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Folate Deficiency: Symptoms, Causes & Prevention

https://my.clevelandclinic.org/health/diseases/22198-folate-deficiency

Folate is a B vitamin that your body needs to work properly. Folate is especially important if you're pregnant. Folate deficiency occurs when your body doesn’t get enough folate. Symptoms include fatigue, weakness, mouth sores and neurological issues. Folate deficiency can be prevented by eating a diet rich in foods that contain folate.

What is folate deficiency?

Folate deficiency is when your blood lacks the amount of vitamin B9 (folate) it needs to function properly. Folate deficiency can cause a wide range of symptoms and complications.

What is folate?

Folate is a B vitamin found naturally in many of the foods you eat. These foods include leafy greens, citrus fruits, nuts, beans, peas, seafood, eggs, dairy, meat, poultry and grains. Your body needs folate to make new red blood cells and DNA, the genetic material in your cells. Folate is especially important during pregnancy. Folate helps in the growth and development of the fetus and can help prevent birth defects.

What is folic acid?

Folic acid is a manmade (synthetic) form of folate. Your body can’t store large amounts of natural folate. But your body can easily absorb folic acid. As a result, it’s added to some of the foods you eat. Grains such as rice, bread, pasta and some cereals are enriched (fortified) with folic acid. Folic acid is also available as a dietary supplement.

What complications can occur due to folate deficiency?

When you don’t get enough folate, several complications can occur.

Folate deficiency during pregnancy

Folate deficiency during pregnancy can cause severe complications. Folate is important for the growth of the fetus's brain and spinal cord. Folate deficiency can cause severe birth defects called neural tube defects. Neural tube defects include spina bifida and anencephaly.

Folate deficiency can also increase your chances of placental abruption, a condition where your placenta separates from your uterus. In addition, your baby may be premature (preterm birth) and/or have a low birth weight. Studies have also shown low folate during pregnancy could lead to the development of autism in your child.

Folate deficiency anemia

Folate deficiency can also lead to folate deficiency anemia. Anemia can happen when your body doesn’t have enough healthy red blood cells. Your body needs red blood cells to carry oxygen to your body tissues. Folate deficiency anemia can also cause your body to produce abnormally large red blood cells that don’t function properly.

Other complications of folate deficiency can include:

- Infertility.
- Certain cancers.
- Cardiovascular disease.
- Depression.
- Dementia.
- Decreased cognitive function.
- Alzheimer’s disease.

What are the symptoms of folate deficiency?

One of the first symptoms of folate deficiency is extreme tiredness (fatigue). Other symptoms may include:

Anemia symptoms
- Paleness.
- Shortness of breath (dyspnea).
- Irritability.
- Dizziness.

Oral symptoms
- Tender, red tongue.
- Mouth sores or mouth ulcers.
- Reduced sense of taste.

Neurological symptoms
- Memory loss.
- Difficulty concentrating.
- Confusion.
- Problems with judgment.

Additional symptoms of folate deficiency may include:
- Lack of energy.
- Muscle weakness.
- Depression.
- Weight loss.
- Diarrhea.

What causes folate deficiency?

One of the most common causes of folate deficiency is not eating a healthy, balanced diet. A healthy diet includes foods that naturally contain folate or are enriched with folic acid. Other causes of folate deficiency can include:

- Digestive system diseases: Your digestive system doesn’t absorb folic acid well if you have a disease such as Crohn’s disease or celiac disease.
- Excessive alcohol use: People who drink large amounts of alcohol sometimes substitute alcohol for food. As a result, they don’t get enough folate.
- Overcooking your fruits and vegetables: When you overcook, the heat can destroy the naturally occurring folate in your produce.
- Hemolytic anemia: A blood disorder that occurs when your red blood cells are destroyed and can’t be replaced fast enough.
- Certain medications: Some anti-seizure drugs and ulcerative colitis drugs interfere with the proper absorption of folate.
- Kidney dialysis: A treatment for people with kidney failure.

How is folate deficiency diagnosed?

