What causes folate deficiencies?

Neal Spruce
Neal Spruce on behalf of dotFIT
A lack of sufficient intake of the B vitamin folate will contribute to a deficiency state. Also, any condition that leads to losses exceeding intake can contribute to a deficiency. Situations or medical conditions that increase the need for folate or result in increased losses include the following: pregnancy and lactation (breastfeeding), alcohol abuse, malabsorption, kidney dialysis, liver disease and certain anemias. Medications that interfere with folate utilization include anticonvulsant medications (such as dilantin, phenytoin and primidone), metformin (sometimes prescribed to control blood sugar in type 2 diabetes), sulfasalazine (used to control inflammation associated with Crohn's disease and ulcerative colitis), triamterene (a diuretic), methotrexate (used for cancer and other diseases such as rheumatoid arthritis), and barbiturates (used as sedatives).
Not getting enough folate can be a serious problem. Deficiencies can occur if your diet doesn’t contain enough folic acid. Some medication may interfere with how the body processes this nutrient. In addition, certain medical conditions can lead to folate deficiencies. These include:
  • Pregnancy
  • Breastfeeding
  • Alcohol abuse
  • Dialysis. This is a treatment that cleans damaged kidneys.
  • Liver disease
  • Anemia. This is a lack of red blood cells caused by too little oxygen in the blood.
  • Malabsorption. Nutrients not being absorbed by the small intestine.
Dr. Michael Roizen, MD
Internal Medicine
Folate (a B vitamin -- B9 to be exact) is water-soluble, which means you have to get some folate in every day because any extra gets passed along in your urine. There isn’t a folate “bank” to draw from on those days when spinach and liver (both good sources of folate) just don’t sound as good as a pepperoni pizza and cheese sticks. This means that if you are living mainly on a diet of junk food, with little or no fruit and veggies in your diet, you could be at risk for folate deficiency. Other factors that put you at risk for folate deficiency include certain medications, such as the anti-seizure drug phenytoin, celiac disease, alcoholism, pregnant women in their third trimester especially, and hemolytic anemia.
Finally, even if you are a fruit and vegetable pro, make sure you’re cooking them properly. Overcooking them zaps a lot of the nutrients.

Questions? Concerns? Talk to your doc. He or she can talk to you about your usual diet. Be honest -- it won’t help you any if your doc thinks you eat spinach 12 times a day. If you are really worried, your doc can probably check your level of folate with a quick blood test. If you are low, your doc will help you figure out ways to raise your folate, both with a supplement and with a healthier diet.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.