<<Disclaimer: Verify this information before applying it to your situation.>> 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.] -------------- [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." --------------- ________________________________________________________________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/web/. * Visit the Celiac Web Page at www.enabling.org/ia/celiac/index.html *