Folic acid deficiency can also be called folate deficiency. Folate is known as vitamin B9, which alongside vitamin B12, helps the body make red blood cells. These vitamins also assist with the synthesis of DNA, RNA, and other proteins. When there is not enough folic acid, an insufficient number of healthy red blood cells can occur, causing megaloblastic anemia.

The most common cause of folic acid deficiency is diet, which can be caused by low dietary intake or malabsorption. Low dietary intake is when not enough foods high in folic acid are being consumed (i.e. beans, leafy vegetables, citrus fruits, and whole grains). Malabsorption is can be caused by age, liver or gastrointestinal problems, pancreatitis, renal dialysis, or bariatric or gastrointestinal surgery. This condition can also be caused by certain prescription drugs (proton pump inhibitors (PPI), diabetic medications, seizure medications, etc.) or excessive amounts of alcohol.

Women who are pregnant or nursing may also have folic acid deficiency, as the amount of folic acid needed for their body is increased.

Fatigue and muscle weakness are common symptoms of folic acid deficiency. Other symptoms include:

• neurological signs (tingling, numbness, or peripheral neuropathy in extremities)

• psychological problems (i.e. depression, memory problems, confusion, etc.)

• headaches or dizziness

• gastrointestinal signs (i.e. nausea, vomiting, weight loss, diarrhea, or abdominal pain)

• shortness of breath

• appearing pale

• mouth sores 

Diagnosis for folic acid deficiency is based on the report and evaluation of symptoms, as well as complete blood count (CBC) and other laboratory testing, while considering the individual's medical history and dietary intake. In some cases, a diagnosis may be given after all other possible causes for the symptoms are excluded.

Determining the cause of the folic acid deficiency is crucial to determining the type of treatment needed. Treating the underlying cause of the condition is important so as to reduce the chances of recurrence. Folic acid deficiency is easily treatable with vitamin supplementation and eating a diet that is vitamin-rich. However, when it has caused anemia, the condition becomes more difficult to treat.

If folate deficiency is promptly diagnosed and treated, long-term residuals usually will not occur.

If untreated, a decrease in folate for pregnant women may result in serious birth defects in the spinal cord and brain of a developing fetus.

• Consider service connection for primary anemia on a presumptive basis as a chronic condition (38 CFR 3.307; §3.309(a)).

• Consider service connection for any other nutritional deficiency on a presumptive basis as a condition associated with former prisoners of war (38 CFR 3.307; §3.309(c)).

• None.