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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you’ve recently had a folate blood test but haven’t had a chance to speak with your provider about the results, you may be looking for a way to interpret the numbers.
For adults, normal serum folate levels range from 3–10 ng/mL. Normal red blood cell folate levels are typically between 140–630 ng/mL.
While certain laboratory tests have standardized values, others vary from lab to lab. There are two main measurements when it comes to folate (also known as folic acid). The first is folate in your serum (a yellowish liquid that makes up the fluid part of your blood) and the second is folate in your red blood cells.
Where does folate come from?
Folate and folic acid are two forms of vitamin B9. We get this essential vitamin from the food we eat, which is why many basic food staples are fortified with folic acid in the United States (NIH, 2021).
Many fruits and vegetables contain folate naturally. Processed grains like rice, pasta, and cereal usually have vitamin B9 added as folic acid. Folate deficiencies are pretty rare, however, people who don’t eat or have access to folate-containing foods may be at risk.
When should I take folate?
Whether or not you’ve had your folate levels tested, if you’re pregnant or planning to become pregnant, it’s important to take a folate supplement.
Folate plays a pivotal role in forming something called the neural tube, which develops into the brain and spinal cord. Without enough folate, the neural tube doesn’t close properly, resulting in conditions like spina bifida.
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How much folate should pregnant women be taking?
Even if your folate levels are normal, you should still up your folate intake before and during pregnancy.
That’s because a developing fetus needs a lot, and your body needs more when you’re pregnant, too. During pregnancy, your body makes a lot more blood, which also can deplete your folate supply.
For pregnancy, 600 mcg of folate per day is recommended. About half of all pregnancies in the United States are unplanned, and most neural tube defects occur very early on in pregnancy (during the third or fourth week of fetal development) before many people even know they’re pregnant (Finer, 2016).
If you’ve had a pregnancy in the past where the fetus was diagnosed with a neural tube defect, the Centers for Disease Control (CDC) recommends taking 4,000 mcg of folate daily.
What causes low folate?
A few things can lead to folate deficiency, including (NIH, 2021):
- When your body uses more folate than usual, like during pregnancy
- If you’re malnourished, meaning you’re not getting enough folic acid
- Malabsorption, or when your body isn’t absorbing any folate you eat
- A medication that’s interfering with your folate levels
Research has shown that people who consume a lot of alcohol may have low folate levels, too. Excessive alcohol consumption can end up replacing nutrient-rich food, resulting in malnutrition. Additionally, alcohol changes the way your gut absorbs nutrients, so you end up absorbing less folate than you normally would (Medici, 2013).
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Inflammatory gut conditions like celiac disease and inflammatory bowel disease can also decrease the absorption of many vitamins (NIH, 2021). Sometimes, low folate levels are the first sign of celiac disease.
Medications, like methotrexate and anti-seizure drugs, can also affect folate levels. If your levels become too low or you experience side effects from medication, your healthcare provider may recommend folic acid supplements.
That said, consult with a healthcare professional before starting any supplements, as taking folic acid could interfere with the medications you’re taking (Friedman, 2019; Linneback, 2011).
What happens if you have low folate?
If folate had a partner in crime, it would be cobalamin or vitamin B12.
These two vitamins work hand-in-hand to make red blood cells. If either is low, your body will have trouble producing red blood cells resulting in a condition called megaloblastic anemia. Symptoms of this include tiredness, shortness of breath, and an irregular heartbeat when you’re active (Socha, 2020).
How much folate do you need every day?
People aged 14 and older should get 400 mcg of folate daily, and you should be able to get all of it from your diet.
If you’re pregnant or planning to become pregnant, you should get 600 mcg per day. If you’re breastfeeding, aim for 500 mcg each day.
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Most Americans get enough vitamin B9 from their diet. Foods naturally high in folate include beef liver, green leafy vegetables, and legumes. Additionally, many processed grains like cereal, pasta, and rice are fortified with folic acid.
People who are pregnant, breastfeeding, or have a medical condition that puts them at risk for low folate levels might need a supplement. Folic acid supplements are available without a prescription and come as multivitamins, prenatal vitamins, B-complex supplements, and just folic acid on its own.
While folic acid is readily available over the counter, it’s best to talk to a healthcare provider to see if you need to add a supplement.
- Chan, Y. M., Bailey, R., & O’Connor, D. L. (2013). Folate. Advances in Nutrition (Bethesda, Md.), 4(1), 123–125. doi: 10.3945/an.112.003392. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23319130/
- Farrell, C. J., Kirsch, S. H., & Herrmann, M. (2013). Red cell or serum folate: what to do in clinical practice? Clinical Chemistry and Laboratory Medicine, 51(3), 555–569. doi: 10.1515/cclm-2012-0639. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23449524/
- Finer, L. B., Stevenson, A. J., Richards, C., & Jara, A. (2016). Declines in unintended pregnancy in the United STATES, 2008–2011. New England Journal of Medicine. doi: 10.1056/NEJMsa1506575. Retrieved from https://www.nejm.org/doi/full/10.1056/nejmsa1506575
- Friedman, B., & Cronstein, B. (2019). Methotrexate mechanism in treatment of rheumatoid arthritis. Joint Bone Spine, 86(3), 301–307. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30081197/
- Linnebank, M., Moskau, S., Semmler, A., Widman, G., Stoffel-Wagner, B., Weller, M., & Elger, C. E. (2011). Antiepileptic drugs interact with folate and vitamin B12 serum levels. Annals of Neurology, 69(2), 352–359. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21246600/
- Medici, V., & Halsted, C. H. (2013). Folate, alcohol, and liver disease. Molecular Nutrition and Food Research, 57(4), 596–606. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23136133/
- Office of Dietary Supplements (NIH). (2021, March). Folate Fact sheet for health professionals. Retrieved June 29, 2021 from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#en2
- Socha, D. S., DeSouza, S. I., Flagg, A., Sekeres, M., & Rogers, H. J. (2020). Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleveland Clinic Journal of Medicine, 87(3), 153–164. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32127439/
- Wierdsma, N. J., van Bokhorst-de van der Schueren, M. A., Berkenpas, M., Mulder, C. J., & van Bodegraven, A. A. (2013). Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients, 5(10), 3975–3992. doi: 10.3390/nu5103975. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24084055/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.