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Folate deficiency (vitamin B9 deficiency) occurs when the blood lacks sufficient folate, a B vitamin essential for making normal red blood cells and DNA synthesis. Without adequate folate, the body produces abnormally large red blood cells that cannot function properly, leading to megaloblastic anemia.

Common symptoms develop gradually and include extreme tiredness, lack of energy, pale skin, shortness of breath, palpitations, headaches, irritability, diarrhea, and a sore or red tongue with mouth ulcers. Severe deficiency may cause depression, confusion, dementia, reduced taste sensation, and weight loss. Cognitive changes affecting memory, understanding, and judgment can also occur.

Key causes include inadequate dietary intake (lack of green leafy vegetables, fresh fruits, fortified cereals, yeast, and meats), excessive alcohol consumption, malabsorption disorders (celiac disease, inflammatory bowel disease), pregnancy (increased fetal demand), certain medications (anti-seizure drugs), and cancer.

The most serious complication is neural tube defects in developing fetuses, including spina bifida, which can cause paralysis or death before or soon after birth. Pregnant women with folate deficiency face significantly increased risk of birth defects affecting the brain and spinal cord.

Treatment involves oral folic acid supplements, typically taken for 4 months to restore levels. Improving diet with folate-rich foods and limiting alcohol intake are also important. People taking medications that interfere with folate absorption should take preventive supplements. Early treatment prevents complications, though some symptoms may take time to resolve.