Do you Need Vitamin B6 or P5P Vitamins?

Do you Need Vitamin B6 or P5P Vitamins?

Vitamin B6 is fascinating. I hope that this in-depth look gives you a big appreciation of the vitality we get from nutrients. Activated vitamin B6 or P5P (pyridoxal-5-phosphate) are sometimes needed for best health and mood. Why?  Modern diets and medicines.  Read on to learn more about activated vitamin B6, food content, and why you may need more.

Simply put, vitamin B6 helps us manage our food by changing its destiny in our body. Changing the destiny of a substance in our body is called metabolism.

Protein metabolism depends on vitamin B6;  this powerhouse nutrient also plays key role in carbohydrate and fat metabolism.

I’ve mentioned it in earlier blogs, but will mention it again with emphasis: headlines are often wrong about nutrients.

Vitamin B6 is no exception.  When many headlines come out, they are not a cohesive look at the big picture.

Is Nutrient Deficiency a Problem in General?

A huge research database of over 15,000 Americans, called the National Health and Nutrition Examination Survey (NHANES), aims to explore nutrient deficiencies.

Findings of this research study: people who don’t supplement their diets have 40% deficiency rates. This includes both adults and children.

Still believing those national headlines about throwing away your vitamins?  Supplement users were 3 times more likely to have adequate nutrition stores than people who did not supplement.

Imagine this:  you indulge in cake (just this one time) then tomorrow, you have a pizza dinner, with beer!  It’s Friday, you deserve it, right?  You might then pop by and get an ice cream.

These foods, while fun, crowd out healthier foods that would have been rich in B6.  They also USE UP vitamin B6 in your body to be metabolized, putting you further behind.

Pretty soon, a third or more of your diet is crowded out by low-nutrient foods. Your metabolism can’t catch up.

You don’t have to be a scientist to do the math.

You don’t even have to measure your blood levels to understand that your nutrients, including vitamin B6, might be low. with your typical American diet.

Measuring vitamin B6 levels at the doctors office rarely happens in reality anyway, although after reading this, you may agree that it should.

Read on to find out why other current diet trends, medications, and lifestyles may leave you in a deficit of vitamin B6, and why it is critical that you don’t fall short in it. Learn why you may benefit from activated B6, or P5P, instead of pyridoxine form as well.

If you love this information, and want to get high-quality supplements, let me know.  While I write to help people, your support helps keep me going.  I make a small percentage from a couple clicks at no extra cost to you.

Vitamin B6 Deficiency Is Common

It happens. You eat a typical American diet or fad diet. You probably would benefit from vitamin B6 or P5P supplementation if you don’t plan carefully.

Of all the B-vitamins, vitamin B6 has the most diverse roles in our body, so its health effects are large.  Adequate B6 is important for every cell type in our bodies.

Some recent research suggests that 30 to 50 percent of people may have vitamin B6 deficiency.

If you have diabetes, your chances of vitamin B6 deficiency are between 25-63%.

Before we get to why deficiencies are so common, the vast functions of B6 is reviewed here.

Functions of Vitamin B6

Vitamin B6 makes at least 100 unique enzymes in the body do their job. Enzymes are critical in making one thing into another.

Vitamin B6 helps transform.   Examples are detoxing and building new tissue [4].

Here are some of broad-sweeping roles of vitamin B6:

  • Protein metabolism
  • Growth
  • Nervous system function
  • Hormone function
  • Immune systems function

Here are some of the more detailed roles of vitamin B6:

  • Helps make red blood cells, so supports energy
  • Blood sugar regulation; converts carbohydrate to energy
  • Development of myelin sheath, protects nerve cells
  • Fat metabolism into essential fatty acids
  • Neurotransmitter production (dopamine, epinephrine, gamma-aminobutyric acid, histamine, norepinephrine, and serotonin)
  • Phospholipid and sphingolipid production: structure of cell membranes
  • Converts tryptophan into niacin
  • Helps makes glucocorticoid hormones
  • Acts as a potent antioxidant

Symptoms of Vitamin B6 Deficiency

The classic clinical syndrome for vitamin B6 deficiency is a skin rash and redness.  This results from inadequate cell membrane function and anemia. However, a rash is not always present.

