Folic Acid Deficiency: What You Need to Know

Feeling tired, forgetful, or getting pale easily? Folic acid deficiency (also called folate deficiency) is a common, fixable cause of those problems. It matters especially for women who are planning pregnancy — a small step now can prevent serious issues like neural tube defects.

Causes & Symptoms

Folate is a B vitamin your body uses to make new cells. You can run low because of poor diet, some medicines, or problems absorbing nutrients. Common causes include heavy drinking, long-term use of anticonvulsants or methotrexate, bariatric surgery, celiac disease, and not eating enough leafy greens or fortified foods.

Watch for these signs: persistent fatigue, shortness of breath, pale skin, a sore tongue, mouth sores, and trouble concentrating. In more advanced cases you may see large red blood cells on a blood test (macrocytic anemia) or tingling and numbness in hands and feet.

How It’s Diagnosed and Fixed

Your doctor will check a blood sample. Tests often include a complete blood count (CBC), serum folate, and sometimes red blood cell folate. Low folate plus big red blood cells points to deficiency. If you take medicines that cause low folate, your doctor may suggest alternative drugs or add a supplement.

Treatment is straightforward: most adults take 400 mcg (micrograms) of folic acid daily. Pregnant people should take 600–800 mcg daily, and those with a previous pregnancy affected by neural tube defects are often advised 4,000 mcg (4 mg) under medical supervision. If you have genetic variations like MTHFR, your doctor might recommend methylfolate instead of folic acid.

Food helps a lot. Add more:

• Leafy greens: spinach, kale, and romaine
• Legumes: lentils, chickpeas, and black beans
• Fortified grains: many breads, cereals, and pastas
• Liver (eat sparingly if pregnant unless directed by your doctor)

Supplements are cheap and effective. Pick a daily multivitamin with folic acid or a stand-alone folic acid tablet. If you’re on interacting meds, pregnant, or have absorption issues, talk to your clinician about dose and form.

When should you see a doctor? If you feel unexplained fatigue, breathlessness with light activity, persistent mouth sores, or new numbness, get a blood test. Also get checked before trying to conceive — taking folic acid for at least one month before pregnancy lowers the risk of neural tube defects.

Small changes — a daily supplement and a few folate-rich meals a week — often fix the problem quickly. If supplements don’t help, your doctor will look for other causes and adjust treatment.

Want quick tips? Start a 400 mcg folic acid tablet today if you’re an adult, bump to 600–800 mcg if pregnant, and eat a handful of greens or a cup of lentils three times a week. Simple, low-cost moves that really make a difference.