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A little-known nutrient with some powerful actions is called P5P (pyridoxal-5-phosphate) which is the active form of vitamin B6.
P5P benefits as active vitamin B6 are many, from eye health to brain health. Vitamin B6 as a nutrient is fascinating. In this post, vitamin B6 and P5P are referred to as the same nutrient. This is because P5P is the important form of B6 in our bodies.
I hope that this in-depth look gives you a big appreciation of the vitality we get from nutrients. Read on to learn more about activated vitamin B6, food content, and why you may need more.
Table of Contents
Vitamin B6 Deficiency (P5P Deficiency) is Common
Vitamin B6 in its active form is called P5P and it is a key nutrient for protein metabolism.
Deficiency of vitamin B6 happens easily. For example, you may eat a typical American diet or a fad diet, as many people do. If this describes you, you probably would benefit from vitamin B6 or P5P supplements.
The P5P form of B6 is sometimes needed for best health and mood. This is because modern diets and medicines rob the body of this essential nutrient. Some recent research suggests that 30 to 50 percent of people may have vitamin B6 deficiency determined by vitamin B6 low blood levels. Another study found that if you have diabetes, your chances of vitamin B6 low blood levels are between 25-63%. That’s a lot of people!
Before we get to why vitamin B6 deficiency is so common, we will review how important vitamin B6 is for your health.
What Does Vitamin B6 (P5P) Do?
Vitamin B6 as P5P helps make at least 100 unique enzymes in the body do their job. These enzymes are critical in making one thing into another in our body. Vitamin B6 helps transform, in other words.
Examples of where vitamin B6 are needed in the body are:
- Protein metabolism
- Growth
- Makes blood cells
- Nervous system function
- Hormone function
- Immune system function
- Building new tissue
- Detoxifying
- Helps make red blood cells, so supports energy
- Blood sugar regulation; converts carbohydrates to energy
- Development of myelin sheath protects nerve cells
- Fat metabolism into essential fatty acids
- Neurotransmitter production (dopamine, epinephrine, gamma-aminobutyric acid, histamine, norepinephrine, and serotonin)
- Phospholipid and sphingolipid production: structure of cell membranes
- Converts tryptophan into niacin
- Helps make glucocorticoid hormones
- Acts as a potent antioxidant
Summary of Vitamin B6 Functions
Simply put, vitamin B6 helps us manage our food by changing its destiny in our body. It does this through protein metabolism and amino acid metabolism. Vitamin B6 as an active form called P5P also plays key roles in carbohydrate and fat metabolism.
Because of its role in all types of energy metabolism, a lack of P5P can create some big problems in the body from anemia, or reduced red blood cells, to severe dermatitis. The deficiency of P5P can also make you low in hormones and neurotransmitters. Low B6 even puts you at risk for heart disease because it causes high homocysteine levels.
Of all the B vitamins, vitamin B6 has the most diverse roles in our body, so its health benefits are large. Adequate vitamin B6 is important for every cell type in your body.
Symptoms of Vitamin B6 (P5P) Deficiency
Vitamin B6/P5P deficiency can look benign, but there is trouble behind the scenes due to the inflammation that vitamin B6 deficiency causes. The classic clinical symptoms of vitamin B6 deficiency are skin rash and redness. This results from inadequate cell membrane function and anemia. However, a rash is not always present with deficiency.
Other more pronounced symptoms of a vitamin B6 deficiency can include:
- Weakness
- Mental confusion
- Depression
- Insomnia
- PMS symptoms
- Nerve pain and damage
- Seizures
Since these symptoms can look like a lot of other things, vitamin B6 deficiency almost always is missed by doctors.
Vitamin P5P, as a supplement, benefits many people, from potential sleep benefits to energy benefits. Let’s get into why many people can benefit from a Vitamin B6 (P5P) supplement.
Related post: Vitality and Work Performance Nutrition
Why is P5P the Best Form of Vitamin B6?
