What Is Folic Acid Deficiency Anemia?

Medically Reviewed by Carol DerSarkissian, MD on December 05, 2022

Anemia is a condition that happens when you don’t have enough red blood cells to carry oxygen to your body’s tissues. One reason could be that you don’t have enough hemoglobin to make red blood cells. That’s a protein in red blood cells that helps carry oxygen throughout the body. You can also become anemic by not getting enough folate (vitamin B9), the natural form of folic acid found in foods.

What Causes It?

You can get folic acid deficiency anemia a few different ways. Here are some examples:

You don’t eat enough foods that contain folic acid. This is the case for most people. You might not be eating enough foods like leafy green vegetables, beans, citrus fruits, or whole grains.

You drink a lot of alcohol. Over time, this makes it harder for your intestines to absorb folate.

You have stomach problems. When your small intestine isn’t working the way it should, your body has a hard time hanging on to as much folate as it needs. For instance, people with celiac disease are at risk for this type of anemia. People with cancer are, as well.

You’re pregnant. A growing baby absorbs lots of folic acid from its mother.

A medication you’re taking is keeping your body from absorbing folate. This is the case with many medicines, such as phenytoin (Dilantin), methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates.

You were born with it. Problems absorbing enough folic acid can run in families. Infants with this problem need treatment right away to avoid long-term problems.

What Are the Symptoms?

Any kind of anemia can cause problems like:

If your anemia is caused by not having enough folate in your body, you could also notice the following:

How Is It Diagnosed?

To check for folate deficiency anemia, your doctor will ask you about your symptoms. They might also order blood tests and a complete blood count (CBC) test to measure the number and appearance of your red blood cells. If you have a lack of folate, your red blood cells look large and immature.

What’s the Treatment?

Folate deficiency anemia is prevented and treated by eating a healthy diet. This includes foods rich in folic acid, such as nuts, leafy green vegetables, enriched breads and cereals, and fruit. Your doctor will also likely prescribe you a daily folic acid supplement. If your folate levels return to normal, you may be able to stop taking it. But some people need a supplement for life.

Are There Any Complications?

Most cases of this type of anemia are easily treated. Severe effects are rare. But if you’ve been without folate for a long time, your risk of having some types of cancer and heart disease goes up. You might also find it harder to get pregnant. Your fertility will likely return to normal once you’re getting enough folate again.

If you are pregnant and don’t get enough folate, you are at higher risk of a placental abruption. This happens when the placenta pulls away from the uterus wall and disrupts blood flow to your fetus. It can cause pain and increased bleeding. Your fetus could die.

Your unborn child can also be harmed by too little folate. They may have a low birth weight or be born before their due date. They are also more likely to have spina bifida, a disease that causes damage to the spinal cord and nerves.

When Should I Call the Doctor?

As soon as you notice any symptoms. If left untreated, some of these could get worse and your anemia could cause lasting damage.

Show Sources


Mayo Clinic: “Low Hemoglobin Count,” “Vitamin Deficiency Anemia.”

NHS: “Vitamin B12 or Folate Deficiency Anaemia,” “Vitamin B12 or folate deficiency anaemia -- Symptoms,” Vitamin B12 or Folate Deficiency Anaemia -- Complications.”

University of Rochester Medical Center: “Folate-Deficiency Anemia.”

The Journal of Nutrition: “Metabolic interactions of alcohol and folate.”

European Review of Medical and Pharmacological Sciences: “Folate in gastrointestinal health and disease.”

Drugs: “Drugs and Folate Metabolism.”

Novant Health/Matthews Medical Center: “Anemia of Folate Deficiency.”

CDC: “Spina Bifida.”

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