Health Library Folic Acid Deficiency AnemiaFrom Healthwise

What is folic acid deficiency anemia?

Folic acid deficiency anemia happens when your body does not get enough folic acid. Folic acid is one of the B vitamins, and it helps your body make new cells, including new red blood cells. Your body needs red blood cells to carry oxygen. If you have don't have enough red blood cells, you have anemia, which can make you feel weak and tired. So it’s important that you get enough folic acid every day.

Most people get enough folic acid in the food they eat. But some people either don't get enough in their diet or have trouble absorbing it from the foods they eat. Talk to your doctor about whether you should take a daily vitamin with folic acid.

Pregnant women who do not get enough folic acid are more likely to have babies with very serious birth defects.

What causes folic acid deficiency anemia?

You can get folic acid deficiency anemia if:

• You don't eat enough foods that contain folic acid. These include citrus fruits, leafy green vegetables, and fortified cereals.
• You have a greater need for folic acid. This might happen if you are pregnant or have some medical problems, such as sickle cell disease.
• Your body doesn't absorb enough folic acid. This might happen if you drink too much alcohol or have severe kidney problems that require blood-cleaning procedures.
• You take certain medicines, such as some used for cancer, rheumatoid arthritis, and seizures.

What are the symptoms?

Anemia may make you:

• Feel weak and tired.
• Feel lightheaded.
• Be forgetful.
• Feel grouchy.
• Lose your appetite and lose weight.
• Have trouble concentrating.

If you think you have anemia, it is important to see your doctor and get tested so you can get the right treatment. Being treated for a shortage of folic acid when your anemia is caused by something else can be dangerous.

How is folic acid deficiency anemia diagnosed?

Your doctor will examine you and ask questions about your past health and how you are feeling now. You will also have blood tests to check the number of red blood cells and to see if your body has enough folic acid.

The level of vitamin B12 will be checked too. Some people whose folic acid levels are too low also have low levels of vitamin B12. The two problems can cause similar symptoms.

How is it treated?

To treat the anemia, you can take folic acid pills each day to bring your folic acid level back up.

Why is folic acid important?

Folic acid helps prevent neural tube defects, such as spina bifida. These are major birth defects in which the baby’s brain or spine is not fully formed. These birth defects usually happen in the first few weeks of pregnancy, before a woman even knows she is pregnant.

If you are a woman who could get pregnant, think about taking a daily vitamin to make sure you get enough folic acid. For folic acid to help, you need to take it every day, starting before you become pregnant.

Frequently Asked Questions

Mild folic acid deficiency anemia may not produce any symptoms. As folic acid deficiency progresses, the following common symptoms of anemia may develop:

• Weakness
• Fatigue
• Lightheadedness
• Forgetfulness
• Irritability
• Pale appearance (pallor)
• Lack of appetite and weight loss
• Difficulty concentrating or focusing attention

Less common symptoms include:

• Diarrhea.
• Abdominal pain.
• Sore, smooth tongue.
• Cracked lips, especially at the corners of the mouth.
• Shortness of breath with exertion.
• Rapid or irregular heart rate.
• Chest pain.

If your health professional suspects folic acid deficiency anemia, he or she will ask about your medical history and conduct a physical exam. Be sure to discuss:

• Current or past conditions or diseases that you or a close family member has had.
• Your eating habits.
• Any medications that you are taking.
• Whether you drink alcohol, and if so, how much you drink.

Usually, your doctor will want to draw blood in order to perform standard tests. These tests, which check for low folic acid levels and associated anemia, include:

• A complete blood count (CBC) and a blood smear. Blood cells are checked for the proper shape, color, number, and size. These features help your health professional determine what type of anemia may be present, if any. If these tests show red blood cells that are larger than normal (macrocytic), the doctor may suspect folic acid deficiency.
• Measurements of folic acid levels (folate) and vitamin B12 levels, to distinguish between these two causes of anemia.

You can treat folic acid deficiency anemia by increasing your intake of folic acid (folate). Usually taking a 1 mg folic acid supplement daily will improve anemia within 5 to 7 days. You can continue to take supplements until your body reaches proper levels of folic acid, usually between 1 week and 2 months.¹

When you no longer have folic acid deficiency anemia, you most likely will be able to maintain a proper level of folic acid if you eat foods high in folic acid, such as citrus fruits and dark green, leafy vegetables. A few people with chronic conditions (such as hemolytic anemia, overactive thyroid, and chronic liver failure) may have to take folic acid supplements for the rest of their lives.

What to think about

Before you begin your treatment, your health professional will determine if the cause of your anemia is low levels of folic acid or vitamin B12. Treating folic acid deficiency when a person has a vitamin B12 deficiency can be dangerous. A vitamin B12 deficiency causes nervous system damage over time. A person mistakenly treated for a folic acid deficiency may feel better at first, because many symptoms of anemia improve. Consequently, the nervous system damage caused by vitamin B12 deficiency may be missed and become worse.

You can prevent or reverse folic acid deficiency anemia by eating a diet that includes foods high in folic acid, including citrus fruits, leafy green vegetables, and fortified cereals. The United States government sets dietary guidelines to recommend nutrition levels for healthy people.

Note: Cooking vegetables often makes the vegetable smaller. A cup of cooked vegetable weighs more than a cup of raw vegetable, so the amount of folic acid in each will be different.

Other folic acid food facts

• Many breakfast cereals and breads are fortified with folic acid. Read labels for the folic acid amount.
• Eat vegetables raw or lightly steamed. Cooking may destroy some of the folic acid found in food.
• Drinking orange juice or other juice high in vitamin C increases the amount of folic acid that your body absorbs from food.
• Vitamin supplements often contain folic acid.

Organizations

• Pregnancy
• Vitamin B12 Deficiency Anemia

Citations

1. Linker CA (2005). Anemias. In LM Tierney Jr et al., eds., Current Medical Diagnosis and Treatment 2005, 44th ed., pp. 470–472. New York: Lange Medical Books/McGraw-Hill.

2. Food and Nutrition Board, Institute of Medicine (2004). Table 15-1: Dietary reference intakes for vitamins and minerals: RDAs or AIs. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition and Diet Therapy, 11th ed., pp. 366–367. Philadelphia: Saunders.

3. Group Health Cooperative (2001). Recommendation: Folate. In Nutrition Guideline, DP-1048, pp. 10–29. Seattle: Group Health Cooperative.

4. Food and Nutrition Board, Institute of Medicine (2004). Table 34-4: Folic acid content of some common foods. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition and Diet Therapy, 11th ed., p. 856. Philadelphia: Saunders.

Other Works Consulted

• Babior BM (2006). Folate, cobalamin, and megaloblastic anemias. In MA Lichtman et al., eds., Williams Hematology, 7th ed., pp. 477–509. New York: McGraw-Hill.

• Carmel R (2004). Megaloblastic anemias: Disorders of impaired DNA synthesis. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 11th ed., vol. 1, section 5, pp. 1367–1395. Philadelphia: Lippincott Williams and Wilkins.

• Stopler T (2004). Medical nutrition therapy for anemia. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition and Diet Therapy, 11th ed., pp. 838–859. Philadelphia: Saunders.

Author:	Ralph Poore	Last Updated: March 2, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Brian Leber, MDCM, FRCPC - Hematology
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