Vitamin B6 is found in foods in different forms. Plant sources of B6 are called PNG (pyridoxine-5′-β-D-glucoside) form. In foods, the following forms also occur as pyridoxal, pyridoxine (pyridoxal), and pyridoxamine. Once our body absorbs vitamin B6, it becomes activated by the liver into a form called pyridoxal-5-phosphate, or P5P or PLP, as it is commonly abbreviated.
As you can imagine, if someone has a genetic variant in B6 metabolism, inflammation, or altered liver function, vitamin B6 doesn’t get activated in the body. So it makes sense to supplement with activated vitamin B6 or P5P when you can.
13 Vitamin B6 (P5P) Benefits
With so many roles in the body, it isn’t too surprising that clinical studies are showing the beneficial effects of P5P and vitamin B6 supplements. Here are the 13 roles we know of today for this key vitamin. Let’s review these next.
Vitamin B6 (P5P) Reduces Inflammation
Inflammation is at the root of many chronic illnesses, so much research is focused on the best ways to reduce it. P5P reduces homocysteine, so it logically may reduce inflammation. Here is the research we have so far. In one large study of over 2600 people, vitamin B6 intake at 5 mg/day or more was related to less inflammation. In another study, supplemental B-complex including P5P compared to placebo reduced inflammation in 62 patients. These patients had rheumatoid arthritis. Another study of patients with rheumatoid arthritis found that vitamin B6 supplements at doses of 5 mg per day reduced markers of inflammation, including plasma IL-6 and TNF alpha.
Further, high doses of vitamin B6 has potent anti-inflammatory effects in early cell studies. Low P5P levels in women strongly predict an increased risk of cardiovascular disease, an inflammatory condition.
In summary, P5P and B-complex supplements help dampen down the inflammatory response in the body.
Vitamin B6 May Reduce Cancer Risk
Cancer risk is affected by the foods we eat and research is finding that vitamin B6 foods may reduce our chances of these deadly diseases. For example, high dietary intake of B6 may reduce the risk of colon cancer, especially in women who drink alcohol. Vitamin B6 blood levels are related to a reduced risk of breast cancer in post-menopausal women. However, vitamin B6 levels in the blood did not seem to be related to stomach or esophageal cancer.
The research in this area remains preliminary but very promising. Some research shows that the type of folate used affects cancer risk too. Read my blog about folate.
Vitamin P5P Benefits for Anemia
Anemia makes you feel tired and lose focus. One reason that people can become anemic or have low red blood cell levels is because of vitamin B6 deficiency. Specifically, a type of anemia called sideroblastic anemia results in abnormally shaped blood cells. This can be caused by several things, one of them being vitamin B6 deficiency.
Vitamin B6 helps resolve anemia in about 50% of the cases of sideroblastic anemia. When unresponsive to treatment, a type of B6 called P5P may help people recover from this condition. This is because P5P, or pyridoxal phosphate, is the active form of B6.Much lower doses of P5P than other forms of B6 can be given with success in these cases for treating this specific type of anemia.
Vitamin B6 Reduces Seizures
Seizures are debilitating and difficult to treat. Could some seizures have a simple treatment such as vitamin B6? Research suggests so. For example, seizures can be caused by a vitamin B6 deficiency. Seizures can appear in infants with specific vitamin B6 gene variants as well. Vitamin B6 deficiency can also cause seizures in adults. They are more likely to be caused by drug-induced vitamin B6 depletion. Simple supplementation of P5P reverses seizures in these cases.
Vitamin B6 may reduce seizures in patients who do not respond to drug treatment for seizures as well. Inform your healthcare provider of this simple and safe use of vitamin B6 for possible seizure symptom relief.
Vitamin B6 Benefits for Depression and Brain Health
P5P benefits extend to brain health. Vitamin B6 helps improve mood and may even improve memory. Let’s dig in a little bit more about this.
