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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....

Puddleg 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.

Puddleg 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 ?

Puddleg 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)

Puddleg 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.

Unknown 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

Puddleg 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.

Unknown 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

Puddleg 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.

Puddleg 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.

Puddleg 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.

Unknown 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

Puddleg 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.

Unknown said...

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

Puddleg said...

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

Unknown 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!

Puddleg 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.

Unknown 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.

Unknown 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.

Puddleg 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

Unknown said...

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

Puddleg 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??

Puddleg 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.

SunnySky 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!

SunnySky said...

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

Puddleg 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.

Puddleg 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.

Unknown 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.

Puddleg 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.

Urba Law PLLC : V. Jonas Urba, Esq. 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.

Kevin Wilson said...

George, thanks for sharing your story and information.

I too have B6 toxicity and am only 5 months off of it now.

How are you doing these days? Any type of symptoms/food sensitivities left?

Puddleg said...

I think I'm totally clear now.
The neuropathy etc took a year or two to clear but the visual effect took longer.
I think fasting between meals really helps. I have 4-5 eggs in a little fat for breakfast (swap one for sardines or a piece of bacon now and then), late if possible, then nothing much until dinner, maybe a little bit of fruit or cheese, and try not to eat after.
I was never sensitive to food sources of B6 that I knew off, but certainly was to many grains and soy.

Unknown said...
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Unknown said...
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Unknown said...

Hi Prof henderson.

I seem to be suffering from b6 overdose which I took at astronomical doses for about a week. Very stupid. I see that you suggest the Ketogenic diet. However, I find that when I eat meats high in b6 that the symptoms increase exponentially. I am worried that I am doing more damage. Did you notice an uptick in symptoms in this regard. Strangely i am also reacting badly to rice and oats. the problem is that I have lost much weight and I am on my last legs quite honestly. what can I eat to boost my weight? coconut oil? Most importantly I would like to know if you continued eating meats in spite of any upticks in symptoms?

one last thing, was head fog, like a complete fishbowl over the head effect one of your symptoms? I feel like I struggle to interact with my family, like I am cognitively blurred. and if so did this go away at all, fairly quickly?

Unknown said...

Urba, Isabella, Dwayne,

Haqve any of you noticed any improvements since your last comments on this site? Did any of you avoid any types of foods in particular and or find foods that a agreed with you? Or did you all just eat normally? if you had sensitivities did you just fight through them?


Puddleg said...

Hi James,

A ketogenic diet isn't any higher in protein than the usual diet, and you can use foods like eggs and bacon (which is quite low in B6) or fish; it doesn't need to be fully ketogenic, you just need to be in ketosis some of the time, which is probably more tolerable at first than going strict keto. So you could do a long overnight fast, have bacon and eggs in a little butter at breakfast/lunch, then have a potato or such for carbs with your dinner - you'd only be interrupting ketosis once a day.
Definitely use some coconut oil or frozen grated coconut, but also use animal fats like butter, ghee or dripping (tallow), and avoid seed oils, sugar, and grains. Keep fruit to one piece a day, other than berries and tomatoes.
To boost your weight, cream is pretty good, and eat more fruit and root veges if you like; just try to get long windows between meals where you're not eating or not eating carbs as this is where the magic will happen. This should help brain fog too, it did for me.
I didn't get upticks with meat (or if I did I ignored them) and I actually took very low dose P5P supps sometimes, I would notice both good and bad effects from these - but they didn't stop me recovering.
The sensitivity to dietary B6 (or it could be a sensitivity to something you need better B6 function to detoxify) is a different order to the effects of supps - it's a minor fluctuation that will cease to be noticed as the blood level drops. It's like being splashed by the waves at high tide - they will reach you less and less as the tide goes out, till you no longer notice them.

Unknown said...

