Causes of folate deficiency

Nutritional deficiency

Substance use disorders that lead to inadequate dietary intake

Chronic excessive alcohol use, which may be associated with malnutrition and increased metabolic demands

Inadequate dietary intake due to severe malnutrition or restrictive diets

Consumption of overcooked foods (cooking inactivates folates)

Reduced intake of green leafy vegetables if residing in a country where cereals and grains are not supplemented with folic acid

Malabsorption

Celiac disease (sprue)

Inflammatory bowel disease

Infiltrative bowel disease

Short bowel syndrome

Bariatric surgery

Drugs (various mechanisms)

Methotrexate

Trimethoprim

Ethanol

Phenytoin

Increased requirements

Pregnancy, lactation

Chronic hemolysis

Exfoliative dermatitis or severe eczema

Other conditions with high cellular turnover

Several countries (eg, United States, Canada, Costa Rica, Chile, South Africa) have required manufacturers to enrich cereals and grain products with folic acid to reduce the risk of neural tube defects. Thus, folate deficiency has become uncommon in individuals in these countries that provide routine fortification. However, individuals with the above conditions may be at increased risk of developing folate deficiency. Refer to UpToDate for additional details of mechanisms and other causes.

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Causes of folate deficiency