What is the relationship between vitamin B6, homocysteine, and heart disease?

A deficiency of vitamin B6, folic acid, or vitamin B12 may increase your level of homocysteine, an amino acid normally found in your blood [28]. There is evidence that an elevated homocysteine level is an independent risk factor for heart disease and stroke [29-37]. The evidence suggests that high levels of homocysteine may damage coronary arteries or make it easier for blood clotting cells called platelets to clump together and form a clot. However, there is currently no evidence available to suggest that lowering homocysteine level with vitamins will reduce your risk of heart disease. Clinical intervention trials are needed to determine whether supplementation with vitamin B6, folic acid, or vitamin B12 can help protect you against developing coronary heart disease.

What are some current issues and controversies about vitamin B6?

Vitamin B6 and the nervous systemVitamin B6 is needed for the synthesis of neurotransmitters such as serotonin and dopamine [1]. These neurotransmitters are required for normal nerve cell communication. Researchers have been investigating the relationship between vitamin B6 status and a wide variety of neurologic conditions such as seizures, chronic pain, depression, headache, and Parkinson's disease [18]. Lower levels of serotonin have been found in individuals suffering from depression and migraine headaches. So far, however, vitamin B6 supplements have not proved effective for relieving these symptoms. One study found that a sugar pill was just as likely as vitamin B6 to relieve headaches and depression associated with low dose oral contraceptives [19]. Alcohol abuse can result in neuropathy, abnormal nerve sensations in the arms and legs [20]. A poor dietary intake contributes to this neuropathy and dietary supplements that include vitamin B6 may prevent or decrease its incidence [18]. Vitamin B6 and carpal tunnel syndromeVitamin B6 was first recommended for carpal tunnel syndrome almost 30 years ago [21]. Several popular books still recommend taking 100 to 200 milligrams (mg) of vitamin B6 daily to treat carpal tunnel syndrome, even though scientific studies do not indicate it is effective. Anyone taking large doses of vitamin B6 supplements for carpal tunnel syndrome needs to be aware that the Institute of Medicine recently established an upper tolerable limit of 100 mg per day for adults [12]. There are documented cases in the literature of neuropathy caused by excessive vitamin B6 taken for treatment of carpal tunnel syndrome [22]. Vitamin B6 and premenstrual syndromeVitamin B6 has become a popular remedy for treating the discomforts associated with premenstrual syndrome (PMS). Unfortunately, clinical trials have failed to support any significant benefit [23]. One recent study indicated that a sugar pill was as likely to relieve symptoms of PMS as vitamin B6 [24]. In addition, vitamin B6 toxicity has been seen in increasing numbers of women taking vitamin B6 supplements for PMS. One review indicated that neuropathy was present in 23 of 58 women taking daily vitamin B6 supplements for PMS whose blood levels of B6 were above normal [25]. There is no convincing scientific evidence to support recommending vitamin B6 supplements for PMS. Vitamin B6 and interactions with medicationsThere are many drugs that interfere with the metabolism of vitamin B6. Isoniazid, which is used to treat tuberculosis, and L-DOPA, which is used to treat a variety of neurologic problems such as Parkinson's disease, alter the activity of vitamin B6. There is disagreement about the need for routine vitamin B6 supplementation when taking isoniazid [26,27]. Acute isoniazid toxicity can result in coma and seizures that are reversed by vitamin B6, but in a group of children receiving isoniazid, no cases of neurological or neuropsychiatric problems were observed regardless of whether or not they took a vitamin B6 supplement. Some doctors recommend taking a supplement that provides 100% of the RDA for B6 when isoniazid is prescribed, which is usually enough to prevent symptoms of vitamin B6 deficiency. It is important to consult with a physician about the need for a vitamin B6 supplement when taking isoniazid.