What Is Folate? What Causes Low and High Folate Levels?

Folate (vitamin B9) is an essential micronutrient that plays a role in vital processes in the body such as DNA synthesis, cell division and red blood cell production, and is critically important for maintaining healthy cellular function at every stage of life and for preventing birth defects. It occurs naturally in legumes, certain fruits, nuts and various other foods, above all in dark green leafy vegetables.

What Is Folate?

Folate, known as vitamin B9, is a vitamin involved in fundamental processes in the body such as DNA synthesis and cell division. It is especially important for the healthy development of rapidly dividing cells. It also plays a role in the formation of red blood cells. For this reason, low folate should not be regarded simply as a nutrition-related issue and should be assessed with blood tests when necessary. Folic acid, on the other hand, is the synthetic form of folate used in supplements and some fortified foods. Both are related to vitamin B9, but they are not exactly the same thing.
Folate intake becomes particularly important before pregnancy and in early pregnancy. Adequate folic acid intake is important for the healthy development of the neural tube, which forms in the very early stages of pregnancy. For this reason, in people who are planning a pregnancy or who may become pregnant, the use of folate medication or supplements is evaluated in line with physician recommendations. A daily intake of 400 micrograms of folic acid has been shown to help prevent certain serious birth defects known as neural tube defects.
The functions of folate in the body are not limited to this. Because it plays a role in processes such as cell renewal, blood cell production and the synthesis of genetic material, it is needed at every stage of life. When inadequate intake persists for a long time, problems such as anaemia may develop.

What Does Folate Do?

The main function of folate is to contribute to cell division and the formation of new cells. The tissues of the human body are constantly renewed. Blood cells are among the cells that renew rapidly. Since folate is involved in these processes, adequate levels help maintain normal blood cell production.
Vitamin B9 also plays a role in DNA synthesis and in the metabolism of certain amino acids. For this reason, deficiency may particularly affect rapidly dividing cells. In prolonged folic acid deficiency, a form of anaemia called megaloblastic anaemia may develop.
The importance of folate becomes even more pronounced during pregnancy. The embryo's nervous system begins to develop in the first weeks of pregnancy. Since the structure called the neural tube develops very early in pregnancy, it is important that adequate folic acid is taken before conception. Regarding when folic acid should be taken, experts recommend regular use starting from the pregnancy-planning stage. Folic acid use has been shown to reduce the risk of neural tube defects.
Folate is also involved in the formation of red blood cells. Therefore, low folate levels may be associated with anaemia. However, folate deficiency is not the only cause of anaemia. Other causes such as iron deficiency and vitamin B12 deficiency may also lead to similar complaints. Therefore, it is not correct to diagnose folate deficiency based solely on symptoms such as tiredness or weakness.

What Is Low Folate?

Low folate refers to a condition in which folate levels in the blood or body are below the expected level. Inadequate nutrition may be an important factor in its development. However, nutrition is not the only cause.
Insufficient consumption of folate-containing foods over a long period may lead to depletion of folate stores. In addition, certain diseases that affect the absorption of nutrients from the intestines may also cause folate deficiency. In malabsorption disorders such as coeliac disease, vitamins taken in from food may not pass into the body sufficiently.
In some cases, increased requirements may also predispose to low folate. During pregnancy, folate requirements increase because cell division and tissue development accelerate. This is why ensuring adequate folic acid intake in advance is important for people planning a pregnancy.
When low folate is found, simply starting folic acid may not be sufficient. The cause of the deficiency needs to be understood. Nutritional deficiency, an absorption problem or another health problem may be involved.

What Is High Folate?

