You are about to get pregnant, or you just did, and everywhere you look you read that you should take folic acid. But why exactly, and how much? And what if you have no wish to conceive: can you still be low on folate? The short answer is yes, and the symptoms closely resemble those of a vitamin B12 deficiency.
My view: around a wish to conceive, folate is not an optional extra but a proven preventive measure you should not skip. Outside that window, targeted testing makes more sense than supplementing on a hunch.
What is folate?
Folic acid is the synthetic form of folate, a B vitamin (B11, internationally called B9). Your body uses it to make DNA, divide cells and form red blood cells. You get folate from food and folic acid from supplements and fortified products. The synthetic form is absorbed slightly better, which is exactly why folic acid is practical around pregnancy.
Symptoms of a folate deficiency
A folate deficiency resembles a vitamin B12 deficiency in its symptoms, because both are needed to make blood. The complaints build up slowly and are not very specific. Common signs are:
- Fatigue and weakness
- Pale skin and shortness of breath from anaemia (megaloblastic anaemia)
- Mouth ulcers and a red, smooth tongue
- Irritability and trouble concentrating
Because the symptoms look so much like a B12 deficiency, and because folate can mask a B12 deficiency, both vitamins are often assessed together in blood tests.
Folate and pregnancy
Around pregnancy, folate is especially important. The Voedingscentrum (Netherlands Nutrition Centre) advises women who wish to conceive to take 400 micrograms of folic acid per day, from the moment you want to become pregnant until ten weeks into the pregnancy. Extra folic acid in this period lowers the risk of a neural tube defect such as spina bifida in the baby.
Important: this advice applies even if your folate level is normal. It is a preventive measure, not treatment of a deficiency. You take it not because you lack something, but to reduce a risk during the development of the baby's nervous system.
Which situation fits which step?
This table helps you judge when folate is relevant and what the logical next step is. It does not replace advice from your doctor.
| Situation | Is folate relevant? | What is the step? |
|---|---|---|
| Active wish to conceive or early pregnancy | Yes, strongly | Take 400 ug per day regardless of your level |
| Fatigue plus pale skin or mouth ulcers | Possibly | Test folate and vitamin B12 together |
| One-sided diet, little veg and legumes | Possibly | Adjust diet, test if in doubt |
| Bowel disease or heavy alcohol use | Possibly | Test, absorption may be disrupted |
| No symptoms, no wish to conceive | Usually not | Targeted test only with risk factors |
Where do you find folate?
- Green leafy vegetables: spinach, kale, lettuce
- Legumes: lentils, chickpeas, beans
- Citrus fruit and wholegrain products
- Fortified products such as some breakfast cereals
Folate from food is sensitive to heat. Long cooking destroys part of it, while raw or briefly cooked vegetables keep more folate. A handful of steamed spinach or a portion of lentils already provides a good share of your daily need, while the same vegetable after an hour of simmering provides much less.
How is folate measured?
In blood tests, folate is usually measured in your serum, sometimes supplemented by the folate in your red blood cells. Serum folate fluctuates strongly with what you ate over the past few days, while the folate in your red blood cells gives a more stable longer-term picture. For most questions the serum measurement is enough. If you deliberately eat extra vegetables just before the test, your value may look temporarily more favourable than your average, so in the days before, eat as you normally would.
A low folate value on its own is no cause for panic. Your doctor looks at the whole picture: your symptoms, your diet, your vitamin B12 and whether there is anaemia. Only then does it become clear whether a low value really calls for action.
Who is at risk of a folate deficiency?
- Women with a wish to conceive or who are pregnant, due to increased need
- People with a one-sided diet, low in vegetables and legumes
- People with bowel disease such as coeliac disease or Crohn's
- People who drink a lot of alcohol, as alcohol inhibits absorption
- Users of certain medicines that affect folate metabolism
Testing for a folate deficiency
A blood test measures your folate level. Because a folate deficiency and a vitamin B12 deficiency resemble each other and can mask one another, they are often measured together. If you want to check both, the B-vitamins panel covers the main B vitamins at once. If you suspect anaemia, also consider the anaemia panel.
This article is part of our vitamin deficiency overview and connects to vitamin B12 deficiency.
Frequently asked questions
What is the difference between folic acid and folate?
Folate is the natural form in food, folic acid the synthetic form in supplements and fortified products. Folic acid is absorbed slightly better, which makes it convenient around pregnancy.
Can I get too much folic acid?
Not through food. Through supplements there is an upper limit of 1 milligram per day. A high intake can mask a vitamin B12 deficiency, so coordinating with your doctor is wise.
Every blood test result at Vitalcheck includes a professional assessment by a BIG-registered doctor. A blood value is not a diagnosis: always discuss symptoms and treatment decisions with your GP.
Sources
- Voedingscentrum. Folic acid and pregnancy. Accessed 2026.
- RIVM. Folic acid around pregnancy. 2019.
- Gezondheidsraad (Health Council). Dietary reference values for vitamins and minerals. 2018.
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