What folate is
Folate is vitamin B9. Your body uses it to build DNA and to make new cells, especially red blood cells. Because the body makes millions of new cells every second, it needs a steady supply.
Folate is the natural form found in food. Folic acid is the man-made form used in supplements and added to bread, pasta, rice, and cereal. The body handles both, though folic acid is actually absorbed a bit better. The United States has required folic acid in enriched grain foods since 1998, which cut deficiency rates sharply.
Signs you might be low
Early signs are vague. You feel tired and weak. You may be irritable or find it hard to focus. Some people get a sore, smooth, red tongue or small sores in the mouth. Diarrhea and a loss of appetite can show up too.
If the deficiency goes on, it causes a type of anemia called megaloblastic anemia. The body makes red blood cells that are too large and do not work well. That brings pale skin, shortness of breath, a fast heartbeat, and headaches.
In pregnancy, low folate is especially serious. The baby's brain and spine form in the first weeks, often before a woman knows she is pregnant. Low folate raises the risk of birth defects like spina bifida. That is the main reason grains are fortified.
Why people run low
The most common cause is simply not eating enough folate-rich food. Leafy greens, beans, lentils, citrus, and liver are the best sources. People who eat mostly processed food or who are on very restrictive diets are at risk.
Alcohol is a big one. Heavy drinking blocks folate absorption and makes the kidneys dump more of it. Gut diseases like celiac disease and Crohn's disease reduce absorption. So does bariatric surgery.
Several medicines interfere with folate. Methotrexate, used for arthritis and some cancers, blocks it directly. Some seizure drugs like phenytoin, the antibiotic trimethoprim, and the bowel drug sulfasalazine lower it too. Pregnancy, breastfeeding, and kidney dialysis raise your need. A few people carry a gene change called MTHFR that makes it harder to use folate, though for most of them a normal diet is still enough.
How it is diagnosed
A simple blood test measures folate. Serum folate reflects what you have eaten in the past few days. Red blood cell folate reflects the past few months and is a better picture of your long-term level. A complete blood count checks for the oversized red cells of megaloblastic anemia.
One step is essential. Your clinician must also check vitamin B12. Folate and B12 deficiency look almost identical on blood tests, and they often travel together. Treating low folate without checking B12 can hide an ongoing B12 problem, and untreated B12 deficiency can cause permanent nerve damage. Never take high-dose folic acid without a B12 level.
How it is treated
Treatment is straightforward. Most adults take folic acid, usually 400 micrograms to 1 milligram a day, until levels return to normal. Blood counts usually start to improve within a week or two, and energy follows. If the cause is ongoing, such as a medicine you cannot stop, you may stay on a daily dose.
Adults need about 400 micrograms of folate a day. Women who are pregnant need 600, and anyone planning a pregnancy should start folic acid at least a month before. There is a safe upper limit of 1,000 micrograms a day from supplements and fortified food, because very high doses can mask B12 deficiency.
Food still matters. A cup of cooked lentils gives you about 90 percent of a day's folate. Spinach, asparagus, broccoli, avocado, oranges, and fortified cereal all help.
How Zen IV Spa can help
Zen IV Spa serves New York and New Jersey. If you feel tired and foggy and want answers, a licensed nurse can draw your labs at home, including folate, B12, iron, and a full blood count. Our medical team reviews the results with you on a free video visit. If you are low, we can prescribe what you need through our everyday prescriptions program, $79 a month, or give you a fast lift with a Myers' cocktail IV, $299, which includes a full B-vitamin complex. Learn more at /everyday-health/ or call (332) 239-2005.
Common Questions
What is the difference between folate and folic acid?+
Folate is the natural form in food. Folic acid is the man-made form in supplements and fortified grains. Both work, and folic acid is absorbed slightly better.
What are the first signs of folate deficiency?+
Tiredness, weakness, irritability, trouble focusing, and sometimes a sore red tongue or mouth sores.
How long does it take to fix?+
Blood counts usually start improving within one to two weeks of taking folic acid. Full recovery can take a few months.
Why does my doctor check B12 too?+
Low folate and low B12 look the same on blood tests. Taking folic acid alone can hide a B12 problem, and untreated B12 deficiency can damage nerves.
Can I get too much folic acid?+
Yes. Stay under 1,000 micrograms a day from supplements unless a clinician tells you otherwise.
Which foods have the most folate?+
Lentils, beans, spinach, asparagus, broccoli, avocado, oranges, liver, and fortified cereal.
Sources: NIH Office of Dietary Supplements, Folate Fact Sheet for Health Professionals, 2022; Mayo Clinic, Folate deficiency anemia; Cleveland Clinic, Folate Deficiency; CDC, Folic Acid recommendations.
All treatments are medical services. Every guest is screened, and every treatment is prescribed by a licensed provider. Nothing on this page is medical advice for you personally, and the opinions summarized here belong to the doctors named, not to Zen IV Spa. Talk to a provider before starting or stopping anything.
