption and increases its excretion.
Malabsorption disorders: Conditions like celiac disease or inflammatory bowel disease can prevent proper absorption.
Medications: Certain drugs, including some for epilepsy, can interfere with folate metabolism.
Increased requirements: Pregnancy, cancer, and specific blood disorders can increase the body's need for folate.

Your healthcare provider will investigate these potential causes to tailor the most effective and sustainable treatment plan for you. The National Institutes of Health (NIH) provides extensive facts on folate and its role in health.

Conclusion

For those wondering what to take if serum folate is low, the answer is a combination of medically prescribed folic acid supplements and increased consumption of natural and fortified folate sources. It is crucial to consult a healthcare provider for a proper diagnosis and dosage, as well as to rule out a concurrent vitamin B12 deficiency. By following a doctor's guidance and making sustainable dietary improvements, individuals can effectively treat low folate levels and prevent future complications.

Frequently Asked Questions

The most rapid and effective way to raise serum folate levels is by taking prescribed folic acid supplements, as recommended by a doctor.

For most people, it takes about four months of taking daily folic acid tablets to restore folate levels. However, the duration can vary depending on the severity of the deficiency and the underlying cause.

While it's possible to get sufficient folate from a balanced diet, many people with a deficiency will need supplements to quickly replenish their stores. For long-term health, a combination of supplements and folate-rich foods is best.

It is crucial to check vitamin B12 levels because folic acid can treat the anemia associated with a B12 deficiency, but not the neurological damage. If the B12 deficiency is not identified and treated separately, the nerve damage can progress unnoticed and become irreversible.

Folate is the natural form of vitamin B9 found in foods, while folic acid is the synthetic form used in fortified foods and supplements. Folic acid is more stable and readily absorbed than natural folate.

Some individuals with an MTHFR gene mutation have trouble converting folic acid into its active form. For them, a doctor may recommend methylfolate supplements, which bypass the conversion process. This decision should be made with a healthcare provider.

Excellent sources of folate include dark green leafy vegetables like spinach and kale, legumes such as lentils and chickpeas, and fortified grain products. Fruits like oranges and papaya are also good options.

Yes, overcooking fruits and vegetables can destroy their natural folate content, contributing to a deficiency.