Low folate levels are caused by several factors including inadequate dietary intake, malabsorption syndromes, increased physiological demand, certain medications, and chronic alcohol use.
Main Causes of Low Folate Levels
- Inadequate Intake: Diets lacking in folate-rich foods such as leafy green vegetables, legumes, fruits, and fortified grains. This may occur in people with malnutrition, restrictive diets, or alcohol use disorder, and in those eating overcooked foods that destroy folate.
- Malabsorption: Conditions impairing absorption in the digestive tract, such as celiac disease, Crohn disease, inflammatory bowel disease, tropical sprue, and after bowel surgery. Certain drugs like proton-pump inhibitors and antiseizure medications can also reduce folate absorption.
- Increased Demand: Pregnancy, lactation, infancy, adolescents during growth, hemolytic anemia, and exfoliative skin disorders increase the body’s need for folate beyond the usual amount.
- Medications: Some drugs interfere with folate metabolism and utilization, such as methotrexate, phenytoin, trimethoprim, sulfasalazine, and metformin.
- Alcohol Use: Chronic alcohol consumption disrupts folate absorption, liver storage, and increases renal excretion. Alcoholics often have poor dietary intake as well.
- Increased Excretion: Conditions like renal dialysis can lead to loss of folate through urine.
- Genetic Factors: Variants in genes like MTHFR can impair folate metabolism, contributing to low folate levels.
Due to folate being water-soluble and not stored in large amounts in the body, deficiency can develop quickly if intake or absorption is inadequate or demand is increased.
These causes highlight the importance of a balanced diet and addressing underlying medical conditions to maintain adequate folate levels. References:
- Folate deficiency common causes and etiology