Other symptoms of deficiency can include:

  • Weakness
  • Mental confusion
  • Depression
  • Insomnia
  • PMS symptoms
  • Nerve pain and damage
  • Seizures

Vitamin B6 is Lost in Cooking

Vitamin B6 is vulnerable to almost all food preparation methods.  Take these examples of food preparation that destroy some, if not most, of the vitamin B6 in your foods.

  • Processing (think grains, crackers, pastas, desserts)
  • Prolonged  heating (up to 50% loss of vitamin B6)
  • High heat cooking (up to 50% loss)
  • Canning (20-30% loss)
  • Instant pots (pressure cooking)
  • Milling of grains into refined flour (80-90% loss)
  • Sterilization
  • Freezing
  • Exposure to light (think milk, vegetables, fruits)
  • Alkaline conditions

Types of Vitamin B6

Vitamin B6 is found in foods in different forms.  Plant sources of B6 are called PNG form.  In foods the following forms also occor: pyridoxal, pyridoxine (pyridoxol), pyridoxamine.

Once our body absorbs vitamin B6, it becomes activated by the liver into a form called pyridoxal 5 phosphate, or P5P or PLP, as it is commonly abbreviated.

As you can imagine, if someone has genetic variance in B6 metabolism or altered liver function, B6 doesn’t get activated in the body.  It makes sense to then supplement with activated vitamin B6 or P5P.

Medications and Drugs that Deplete Vitamin B6

Vitamin B6 is affected by a lot of different medications, drugs, and alcohol.  Below is a partial list of drugs that may create a vitamin B6 deficiency in your body.

As a general rule of thumb, the longer these drugs are taken, the larger the risk for deficiency

Drugs that deplete vitamin B2 will also indirectly deplete vitamin B6.

  • NSAIDS or over-the-counter ibuprofen, naproxen
  • Alcohol
  • SSRI anti-depressants
  • Selective Serotonin Reuptake Inhibitors (Effexor)
  • Benzodiazepenes
  • Diuretics (Lasix)
  • Theophylline and other asthma medications
  • Estrogen
  • Dilantin
  • Steroid drugs like prednisone
  • Oral contraceptives
  • Tetracycline and other antibiotics
  • Most chemotherapy drugs

Drugs That May Interact with Vitamin B6 Supplements

Dilantin and Phenobarbitol.  Vitamin B6 is depleted by these medications. However, high doses of vitamin B6 are thought to speed up the loss of these drugs in the body.

If you want to supplement, consult your doctor first. It is important to not that individuals taking Dilantin have a high risk of vitamin B6 deficiency [11].

Who Else Is Likely Deficient in Vitamin B6?

B6 deficiency is more common if you are low in these nutrients:

  • Folate
  • Riboflavin (vitamin B2)
  • Vitamin B12

Vitamin B6 deficiency is quite common in people with high levels of inflammation.  People with inflammation have a 50% chance of deficiency [1213].

Vitamin B6 deficiency is common in people with[14]:

  • Liver disease
  • Kidney disease
  • Indigestion or poor digestion
  • Autoimmune diseases
  • Diabetes
  • Inflammation

It is also more common in [1516]:

  • Smokers
  • Obesity
  • Women
  • Alcoholics and casual alcohol drinkers
  • Pregnant women
  • Older adults: they have increased need
  • Vegetarians and vegans

Is the B6 RDI Enough?

Some experts  suggest that the Recommended Daily Intake is not enough vitamin B6 for health [R].

I speculate this is true because of increases in inflammatory diseases. We also have many depleting factors we have as mentioned above.

Here is a link to RDI values for vitamin B6.  Keep in mind, age, diet, body size, gender, and disease states change the required amounts for health.

As a rule of thumb, RDI value is around 2 mg per day.

Why Does The Type of Vitamin B6 in Food Matter?

Vitamin B6 from animal sources is 10 to 100 percent better than plant sources.

With vegetarian diets or high carbohydrate diets:

  • The vitamin B6 is not easy to absorb in most plant sources
  • Zinc is poorly absorbed
  • Plants do not contain vitamin B12

Some plant sources of vitamin B6 have up to a 75% reduced absorption [16].

For example, the type of vitamin B6 in peanut butter is 36% less absorbed than the vitamin B6 in tuna.

Selected Absorption (Bioavailability) of Vitamin B6 from Foods [R]:

  • Meats, fish and poultry 100%
  • Walnuts 78%
  • Peanut butter 63%
  • Banana 79%
  • Tomato 25%
  • Spinach 22%
  • Orange juice 9%
  • Carrots 0%

Soaking and fermenting reduces the total B6 content of plant sources of vitamin B6  by up to 85 to 89% [18].

