Supplementing Nutrients - B6
A look at your naturopathic prescriptions and the attention B6 is receiving
Recent media attention and questions from clients has led me down a path to assess vitamin B6 and ensure confidence in my clinic prescriptions. I don’t take it lightly when I prescribe nutraceuticals as part of your treatment. Miconutrients are in fact powerhouses and are not nebulous inactive compounds that get flushed down the toilet. This is why when I undertake naturopathic consultations, and in over-the-counter consults, as a university trained naturopath I undertake a full consultation with you and I check and record all supplements that are being taken to ensure the right choices are being made for you your prescription and that toxic high doses are not reached.
This article in principle can be applied across all prescriptions - micronutrients and herbal, but the focus is to answer the following key questions:
What is Vitamin B6? What is Vitamin B6's role in our physiology? What is the gamut of recommended dosages? Why might you need higher levels than the RDI? What are the toxicities that are likely to occur, and why?
B vitamins provide the body with essential co-factors for metabolism - energy production, neurotransmitter production and tissue building, to name a few. B vitamins are water soluble micronutrients distributed within the body in the cell plasma and are not stored in significant amounts, making their regular consumption a necessity. B vitamins in essence work in a complex relationship with each other and other nutrients within the cell. B vitamins are obtained from a fresh whole food diet - plenty of colourful fresh fruits and vegetables.
What is B6 (pyrodoxine)?
Vitamin B6 (pyridoxine) is defined as an essential nutrient, meaning that the body can’t function without it. Vitamin B6 occurs naturally in our diet and is a collective term for six different vitamin forms, meaning they have slight variations in chemical structure (pyridoxine, pyridoxamine, and pyridoxal). Vitamin B6 also has what is referred to as the ‘active’ phosphorylated forms (the attachment of a phosphate group) such as pyridoxal-5-phosphate, known as PLP or P5P. ‘Activated’ for the most part means that the molecule or nutrient can get ‘into’ the cell easier. The body is inherently very careful to also limit where phosphorylation occurs to avoid this activated, energised form of Vitamin B6, creating havoc and reactions in the wrong unintended places if over-loaded.
What is Vitamin B6’s role in physiology? (ie why do you need B6)
B6 performs many functions and acts as a cofactor for numerous reactions within the cell. It is difficult to simply list the role of each micronutrient due to their complex relationship with each other, either directly or indirectly, and therefore will influence entire physiology. This makes it near impossible to extract and label each micronutrient with one unique role.
However, some roles of Vitamin B6 with demonstrated research include (this is just a drop in the ocean of clinical studies):
For the female reproductive system, studies have demonstrated that 80mg of vitamin B6 for two consecutive cycles reduced the symptoms of PMS. (1)
Vitamin B6 is also required for ovulation as it regulates homocysteine concentrations and high levels of homocysteine can increase the risk of anovulation by 33%. (2)
Vitamin B6 works together with vitamins C and B12, and Folate, for iron absorption.
Cardiovascular disease, irritable bowel syndrome, rheumatoid arthritis and other inflammatory chronic diseases have been linked to low plasma levels of Vitamin B6 (pyridoxal -5’-phosphate).
Based on a number of indicators, a recent study suggests that people with the lowest levels of pyridoxal 5’-phosphate (P5P) in their blood had the highest levels of chronic inflammation. (3)
Low plasma levels of pyridoxal-5’-phosphate have been linked with some inflammatory diseases including Alzheimer’s disease, irritable bowel syndrome, and rheumatoid arthritis. (3)
Mauve Factor is a condition caused by an abnormality in the synthesis and metabolism of haemoglobin, the oxygen carrying component of red blood cells. This byproduct of haemoglobin accumulates in the body, binding to zinc and B6 and resulting in mild to severe deficiencies. Implications of Mauve Factor are wide and varied, with a high prevalence in mental health disorders. This can be expected as both zinc and Vitamin B6 play direct roles in many enzyme systems required for neurotransmitter formation and synthesis, with deficiencies in these nutrients resulting in low brain levels of serotonin, GABA and dopamine. (4 , 5)
The role of B6, specifically PLP in amino acid metabolism makes it a rate limiting co-factor in the synthesis of neurotransmitters such as dopamine, serotonin, gamma-aminobutyric acid (GABA), noradrenaline and the hormone melatonin. As such, even a mild Vitamin B6 deficiency will result in a down-regulation of neurotransmitter production, with subsequent effects on sleep, behaviour, cardiovascular function and hormone excretion.
What are the recommended levels of dosages of Vitamin B6?
The recent increased reports of peripheral neuropathy have resulted in a labelling requirement with a warning of supplements with more than 10mg, however, a supplement may still contain up to 100mg according to the TGA (Therapeutic Goods Administration) . The recommended daily intake is between 1.3 and 1.5 mg for a female depending on age. The upper level intake for women in the same age group is 50mg. All of these levels are listed on the eat for health government website - https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/vitamin-b6 .
Understanding recommended levels of B6 is what really led me down a deep rabbit hole. Researching how the daily recommended levels that are provided by the TGA are determined to hopefully answer the question as to why B6 supplement levels are so far above the recommended intake was my big question. The higher levels in the supplements that I prescribe offer relief and resolve many conditions and symptoms I treat in clinic - yet these levels are well above the TGA recommended of 1.5mg/day.
