Low Folic Acid Levels

by Matthew Fox, MD

About Matthew Fox, MD

Dr. Matthew Fox graduated from the University of California with a Bachelor of Arts in molecular, cell and developmental biology and received a M.D. from the University of Virginia. He is a pathologist and has experience in internal medicine and cancer research.


Folic acid, also called vitamin B9 or folate, is important during cell division and times of growth because it helps make the DNA needed for newborn cells. Folate deficiency is uncommon, and usually only occurs because of malnutrition or alcoholism. Additional folic acid is needed during pregnancy to support the growth of a developing baby. Deficiency can cause health problems, and it is important to discuss vitamin deficiencies and other health-related issues with a physician.

Symptoms and Signs

Low folic acid may not cause any symptoms or signs for several months, because the body has a reserve store of folic acid that it can use to support day to day functioning. When it does lead to symptoms, folate deficiency can cause low red blood cell counts called anemia, inflammation of the tongue and mouth, GI problems such as diarrhea, central nervous system problems leading to depression or confusion. Low folic acid during pregnancy can lead to problems with development of the nervous system and cause severe birth defects.


Malnutrition and risk factors for malnutrition lead to low folic acid levels. The elderly, very ill and very young are at a greater risk of malnutrition than the general population. Alcoholism is another risk factor for low folic acid. In addition to alcohol, certain other drugs -- such as seizure medications -- can lead to low folic acid, or interfere with the activity of folic acid. Certain conditions, such as the GI absorption disorder celiac disease, can also contribute to low folic acid levels.


The diagnosis of low folic acid can be made by a blood test. A complete blood count can show a low number of large-sized red blood cells, known as a megaloblastic anemia. Since this can also be caused by low vitamin B12, a vitamin B12 level along with folic acid level are also checked. Additional tests may include methylmalonic acid and homocysteine. Increased homocysteine and normal methylmalanic acid indicates low folic acid.


The treatment of low folic acid is the administration of folic acid, generally orally. Underlying conditions such as alcoholism should be addressed as well. It is important to also rule out a vitamin B12 deficiency because the administration of folic acid to treat an underlying low vitamin B12 will treat anemia but lead to nerve damage. It is important to discuss these issues with a physician or other licensed health-care professional.

References (3)

  • “Nutrition Concepts and Controversies,” 11th Ed.; Frances Sizer, et al.; 2007
  • “Harrison’s Principles of Internal Medicine,” 17th Ed.; Anthony S. Fauci, et al.; 2008
  • Linus Pauling Institute: Folic Acid

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