Are you always tired? Let's learn everything about folate deficiency anemia!

Do you also feel tired all day long, unable to do anything? Or do you sometimes feel like your body is getting cold and it's a little hard to breathe? These are not just random things, perhaps your body is deficient in the nutrient folate, which may be causing a blood deficiency, that is, anemia. Today, let's talk about what folate deficiency anemia is, why it occurs, and how to avoid it.

What is Folate Deficiency Anemia? Let's understand it simply!

Simply put, folate deficiency anemia is a blood disorder caused by a lack of folate, or vitamin B9, in your body. What happens in this is that the number of red blood cells in your body is lower than normal and the red blood cells that are present are abnormally large. Think about it, these red blood cells carry oxygen throughout our bodies. So when these cells decrease, become larger, or cannot function properly, the amount of oxygen that the body receives decreases. Over time, this lack of oxygen is what makes you feel tired, weak, and cold.

Why does anemia occur when folate is deficient? What happens inside the body?

Do you know how our red blood cells are formed? They are first formed from stem cells in the bone marrow inside our bones. These red blood cells gradually grow and join our blood, carrying oxygen to every organ and tissue in the body.

Here, a nutrient called folate is essential for the proper formation of healthy red blood cells. It's like building a house with cement. So, if your body doesn't get enough folate, your bone marrow won't produce normal red blood cells. Instead, it produces an abnormally large type of red blood cell called ``megaloblasts.''

Because these ``megaloblastic'' cells are so large, some of them don't even come out of the bone marrow and join the blood. The cells that do join don't live as long as healthy red blood cells. They die quickly. That's why the number of red blood cells in the body decreases, causing anemia, which means a lack of blood. Do you understand?

Are there other types of anemia?

Yes, anemia is a common condition that many people can develop. It is caused by a lack of healthy red blood cells. There are many causes of anemia:

• Abnormally large red blood cells (this is also due to the folate deficiency we're talking about).
• Decreased production of healthy red blood cells.
• Excessive destruction of red blood cells by the liver and spleen.
• Decreased levels of hemoglobin, a protein in red blood cells that carries oxygen.
• Hemoglobin not working properly, meaning it cannot properly capture oxygen.
• The bursting of red blood cells in the blood.

The group of anemias caused by abnormally large red blood cells is called ``macrocytic anemia``. One type of this is ``megaloblastic anemia``. The following fall under this ``megaloblastic anemia``:

• Folate deficiency anemia
• Vitamin B12 deficiency anemia
• Pernicious anemia

In addition to this, other types of anemia that many people have heard of are:

• Iron deficiency anemia
• Sickle cell anemia

How common is folate deficiency?

Folate deficiency is not that common in developed countries. This is because folate is added to many foods in those countries. For example, in the United States, it has been mandatory to add folate to foods since 1998. The reason for this is that folate is extremely important for the development of the child during the fetal stage.

Doctors have found that a lack of folate can cause certain birth defects, especially neural tube defects such as spina bifida. That's why in many countries, folate is added to many of the foods we eat, especially cereals and rice.

Who is at higher risk of developing folate deficiency anemia?

There are people who are more likely to develop this condition. See if you fall into this category:

• Women of childbearing age: Folate needs are especially high for women who are planning to become pregnant, during pregnancy, and breastfeeding.
• People who consume excessive amounts of alcohol: Alcohol impairs the body's ability to absorb nutrients.
• People over 60 years of age.
• People with economic difficulties: Because it is difficult to eat a balanced diet.
• Pregnant and lactating mothers.

What causes folate deficiency anemia?

The main reason is that we don't get enough folate from the foods we eat. Apart from that, there are other reasons that prevent the body from absorbing or using folate properly:

• Alcohol addiction (`Alcohol use disorder`).
• Undergoing dialysis treatment due to kidney failure.
• Digestive system diseases, for example, Crohn's disease and celiac disease.
• Long-term use of certain medications (e.g., for epilepsy, rheumatic disorders, some antibiotics, and immunosuppressants).
• Inherited conditions such as ``Hereditary folate malabsorption`` (in which the body's ability to absorb folate is reduced from birth).

What are the symptoms of this? How do you recognize it?

Sometimes folate deficiency anemia can be present without any symptoms. Your doctor may only find it when you have a blood test for something else.

However, when symptoms appear, they may include:

• Feeling tired all the time (`fatigue`): It's as if the tiredness doesn't go away even after sleeping.
• Feeling sluggish and weak while doing daily activities.
• Dizziness, feeling lightheaded.
• Pale skin (`pallor`): Areas such as the face, lips, and palms appear pale.
• Feeling like your heart is beating fast, hearing a pounding sound in your chest, or feeling like your heart is skipping a beat (heart palpitations).
• Difficulty breathing (dyspnea): Shortness of breath even with small tasks.

How is this disease accurately diagnosed ?

If you have these symptoms, you should definitely see a doctor. Your doctor will do a physical exam and ask about your medical history and symptoms. Since the symptoms of folate deficiency anemia are similar to many other conditions, you may need to have several blood tests to find out if this is the case.

The main ones of these blood tests are:

• Complete blood count (CBC): This checks many things, such as the number of red blood cells, white blood cells, and platelets in your blood, as well as the amount of hemoglobin.
• Peripheral blood smear (PBS): This involves taking a sample of your blood and looking at it under a microscope. This allows you to see exactly what shape the blood cells are, whether they are large or small, and if there are any abnormalities.
• Reticulocyte count: Reticulocytes are young, immature red blood cells. This test checks whether your bone marrow is producing enough red blood cells.