High folate may mean that the folate level measured in a blood test is above the reference range provided by the laboratory. However, a high folate result on its own is generally not regarded as a definitive indicator of a specific disease.
Folate levels may be affected by supplements used and by dietary habits. In particular, the use of folate supplements or vitamin products containing folic acid may cause the blood level to rise. For this reason, it is important to know which vitamins and medications are being used when the laboratory result is evaluated.
A high blood result does not always mean that there is a harmful amount of folate in the body. The method by which the test was performed, the laboratory's reference range and the supplements used should be evaluated together.
High-dose folic acid in particular should not be continued indiscriminately. Even if no obvious side effects occur, long-term high-dose use may mask the signs of anaemia due to B12 deficiency, because folate and vitamin B12 are metabolically interrelated. Therefore, high-dose supplements should not be used without the recommendation of a healthcare professional.

Which Foods Contain Folate?

Folate occurs naturally in many foods. Dark green leafy vegetables are among the important sources of folate. Spinach and similar green leafy vegetables can contribute to folate intake in the daily diet.
Legumes are also valuable sources of folate. Options such as lentils, dried beans and peas can support folate intake in the diet. Nuts and some fruits also contain folate.
Some fruits, such as oranges and other citrus fruits as well as strawberries, can provide folate. Including different food groups in a balanced diet helps diversify folate intake.
There is an important distinction here between folate and folic acid. While folate refers to the forms of vitamin B9 found in natural foods, folic acid is the synthetic form used particularly in supplements and in some foods fortified with folic acid.
Some flours, breads, pastas, rice and breakfast cereals may contain folic acid. The folic acid content may be indicated on the labels of fortified products.
Rather than evaluating foods solely by their folate content, it is more appropriate to consider them within the overall balance of the diet. The fact that a food contains folate does not by itself determine the need for supplementation.

What Is Serum/Plasma Folate?

Serum or plasma folate is one of the laboratory measurements performed to assess the amount of folate in the blood. In everyday language, it may also be referred to as a folate test or blood folate.
Serum folate levels may be affected by recent folate intake. Therefore, a single result may not always fully reflect the body's long-term folate status. Dietary habits, supplement use and the person's general state of health are taken into account when the result is evaluated.
When folate is found to be low in a blood test, it is important to understand the reason. Particularly if anaemia is present, other blood parameters such as a complete blood count may also be evaluated. Vitamin B12 levels may likewise be important.
A folate result should not be interpreted on its own. It should be interpreted by considering the laboratory's reference range and the clinical picture together.

What Is Blood Folate?

Blood folate is a laboratory measurement that shows the amount of folate circulating in the body. It is assessed on a blood sample and may be used particularly when folate deficiency is suspected.
Low blood folate may arise from various causes such as inadequate intake, as well as malabsorption disorders or increased requirements. For this reason, when a low result is seen, the cause should be investigated rather than immediately starting high-dose folic acid.
Because blood folate levels may be affected by diet and supplements, results need to be considered together with clinical evaluation. Particularly in people with signs of anaemia, other assessments such as a complete blood count and B12 may also be necessary.
A normal blood folate level does not always mean that the entire folate metabolism is flawless. This is why it is important to evaluate laboratory results together with the person's general condition.

What Is a Folate Value?

The folate value refers to the amount of folate measured in a blood test. Results are generally evaluated together with the measurement method and the reference range used by the laboratory.
It is not correct to give a single normal value for folate that applies to all laboratories. Reference ranges may vary depending on the method used. Therefore, when deciding whether a test result is low or high, the reference range stated in the report should be taken into account.
When interpreting a folate value, looking only at the number is not sufficient. Age, pregnancy status, dietary habits, vitamins used, existing diseases and other blood results may be included in the evaluation.
For example, if a low folate result is accompanied by anaemia, the effect of folate deficiency on blood cells may be investigated. However, a similar blood picture may also have other causes, such as B12 deficiency.

Why Does Folate Drop?