If I could ask another question. were any of your symptoms a feeling of slight psychosis early on. like you were going crazy. I have nerve pain in my legs, but I get this brain fog coupled with this sense that I'm losing my mind and high high body anxiety. It has been 5 weeks now and it is not getting much better. Could I have done permanent nerve damage in my brain? At certain parts of the day i clear up and have no symptoms, but most of the day I am symptomatic. I find when I am not eating I am at my best, but my weight is now dangerously low. If you had any feelings of losing your mind (you did say you were "messed up"?).

Puddleg said...

Hi James, I guess I was quite used to feelings of anxiety before the B6 thing so it was relief to find a solid cause for some of the things I was anxious about. It sounds like you need to eat more - deficiencies of other B vits, protein, essential fats won't be helping.
I recommend eating as many eggs, lightly cooked with butter and salt, as you can for breakfast - it is hard not to be grounded both psychically and somatically by eating such a nutrient dense, high protein food.
I found nicotinamide (a form of B3) was the best antianxiety supplement, 500mg 2-3x a day. This sensitises the brain to GABA. It's also one of the things you need B6 to make, so might decrease the effect of a disordered B6 metabolism. Magnesium supps might also help. Also consider whether your vitamin D level will be adequate, this is another deficiency that feeds into feelings of fragility.
What dose of B6 did you take? I don't think permanent brain damage is very likely from B6 alone, especially over a short term. That you have periods with no symptoms is hopeful. 5 weeks is not long at all, that's the "coasting" effect, and things will improve over the longer term.

Unknown said...

Unfortunately is was b complex and other multi vitmains. the only ones in dangerous doses were the b vitamins so it was a combination of all of them. the folate was also particularly high at around 2000 mcgs a day. So I might have done more damage than I know of. If i eat any carbs like oats or rice Iget this soar of energy through my mind, intense detachment and outrageous anxiety. If I eat high B6 meals like meat or fish, I then get severe burning in my skin. So I fear I might have done more damage as I say. I have a lot of regret in this regard as I always thought that more vitamins are better and that they cannot hurt. I took 6 different forms of B-complex and multivitamins each day for 4 days, on one day I took them all morning and again at night, really really regrettable and stupid. I guess the damage is done. the other problem is that with this comes a massive sensitivity to msg and other preservatives so things like butter, yogurt and milk are also no goes for me. the only stable foods for me are eggs and vegetables low in b6. But thank you George, I guess the head issues might be more than just damage from B6. the neuropathy in my legs skin and arms is definitely from B6 I would assume. Seems like I have generally just poisoned my nervous system generally beyond repair and I am reasonably terrified. Worst of all is that my body wont hold weight, and I think the next stop is hospitalization. Thank you.

Unknown said...

James. B6 Toxicity causes severe anxiety in most people who become toxic and can cause severe panic attacks.

Puddleg said...

Hi James,

there is no MSG or preservative in milk, yoghurt or butter. Of course you could be sensitive to casein, which often accompanies gluten intolerance. In this case ghee would be okay, everything except milk might be tolerated in small amounts mixed in meals. Mik and fake yoghurts made with milk solids are really the foods to avoid. As far as I know you will recover from a short B6 exposure, though the effects can be terrifying. If you become deficient in vitamins, protein, energy, your neuropathy might get worse - so it's worth eating foods like meats and fish occasionally until you find types you can tolerate - lamb is probably the best meat for someone with sensitivities.

Brindy said...

Part 2. Hi George! HG. GT3a

I was so so disappointed to get the increased V load results & have so much more Neuropathic pain this winter. (always get P.N over 7 mths of cold weather;)
I asked Dr for a selenium toxicity test, or how to get rid of but he just said stop taking it.

If plant polyphenols will chelate iron, will they also chelate selenium? But which ones to not be stuffing with carbs?
Grapefruit & orange pith?

I also later, recently, bought Alpha Lipoic Acid caps, & taking them, but did I just read you said it was a bad oil? Please could you help me & answer soon?

I have other interesting self experiment/diet over time/GOOD data to share also. Thank you so much George for your fantastic research & info, which I only just found yesterday after wading through miles of only typical medical normal garbage until yours! I was doing the LCHF for years (mainly just full fat dairy & eggs) as I can't usually stand eating animals, but had never read SatFat was good for HCV, as they all rave about LOWfat.