Your healthcare provider will ask about your medical history and your symptoms. They can diagnose folate deficiency through a blood test. The blood test measures the amount of folate in your blood. A low level of folate indicates a folate deficiency.

How is folate deficiency treated?

Your healthcare provider will treat your folate deficiency with a folic acid supplement. Most adults need 400 micrograms (mcg) of folic acid each day. Your healthcare provider will let you know how much you should take.

Your healthcare provider will also advise you to eat a healthy, balanced diet. A balanced diet includes fruits, vegetables and other foods that contain folate or are enriched with folic acid.

What can I expect if I have folate deficiency?

If you increase your folate intake, the effects of folate deficiency should start to reverse. It’s important to eat enough foods that contain folate or are enriched with folic acid. In addition, take a folic acid supplement. If you don’t get enough folate, complications such as anemia will be ongoing.

How can I prevent folate deficiency?

The best way to prevent folate deficiency is to eat a healthy diet that includes foods that contain folate or folic acid. Folate can be found naturally in:

- Peas, beans and legumes.
- Citrus fruits.
- Dark green leafy vegetables.
- Liver.
- Seafood.
- Eggs and dairy.
- Meat and poultry.

Folic acid can be found in enriched or fortified:

- Bread.
- Flour.
- Pasta.
- Rice.
- Cereal.

The amount of folate you need every day depends on your age and other factors. Most adults should get 400 micrograms (mcg) of folate daily. If you're pregnant, you should take a folic acid supplement to make sure you're getting enough folate each day. The average daily recommended amount of folate you need are:

Age/Life Stage    Recommended Amount of Dietary Folate Equivalents (DFEs)
Birth to age 6 months    65 mcg DFE
Infants ages 7 to 12 months    80 mcg DFE
Children ages 1 to 3 years    150 mcg DFE
Children ages 4 to 8 years    200 mcg DFE
Children ages 9 to 13 years    300 mcg DFE
Teenagers ages 14 to 18 years    400 mcg DFE
Adults ages 19 years and up    400 mcg DFE
While pregnant    600 mcg DFE
While breastfeeding    500 mcg DFE

If you’re taking any medication that interferes with folate absorption, you should also take a folic acid supplement.

What is cerebral folate deficiency?

Cerebral folate deficiency is a very rare disorder that occurs when there’s a shortage of folate in the fetus's brain. Babies born with cerebral folate deficiency develop normally during infancy. Then, they begin to slowly lose their mental skills and movement abilities about age 2. Intellectual disabilities, speech difficulties, seizures and difficulty coordinating movements (ataxia) can be severe. Cerebral folate deficiency is caused by a gene change (mutation).

What’s the difference between B12 and folate deficiency?

Vitamin B12 and folate are both important for the formation of your red blood cells and DNA. A deficiency in either vitamin can lead to fatigue, weakness and anemia. Unlike folate, B12 isn’t found in plants. B12 is mainly found in meat, eggs and dairy products. Vegetarians and vegans are at a high risk of B12 deficiency. Severe vitamin B12 deficiency can lead to complications such as depression, paranoia, delusions, memory loss, incontinence and loss of taste and smell.

What is MTHFR polymorphism?

MTHFR stands for methylenetetrahydrofolate reductase. Some people have a genetic change (mutation) in their MTHFR gene. If you have this mutation, you aren’t able to convert folate to its active form, 5-MTHF. This genetic mutation affects about 25% of Hispanic people, 10% of white people, 10% of Asian people and 1% of Black people. If you have this genetic mutation, you may benefit from using a folate supplement that contains 5-methyl-THF, the active form of folic acid.

A note from Cleveland Clinic

Folate is a vitamin that helps your body make red blood cells and DNA. Folate is especially important when you're pregnant, as it aids in fetal development. While folate deficiency is rare, it can cause severe complications such as birth defects and anemia. So it’s important to eat a diet rich in fruits, vegetables and other foods that contain folate or folic acid. In addition, you can take a folic acid supplement. Your healthcare provider can advise you on the amount of folate you should be getting each day.

The Kelpie by Herbert James Draper, 1913.

