Folate Deficiency: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Folate Deficiency?
Folate deficiency is often found by a primary care doctor or an internal medicine doctor. A hematologist, a doctor who treats blood diseases, may care for related anemia. A gastroenterologist, a doctor who treats digestive diseases, may help if a gut problem is the cause. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is folate deficiency?
Folate deficiency means you have a lower-than-normal amount of folate in your blood. Folate is a B vitamin that is found naturally in many foods. Folic acid is a form of folate used in supplements and added to foods. Your body needs it to make DNA, the building block that carries genetic information. It also helps form red and white blood cells.
Your body does not store much folate. Your blood level can get low after only a few weeks of eating little folate. Folate deficiency is rare in the United States, but some people do not get enough.
Low folate can cause anemia. Anemia means the body does not have enough healthy red blood cells to carry oxygen. In folate-deficiency anemia, the red blood cells are abnormally large.
Symptoms
Folate deficiency can cause:
- Tiredness, irritability, or diarrhea.
- Weakness, trouble concentrating, headache, a pounding heartbeat, and shortness of breath from anemia.
- A smooth, tender, or sore tongue and sores in the mouth.
- Changes in the color of the skin, hair, or fingernails.
- Poor growth in children.
In severe cases, low folate can also lower white blood cells and platelets.
Causes and who gets it
Several things can lead to low folate:
- A diet without enough fruits and vegetables.
- Overcooked fruits and vegetables, because heat easily destroys folic acid.
- Drinking too much alcohol.
- Gut diseases that block absorption, such as celiac disease or Crohn disease.
- Hemolytic anemia, which makes the body need more folic acid to build red blood cells.
- Certain medicines, such as phenytoin, sulfasalazine, or trimethoprim-sulfamethoxazole.
- Kidney dialysis.
Pregnancy and weight loss diets also raise the risk of folate-deficiency anemia. Some people have more trouble getting enough folate. They include teen girls, young women, and non-Hispanic Black women. They also include people with alcohol use disorder or a gut that absorbs nutrients poorly.
Folate matters for a baby's growing spinal cord and brain. Too little folic acid in pregnancy may lead to birth defects in a baby, including neural tube defects such as spina bifida.
How doctors diagnose it
A blood test can diagnose folate deficiency. Pregnant women commonly have this blood test at prenatal checkups. For anemia, your provider will do a physical exam. Tests may include a complete blood count (CBC), which counts your blood cells, and a red blood cell folate level. In rare cases, a bone marrow aspiration may be done. This test takes a sample from the bone marrow. That is the soft center of the bones, where blood cells are made.
Treatment
The goal is to find and treat the cause of the low folate. You may take folic acid supplements by mouth. Some people need folic acid injected into a muscle or, rarely, through a vein. If a problem with your intestines causes the low folate, you may need treatment for the rest of your life.
Diet changes can help raise your folate level. Eat more green, leafy vegetables and citrus fruits. Beans, peas, nuts, and liver also have folate. Bread, cereal, pasta, and rice often have folic acid added. Folate-deficiency anemia most often responds well to treatment within 3 to 6 days.
Take folic acid supplements only in the amounts your provider recommends. Large amounts of folate might hide a vitamin B12 deficiency. A B12 deficiency can cause permanent damage to the brain, spinal cord, and nerves. Tell your doctor about all medicines and supplements you take. Follow your doctor's instructions about any change.
When to see a doctor
Contact your provider if you have symptoms of folate deficiency. Examples are ongoing tiredness, weakness, a sore tongue, or shortness of breath. Folate-deficiency anemia can also make heart disease or heart failure worse. Call 911 or go to the emergency room if you have chest pain, fainting, or sudden severe trouble breathing.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A doctor in one of these practices can order a blood test for folate, review your diet and medicines, and refer you to a specialist if a gut or blood problem is found.
Common questions
Can folate deficiency cause anemia?
Yes, it can. Folate helps form red blood cells, and low folate can lower the red blood cell count. This type of anemia has unusually large red blood cells.
Is folate deficiency a problem in pregnancy?
Yes, it can be. Too little folate raises the risk of neural tube defects. These are serious birth defects of a baby's brain or spine, such as spina bifida.
How fast does treatment work?
Often within days. Folate-deficiency anemia most often responds well to treatment within 3 to 6 days. It also tends to get better when the cause of the low folate is treated.
Sources
- MedlinePlus - Folate deficiency
- MedlinePlus - Folate-deficiency anemia
- NIH Office of Dietary Supplements - Folate
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
