Understanding folate results

Overview

Folate is a B vitamin (vitamin B9) that helps your body make healthy red blood cells and DNA. A folate test measures how much folate is in your blood. Low levels can cause a type of anemia, while high levels are usually harmless but may be a sign of taking too many supplements.

Folate deficiency is less common in countries where flour and grains are fortified with folic acid, but it still affects some people, especially those with poor diets, absorption problems, or increased needs like during pregnancy.

It can affect anyone, but it is more common in people with a poor diet, pregnant women, people who drink too much alcohol, older adults, and people with digestive conditions like Crohn’s disease or celiac disease.

Symptoms

Common symptoms

• Feeling very tired and weak
• Pale skin
• Shortness of breath, especially when active
• Irritability or mood changes
• Sore, red tongue

Symptoms in children

• Slow growth and development
• Irritability
• Getting sick often

Symptoms in older adults

• Confusion or trouble remembering things
• Loss of energy
• Feeling depressed

Causes

Main causes

• Not eating enough foods rich in folate (like leafy greens, beans, citrus fruits)
• Problems absorbing folate from food due to conditions like celiac disease, Crohn’s disease, or after stomach surgery
• Increased need for folate during pregnancy, breastfeeding, or times of rapid growth
• Heavy alcohol use, which interferes with how your body uses folate

Risk factors

• Having a diet low in fruits and vegetables
• Being pregnant or breastfeeding
• Having a condition that affects how your body absorbs nutrients
• Taking certain medicines that lower folate levels (such as some used for seizures or cancer)
• Drinking alcohol regularly in large amounts

When to see a doctor

See a doctor urgently if:

• If you have chest pain, trouble breathing, or feel like you might faint
• If you notice unusual bruising or bleeding

Book a routine appointment if:

• If you have ongoing tiredness, pale skin, or a sore tongue
• If you are pregnant or planning to become pregnant and want to check your folate levels
• If you have a condition that affects how your body absorbs nutrients and you haven’t been tested recently

Diagnosis

A healthcare provider will take a sample of your blood to measure the amount of folate. This is usually done in a lab. Sometimes they also measure vitamin B12 because low levels of both can cause similar symptoms.

Tests that may be done

• Serum folate test – this checks the folate in the liquid part of your blood
• Red blood cell (RBC) folate test – this shows how much folate your body has stored over time

What to expect at your appointment

A simple blood draw from your arm. You may be asked to fast (not eat or drink anything except water) for a few hours before the test. The results usually come back in a few days. Your doctor will explain what they mean.

Treatment

Treatment for low folate focuses on increasing your folate levels through changes in diet or by taking supplements as recommended by your doctor. High folate levels usually do not need treatment, but your doctor may check why they are high.

Self-care at home

• Eat more folate-rich foods such as dark green leafy vegetables (spinach, kale), citrus fruits, beans, peas, lentils, and fortified cereals or breads
• Limit alcohol, which can lower folate levels
• If you are pregnant or planning pregnancy, take a daily supplement with folic acid as advised by your doctor

Medical treatments

Your doctor may recommend a folic acid supplement, which is the lab-made form of folate. The dose and how long you take it will depend on your age, your test results, and whether you have any other health conditions. Always follow your doctor’s advice. Do not take high-dose supplements without checking with a healthcare provider.

When is surgery considered?

Surgery is not used to treat abnormal folate levels.

Living with this condition

Most people with low folate feel much better within a few weeks of starting treatment. You can manage your levels by eating a balanced diet and taking any supplements as prescribed. It may take a few months for your stores to fully recover.

Lifestyle tips

• Eat a variety of fruits, vegetables, and legumes every day
• If you drink alcohol, try to cut down or stop – even a little can affect folate levels
• Get regular checkups to monitor your levels if you have an ongoing condition that affects absorption

Diet and exercise

A diet rich in natural folate and fortified foods is key. Regular physical activity can help improve your energy and overall health once your energy levels start to improve. Your doctor can guide you on when it is safe to exercise.

Mental health and emotional wellbeing

Fatigue and other symptoms can make you feel down or frustrated. It is normal to feel worried about your health. Remember that folate deficiency is treatable, and many people feel much better after treatment. If you feel anxious or depressed, talk to your doctor – they can offer support.

Prevention

Yes, in most cases. Eating a balanced diet with plenty of folate-rich foods and taking a folic acid supplement if you are pregnant or planning to become pregnant can help prevent low levels. Limiting alcohol also helps.

Screening programmes

Routine screening for folate levels is not recommended for everyone, but your doctor may suggest it if you have risk factors, symptoms, or a condition that affects absorption. Pregnant women are often advised to take folic acid without needing a blood test first.

Complications

If left untreated

• Megaloblastic anemia (large, immature red blood cells that do not carry oxygen well)
• Fatigue, weakness, pale skin, and shortness of breath
• In pregnancy, low folate increases the risk of neural tube defects (like spina bifida) in the baby
• Possible higher risk of heart disease and depression if low levels continue long-term

Long-term outlook

Folate deficiency is highly treatable. Most people respond well to dietary changes and supplements, and symptoms usually improve within weeks. With proper treatment, you can expect to feel much better and avoid long-term problems. For high folate levels, the outlook is generally good – they often resolve when the cause is addressed.

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