Folate deficiency: myths, facts and what to do

We published one clear piece in September 2024 that cuts through the noise around folate (and folic acid). If you’re confused about symptoms, supplements, or who needs more folate — this page sums up the essentials so you can act fast.

Myths vs facts — quick and useful

Myth: "Folate and folic acid are the same, so it doesn’t matter which one you take." Fact: Folate is the natural form found in food. Folic acid is the synthetic form used in fortified foods and many supplements. Most people do fine with folic acid, but some people with certain gene variants (like MTHFR) may do better with methylated forms such as 5‑MTHF. If you’re unsure, ask your clinician.

Myth: "Only pregnant people need folate." Fact: Pregnancy raises folate needs because folate prevents neural tube defects. But folate also helps make red blood cells and supports DNA repair and cell growth — important for everyone, especially people with heavy alcohol use, certain medications, or malabsorption issues.

Recognize real symptoms and risks

Low folate commonly shows up as fatigue, shortness of breath, pale skin, and weakness due to megaloblastic anemia. Less obvious signs include irritability, poor concentration, and digestive troubles. Severe deficiency can cause complications in pregnancy and raise homocysteine levels, which are linked to vascular risk.

Who’s at higher risk? Pregnant people, people who drink heavily, older adults, people on drugs like methotrexate or some anticonvulsants, and those with celiac disease or other gut problems. If you fall into any of these groups, consider testing.

Testing is simple: labs measure serum folate and sometimes RBC folate. High homocysteine with low folate suggests functional deficiency. Don’t self‑diagnose — talk to a doctor before starting high‑dose supplements.

Food first: eat leafy greens (spinach, kale), legumes (lentils, chickpeas), asparagus, and fortified cereals. These choices raise folate naturally and help overall nutrition.

Supplement basics: a typical preventive dose is 400 mcg of folic acid daily for nonpregnant adults. Pregnant people usually get 400–800 mcg before and during early pregnancy; some need higher doses under medical advice. If you have a genetic variant or absorption issue, a methylated form (5‑MTHF) might be recommended.

Watch interactions: some meds interfere with folate. If you take prescription drugs long‑term, check with your pharmacist or doctor about folate status.

Practical next steps: 1) Add folate-rich foods to meals this week. 2) If you’re pregnant or planning pregnancy, make folic acid part of your routine and confirm dose with a provider. 3) If you have unexplained fatigue or risk factors, ask for a folate test. 4) Avoid mega‑dosing without medical advice.

Want more details? Read the full September post for a straight talk on how to tell myth from fact and what to do next. If something sounds off about your health, get checked — folate issues are common and treatable when caught early.