Folate deficiency is a disease characterized by vitamin B9 deficiency caused by its insufficient intake with food, malabsorption or accelerated excretion from the body. The main symptoms are pallor of the mucous membranes, depression, anxiety, high fatigue, insomnia, memory loss, digestive disorders, peeling and redness of the skin, stomatitis, folic deficiency anemia. Pregnant women have fetal pathologies, premature birth, miscarriages. The diagnosis is based on the study of the vitamin level in blood plasma. Treatment includes taking vitamin preparations, correcting the diet, eliminating concomitant diseases.
ICD 10
E53.8 Insufficiency of other refined B vitamins
folate deficiency causes
Folate deficiency occurs when one of the links of folic acid metabolism is disrupted: at the stage of its entry into the body, absorption from the small intestine, binding and transfer by proteins, participation in biochemical reactions. The causes of vitamin deficiency can be grouped as follows:
- Lack of vitamin in the diet. Most often, pathology develops in people who practice strict diets and fasting, as well as in patients with anorexia. Mild forms of the disease are possible with the predominant use of food that has undergone culinary processing, a lack of raw vegetables.
- Violation of absorption from the gastrointestinal tract. The absorption of vitamin from the stomach and intestines is reduced in inflammatory diseases, for example, colitis. The transport process is hindered by the use of alcohol, coffee, analgesics, antacids and sulfasalazine.
- Rapid decay and excretion. The reason for the lack of vitamin can be its accelerated metabolism or loss unchanged. With liver diseases, taking anticonvulsants and hormonal drugs, the body does not have time to use B9 before disintegration, and with renal insufficiency, its excretion increases.
- Increasing the needs of the body. Folate deficiency affects people who have increased costs of vitamins and other trace elements. These groups include pregnant women, women who support lactation, patients undergoing hemodialysis procedures, cancer patients.
Pathogenesis
The main function of vitamin B9 is the transfer of methyl residue CH3. During such reactions, DNA molecules and individual amino acids are formed, for example, glycine and methionine. With folate deficiency, DNA production slows down, defective molecules appear, which are easily destroyed due to the presence of uridine bases instead of thymine. The first to suffer are rapidly renewing cells and tissues – epithelium and blood. Megaloblastic anemia is formed – atypical cells are detected in the blood test, patients suffer from weakness, fatigue. The number of platelets and leukocytes decreases. Epithelial lesions are manifested by slow wound healing. In the gastrointestinal tract, the production of digestive enzymes decreases, glossitis, esophagitis, gastritis and enteritis develop.
Another function of folic acid is to participate in the production of methionine from homocysteine. Folate deficiency is accompanied by an increase in homocysteine levels and an increase in the risk of cardiovascular pathology. During pregnancy, vitamin B9 is responsible for the proper laying of the nervous system and internal organs. With folate deficiency, malformations occur – anencephaly, hydrocephalus, anomalies of the structure of the heart and limbs. Incorrect formation of the placenta and early miscarriage are possible.
Folate deficiency symptoms
Manifestations of folic acid deficiency occur 5-30 days after a decrease in its concentration in the bloodstream. The first symptoms are a rapid increase in fatigue, poor appetite, irritability. The process of hematopoiesis is disrupted, megaloblasts are produced by the bone marrow – large immature blood cells. Anemia develops, in which the level of normal red blood cells decreases, patients experience weakness, dizziness, nausea, drowsiness. Insufficient synthesis of normal leukocytes is accompanied by leukopenia, the body becomes susceptible to infections.
Focal lesions of the oral mucosa, stomach and intestinal tract are detected. There is prolonged wound healing, frequent conjunctivitis, growth retardation in children, hair loss and inflammation of the tongue. The temperature rises to subfebrile values, chills increase, headaches appear. Emotional disorders are represented by anxiety and depressed mood, which develops into depression. Memory deteriorates, insomnia, causeless anxiety, aggressiveness are observed.
Complications
In the absence of treatment of folate deficiency, ulceration in the mouth becomes infected a second time, stomatitis develops. Intestinal and stomach lesions provoke enterocolitis and gastritis. Prolonged anemia increases the risk of cardiovascular diseases, gout, gallbladder and stomach diseases. Leukopenia becomes the cause of secondary immunodeficiency. Women during pregnancy are diagnosed with placental abruption, miscarriage at an early stage, premature onset of labor. Abnormalities of neural tube formation are detected in the fetus, leading to hydrocephalus, anencephaly and oligophrenia of varying degrees.
Diagnostics
Examination for folate deficiency is carried out with characteristic symptoms, including anemia, especially if they are found in hemodialysis patients, pregnant women, people with chronic pathologies of the stomach, intestines and liver. The disease is usually diagnosed by gastroenterologists or hematologists with the participation of neurologists. Differentiation of folate deficiency with normocytic and aplastic anemia will be performed. The following techniques are used:
- Clinical and anamnestic analysis. Using the survey method, the doctor finds out the symptoms of the disease, their duration, and the patient’s nutritional characteristics. The presence of factors capable of provoking folate deficiency is taken into account: pregnancy, breastfeeding, malabsorption syndrome, hemolytic anemia, malignant tumors, pathologies of the liver, kidneys and intestines.
- Inspection. In severe forms of folate deficiency, glossitis is diagnosed, ulceration in the oral cavity is detected. Anemia is accompanied by pallor of the skin, thinning and delamination of the nail plates, shakiness of gait due to weakness and dizziness.
- Blood and urinalysis. The concentration of B9 in venous blood is being investigated. The diagnosis of folate deficiency is confirmed by indicators below 7 nmol/L.
Folate deficiency treatment
Therapy consists in replenishing vitamin deficiency. Folic acid preparations and complex vitamin supplements are used for this purpose. The presence of vitamins B12 and C is necessary for the successful assimilation of B9. The duration of taking medications ranges from 1 to 3 months. When choosing the dosage, it is taken into account that in adults the daily need for folic acid is 25 mcg. In addition to medical treatment, the diet is corrected, products containing folates in large quantities are introduced into the menu: green salad, cabbage, spinach, parsley, mint, walnuts, tomatoes, citrus fruits, beets, buckwheat. At the same time, gastrointestinal, kidney and liver diseases are treated.
Prognosis and prevention
With proper treatment, the condition of folate deficiency is eliminated within a few months. In the absence of complications, the prognosis is favorable. To prevent B9 deficiency, you need to adhere to a balanced diet with the presence of fresh green vegetables in your daily diet – lettuce, broccoli, spinach, white cabbage and cauliflower, parsley, tomatoes, carrots, beets. At the onset of pregnancy and breastfeeding, it is worth consulting with a gynecologist about taking appropriate vitamin preparations. Patients with digestive diseases are recommended to take a blood vitamin test at least once a year.
Literature
- Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017 Mar;101(2):297-317. – link
- Attia AAA, Amer MAEM, Hassan M, Din SFG. Low serum folic acid can be a potential independent risk factor for erectile dysfunction: a prospective case-control study. Int Urol Nephrol. 2019 Feb;51(2):223-229. – link
- Lever EG, Elwes RD, Williams A, Reynolds EH. Subacute combined degeneration of the cord due to folate deficiency: response to methyl folate treatment. J Neurol Neurosurg Psychiatry. 1986 Oct;49(10):1203-7. link
- Green R, Miller JW. Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status. Semin Hematol. 1999 Jan;36(1):47-64. – link
- Okada A, Koike H, Nakamura T, Watanabe H, Sobue G. Slowly progressive folate-deficiency myelopathy: report of a case. J Neurol Sci. 2014 Jan 15;336(1-2):273-5. – link
