Folic acid deficiency symptoms

Folate Deficiency

(Folic Acid)

Folate deficiency is common. It may result from inadequate intake, malabsorption, or use of various drugs. Deficiency causes megaloblastic anemia (indistinguishable from that due to vitamin B12 deficiency). Maternal deficiency increases the risk of neural tube birth defects. Diagnosis requires laboratory testing to confirm. Measurement of neutrophil hypersegmentation is sensitive and readily available. Treatment with oral folate is usually successful.

Folate is now added to enriched grain foods in the US and Canada. Folate is also plentiful in various plant foods and meats, particularly raw green leafy vegetables, fruits, organ meats (eg, liver), but its bioavailability is greater when it is in supplements or enriched foods than when it occurs naturally in food (see table Sources, Functions, and Effects of Vitamins).

Folates are involved in red blood cell maturation and synthesis of purines and pyrimidines. They are required for development of the fetal nervous system. Absorption occurs in the duodenum and upper jejunum. Enterohepatic circulation of folate occurs.

Folate supplements do not protect against coronary artery disease or stroke (even though they lower homocysteine levels); current evidence does not support claims that folate supplementation increases or reduces the risk of various cancers. Any role for using supplemental folate, methyltetrahydrofolate, or L-methylfolate, or for testing for mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene in patients with depression is uncertain at this time.

The upper limit for folate intake is 1000 mcg; higher daily doses (up to 4 mg) are recommended for women who have had a baby with a neural tube defect. Folate is essentially nontoxic.

Women taking both oral contraceptives and antiseizure drugs may need to take folate supplements to maintain birth control effectiveness.

Etiology of Folate Deficiency

The most common causes of folate deficiency are

• Inadequate intake (usually in patients with undernutrition or alcoholism)

• Increased demand (eg, due to pregnancy or lactation)

• Impaired absorption (eg, in celiac disease or due to certain drugs)

• Deficiency can also result from inadequate bioavailability and increased excretion 

Prolonged cooking destroys folate, predisposing to inadequate intake. Intake is sometimes barely adequate (eg, in alcoholics). Liver stores provide only a several-month supply.

Alcohol interferes with folate absorption, metabolism, renal excretion, and enterohepatic reabsorption and reduces healthy food intake. 5-Fluorouracil, metformin, methotrexate, phenobarbital, phenytoin, sulfasalazine, triamterene, and trimethoprim impair folate metabolism.

In the US and Canada, many dietary staples (eg, cereals, grain products) are routinely enriched with folate, tending to reduce risk of deficiency.

Symptoms and Signs of Folate Deficiency

Folate deficiency may cause glossitis, diarrhea, depression, and confusion. Anemia may develop insidiously and, because of compensatory mechanisms, be more severe than symptoms suggest.
Folate deficiency during pregnancy increases the risk of fetal neural tube defects and perhaps other brain defects.

Diagnosis of Folate Deficiency

Complete blood count and serum vitamin B12 and folate levels
Complete blood count may indicate megaloblastic anemia indistinguishable from that of vitamin B12 deficiency.

Treatment of Folate Deficiency

Supplemental oral folate
Folate 400 to 1000 mcg orally once a day replenishes tissues and is usually successful even if deficiency has resulted from malabsorption. The normal requirement is 400 mcg/day. (CAUTION: In patients with megaloblastic anemia, vitamin B12 deficiency must be ruled out before treating with folate. If vitamin B12 deficiency is present, folate supplementation can alleviate the anemia but does not reverse, and may even worsen, neurologic deficits.)

For pregnant women, the recommended daily allowance (RDA) is 600 mcg/day. For women who have had a fetus or infant with a neural tube defect, the recommended dose is 4000 mcg/day, started 1 month before conception (if possible) and continued until 3 months after conception.

Key Points 

• Most commonly, folate deficiency results from reduced intake (eg, due to alcoholism), increased demand (eg, due to pregnancy), or impaired absorption (eg, due to drugs or malabsorption disorders).

• Prolonged cooking destroys folate, but many dietary staples are supplemented with folate.

• Deficiency causes megaloblastic anemia and sometimes glossitis, diarrhea, depression, and confusion.

• Measure serum folate and vitamin B12 levels in patients who have megaloblastic anemia.

• To treat deficiency, give patients supplemental folate 400 to 1000 mcg orally once a day.

1. CORONA VIRUS
2. MONKEY POX
3. VAGINAL DRYNESS
4. FIBROID
5. INFERTILITY
6. OVULATION CYCLE
7. OVARIAN CANCER
8. VAGINAL BACTERIA
9. MALE INFERTILITY
10. BEST DAYS OF CONCIEVING
11. MUCUS AFTER OVULATION
12. FOODS FOR ERECTILE FUNCTIONS
13. PREGNANCY ANEMIA
14. DO AND DONT DURING PREGNANCY
15. ERECTILE DYSFUNCTION
16. U.T.I IN PREGNANCY
17. STROKE RISK
18. EAT THIS NOT THAT
19. HOOKWORMS INFECTION
20. OMEGA 3 BENEFITS
21. FASTING
22. WEIGHT LOSS TIPS
23. vitiligo
24. ABORTION
25. DENGUE VIRUS
26. EBORA VIRUS
27. FEVER
28. URINARY TRACT INFECTION
29. HOSPITAL INFECTIONS
30. WEST NILE VIRUS
31. YELLOW FEVER
32. EYE DISEASE
33. ZIKA VIRUS
34. STRESS
35. IRON DEFFICIENCE
36. INSOMNIA (SLEEPING PROBLEMS)
37. HEART PROBLEMS
38. COMPONENTS OF BLOOD
39. BLOOD DISORDER
40. LABORATORY TEST OF BLOOD DISORDER
41. BONE MARROW EXAMINATION
42. BLOOD ANEMIA
43. ANIMAL BITES
44. EYE BURN
45. CHOCKING
46. HEAT STROKE
47. SMOKE EFFECTS
48. SNAKE BITE
49. MALARIA VACCINE
50. BEST WAY TO SLEEP A CHILD
51. CHILD FEVER REDUCING
52. ELEPHANTIASIS
53. WOMEN BEARDS
54. DATES
55. PAPAYA FRUITS