Folate is one of those nutrients you rarely think about until it comes up in a blood result or a pregnancy conversation. Also known as vitamin B9, it is a water-soluble vitamin that your body cannot make for itself, so you rely on your diet to keep levels topped up. Despite its quiet reputation, folate does some of the most fundamental work in the body.
What folate actually does
Folate is essential for making and repairing DNA and for producing healthy red blood cells. Cells that divide quickly — such as those in your bone marrow — have a particularly high demand for it. When folate runs low, red blood cell production suffers, which is why deficiency can show up as a specific type of anaemia.
It also works closely alongside vitamin B12. The two vitamins share several chemical pathways, and a shortfall in one can mask or mimic problems with the other. That is one reason clinicians often look at folate and B12 together rather than in isolation.
Why it matters most in pregnancy
Folate's best-known role is in early pregnancy. In the first few weeks, it helps the baby's neural tube — which becomes the brain and spinal cord — form correctly. Adequate folate around conception and in early pregnancy is associated with a lower risk of neural tube defects such as spina bifida. This is why anyone who could become pregnant is generally advised to think about folate well before a positive test, since the neural tube closes very early on. Advice on supplements is best discussed with your midwife or GP.
Signs and causes of low folate
Folate deficiency can develop gradually and its symptoms overlap with many other conditions. Common features include:
- Persistent tiredness and low energy
- Weakness or breathlessness on exertion
- A sore or red tongue and mouth ulcers
- Pins and needles, or changes in mood and concentration
Low folate can stem from a diet short on leafy greens, pulses and fortified foods; from conditions that affect absorption such as coeliac disease; from certain medications; and from higher demand, for example in pregnancy. Alcohol can also reduce folate levels over time.
How folate is tested
A serum folate blood test measures the amount of folate circulating in your blood. It is a simple test that needs only a standard sample. Results are usually interpreted alongside a full blood count and, where relevant, vitamin B12, because the picture is clearer when these are viewed together. If a deficiency is found, your clinician will look for the underlying cause rather than simply treating the number.
Who might consider testing
Testing folate can be worthwhile if you have unexplained tiredness, symptoms of anaemia, a restricted or plant-based diet, a digestive condition affecting absorption, or if you are planning a pregnancy. It can also be useful when a full blood count hints at larger-than-normal red blood cells, which sometimes points to a folate or B12 shortfall.
The bottom line
Folate is a small nutrient with an outsized role in energy, blood health and early development. If your symptoms or circumstances suggest you might be running low, a straightforward blood test gives you a clear answer and lets your clinician act on the cause with confidence.
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Specialist interest: Cardiovascular Medicine · OneMedicine, CQC-registered clinic