High Vitamin B6 Levels: Could Your Supplements Be the Cause?

Most of us think of vitamins as something we can safely take every day.

But vitamin B6 is a good example of why it is worth looking closely at what is actually in your supplements. This is particularly important if you have been taking them for several months or even years!

Vitamin B6 is an essential nutrient involved in normal nerve function, energy metabolism and red blood cell production. We only require a relatively small amount each day, and most people obtain enough through food.

The concern comes with supplemental vitamin B6.

Too much vitamin B6 can damage the peripheral nerves and cause peripheral neuropathy, with symptoms including numbness, tingling and burning sensations in the hands and feet.

Australia's Therapeutic Goods Administration (TGA) has continued to strengthen its warnings around vitamin B6 after receiving increasing reports of peripheral neuropathy and elevated B6 levels associated with supplements.

And importantly, it isn't only happening to people taking exceptionally large doses.

The Original Concern: Vitamin B6 Hiding Across Multiple Supplements

One of the first major concerns around B6 toxicity was supplement stacking.

Someone may take a multivitamin in the morning, magnesium at night and perhaps another supplement for energy, stress, iron or general wellbeing.

Individually, none of those products may look concerning.

The problem is that each one may contain vitamin B6.

You then end up taking B6 several times throughout the day without consciously choosing to supplement with it at all.

The TGA has specifically highlighted this issue. B6 is commonly found in:

● multivitamins
● vitamin B-complex products
● magnesium supplements
● zinc supplements
● iron supplements
● anti-stress formulations
● some energy and nutritional products

In many reported cases, people did not even realise their supplement contained vitamin B6.

But It Doesn't Have to Be Several Supplements

This is the other important part of the conversation.

You do not necessarily need to be taking three or four different products to develop a problem.

Long-term use of a single supplement containing vitamin B6 can also increase your exposure.

That could be a multivitamin or B-complex supplement that someone started several years ago and has simply continued taking every day.

Some B-complex injections and other vitamin preparations may also contain B6, depending on the formulation, so it is worth checking exactly what is in any regular vitamin product rather than assuming it only contains the nutrient you initially started it for.

The TGA notes that peripheral neuropathy has been associated with both higher doses and prolonged use of vitamin B6 products. More recent safety reviews have also found that there is no clearly established minimum dose or minimum duration of exposure at which neuropathy will occur.

In other words, there isn't a simple rule such as:

"Under this amount is always safe."

Individual susceptibility appears to vary considerably.

A Supplement You Started Five Years Ago Still Counts

This is particularly important with supplements that become part of someone's everyday routine.

You might have started a multivitamin five years ago because you were tired, recovering from illness or had been advised to supplement after a procedure.

Five years later, you are still taking it every morning.

Because vitamins are readily available without a prescription, they often don't receive the same regular medication review that prescription medicines do.

But your nutritional requirements may have changed.

The formulation of your other supplements may also have changed.

And you may now be getting additional vitamin B6 from several other sources.

That is why it is worthwhile periodically reviewing everything you take, rather than assuming that a long-term supplement is still necessary simply because you have always taken it.

What Does Vitamin B6 Toxicity Feel Like?

The main adverse effect we are concerned about is peripheral neuropathy.

This is damage to the nerves outside the brain and spinal cord.

People may describe it in very different ways.

You might notice:

● pins and needles in the fingertips
● reduced sensation or numbness in the fingers
● tingling in the feet or toes
● burning sensations in the feet or lower legs
● numbness in the soles of the feet
● altered sensation under the feet, sometimes described as feeling like you are “walking on pillows” or unable to properly feel the ground beneath you
● muscle weakness
● difficulty walking or balancing in more significant cases

Someone might simply say:

"My fingertips feel numb."

Or:

"I keep getting burning and tingling down my legs."

These symptoms can easily be attributed to something else.

Peripheral neuropathy is already relatively common, and its prevalence increases significantly with age. It can have many causes, including diabetes, nutritional deficiencies, nerve compression and other neurological conditions.

That is exactly why supplement use should be part of the investigation, particularly when the cause of peripheral neuropathy is unclear. A full review of prescription medicines, over-the-counter products and supplements, for example through a Home Medicines Review, can help identify hidden or duplicated sources of vitamin B6.

The TGA now specifically recommends that healthcare professionals consider vitamin B6 toxicity when someone presents with otherwise unexplained peripheral neuropathy.