Amounts of Bioavailable Vitamin B6 in Foods [R]:

Eating Patterns and Vitamin B6 Issues

Let’s talk about a few popular diet categories now.  Here is what I am seeing:

  • High sugar, highly processed foods diet
  • Vegan diets
  • Ultra-high protein diets

Potential verdict for all?  Vitamin B6 deficient.


1. Processed foods and sugary foods are low in vitamin B6.  The inflammation that stems from the diet drives up the need for MORE vitamin B6.

2. The more protein you eat, the more vitamin B6 you need.  High doses of protein powders may not have enough vitamin B6 to support the metabolism [19]. High-heat cooking of meats reduces B6 content.

3. Absorbable B6 in many vegan foods is low [2021].

While I understand the various food  movements, they need careful consideration.

Vitamin B6 comes from both plants and animals in fairly good amounts.  The question isn’t about how much, it is about bio availability.

A balanced diet of whole foods gives us the best chance of getting this critical nutrient through foods.

13 Emerging Therapeutic Roles of Vitamin B6 Supplementation

1. Brain and Memory

Vitamin B complex reduced brain shrinkage in Alzheimer’s disease patients [R]. The effects didn’t seem to apply to patients after stroke, however [R].

2. Vitamin B6 May Help Reduce Inflammation

In a large observational study, B6 supplements at 5 mg/day or more was related to less inflammation [R].

Inflammation may cause vitamin B6 to be broken down more quickly in the body.  So, inflammation may increase requirements for this vitamin [R].

Supplemental B complex compared to placebo reduced inflammation in 62 patients [R].  These patients had rheumatoid arthritis.

3. Vitamin B6 May Reduce Cancer Risk

High dietary intake of B6 may reduce risk of colon cancer, especially in women who drink alcohol [R].

Some trials of vitamins may be affected by the type of folate they use [R].  Read my blog about folate.

Vitamin B6 blood levels was related to a reduced risk of breast cancer in post-menopausal women [R].

Vitamin B6 levels in the blood did not seem to be related to stomach or esophageal cancer [R].

Research in this area remains preliminary.

4. Vitamin B6 May Reduce Anemia

A type of anemia called sideroblastic anemia results in abnormal shaped blood cells.  This can be caused from several things, one of them being vitamin B6 deficiency.

Vitamin B6 helps about 50% of the cases of siderblastic anemia.  When unresponsive to treatment, a type of B6 called P5P may help when people recover.  This is because P5P, or pyridoxal phosphate, is the active form of B6 [R].

Much lower doses of P5P can be given with success in these cases for treating this specific type of anemia.

5. Vitamin B6 May Reduce Seizures

Seizures can be caused by vitamin B6 deficiency. Seizures can appear in infants with specific vitamin B6 gene variances.

Vitamin B6 deficiency can cause seizures in adults.  They are more likely to be caused by drug-induced vitamin B6 depletion.  Simple supplementation reverses seizures in these cases [R].

Vitamin B6 may reduce seizures in patients who do not respond to drug treatment [R].

6. Vitamin B6 May Reduce Depression

A large study of vitamin B6 with folate and B12 reduced the risk of depression in older adults by 50% [R].

Low blood levels of vitmin B6 may be related to depressive symptoms [R].

B6 along with magnesium reduced anxiety-related premenstrual syndrome [R]


7. Vitamin B6 May Reduce Kidney Stones and Protect the Kidney

High intake of vitamin B6 (greater than 40 mg per day)  reduced the risk of kidney stones by 65% [R].

In rats, vitamin B6 reduce urinary oxalate levels by 50% [R].

Vitamin B6 as P5P form reduced kidney damage due to diabetes  in a rat study [R].

8. Vitamin B6 Improves Eye Health

A large clinical trial showed that vitamin B6, folate and B12 reduced macular degeneration risk by 33-41% [R].

Folate, vitamin B12 and  vitamin B6 as PLP improved eye function in a pilot study of patients with Type 2 diabetes [R].

9. Vitamin B6 Reduces Premenstrual Syndrome

Nine clinical studies show that vitamin B6 (50-100 mg/day) may reduce symptoms of premenstrual syndrome.

Vitamin B6 was better than placebo for symptoms of depression in these women [R].

