Folic acid deficiency in the elderly: This is the cause and the solution
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Leesduur: 10 min
Most people know folic acid primarily as a vitamin that's important during pregnancy. But what's much less well-known is that older adults often have a folic acid deficiency as well.
Folic acid is the synthetic form of folate, the natural variant found in our diet. Both are also called vitamin B11.
Have you reached the respectable age of 65? Or are you caring for someone over that age? Then it's wise to read on. In this article, you'll discover the main causes of a deficiency and what you can do about it.
Good to know : In this article, I'll use the term "elderly" for convenience, meaning people aged 65 and older. Whether you consider that old is up to you!
Older adults are more likely to have an increased risk of folic acid deficiency due to decreased appetite, B12 deficiency, reduced absorption, and medication use.
A folic acid deficiency can lead to fatigue, anemia, irritability, loss of concentration, increased susceptibility to infections and, in case of long-term deficiency, also neurological complaints.
Treatment consists of a folate-rich diet, supplementation with 5-MTHF, B12 and B6, and improving lifestyle habits.
Table of contents
Causes of folic acid deficiency in the elderly Consequences of a folic acid deficiency Solving folic acid deficiency in the elderly (step-by-step plan) 1. Request a blood test from your GP 2. Adjust your diet 3. Start with quality supplements 4. Discuss any medication you are taking with your doctor 5. Adjust your lifestyle 6. Have your blood checked regularly The best folic acid/folate supplement for the elderly? Why 5-MTHF folate for the elderly? Conclusion
Causes of folic acid deficiency in the elderly
First of all, it is good to understand why older people are more likely to develop a folic acid deficiency.
These are the 9 most common causes:
- Your appetite often decreases somewhat - Many people notice that they're less hungry as they get older. And when you eat less, you also get fewer vitamins, including folic acid. This can be a problem, especially if you eat little bread, green vegetables, or legumes.
- Less vitamin B12 = less active folic acid - You need vitamin B12 to convert folic acid into the active form (5-MTHF) in your body. However, B12 is often less well absorbed in older adults. So even if you eat enough folic acid, your body may still use it less effectively.
- You might be eating less varied food - Many older adults eat less varied food, for example, because they live alone, prepare larger portions ahead of time, or eat ready-made meals more often. This is understandable, but it can quickly lead to missing important vitamins like folic acid, which are found in a wide variety of products. Variety remains important, even when it's meant to be easy.
- Your body absorbs it less well - As you age, your digestion changes. Some people develop conditions like atrophic gastritis, where the stomach lining thins, or celiac disease, an autoimmune disease in which gluten damages the intestinal lining. In such cases, your body absorbs folic acid from food less effectively (so this doesn't apply to everyone, but it's more common in older adults).
- Medications can interfere - Are you taking antacids, methotrexate, or metformin (for diabetes)? Then your body may absorb folic acid and B12 less effectively. These vitamins are then less readily absorbed from your diet, even if you eat healthily. You won't always notice this immediately, but it can contribute to symptoms like fatigue, depression, or memory problems.
- You sometimes need more than before - With illnesses like cancer, COPD, or rheumatoid conditions, your body uses more folic acid. Your needs can also increase with inflammation, infections, or when recovering from surgery. And if you also eat less or have a decreased appetite, a deficiency develops faster than you think.
- Smoking and alcohol are counterproductive - Do you smoke? Or do you enjoy a drink? Then it's good to know that smoking and excessive alcohol consumption can also significantly reduce folic acid absorption.
- Heredity sometimes plays a role - Some people have a genetic predisposition (MTHFR mutation) that causes the body to convert folic acid less efficiently. While you might not notice this, it can contribute to a deficiency. A blood test can provide clarity.
- Overweight or underweight? - Both overweight and underweight can disrupt folic acid absorption. This is partly because the body processes food and vitamins differently. A healthy weight also helps in this regard.
Consequences of a folic acid deficiency
A folic acid deficiency can manifest itself in various ways, both physically and mentally. Symptoms may begin vaguely but often become more pronounced as the deficiency persists.
These are the signs to look out for:
- You feel tired or listless, even after enough sleep
- You have anemia : your body produces fewer red blood cells that function properly (this is also called megaloblastic anemia)
- You become irritable more quickly or suffer from gloomy moods
- You notice that you are less able to concentrate
- You are sick more often or more susceptible to infections
- You have a headache or get dizzy easily
Good to know : With a long-term deficiency, you may sometimes experience tingling or other nerve symptoms in your hands or feet. This is especially common with a vitamin B12 deficiency, but a severe folic acid deficiency can also play a role.
Curious about what folic acid does for your body? Then read my article about the benefits of folic acid .
Solving folic acid deficiency in the elderly (step-by-step plan)
Do you have a folic acid deficiency or suspect something is wrong? Follow this practical step-by-step plan to restore your folic acid levels.
Here's how to tackle folic acid deficiency in the elderly step by step:
1. Request a blood test from your GP
The first step is simple but important: Ask your doctor for a blood test . This will let you know if there really is a deficiency.
The risk of folic acid/folate and vitamin B12 deficiencies is particularly high in older adults. The doctor will usually test the following three values to get a good picture:
- Folate Levels - This is the amount of folic acid in your blood
- Vitamin B12 - Because a deficiency can cause similar complaints
- Homocysteine - This is a substance in your blood that shows how well your body is handling B vitamins (this value often rises with a folic acid or B12 deficiency)
Good to know : The symptoms of a folic acid deficiency can resemble other deficiencies. Blood tests can tell you for sure what's going on and allow you to take targeted action.