One of the most fundamental reasons for a drop in folate is inadequate folate intake. A folate-poor diet maintained for a long time may cause folate levels in the body to decrease.
Diseases affecting vitamin absorption from the intestines may also lead to low folate. Particularly in conditions that impair nutrient absorption in the small intestine, folate that is taken in may not be adequately absorbed by the body.
During periods of increased folate requirement such as pregnancy, the likelihood of developing a deficiency may also increase if adequate intake is not ensured. In addition, certain medications and health conditions may affect folate metabolism. In such cases, the medications being used need to be evaluated by a physician.
Heavy alcohol consumption may also be considered among the factors that can adversely affect folate metabolism and dietary habits.
When low folate is detected, the aim should not be merely to raise the value. The cause of the deficiency needs to be identified and appropriate treatment planned.

What Does Folate Deficiency Cause?

Folate deficiency may particularly affect the production of blood cells. In marked and prolonged deficiency, megaloblastic anaemia may develop. As a result, anaemia-related complaints such as weakness, tiredness, lack of strength, dizziness or shortness of breath may occur.
However, these symptoms are not specific to folate deficiency. Iron deficiency, B12 deficiency, chronic diseases and many other conditions may cause similar complaints. Therefore, folate deficiency cannot be asserted based on symptoms alone.
Folate deficiency is also important with regard to pregnancy. Inadequate folic acid intake in early pregnancy may increase the risk of neural tube defects. For this reason, it is important to ensure adequate folic acid intake before pregnancy is planned.
Adequate folate intake is also important in childhood and periods of growth because cell division is intense. In adulthood, it is necessary for blood cell production and cellular metabolism.
When folate deficiency is suspected, a blood test and physician evaluation are important. Using supplements alone without identifying the underlying cause of the deficiency may not completely resolve the problem.

What Should the Folate Level Be?

It is not correct to answer the question “What should the folate level be?” with a single number. The reference ranges used by laboratories for serum folate assessed in a blood test may differ.
Therefore, the reference range on the result sheet should be taken into account. The range given next to the test result is used as the basis for normal assessment. Nevertheless, looking only at the reference range is not sufficient either.
The folate value may be affected by factors such as both diet and supplement use. For this reason, low or high results need to be evaluated together with the person's state of health.
In the context of pregnancy, the evaluation is not limited to the blood folate value alone. For people planning a pregnancy or who may become pregnant, a daily intake of 400 micrograms of folic acid is particularly important. Taking this amount regularly helps reduce the risk of neural tube defects.
During pregnancy or in certain health conditions, requirements may vary from person to person. Therefore, folic acid above the standard dose should not be used without a physician's recommendation.

Is Folate the Same as Folic Acid?

Folate and folic acid are not the same thing, but both are related to vitamin B9. Folate refers to the forms of vitamin B9 that occur naturally in foods. Folic acid, on the other hand, is the synthetically produced form used particularly in supplements and fortified foods.
Although the two terms may be used interchangeably in everyday speech, there is a scientific difference between them. The concept of folic acid is of particular importance, especially in the context of pregnancy.
The effect of folic acid in preventing neural tube defects has been scientifically demonstrated. A daily intake of 400 micrograms of folic acid is important before conception and in early pregnancy.
Therefore, although obtaining folate from natural foods is part of a healthy diet, whether folic acid supplementation is needed should be evaluated separately in people planning a pregnancy.

What Are the Symptoms of Low Folate?

When low folate becomes pronounced, general complaints such as weakness and tiredness may occur. If anaemia has developed, symptoms such as pallor, easy fatigability, shortness of breath, dizziness and palpitations may appear.
Loss of appetite, tenderness of the tongue or certain changes in the mouth may also be seen. However, none of these symptoms alone indicates folate deficiency.
Folate-deficiency anaemia and B12-deficiency anaemia may resemble each other. Therefore, particularly when anaemia is detected, it may be necessary to evaluate B12 and other relevant blood parameters rather than looking only at the folate value.
The absence of symptoms does not necessarily mean that the folate level is adequate. In some people, the deficiency may be noticed during laboratory investigations.
Particularly in people planning a pregnancy, it is important to evaluate folic acid intake without waiting for symptoms. Since neural tube development takes place very early in pregnancy, it is recommended that folic acid supplementation be started before pregnancy.

