Folic acid deficiency – how to recognise it and treat it?

Folic acid, the synthetic form of vitamin B9, and folates found naturally in food are essential for many important processes within the body. An insufficient intake over a prolonged period may be linked to health issues that are not always immediately obvious or easy to attribute to a single dietary component. If you suspect a folic acid deficiency, it is best to consult a specialist in medical and health sciences.

1. Diagnosing folic acid deficiency
2. Reducing folic acid deficiency
3. UK standards and recommendations

Diagnosing folic acid deficiency

Folic acid deficiency can develop over a long period without any clear or obvious symptoms, which is why it is easy to overlook or mistake it for other health issues.

Fatigue and weakness

Some people may experience chronic fatigue, weakness, increased drowsiness, difficulty concentrating, a decline in well-being, pale skin or reduced exercise tolerance. However, these are not symptoms specific solely to an insufficient intake of vitamin B9, as similar symptoms may also accompany deficiencies in other nutrients, physical overexertion, stress, lack of sleep or various health conditions.

What is important?

It is also important to note that folate levels in the body do not depend solely on the presence of a single type of food in the diet, but on the overall dietary pattern maintained over a longer period. The risk may be higher among people who eat few offal (mainly liver), green leafy vegetables, pulses, fruit and wholegrain cereal products, as well as among those following a monotonous diet rich in processed foods or very restrictive meal plans.

"Ensuring an adequate intake of nutrients is important at every stage of life, but it is particularly crucial during pregnancy, as a woman is no longer nourishing just her own body, but also the baby growing inside her." Agata Bugorska – Dietitian

High-risk groups and medication

Extra caution is also advised for women planning a pregnancy, pregnant women, older people, those who abuse alcohol, and those with malabsorption disorders or chronic gastrointestinal problems. Certain medications (such as methotrexate, sulfasalazine, trimethoprim or some anti-epileptic drugs) may also be a factor.

When to see a doctor?

Given the many potential causes of deficiency, the symptoms alone should not be used as a basis for self-diagnosis. If fatigue, a decline in fitness, impaired concentration or other worrying symptoms persist for a prolonged period, it is worth taking a broader look at your diet and health, and consulting a doctor if necessary. This approach helps to avoid jumping to conclusions and allows for a better assessment of whether the problem is actually linked to an insufficient intake of folate.

Estimated folate content in selected foods

Reducing folic acid deficiency

The best way to address an insufficient intake of folic acid is to start with your daily diet, as it is your regular dietary choices that have the greatest impact on your long-term nutritional status regarding B vitamins. In practice, this means increasing your intake of leafy vegetables, pulses and certain fruits. In some cases, simply improving the quality of the foods chosen, or including liver in the diet, can be an important step towards a higher intake of vitamin B9.

UK standards and recommendations

According to UK guidelines, the recommended intake of folate for adults is 200 µg per day, whilst during pregnancy the requirement increases to 300 µg per day; women planning a pregnancy and those in their first trimester are advised to take an additional supplement of 400 µg of folic acid per day. However, there are situations where diet alone is insufficient or the requirement is higher, which is why some people consider taking supplements. This applies particularly to periods of increased need, medical advice, or difficulties in meeting requirements through diet alone. However, a supplement should not be treated as a simple substitute for a well-balanced diet, but rather as a complement to it in specific circumstances.

In dietary supplements, folates are most commonly found as folic acid or in the active form 5-MTHF, including as calcium L-methylfolate. They can be found in single-ingredient preparations, multivitamins, B-complex vitamins, and supplements for women planning pregnancy and during pregnancy.

Sources:

• McNulty, H., & Scott, J. M. (2008). Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status. The British journal of nutrition, 99 Suppl 3, S48–S54. https://doi.org/10.1017/S0007114508006855
• Bailey L. B. (1990). Folate status assessment. The Journal of nutrition, 120 Suppl 11, 1508–1511. https://doi.org/10.1093/jn/120.suppl_11.1508
• Novaković, R., Geelen, A., Ristić-Medić, D., Nikolić, M., Souverein, O. W., McNulty, H., Duffy, M., Hoey, L., Dullemeijer, C., Renkema, J. M. S., Gurinović, M., Glibetić, M., de Groot, L. C. P. G. M., & Van't Veer, P. (2018). Systematic Review of Observational Studies with Dose-Response Meta-Analysis between Folate Intake and Status Biomarkers in Adults and the Elderly. Annals of nutrition & metabolism, 73(1), 30–43. https://doi.org/10.1159/000490003