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Vitamin B6, pyridoxal

Vitamin: B6, pyridoxine

Daily Value: 2.0 mg

Hazardous level: 25 mg

Average intake in US diet: 1.87 mg

Function: primarily a coenzyme for transamination reactions for transamination reactions,

required for amino acid, fat, and nucleic acid metabolism; necessary for protein metabolism and

for the formation of antibodies; involved in the synthesis of hormones and red blood cells

SENIOR DOSAGE RATIONALE: Necessary to reduce risk of homocysteine and heart disease.

But harmful at elevated levels. Dror indicates higher dosage may be needed. Rimm shows

highest quintile intake has lowest disease rate. Even with high dietary intake this level is safe.

Want at least 3 mg weight adjusted.

KEY NOTES AND REFERENCES:

"Vitamin B-6 requirement and status assessment of young women fed a high-protein diet with

various levels of vitamin B-6", Huang YC; Chen W; Evans MA; Mitchell ME; Shultz TD, Am J

Clin Nutr 1998 Feb;67(2):208-20

"The vitamin B-6 requirement of young women consuming a constant high-protein diet

(1.55 g/kg body wt) and the effect of various ratios of vitamin B-6 to protein on this

requirement were studied. .. Regression analysis revealed that the amount of dietary

vitamin B-6 required to normalize urinary 4-pyridoxic acid, plasma pyridoxal-P,

erythrocyte pyridoxal-P and pyridoxal, and erythrocyte alanine and aspartate

aminotransferase activity coefficients to predepletion baseline values was 1.94 mg

vitamin B-6/d (0.019 mg vitamin B-6/g protein). This study suggests that the current

vitamin B-6 recommended dietary allowance of 1.6 mg/d based on 0.016 mg/g

protein is not an adequate intake and may require reevaluation."

Ellis, J.M., and McCully, K.S. , "Prevention of myocardial infarction by vitamin B6", Res Commun Mol

Pathol Pharmacol. 89: 208-20 (1995)

"Patients who were given vitamin B6 for carpal tunnel syndrome and other degenerative diseases

were found to have 27% of the risk of developing acute cardiac chest pain or myocardial infarction,

compared with patients who had not taken vitamin B6. Among elderly patients of the author (JE)

expiring at home, the average age at death from myocardial infarction was 8 years later in those who

had taken vitamin B6, compared with those who had not taken vitamin B6."

Chasan-Taber, L., et al , "A prospective study of folate and vitamin B6 and risk of myocardial infarction in

US physicians", J Am Coll Nutr. 15: 136-43 (1996)

"To assess prospectively the risk of myocardial infarction (MI) associated with decreased plasma

levels of folate and pyridoxal phosphate (PLP, a form of vitamin B6) in relation to elevated levels

of total homocysteine (tHcy)... SETTING: Participants in the Physicians' Health Study. SUBJECTS:

14,916 male physicians, aged 40-84 years, with no prior MI or stroke provided plasma samples at

baseline and were followed for 7.5 years. ... RESULTS:...men with the lowest 20% of folate levels

... had a relative risk of 1.4...compared with those in the top 80%. For the lowest 20% of vitamin B6

values, the relative risk was 1.5 ... these prospective data are compatible with the hypothesis that low

dietary intake of folate and/or vitamin B6 contribute to risk of MI. "

Selhub, J., et al , "Association between plasma homocysteine concentrations and extracranial carotid-artery

stenosis", N Engl J Med. 332: 286-91 (1995)

"BACKGROUND. Epidemiologic studies have identified hyperhomocysteinemia as a possible risk

factor for atherosclerosis... a cross-sectional study of 1041 elderly subjects (418 men and 623

women; age range, 67 to 96 years) from the Framingham Heart Study... CONCLUSIONS. High

plasma homocysteine concentrations and low concentrations of folate and vitamin B6, through their

role in homocysteine metabolism, are associated with an increased risk of extracranial carotid-artery

stenosis in the elderly."

