How’s Your B6 Situationship?

Completely breaking up would have been easier for everyone. But cutting the cord isn’t an option because she’s everywhere. She remains essential, beneficial & yes, indicated in some patients as part of their prescription. But her ‘toxic nature’, exposed via excess supplemental intake, is something we shouldn’t turn away from either. So, a ‘situationship’ has emerged involving intense emotions, a lack of clarity & consistency about how we feel, the nature of this new relationship between B6 & us & accordingly, ‘how we should act’. I mean, are we even still friends?? Practitioners seem to be responding to this relationship shift in very different ways…

Ghosting – suddenly ceasing all communication, without warning or goodbye -removed from our shelves & thought processes seemingly overnight.

Slow Fade – gradually pull away, including B6 less & less in your thoughts about the nutrition of patients, either as a potential deficiency or as part of their remedy… then not at all

Benching – storing B6 in a mental “maybe” file or “just in case” folder, remembering the benefits she can bring to some patients but not willing to play her on the pitch right now.

Orbiting – No longer speaking directly… but obsessively watching from afar. Reading every article, every social media post, every case report, every opinion piece. Quietly consumed by everything being said about our ex

Either way B6 is orbiting us! Because even if we did want to ‘forget we ever met’, our patients bring her into almost every consult: they’re ‘seeing’ her, did see her, have experienced awful adverse effects as a result, or are filled with worry that they will. And we’re (rightly) rethinking every product on the shelf, including those we’ve used successfully for years with seemingly ‘no problems’ and reassessing them in this new light. This is tough terrain. Especially when it starts to erode our very own identity as the experts in nutrition.

The bar for attributing blame to B6 is currently incredibly low – and everyone is doing it.
Any altered sensation? Are you taking anything with B6? You are? Well, bingo!
This is where things are getting messy and very misleading

Even those ‘diagnosed’ by way of B6 blood levels, reveal to me, those doing the diagnosing have not read the research – because there is no concentration of any B6 biomarker that consistently in any way correlates with its neurological toxicity, for a start! I’ve heard B6 being blamed for paraesthesia that are not bilateral or do not fit the characteristic distribution pattern of small sensory fibre neuropathy (stocking glove +/- facial). Heck! I’ve heard of some that aren’t even sensory or peripheral, instead it’s about dizziness and altered hearing etc. Hellooooooo 📣 There is no convincing evidence that B6 toxicity produces central nervous system involvement — not in mechanistic work, not in clinical descriptions, not in animal studies nor the broader literature. I’ve been talking with many practitioners recently about this issue and how we should respond – to the valid concerns of their patients, to the very real threat posed by B6 containing supplements as well as the need to keep using these in some, to the enormous concern & confusion caused by these misdiagnoses.

One of the things I’ve been saying repeatedly is, ‘Remember you’re the expert in the room.‘

But, of course that’s only if you are. Being the expert is never permanent. It isn’t something you achieve once and then keep forever without effort. And of course it’s relative to who else is in the room. Nutrition as a science is wonderfully dynamic, & accordingly our understanding of something, can go ‘out of date’, seemingly overnight. So if you’re sitting with someone who’s seen a neurologist — especially one with a clear diagnostic pathway & ideally biopsy findings — and you haven’t kept up with this aspect of B6, your role will be to listen and learn. But if you have read the literature… If you understand what B6 toxicity is — and what it is not — and a patient’s GP is confidently pointing at B6 containing supplements while the clinical picture simply doesn’t fit… Then back yourself. Respectfully. Calmly. And get busy finding the real cause. 🔎

Because good clinical nutrition isn’t about choosing sides – It’s about staying evidence-literate enough to know when B6 deserves the blame and when it’s just an easy-out to accuse your ex of everything!