Folate Deficiency Anemia: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Folate Deficiency Anemia?
A primary care doctor often starts the work-up for folate-deficiency anemia. A hematologist, a doctor who treats blood disorders, may help if needed. 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 anemia?
Folate-deficiency anemia is a decrease in red blood cells due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid. Your body needs folate to make DNA and other genetic material.
Anemia means the body does not have enough healthy red blood cells. Red blood cells carry oxygen to body tissues. In this type, the red blood cells are abnormally large. That is why it is also called a type of megaloblastic anemia.
Symptoms
Symptoms may include:
- Fatigue, or feeling very tired.
- Weakness.
- Headache.
- Pallor, or pale skin.
- A sore mouth and tongue.
- Trouble concentrating, irritability, or a pounding heartbeat.
- Shortness of breath.
- Changes in the color of the skin, hair, or fingernails.
Causes and who gets it
Folate is needed for red blood cells to form and grow. You can get folate by eating green leafy vegetables and liver. Some foods are also fortified with folate, which means it is added. Your body does not store folate in large amounts.
Causes of this type of anemia include:
- Too little folic acid in your diet.
- Hemolytic anemia. This is when red blood cells break down faster than the body can replace them.
- Long-term alcoholism.
- Certain medicines, such as phenytoin, methotrexate, and sulfasalazine.
These also raise your risk:
- Alcohol use disorder.
- A diet low in folate, often seen in older people and people who do not eat fresh fruits or vegetables.
- Eating overcooked food.
- Weight loss diets.
- Disorders that lower nutrient absorption, such as celiac disease and inflammatory bowel disease, which can make it harder to get enough folate.
Folic acid is needed to help a baby in the womb grow properly. Too little folic acid during pregnancy may lead to birth defects in a baby.
How doctors diagnose it
Your provider will do a physical exam. Tests that may be done include:
- A complete blood count (CBC), a blood test that counts your blood cells.
- A red blood cell folate level.
In rare cases, a bone marrow aspiration may be done. This takes a small sample from the soft center of a bone.
Treatment
The goal is to find and treat the cause of the low folate.
You may receive folic acid supplements by mouth, injected into a muscle, or through a vein in rare cases. If a problem with your intestines causes low folate, you may need treatment for the rest of your life.
Taking large amounts of folic acid supplements might hide a vitamin B12 deficiency, so take supplements the way your provider tells you.
Diet changes can help boost your folate level. Eat more green, leafy vegetables and citrus fruits.
Folate-deficiency anemia most often responds well to treatment within 3 to 6 days. It will likely get better when the cause of the low folate is treated.
When to see a doctor
Contact your provider if you have symptoms of folate deficiency anemia. Experts recommend that women take folic acid every day before they get pregnant and through the first 3 months of pregnancy.
Call 911 or go to the emergency room for chest pain lasting two minutes or more, fainting, or 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 direct primary care doctor can order blood tests, look for the cause, and follow your blood counts over time. They can also refer you to a specialist if needed.
Common questions
Is folate-deficiency anemia serious?
It is treatable, and it most often responds well to treatment within 3 to 6 days. Other complications can include worsening of heart disease or heart failure. In pregnant women, low folate has been linked to neural tube or spinal defects, such as spina bifida, in the baby.
What foods have folate?
Many foods have folate. Dark green leafy vegetables, such as spinach, are one source. Oranges and orange juice are another. So are beans and peas, and beef liver. Folic acid is added to enriched bread, pasta, rice, and fortified breakfast cereals.
Can folate-deficiency anemia be prevented?
Eating plenty of folate-rich foods can help prevent it. Women and teen girls who could become pregnant should get folic acid every day from supplements, fortified foods, or both. Taking folic acid before and during early pregnancy helps prevent neural tube defects in babies.
How common is folate deficiency?
Folate deficiency is rare in the United States, but some people do not get enough. Most people in the United States get enough folate. People with alcohol use disorder are more likely to have trouble getting enough.
Sources
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.