WHITE PAPER REFERENCES FOR SENIOR FORMULATION

Curz, A., et al "Longitudinal changes in the intake of vitamins and minerals of elderly Europeans", Eur J

Clin Nutr 50: S77-85 (1996)

658 elderly men and 731 elderly women born 1913-18: "A significant decrease in the median

intake of vitamin B1, B2, B6, C or iron was observed..."

Dror, Y. et al, "Estimation of vitamin needs-riboflavin, vitamin B6, and ascorbic acid-according to blood

parameters and functional-cognitive and emotional indices in a select well-established group of elderly in

a home for the aged in Israel", J Am Coll Nutr 15: 481-88 (1996)

ave. age over 80 "vitamin needs... (mg/day) of >150 for ascorbic acid, >3 for riboflavin, >3 for

vitamin B6"- elderly need >3 mg/day of B6

Manore, M.M., et al, "Plasma pyridoxal 5'-phosphate concentration and dietary vitamin B-6 intake in

free-living, low-income elderly people", Am J Clin Nutr 50:339-45 (1989)

intake: females 60-80 yrs old - 1.5 mg; males 1.9 mg

"Vitamin B6 status was low in 32% of this elderly population." Table 3: those who took

supplements had about 5-fold higher levels of B6 in serum- 198 elderly; B6 low in 32%;

deficiency is prevalent in elderly;

Meydani, S.N., et al, "Vitamin B-6 deficiency impairs Interleukin-2 production and lymphocyte

proliferation in elderly adults," Am J Clin Nutr 53: 1275-80 (1991)

"Vitamin B-6 deficiency impairs in vitro indices of cell-mediated immunity in healthy elderly

adults. This impairment is reversible by vitamin B-6 repletion [2.88 mg/day for men, 1.90

mg/day for women" - 8 healthy elderly-50% of elderly have a low intake of vitamin B6, below

50% of RDA. Deficiency impairs immune function. "Older adults may require amounts of

vitamin B6 higher than those currently recommended"

Naurath, HJ, et al, "Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with

normal serum vitamin concentrations", Lancet 346: 85-89 (1995)

"supplement containing 1mg vitamin B12, 1.1 mg folate, and 5 mg vitamin B6" "Vitamin

supplements significantly reduced all four metabolite concentrations [related to high

homocysteine]... The response rate to vitamin supplements supports the notion that metabolic

evidence of vitamin deficiency is common in the elderly, even in the presence of normal serum

vitamin levels." - elderly deficient in B6 - dose 5 mg IM 8 times over 3 weeks

Selhub, J. et al, "Association between plasma homocysteine concentrations and extracranial

carotid-artery stenosis", NEJM 332: 286-92 (1995)

study of 1041 elderly subjects ages 67-96; "High plasma homocysteine concentrations and low

concentrations of folate and vitamin B6...are associated with an increased risk of extracranial

carotid-artery stenosis in the elderly." - B6 in elderly reduces risk of extracranial carotid-artery

stenosis (atherosclerosis)

van der Wielen, R. P. , et al, "Nutritional status of elderly female nursing home residents: the effect of

supplementation with a physiological dose of water-soluble vitamins", Eur J Clin Nutr 49: 665-74 (1995)

supplementation of 42 women over 60 in nursing homes. "50% of the daily dietary

recommendation of water-soluble vitamins" "significantly improved the concentrations of

thiamin and pyridoxal, increased body weight and decreased serum homocysteine" - dietary

supplements improved pyridoxal levels in elderly

van der Wielen, R. P. , et al, "Dietary intakes of energy and water-soluble vitamins in different categories

of aging", J Gerontol 51: B100-7 (1996)

"Dietary intakes of [thiamin, riboflavin, B6, and C] were below the minimum requirements in

almost half of the nursing home residents" - dietary intakes below RDAs in half of nursing home

residents

Whitney, E. N., et al, Nutrition for Health and Health Care, 1996, West Publ. Co.,, Mpls.

pg 422 "One suggestion is to establish one set of RDA for those 50 to 70 years old and

another for those over 70."

pg 651 "People with renal failure...receive vitamin B6 (5-10 mg) , ...and folate (1 mg)."

