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Sunday, 3 February 2013

Pyridoxine – Toxicity and Deficiency, and the balance between B6 and protein.

You could make an argument that the pyridoxine form of vitamin B6 is the only really dangerous vitamin supplement. Overdosing on anything else is unlikely if you stick to recommendations, but pyridoxine neuropathy is insidious and persistent and may happen at intakes as low as 200mg/day, and quite possibly lower (case history reporting neuropathy from 100mg/day taken for 10 years).

Axonal pathology is also a feature of the neuronopathies, toxic states in which the primary injuries are found in neuronal cell bodies. This is exemplified by pyridoxine neurotoxicity, where there is sublethal or lethal damage to larger cytons in the sensory ganglia, with failure of such neurons to maintain their axons.

In this brilliant study, the 5 volunteers were the study authors: a detectable neuropathy was induced by a 12mg/Kg/d dosage after 7 months.
However, other factors can increase sensitivity, especially protein deficiency.

Large doses of pyridoxine cause injury to the primary sensory neurons in trigeminal and dorsal root ganglia of animals and patients subjected to megavitamin therapy. The increased hazard to subjects with reduced renal excretory function has been explored previously. In the present work, the neurotoxicity of pyridoxine for rats was found to be increased by dietary protein deficiency. A mere 3 or 7 days of pretreatment with either of two protein-deficient diets were sufficient to accelerate and intensify the clinical neurological signs and histological lesions from pyridoxine injections. These results are caused, at least in part, by loss of body weight, decreased protein binding in serum and decreased consumption of water and decreased volume of urine, which reduce the urinary losses of the toxicant. The vitamers related to pyridoxine (pyridoxal, pyridoxamine) and the coenzyme (pyridoxal 5-phosphate) did not cause clinical signs or lesions similar to those produced by pyridoxine even when injected in maximum tolerated doses. Neither a protein-deficient diet nor bilateral nephrectomy changed the results with the vitamers.

Note that the vitamers (the animal forms of pyridoxine) and the co-enzyme P-5-P (PLP) were not toxic.

I strongly recommend using only vitamin supplements that contain P-5-P or one of the vitamers. A much lower dose can be effective if P-5-P replaces pyridoxine.
The relationship of B6 to protein is important because P-5-P is the coenzyme for most reactions involving amino acid metabolism or catabolism. To make niacin from tryptophan, nitric oxide from arginine, serotinon from tryptophan, cysteine from methionine via homocysteine, these and many more reactions of that type all require P-5-P. It is also required for glycogenolysis and phospholipid synthesis.
Meat, fatty fish, potatoes and bananas are all good B6 sources, but processed meat can be very low in B6 relative to how much protein it supplies. Low B6 status is one of the more common deficiencies detected when populations are studied. Could this be one of the reasons there is always an epidemiological difference between red meat and processed meat? Or could it just be that people who eat processed meats tend to have a greater appetite for, or tolerance of, processed rubbish in general?
The activation of pyridoxine to P-5-P requires riboflavin and magnesium, and deficiencies of these 2 nutrients, deficiencies which are in all conscience common enough (B2 is easily destroyed by UV light) could in theory also sensitize one to pyridoxine toxicity.

There are many features of amino acid metabolism in cirrhosis that suggest that activation of dietary pyridoxine to P-5-P by liver has become inadequate, and/or that the breakdown of P-5-P is excessive.
After administration of pyridoxine there was a significant increase in the plasma PLP level over a 2- to 12-hr period, after which the concentration returned gradually toward the initial value. The area under the concentration/time curve was from 2 to 8 times smaller (P less than 0.002) in the patients with liver disease. To assess possible mechanisms of this change, 5 mg of PLP were intravenously administered to the various patient groups and the pharmacokinetics of the disposition were assessed. The initial and steady state volumes of distribution of PLP were comparable in cirrhotics and controls (P greater than 0.05), but the clearance of plasma PLP in cirrhotics was much faster (63.0 +/- 7.4 versus 31.7 +/- 2.7 ml per min, P less than 0.004). Similar findings were obtained in the other liver disease subjects

There is an inverse association between dietary B6 and deep vein thrombosis.

