What does it mean if you have reduced folic acid?

September 28, 2025 •

4 min read

Folic acid is vital for cell production and DNA synthesis, with research indicating its importance for overall health. A reduced folic acid level indicates a deficiency in this essential B vitamin, which can disrupt your body's most basic cellular functions, leading to various health complications if left unaddressed.

Quick Summary

A reduced folic acid level, or folate deficiency, means your body lacks the vitamin needed to produce healthy red blood cells, potentially causing megaloblastic anemia and affecting DNA synthesis.

Key Points

Megaloblastic Anemia: A reduced folic acid level is a common cause of this type of anemia, where the body produces abnormally large, inefficient red blood cells.
Essential for DNA Synthesis: Folic acid is critical for making and repairing DNA, meaning a deficiency impairs fundamental cellular processes throughout the body.
Pregnancy Complications: Low folate during pregnancy significantly increases the risk of severe birth defects of the brain and spine, known as neural tube defects.
Varied Causes: Common causes include poor diet, alcoholism, malabsorption disorders like celiac disease, certain medications, and genetic mutations, such as MTHFR.
Hidden B12 Deficiency: High-dose folic acid supplementation can mask a vitamin B12 deficiency, potentially allowing neurological damage from the B12 issue to progress unnoticed.
Elevated Homocysteine: Low folate impairs the metabolism of homocysteine, leading to elevated levels that can increase cardiovascular risk.

The Essential Role of Folic Acid

Folic acid, also known as vitamin B9, is a crucial nutrient that plays a fundamental role in several bodily processes. It is essential for producing and maintaining new cells, particularly red blood cells, and for creating DNA and RNA, the building blocks of life. Without adequate folic acid, cell growth and division can be impaired, affecting various systems throughout the body. While folate is found naturally in foods like leafy greens and beans, folic acid is the synthetic form used in supplements and to fortify many grains. A reduced level of this vitamin signals that the body's essential cellular machinery is not operating at full capacity.

Understanding What Reduced Folic Acid Signifies

When your blood tests reveal a reduced level of folic acid (or its natural counterpart, folate), it primarily means one of two things: either your body is not getting enough, or it is not absorbing or using it properly. The most common outcome of this deficiency is a condition called megaloblastic anemia. This happens because the body requires folate to create healthy red blood cells. In a deficiency state, the bone marrow produces abnormally large, immature, and fewer red blood cells (megaloblasts) that don't function correctly. These large cells are inefficient at carrying oxygen, leading to symptoms like fatigue and weakness. Beyond anemia, low folate can also lead to more serious issues, particularly during key periods of growth.

Causes Behind the Deficiency

Multiple factors can lead to reduced folic acid levels, ranging from lifestyle choices to genetic predispositions.

Dietary Insufficiency: A diet low in folate-rich foods is the most common cause. Folic acid is sensitive to heat, so overcooking vegetables can destroy a significant portion of their folate content.
Increased Demand: Certain periods in life require higher folate intake. Pregnancy and lactation are primary examples, as the developing fetus and newborn need large amounts of folate for growth. Chronic hemolytic anemia and exfoliative skin disorders also increase the body's demands.
Malabsorption Issues: Conditions that affect the digestive tract can impair folate absorption. These include celiac disease, Crohn's disease, and other inflammatory bowel diseases. Alcoholism can also interfere with folate absorption and metabolism.
Genetic Factors: A significant number of people have a genetic mutation in the MTHFR gene, which produces an enzyme crucial for converting folic acid into its active form, 5-MTHF. A mutation can reduce the enzyme's activity, hindering the body's ability to utilize folic acid effectively.
Medications: Some prescription drugs can interfere with folate absorption or metabolism. Examples include certain anti-seizure medications, methotrexate, and some antibiotics.

The Symptom Checklist of a Folate Deficiency

Symptoms of a folate deficiency can develop slowly and are often similar to those of vitamin B12 deficiency, making accurate diagnosis important.

