Folic acid, a B vitamin, is an essential vitamin for the production of red blood cells. As such, a deficiency in this vitamin can cause anemia. A reduced number of red cells deprives body tissues of an adequate supply of oxygen, resulting in the classic symptoms of anemia.

The disorder is particularly common among infants, adolescents during a growth spurt, pregnant or lactating women, the elderly, smokers, alcoholics, and those on fad diets or who suffer from intestinal disorders. It can be accompanied by iron deficiency anemia.

What Causes Folic Acid Deficiency Anemia?

  • Folic acid deficiency is due to either insufficient dietary intake of folic acid or, rarely, an inability of the intestine to absorb folic acid properly.
  • Alcoholism interferes with the body’s ability to absorb and use folic acid; many alcoholics also have poor diets lacking in folic acid.
  • Intestinal disorders such as tropical sprue, celiac disease, inflammatory bowel disease, or bowel resection may impede folic acid absorption.
  • The body does not store large amounts of folic acid, and at certain times in the life cycle (such as childhood, pregnancy, and when breastfeeding) the body’s demands for it outweigh dietary intake.
  • Certain medications (such as anticonvulsants, antibiotics, oral contraceptives, and anticancer drugs) can lead to folic acid deficiency.
  • Risk of folic acid deficiency increases in association with certain skin diseases, including psoriasis and exfoliative dermatitis.
  • Certain blood disorders in which there is an increased demand for red cells (such as sickle cell anemia or thalassemia) can lead to depletion of body folate stores unless supplemental folic acid is provided.
  • Pregnancy, during which the body needs 8 times more folic acid than usual, increases the risk for folic acid anemia.
  • Overcooking foods destroys folic acid.
  • Vitamin B12 or vitamin C deficiency can cause folic acid anemia.

Symptoms of Folic Acid Deficiency Anemia

  • Severe fatigue and weakness
  • Paleness (pallor)
  • Shortness of breath
  • Heart palpitations or noticeably rapid heartbeat upon exertion
  • Sore, red, and glazed-looking tongue
  • Loss of appetite leading to weight loss
  • Abdominal swelling
  • Nausea, vomiting and diarrhea
  • Headache
  • Irritability

Prevention of Folic Acid Deficiency Anemia

  • Eat a healthy, well-balanced diet. The main sources of folic acid include fresh green leafy vegetables, raw fruit, mushrooms, lima and kidney beans, yeast, and organ meats such as liver and kidney. Avoid fad diets.
  • Avoid overcooking foods rich in folic acid (overcooking destroys their vitamin content).
  • Consume alcohol only in moderation.
  • Be sure to see your doctor regularly during pregnancy. Take natural prenatal vitamins and supplements as recommended by your health care practitioner.
  • Do not smoke as smoking increases vitamin requirements.

Diagnosis of Folic Acid Deficiency Anemia

  • A blood test that measures folic acid in red blood cells can determine whether the body’s folate stores are adequate.
  • A patient history is taken and physical examination is performed.
  • Diagnostic tests may include laboratory blood studies, a Schilling test to measure vitamin B-12 levels and a therapeutic trial of vitamin B-12.
  • Bone marrow examination is used very rarely.
  • If the anemia is thought to be caused by a problem in the digestive tract, a barium study of the digestive system may be performed.

How Folic Acid Deficiency Anemia Is Treated

  • Proper diet is frequently all that is required to correct the problem.
  • Folic acid tablets can quickly correct the disorder. Depending on the cause of the deficiency, supplemental folic acid may be needed for a time; in rare instances, injections of folic acid are necessary.
  • Elimination of causative factors (poor diet or excessive drinking, for example) is essential.
  • Treatment of an underlying intestinal disorder causing folic acid deficiency may serve as a cure.

When to Call a Doctor

  • Make an appointment with your doctor if you have symptoms of anemia.
  • If you’re already being treated for folic acid deficiency and symptoms don’t improve after two weeks, notify your doctor.
  • All women who are considering pregnancy should discuss folic acid supplementation with their doctors. Such supplementation during the early weeks of pregnancy decreases the incidence of nerve (neural) defects in a developing child.


Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 17 Aug 2011

Last Modified: 02 Oct 2014