Would u tend to agree my Viral load went up due to high selenium?
&/or iron from the beef/roo/lamb? (as I never usually eat meat but was trying to not get PN sensory pain this winter)
or maybe also from all that tomato paste, but I ate it usually with tonnes of olive oil & oregano.
I was eating SO MUCH Hiimalayan salt, resulting in the increased Viral load & worse PN, & now I read that salt is BAD FOR THE LIVER. (but u encourage salt) SOMETHING made my numbers rise suddenly, & I never ever drink alcohol. oh, I also ate LOTS OF NUTMEG & cinnamon for a time, in raw egg-nog I made. ( I heated the vanilla first if I used it) with cloves.

This winter, I kept all doors/windows tightly shut all night, instead of letting in air, & many nights I've had super dry mouth, which I never had in my life, & cracked lips, even tho I put coconut oil on them. Maybe too much protein/salt(before?

I am too afraid to do the anti viral drugs, as I know myself, & like 'natural' so much, & do not trust medical drugs usually, or believing doctors only want to help you. (even if they really do, their beliefs are often different than mine)
If I was taking those drugs for 6 months, I know that the very first headache, or feeling of nausea or insomnia etc. I would just want to STOP, as it would feel I was hurting/poisoning myself, & they are so new, without history, & no real follow up. You are so lucky you are cured & so far seem fine! I also followed some forums, & people complained of newfound neuropathic symptoms, & their doctors didn't take them seriously & basically told them to get lost. These neurological symptoms sometimes stayed way longer after the treatment was over, & no one was helping them.

Thank you so much George for any help/advice you might be able to give me please?! Brindy

Brindy said...

Hello George,(HG) PART 1. GenType3a Can you help me please,with an acute dietary dilemma, re how to quickly get rid of excessive (found out hurtful, after increased Viral Load results) overdose of selenium (have long-term chronic hcv) safely?

For 10 months I enthusiastically followed net advice & (instead of suggested synthetic 3,000 gms) I ate 12 brazil nuts each day,plus advice of Grassfed beef (for ALA) ( about 7 Kilos over 8 months, plus 2K kangaroo (as grass fed too, but all too much iron) with my idea of hcv anti-ox diet of 50-100 gms dark Lindt 90% chocolate, 1 huge avocado, 4-5 cups tea, 3 oranges (same time) tonnes white pepper, tonnes oregano, tonnes Himalayan pink rock salt, massive icebergs of org.butter on teensy pita bread, & dumbly 1/2 -1 jar tomato paste mixed w same amount EV olive oil sometimes, & lots of broccoli etc. & raw carrots.(other veg occasionally) & eggs as usual.
End up w Viral Load of 778,000 up from 203,900 year before & WAY WAY worse sensory/ P.Neuropathy this winter than other winters.. (though I didn't walk much as I did other years, as my dog was sick) (Don't test + for Cryoglobumins, but micro-inflammation of nerves can occur either way) Triglycerides 0.4 (*1 below lowest range)
HDL 2.0
LDL 3.4 (I used to ALWAYS have HIGHER HDL/LOWER LDL before, but as I stuffed with butter this year (never did b4) got different numbers & instead of a * TOO LOW overall cholesterol, got a *5.6 (same as last year from eating butter).
AST *66 *(up 1 from year before)
ALT *94 *(up 1 from year before)

I also lay in the sun long periods to make more Vitamin D w my eaten butter, (but now read that UV radiation can hurt HCV liver?)
Ate coconut oil too.(even though it's called RAW they use heat to process it & it tastes nothing like a real coconut)
I had a few stints of eating cheap lamb chops too, forgetting about too much iron but trying to get some protein.(Iron normal 21.2)
Vit D.90.

8 months PRIOR, Fibroscan 3.4 (suggestive of normal/minimal fibrosis) (Perhaps I m;ight have a higher FS result to correspond with Viral Load increase) I've never had any kind of cirrhosis, or any problems at ALL w my liver, except the P.N. Sensory neuropathy in legs & feet. (plus many other places before, when I had severe injuries) (Continued above in Part 2 sorry!)