Our study indicates that low vitamin B6 is associated with an increased risk of recurrent VTE. Until recently, the thrombotic risk associated with low vitamin status was entirely attributed to impaired homocysteine metabolism. But since doubts have been raised about the causal role of homocysteine in thrombotic disease,4 other functions of B vitamins need to be considered. Vitamin B6 is a co-enzyme in the metabolism of aminoacids, carbohydrates, neuro-transmitters and lipids,12 and administration of vitamin B6 inhibits platelet function.13 Low vitamin B6 has also been related to elevated C-reactive protein levels and other markers of inflammation,14,15. In fact, patients with chronic inflammatory diseases, who are at heightened risk of VTE, exhibit low vitamin B6 levels.16

From personal experience, I can testify that years of overuse of pyridoxine, especially by someone who is not eating regularly, can result in long-lasting sensory problems even if the doses taken are those normally prescribed or recommended on line. This is not an exclusive problem of the supplement industry, as most of the pyridoxine I have used has been a prescription medication.
Pyridoxine neuropathy is likely to be missed in diagnosis and could even be misdiagnosed as early MS (the difference is that pyridoxine toxicity affects the body symmetrically, MS is asymmetrical). The visual disturbance is interesting and unusual; objects are doubled in the horizontal plane, like watching a 3d movie without the glasses. I still notice this slightly when I look at spires or poles in the middle distance, although the other symptoms have completely cleared, albeit very slowly. Ketogenic dieting was helpful. At one time I could barely read.

Pyridoxine has a fascinating effect on dream recall (very tempting for an opiate addict). Take enough of it, and the very dream changes; a dream that allows you completely perfect recall can be a very vivid but barren dream, with bare floors, little furniture, simple and repetitive architecture, and little in the way of characters or events. The orthomolecular theory is that inability to remember one’s dreams is indicative of pyridoxine deficiency. It is certainly corrected by B6.
Maybe, like DVT, it is caused by a diet too dependent on processed meat and refined carbohydrate.


tess said...

well, THAT is interesting -- i've always dreamt a lot, but rarely remember it well.... adding epimedium to my supplement list has improved my recall, i believe. i wonder if it contains B6? wikipedia, here i come....

George Henderson said...

If it up-regulates nitric oxide, that would be through a PLP dependent reaction (which also relates to DVT).
The role of B6 in maintaining brain circulation might be how that works (I wonder if ginkgo has a similar effect on dreams).
The high-dose B6 dream effect is weirder though. Memory is boosted at the cost of creativity. Instead of remembering emotions and impressions, one remembers bare facts, layouts, like the difference between a gothic painting and a schematic map of the same mountain.

George Henderson said...

I should point out that B6 deficiency is supposed to suppress recall to the extent that one has no memory of dreaming at all for months on end.
One tells others "I do not dream".
To dream , know it, but forget is more-or-less normal.

tess said...

you just burst my bubble -- me normal? ;-)

majkinetor said...

Any reference for dreaming ?

I found this:

Effects of pyridoxine on dreaming: a preliminary study

The effect of pyridoxine administration on melatonin secretion in normal men

The first mentions pffeifer paper from 1975 however, I couldn't obtain full paper to see full reference.

100mg of B6 is totally safe. No need to take more of it, such dose is even therapeutical with some problems likes sciatica, CVD problems etc.

How much did you take for years ? Did you take complex or solo ?

George Henderson said...

I would have picked it up from Carl C. Pfeiffer; I don't know if it's been tested but I consider it to be experientially testable by most people.

I don't know that 100mg is safe, it may not be if someone is eating poorly and uses it daily for years. I don't know what amount is safe for everyone. There's no need to take pyridoxine, P-5-P is far more effective.
I took 100-300mg daily intermittently (not constantly, but possibly on most days) for about 25 years. I took other supps a lot of that time, esp. other B complex and C but not magnesium.
It took about 5 years to get over, and I am still sensitive to very small amounts (there is even some sensitivity to P-5-P) which affect my vision.
I wouldn't take more than 2mg P-5-P now, and only occasionally in a bit broken off a multivitamin.

I think it is a good principle to minimize exposure to neurotoxins, for example acrylamide, MSG, regardless of the certainty of available safety data.

100mg pyridoxine probably safe as short-term treatment, but P-5-P or pyridoxal/pyridoxamine would be better for a long-term B6-dependent condition.

majkinetor said...

Or its just an individual problem.

25 years of usage of very high dose and such side effect, I guess it would be proof of safety by majority.

B6 vs P-5-P is matter of availability and even prescription.

