Vitamin B₆ protects against depression, anxiety, insomnia, age-related cognitive decline, hypoglycemia, kidney stones, and the morning sickness of pregnancy.

Tune in for everything you need to know about how to manage your B₆ status!

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Read the Transcript

From keeping inflammation down and your blood sugar up, to staying mentally sharp, sleeping well, and staying happy, vitamin B₆ is an incredibly important nutrient.

And this is how to make sure that you are getting enough.

Hi. I’m Dr. Chris Masterjohn of chrismasterjohnphd.com. And this is Chris Masterjohn Lite, where the name of the game is “Details? Shmeetails. Just tell me what works!”

And today we’re going to talk about how to manage your vitamin B₆ status.

Now, in its most severe form, which you and I are unlikely to encounter, vitamin B₆ deficiency causes convulsive seizures. And when you look at that level of deficiency, you’re also seeing irritability, vulnerability to infection, and skin lesions that look the same as what you get in deficiencies of riboflavin, or vitamin B₆, where you have a reddened tongue, a reddened inside of the mouth, and you have lesions around the corners of your mouth as well.

Now, the depression and irritability and those things, we may see in more moderate deficiencies of B₆. In fact, although the evidence isn’t really strong, we might expect problems with moderate deficits of vitamin B₆ to include cognitive decline over time with age, depression, anxiety, insomnia, and hypoglycemia. In fact, in the case of hypoglycemia, 80% of the vitamin B₆ in your body is used to make sure that you can store enough carbohydrate in your liver so that when you don’t eat, your blood sugar stays stable. And so if not eating overnight or for a long period of time during the day is causing you to crash, that could be a sign that you need more vitamin B₆.

We might also expect vitamin B₆ moderate deficits to contribute to kidney stones. And so if you’re at risk for kidney stones, you should be checking your vitamin B₆ status. And there’s increasing evidence that vitamin B₆ is involved in protecting against the morning sickness of pregnancy. There is also a specific vitamin B₆-dependent anemia called sideroblastic anemia, and that’s where you have normal hemoglobin concentrations, but if you look under a microscope, you see the hemoglobin accumulating around the edges of the red blood cells. It’s not that common, so it’s not regularly screened for, but basically it makes you unable to carry oxygen in a normal capacity because your red blood cells aren’t working correctly, even though you have normal amounts of red blood cells in your blood.

More moderate deficits of vitamin B₆ also contribute to high homocysteine, which contributes to cardiovascular disease and is something that’s usually tested in regular blood testing. And B₆ probably generally contributes to chronic, low-level inflammation and to the risk of cardiovascular disease. So, we want to make sure that we’re getting enough vitamin B₆. How do we do that?

Although vegetarianism and veganism don’t necessarily contribute to vitamin B₆ deficiency, consuming animal foods makes you more robust to B₆ deficiency, and the reason is basically as follows: there are two different types of B₆ in plant foods and in animal foods.

The vitamin B₆ that is found in animal foods is in the form that you need it, and you can consistently absorb good amounts of it. On the other hand, the vitamin B₆ that’s found in plant foods is often bound up to sugars, and whether you absorb it and how much you absorb is entirely dependent on your gut flora because we don’t have the enzymes to liberate that B₆ from the plant foods, and we are dependent on our gut flora doing it for us, so there can be wide variability in whether you absorb it.

Furthermore, once you absorb the form of B₆ in plant foods, it’s got to go to your liver and it’s got to be converted to the active form using another B vitamin, riboflavin, or vitamin B2. So if your gut flora is off, or your liver health is off, or your riboflavin status is off, you may not get enough vitamin B₆ from plant foods.

Cooking foods not only destroys some of the vitamin B₆, but it actually converts it into an anti-B₆ that can actually antagonize the B₆ that is in the food. Overall, when you’re looking at cooking foods, you’re generally looking at a 40% loss of bioavailability, meaning between what you aren’t getting and the antagonist that you are getting, it’s equivalent to getting 40% less B₆ in your diet than if those same foods were raw.

High intakes of protein, especially animal protein, can raise your need for vitamin B₆, and low levels of other nutrients, like riboflavin or molybdenum, a mineral, can also raise your needs for vitamin B₆. And putting diet aside for a moment, oral contraceptives, high estrogen status, even when you are making your own estrogen in high amounts, and inflammation, as well as non-steroidal anti-inflammatory drugs, the NSAIDS, the over-the-counter anti-inflammatories, and some of the drugs used to treat tuberculosis and Parkinson’s, can all contribute to B₆ deficiencies.

So when you put that all together, a diet that is low in animal foods or high in proteins when you don’t have the accompanying B₆, for example, if you’re consuming a very large amount of protein powder instead of getting your protein from the animal foods that have the B₆in it, or diets low in riboflavin, or just overwhelmingly cooked and overcooked foods without any raw foods, as well as use of estrogens and the drugs that I just mentioned, are all potential contributing factors to B₆ deficiency.

Well, how can you test for it? How would you know? Plasma B₆ is a very good test and easy to get, and it tends to be low in deficiency. If you want to get a little bit more nuanced, if you have an organic acids test—and the organic acids test that has the most number of these markers is the Genova ION Panel, but on any urinary organic acids test, you will probably see at least one of the markers of vitamin B₆ deficiency. And those include xanthurenate, kynurenate, and quinolinate. Out of all of those, the one that is most likely to be elevated in early B₆ deficiency is xanthurenate. Usually quinolinate is the last to rise.

One thing that’s not clear is that high estrogen levels and use of oral contraceptives can raise these urinary markers of vitamin B₆ status, but the science isn’t quite there to be able to say that supplementing B₆ or raising B₆ levels in the diet gets rid of that effect and any of the potential consequences. So it’s not clear whether estrogen in high amounts is just distorting your metabolism or is actually raising your needs for vitamin B₆, but I will say anecdotally, there does seem to be a sort of syndrome or pattern where women with very high estrogen levels may have symptoms such as insomnia that are at least helped, maybe not cured, but at least helped by using supplemental vitamin B₆.

I will also say anecdotally that there seem to be a number of people who have some symptoms of vitamin B₆ deficiency or some markers of vitamin B₆ deficiency that don’t go away, unless they take relatively high doses of vitamin B₆ in the form of pyridoxal 5′-phosphate, or P5P, at doses between 30 and 100 milligrams. So in general, I would say if you have the symptoms and you have the markers, or you have one or the other, I think it’s safe to experiment with vitamin B₆ supplementation providing you have first looked at your diet and made sure that you’ve fixed any dietary problems. But if you’re going to supplement, I would not use pyridoxine. I would use pyridoxal 5′-phosphate, P5P, and I think it’s safe to experiment first with doses of 5 to 10 milligrams. If that’s not getting you results, try going in the 30- to 100-milligram per day range. I would not go over 100 milligrams per day. That is set as the upper limit by the Institute of Medicine on the basis that doses of 500 milligrams per day or more are associated with neurological problems from toxicity.

The good news is those neurological problems, according to what’s out there in the literature, go away when you take out the B₆, and keeping your B₆ no higher than 100 milligrams should provide a very significant margin of safety so that that’s not something you need to worry about.

Managing B₆ status is something that you can get information on in more detail and better integrated into the overall context for managing your dietary nutrients in my ebook Testing Nutritional Status: The Ultimate Cheat Sheet.