Topic Overview

What is folic acid deficiency anemia?

Folic acid deficiency anemia happens when your body does not get enough folic acid. Folic acid is one of the B vitamins, and it helps your body make new cells, including new red blood cells. Your body needs red blood cells to carry oxygen. If you don't have enough red blood cells, you have anemia, which can make you feel weak and tired. So it’s important that you get enough folic acid every day.

Most people get enough folic acid in the food they eat. But some people either don't get enough in their diet or have trouble absorbing it from the foods they eat. Talk to your doctor about whether you should take a daily vitamin with folic acid.

Pregnant women who do not get enough folic acid are more likely to have babies with very serious birth defects.

What causes folic acid deficiency anemia?

You can get folic acid deficiency anemia if:

• You don't eat enough foods that contain folic acid. These include citrus fruits, leafy green vegetables, and fortified cereals.
• You have a greater need for folic acid. This might happen if you are pregnant or have some medical problems, such as sickle cell disease.
• Your body doesn't absorb enough folic acid. This might happen if you drink too much alcohol or have severe kidney problems that require blood-cleaning procedures.
• You take certain medicines, such as some used for cancer, rheumatoid arthritis, and seizures.

What are the symptoms?

Anemia may make you:

• Feel weak and tired.
• Feel lightheaded.
• Be forgetful.
• Feel grouchy.
• Lose your appetite and lose weight.
• Have trouble concentrating.

If you think you have anemia, it is important to see your doctor and get tested so you can get the right treatment. Being treated for a shortage of folic acid when your anemia is caused by something else can be dangerous.

How is folic acid deficiency anemia diagnosed?

Your doctor will examine you and ask questions about your past health and how you are feeling now. You will also have blood tests to check the number of red blood cells and to see if your body has enough folic acid.

The level of vitamin B12 will be checked too. Some people whose folic acid levels are too low also have low levels of vitamin B12. The two problems can cause similar symptoms.

How is it treated?

To treat the anemia, you can take folic acid pills each day to bring your folic acid level back up.

Why is folic acid important?

Folic acid helps prevent neural tube defects, such as spina bifida. These are major birth defects in which the baby’s brain or spine is not fully formed. These birth defects usually happen in the first few weeks of pregnancy, before a woman even knows she is pregnant.

If you are a woman who could get pregnant, think about taking a daily vitamin to make sure you get enough folic acid. For folic acid to help, you need to take it every day, starting before you become pregnant.

Frequently Asked Questions

Learning about folic acid deficiency anemia:	What is folic acid deficiency anemia? What causes it? What are the symptoms? Can folic acid deficiency anemia be prevented?
Being diagnosed:	How is folic acid deficiency anemia diagnosed?
Getting treatment:	How is folic acid deficiency anemia treated? How much folic acid do I need in my diet? What foods contain folic acid?
Ongoing concerns:	What can I do at home to treat folic acid deficiency anemia? Can having folic acid deficiency affect an unborn baby?

Symptoms

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.

Exams and Tests

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.

Treatment Overview

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.¹

When you no longer have folic acid deficiency anemia, you most likely will 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.

Home Treatment

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 United States government sets dietary guidelines to recommend nutrition levels for healthy people.

Daily recommended intake of folic acid: ²

Category	Age	Amount of folic acid (folate)
Babies	0 to 6 months	65 micrograms (mcg)
	7 to 12 months	80 mcg
Children	1 to 3 years	150 mcg
	4 to 8 years	200 mcg
Males	9 to 13 years	300 mcg
	Over 13 years	400 mcg
Females	9 to 13 years	300 mcg
	Over 13 years	400-600 mcg
Pregnancy	All ages	400-600 mcg
Nursing (lactation)	All ages	500 mcg

 

Foods that provide folic acid ³

• Asparagus
• Broccoli
• Green peas
• Liver
• Most fortified breakfast cereals
• Oranges
• Orange juice
• Spinach
• Wheat germ