What Is a Folate Test?

A folate test is a blood test performed to assess the folate level in the blood. It is usually evaluated together with other laboratory tests when folate deficiency is suspected or when investigating the cause of anaemia.
The meaning of the test result may vary according to the person's general condition. Recent use of a folate-containing supplement may affect the result. Dietary habits may also play a role in the serum folate level.
A folate test alone does not establish the diagnosis of a disease. When a low result is seen, the cause of the deficiency is investigated by evaluating dietary habits, absorption problems, medications used and other blood values.
A high folate result does not automatically mean that a disease is present either. In particular, if vitamin or folic acid supplements are being used, this should be reported to the healthcare professional.
When evaluating a blood test result, the reference range given in the report should be used as the basis. Because of the different methods used in different laboratories, comparing with a single normal value found on the internet may be misleading.

What Raises Folate the Fastest?

The most appropriate way to raise folate levels is to act according to the cause of the deficiency. If the deficiency is diet-related, regular consumption of folate-containing foods may be supportive. Dark green leafy vegetables, legumes, some fruits and nuts are valuable in this respect.
When a marked deficiency is detected, it may not always be possible to reach adequate levels in a short time with food alone. In such cases, supplements containing folic acid may be used. However, the dose and duration of use of the product should be determined according to the degree and cause of the deficiency.
If there is a problem such as malabsorption, simply increasing folate-containing foods may not be sufficient. The underlying health problem needs to be evaluated first.
Pregnancy is a situation in which folic acid use is of particular importance. In people planning a pregnancy or who may become pregnant, a daily intake of 400 micrograms of folic acid helps reduce the risk of neural tube defects.
A higher dose should not be assumed to be faster-acting or more beneficial. Using more than necessary in supplements does not always mean a better outcome. In particular, long-term high-dose folic acid should not be used without the recommendation of a healthcare professional.

Are B12 and Folate the Same?

Vitamin B12 and folate are not the same vitamins. Folate is known as vitamin B9, while B12 is a different vitamin. However, because the two vitamins participate in certain shared biochemical processes in the body, the blood picture caused by their deficiencies may be similar.
Deficiency of either vitamin may lead to megaloblastic anaemia. Therefore, it is not possible to determine which vitamin is deficient based solely on the size of the blood cells or the symptoms of anaemia.
B12 deficiency may also have symptoms related to the nervous system. Complaints such as numbness, tingling and balance problems may require evaluation for B12 deficiency. For this reason, when anaemia or low folate is found, it is important that the B12 level is also evaluated where appropriate.
Folate and B12 are metabolically interrelated. Folic acid use may correct some of the blood findings caused by B12 deficiency, but it does not eliminate the underlying B12 deficiency. Therefore, B12 status should be taken into account, particularly before long-term high-dose folic acid use.
Folate and vitamin B12 cannot substitute for each other. Adequate levels of both vitamins are important for healthy blood cell production and normal cellular function.
When folate deficiency or an abnormal folate value is detected, treatment should be planned according to the person's state of health. Dietary habits, pregnancy status, medications used, other vitamin levels and any absorption problems should be evaluated together. Regular consumption of folate-containing foods is an important part of a healthy diet, but relying on diet alone may not be sufficient in every case for the treatment of a diagnosed deficiency.
Particularly in people with pregnancy plans, folic acid use should not be delayed and the appropriate dose should be evaluated with a healthcare professional. Adequate folic acid intake before pregnancy and in early pregnancy plays an important role in reducing the risk of neural tube defects.
When a low or high result is seen in a folate test, the result should not be interpreted on its own. The most appropriate approach is to carry out the evaluation by taking into account the laboratory's reference range and the person's general state of health. You can also receive specialist support from Yeditepe University Hospitals for your routine check-ups.

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