As you may recall, P5P is involved in all types of energy metabolism. The brain likes energy as do most of the tissues in your body. A few examples of research related to brain health and vitamin B6 include a large study of vitamin B6 with folate and B12 reduced the risk of depression in older adults by 50%. Low blood levels of vitamin B6 may be related to depressive symptoms. In yet another study, vitamin B6 and magnesium supplements reduced anxiety-related premenstrual syndrome.
In a large study of young adults, supplemental vitamin B6 reduced anxiety symptoms and tended to reduce depression symptoms as well. The authors speculate that vitamin B6 helps anxiety because it helps the body make the neurotransmitter called GABA. Women with a first episode of psychosis benefited from vitamins including vitamin B6. Supplements improved brain function in this group of people in one study.
Vitamin B complex reduced brain shrinkage in Alzheimer’s disease patients as well, although more research is needed. The effects didn’t seem to apply to patients after a stroke, however.
In summary vitamin B6 as P5P plays critical roles in neurotransmitter and brain function and may serve to help treat depressive symptoms.
Vitamin B6 May Reduce Kidney Stones
Vitamin B6 plays a role in our kidney health too, especially in reducing kidney stone risk. Research shows that a high intake of vitamin B6 (greater than 40 mg per day) may reduce the risk of kidney stones by as much as 65%.
How might B6 reduce the risk of kidney stones? In preclinical work, vitamin B6 reduces urinary oxalate levels by 50%. Supplemental P5P also reduced kidney damage due to diabetes in a rat study.
In summary you may want to include P5P as part of your healthy kidney routine.
P5P Vitamin Improves Eye Health
P5P benefits also seem to extend to eye health because it plays a role in the structure of the eye. Here are some of the research we have for P5P and eye health. A large clinical trial showed that vitamin B6, folate, and B12 reduced macular degeneration risk by 33-41%. When combining folate, vitamin B12, and vitamin B6 as PLP, eye function was improved in a pilot study of patients with Type 2 diabetes.
Vitamin B6 Reduces PMS Symptoms
Premenstrual syndrome causes a lot of physical and emotional distress. Many people don’t realize that nutrients can make a big difference in this condition. So far, nine clinical studies have shown that vitamin B6 (50-100 mg/day) may reduce symptoms of premenstrual syndrome.
Here are some examples of those studies.
- Depressive symptoms are alleviated by P5P.
- Vitamin B6 reduces symptoms of depression in all of these studies.
- The studies were small but consistently effective.
- When combined with magnesium, vitamin B6 helped to also reduce water retention symptoms during PMS.
In summary, vitamin B6 foods and even supplements should be included in your diet if you suffer from PMS.
Related post: Can Probiotics Affect Your Periods?
Vitamin B6 for Carpal Tunnel Syndrome Symptoms
As you may recall, vitamin B6 plays a role in the structure of nerves and has long been used for helping to manage these conditions. Now we have several studies that show that P5P helps some of these conditions.
For example, in a double-blinded, randomized trial of 40 patients, supplemental vitamin B6 reduced symptoms of carpal tunnel syndrome, including pain, numbness, weakness, tingling, and improved sleep. Patients with severe carpal tunnel syndrome usually have a vitamin B6 deficiency. They often respond to treatment with supplemental vitamin B6.
Vitamin B6 for Other Types of Nerve Pain
Vitamin B6 plays a role in maintaining nerve health, so it may help reduce symptoms of other nerve conditions. When combined with thiamine, vitamin B6 helped reduce the pain of diabetes called diabetic neuropathy in a clinical study.
P5P Reduces Restlessness From Medications
Mood-stabilizing drugs are often in the category of antipsychotic medications or atypical antipsychotic drugs. These are prescribed now more than ever. One common downside to these medications is symptoms of restlessness and dyskinesia. Research shows that vitamin B6 is helpful in reducing the side effects of antipsychotic medications. For example, B6 was as effective at treating restlessness as the drug propranolol in a clinical study. Another pilot study found that vitamin B6 reduced symptoms of restlessness by 80%.
