What happens when your Vitamin B9 levels are too high or too low?

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What is a normal folic acid level?

Folate can be measured in the liquid part of the blood (serum) or inside red blood cells.

Typical serum folate levels are approximately:

Folic acid level

MeaningWhat should folic acid levels be in the blood?

Below 3 ng/mL

Low (deficient)

3–4 ng/mL

Borderline low

Above 4 ng/mL

Generally normal

What is folic acid?

Folic acid is a form of vitamin B9. The natural form found in foods is called folate.

Your body needs folate to produce healthy new cells, especially red blood cells. It also helps your body make and repair DNA.

When folate levels are too low, you may develop folate deficiency anaemia, which means your body cannot produce enough healthy red blood cells to carry oxygen around your body.

What causes low folic acid?

The most common causes include:

  1. Poor diet: Not eating enough leafy green vegetables, beans, fruit, and other foods rich in folate.

  2. Poor absorption: Digestive conditions, such as coeliac disease, can prevent the body from absorbing folate properly.

  3. Excessive alcohol consumption: Alcohol can interfere with folate absorption and how the body uses it.

  4. Certain medications: Some medicines, including certain epilepsy treatments and methotrexate, can affect folate levels.

  5. Increased need: Pregnancy and certain illnesses increase the body's need for folate.

  6. Food preparation: Overcooking vegetables, particularly boiling them for a long time, can reduce their folate content.

What are the symptoms of low folic acid?

Low folate levels may cause:

  • Tiredness and weakness

  • Dizziness or headaches

  • Shortness of breath

  • Mouth ulcers or a sore tongue

  • Difficulty concentrating

  • Pale skin

  • Anaemia

Some people may have low folate levels without noticeable symptoms.

Can low folic acid cause hair loss?

Folate helps the body produce and repair DNA, which is important for healthy cell growth, including the cells involved in hair production.

A folate deficiency may contribute to hair problems, particularly when it occurs alongside other nutritional deficiencies.

However, there is limited evidence that low folate alone directly causes hair loss or alopecia. Hair loss can also result from low iron, thyroid problems, hormonal changes, stress, and other medical conditions.

What illnesses can cause low folic acid?

Certain medical conditions can contribute to folate deficiency, including:

  • Coeliac disease: Damages the small intestine and reduces nutrient absorption.

  • Inflammatory bowel disease: Conditions such as Crohn's disease may interfere with folate absorption.

  • Liver disease: Particularly when associated with excessive alcohol consumption.

  • Kidney conditions: Some conditions, especially those involving dialysis, may increase folate loss.

  • Certain blood disorders: Conditions that cause rapid red blood cell breakdown can increase the body's folate requirements.

Some illnesses may also increase folate loss through urine, although this is not one of the most common causes of deficiency.

Are vitamin B12 and folic acid the same?

No. Vitamin B12 and vitamin B9 (folate) are two different vitamins, but they work closely together.

Both are important for:

  • Producing healthy red blood cells

  • Making and repairing DNA

  • Supporting normal cell function

  • Maintaining overall health

Folate and vitamin B12 also work together in processes involved in producing S-adenosylmethionine (SAMe), a compound important for several functions in the body.

A deficiency in either vitamin can cause anaemia.

Important: Vitamin B12 levels should be checked before treating folate deficiency, because taking folic acid can improve anaemia while an untreated B12 deficiency continues to cause nerve damage.

How long does it take to recover from low folate?

Most people with folate deficiency anaemia are prescribed folic acid tablets for approximately 4 months.

Blood cell production often begins improving within days or weeks, although full recovery may take longer.

If the underlying cause continues, treatment may be needed for longer, sometimes for life.

Your doctor may repeat blood tests to check that treatment is working.

Red blood cell (RBC) folate levels

One example of a laboratory reference range for adults is:

140–628 ng/mL (approximately 317–1,422 nmol/L).

However, RBC folate reference ranges vary significantly depending on the testing method and laboratory. These values should not be used as universal cutoffs.

Serum folate and RBC folate results measure different things and cannot be compared directly.

What does high folic acid mean?

High blood folate levels can occur because of:

  • Taking folic acid supplements

  • Eating foods fortified with folic acid

  • Recent intake of folate-rich foods

  • Certain medical or metabolic factors

High folate does not automatically mean something is wrong.

High folate does not necessarily indicate vitamin B12 deficiency. However, folate and B12 work closely together, so checking B12 may be important when interpreting abnormal results.

Can too much folic acid be harmful?

Taking excessive amounts of folic acid from supplements or fortified foods may cause problems.

For most adults, the recommended upper limit is 1,000 micrograms (1 mg) of folic acid per day from supplements and fortified foods, unless a healthcare professional prescribes a higher dose.

The main concern is that high folic acid intake may hide the anaemia caused by vitamin B12 deficiency, allowing nerve damage to progress unnoticed.

Some people may also experience digestive discomfort or other side effects.

Higher doses are sometimes prescribed for medical reasons and can be appropriate under medical supervision.

How can you reduce high folic acid levels?

If your blood test shows high folate levels:

  1. Check whether you are taking folic acid supplements or multivitamins.

  2. Review the amount of folic acid in your supplements with your doctor.

  3. Check whether your vitamin B12 levels have also been measured.

  4. Avoid taking unnecessary high-dose folic acid supplements.

  5. Speak with your doctor before stopping any prescribed treatment.

You generally do not need to avoid naturally folate-rich foods, such as leafy green vegetables, beans, and fruit. These are important parts of a healthy diet.

You should also not automatically switch to methylfolate supplements to treat high folate levels.

Summary

Folate (vitamin B9) is essential for healthy red blood cells, DNA production, and normal cell growth.

Low folate can result from poor diet, absorption problems, excessive alcohol consumption, certain medications, or increased nutritional needs.

High folate is often related to supplements or fortified foods and is not necessarily harmful.

The most important step is to understand why your folate level is abnormal and check your vitamin B12 level when appropriate. Treatment should address the underlying cause rather than simply raising or lowering the folate number.

References:

National Institutes of Health (NIH). Folate – Health Professional Fact Sheet.
https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

National Health Service (NHS). Vitamin B12 or Folate Deficiency Anaemia – Causes
https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/causes/

National Health Service (NHS). Vitamin B12 or Folate Deficiency Anaemia – Treatment
https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/

MedlinePlus, U.S. National Library of Medicine.
https://medlineplus.gov/ency/article/000354.htm

 

© 2000-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

 

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