I don't recall dreams almost never. It was always like that. I will have to try high dose for a month of so. Its unlikely its symphtom of deficiency since I use multivitamins and B complexes (among other things) for few years now almost every day. B6 since I started low carb, higher protein diet. In some papers daily dose is listed per g of protein. Unless I have some genetic malfunction in B6 uptake. I am doubtful that it represents deficiency since very high dose is required for dream recall (looks like >2*100mg)

George Henderson said...

If I hadn't been skeptical about the possibility of pyridoxine neuropathy, I'd have realized it was happening much sooner - and if I'd stopped immediately I noticed unusual sensations, I'd likely have had no problem.
0.02 mg per G protein is the ratio on the Linus Pauling Foundation resource (good nutrient fact sheets there).

B6 on dreams is like a pharmacological effect. 100-200mg nocte for a week should produce it. Just don't get hooked on it like I did!
Interestingly dream recall would return intensified at nightfall - indicating melatonin was involved.

Anna C said...

To George Henderson about pyridoxine toxicity:
Hi, I’m a new one here. I got interested in your case. Did you really take 100 to 200 mg of pyridoxine a day for 25 years?! I’m shocked as I took 200 mg only for 3 months and I got severely hit by it. It’s been more than 5 months now and I’m still symptomatic. I feel dizzy, which is so scary to me, and I’ve got a feeling of burning in my arms and legs, which gets worse at night. I feel my legs from knees to ankles tight or stiff a bit. I wonder if you’ve experienced anything like that. Anyway, it’s comforting to me that you got your symptoms over, though 5 years is a lot of time. I’d be grateful if you could share your personal experience on pyridoxine toxicity with me. Greetings from Anna

George Henderson said...

Hi Anna, that sounds bad.
My sensations were - muscular weakness; a brushing sensation on my skin; loss of feeling, including hot and cold; pins and needles; and a type of double vision blurring and also at times very fuzzy vision. At times I had other sensations but can't be sure they were due to pyridoxine.
What helped was -
avoiding pyridoxine in supplements or fortified foods.
Taking alpha-lipoic acid; this made me feel a lot better, but it's tricky because it can increase the need for B1, B2 and biotin after a while, these are more expensive if you're avoiding B6. But they probably help too, especially B1.
Following a ketogenic diet for a while, including consuming coconut flesh, coconut oil and coconut cream as regular items of diet.
But this still takes time; these are just the things I noticed were associated with relatively sudden and significant improvements.

Anna C said...

Hi,thanks for your answer and advice concerning supplements. I've got some more questions if you don't mind.I've read that 200 mg of pyridoxine intake a day for more than 40 days can lead to pyridoxine dependency syndrome.I must say I experienced very hard days when quiting pyridoxine myself - my neuropathy-like symptoms rapidly got worse during the 1st month of pyridoxine withdrawal.I developed severe insomnia,leg cramps and anxiety then, too. Did you have such a strong withdrawal reaction yourself? I'm desperately looking for some rational explanation for my dizziness and I just wonder if it's possible to get addicted to pyridoxine and have problems after its rapid withdrawal.Do you think the brain can't function properly without high pyridoxine doses it had been used to? And that's why this dizziness? Do you think p-5-p form of B6 in some reasonable intake could help if this is the case? This is just my theory but I'm a laic. Doctors are not much helpful once you've got clean head MRI.I can see you've got extensive knowledge and you experienced pyridoxine toxicity yourself so your suggestions can be of great value to me. Anna

George Henderson said...

First I want to check you're not on any statins, that could produce some of those symptoms and if so it would be serious.
Dependency could be due to needing high levels of some product of pyridoxine, such as serotonin or NAC, or excess consumption of vitamin-free proteins (protein powders, processed meats). I haven't heard of it myself but it's possible. I found pyridoxine psychologically addictive for sure, there's no other explanation for why I used so much of it.

Using a little p-5-p now and then won't do any harm. It blurs my vision like pyridoxine but occasional use of very low doses (1-3mg) hasn't stopped me getting better. It's worth trying.

I don't know how you eat but I would recommend following the ketogenic version of the Perfect Health Diet, with 50g daily carbohydrate and some coconut oil. This can help rebuild nerves. And avoiding food toxins from grains and legumes, which might be making things worse. But read the PHD book, you don't want to starve youself. Ketogenic dieting should be the first thing tried for neurological problems as it can very often reverse them fairly quickly.

