INTRODUCTION

Vitamin B6 is a water-soluble vitamin that exists in three major chemical forms: pyridoxine, pyridoxal, and pyridoxamine. It performs a wide variety of functions in your body and is essential for your good health. For example, vitamin B6 is needed for more than 100 enzymes involved in protein metabolism. It is also essential for red blood cell metabolism. The nervous and immune systems need vitamin B6 to function efficiently, and it is also needed for the conversion of tryptophan (an amino acid) to niacin (a vitamin).

Hemoglobin within red blood cells carries oxygen to tissues. Your body needs vitamin B6 to make hemoglobin. Vitamin B6 also helps increase the amount of oxygen carried by hemoglobin. A vitamin B6 deficiency can result in a form of anemia that is similar to iron deficiency anemia.

An immune response is a broad term that describes a variety of biochemical changes that occur in an effort to fight off infections. Calories, protein, vitamins, and minerals are important to your immune defenses because they promote the growth of white blood cells that directly fight infections. Vitamin B6, through its involvement in protein metabolism and cellular growth, is important to the immune system. It helps maintain the health of lymphoid organs (thymus, spleen, and lymph nodes) that make your white blood cells. Animal studies show that a vitamin B6 deficiency can decrease your antibody production and suppress your immune response.

Vitamin B6 also helps maintain your blood glucose (sugar) within a normal range. When caloric intake is low your body needs vitamin B6 to help convert stored carbohydrate or other nutrients to glucose to maintain normal blood sugar levels. While a shortage of vitamin B6 will limit these functions, supplements of this vitamin do not enhance them in well-nourished individuals.

The 1998 RDAs for vitamin B6 (12) for adults, in milligrams, are:
Ages 19-50: Men: 1.3 mg     Women: 1.3 mg
Ages 51+:    Men: 1.7 mg     Women: 1.5 mg
All ages:       Pregnancy: 1.9 mg                  Lactation: 2.0 mg

Results of two national surveys, the National Health and Nutrition Examination Survey (NHANES III1988-94) (12, 13) and the Continuing Survey of Food Intakes by Individuals (1994-96 CSFII), indicated that diets of most Americans meet current intake recommendations for vitamin B6.

Clinical signs of vitamin B6 deficiency are rarely seen in the United States. Many older Americans, however, have low blood levels of vitamin B6, which may suggest a marginal or sub-optimal vitamin B6 nutritional status. Vitamin B6 deficiency can occur in individuals with poor quality diets that are deficient in many nutrients. Symptoms occur during later stages of deficiency, when intake has been very low for an extended time. Signs of vitamin B6 deficiency include dermatitis (skin inflammation), glossitis (a sore tongue), depression, confusion, and. Vitamin B6 deficiency also can cause anemia. Some of these symptoms can also result from a variety of medical conditions other than vitamin B6 deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

Do you need to supplement
your diet with vitamin B6?

Individuals with a poor quality diet or an inadequate B6 intake for an extended period may benefit from taking a vitamin B6 supplement if they are unable to increase their dietary intake of vitamin B6. Alcoholics and older adults are more likely to have inadequate vitamin B6 intakes than other segments of the population because they may have limited variety in their diet. Alcohol also promotes the destruction and loss of vitamin B6 from the body.

Asthmatic children treated with the medicine theophylline may need to take a vitamin B6 supplement. Theophylline decreases body stores of vitamin B6, and theophylline-induced seizures have been linked to low body stores of the vitamin. A physician should be consulted about the need for a vitamin B6 supplement when theophylline is prescribed.

Lower levels of serotonin have been found in individuals suffering from depression and migraine headaches. So far, however, vitamin B6 supplements have not proved effective for relieving these symptoms. One study found that a sugar pill was just as likely as vitamin B6 to relieve headaches and depression associated with low dose oral contraceptives.