In summary, if you are getting restless legs syndrome from medications, you may benefit from P5P supplements.
Vitamin B6 Reduces Morning Sickness
Morning sickness is common and very unpleasant. Vitamin B6 safely helps with these morning sickness symptoms. For example, supplemental B6 at 20 mg per day reduced symptoms of nausea and vomiting in pregnant women with morning sickness. Both ginger and vitamin B6 were effective at reducing vomiting in pregnancy in another study. Ginger was more effective at reducing nausea symptoms than vitamin B6, however. Another study found ginger and vitamin B6 equally effective in reducing nausea and vomiting in pregnancy (better than placebo).
Vitamin B6 Autism Benefits
While we don’t fully know the cause of autism, many different types of nutrients and foods are proving beneficial for the symptoms of autism. For example, a comprehensive vitamin and mineral supplementation regimen, including vitamin B6, reduced symptoms of autism compared to a placebo over a 1 year period. A combination of vitamin B6 and magnesium improved symptoms of autism in 33 children over 6 months. When supplementation stopped, symptoms reappeared.
The Best Vitamin B6 Forms
Two types of vitamin B6 supplements are commonly available:
- P5P (pyridoxal phosphate) or active vitamin B6
- pyridoxine hydrochloride
The most common type of vitamin B6 available is pyridoxine hydrochloride. This is not the active form of B6: it must first be converted by the liver. Using P5P vitamins are best because they are activated vitamin B6. This is especially true for certain conditions, such as anemia and liver disease. However, pyridoxine may work better in autism. Inflammation may cause vitamin B6 to be broken down more quickly in the body. In other words, inflammation may increase the requirements for this vitamin. P5P is the best form in this case. The type that benefits you most may also depend on your genes. The amount of vitamin B6 you should supplement depends on a number of factors.
In summary, if you don’t tolerate one kind of vitamin B6, try the other. Our bodies are usually pretty good at giving us signals of tolerance.
You Should Take Vitamin B6 with Other Vitamins
Another important point about vitamin B6 supplementation is that B-vitamins like vitamin B6 usually work better when taken in combination with other vitamins and minerals. When taking vitamin B6, make sure you are taking it with riboflavin (vitamin B2), thiamine, vitamin B12, and folate.
Like other B-vitamins, it is best to take vitamin B6 as part of a B-complex because taking vitamin B6 on its own is more likely to cause toxicity than if you take it with other vitamins. Generally speaking, doses of vitamin B6 that are less than 100 mg per day are safe.
One easy way to do this is to take vitamin B6 along with a multivitamin or vitamin B complex. Vitamin B6 as P5P has no known toxicity in contrast to pyridoxine, so next I will review P5P supplement brands for you.
P5P Vitamin Supplements
The following brands contain activated B6 as P5P or P5P plus magnesium. Quality matters with vitamin B6 supplements. I chose brands that have the best forms of B6, 3rd party testing, and that have GMP standards in manufacturing. The best vitamin brands undergo rigorous testing.
Seeking Health B Complex Plus contains natural folate and all of the B-vitamins including vitamin B6 as P5P at 20 mg per serving. This is a favorite B-complex of mine.
Vitamin B6 is Lost in Cooking
Vitamin B6 is vulnerable to almost all food preparation methods. Take these examples of food preparation that destroy some, if not most, of the vitamin B6 in your foods.
- Processing (think grains, crackers, pasta, desserts)
- Prolonged heating (up to 50% loss of vitamin B6)
- High heat cooking (up to 50% loss)
- Canning (20-30% loss)
- Instant pots (pressure cooking)
- Milling of grains into refined flour (80-90% loss)
- Sterilization
- Freezing
- Exposure to light (think milk, vegetables, fruits)
- Alkaline conditions
In summary, a processed and cooked diet loses a lot of vitamin B6. Unless you eat a lot of fresh foods and highly absorbed B6, you may need a supplement of vitamin B6.