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.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD  20824
Phone:	1-800-352-9424 (301) 496-5751
TDD:	(301) 468-5981
Web Address:	www.ninds.nih.gov
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
Centers for Disease Control and Prevention (CDC): National Center on Birth Defects and Developmental Disabilities (NCBDDD)
1600 Clifton Road
Atlanta, GA  30333
Phone:	1-800-232-4636 (1-800-CDC-INFO)
TDD:	1-888-232-6348
E-mail:	cdcinfo@cdc.gov
Web Address:	www.cdc.gov/ncbddd
NCBDDD aims to find the cause of and prevent birth defects and developmental disabilities. This agency works to help people of all ages with disabilities live to the fullest. The Web site has information on many topics, including genetics, autism, ADHD, fetal alcohol spectrum disorders, diabetes and pregnancy, blood disorders, and hearing loss.
March of Dimes
1275 Mamaroneck Avenue
White Plains, NY  10605
Phone:	(914) 997-4488
Web Address:	www.marchofdimes.com
The March of Dimes tries to improve the health of babies by preventing birth defects, premature birth, and early death. March of Dimes supports research, community services, education, and advocacy to save babies' lives. The organization's Web site has information on premature birth, birth defects, birth defects testing, pregnancy, and prenatal care. You can sign up to get a free newsletter and also explore Understanding Your Newborn: An Interactive Program for New Parents.
Office of Dietary Supplements, National Institutes of Health
6100 Executive Blvd., Room 3B01, MSC 7517
Bethesda, MD  20892-7517
Phone:	(301) 435-2920
Fax:	(301) 480-1845
E-mail:	ods@nih.gov
Web Address:	http://dietary-supplements.info.nih.gov
The Office of Dietary Supplements (ODS) supports research and disseminates research results in the area of dietary supplements. The ODS also provides advice to other federal agencies regarding research results related to dietary supplements.
Spina Bifida Association
4590 MacArthur Boulevard NW
Suite 250
Washington, DC  20007
Phone:	1-800-621-3141 (202) 944-3285
Fax:	(202) 944-3295
E-mail:	sbaa@sbaa.org
Web Address:	www.sbaa.org
The Spina Bifida Association of America is a voluntary health agency that provides information about spina bifida to parents and health professionals to promote public awareness, advocacy, and research. This organization produces written and audiovisual materials, including a newsletter and brochures covering topics such as latex allergy and folic acid.

Related Information

• Pregnancy
• Vitamin B12 Deficiency Anemia

References

Citations

1. Linker CA (2008). Blood disorders. In SJ McPhee et al., eds., Current Medical Diagnosis and Treatment 2008, 47th ed., pp. 429–430. New York: McGraw-Hill.
2. Food and Nutrition Board, Institute of Medicine (2008). Dietary reference intakes (DRIs): Recommended intakes for individuals, vitamins. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed. St Louis: Saunders Elsevier.
3. Stopler T (2008). Medical nutrition therapy for anemia. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed., pp. 810–832. St. Louis, Mo: Saunders Elsevier.

Other Works Consulted

• Katz DL (2008). Appendices and resource materials, Folate. In Nutrition in Clinical Practice, pp. 517–519. Philadelphia: Lippincott Williams and Wilkins.
• Babior BM (2006). Folate, cobalamin, and megaloblastic anemias. In MA Lichtman et al., eds., Williams Hematology, 7th ed., pp. 477–509. New York: McGraw-Hill.
• 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.
• Chitambar CR, Antony AC (2006). Nutritional aspects of hematologic diseases. In ME Shils et al., eds., Modern Nutrition In Health and Disease, 10th ed., pp. 1436–1461. Philadelphia: Lippincott Williams and Wilkins.

Credits

Author	Caroline Rea, RN, BS, MS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Denele Ivins
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Brian Leber, MDCM, FRCPC - Hematology
Last Updated	December 23, 2008