Folate deficiency

Folate (vitamin B9) is needed to make blood cells and matters especially in early pregnancy. The US has fortified flour with folic acid for over twenty years, and England starts in December 2026. Ukraine has no such law, so folate depends on what you eat.

Symptoms

Low folate causes the same anaemia as low B12:

• tiredness, breathlessness on mild effort;
• a sore, red tongue, mouth ulcers;
• poor concentration, low mood.

Unlike B12, folate rarely damages nerves.

Who is at risk

• few leafy greens, vegetables, beans or whole grains;
• heavy alcohol use;
• pregnancy, planning a pregnancy, breastfeeding;
• coeliac disease and other conditions that impair absorption;
• anti-epileptic medicines, methotrexate and some other drugs.

Which test to ask for

Serum folate, together with B12. Both deficiencies change the blood count in the same way, but the treatment differs.

Pitfall: serum folate reflects the last few days of eating. One large salad before the test can raise it.

Pregnancy

If you are planning a pregnancy or are pregnant, folic acid is part of routine care from your midwife or doctor. That is standard practice, not a reason for a separate test.

What not to do

Do not take folic acid without checking B12: it masks a B12 deficiency, and nerve damage can progress unnoticed.