You probably know the feeling of waking up tired no matter how long you slept, with a mouth that feels sore and a mind that will not focus.
Most of us blame a busy stretch, poor sleep or stress. For some people, the body is actually short of one basic B vitamin.
Folate, also called vitamin B9, helps the body make red blood cells and build DNA. According to the NIH Office of Dietary Supplements, running low on it can trigger weakness, trouble concentrating, mouth sores, pale skin, heart palpitations and shortness of breath.
The problem is that each sign on its own looks like something else, a bad week, a cold coming on or ordinary stress.
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Severe folate deficiency has been rare in the United States since 1998, when the FDA required folic acid to be added to enriched grain products.
Even so, people with poor diets, heavy drinkers, those with gut disorders and women trying to conceive can still slip into shortfall without realizing it.
The eight symptoms to watch for
1. Persistent fatigue and weakness. Low folate drives megaloblastic anemia, where red blood cells grow too large and carry oxygen poorly. The result is tiredness that a weekend of rest does not fix.
2. A sore tongue and mouth ulcers. Soreness on the tongue, cracks at the corners of the mouth and shallow mouth ulcers are classic signs flagged by the National Library of Medicine in its StatPearls review of folic acid deficiency.
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3. Brain fog and trouble concentrating. Difficulty concentrating, memory lapses and that general foggy feeling are listed among the symptoms of folate-linked anemia.
4. Pale skin, hair or nails. As healthy red blood cells drop, the skin can take on a pale or slightly yellow cast. Changes in skin, hair or nail color are mentioned by the NIH too.
5. Heart palpitations and shortness of breath. With fewer healthy red blood cells, the heart compensates by pumping faster. People notice fluttering, a racing pulse or getting winded on light stairs.
6. Headaches that come out of nowhere. Frequent headaches sit on the NIH list of symptoms linked to the anemia caused by low folate.
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7. Mood changes and irritability. Depression, irritability, insomnia and cognitive decline have all been reported in folate deficiency, especially when it drags on untreated.
8. A high homocysteine reading on a routine blood test. Folate helps clear homocysteine, an amino acid in the blood. When folate is low, homocysteine builds up, and elevated levels have been linked to a higher risk of cardiovascular disease.
Who is most at risk of a folate shortfall
Four groups stand out. Pregnant women and those trying to conceive need more folate to support the baby's spine and brain. Not getting enough early in pregnancy is a known risk factor for neural tube defects such as spina bifida.
Heavy drinking is another one. Alcohol disrupts folate absorption and metabolism, which is why long-term drinkers often turn up with low levels.
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People with celiac disease, Crohn's disease or other inflammatory bowel conditions absorb fewer nutrients from food, folate included.
The same goes for anyone on long-term methotrexate (used for rheumatoid arthritis and some cancers), phenytoin for epilepsy or sulfasalazine, all of which can interfere with folate.
What to do if the signs sound familiar
The CDC recommends that all women capable of becoming pregnant get 400 micrograms of folic acid daily to help prevent neural tube defects. For most other adults, folate from food, leafy greens, beans, lentils, citrus and fortified cereals, covers the daily need.
A simple blood test can measure folate and homocysteine levels. If several signs on the list apply to you and will not pass, bring it up with your doctor rather than reaching for a supplement first.
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The symptoms overlap heavily with vitamin B12 deficiency, and treating the wrong one can mask the real problem.
This article is made and published by Mie Hermansen, who may have used AI in the preparation.