Anemia-related symptoms:
- Persistent fatigue and weakness
- Paleness
- Shortness of breath
- Dizziness or lightheadedness
Gastrointestinal and oral symptoms:
- A smooth, sore, and red tongue
- Mouth sores or ulcers
- Decreased appetite and weight loss
- Diarrhea
Neurological and psychiatric symptoms:
- Irritability
- Forgetfulness or difficulty concentrating
- Confusion
- Depression

Diagnosing and Treating Reduced Folic Acid

Diagnosis of a folate deficiency typically involves a blood test to measure serum folate levels, which reflect recent intake, and red blood cell (RBC) folate, which indicates long-term status. Doctors will also check homocysteine levels, which are often elevated in folate deficiency, and vitamin B12 levels to differentiate between the two deficiencies. Treating the deficiency usually involves dietary adjustments and supplementation. For women of childbearing age, adequate folic acid intake is critical to prevent neural tube defects. In some cases, particularly with MTHFR mutations, doctors may recommend a different form of folate supplementation, such as 5-MTHF.

Comparison of Folate Deficiency Causes


Cause	Mechanism	At-Risk Groups	Intervention Strategy
Dietary Insufficiency	Inadequate intake of folate-rich foods or overcooking foods.	Individuals with poor diet, elderly, those with alcohol dependence.	Increase consumption of raw leafy greens, citrus fruits, and fortified grains.
Malabsorption Issues	Impaired absorption in the small intestine due to disease.	Individuals with celiac disease, Crohn's disease, or those undergoing dialysis.	Treat the underlying condition; higher doses of supplements may be needed.
Genetic Factors (MTHFR)	Reduced ability to convert folic acid into its active form due to a gene variant.	Those with an MTHFR gene mutation (up to 50% of the population).	Potential use of 5-MTHF supplements, as advised by a doctor.
Increased Physiological Need	Higher demand for folate due to rapid cell division.	Pregnant or breastfeeding women, and those with chronic hemolytic anemia.	Increased dietary intake and/or supplementation, particularly important during pregnancy.
Medications	Drugs that interfere with folate metabolism.	People on certain anti-seizure meds, methotrexate, and others.	Adjusting medication or increasing supplementation under medical supervision.

Long-Term Complications of Untreated Deficiency

Left untreated, reduced folic acid levels can lead to several serious health problems. For pregnant women, it poses a significant risk of neural tube defects like spina bifida and anencephaly in the baby. Elevated homocysteine levels, a byproduct of folate metabolism issues, can increase the risk of cardiovascular disease, including stroke. Cognitive decline, dementia, depression, and other neurological issues can also arise, especially if a co-existing vitamin B12 deficiency is masked by folate treatment. Therefore, addressing the deficiency is crucial for preventing long-term health consequences.

Conclusion: Seeking Medical Advice

Understanding what it means to have reduced folic acid levels is the first step toward effective management. While diet and lifestyle changes are often sufficient, underlying genetic or medical issues may require more specific interventions. Always consult a healthcare professional to get an accurate diagnosis and a personalized treatment plan. Proper management can effectively reverse symptoms and prevent serious health complications. For more information, read this resource on folate from a trusted authority: Learn more about folate from the National Institutes of Health.

Frequently Asked Questions

The primary signs of reduced folic acid often include symptoms related to anemia, such as persistent fatigue, weakness, paleness, and shortness of breath. You may also experience a sore or tender tongue and mouth sores.

Doctors diagnose a folic acid deficiency with blood tests that measure the level of folate in your blood (serum folate) and red blood cells (RBC folate). They will also typically test for vitamin B12 levels to rule out a coexisting deficiency.

Foods rich in natural folate include dark leafy green vegetables like spinach, asparagus, and broccoli, as well as citrus fruits, beans, and lentils. Folic acid is also added to fortified foods such as bread, pasta, and cereals.

Yes, a severe or chronic folate deficiency can lead to neuropsychiatric symptoms, including irritability, depression, confusion, and problems with memory. It can also cause numbness and tingling in the hands and feet.

Yes, it is possible. Factors like genetic mutations (e.g., MTHFR), malabsorption issues, certain medications, and chronic alcohol use can prevent your body from absorbing or utilizing folate effectively, even with a healthy diet.

Folate is the natural form of vitamin B9 found in food. Folic acid is the synthetic form, which is more easily absorbed by the body and is used in supplements and fortified foods.

An MTHFR gene mutation can reduce the activity of an enzyme needed to convert folic acid into its active form. This can lead to low levels of usable folate, potentially causing symptoms and health issues.

Folic acid supplements are a common treatment for folate deficiency and can restore levels in most cases. However, the correct treatment depends on the underlying cause, and medical supervision is advised to prevent masking a B12 deficiency.