Medications and Drugs that Deplete Vitamin B6
Vitamin B6 is affected by a lot of different medications, drugs, and alcohol. Below is a partial list of drugs that may create a vitamin B6 deficiency in your body.
As a general rule of thumb, the longer these drugs are taken, the larger the risk of deficiency
Drugs that deplete vitamin B2 will also indirectly deplete vitamin B6:
- NSAIDS or over-the-counter ibuprofen, naproxen
- Alcohol
- SSRI anti-depressants
- Selective Serotonin Reuptake Inhibitors (Effexor)
- Benzodiazepines
- Diuretics (Lasix)
- Theophylline and other asthma medications
- Estrogen
- Dilantin
- Steroid drugs like prednisone
- Oral contraceptives
- Tetracycline and other antibiotics
- Most chemotherapy drugs
The number of drugs that deplete vitamin B6 is staggering. Considering P5P benefits, it is a good idea to consider adding a supplement to your diet.
Drugs That Interact with Vitamin B6
Dilantin and Phenobarbitol are drugs that deplete vitamin B6. However, high doses of vitamin B6 are thought to speed up the loss of these drugs in the body. If you want to supplement, consult your doctor first. It is important to note that individuals taking Dilantin have a high risk of vitamin B6 deficiency.
Who Else Is Likely Deficient in Vitamin B6?
B6 deficiency is more common if you are low in these nutrients:
- Folate
- Riboflavin (vitamin B2)
- Vitamin B12
Vitamin B6 deficiency is quite common in people with high levels of inflammation. People with inflammation have a 50% chance of deficiency. P5P benefits are best achieved when combined with other B vitamins.
Vitamin B6 deficiency is common in people with:
- Liver disease
- Kidney disease
- Indigestion or poor digestion
- Autoimmune diseases
- Diabetes
- Inflammation
A B6 deficiency is also more common in people who are:
- Smokers
- Are obese
- Women
- Alcoholics and casual alcohol drinkers
- Pregnant women
- Older adults: have an increased need
- Vegetarians and vegans
The list of people who potentially have insufficient vitamin B6 is long as you can see. P5P benefits include that it is safe at moderate doses for almost anyone to try.
Is the RDI for Vitamin B6 Enough for Best Health?
Some experts suggest that the Recommended Daily Intake is not enough vitamin B6 for best health. I speculate this is true because of increases in inflammatory diseases, medications, and poor diets. We also have many depleting factors, as mentioned above.
Here is a link to RDI values for vitamin B6. Keep in mind, that age, diet, body size, gender, and disease states change the required amounts for health. As a rule of thumb, the RDI for vitamin B6 is around 2 mg per day. P5P benefits likely extend beyond the RDI because this level is designed to prevent death from deficiency, not for optimal health.
Why Does the Type of Vitamin B6 in Food Matter?
Vitamin B6 from animal sources is 10 to 100 percent better than from plant sources.
With vegetarian diets or high carbohydrate diets:
- The vitamin B6 is not easy to absorb in most plant sources
- Zinc is poorly absorbed
- Plants do not contain vitamin B12
Some plant sources of vitamin B6 have up to 75% reduced absorption. For example, the type of vitamin B6 in peanut butter is 36% less absorbed than the vitamin B6 in tuna.
Selected absorption (bioavailability) of vitamin B6 from foods:
- Meats, fish, and poultry 100%
- Walnuts 78%
- Peanut butter 63%
- Banana 79%
- Tomato 25%
- Spinach 22%
- Orange juice 9%
- Carrots 0%
Soaking and fermenting vegetables reduces the total B6 content of plant sources of vitamin B6 by up to 85 to 89%.
Amounts of bioavailable vitamin B6 in foods:
Eating Patterns and Vitamin B6 Issues
Let’s talk about a few popular diet categories now. Here is what I am seeing:
- High sugar, highly processed foods diet
- Vegan diets
- Ultra-high protein diets
Potential verdict for all? Vitamin B6 deficiency.