The studies were small, but consistently effective.

10. Vitamin B6 Reduces Symptoms of Carpal Tunnel Syndrome

In a double-blinded, randomized trial of 40 patients, supplemental vitamin B6 reduced symptoms of pain, numbness, weakness, tingling, and improved sleep [R].

Patients with severe carpal tunnel syndrome usually have vitamin B6 deficiency. They often respond to treatment with supplemental vitamin B6 [RR].


11. Restlessness Caused by Mood Stabilizing Drugs

Vitamin B6 was helpful in reducing side effects of antipsychotic medications. B6 was as effective at treating restlessness as the drug propranolol [R].

Another pilot study found that vitamin B6 reduced symptoms of restlessness by 80% [R].

12. Vitamin B6 Reduces Nausea and Vomiting

Supplemental B6 at 20 mg per day reduced symptoms of nausea and vomiting in pregnant women [R].

Both ginger and vitamin B6 were effective at reducing vomiting in pregnancy. Ginger was more effective at reducing nausea symptoms [R].

Another study found ginger and vitamin B6 equally effective in reducing nausea and vomiting in pregnancy (better than placebo) [R].

13. Vitamin B6 May Improve Symptoms of Autism

A comprehensive vitamin and mineral supplementation regimen, including vitamin B6, reduced symptoms of autism compared to placebo over a 1 year period [R].

A combination of vitamin B6 and magnesium improved symptoms of autism in 33 children over 6 months. When supplementation stopped, symptoms reappeared [R].

Testing Vitamin B6 Blood Levels

  • A blood test for plasma PLP is considered the single best indicator of tissue B6 stores.
  • All tests must be interpreted by a qualified practitioner because many factors affect this blood test.
  • Elevated levels of homocysteine in the blood may suggest B6 deficiency as well.

Dosing and Supplementing Vitamin B6

Two types of vitamin B6 are commonly available: P5P and pyridoxine.  Other types of vitamin B6 are available including Pyridoxine, Pyridoxal, Pyridoxamine. Only P5P is activated.

Some experts recommend P5P for certain conditions, such as anemia and with liver disease. Others recommend pyridoxine, as in the case of autism.

The type that benefits you most may depend on your genes.

My suggestion: if you don’t tolerate one kind, try the other. Our bodies are usually pretty good at giving us signals of tolerance.

Another important point for supplementation.  B vitamins like vitamin B6 usually work better when taken in combination with other vitamins and minerals.

When taking vitamin B6, make sure you are taking it with riboflavin (vitamin B2) and folate (see blog about types of folate).

A great comprehensive vitamin supplement that I love can be found here.

The most common type of vitamin B6 is pyridoxine. It is not the active form of B6: it must first be converted by the liver.

Dosing of vitamin B6 appears safe between 2-250 mg per day[R].

The daily Upper Limit is set at 100 mg per day.  The safety may depend on the type of vitamin B6 used; P5P typically requires smaller dosing.

How to Keep Vitamin B6 From Breaking Down in Food

  • Cook in an acid, such as tomatoes, lemon or vinegar.
  • Shorten cooking time when possible.
  • Dried meats retain almost all of the vitamin B6.
  • Try to bake or steam:  Liquid cooking increases loss of B6.
  • Baked vegetables retain more vitamin B6 content.
  • Avoid evaporated milk and ultra-high temperature processed milk.

 Vitamin B6 Toxicity

It is possible to supplement with too much vitamin B6.

The resulting toxicity is neuropathy symptoms, or nerve tingling and pain.  This is usually reversible.

Toxicity is seen at 1000 mg per day, but a few cases have occurred at doses of 500 mg per day over many months [R].

I have seen some reviews online of people feeling toxic effects after 50 mg of the P5P variety.  The person was taking isolated vitamin B6 without other nutrients (no other vitamins).


Vitamin B6 deficiency is common.  This is due to current diets, increased body weights, inflammation, medications, and many diseases.  Vitamin B6 is lost in cooking and is also robbed by many drugs.

Supplementation may be necessary to keep your blood levels normal.  Make sure to supplement with a comprehensive supplement like this one to make sure your nutrients work together.

Always ask your doctor or healthcare provider before starting any new lifestyle or supplements.

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body and is shared for educational purposes only. Consult your doctor or healthcare provider before making changes to your supplement regimen or lifestyle.

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