Puddleg said...

Hi Brindy,

I had selenosis at one time, but I don't remember it increasing VL. It just went away; I don't know what would help remove it - maybe Vit C? If you supplement NAC the cysteine will compete with selenium in places like muscles, hair, nails and reduce side effects. Toxicity from brazil nuts is rare compared with toxicity from supps - do you have changes in nails and do people say you smell strange? These are good signs of selenosis.
Fish-oil type fatty acids are antiviral for HCV should reduce viral load, so eat sardines and salmon regularly, if you want to supplement krill oil is better than fish oil. This is better than choosing meats as sources of ALA, which won't make much difference.
Coconut oil is fine, however it's processed, it ought to help the VL.
You want sun exposure to the rate that you can tan as summer approaches, not a lot if you're not able to tan or already tanned. Tanning is your protection against cancer and sign that Vit D is being synthesised so build it up before the sun gets too strong in the year, then cover up mostly after that (but only use sunblock when excess exposure can't be avoided with clothing, as when swimming). Will too much UV hurt your liver? Only if you burn I think, because this will trigger inflammation.
The drug combo you want for Geno3 is called Epclusa, and you should be able to source it relatively cheaply and safely through a buyer's club with a little research. A course only lasts 6-8 weeks and in my experience has minimal side effects, comparable to drinking an extra cup of coffee, i.e. you wish you hadn't but it's not that bad and you soon get used to it.(Most people feel nothing)
To get my VL down, I had to cut carbs under 50g before tests - try to be keto. Over that there was a normal variation eventually. So going keto would cut the VL, this would last a while, then it would creep up and over 50g wasn't related to carbs (though other symptoms were).
Someone reported to me the other day that using one of those vibration plates that are hyped for weight loss improved their brother's diabetic neuropathy, without weight loss. Just an anecdote, but interesting if stimulating circulation in feet and legs improves nerves.
As well as restricting iron you can try restricting dietary cholesterol - at least on a day or two every week. I'm loath to suggest this as it should be less relevant in low carb context and could cause you to skip beneficial foods, but there is some evidence for it in people with Hep C on normal diets.
That said, your lipid results are excellent. Nothing wrong with having higher LDL when you have HCV - it predicts less fibrosis, better antiviral response, lower risk of diabetes, better health all round. Those are in fact GREAT lipids for you (and VL could just be a blip.
If you're not already, I suggest supplementing zinc (gluconate is probably best form available) 30mg/day as there is good evidence for this as stand-alone; it brought my ALT and AST down to within normal range and stopped leg cramps.

Puddleg said...


I would just use iodised table salt - why risk iodine deficiency, which will make everything more complicated? I do only use iodised table salt myself.

Brindy said...

Than q so much 4 reply!(never got auto email notfctn & everytime I clicked on old http link, your answer never showed up, nor going to your blog page & manually checking. Had to do a search for VitB6 causes neuropathy today to finally get to this comments page for my answer!)

