This Is What Causes B6 "Toxicity"

Here's how to stop your hands and feet from tingling. Lessons from the literature, biochemical reasoning, and my own experiment in self-induced B6 neuropathy.

Looking beautiful, feeling great, and living a long healthy life is hard, but B6 can help you do it.

Vitamin B6 is an essential nutrient required to prevent blood glucose from dropping too low, to allow your muscles to burn glycogen during exercise, to prevent anemia, to clear histamine, to keep oxalate levels low, and to provide smooth, shiny, beautiful skin.

Without enough B6 your mood can crash, your handling of stress can deteriorate, your anxiety can rise, your sleep can tank, your joints can hurt, and you’ll start getting sick more often.

Estrogen raises your need for B6, so anything that correlates with your menstrual cycle or your use of HRT as a woman, or your body fat gain as a man, could be related to B6.

Inflammation raises your need for B6, so getting sick or being chronically inflamed can launch a vicious cycle of needing more.

As I covered in The Three Nutrients You Need More of On a High-Protein Diet, most people don’t get enough, and people eating high-protein diets almost universally don’t get enough.

If you have sulfur dysregulation issues, moreover, this could send your B6 requirement into megadose territory, especially if you eat a lot of protein.

Before you go reaching for that bottle of B6, however, know this: B6 supplements can cause neuropathy.

The neuropathy often starts in the toes, usually affects the feet, hands, and lower legs the most, and when it gets bad it can prevent you from being able to walk. More commonly, it manifests as a sense of tingling, numbness, burning, crawling, stinging, itching, metal scraping, or biting ants along the skin, but can be widely variable, cause bone problems, and affect the genitals, leading to the loss of libido. It can make it more difficult to run, lift, or climb stairs; to type, play piano, grip a steering wheel, or otherwise use the hands for things more complex than holding objects; and it can lead to twitching, fidgeting, or sensations of other types of movement running underneath the skin.

If you stop B6 at the first sign of symptoms, it typically gets worse for 2-3 weeks then goes away.

If you stop the B6 months or years into the symptoms, it typically is gone within six months after stopping if you were taking less than 500 milligrams a day, or it can take three years to fully resolve if you were taking a gram or more per day.

Now here’s the big problem.

Classically, B6-induced neuropathy is considered a “toxicity” from “megavitaminosis” or “hypervitaminosis” even though there is literally no remotely settled science on how the accumulation of B6 could drive neuropathy, and even though experimental induction of B6 neuropathy in humans doesn’t resemble a phenomenon driven by bioaccumulation of a toxin at all.

This misunderstanding of B6-induced neuropathy has led to the erroneous belief that there is a predictable dose-response relationship, where doses under the National Academy of Medicine’s tolerable upper intake level and found on supplement shelves are “safe” — they aren’t — and where doses above those levels are predictably harmful — they aren’t.

Even if you take the erroneous dose-response beliefs seriously, you still are in a quagmire of conflicting ideas: sulfur dysregulation could lead you to require neuropathic doses; doses used to treat PMS, nausea and vomiting of pregnancy, high oxalate levels, and some forms of seizures are neuropathic; and doses used to treat some forms of drug-induced neuropathy are themselves neuropathic.

But once you leave this erroneous belief behind you can look at the broad base of evidence suggesting people can develop neuropathy on doses less than 20 milligrams per day, very close to the typical requirement, which I estimate at 5-6 milligrams per day.

In fact, there are numerous Facebook groups dedicated to people who believe they are suffering from B6-induced neuropathy, and within them there are people who claim to have developed neuropathy from as little as 2 milligrams of supplemental B6!

While there is some evidence that within each person, the dose determines the neuropathy, the variation between each person’s threshold is vastly more important, making any predictions about the safety or tolerability of a given dose virtually meaningless on an individual level.

(Even though the average response makes such predictions somewhat useful on a population level).

I did my own experiment in self-induced B6 neuropathy, and I showed that neuropathy can be induced at the same dose that provides normal physiological benefits of B6. In contrast to what I had believed for over a decade, I showed that it can be induced rather easily with P5P, and is not the specific province of pyridoxine hydrochloride, used in cheaper supplements. I consider my conclusions extremely valuable for shedding light on what causes it, and on how to get rid of it.

Once we leave behind the traditional idea of “toxicity” and think about B6 neuropathy as an imbalance created within a complex web of biochemical pathways, the light bulb will go off in our heads allowing us to understand it with the clarity needed prevent it and resolve it.

And that is what we will do in this article.

This is educational in nature and not medical or dietetic advice. See terms for additional and more complete disclaimers.

In This Article:

• The Short Answer

• This Is How B6 Neuropathy Manifests

• Why the Upper Limit Is Misleading

• A Broader View of How the Neuropathy Manifests

• What We Learned From the Scientists Who Induced B6 Neuropathy in Themselves

• Why Megadoses Aren’t Needed

• What Causes B6 Neuropathy? Lessons From Animal Experiments

• What Causes Neuropathy In General?

• The Role of Energetic Failure

• Why Your Individual Idiosyncrasy Matters

• Lessons From My Own Self-Experiment in B6-Induced Neuropathy

• The Bottom Line: What to Do

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