Folate deficiency caused by a lack of folate in the diet is more common in people who have a generally unbalanced and unhealthy diet, in people who regularly consume alcohol, and in people who follow a restrictive diet that does not involve consuming good sources of folate. Folic acid deficiency can be due to multiple causes, including inadequate dietary intake. Heating during cooking destroys folic acid. Folate is absorbed in the jejunum through active and passive transport mechanisms through the intestinal wall.
Therefore, diseases such as celiac disease, tropical sprue, short bowel syndrome, amyloidosis, gastric bypass or mesenteric vascular insufficiency can inhibit folate absorption and result in deficiency. High pH, such as in achlorhydria, can also cause poor absorption of folate. Drugs such as methotrexate, phenytoin, sulfasalazine and trimethoprim can antagonize the use of folate and inhibit its absorption or conversion to its active form, resulting in folate deficiency. Congenital deficiencies in the enzymes necessary for folate metabolism can result in folate deficiency.
Folic acid deficiency can occur after vitamin B-12 deficiency due to an alteration of methionine synthase, which results in folate being trapped in the form of methyltetrahydrofolate, so methylene THFA accumulates in the serum, causing the phenomenon of folate trapping and an increase in urinary folate excretion. Alcoholism is a major cause of folate deficiency. Pregnancy, hemolytic anemia, and dialysis can also result in folate deficiency. The best way to prevent folate deficiency is to follow a healthy diet that includes foods that contain folate or folic acid.
Alcohol interferes with folate absorption, metabolism, renal excretion, and enterohepatic reabsorption and reduces the intake of healthy foods.