There are in fact several nutrient reference values (NRV) with descriptions found on the government website - https://www.eatforhealth.gov.au/nutrient-reference-values/introduction. Australian reference values have been adopted from the US/Canadian Dietary Reference Intakes (DRIs). Studies and research has determined the minimum metabolic requirement for the nutrients where possible. Formulas are then used to extrapolate such levels as Estimated Average Limits and Upper Limits. From my research and for the scope of this article I could not find complete transparency - I found how they determined levels but not the why? Quite simply I believe that the ease of transparency is actually due to the complexity of the human body, and the unique health picture that every single person has.
As a naturopathic clinician the utmost priority is obtaining your daily nutrient requirements from your diet, and this is always what I work with first. Follow-up appointments are to continually assess and provide guidance for ‘pimping’ up your meals - adding fresh whole foods wherever you can. However, there are also many factors that influence why an individual may need higher amounts of certain nutrients. Some of these factors include:
Compromised digestive system function - both upper digestion to break down the food, and lower digestion to absorb the nutrients. In both cases these functions may actually be influenced by a nutrient deficiency in itself;
Stress, chronic disease and inflammation are all conditions that may influence the cell ability to use the nutrients, and in fact may increase the requirements for nutrients; and,
Genetic polymorphisms influence the effectiveness of metabolic, enzyme pathways and the nutrient form for use ie active or inactive nutrient;
Why is Vitamin B6 toxicity peripheral neuropathy occurring?
Peripheral Neuropathy is damage or dysfunction to nerves of the periphery nervous system - experienced as a numbness or tingling. Vitamin B6 peripheral neuropathy is usually temporary and resolves when supplementation is ceased. It is also important to note that a deficiency of B6 can also cause peripheral neuropathy - similarly for B1, B12, copper and vitamin E.
Questions to consider with the increased occurrence of toxicity - Is it the form? Is it pyridoxine or pyridoxal? Is it the dose? Is it the duration? Is it individual variability in pharmacokinetics and susceptibility and threshold for toxicity? Is it a person's state of health? Is it the medications they are on that influence the metabolism of B6?
For me the answer is all of the above.
With the multibillion dollar supplement industry that exists, and the fortification in foods and marketing of foods and supplements that is for the most part ‘unregulated’ - food and health is an industry for profit, not healthcare (sorry, not sorry, big statement I dropped in that can unleash a big can of worms). The supplements are available for purchase off supermarket shelves, gyms, online, gummies, 'fortified superfoods’. Unfortunately self-prescribing occurs without understanding or checking the cumulative effect of the vitamins in the supplements and foods that may be purchased and consumed.
Naturopathic Clinic
As a university trained naturopath with a clinical practice - meaning I see clients in clinic consultations for their health concerns - I look at a client's entire health picture.
Why are they sitting in front of me? What is their prime health concern? What is their health history - a timeline of symptoms, past illnesses, conditions and injuries, family history? An assessment of each and every body system - digestion through to the reproductive system? What pharmaceuticals and supplements are they taking? Sleep? Energy? Mental health? Stress? Emotional and Spiritual sense of purpose?
Nothing is considered in isolation. And similarly nutraceuticals are rarely prescribed in isolation.
This is especially true for B vitamins. B vitamins work together with such complexity that if only one particular B vitamin is supplemented in isolation, such as B6, it is more likely to cause an imbalance or skew in metabolic processes if taken over a long period of time.
Naturopathic principles overarch all my practices - Treat the Cause, Treat the person, Treat the symptoms and Do No Harm.
When following these guidelines, supporting balance and homeostasis to return to the body - emotionally, physically, mentally and spiritually - then health will come.
For some, this requires a higher level of B6 than the RDI of 1.5mg/day in a prescribed supplement, and I hope I have explained this to say why. I am always open to questions if you wish to ask in your consultation why I have chosen the treatments that I have.
References:
Masoumi, S. Z., Ataollahi, M. & Oshvandi, K. Effect of Combined Use of Calcium and Vitamin B6 on Premenstrual Syndrome Symptoms: a Randomized Clinical Trial. J. Caring Sci.5, 67–73 (2016).
Masoumi, S. Z., Ataollahi, M. & Oshvandi, K. Effect of Combined Use of Calcium and Vitamin B6 on Premenstrual Syndrome Symptoms: a Randomized Clinical Trial. J. Caring Sci.5, 67–73 (2016).
Sakakeeny L, et al. Plasma pyridoxal-5-phosphate is inversely associated with systemic markers of inflammation in a population of U.S. Adults. J Nutr. 2012 Jul;142(7):1280-5. Epub 2012 May 23.
Vashum, K. P., McEvoy, M., Milton, A. H., McElduff, P., Hure, A., Byles, J., & Attia, J. (2014). Dietary zinc is associated with a lower incidence of depression: Findings from two Australian cohorts. Journal of affective disorders, 166, 249-257.
McGinnis, W. R., Audhya, T., Walsh, W. J., Jackson, J. A., McLaren-Howard, J., Lewis, A. & Hoffer, A. (2007). DISCERNING THE MAUVE FACTOR, PART. New Research in Bone Regrowth, 40.
Please reach out for further guidance and naturopathic treatment that can assist and guide you back to wellness.
See me in naturopathic clinic or at the apothecary for nutrient and herbal medicine to support the nervous system, gut health, hormonal health, stress, detoxification and methylation pathways.