2. Adjust your diet
Older people are more likely to have a one-sided diet than people who are still in the prime of their life.
Folic acid (or more accurately, folate, the natural form) is found in many healthy, fresh foods . Think spinach, kale, broccoli, whole-wheat bread, lentils, and oranges.
By including these on the menu more often, you can naturally replenish your folic acid levels.
Try to vary as much as possible - Don't eat the same thing every day, but alternate vegetables and choose whole-grain products more often instead of white bread or white rice.
Tip : Do you find it difficult to cook fresh food every day, perhaps because you live alone or have little energy? Then healthy ready-made meals, such as frozen meals with lots of vegetables or meal-sized soups, can be a great solution.
3. Start with quality supplements
If blood tests show that you have a deficiency, or are at risk of a deficiency, a supplement can help quickly restore your folic acid levels.
Preferably choose a supplement with at least 400 micrograms of active folate , also known as 5-MTHF . This form doesn't need to be converted in your body, making it immediately usable.
Good to know : Even better is a combination with active forms of vitamin B12 (methylcobalamin) and B6 (P5P). These three vitamins work closely together in your metabolism and support each other.
In the elderly it is even more important to take the active forms of B12 and folic acid (5-MTHF folate), because the elderly have more difficulty converting vitamins into the active form.
4. Discuss any medication use with your doctor
Are you taking medications? Always discuss with your doctor whether they affect your folic acid status. This is an important step, especially if you have symptoms or have been diagnosed with a deficiency.
Some medications can disrupt the absorption or processing of folic acid. (1) (2) (3).
Even with a healthy diet, you can still develop a deficiency due to these medications:
- Antacids (such as omeprazole) - Reduce the absorption of vitamin B12, which also indirectly affects the effect of folic acid
- Metformin (for diabetes) - May decrease B12 absorption, which disrupts folic acid metabolism
- Methotrexate (for rheumatism or psoriasis) - Inhibits the conversion of folic acid in the body
Note : Never adjust your medication yourself. Only your doctor can properly assess your needs and whether adjustments or supplementation are necessary.
5. Adjust your lifestyle
Smoking and drinking a lot of alcohol reduce the absorption of folic acid in your body. (4) (5) Quitting smoking and drinking in moderation therefore helps to prevent a deficiency.
Even a little daily exercise , such as walking or cycling, supports your digestion and overall health. This helps your body better utilize nutrients, including folic acid.
Tip : Start small, for example, take a 10-minute walk around the block every day after lunch. This way, you'll easily make it a habit that will really benefit your health.
It's good to know that it's never too late to change your lifestyle. Even if you're 80+, you can still achieve health benefits by quitting smoking and exercising more.
6. Have your blood checked regularly
A one-time measurement isn't enough. Have your blood tested again after 2 to 3 months to see if your folic acid levels have improved. This way, you'll know if the changes in your diet and supplements are truly working.
If the test shows a continued deficiency, you can discuss with your doctor or dietitian what adjustments you can make.
Tip : Do you find it difficult to keep track of everything yourself? Ask a friend or family member for help. It's often easier together, and you'll stay more motivated.
The best folic acid/folate supplement for seniors?
The best folic acid supplement for seniors contains the following:
- At least 400 micrograms of the active form of folic acid: 5-MTHF-folate .
- Active B12 (methylcobalamin)
- Active vitamin B6 (in the P5P form)
- No unnecessary additives (so it remains as natural and easily absorbable as possible)
Why 5-MTHF folate for the elderly?
Most supplements contain folic acid, the synthetic form of vitamin B11. But your body must first convert folic acid into the active form: 5-MTHF-folate.
And that's precisely where things often go wrong for older adults. Due to natural aging, medication use, or a deficiency of other B vitamins, this conversion process is less efficient. The risk? That your body doesn't utilize the folic acid properly, even if you do take it.
That's why it's smart to choose the active form, 5-MTHF folate . This form is immediately usable by your body, without the need for any complicated conversions. This way, you can be sure you're getting something your body truly benefits from.
Tip : Use this supplement daily, preferably with a meal.
Conclusion
A folic acid deficiency in older adults often develops slowly and is therefore easily overlooked. However, it's more common than you might think, and the symptoms can significantly impact your energy, memory, and immune system.
That's why it's important to have your folic acid levels tested. Ask your doctor for a blood test to confirm a deficiency and to rule out other causes, such as a B12 deficiency.
Do you indeed have a deficiency? Then start with the natural approach: Eat more folate-rich foods, such as green vegetables, legumes, and whole grains, and see if you can improve your lifestyle. Consider exercising more and cutting down on alcohol or cigarettes.
If a second blood test shows that this does not help enough, it is wise to use a good quality nutritional supplement, preferably with active folate (5-MTHF), B12 and B6.
This way you give your body exactly what it needs, in a way that suits you.
Ebrina van der Bijl
Ebrina is a nutritionist with a deep commitment to healthy eating and a sustainable lifestyle, based in beautiful Portugal. Her passion for natural and organic products is at the heart of her work. With a background in Nutrition & Dietetics and experience in product development and writing, she translates complex scientific information into practical advice for a balanced lifestyle.
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