Why?
- Processed foods and sugary foods are low in vitamin B6. The inflammation that stems from the diet drives up the need for MORE vitamin B6.
- The more protein you eat, the more vitamin B6 you need. High doses of protein powders may not have enough vitamin B6 to support metabolism. Additionally, high-heat cooking of meats reduces B6 content.
- Absorbable B6 in many vegan foods is low, such as high-fiber foods, including broccoli, Brussels sprouts, and cabbage.
While I understand the various food movements, they need careful consideration.
Vitamin B6 comes from both plants and animals in fairly good amounts. The question isn’t about how much, it is about bioavailability.
A balanced diet of whole foods gives us the best chance of getting this critical nutrient through foods.
Testing Vitamin B6 Blood Levels
A blood test for plasma PLP is considered the single best indicator of tissue B6 stores. All tests must be interpreted by a qualified practitioner because many factors affect this blood test. Elevated levels of homocysteine in the blood may suggest B6 deficiency as well.
How to Keep Vitamin B6 From Breaking Down in Food
Vitamin B6 is broken down when it is cooked. Here are some tips to help retain the B6 in your foods:
- Cook in an acid, such as tomatoes, lemon, or vinegar.
- Shorten cooking time when possible.
- Dried meats retain almost all of the vitamin B6.
- Try to bake or steam: Liquid cooking increases the loss of B6.
- Baked vegetables retain more vitamin B6 content.
- Avoid evaporated milk and ultra-high-temperature processed milk.
Vitamin B6 Toxicity
It is possible to supplement with too much vitamin B6. The resulting toxicity is neuropathy symptoms, or nerve tingling and pain. This is usually reversible.Toxicity of vitamin B6 is seen at 1000 mg per day, but a few cases have occurred at doses of 500 mg per day over many months.
I have seen some reviews online of people feeling toxic effects after 50 mg of the P5P variety. The person was taking isolated vitamin B6 without other nutrients (no other vitamins).
Is Nutrient Deficiency a Problem in General?
A huge research database of over 15,000 Americans, called the National Health and Nutrition Examination Survey (NHANES), aims to explore nutrient deficiencies. Findings of this research study: people who don’t supplement their diets have 40% deficiency rates. This includes both adults and children.
Still, believing those national headlines about throwing away your vitamins? Supplement users were 3 times more likely to have adequate nutrition stores than people who did not supplement.
Imagine this: you indulge in cake (just this one time) then tomorrow, you have a pizza dinner, with beer! It’s Friday, you deserve it, right? You might then pop by and get ice cream. These foods, while fun, crowd out healthier foods that would have been rich in B6. They also USE UP vitamin B6 in your body to be metabolized, putting you further behind. Pretty soon, a third or more of your diet is crowded out by low-nutrient foods. Your metabolism can’t catch up. You don’t have to be a scientist to do the math. You don’t even have to measure your blood levels to understand that your nutrients, including vitamin B6, might be low with your typical American diet.
Measuring vitamin B6 levels at the doctor’s office rarely happens in reality anyway, although after reading this, you may agree that it should.
Summary
Vitamin B6 deficiency is common. Vitamin P5P benefits the body because it is the active form of vitamin B6. The need for vitamin P5P supplements and B-vitamins is due to current diets, increased body weights, inflammation, medications, and many diseases. Vitamin B6 is lost in cooking and is also robbed by many drugs.
Supplementation of vitamin B6 may be necessary to keep your blood levels normal. Make sure to try to get a balance of nutrients and a healthy diet. Use low cooking temperatures for the absorption of vitamin B6 from foods.
The information on this website has not been evaluated by the Food & Drug Administration or any other medical body and is shared for educational purposes only. Consult your doctor or healthcare provider for medical advice before making changes to your supplement regimen or lifestyle.