Zhang, ZF, et al "Adenocarcinomas of the esophagus and gastric cardia: the role of diet", Nutr. Cancer

27: 298-309 (1997)

"Decreased risk...was significantly associated with high ingestion of...niacin, vitamin B6, iron,

and zinc. Higher intakes of vitamin A, beta-carotene, vitamin E, folate, phosphorus, and

potassium were associated with a decreased risk..." - decreased risk of adenocarcinoma with

higher intake of vitamin B6

Alhadeff, L. et al, "Toxic effects of water-soluble vitamins", Nutr. Rev. 42: 33-40 (1984)

"it is now known that high doses of water-soluble vitamins may indeed have toxic effects"

Table II: vitamin disorder

nicotinic acid asthma, diabetes, liver, gout, cardiac, CNS

folate masks B12 deficiency, causes insomnia

pantothenate causes diarrhea

B1 causes irritability

B6 causes convulsions, antagonizes L-dopa in

Parkinsons, neural troubles

- high doses cause convulsions, antagonizes L-dopa in Parkinson's, causes neural troubles

Chavance, M. et al, "Vitamin Status, immunity, and infections in an elderly population", Eur J Clin Nutr

43: 827-835 (1989)

"Two results ...should be underlined. Vitamin B6 status was positively related to percentages of

T-cell subsets" "Vitamin E status was negatively related to the number of past infections:

subjects with a high alpha-tocopherol plasma concentration had fewer infections during the last 3

years than those with a medium or a low concentration."- B6 level in elderly correlates with good

immune system, T-cells

Baker, H., et al, "Vitamin Profiles in elderly persons living at home or in nursing homes, versus profile in

healthy young subjects," J Am Ger Soc 27:444-50 (1979)

"473 elderly persons...The circulating levels of biotin, pantothenate, riboflavin, vitamins A, B6,

B12, C, E, folate, Thiamine, nicotinate, and carotenes were determined in all groups."

"Thiamine, vitamin C and vitamin B12 levels were strikingly depressed in the non-institutional

elderly... Over 30% of the institutional elderly had vitamin B6 and nicotinate

hypovitaminemia...Both the institutional and the non-institutional elderly showed depressed

levels of folate and vitamin B12...Vitamin supplementation reduced the percentage of folate and

B12 deficits."- B6 was most common deficit in elderly (31%)

Shimikawa, T. et al, "Vitamin intake: a possible determinant of plasma homocysteine among middle-aged

adults", Ann Epidemiol 7: 285-93 (1997)

"Plasma homocysteine among users of vitamin supplement products was 1.5 micromol/L lower

than among nonusers."

Benton D; Haller J; Fordy J, "The vitamin status of young British adults", Int J Vitam Nutr Res

67(1):34-40 (1997)

"thiamin, riboflavin, pyridoxine, ascorbic acid, retinol, alpha-tocopherol, folic acid,

cyanocobalanin, carotene and biotin status were assessed in a sample of 243 young British

adults... The status of ascorbic acid, cyanocobalamin, alpha-tocopherol, folic acid and in males

retinol, was adequate in the majority of cases. In the cases of riboflavin and pyridoxine the status

of a substantial minority was either borderline or deficient. The thiamin and biotin status of a

minority of both sexes, and retinol in the females, was marginal"

Rimm, E.B., et al, "Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart

disease among women," JAMA 279: 359-64 (1998)

"a total of 80,082 women from the Nurses' Health Study...the relative risks of coronary heart disease

between extreme quintiles were 0.69 for folate (median intake, 696 mcg/d vs 158 mcg/d)... and 0.67

for vitamin B6 (median intake, 4.6 mg/d vs 1.1 mg/d)...These results suggest that intake of folate and

vitamin B6 above the current RDA may be important in the primary prevention of coronary heart

disease among women...".actual highest quintile is 774 mcg/day folate, 5.9 mg/day B6- highest

quintile, lowest heart disease - intake 696 mcg folate, 4.6 mg B6 [ 4.6 mg - 50%*1.6 = 3.8 mg]

