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Nutritional deficiencies are common in celiac disease even with
compliance to the GF diet.  I've had two serious bouts with anemia caused
by B12 & folic acid deficiency.  The first was B 12 deficiency macrocytic
anemia after being GF for 6 months.  I started B12 shots & about one year
later  had macrocytic anemia again, this time from folic acid deficiency.
 Even though I eat a diet rich in these two nutrients, I still need
supplementation because I don't absorb either of them very well.
        Since posting about my own experiences with macrocytic anemia, I've been
given some good references about homocysteine.  Homocysteine is an amino
acid that is produced in the steps of protein metabolism.
Hyperhomocysteinemia, elevated levels of homocysteine in the blood [hyper
= high, -emia = in the blood], is a known risk factor in cardiovascular
disease.  It is also known that deficiencies of B vitamins, B12, folic
acid & B6 are essential for keeping homocysteine levels at a safe &
normal level.  Here are some of the interesting things people have sent
me about homocysteine as well as a few websites I found that discuss this
topic.  Below is also a reference about methylmelonic acid, which is also
related to this topic.  [My comments & explanations are in bracketts.]
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[This first article is an overview of much of the latest research on the
subject of B vitamins & heart disease.  It's written in easy to
understand language.]
The B-Vitamins and Heart Disease  -- "Folic acid and other B vitamins
reduce the risk of coronary heart disease and stroke, according to a
detailed analysis of more than three dozen scientific studies.
        "These nutrients work by quenching homocysteine, an amino acid in the
blood that attacks blood vessel walls and promotes cardiovascular
disease.
        "Homocysteine (pronounced ho´-mo-sis´-teen) has emerged after 25 years
of research as the "new cholesterol," and researchers estimate that it is
a major risk factor in 10 to 40 percent of heart attacks and strokes in
the United States. Under normal circumstances, this amino acid is a
short-lived byproduct of methionine metabolism, but a diet short on B
vitamins prevents its breakdown."
        "Very high doses of folic acid can mask these blood abnormalities
[macrocytic anemia], allowing neurological damage from B12 deficiency to
continue unnoticed. Today, a laboratory test for methylmalonic acid
serves as a more sensitive and specific test for vitamin B12 deficiency.
        "In the 1980s, Carlton Fredericks, PhD, offered a simple safeguard for
anyone contemplating folic acid supplements: take some vitamin B12 as
well. Writing in JAMA, Beresford echoed this advice in suggesting that
people take 1 mg (1,000 mcg) of B12 with every 400 mcg tablet of folic
acid. It's a simple solution.
For complete article see:
http://www.nutritionreporter.com/B-vitamins.html
---------------
This one is an abstract of an article from Journal of Human Hypertension.
  "Reversible hypertension following coeliac disease treatment: the role
of moderate hyperhomocysteinaemia and vascular endothelial dysfunction."
        The vascular endothelium [the inside of our blood vessels] maintains a
relatively vasodilated [relaxed & open] state via the release of nitric
oxide (NO), a process that could be disrupted by hyperhomocysteinaemia.
[In other words, hyperhomocysteinaemia can cause high blood pressure.]
... we hypothesised that in patients with both hypertension and coeliac
disease with hyperhomocysteinaemia (via malabsorption of essential
cofactors), treatment of the latter disease could improve blood pressure
(BP) control. A single patient with proven sustained hypertension and
newly-diagnosed coeliac disease had baseline and post-treatment BP ...
This 49 year-old woman had uncomplicated sustained hypertension [high
blood pressure] and sub-clinical coeliac disease (gluten-sensitive
enteropathy). Initial assessments revealed raised homocysteine levels
with low normal vitamin B(12) level. It was likely that she had impaired
absorption of essential cofactors for normal homocysteine metabolism. She
adhered to a gluten-free diet and was give oral iron, folate and B(6)
supplementations as well as B(12) injections for 3 months. Her BP had
improved by 6 months and normalised by 15 months (daytime ABPM mean
128/80 mm Hg). .... These observations suggest that sub-clinical coeliac
disease related hyperhomocysteinaemia might cause... a reversible form of
hypertension.
-------------------------
Another abstract.  This one from Therapeutische Umschau
Deep venous thrombosis of the leg in acquired
thrombophilia--hyperhomocysteinemia as a sequela of undetected celiac
disease. [German]
        Today hyperhomocysteinemia is a well known and important risk factor
for arteriosclerotic vascular and venous thromboembolic disease with a
high prevalence in the general population. Elevation of plasma
homocysteine levels are caused either by genetic defects in the enzymes
involved in homocysteine metabolism or by nutritional deficiencies of
vitamin cofactors (folate, vitamin B12, vitamin B6). A number of other
factors may influence homocysteine metabolism, such as several disease
states and medications. It has been demonstrated, that supplementation of
folate, vitamin B12, or vitamin B6 can correct mild and moderate
hyperhomocysteinemia.
-----------------------
This one is a diaglogue:
Q: What do you think about testing for B12 and folate with these tests:
homocysteine  & methylmalonic acid
A: I'm sure they are more expensive than folate or B12 levels, but more
accurate in terms of actual function in the body.
Q: Recognizing that it doesn't cost much to supplement with the vitamins,
is there any reason to do the tests?
A: I think so.  First, for someone who needs proof that they need the
supplements. Second, for someone who is taking supplements but not
absorbing them. (ie: If someone is taking these supplements, but still
has an elevated MCV +/or anemia, they may not be absorbing sufficient
amounts of B12 and folate. Perhaps a positive test would be enough to
persuade a person (or the payer) that they needed to use B12 injections
and use a higher dose of folate.) [MCV stands for mean corpustular
volume, elevated MCV means extra large red blood cells as seen in
macrocytic anemia which can be caused by folic acid & B12 deficiency]
-----------------
http://www.b12.com/  This website has an interesting discussion about
about the methylmalonic acid (MMA) test and the importance of B12 in
preventing dementia, anemia and eleveted homocysteine.  It also offers an
at home test for MMA by mail.  From this website:
"However, Norkus et al.49A found no effect between multivitamin (MVT) use
(2-30 micrograms B12 daily) and B12 status in elderly subjects suggesting
bioavailability of B12 from MVT use can be unpredictable. 4A Crane et al.
recommend subjects in their studies chew 500 microgram B12 tablets since
some do not dissolve quickly enough to obtain consistent results."
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