Why folate deficiency causes anemia

If the cause can be identified, it will help to determine the most appropriate treatment. For example, you may have additional blood tests to check for a condition called pernicious anaemia. This is an autoimmune condition where your immune system produces antibodies to attack healthy cells , which means you're unable to absorb vitamin B12 from the food you eat.

Tests for pernicious anaemia aren't always conclusive, but they can often give your GP a good idea of whether you have the condition. A dietitian can devise a personalised eating plan for you to increase the amount of vitamin B12 or folate in your diet. The treatment for vitamin B12 or folate deficiency anaemia depends on what's causing the condition.

Most people can be easily treated with injections or tablets to replace the missing vitamins. Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin.

At first, you'll have these injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give the injections. After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet. The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which isn't related to your diet.

Read more about the causes of vitamin B12 or folate deficiency. If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals.

Alternatively, you may need to have an injection of hydroxocobalamin twice a year. People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.

Although it's less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved. If you're a vegetarian and vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract including Marmite , as well as some fortified breakfast cereals and soy products.

Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain. If your vitamin B12 deficiency isn't caused by a lack of vitamin B12 in your diet, you'll usually need to have an injection of hydroxocobalamin every three months for the rest of your life.

If you've had neurological symptoms symptoms that affect your nervous system, such as numbness or tingling in your hands and feet caused by a vitamin B12 deficiency, you'll be referred to a haematologist, and you may need to have injections every two months.

Your haematologist will advise on how long you need to keep taking the injections. For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin.

This is because hydroxocobalamin stays in the body for longer. If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every three months. Cyanocobalamin injections aren't routinely available on the NHS.

However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin. To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake. Most people need to take folic acid tablets for about four months.

However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer — possibly for life.

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. To ensure your treatment is working, you may need to have further blood tests. A blood test is often carried out around days after starting treatment to assess whether treatment is working.

This is to check your haemoglobin level and the number of the immature red blood cells reticulocytes in your blood. Another blood test may also be carried out after approximately eight weeks to confirm your treatment has been successful.

If you've been taking folic acid tablets, you may be tested again once the treatment has finished usually after four months. Most people who have had a vitamin B12 or folate deficiency won't need further monitoring unless their symptoms return, or their treatment is ineffective. If your GP feels it's necessary, you may have to return for an annual blood test to see whether your condition has returned. As most cases of vitamin B12 deficiency or folate deficiency can be easily and effectively treated, complications are rare.

However, complications can occasionally develop, particularly if you've been deficient in either vitamin for some time. All types of anaemia, regardless of the cause, can lead to heart and lung complications as the heart struggles to pump oxygen to the vital organs.

A lack of vitamin B12 can cause neurological problems issues affecting your nervous system , such as:. Vitamin B12 deficiency can sometimes lead to temporary infertility an inability to conceive. This usually improves with appropriate vitamin B12 treatment.

If you have a vitamin B12 deficiency caused by pernicious anaemia a condition where your immune system attacks healthy cells in your stomach , your risk of developing stomach cancer is increased. If you're pregnant, not having enough vitamin B12 can increase the risk of your baby developing a serious birth defect known as a neural tube defect.

The neural tube is a narrow channel that eventually forms the brain and spinal cord. A lack of folate with or without anaemia can also cause complications, some of which are outlined below. As with a lack of vitamin B12, a folate deficiency can also affect your fertility. However, this is only temporary and can usually be reversed with folate supplements. Research has shown a lack of folate in your body may increase your risk of cardiovascular disease CVD. CVD is a general term that describes a disease of the heart or blood vessels, such as coronary heart disease CHD.

Research has shown that folate deficiency can increase your risk of some cancers, such as colon cancer. A lack of folate during pregnancy may increase the risk of the baby being born prematurely before the 37th week of pregnancy or having a low birthweight. The risk of placental abruption may also be increased. Folate dissolves in water, which means your body is unable to store it for long periods of time.

Your body's store of folate is usually enough to last 4 months. This means you need folate in your daily diet to ensure your body has sufficient stores of the vitamin. Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons.

Good sources of folate include broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. If you do not regularly eat these types of foods, you may develop a folate deficiency. Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a fad diet that does not involve eating good sources of folate. Sometimes your body may be unable to absorb folate as effectively as it should.

This is usually caused by an underlying condition affecting your digestive system, such as coeliac disease. This can be caused by an underlying condition that affects one of your organs, such as:. Some types of medicines reduce the amount of folate in your body or make the folate harder to absorb. These include some anticonvulsants medicines used to treat epilepsy , colestyramine, sulfasalazine and methotrexate. Your GP will be aware of medicines that can affect your folate levels and will monitor you if necessary.

Your body sometimes requires more folate than normal. This can cause folate deficiency if you cannot meet your body's demands for the vitamin. Premature babies born before the 37th week of pregnancy are also more likely to develop a folate deficiency because their developing bodies require higher amounts of folate than normal.

If you're pregnant or there's a chance you could get pregnant, it's recommended that you take a microgram folic acid tablet every day before pregnancy and until you're 12 weeks pregnant. Diet changes can help boost your folate level. Eat more green, leafy vegetables and citrus fruits. Folate-deficiency anemia most often responds well to treatment within 3 to 6 months. It will likely get better when the underlying cause of the deficiency is treated. Symptoms of anemia can cause discomfort.

In pregnant women, folate deficiency has been associated with neural tube or spinal defects such as spina bifida in the infant. Experts recommend that women take micrograms mcg of folic acid every day before they get pregnant and through the first 3 months of their pregnancy.

Antony AC. Megaloblastic anemias. Hematology: Basic Principles and Practice. Philadelphia, PA: Elsevier; chap This might happen if you drink too much alcohol or have severe kidney problems that require dialysis.

You take certain medicines, such as some used for cancer, rheumatoid arthritis , and seizures. What are the symptoms? Anemia may make you: Feel weak and tired.

Feel lightheaded. Be forgetful. Feel grouchy. Lose your appetite and lose weight. Have trouble concentrating. How is it diagnosed? How is it treated? To treat the anemia, you can take folic acid pills each day to bring your folate level back up.

Why is folic acid important during pregnancy? Credits Current as of: September 23, Top of the page Next Section: Related Information.