Neurologists and dietitians reveal who’s most at risk, and how alcohol makes it worse.
Emily is a journalist and certified health coach living in Cary, North Carolina.
For some people, feeling exhausted or getting headaches happens so frequently that they’re just used to living with it. PSA: These are not symptoms anyone should put up with.
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Fatigue and headaches are the body’s way of communicating that something is off, such as a need that isn’t being met. This might mean you aren’t getting enough rest, drinking enough water or meeting your nutritional needs.
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There’s one nutrient in particular that’s easy to miss, and not getting enough can cause fatigue, headaches and memory problems when left untreated: folate. Here’s what doctors want you to know.
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Folate deficiency can cause anemia, and that can lead to a host of issues.
Pinpointing the root cause of fatigue isn’t always easy. There are certain culprits you may think of right away, such as not getting enough protein or iron. But one nutrient you may be overlooking is folate. According to Dr. Nada Hindiyeh, a neurologist and the chief medical officer of Haven Headache & Migraine Center, fatigue is the most common symptom of folate deficiency.
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“Folate is essential for making healthy red blood cells. Without enough of it, people can develop anemia, and anemia means your body isn’t delivering oxygen as efficiently as it should. That’s why people often feel tired, weak or short of breath,” Hindiyeh told HuffPost.
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Hindiyeh explained that the symptoms of not consuming enough folate happen over time and can lead to outcomes such as headaches and cognitive problems. While Hindiyeh emphasized that folate deficiency isn’t a common cause of headaches or migraines, a significant folate deficiency can lead to folate-deficiency anemia, also known as megaloblastic anemia, over time, and this can then lead to headaches.
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“When someone becomes anemic, they may develop symptoms like fatigue, weakness and sometimes headache. So if a headache occurs, it’s usually because of the anemia rather than the vitamin deficiency directly,” Hindiyeh said.
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Folate deficiency can negatively impact brain health long term, too, especially when it comes to memory. According to a 2022 study published in the European Journal for Clinical Nutrition, low folate was associated with an accelerated decline in cognitive function and was an important marker for cognitive decline among older adults.
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Dr. Shivang Joshi, an assistant professor of neurology at the University of Massachusetts and the vice president of the Association of Migraine Disorders, told HuffPost that many people with a folate deficiency also have low levels of vitamin B12, which is closely associated with memory problems and cognitive decline, according to a 2020 study published in The Journal of Nutrition, Health, & Aging.
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“Folate is important for normal brain function, so severe deficiency has been associated with cognitive changes. But memory is complicated,” Hindiyeh shared.
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She explained that there are many reasons someone might notice memory problems, and folate deficiency is just one possible contributor. While a folate deficiency wouldn’t be the first factor Hindiyeh would consider if someone was experiencing memory problems, she said it certainly can be a piece of the puzzle and shouldn’t be overlooked.
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Who is most likely to have a folate deficiency?
Here’s the good news: Both neurologists told HuffPost that having a folate deficiency is rare.
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“It’s hard for anyone in the US to have a true folate deficiency because so many foods are fortified with it,” Joshi said.
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Folate is found in a wide range of foods, including vegetables, fruit, nuts, beans, seafood, eggs, dairy products, meat, poultry and grains. For this reason, both doctors shared that if someone has a folate deficiency, they are likely deficient in other important nutrients, too.
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Even though there is no shortage of folate-containing foods, some people are still at risk for having a folate deficiency. Sophia Guillot, a registered dietitian at TeamNutrition, told HuffPost that people with alcohol use disorder are at higher risk of a folate deficiency because alcohol interferes with its absorption.
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Joshi said that alcohol can also interfere with vitamin B12 absorption, which can also lead to fatigue, headaches and memory problems. But he emphasized that this isn’t something that happens by just having one or two drinks regularly; it’s a symptom of chronic alcohol use.
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Hindiyeh added to this, saying, “Chronic heavy alcohol use can interfere with folate in several ways. It reduces absorption, affects how the body stores folate, and people who drink heavily are also more likely to have poor nutrition overall. Those factors together increase the risk of deficiency.”
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If you have any sort of health condition that can impede nutrient absorption (such as celiac disease or inflammatory bowel disease), you are also at higher risk for a folate deficiency, according to Guillot. “Pregnant women also have higher folate needs to support DNA synthesis and cell division,” Guillot added.
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There are easy ways to make sure you’re getting enough folate.
The National Institutes of Health recommends that non-pregnant US adults get 400 micrograms of dietary folate equivalents a day.
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“Dietary folate equivalents are used since only certain percentages of folate are bioavailable when consumed in forms other than from whole foods,” explained Kelsey Kunik, a registered dietitian and owner of Graciously Nourished.
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She said that if you take a folic acid supplement on an empty stomach, you’ll only absorb 50% of the folic acid in the supplement, but if you consume folic acid via fortified foods or take a supplement with food, you’ll absorb 60%.
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Again, most people in the US get enough folate through their diet and are not deficient. But if you are experiencing fatigue, headaches and memory problems regularly and you want to know if low folate levels are the reason, ask your healthcare provider for a serum folate test. This simple blood test measures how much folate is in your blood at that current moment.
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“Eating a varied diet helps ensure sufficient folate intake,” registered dietitian Amy Brownstein told HuffPost. “Folate exists in a variety of foods, including many plant foods, dairy, fish and animal products. The best sources of folate include black-eyed peas, boiled spinach and fortified breakfast cereals. Adding a serving of a folate-rich food to your daily routine can help meet your overall folate needs.”
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Brownstein shared that the main people who can benefit from taking a folate supplement are women who are pregnant or are trying to become pregnant. She explained that folate is particularly important during early pregnancy when the baby’s spinal cord develops.
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“Incorporating folate-rich foods or taking a regular multivitamin that contains folate helps meet needs,” Brownstein said. Of course, it’s always a good idea to talk to your doctor before starting any supplement, especially if you have any underlying health conditions. The health experts HuffPost spoke to said it’s unlikely you can consume too much folate from natural food sources, but you should not exceed 1,000 micrograms if you’re taking supplements with folate.
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Folate deficiency is rare, but it can happen, and when it does, it can lead to a whole slew of symptoms you want to avoid. If you are experiencing fatigue, headaches and memory problems, see your healthcare provider. That way, you can pinpoint the root cause — the first step to feeling more energized and clear-headed.