I forgot to mention last time that I ate salmon kind of regularly plus fresh cooked sardines for a while, but the salmon all farmed, so has tons of toxins/fed crap/ no normal eating of life forms which give salmon it's natural orange color, they are injected with dye, so seem kind of almost worthless to eat because of the diet they are fed. REAL unfarmed salmon is only obtained in cans; cooked/heated to massive degrees for HOURS, then canned in who knows what kind of tin whose elements seep into the fish. The sardines (REAL caught at sea/natural diet so provide Omega3 etc still) I ate whole, which I also fed my dog WHOLE as recommended, but that meant I was eating it's pooh too, & they didn't taste nice. But most tinned sardines are in soy or crap oil. Even if u wash them, they contain oil. Other real salmon is smoked which gives nitrates.
I know you're a SuperScientific Guy, (my hero type in HCV & stuff I'm interested in) so u
probly have a less 'emotional' way of thinking about health & food, & more xyz/ ab + c = Y, whatever, mathematical/factual/ kind of thinking/approach, whereas I'm Ms Hippy/skipping through buttercups in the sun type,& can't get away from 'natural/pure' is best thinking/feeling. 'purist/Naturalist', & shy away from artificial/fake stuff.
I met w DAA drug docs x 2 before. Maybe it was 3 month treatment w the latest which treats MANY Gentotypes now. I personally thought I think I'd rather take 2 of the drugs available the year before to take, than the one which treats every type of HCV GT ever found w one tablet, as maybe then you might be getting a lot of extra poison to cover the whole lot, instead of chemicals needed to just get rid of your OWN single type??? (you might be up on
the exact inhibitors provided by the older 2 drug treatment, versus the one size kills all latest drug?)
You just guessing that maybe my last VL was perhaps a blip (do you mean a 'mistake' or just a one short burst of high v load but back to normal soon after the test?) was a REALLY big
jump, like almost 4 times my lower VL. I had 250,000 3 months before that, which went down to the 203900. I think in 2001, it was 600,000 but I was taking pain drugs, & even drank red wine (I hate alcohol taste) which relaxed my capillaries/arterioles/muscles whatever, & then my feet weren't like ice, & blood flowed. (this is when I had bed rest for a year w no movement, & windows wide open for fresh air even in winter so freezing!)

I was doing fine last year, until I then decided I would heal the hcv myself without the drugs. Thats' when the VL shot up so high, after me going whole hog, & consuming all those foods anti-ox stuff I thought would help me.

Brindy said...

pART 2. Hi G.
I did not cut down carbs like you do/did. I actually am part pig I must admit,
or calf, as I graze all day long!

I'm a natural gutz/grazer & didn't see the harm w nuts/veggies & fruit before.

Maybe all that tomato paste I ate from jar w olive oil made too much insulin?

But my fasting blood test with the * 0.4 EXTREMELY LOW TriGlycerides.( * under lowest number in range) Doesn't that show I was well below carb level?

Though I know myself I ate STACKS of veggies/broccoli (for magnesium/calcium & glutathione) bare or w olive oil or cheese.

I used to buy Dead Sea salt or Celtic salt in California,years ago, but not there now. (it was wet & grey - Natural) Mercola. com raved about health benefits of Himalayan pink salt. I probably only ate that for a few months before VL test, but on every single thing, every mouthful. I probably overdid it like all the other stuff? But had been using Iodised sea salt for years before that. Do you think Iodised sea salt is okay? table salt has that bad stuff added to make it flow better.

I started stuffing with butter occasionally, to increase my Total cholesterol, which was ALWAYS asterked in the past as LOW *.(from being vegetarian usually)

Mercola said he always had low cholesterol & cold feet/hands so he ate butter to increase it to increase cholesterol & his circulation.

Stuffing w butter increased my cholesterol by far, but DID NOT increase my circulation, & PERHAPS has contributed to way INCREASED Viral Load.

When I finally got the VL high numbers back, I stopped doing all those things I was doing in excess before while trying to fix my HCV.
So, DO YOU RECOMMEND taking the ALA capsules please?


But what about the researcher working for Gilead who said Nov 2016 that after following about 3,000? patients for 10 months during & after DAA treatment, that some patients developed previously undiagnosed EXTREMELY AGGRESSIVE HEPATIC TUMORS????

THAT is the kind of thing I was most afraid of, not just the symptoms whilst taking the drugs. But the FUTURE LONG TERM POSSIBLE BUT YET OF COURSE UNKNOWN RAMIFICATIONS of that treatment. (because to me, as a 'purist' the drug just seemed 'too good to be true' 'TOO EASY') Starving the liver's own kind of little 'immune' system, by feeding all those inhibitors etc hard core for so long, can stop it's own little 'Security' system for watching out for other bad things which might be happening whilst taking the drugs dont' you think maybe?????

I have lots more questions so will return later on. Thank you George!

Puddleg said...

