Vitamin B6 concerns

B vitamin Concerns

There has been much media discussion recently regarding the safety of vitamin B6 and a link with neurological symptoms such as peripheral neuropathy (experienced as tingling or numbness in hands and feet).

This of course requires attention. I have been looking into it particularly because in over thirty years of practice I have not in my practice come across one case of this despite many clients taking B complex vitamins as part of a recommended regime.  So it raises a few questions in my mind.

 Studies I have looked at indicate that it is the higher doses of Vitamin B6 that may be problematic. I am not a fan of high-dose vitamin supplementation in most cases, certainly not long-term.

One other point is to consider what form of B6 are we talking about.  I am interested in this because many B vitamins being sold these days contain B6 in the ‘activated’ form: Pyridoxal-5-phosphate (P5P). In my practice, I tend to prescribe the non-activated form as I noted that those who had chosen to take it seemed to experience an initial surge in energy but then a ‘crash’ within a few weeks. More research required, but looking at it biochemically, this form of B6 is designed to bypass a natural enzyme breakdown in the body, making it more readily available. In doing this, it is pushing past biochemical pathways which are structured for a reason. My concern with this is interference with natural (often protective) body processes, introducing something that does not get broken down naturally to its next stage for use by the body. In the case of ‘activated’ Bs particularly, we need to consider whether as a consequence, we are then depleted in (for instance, magnesium and zinc) because the neglect of enzymatic processes may create imbalance with other nutrients.

My aim in practice is to keep things as simple as possible and only supplement where immediately necessary and as indicated by individual history and symptoms.  First and foremost is to try and ensure that the diet is adequate to supply needs, along with attending to good digestion.

Another issue that I have is this: I was always taught that within the body, B vitamins are very synchronistic, and should be given as a combination rather than focussing on (particularly large) doses of one vitamin alone.  All our vitamins and minerals perform their complex tasks together in a large web of interconnection and interdependence.  An example of this is the krebs (or citric acid) cycle, a central metabolic pathway in all living cells, which produces molecules of energy from each cell.  At each point in the cycle, another nutrient comes in to continue the flow. It is important to ensure that the diet is adequate to cover that natural combination of B vitamins and to take, in most cases, a B complex which contains the vitamins in the best balance available.

It is also important to note that conditions can be triggered by a combination of what I call contributing factors.  Stress is a big, and common, one.  Others are poor diet, over-exposure to harmful chemicals particularly long-term, lack of sleep, inflammation, and digestive issues.  To name just a few in today’s world.  Genetic inheritance may also cause a tendency in certain directions. According to the recent data, one of the triggers may be the B6 issue, and this should be assessed in context of all these factors.

It should also be noted that B6 has traditionally been prescribed for cases of peripheral neuropathy as it has been found to have a role in prevention. Importantly, dosage and individual history is a critical consideration.

My conclusion from my research and experience supports the same dictum that I have always followed:  Properly assess the individual situation with a comprehensive case history, assess all the potential contributing factors, avoid high doses, recommend to avoid taking any supplement long-term unless absolutely necessary, to have one’s diet providing a good range of nutrients on a daily basis, and avoid damaging environmental exposures where possible.

As always, the prime consideration is thorough individual assessment.

If you experience symptoms of peripheral neuropathy while taking B vitamins in any form, it is important to discontinue the supplement and contact your practitioner to determine causative factors.

 References

 Muhamad R, Akrivaki A, Papagiannopoulou G, Zavridis P, Zis P. The Role of Vitamin B6 in Peripheral Neuropathy: A Systematic Review. Nutrients. 2023 Jun 21;15(13):2823. doi: 10.3390/nu15132823. PMID: 37447150; PMCID: PMC10343656.

 Hadtstein F, Vrolijk, M. Vitamin B-6-Induced Neuropathy: Exploring the Mechanisms of Pyridoxine Toxicity. Advances in Nutrition Vol.12, Issue 5, September 2021, pages 1911-1929

 Complementary Medicines Australia. Health and Safety: Understanding Vitamin B6 https://cmaustralia.org.au/health-and-safety-understanding-vitamin-b6/. January 9 2025