WHITE PAPER REFERENCES FOR STAY WELL FORMULATIONS

Chandra, R. K., "Effect of vitamin and trace-element supplementation on immune responses and

infection in elderly subjects", Lancet 340: 1124-27 (1992)

study of 96 people, had 23 vs. 48 days of illness, recipe 400 iu retinol, 16 mg beta-carotene, 2.2

mg thiamin, 1.5 mg riboflavin, 16 mg niacin, 3 mg B6, 400 mcg folate, 4 mcg B12, 80 mg C, 4

mcg D, 44 mg E, 16 mg Iron, 200 mg Ca, 100 mg Mg

Gridley, DS, Shultz, TD, Stickney, DR, and Slater, JM, "In vivo and in vitro stimulation of cell-mediated

immunity by vitamin B6", Nutr Res 8: 201-7 (1988)

"These data suggest that vitamin B6 (7.7mg/kg) is an important in vivo and in vitro modulator of

immune function and that dietary supplementation with this vitamin can enhance cellular

immune mechanisms"

ein, and carbohydrate metabolism

DOSAGE RATIONALE: Safe, so goal is at least 150% of RDA including dietary intake

KEY NOTES AND REFERENCES:

Alhadeff, L. et al, "Toxic effects of water-soluble vitamins", Nutr. Rev. 42: 33-40 (1984)

"it is now known that high doses of water-soluble vitamins may indeed have toxic effects"

Table II: vitamin disorder

nicotinic acid asthma, diabetes, liver, gout, cardiac, CNS

folate masks B12 deficiency, causes insomnia

pantothenate causes diarrhea

B1 causes irritability

B6 causes convulsions, antagonizes L-dopa in Parkinsons, neural troubles

- promotes diarrhea at 10g / day

WHITE PAPER REFERENCES FOR STAY WELL FORMULATIONS

no evidence of connection with colds, viruses, immune system

s...The circulating levels of biotin, pantothenate, riboflavin, vitamins A, B6,

B12, C, E, folate, Thiamine, nicotinate, and carotenes were determined in all groups."

"Thiamine, vitamin C and vitamin B12 levels were strikingly depressed in the non-institutional

elderly... Over 30% of the institutional elderly had vitamin B6 and nicotinate

hypovitaminemia...Both the institutional and the non-institutional elderly showed depressed

levels of folate and vitamin B12...Vitamin supplementation reduced the percentage of folate and

B12 deficits." - 29% of elderly were deficient

WHITE PAPER REFERENCES FOR STAY WELL FORMULATIONS

Chandra, R. K., "Effect of vitamin and trace-element supplementation on immune responses and

infection in elderly subjects", Lancet 340: 1124-27 (1992)

study of 96 people, had 23 vs. 48 days of illness, recipe 400 iu retinol, 16 mg beta-

carotene, 2.2 mg thiamin, 1.5 mg riboflavin, 16 mg niacin, 3 mg B6, 400 mcg folate, 4

mcg B12, 80 mg C, 4 mcg D, 44 mg E, 16 mg Iron, 200 mg Ca, 100 mg Mg

"thiamin, riboflavin, pyridoxine, ascorbic acid, retinol, alpha-tocopherol, folic acid,

cyanocobalanin, carotene and biotin status were assessed in a sample of 243 young

British adults... The status of ascorbic acid, cyanocobalamin, alpha-tocopherol, folic acid

and in males retinol, was adequate in the majority of cases. In the cases of riboflavin and

pyridoxine the status of a substantial minority was either borderline or deficient. The

thiamin and biotin status of a minority of both sexes, and retinol in the females, was

marginal" In riboflavin the status of a substantial minority of 243 British students was

either borderline or deficient.

WHITE PAPER REFERENCES FOR STAY WELL FORMULATIONS

Chandra, R. K., "Effect of vitamin and trace-element supplementation on immune responses and

infection in elderly subjects", Lancet 340: 1124-27 (1992)

study of 96 people, had 23 vs. 48 days of illness, recipe 400 iu retinol, 16 mg beta-

carotene, 2.2 mg thiamin, 1.5 mg riboflavin, 16 mg niacin, 3 mg B6, 400 mcg folate, 4

mcg B12, 80 mg C, 4 mcg D, 44 mg E, 16 mg Iron, 200 mg Ca, 100 mg Mg