Folic Acid Deficiency Anemia

What is folic acid deficiency anemia?

Folic acid deficiency anemia results from lower-than-normal levels of folic acid in the body. Your body needs folic acid, one of the B vitamins, to produce red blood cells . The human body does not produce enough folic acid to meet its needs, so your diet should include foods high in folic acid, such as citrus fruits, leafy green vegetables, and fortified cereals.¹

Your body can store enough folic acid to last 2 to 6 months. However, anemia can develop within weeks of a shortage of folic acid. Folic acid deficiency in women who become pregnant can result in babies with low birth weights or birth defects, particularly of the spine and brain (neural tube defects). Folic acid deficiency may increase the risk for other health conditions, including cardiovascular disease and blood clots in the legs (thrombosis).^{2, 3}

What causes folic acid deficiency anemia?

Causes of folic acid deficiency anemia include:

• Not eating enough foods that contain folic acid.
• Having an increased need for folic acid, as might happen with pregnancy or certain medical conditions, such as sickle cell disease.
• Not absorbing or retaining folic acid. If you drink too much alcohol or have severe kidney problems that require blood-cleaning procedures, your body might not absorb folic acid.
• Taking medications for certain conditions, such as cancer, rheumatoid arthritis, and seizures.

What are the symptoms of folic acid deficiency anemia?

Common symptoms of folic acid deficiency anemia are:

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

How is folic acid deficiency anemia diagnosed?

Your health professional will diagnose folic acid deficiency anemia by performing blood tests, including a complete blood count (CBC) and measurements of folic acid and vitamin B₁₂ levels.

What is the treatment for folic acid deficiency anemia?

Treatment for folic acid deficiency anemia is an increase in your intake of folic acid, through daily supplements, until your folic acid levels become normal.

How can I prevent folic acid deficiency anemia?

You can prevent folic acid deficiency anemia by eating a diet that includes foods high in folic acid. These foods include citrus fruits, leafy green vegetables, fortified cereals, beans and legumes, wheat bran and other whole grains, and meats (poultry, pork, shellfish, and liver). Some people take a daily multivitamin that contains folic acid.

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.⁴

Once you no longer have folic acid deficiency anemia, you should 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 U.S. 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. Schrier SL (2004). Anemia: Production defects. In DC Dale, DD Federman, eds., ACP Medicine, section 5, chap. 3. New York: WebMD.

2. Stabler SP, Allen RH (2004). Megaloblastic anemias. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 22nd ed., vol. 1, pp. 1050–1057. Philadelphia: Saunders.

3. Babior BM, Bunn HF (2005). Megaloblastic anemias. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 16th ed., vol. 1, pp. 601–607. New York: McGraw-Hill.

4. 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.

5. National Academy of Sciences (1998). Table 15–2, Food and Nutrition Board, Institute of Medicine—National Academy of Sciences dietary reference intakes: Recommended intakes for individuals. In LK Mahan, S Escott-Stump, eds., Food, Nutrition, and Diet Therapy, 10th ed., pp. 334–335. Philadelphia: W.B. Saunders.

Other Works Consulted

• 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.

Author:	Kerry V. Cooke	Last Updated March 8, 2005
Medical Review:	Adam Husney, MD - Family Medicine Joseph O'Donnell, MD - Hematology
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.