George Henderson said...

I don't remember any withdrawals, but I was pretty messed up and there was a lot going on at the time...I had after-effects rather than withdrawals.

George Henderson said...

Pyridoxine depenency only exists in the literature as a genetic condition causing seizures which can be relieved by pyridoxine. Very likely ketogenic dieting would help as well.

Anna C said...

I’m not on statins. It’s all so weird. It seems everyone’s reaction is different.
I’d like to try the ketogenic diet you’ve mentioned. I’ve read something about Perfect Health Diet and its ketogenic form but not in details. Please give me some practical tips. Did you mix coconut oil with milk and drink it with meals? What are the proportions? And one more – I wonder where I could buy it cause I don’t think I’ve come across it before.
I've tried something different instead. I don’t know whether you‘ve heard about flax oil and dr Budwig’s diet but in Poland, where I live, it’s a popular unconventional treatment for many diseases, including neurological ones. I’ve been on it but probably too short (2 months) to see any difference.I guess, this oil is forbidden in the ketogenic diet as it's plant oil, correct me if I'm wrong.
I think I should try alpha lipoic acid you’ve suggested so I’d like to ask you how much of it you took a day to feel better ? I’ve read about different dosages, like from 200 to 600 mg a day.
Thank you in advance. Anna

George Henderson said...

The reaction to pyridoxine can be modified by other factors; protein, magnesium, and B2 should help it at the time, I was taking these after a while.
I really think buy the Perfect Health Diet book, get it out of the library, or study the website, as there is more too it than just restricting the diet. Coconut cream/ milk can be used (this is about 25% fat or should be). Dairy fat is also ketogenic, about half as much as coconut oil.
I don't see much reason why the Budwig diet would work. What you need most is to be well nourished by eating lots of real, nutrient-dense and non-toxic foods that contain nutrients that help nerves to rebuild, while in a ketogenic state that promotes them healing.
It is not a diet in the sense of feeling hungry or losing weight that's needed, nor need it involve special foods (you could do it without coconut, but coconut helps).
Meat, fish, fats, eggs, offal, cheese, roots and (a little) tubers or rice, leafy greens, (a little) fruit, vinegar and spices, some tea, coffee, and dark chocolate are the main things. No sweets, no oils (other than coconut and olive), no grains (other than white rice) or legumes.
A few supplements that are listed in the book and on the website, but no regular use of multivitamins.
Adequate vitamin D and vitamin K2 are important for nerves and will probably need to be supplemented, magnesium too (this will help with cramps; also, get enough iodised salt). But the book says it all so much better! Chapter 13.

Lisa B said...

Can I ask you a few questions about your experience with b6 toxicity?

George Henderson said...

Sure - not certain what there is that I haven't mentioned in the post or comments, but feel free to ask.

Lisa B said...

Did you have burning with it? Did you notice sensitivity to high b6 foods at all and what you ate? It took 5 years to get over, so did it gradually improve or were there worsening of symptoms and lessening or did it just gradually get better? I'm just curious. I've been dealing with b6 toxicity for months. I am considering the ketogenic diet to see if it helps but feel like nothing is improving. Thanks!

George Henderson said...

Hi Lisa,
- yes, I had feelings of heat in my legs and feet. Note that this is also a sign of high blood sugars so have your fasting glucose and HbA1c tested to be sure - if so, a ketogenic or low carb diet, and/or some intermittent fasting will help with this too.
- I don't think any real foods are high enough in B6 to trigger symptoms, it is a fairly scarce vitamin, but I definitely stayed away from any food supplemented with vitamins. B6 in real foods is mainly in the vitamer forms which are non-toxic. If a food seems to make symptoms worse that is more likely to be an allergic reaction to that food or, if it's a carbohydrate food, a spike in insulin caused by eating it. Also, there are chemicals in processed foods that could produce similar effects if you were sensitized to them, such as MSG (usually in processed meat), acrylamide (formed by high temperature baking and frying of carbohydrates, e.g. bread, fries), and artificial colourings.
- The symptoms didn't come right quickly, though some cleared faster than others; the visual disturbance is still very slightly noticeable even now. Usually, but not always, and not to a degree that bothers me. The scientists who produced toxicity in themselves reported a "coasting" effect, that is the symptoms continued and got worse for a while (5-6 weeks) after stopping even when the B6 level was completely back to normal.

