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Folate and B12 look the same in the blood count — if only folate is given, the warning sign disappears while the B12 deficiency goes on at the nerves.
Also known as: folate deficiency · vitamin B9 deficiency
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Folate, also called vitamin B9, is needed wherever cells divide quickly — in the marrow, in the lining of the gut, in the growing child before birth. The body’s store lasts only a few months, markedly shorter than for the related vitamin B12, so a shortage arises comparatively fast. The commonest reasons are a diet without green vegetables and pulses, regular alcohol, coeliac disease or chronic bowel inflammation, pregnancy with its raised need, and a few medicines, above all methotrexate and certain drugs against epilepsy. The shortage shows itself as tiredness and pallor, often with a smooth, reddened, burning tongue and sore corners of the mouth. In the blood count the red cells grow too large. Exactly here lies the decisive trap: a B12 deficiency looks identical in the blood count. If only folate is given, the blood count tidies itself — and the one visible warning sign for the B12 deficiency disappears while that deficiency goes on damaging the nerves. Before anything is taken, B12 therefore belongs measured. In pregnancy folate stands on its own: the need begins before the first missed period, because the child’s neural tube closes in the first weeks.
The one order that matters. It costs nothing and prevents the only serious harm this subject can do.
Anyone planning a pregnancy starts a good month beforehand — not once the test is positive. By then the decisive window has already passed.
Folate is sensitive to heat and water. Steaming or a quick fry keeps considerably more than long boiling, where a large part stays in the water.
Methotrexate, sulfasalazine and some drugs against epilepsy act on folate metabolism. With methotrexate folate is part of the plan anyway — but spaced away from the dose.
A shortage that returns despite good eating is an absorption problem until proven otherwise. The coeliac antibodies are the simplest first step.
Red cells live around four months. Before that the blood count shows little, however well the gap has been closed.
Folic acid refills the store in one to two weeks, the blood count follows in four to eight weeks. It does not replace B12 — and that is the decisive point: with a simultaneous B12 shortfall, folic acid corrects the blood while nerve damage carries on. That is why B12 is measured first. In pregnancy it works only if started before conception, because the neural tube closes in the first four weeks.
The store lasts three to four months — considerably shorter than for B12, where it is years. The daily requirement is about 300 micrograms, 550 in pregnancy. To prevent a neural tube defect, 400 micrograms are started at least four weeks before conception, because the neural tube closes on the twenty-eighth day — so often before the pregnancy is known. The blood count recovers in four to eight weeks.
The fine papillae recede, the tongue looks red and glossy and reacts to anything acidic. It is one of the few visible signs.
Often together with iron and B2 shortage. In this situation it is worth measuring more than one value.
Alcohol disturbs uptake and storage of folate in several ways at once. In everyday life it is the commonest cause of all.
Coeliac disease and chronic bowel inflammation deprive the body of folate at exactly the place where it should be absorbed — the upper small intestine.
Here folate is not a side value. The need begins before the first missed period, because the neural tube closes in the first weeks.
What a deficiency makes visible on the body — skin, nails, tongue, eyes and nerves. The signs are unspecific: they show where to look, they prove nothing.
The serum value mostly mirrors the last few days and rises after a meal with salad. More telling for the store is folate inside the red cells.
Always belongs alongside, and beforehand. It is the single point in this dossier where the order decides whether harm is done.
A high value is the first clue. It can hide when iron is short at the same time — then too large and too small cells cancel out in the average.
Rises with folate as with B12 shortage and shows that the shortage has reached the metabolism. It cannot tell the two apart.
The requirement rises markedly in pregnancy, and the benefit lies in the first weeks — often before the pregnancy is noticed. This is why taking it begins before conception, not after the test.
Folate and B12 work in the same cycle. If only folate is replaced the blood count improves while a B12 deficiency in the background goes on damaging nerves — that is the reason always to measure both together.
Leafy greens, pulses and liver are the densest sources; folate is heat-sensitive and long cooking halves the content. Important: folate can mask a B12 deficiency in the blood count while nerve damage continues — so both are measured together.