Folate Deficiency - Symptoms, Diagnosis, and Treatment

What Is Folate?

Folate is the natural form of vitamin B, especially B9, water-soluble, produced by the body, or naturally found in many foods. Folate, folic acid, is a type of B vitamin that helps form deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and the production of red blood cells and is involved in protein metabolism. It plays a vital role in breaking down homocysteine, an amino acid that can cause harmful effects on the body if it is in high amounts. Folate is also needed to produce red blood cells and is critical during periods of rapid growth, such as during pregnancy and fetal development.

What Is Folic Acid?

Folic acid can be described as a man-made or synthetic form of folate. The body is not able to store large amounts of natural folate. But the body can absorb folic acid very easily. Therefore it can be added to some of the foods eaten. Food items like grains, for example, rice, bread, pasta, and some cereals, are enriched with folic acid. Folic acid can also be accessible through dietary supplements like milk and cheeses.

What Is Folate Deficiency?

Folate deficiency can be defined as a lack of folate or vitamin B9 in the blood. It is mainly required to function correctly. Folate deficiency can lead to varieties problems and complications.

What Are the Causes of Folate Deficiency?

Folic acid is vitamin B9, which works with different vitamins like vitamins B12 and vitamin C to help the body break down, use, and produce proteins. The vitamin helps in the formation of red and white blood cells. It also helps produce DNA, which carries the genetic information of humans. Folic acid is a type of vitamin B that is water-soluble. This means as folic acid is not stored in the fat tissues of the body. An excessive amount of the vitamin is eliminated through the body by urine as folate can not be stored in the body in large amounts, which affects the folate level in the blood due to the intake of a low folate diet. Folate is present mainly in leafy greens, legumes, citrus fruits, eggs, beets, bananas, and liver.

The following are the causative factors for folate deficiency -

• Diseases in which folic acid is not absorbed by the digestive system (such as celiac disease or Crohn's disease).

• Drinking an excessive amount of alcohol.

• Eating overcooked fruits and vegetables. Folate can be easily destroyed by heat.

• Hemolytic anemia disorders.

• Certain medicines or drugs (such as phenytoin, sulfasalazine, or trimethoprim-sulfamethoxazole)

• Kidney dialysis.

• The diet also plays a role in folate deficiency or eating an unhealthy diet; fresh fruits, vegetables, and fortified cereals are the leading cause of folate deficiency.

• Genetics can be a reason for folate deficiency by a genetic mutation that inhibits the body from properly and efficiently converting dietary or supplemental folate to its usable form, methyl folate.

What Are the Associated Signs and Symptoms of Folate Deficiency?

The followings are the signs and symptoms of folate deficiency:

• Fatigue.

• Mouth sores.

• Gray hair.

• Growth problems.

• Tongue swelling.

• Peripheral neuropathy.

• Memory loss.

• Confusion.

• Difficulty in concentration.

• Mouth ulcers.

• Diarrhea.

• Weight loss.

• Depression.

The symptoms of folate deficiency in anemia patients include:

• Persistent fatigue.

• Weakness.

• Lethargy.

• Pale skin.

• Shortness of breath.

• Irritability.

What Are the Risk Factors Associated With Folate Deficiency?

The following are the risk factors associated with folate deficiency.

• Excessive alcohol abuse.

• Pregnancy.

• Being of childbearing age.

• Eating overcooked or over-processed foods.

• Consuming a vitamin-poor diet.

• Some medical conditions, for example, sickle cell disease.

• Low socioeconomic status.

• Elderly people are living in institutions.

• Genetic polymorphism was seen in the gene named MTHFR.

• Malabsorption syndromes.

• Celiac disease.

• Inflammatory bowel disease.

• Certain medications or drug administration.

What Are the Risks Associated With Folate Deficiency in Pregnancy?

Folic acid is very important during pregnancy. Folic acid can help prevent specific birth abnormalities called neural tube defects in babies. Neural tube defects are severe as they affect the spinal cord or brain of the baby. The following are the risks reported while pregnant in the cases of folate deficiency.

• Spina Bifida - It is a problem that occurs when a newborn's spinal cord or brain cannot develop fully in the womb. Babies born with spina bifida may require specific treatment or surgery and often suffer from paralysis and other physical disabilities.

• Anencephaly - It is a condition where a baby's brain and skull are not developed completely. In most cases, babies with anencephaly can stillborn or die after birth.

What Are the Investigations Performed to Diagnose Folate Deficiency?

The healthcare provider can investigate and evaluate the patient's medical and personal history by examining the patient physically. The physical examination involves inspection, palpitation, and auscultation.

Some investigations can also be performed by the healthcare provider -

Blood Test - A blood test is performed to detect the count of blood cells in the given sample. The main reason they conduct the blood investigation is to determine folate deficiency. If the folate is more than 4 nanograms per milliliter (ng/ml), then it is standard. If it ranges between 2 to 4 ng/ml, then it is considered borderline. But if the range is below 2 ng/ml is considered a folate deficiency.

What Are the Treatment Modalities for Folate Deficiency?

The folate deficiency can be treated by consuming folic acid in the diet. It is mainly indicated to have 400 grams of folate in the diet of the affected patients. It is also recommended to have multivitamins and B complex to overcome the deficiency of folate.

How to Prevent Folate Deficiency?

The correct and accurate way to prevent folate deficiency is to have a balanced diet. The following are the food items that can help to prevent folate deficiency.

• Beans

• Legumes.

• Citrus fruits

• Juices.

• Green leafy vegetables such as asparagus, broccoli, and spinach.

• Mushrooms.

• Poultry.

• Pork.

• Shellfish.

• Wheat bran and other whole grains.

Conclusion

Folate deficiency is rarely reported in women, especially in pregnant women, which can lead to severe health conditions. Folate helps in the regulation of red blood cells and fetal development. It is recommended to have a balanced diet that comprises all the important vitamins and minerals essential for the body to work correctly. If a person experiences any related signs and symptoms, they should consult a doctor to avoid unfortunate circumstances.