Along with these tests, your doctor will also check your blood folate levels. This is usually measured in units called `nanograms per milliliter` (`ng/mL`).

• Deficient: Less than 2 nanograms per milliliter (`< 2 ng/mL`).
• Borderline: Between 2 and 4 nanograms per milliliter (`2 ng/mL - 4 ng/mL`).
• Sufficient: Greater than 4 nanograms per milliliter (`> 4 ng/mL`).

Since vitamin B12 deficiency and folate deficiency can often occur together, the doctor will also check your vitamin B12 level.

What are the treatments for this?

The good news is, there is treatment for this, and it is very successful.

The main treatment is to give vitamin B9 supplements. These are usually given as pills to take by mouth. For some people who have difficulty swallowing pills, they can be given as an injection or intravenously (IV) with saline. These supplements need to be taken continuously for at least several months.

Your doctor may also recommend changes to your diet. If folate deficiency is caused by an underlying medical condition, it is important to treat that condition as well.

Can folate deficiency anemia be prevented?

Yes, it definitely is possible. It's easy to avoid this situation if you take care of these things:

• Get your daily dose of folate, either through the foods you eat or by taking a supplement containing vitamin B9 (folic acid).
• Reduce the amount of alcohol you drink, or stop drinking altogether. Excessive alcohol consumption prevents the body from absorbing essential nutrients, including folate.
• If you have any medical condition that prevents your body from absorbing or using folate, talk to your doctor about it.

How much folate (vitamin B9) do we need per day?

The vitamin B9 we get naturally from food is called folate. The vitamin B9 added to food or found in vitamin pills is called folic acid. The amount of folate we need per day depends on several factors:

• Age: As you get older, your need for folate increases.
• Food source: Our bodies absorb folic acid better than folate from food.

Recommended Daily Allowances (RDAs) are expressed in micrograms (mcg), measured in Dietary Folate Equivalents (DFE). This may seem a little confusing, but it's simple.

• `1 mcg` of folate from food is equivalent to `1 mcg DFE`.
• Whether you get folic acid added to food or from vitamin pills taken with food, 1 mcg of folic acid is equivalent to 1.67 mcg DFE (meaning the body absorbs more).
• 1 mcg of folic acid from vitamin pills taken on an empty stomach is equivalent to 2 mcg of DFE (which is absorbed even better by the body).

For example, if you take a multivitamin with `200 mcg` of folic acid on an empty stomach, it can be calculated as `400 mcg DFE` (200 mcg x 2 = 400 mcg).

An average adult needs 400 mcg of DFE per day. Pregnant women need 600 mcg of DFE, and breastfeeding mothers need 500 mcg of DFE. It's best to ask your doctor for the right amount for you.

What foods are high in folate?

Fortunately, there are many foods that are good sources of folate. Try adding these to your diet:

• Meats: Beef liver (there's a lot of this, but you also have to think about cholesterol)
• Green vegetables and herbs: Greens like spinach, kale, collard greens, asparagus, Brussels sprouts, avocado, broccoli.
• Fortified foods: Some cereals (breakfast cereals), rice, bread, pasta, bread flour, cornmeal. (Check the label to see if folic acid is added.)
• Beans: Kidney beans, kidney beans.
• Nuts: Peanuts, walnuts.
• Fruit: Citrus fruits like oranges and tangerines and their juices.

Remember: Folate can be destroyed when these foods are cooked for a long time, such as when boiled in water. So cook them as little as possible, or add them to your meals if they can be eaten raw (washed well).

Will this condition be cured if treated?

Most likely yes! Treatment for folate deficiency anemia is usually very successful. Within a few months of starting vitamin B9 supplements, most people start producing healthy red blood cells again, and their symptoms gradually improve.

When should you talk to a doctor about folate deficiency anemia?

Be sure to seek medical advice in cases like these:

• If you're not sure how much folate you need per day, or if you're getting enough of it.
• If you have symptoms of anemia (such as fatigue, weakness, shortness of breath).
• If you have another medical condition that can cause folate deficiency.
• If you have previously been treated for folate deficiency anemia and feel like your symptoms are coming back.
• If you are planning to get pregnant, or are already pregnant. This is very important!

It can be a little disconcerting to learn that you have a problem with your blood cells. But remember, symptoms are your body's way of telling you that something is wrong. It could be that you need a balanced diet, or it could be an underlying medical condition. Your doctor will work with you to find the cause. They will also prescribe vitamin B9 supplements and other treatments if necessary. With proper treatment and following your doctor's instructions, your symptoms will most likely improve.

The most important things to remember (Take-Home Message)

Okay, so here are some things to keep in mind from what we've talked about:

• Folate (vitamin B9) is an essential nutrient for making healthy red blood cells.
• A deficiency in folate can lead to the formation of large, abnormal red blood cells (`megaloblasts`), leading to anemia.
• If you experience symptoms such as constant fatigue, weakness, pale skin, and difficulty breathing, see a doctor.
• Include foods rich in folate (legumes, green vegetables, nuts, foods with added folate) in your diet.
• Pregnant, breastfeeding, and women who are trying to get pregnant should be especially careful about folate. Take folic acid pills as prescribed by your doctor.
• Often this condition can be completely cured with treatment.

So, take care of your body. Eat a balanced diet. If you have any problems, don't be afraid to talk to a doctor. Staying healthy is the most important thing!

` Folate, anemia, vitamin B9, blood deficiency, red blood cells, nutritional deficiency, pregnancy health