Folic acid, or vitamin B9, is important during cell division and times of growth because it facilitates the synthesis of DNA. Folate deficiency is uncommon. Risk factors include malnutrition and alcoholism. Additional folate is needed during pregnancy and growth. 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. Also, the body has a reserve store of folic acid. 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, called neural tube defects.
Causes
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 can lead to low folic acid, or interfere with the activity of folic acid. The seizure medicine valproic acid, the class of antibiotics known as sulfonamides, the antibiotics trimethaprim and pyrimethamine, and the anti-cancer and antirheumatic drug methotrexate all interfere with folic acid. Certain conditions such as the GI absorption disorder celiac disease can cause low folic acid.
Diagnosis
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.
Treatment
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
- "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
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