Folate (vitamin B9) deficiency: Symptoms, causes, and treatment options

What is folate (vitamin B9)?

Folate, also called vitamin B9, is a type of B vitamin. Folic acid is the synthetic version of vitamin B9, which is found in fortified foods and supplements.

Vitamin B9 plays an essential role in:

• making and repairing your DNA
• breaking down old proteins and creating new ones
• producing red blood cells, which carry oxygen around the body
• breaking down homocysteine, an amino acid that can be harmful if too much builds up

Signs and symptoms of folate deficiency

The symptoms of vitamin B9 deficiency include:

• tiredness
• weakness
• heart palpitations
• shortness of breath
• headaches
• irritability
• difficulty concentrating

Causes of folate deficiency

You can get vitamin B9 from your diet or through supplements. If you're not consuming enough or you have higher needs, then you can become deficient.

Some common causes of folate deficiency include:

• pregnancy or breastfeeding
• not eating enough folate-rich foods (e.g. leafy greens, citrus fruits)
• chronic alcohol consumption
• certain medication (e.g. proton pump inhibitors, anticonvulsants)
• gastrointestinal conditions (e.g. coeliac disease)
• certain conditions (e.g. hemolytic anaemia)

Folate deficiency complications

If you have folate deficiency and it goes untreated, it can potentially cause complications, including:

Neural tube defects

Vitamin B9 plays an essential role in the development of a baby’s brain and spinal cord during pregnancy. If you’re deficient, especially in the first few weeks of pregnancy, you are at a higher risk of a serious birth defect called a neural tube defect (NTD).

Infertility and childbirth complications

Low folate levels are linked to premature birth and complications during birth. While infertility is also a known complication, it can be reversed with folic acid supplements.

Heart disease

Vitamin B9 plays an important role in homocysteine metabolism. If you don’t have enough vitamin B9 to help metabolise and lower your homocysteine levels, it might increase your risk of heart disease.

How to test your folate levels

To check your vitamin B9 levels, you'll need to take a blood test. You can either do this in a doctor's office or with a home test kit.

Thriva's home test kits can be completed in about 15 minutes. After sending your kit back, you'll receive your results and doctor's report

Learn more about types of blood tests and what to expect.

Treatment for folate deficiency

Folic acid (vitamin B9) deficiency can be treated by increasing the amount of folate-rich foods you eat or by taking a folic acid supplement.

Eat folate-rich foods

Even if you're thinking of taking a folic acid supplement, including folate-rich foods in your diet is a good idea. These foods are rich in other nutrients, such as vitamins, minerals, and fibre, which are good for your health.

Foods high in folate include:

• leafy green vegetables (e.g. spinach, mustard greens, romaine lettuce)
• brussels sprouts
• asparagus
• beef liver
• rice
• citrus fruit
• avocado

Take folic acid supplements

If you're trying to get pregnant or in the first 12 weeks of pregnancy, you should take a daily 400 microgram (mcg) folic acid supplement. It's a good idea to speak with your doctor to ensure you're getting enough.

Additionally, if you're deficient in vitamin B9, your doctor may advise you to take a supplement in addition to adjusting your diet.

It’s really important to make sure your vitamin B12 levels are normal when starting a folic acid supplement because they can mask the symptoms of vitamin B12 deficiency. If vitamin B12 deficiency goes untreated, it can damage your nervous system.

Takeaway

Folate (vitamin B9) is essential for DNA synthesis, red blood cell production, and preventing neural tube defects. You can check your levels with a blood test, and if you're deficient or at risk (for example, during pregnancy), you can increase your intake through folate-rich foods and folic acid supplements.