Hi Bindy,

Tumours after DAA are very rare and are in people at high risk anyway; the virus was protecting them by stimulating immunity. But HCV was also the cause of the cancer, so overall the long-term risk is reduced by eliminating it (this was even shown in interferon trials).

I don't worry too much about fish (I'm eating it for the DHA, which is still there in farmed salmon), I get sardines in spring water or olive oil. Generally purer is better but there are just so many areas where this doesn't matter; we need to choose our battles and getting fed is one of them!
I don't recommend ALA oil - if you must have some, eat some ground linseed or LSA. Lamb fat supplies some, so will wallabies and 'roos.

Epclusa (Sofosbuvir and 1 other drug, Velpatasvir) is the combo I had for Geno3, it worked very well, 98% success rate (100% in the trial I was in), very short course, minimal side effects and nothing serious. I would not add anything else to this - it is tried and tested as it is.
If your TGs are low then it looks like you're very insulin sensitive, which you can be on any diet, not just low carb, and which is good. Could you increase VL by adding butter to carbs? Yes indeed, though I would expect TGs to go up too - very odd that they didn't if those tests are done at one time.

Curious said...

I have B6 toxicity, diagnosed 9 months ago. Tinnitus is gone, however neuropathy remains but improving very, very slowly. I also have cold hands and feet and tight muscles and many other symptoms. I have a very odd problem from the toxicity I'm hoping you may explain. My collagen has been decimated. It happened suddenly and severely. Doctor says it looks like large sudden weight loss. Another doctor says it looks like 10-20 year aging in just a month. Can you think of any reason B6 toxicity may have caused it? Could it be oxidative stress from the toxicity and can you think of anything to do to improve it? Do you think it might improve as toxicity comes out of body? Oddly, the bulk of it came after stopping the B6 supplement.

Puddleg said...

I can only say that B6 will be important for forming some of the amino acids needed for collagen if they're not adequate in the diet.
We think B6 toxicity is in part a loss-of-function for B6 enzyme action. So supplementing collagen and eating gelatin (bone broth, tendons, etc) will increase the supply of amino acids like proline and glycine. Vitamin C is also the critical factor in collagen strength. I would use a mixed antioxidant supplement as well as collagen. Don't cut natural B6 in your diet, only avoid supplemental forms - it's a fine line between toxicity and deficiency because the toxicity impairs the use of B6.

Curious said...

Thank you. Would you please explain further about these two statements as I truly want to understand what I am dealing with? "We think B6 toxicity is in part a loss-of-function for B6 enzyme action." and "the toxicity impairs the use of B6." Also, as I heal from the toxicity should I be able to get back to normal B6 function? And, I have been limiting B6 food so if that has caused some of the collagen loss should resuming normal B6 food intake eventually "put the collagen back?"

Curious said...

Just to elaborate - the reason I really want (need) to understand is because I am trying to sort out whether or not I may have fluoroquinolone toxicity. Other B6 toxic people don't seem to have this collagen problem. Other than the collagen my symptoms and timing seem more like B6 toxicity and got really bad after increasing B6 supplementation. But, if B6 toxicity can affect the ability to use B6 and B6 is necessary for collagen synthesis then I guess B6 toxicity could be the cause of my collagen loss. Please do answer my questions for clarification from my post just before this, but do you have any other advice on sorting this out. Also, I made a friend request to your Facebook. The initials that correspond to me name are G.L. and I would sincerely appreciate your help. Thank you.

Puddleg said...


no-one on the curing B6 toxicity facebook groups have mentioned collagen loss.
They've posted studies confirming that high blood levels of B6 inhibit the formation of PLP (the active form) which explains why some (not all) symptoms are similar to B6 deficiency.
I don't believe in avoiding B6 from natural food sources (as opposed to fortified) because these will also supply everything needed for the proper use of B6. The difference between supplement levels and levels in foods is huge, so cutting foods would only contribute a tiny bit to lowering blood levels, and my symptoms got better without avoiding any natural food because of B6. Of course there may be cases where people have unusual responses to foods but that's unlikely to be related to cases of over-supplementation.