Folate Overload

Folate overload happens when you have too much folate in your blood. This usually comes from taking high doses of folic acid supplements. Folate is the natural form of vitamin B9 found in food. Folic acid is the synthetic version added to supplements and fortified foods.

Your body needs folate to make DNA and red blood cells. But too much folic acid can build up as unmetabolized folic acid in your bloodstream. This means your body cannot process it all. The excess folic acid just circulates in your blood.

The biggest concern is not the folate itself. High folate levels can hide a vitamin B12 deficiency. When B12 is low but folate is high, blood tests may look normal. This can delay treatment for B12 deficiency. Left untreated, B12 deficiency causes permanent nerve damage.

Most people with folate overload do not have direct symptoms from the high folate itself. The problems come from the masked B12 deficiency. If you have folate overload hiding a B12 deficiency, you may notice:

• Tingling or numbness in hands and feet
• Difficulty walking or balance problems
• Memory problems or confusion
• Fatigue and weakness
• Pale or yellowish skin
• Shortness of breath
• Mood changes or depression
• Tongue swelling or soreness

Many people have no symptoms until the B12 deficiency becomes severe. This is why testing your folate and B12 levels together is important.

Folate overload almost always comes from taking too much folic acid in supplement form. Fortified breakfast cereals and breads add to your intake. Your body absorbs folic acid differently than natural folate from food. When you take more than 400 micrograms daily, unmetabolized folic acid can build up. Many multivitamins contain 400 to 800 micrograms. Some prenatal vitamins have even more.

Risk factors include taking high dose B complex vitamins, prenatal vitamins when not pregnant, and multiple supplements that contain folic acid. People over 50 are at higher risk because B12 absorption naturally decreases with age. Vegans and vegetarians may take folate supplements but have low B12 from diet. This combination creates the perfect storm for masked B12 deficiency.

Folate overload is diagnosed with a blood test that measures folate levels in your serum. Normal folate levels range from 2.7 to 17.0 nanograms per milliliter. Levels above this range suggest overload. Your doctor should also check your vitamin B12 levels at the same time. This helps identify if high folate is masking a B12 deficiency.

Rite Aid offers folate testing as an add-on to our blood testing panel. You can get tested at over 2,000 Quest Diagnostics locations nationwide. Testing both folate and B12 together gives you the full picture of your B vitamin status. Early detection helps prevent nerve damage from hidden B12 deficiency.

Treatment for folate overload focuses on reducing your folic acid intake and addressing any underlying B12 deficiency. Here are the main approaches:

• Stop or reduce folic acid supplements immediately
• Review all supplements and multivitamins for hidden folic acid
• Check fortified foods like cereals and breads for folic acid content
• Get your B12 levels tested and treated if deficient
• Take B12 supplements or injections if levels are low
• Eat more natural folate from leafy greens, legumes, and citrus
• Focus on whole foods rather than fortified products
• Retest folate and B12 levels every 3 to 6 months

If you have nerve symptoms from B12 deficiency, your doctor may prescribe B12 injections. These work faster than oral supplements. Most people see folate levels return to normal within a few weeks of stopping supplements. Always talk to your doctor before stopping any prescribed vitamins.