Folate Deficiency: Symptoms & Advice From Our In-house Doctor

Author Dr Kate Garside

Advice from our in-house doctor: Dr Kate Garside

This is for informational purposes only. For medical advice or diagnosis, please consult your GP.

Folate is one of those nutrients that quietly does an enormous amount of work in the background. Most people have never given it a second thought until a blood test comes back low, or until they start noticing symptoms that are difficult to explain. Folate deficiency is something GPs see fairly regularly, particularly in people who are pregnant, those who drink more alcohol than they realise, and anyone managing a long term digestive condition.

In this article I want to explain what folate actually does, why levels can drop, and what signs to look out for. I will also cover when it is sensible to test at home and when you should book in with your GP instead.

What is folate, and why does the body need it?

Folate is a B vitamin, also known as vitamin B9. Its synthetic form, added to supplements and fortified foods, is called folic acid. Folate plays a central role in producing new cells, and it is particularly important for making healthy red blood cells. Without enough folate, red blood cells cannot divide and mature properly, which is where many of the symptoms of deficiency come from.

Folate also works closely alongside vitamin B12. The two vitamins are involved in many of the same processes, and a shortage of either one can produce very similar symptoms and a similar type of anaemia.

How much folate do you actually need?

Most adults need around 200 micrograms of folate a day. This is usually achievable through a varied diet that includes vegetables, fruit and fortified foods such as breakfast cereals and bread. Since 2021, folic acid has also been added to non wholemeal wheat flour in the UK, which has helped reduce the number of people with very low intakes.

Pregnant women and those trying to conceive have a higher requirement and are usually advised to take a folic acid supplement. I have covered this in more detail further down this article.

What causes folate deficiency?

Folate deficiency generally develops for one of a few reasons.

• Not eating enough folate rich foods: a diet low in vegetables, legumes and fortified foods.
• Overcooking vegetables: folate is water soluble and heat sensitive, so it breaks down easily when boiled for long periods.
• Alcohol excess: regular heavy drinking interferes with folate absorption and storage in the liver.
• Malabsorption conditions: coeliac disease, Crohn's disease and other bowel conditions can all reduce how well folate is absorbed.
• Pregnancy: the growing baby increases demand for folate considerably.
• Certain medications: some anticonvulsants and drugs such as methotrexate can lower folate levels.

Common signs and symptoms of folate deficiency

Symptoms tend to develop gradually, which is part of why folate deficiency is so often missed for months before it is picked up. Typical symptoms include:

• Persistent tiredness and low energy
• Pale skin
• Shortness of breath, particularly on exertion
• Headaches and poor concentration
• A sore or inflamed tongue
• Mouth ulcers
• Irritability and low mood
• Reduced appetite

 

None of these symptoms are unique, or specific to folate deficiency, which is exactly why testing is so useful rather than relying on symptoms alone.

Folate deficiency anaemia explained

When folate levels drop low enough, the body struggles to produce healthy red blood cells. This leads to a condition called megaloblastic anaemia, where red blood cells are larger than normal and less able to carry oxygen efficiently. Vitamin B12 deficiency causes an almost identical picture, which is why doctors usually check both together when investigating this type of anaemia.

A simple first step at home is to check your haemoglobin level, as low haemoglobin is often the clue that prompts further investigation. Our haemoglobin meter starter pack gives you a quick reading from a finger prick sample, and our home ferritin test kit can help rule out iron deficiency as a separate or additional cause. A specific folate level, however, still needs to be measured through a laboratory blood test arranged by your GP.

Best food sources of folate

A good folate intake is usually achievable through everyday food choices. An easy way to remember where folate comes from is to think of the word foliage, since dark green leafy vegetables are among the richest sources.

Food group	Good sources
Dark leafy greens	Spinach, kale, broccoli, Brussels sprouts
Legumes	Lentils, chickpeas, kidney beans, black eyed peas
Fortified foods	Breakfast cereals, bread, some flours
Fruit	Oranges, grapefruit, bananas
Other	Liver, eggs, nuts and seeds

A helpful tip for home cooking is to steam or microwave vegetables rather than boiling them, since folate leaches out into cooking water and is easily lost when boiled for a long time.

Folate and pregnancy

Folate is particularly important during early pregnancy because it supports the development of the baby's neural tube, which goes on to form the brain and spinal cord. This is why women who are trying to conceive, or who are in the first trimester, are advised to take a daily folic acid supplement, usually 400 micrograms, in addition to eating folate rich foods.

Some women are advised to take a higher dose depending on individual risk factors, so it is always worth checking with your GP or midwife what is right for you. If you think you may be pregnant, you can confirm this with one of our pregnancy test kits before arranging your antenatal care.

When should you see your GP?

Mild dietary shortfalls can often be corrected simply by adjusting what you eat. However, there are situations where it is important to seek proper medical advice rather than trying to manage things alone.

See your GP if: you have persistent unexplained tiredness, a sore tongue or mouth ulcers that will not settle, pins and needles in your hands or feet, or if you are planning a pregnancy and want advice on supplementation.

Numbness, tingling or difficulty with balance can sometimes point towards vitamin B12 deficiency rather than folate alone, and this distinction matters because the treatment approach differs. Your GP can arrange the correct blood tests to work out exactly what is going on.

Testing for folate deficiency at home

While a definitive folate level requires a laboratory blood test, home testing has a genuinely useful role to play. Checking your haemoglobin and ferritin levels at home can flag up anaemia early, giving you a good reason to book a GP appointment for a full blood count and folate and B12 levels. This is particularly useful if you are monitoring an existing diagnosis, or if you simply want more regular insight into your general health between GP visits.

Monitoring your health at home with Valuemed

Understanding what is happening inside your body is one of the best ways to stay on top of your long term health. At Valuemed, we specialise in supplying reliable, accurate home testing kits and medical equipment to households and professionals across the UK. Whether you are keeping an eye on anaemia, monitoring an existing condition, or simply want more regular insight into your health between GP appointments, our range of test kits makes it easy to track your results over time and share them with your doctor when needed.