• Inadequate nutrition, particularly lack of fresh fruits and vegetables;
• Poor absorption, as in malabsorption, with intestinal problems, with pellagra, or after stomach or intestinal surgery;
• Metabolic problems, such as those created by alcohol or drug use; and
• Excessive demands by tissues, as with stress, illness, or pregnancy.

We should be concerned about folate deficiency primarily in pregnancy, during breast-feeding, and in the elderly. Folic acid absorption seems to diminish with age, and deficiency is common in the elderly, especially those in rest or nursing homes, who are unlikely to get fresh vegetables or supplements. Often, the first manifestation of a low folate level is feeling depressed. Folic acid deficiency is more common in people with depression or other psychological symptoms in mental institutions. Alcoholics have had serious problems maintaining proper folic acid levels. Teenagers with poor diets, who do not eat green vegetables or many vegetables at all other than fried potatoes, may more easily become folic acid deficient. If we suspect deficiencies, it is wise to get a blood folate level as well as a B12 level before treatment with supplements. A red-blood-cell folate level may more accurately reflect body stores of folic acid.

Besides causing mental symptoms, folate deficiency can also affect the skin. As in vitamin B2 (riboflavin) deficiency, cracks or scaling at the lips and corners of the mouth (cheilosis) may occur. Also possible with deficiency are decreased growth, fatigue, and more rapid graying of the hair. More recently, folid acid deficiency (along with vitamin A deficiency) has been associated with cervical dysplasia and cancer.

Requirements: The RDA for folic acid is 400 mcg. in adults, 800 mcg. during pregnancy, and 600 mcg. during lactation. And many factors increase the minimum requirement for folic acid. But the average American diet contains only about half of this, about 220 mcg. This reveals why disorders involving folic acid deficiency are so common.

Between 180 and 200 mcg. of folic acid are needed daily to maintain the tissue stores of folate. During pregnancy, times of stress or illness, or with alcohol use, the demands are increased, and a 200 mcg. daily intake is not sufficient for supporting folic acid functions and maintaining tissue stores. Deficiency symptoms may then occur.

Other things besides stress, illness, and alcohol use create greater need for folic acid. Birth control pills may reduce absorption of this vitamin by 50 percent. Other drugs besides estrogen may interfere with absorption or metabolism. These include the sulfa antibiotics,