Alcohol abuse can result in neuropathy, abnormal nerve sensations in the arms and legs. A poor dietary intake contributes to this neuropathy and dietary supplements that include vitamin B6 may prevent or decrease its incidence.

Vitamin B6 and carpal tunnel syndrome
Vitamin B6 was first recommended for carpal tunnel syndrome almost 30 years ago. Several popular books still recommend taking 100 to 200 milligrams (mg) of vitamin B6 daily to treat carpal tunnel syndrome, even though scientific studies do not indicate it is effective. Anyone taking large doses of vitamin B6 supplements for carpal tunnel syndrome needs to be aware that the Institute of Medicine recently established an upper tolerable limit of 100 mg per day for adults. There are documented cases in the literature of neuropathy caused by excessive vitamin B6 taken for treatment of carpal tunnel syndrome.

Vitamin B6 and premenstrual syndrome
Vitamin B6 has become a popular remedy for treating the discomforts associated with premenstrual syndrome (PMS). Unfortunately, clinical trials have failed to support any significant benefit. One recent study indicated that a sugar pill was as likely to relieve symptoms of PMS as vitamin B6. In addition, vitamin B6 toxicity has been seen in increasing numbers of women taking vitamin B6 supplements for PMS. One review indicated that neuropathy was present in 23 of 58 women taking daily vitamin B6 supplements for PMS whose blood levels of B6 were above normal. There is no convincing scientific evidence to support recommending vitamin B6 supplements for PMS.

Vitamin B6 and interactions with medications
There are many drugs that interfere with the metabolism of vitamin B6. Isoniazid, which is used to treat tuberculosis, and L-DOPA, which is used to treat a variety of neurologic problems such as Parkinson's disease, alter the activity of vitamin B6. There is disagreement about the need for routine vitamin B6 supplementation when taking isoniazid. Acute isoniazid toxicity can result in coma and seizures that are reversed by vitamin B6, but in a group of children receiving isoniazid, no cases of neurological or neuropsychiatric problems were observed regardless of whether or not they took a vitamin B6 supplement. Some doctors recommend taking a supplement that provides 100% of the RDA for B6 when isoniazid is prescribed, which is usually enough to prevent symptoms of vitamin B6 deficiency. It is important to consult with a physician about the need for a vitamin B6 supplement when taking isoniazid.

What is the relationship between vitamin B6, homocysteine, and heart disease?
A deficiency of vitamin B6, folic acid, or vitamin B12 may increase your level of homocysteine, an amino acid normally found in your blood. There is evidence that an elevated homocysteine level is an independent risk factor for heart disease and stroke. The evidence suggests that high levels of homocysteine may damage coronary arteries or make it easier for blood clotting cells called platelets to clump together and form a clot. However, there is currently no evidence available to suggest that lowering homocysteine level with vitamins will reduce your risk of heart disease. Clinical intervention trials are needed to determine whether supplementation with vitamin B6, folic acid, or vitamin B12 can help protect you against developing coronary heart disease.

The health risk of too much vitamin B6
Too much vitamin B6 can result in nerve damage to the arms and legs. This neuropathy is usually related to high intake of vitamin B6 from supplements, and is reversible when supplementation is stopped. According to the Institute of Medicine, "Several reports show sensory neuropathy at doses lower than 500 mg per day". As previously mentioned, the Food and Nutrition Board of the Institute of Medicine has established an upper tolerable intake level (UL) for vitamin B6 of 100 mg per day for all adults. "As intake increases above the UL, the risk of adverse effects increases."

Food Sources of vitamin B6
As the 2000 Dietary Guidelines for Americans state, "Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need". Vitamin B6 is found in a wide variety of foods. Foods such as fortified breakfast cereals, fish including salmon and tuna fish, meats such as pork and chicken, bananas, beans and peanut butter, and many vegetables will contribute to your vitamin B6 intake.

SOURCE:
Clinical Nutrition Service, Warren Grant Magnuson Clinical Center, National Institutes of Health (NIH), Bethesda, MD