Can Vitamin B6 Neuropathy Be Reversed?

Sometimes.

If excessive B6 exposure is identified and stopped, symptoms may improve.

The TGA has published an example of a person who had been taking a magnesium supplement containing B6 for around 10 years, along with a multivitamin. After the supplements were stopped, her symptoms began improving within several weeks.

Unfortunately, recovery is not guaranteed.

Vitamin B6-associated nerve damage can be severe and sometimes irreversible, particularly if exposure continues after symptoms have developed.

That makes early recognition important.

If you develop unexplained tingling, burning or numbness while taking supplements containing vitamin B6, stop the product and seek medical advice.

What About People Who Have Had Gastric Sleeve or Bariatric Surgery?

This is another group where vitamin supplementation deserves particular attention.

People who have undergone bariatric surgery, including sleeve gastrectomy, commonly require ongoing vitamin and mineral supplementation because surgery and subsequent changes to dietary intake can increase the risk of nutritional deficiencies.

That makes supplementation important but it also means some people may be taking comprehensive vitamin preparations every day for many years.

Interestingly, research has found elevated vitamin B6 levels are relatively common in people following bariatric surgery.

One study of post-bariatric patients found that only 43% had B6 levels within the reference range, while 50% had levels up to four times the upper limit and another 7% had levels more than four times the upper limit. Regular multivitamin supplementation was associated with higher B6 concentrations.

Another study examining multivitamin supplementation following sleeve gastrectomy found elevated B6 levels were common, while B6 deficiency was uncommon.

Research looking specifically at neuropathy following laparoscopic sleeve gastrectomy has also found significantly higher B6 levels among patients experiencing neuropathy, although researchers noted that larger studies are required to confirm the relationship.

We Still Don't Have Every Answer

This doesn't mean that having a gastric sleeve automatically causes B6 toxicity.

And it doesn't necessarily mean these patients are absorbing B6 differently.

The available evidence points more strongly towards ongoing supplementation and overall B6 exposure as important contributors, but there are still unanswered questions around individual susceptibility and why some people develop very high levels or neurological symptoms while others don't.

A review examining B6 supplementation in bariatric patients found that excessive B6 measurements had become increasingly common and concluded that inappropriate supplementation was likely an important contributor.

For anyone who has had bariatric surgery, the answer is therefore not to stop essential supplements without advice.

Instead, vitamin supplementation should be individualised and periodically reviewed with the person's doctor, pharmacist or bariatric healthcare team.

Check Your Labels - B6 May Have Another Name

One of the challenges is that your supplement may not simply say Vitamin B6.

Look for names including:

● pyridoxine
● pyridoxine hydrochloride
● pyridoxal
● pyridoxamine
● pyridoxal 5-phosphate
● pyridoxal-5-phosphate monohydrate

These are all associated with vitamin B6.

If you take several products, check every label and calculate the total amount you are taking each day.

The TGA now requires neuropathy warnings on medicines providing more than 10 mg of B6 per recommended daily dose, and further restrictions on higher-dose oral products are due to come into effect in Australia from 1 June 2027.

How Much Vitamin B6 Do We Actually Need?

Not very much.

Australian guidance indicates that a healthy adult generally requires around 1.3 - 1.7 mg of vitamin B6 per day, depending on age and sex.

For most people, that can be obtained through everyday foods such as meat, chicken, nuts, legumes and certain fruits and vegetables.

Normal dietary intake of B6 has not been associated with peripheral neuropathy.

The safety concern relates predominantly to supplemental exposure.

This is another reason why automatically adding B6 to every nutritional product is not necessarily beneficial.

Why BOLD Health Protein Complete Doesn't Contain Added Vitamin B6

This is an important consideration behind the BOLD Health Protein Complete formula.

Protein Complete has been designed to provide an easy source of quality protein alongside a broader range of selected vitamins and minerals.

However, we have deliberately not added vitamin B6 to the formula.

For someone who is already taking a multivitamin, bariatric supplement or another nutritional product containing B6, adding a protein supplement doesn't necessarily need to mean adding even more B6.

Likewise, for someone who has had elevated B6 levels identified and has been advised to review their B6 supplementation, Protein Complete can provide protein and selected nutritional support without introducing another source of vitamin B6.