Make sure you only eat real unprocessed foods (no additives), avoid foods that spike blood glucose and insulin (grains, potatoes, sugar), get some good coconut oil (should be extra virgin, but organic is not important, all EV coconuts are basically organic anyway). Consider eating ketogenic (no carbs, high fat), but be sure to eat extra salt if you do. Try intermittent fasting (only eating during 8 hours per day, e.g. from 9am-5pm, is an easy way to do this). Consider supplements used for neuropathy (especially L-acetylcarnitine, alpha lipoic acid, vitamin B1). B6 toxicity will come right eventually, but it is a slow haul.

Lisa B said...

I will. I have noticed increased symptoms with potatoes and some other things. HBA1C and glucose has been normal.. I will definitely try ketogenic diet and the other suggestions.. Thanks for the info.

Nikola Spasic said...

Hi George, I was wondering if you could help me with this..I ve been in B6 toxicity for a year with symptoms showing no clear improvement ..
I was curious how long it took for you to notice a substantial improvement? Was it a gradual improvement or did it take a few years to see a change in symptoms? I am wondering how severe your neuropathy was because I feel that mine is substantial and I question if I am healing at all.
I would appreciate any help. The fact that you recovered eventually makes me hope that I am able to as well.

George Henderson said...

Hi Nikola,

It took me a long time to get better but I probably noticed less frequent symptoms after a few months. Symptoms were bad enough that I thought I had MS. Strange brushing sensations on my skin, fuzzyness in touch perception, heat in legs and feet, pins and needles, doubling of vision in each eye in the horizontal plane, and blurred vision in general.
I suggest reducing calcium in the diet (only if you eat much dairy or have it in supps), and checking the other potential causes of neuropathy such as high blood sugar or heavy metal exposures (e.g. if you've had lots of mercury fillings).

Isabella said...

Hi everyone,

I've just been diagnosed with B6 toxicity after 4years of running around from specialist to specialist ruling out all other possible causes for my symptoms. I was convinced that I had MS at one stage!

My symptoms started with a strange tingling sensation in the back of my leg then pins and needles, calf's cramping up, pain in lower legs mostly,muscle weakness to pins and needle sensations down my arms,fingertips tingling, worse for exercise, headaches/fatigue, insomnia and very sensitive to touch.. it would set off my symptoms.

I used to be very active prior to all this but my symptoms has made exercising impossible even walking has become extremely uncomfortable including gentle exercise such as Pilates/yoga. Anything that activates my muscles causes pain and pins and needles in the area that's been worked.

I've been taken off all B-vitamin supplements and although I felt a lot better during the first 2 weeks, over the past week (week 3) I've noticed the symptoms coming back at worst case scenario. Has anyone experienced this?

I'm also wondering if anyone has had difficulty with movement and exercise with B6 toxicity and how long it took to improve?

Thanks everyone

Lisa B said...

There is a Facebook group for b6 toxicity that is pretty active you could join. I have had all those symptoms.

George Henderson said...

Hi Isabella,

repeating information in an earlier comment, The scientists who produced toxicity in themselves reported a "coasting" effect, that is the symptoms continued and got worse for a while (5-6 weeks) after stopping even when the B6 level was completely back to normal.

I do remember muscle weakness as a symptom, also cramps.

little g said...

Ive had this. Just found out last Oct after getting my B6 level checked. I was advised to quit taking B complex, but I did start up a month or 2 later on a multi vitamin, and had symptoms again. I was not aware this was the problem. I read so many places that some of the symptoms were from deficiency, and Im going through perimenopause and read it was helpful to supplement B6. Probably already too high I started taking a supplement, until I read about neuropathy. I quit taking high doses but continues B Complex til my levels were tested. This is scary! Why isn't more known about the danger. It needs to be out there in the headlines. I took high doses for maybe 4 or 5 months and B Complex for years. I dont know how long Ive been out of range for. My symptoms were excruciating last Sept. I feel a little of it coming back from the multi. How long does it take to heal from this? Will I ever heal from this??

George Henderson said...

Hi Little g,

you will recover, the more real food you eat the more completely. I advise the more ketogenic version of the Perfect Health Diet. But it does take time.
I agree this is a growing problem that needs to be discussed in public health. B6 supplementation, of pills and processed food, is not going away, and people may be becoming less able to cope with it.

