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Folate Deficiency: Causes, Symptoms & Diagnosis

The information provided herein does not constitute an expert or medical advice, nor intended to replace such advice.

Health and Wellness

Nutrient deficiencies can cause significant health problems, and many people are concerned that they may not be getting enough of everything that they need. One important nutrient is folate, also known as folic acid or vitamin B9. Folate is important in a variety of processes throughout the body, and is particularly important for pregnant women.

What happens if you have low folate levels? How can you know if you’re getting enough?

Folate deficiency causes

There are several potential causes of folate deficiency, including:

  • A highly restrictive diet that doesn’t include sources of folate

  • Alcoholism

  • Conditions that impair the ability of your intestines to absorb nutrients

  • Genetic conditions

Folate deficiency symptoms

People who aren’t getting enough folate in their diet can experience a variety of symptoms. Folate is important in making red blood cells, synthesizing DNA and RNA, the function of the nervous system, digestion, and metabolizing certain compounds (such as homocysteine).

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Some of the signs of low folic acid include:

  • Weakness or fatigue

  • Difficulty concentrating

  • Irritability

  • Headache

  • Heart palpitations

  • Shortness of breath

  • Sores on the tongue and inside the mouth

  • Changes in the pigmentation of skin, hair, or fingernails 

  • Digestive issues

Lack of folate causes problems with a pregnancy

Folate is very important during pregnancy. If a pregnant woman has folate deficiency, there’s a risk of neural tube defects in the baby. This is a type of birth defect in which the brain and spinal cord don’t form properly. The most common types are spina bifida, which affects the spinal cord, and anencephaly, which affects the brain.

Women who have had a previous pregnancy in which the baby had a neural tube defect should ensure that they’re getting extra folate while they’re trying to conceive, and for at least the first three months of the pregnancy. 4000mcg a day is recommended in this situation – that’s ten times the standard amount.

Folate deficiency health risks

In addition to the other symptoms that it causes, low folate has been associated with an increased risk for other serious health conditions, including heart disease and cancer

Folate food sources

There are a number of different food sources of folate, including:

  • Leafy greens

  • Brussels sprouts

  • Asparagus

  • Oranges

  • Nuts

  • Beans

  • Peas

  • Beef liver

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In addition to foods which contain folate naturally, certain foods have supplemental folate added to them. These include cereals, bread, pasta, flour, rice, and cornmeal.

Folic acid daily dose & toxicity

The recommended daily dose of folate for most adults is 400mcg per day. Pregnant women need 600mcg, and since folate is most important at the beginning of a pregnancy, it’s recommended to start taking the higher amount if you’re trying to conceive. Lactating women also need a little more – 500mcg per day.

If you get your folate through supplements, then you’ll need somewhat more than this. This is because it’s harder for your body to absorb folate in this form. Only about 50 to 60% of folate taken as a supplement or in a fortified food is able to be absorbed. If this is how you primarily get your folate, then you’ll need to get about double the recommended daily intake.

There is such a thing as taking too much folate. Very high doses of folic acid may lead to problems with the digestive system, immune system, and nervous system. In general, the maximum dose of folate that’s recommended is 1000mcg per day for adults. Your doctor may advise taking higher doses in specific cases, such as if you’ve had a baby with a neural tube defect and you’re trying to conceive another child.

Vitamin B12 and folate deficiency can both cause anemia. When a person is low on vitamin B12, taking high doses of folate may cover up the vitamin B12 deficiency by preventing anemia. Even if the person doesn’t have anemia, vitamin B12 deficiency can still cause symptoms like damage to the nervous system. This is one reason that high doses of folate aren’t recommended; they can cover up a vitamin B12 deficiency.

How to know if you have folate deficiency

You can get a blood test to check that you have enough folate in your bloodstream. This can be performed alone, or as part of a micronutrient panel. This type of test checks for deficiencies of several different vitamins and minerals.

You can ask your doctor to order a micronutrient panel for you, but they often won’t do so. It’s not considered cost-effective for insurance companies to pay for everyone to be screened. You’ll likely need to pay for your testing yourself, unless you’re having obvious symptoms of deficiency. The most convenient option is to order a home testing kit, take a blood sample by fingerprick, and mail the sample back to the lab. You’ll then get your results online.


Folate: Fact Sheet for Health Professionals. National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/. Accessed 26 Jan 2023.

Pieroth R, Paver S, et al. Folate and Its Impact on Cancer Risk. Curr Nutr Rep. 2018; 7(3): 70–84. doi: 10.1007/s13668-018-0237-y

Wang Y, Jin Y, et al. The effect of folic acid in patients with cardiovascular disease. Medicine (Baltimore). 2019 Sep; 98(37): e17095. doi: 10.1097/MD.0000000000017095

Folic Acid Deficiency. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK535377/. Accessed 26 Jan 2023.

Facts about Neural Tube Defects. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/birthdefects/facts-about-neural-tube-defects.html. Accessed 26 Jan 2023.

Dr. Patricia Shelton

Dr. Patricia Shelton

Jan 30, 2023

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