Now listening to Signals by Rush and Cameo by Dusty Springfield...

On Robson Street in Downtown Vancouver. Spring of 2019.

Robson Street is a major southeast-northwest thoroughfare in downtown and West End of Vancouver, British Columbia, Canada. Its core commercial blocks from Burrard Street to Jervis were also known as Robsonstrasse. Its name honours John Robson, a major figure in British Columbia's entry into the Canadian Confederation, and Premier of the province from 1889 to 1892. Robson Street starts at BC Place Stadium near the north shore of False Creek, then runs northwest past Vancouver Library Square, Robson Square and the Vancouver Art Gallery, coming to an end at Lost Lagoon in Stanley Park.

As of 2006, the city of Vancouver overall had the fifth most expensive retail rental rates in the world, averaging US$135 per square foot per year, citywide. Robson Street tops Vancouver with its most expensive locations renting for up to US$200 per square foot per year. In 2006, both Robson Street and the Mink Mile on Bloor Street in Toronto were the 22nd most expensive streets in the world, with rents of $208 per square feet. In 2007, the Mink Mile and Robson slipped to 25th in the world with an average of $198 per square feet. The price of each continues to grow with Vancouver being Burberry's first Canadian location and Toronto's Yorkville neighbourhood (which is bounded on the south side by Bloor) now commanding rents of $300 per square foot.

In 1895, train tracks were laid down the street, supporting a concentration of shops and restaurants. From the early to middle-late 20th century, and especially after significant immigration from postwar Germany, the northwest end of Robson Street was known as a centre of German culture and commerce in Vancouver, earning the nickname Robsonstrasse, even among non-Germans (this name lives on in the Robsonstrasse Hotel on the street). At one time, the city had placed streetsigns reading "Robsonstrasse" though these were placed after the German presence in the area had largely vanished.

Robson Street was featured on an old edition of the Canadian Monopoly board as one of the two most expensive properties.

 

Chronic fatigue doctor talks treatment after CFS found to be possible side effect of COVID-19 | FOX 2 Detroit

https://www.fox2detroit.com/news/chronic-fatigue-doctor-talks-treatment-after-cfs-found-to-be-possible-side-effect-of-covid-19

As if getting infected with COVID-19 isn't hard enough, doctors now believe some with more severe cases aren't fully recovering.

Some are experiencing chronic fatigue syndrome, something that is often misdiagnosed. But a Rochester doctor just published a book that could help.

"It went from I felt terrible, I was told nothing else they can do," said Melanie Lusnak.

She knows all too well the debilitating effects of chronic fatigue syndrome which she believes started in highschool. But was difficult to diagnose since she also suffered from anxiety and depression.

"I wanted to get up and go to work," she said. "I wanted to extra activities, hang out with my family, go shopping, but I couldn't move. I couldn't get out of bed. I felt like there was a 100-pound weight on me."

According to the CDC, more than a third of people who tested positive for COVID-19 aren't fully recovering from the virus and are experiencing long term symptoms including chronic fatigue.

That profound exhaustion and lack of mental clarity are what Lusnak suffered from, for more than a decade, until she met Dr. Joel L.. Young, the medical director of the Rochester Center for Behavioral Medicine.

In fact, he just published the book 'Understanding Chronic Fatigue' highlighting a treatment that is working for many of his patients.

"What I presented in the book, is a study we performed here in Rochester, Michigan, looking at 30 folks treated with lisdexamfetamine, and we found folks with chronic fatigue very well compared to placebo," he said.

Dr. Young says the medication he often prescribes for ADHD patients is helping people who are trying to cope with CFS although the FDA hasn't approved it as an official treatment.

"My goal in writing this book is to reach people who suffer from this, offer them some hope not only with medications but lifestyle changes as well," Dr. Young said.

Like Melanie, who says she finally feels like herself again.

"When anyone asks me how Dr. Young helped me, it sounds corny but I say he saved my life," she said.

Dr. Young recommends talking to your doctor to find what works for you. Although Melanie did not have COVID-19, she knows the challenge of chronic fatigue.