Joni K. said...

I became toxic right after I started P5P. I used pyridoxine hydrochloride prior to that for over 10 years and no problem. Started having numb feet with the P5P. Too bad I didn't get B6 tested for four years since the numb feet started. (Neuros and doctors assumed it was my MS and never tested B6 until I asked for the lab.)

B6 or P5P never helped my dream recall--or even if I did dream!

Joni K. said...

Yes; B6 toxicity is real, whether from pyridoxine hydrochloride or P5P--speaking from personal experience.

George Henderson said...

Hi Joni,

it's likely that pyridoxine sensitised you to the P5P, which does break down to pyridoxine.
In the experiments P5P wasn't as toxic as pyridoxine, starting from scratch, but my thinking is also that it's more effective for whatever you'd supplement B6 for, so someone shouldn't need as much. So if people who needed B6 started with P5P and didn't take more than they needed their total exposure should be much lower. However Solgar make P5P in a 50mg which is much too high for most uses.

Taro said...

Hi I just found out I have vitamin b6 toxicity after 9 months of testing from specialist after specialist. I only took 16mg from a multivitamin. I was wondering if anyone suffered from fatigue on top of numb hands and weird sensation of legs and arms.

George Henderson said...

Hi Taro,

yes, fatigue is a normal symptom. In fact I've had CFS/ME in the past and the B6 syndrome felt very similar with regard the legs.

Why are we seeing B6 toxicity at lower levels than before? I think taking it when not eating or with low-protein diet will increase the risk. More foods are supplemented with it than before. Some infections, e.g. H. Pylori, might be able to produce it in the body.

Dwayne Hillman said...

I have been suffering with b6 toxicity since February 2017 from taking a super b complex vitamin which contained 25 mg of b6 for 3 months. My level went down fairly quickly, as of May, my levels are back to normal, however the symptoms still persist. Numb tongue, sore/straining eyes, burning in arms and legs, dizzy, the list goes on. Some days I feel good, others not so much. I've had 2 MRI's, tons of bloodwork, and a nerve case study, which were all normal. Getting very frustrated, I know it's still early, but I am losing hope that this will go away for good.

George Henderson said...

Hi Dwayne,

it's been about 10 years but I finally think the last symptom, double vision at a distance, has more or less gone. My theory is the Schiff's base reaction of pyridoxine with proteins in nerves sets up oxidative stress hotspots, similar to glycation in diabetes. In time autophagy (replacement of cell parts) will take care of this, which is why I favour low carb, occasional ketosis, and intermittent fasting. And a nutritious diet with plenty of fatty animal foods; eggs, butter, meat, fish and so on.

V Jonas Urba said...

Amazing that B6 or any of these vitamins are not regulated. Apparently, even if a multivitamin says 50mg Pyridoxine, there is no law that prohibits boosting that dosage for shelf life. The bottle I bought 18 months ago was made so that in another 15 months it will still have 50 mg Pyridoxine. Who knows how much I actually took even if they led me to believe it was only 50mg?

I took a multi B Complex with at least 50 mg for 30 years or longer. Blood work in May 2016 showed my B6 plasma at about 9 times the normal upper limit. I was lucky. Gary Zeitlin, M.D., an internal medicine luminary thought I was deficient based on my symptoms and ordered B6 plasma test. Had he not been super intelligent who knows how many neurologists and others I would have been shuffled to.

Feet numb, finger tips tingling, leg cramps, weak, tired.

Stopped all supplements cold turkey. First month off I had puss coming out of my eyes each morning. Bloodshot eyes, issues with ears, throat, felt like a bad cold without the cold. Scary, freaky, bad bad bad stuff.

Eyes are finally clear but were dry for a long time. Fingers no longer tingle. No more cramps. Feet a little prickly in the shower but much less than before. Maybe another 3 to 5 years before I am as good as can be expected following this nightmare.

They still want to argue over how to cut health care costs. Maybe investing a little more in warning us about over the counter Pyridoxine toxicity might start a conversation. Followed by helping doctors understand that accidental vitamin overdosing is not uncommon and that a full blood chemistry should include B6 plasma. And possibly most importantly, require insurers to pay doctors when they talk to us about what we eat day in and day out since that will cut down on the prescriptions and surgeries our premiums cover.