It is important to be clear that Protein Complete is not a treatment for vitamin B6 toxicity or peripheral neuropathy.

But its B6-free formulation can be particularly useful for people who want to increase their protein intake and gain broader nutritional support while being mindful of how much vitamin B6 they are already consuming elsewhere.

More Vitamins Aren't Always Better

There has traditionally been a tendency with supplements to assume that having more nutrients in the formulation automatically makes it better.

That isn't necessarily the case.

A thoughtful supplement should consider not only what needs to be included, but also what may not need to be added.

If someone is already getting adequate B6 through their diet and other supplements, adding another dose simply because it is a B vitamin may provide no meaningful advantage.

BOLD Health Protein Complete takes a more considered approach: supporting protein intake and selected nutritional requirements without simply adding every possible vitamin to the formula.

Take Five Minutes and Audit Your Supplements

If you regularly take vitamins or supplements, put them all on the table and have a look at the labels.

Pay particular attention if you take:

● a multivitamin
● magnesium
● a B complex
● zinc
● iron
● stress or energy supplements
● bariatric vitamins
● nutritional drinks
● regular vitamin injections

Check whether B6 appears in more than one product.

Then think about how long you have been taking them.

A supplement that was appropriate when you started it several years ago may not necessarily be something you need indefinitely.

If you're unsure, take your supplements with you to your pharmacist or doctor and ask them to review your total vitamin B6 intake.

The Bottom Line

Vitamin B6 is essential.

But excessive supplementation can cause peripheral neuropathy, and the issue is broader than simply taking an obviously high-dose B6 tablet.

It may occur because you are:

● unknowingly getting B6 from several different supplements
● taking one B6-containing supplement continuously for many years
● using a vitamin or mineral product without realising B6 is included
● taking long-term nutritional supplementation after bariatric surgery without periodically reassessing your requirements

The warning signs are worth knowing.

Tingling. Burning. Numbness. Altered sensation in your hands or feet.

If those symptoms develop, particularly while you are taking B6-containing supplements, don't automatically assume you need more B vitamins.

Have your supplements reviewed and speak with your doctor or pharmacist.

And if you're looking for additional protein and broader nutritional support without introducing another source of B6, BOLD Health Protein Complete has been formulated without added vitamin B6.

This article provides general information only and is not intended to diagnose or treat a medical condition. Do not stop clinically required vitamin supplementation following bariatric surgery without discussing it with your healthcare professional.

Here are five FAQs that fit the blog and should also help with long-tail SEO:

FAQs

1. What are the symptoms of vitamin B6 toxicity?

Vitamin B6 toxicity most commonly affects the peripheral nerves. Symptoms can include tingling, burning, numbness, pins and needles, reduced sensation in the hands or feet, or an altered feeling under the soles of the feet. In more significant cases, people may also experience weakness or problems with balance and walking.

2. Can you get vitamin B6 toxicity from just one supplement?

Yes. While vitamin B6 toxicity can occur when several supplements containing B6 are taken together, long-term use of a single B6-containing product may also cause problems in some people. There is no clearly established minimum dose or duration of use at which peripheral neuropathy will occur.

3. Which supplements commonly contain vitamin B6?

Vitamin B6 is commonly found in multivitamins, B-complex products, magnesium supplements, zinc supplements, iron products, stress and energy formulas, bariatric supplements and some nutritional products. It may appear on the label as pyridoxine, pyridoxine hydrochloride or pyridoxal-5-phosphate.

4. Is peripheral neuropathy from vitamin B6 reversible?

It can be, particularly when excessive B6 exposure is identified and stopped early. However, recovery can take time and some cases of nerve damage may not fully resolve. Anyone experiencing unexplained tingling, burning or numbness while taking B6-containing supplements should seek medical advice.

5. Does BOLD Health Protein Complete contain vitamin B6?

No. BOLD Health Protein Complete has been formulated without added vitamin B6. This can make it a useful option for people wanting additional protein and selected vitamins and minerals without adding another source of B6 to their existing supplement routine.

Written by Alexandra Shepherd, Accredited Pharmacist at Medicine Review South West

Alexandra is an accredited pharmacist with experience reviewing medicines, supplements and nutritional products, including identifying potential medicine-related causes of symptoms such as peripheral neuropathy. Through Home Medicines Reviews, she works with patients and GPs to assess medication safety, duplication and long-term supplement use.