Quick answer: Folate (vitamin B9) is essential for making DNA, dividing cells, forming red blood cells and processing homocysteine. Low folate can cause fatigue, anemia, mouth sores and mood changes, and it is critical before and during pregnancy. Leafy greens, legumes and liver are rich sources, and some people use methylfolate with guidance.
What is Folate?
Folate is a B vitamin needed to build DNA, support cell division and recycle homocysteine through the methylation cycle. This marker is part of the Healthspan Assessment panel available to my 1-on-1 patients.
Why Folate matters
- DNA synthesis and repair
- Red blood cell production
- Methylation and homocysteine processing
- Healthy pregnancy (neural tube development)
Understanding your result
Reference ranges vary by lab, age and sex. Your provider interprets your result against the lab’s range and your overall picture, rather than chasing a single number. Functional labs are optional. They can be helpful in more complex cases, and in my practice they are available only to patients working 1-on-1 with me.
What low Folate can mean
- Low intake of leafy greens and legumes
- Alcohol use
- Absorption problems such as celiac disease
- Medications such as methotrexate and some anti-seizure drugs
- Increased needs in pregnancy
What high Folate can mean
- High intake from supplements or fortified foods
- Can mask B12 deficiency, so B12 should be checked too
What affects Folate
- Diet
- Alcohol
- Gut health
- Genetic variants such as MTHFR
- Medications
Ways to support healthy levels
- Eat leafy greens, legumes, asparagus, avocado and liver
- Check B12 along with folate (see vitamin B12)
- Discuss folic acid or methylfolate with your provider (see who should consider methylfolate)
- Folic acid is recommended before and during pregnancy to prevent neural tube defects
Folate and healthy aging
Folate is central to DNA synthesis and repair and to methylation, the process that switches genes on and off. Low folate can contribute to genomic instability and epigenetic changes, and raises homocysteine, which affects blood vessels and the brain.
When to see a naturopathic doctor
- Fatigue or anemia
- Elevated homocysteine
- Planning a pregnancy
- Taking medications that affect folate
See a medical provider promptly for severe fatigue with shortness of breath, numbness or tingling, or confusion.
Want help making sense of your labs?
A free 15-minute consultation with Dr. Kneessi. No cost, no obligation. In-office in Odenton, MD or by telehealth.
Frequently asked questions
What causes low folate?
Low intake, alcohol, absorption issues, some medications and higher needs in pregnancy.
Is methylfolate better than folic acid?
Both raise folate. Folic acid is the form proven to prevent neural tube defects; methylfolate may suit some people.
Should I check B12 with folate?
Yes. High intakes of folic acid can hide B12 deficiency.
What foods are high in folate?
Leafy greens, legumes, asparagus, avocado and liver.
What are the symptoms of low folate?
Research has linked low folate to tiredness, weakness, shortness of breath with exertion, a sore or smooth tongue, mouth sores, irritability, and difficulty concentrating. Many of these are related to a type of anemia with large red blood cells, which is also seen with low B12, so both are usually checked together.
What is a normal folate level?
A serum folate level above 4.0 ng/mL is generally considered sufficient, a level from 2.0 to 4.0 ng/mL is often described as borderline, and a level below 2.0 ng/mL is generally considered low or deficient. Lab cutoffs vary, so it is best to compare your result with the range on your own report. Because serum folate reflects recent intake, red blood cell folate and homocysteine are sometimes used for a longer-term picture.
Work with a naturopathic doctor near you
Dr. Kneessi sees patients in person in Odenton and by telehealth anywhere in Maryland. Learn more about visits for Annapolis, Odenton, Crofton, and Severna Park, or read about hormone testing and functional medicine in the area.
You can book a free 15-minute consult, or start with the free 28-Day Longevity Reset, a short daily email series on sleep, light, movement, and food.
Sources
- Medici V, Halsted CH. Folate, alcohol, and liver disease. Mol Nutr Food Res 2013. PMID: 23136133. https://pmc.ncbi.nlm.nih.gov/articles/PMC3736728/
- Miller JW, et al. Excess folic acid and vitamin B12 deficiency: clinical implications? Food Nutr Bull 2024. PMID: 38987872. https://pmc.ncbi.nlm.nih.gov/articles/PMC11288374/
- De-Regil LM, et al. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 2015. PMID: 26662928. https://pmc.ncbi.nlm.nih.gov/articles/PMC8783750/
- Homocysteine Lowering Trialists’ Collaboration. Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials. BMJ 1998. PMID: 9569395. https://pmc.ncbi.nlm.nih.gov/articles/PMC28491/
- NIH Office of Dietary Supplements: Folate (Consumer Fact Sheet)
- MedlinePlus: Folic Acid
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
