Vitamin B6 Deficiency:

By SWA

A Hidden Factor in Complex Symptom Cases
Case observation and Clinical Insight

Introduction

Vitamin B6 (pyridoxine) deficiency is often overlooked in clinical settings, particularly when symptoms overlap with other deficiencies such as B12 or omega-3 fatty acids. This article explores a case study of a 60-year-old vegetarian female with persistent neurological and systemic symptoms that remained unresolved despite B12 supplementation. Further lab analysis revealed critically low levels of vitamin B6, DHA, and B3—highlighting the importance of comprehensive nutritional assessment in managing chronic symptoms.

Case Summary: When B12 Supplementation Fails

A 60-year-old woman presented with:

  • Severe sleep disturbances

  • Persistent fatigue and post-exertional malaise (PEM)

  • Irritability

  • Weakness

  • Poor concentration

She was initially prescribed vitamin B12 due to suspected deficiency, but saw no improvement. A more comprehensive nutritional panel was later ordered, showing:

  • "Functional B12 deficiency despite possibly normal serum B12 levels"

  • Critically low omega-3 index (<0.02%)

  • Extremely low DHA across three measurements

  • Significant deficiencies in vitamin B6 and B3

  • Fatty acid imbalance

Importantly, her vegetarian diet had never been investigated by her doctor—or even discussed—until after the test results.
This case underlines how B6 deficiency can mask or complicate B12-related symptoms and how inadequate intake, especially in vegetarian populations, can contribute to multiple micronutrient deficiencies.

Symptoms of Vitamin B6 Deficiency

  1. Dermatological Symptoms

Causes of Vitamin B6 Deficiency

  • Inadequate dietary intake (e.g., strict vegetarian or vegan diets)

  • Malabsorption syndromes: Celiac disease, Crohn’s disease

  • Kidney disease: Impaired conversion or excretion

  • Medications: Isoniazid, hydralazine, penicillamine, some antiepileptics

  • Chronic alcohol use

  • Genetic variations affecting B6 metabolism

“Vitamin B6 deficiency is often associated with deficiencies in other B vitamins such as folic acid and B12, and it commonly occurs in individuals with alcohol dependency, obesity, and malnutrition.”
– NIH: Vitamin B6 Overview

Genetic Factors Influencing Vitamin B6 Levels

  1. ALPL Gene Variants
    The ALPL gene encodes alkaline phosphatase, which plays a role in converting B6 to its active form (PLP). Certain gene variants can reduce B6 activity by 12–18%, increasing the risk of deficiency.

 

B6 and Brain Chemistry

Vitamin B6 is a coenzyme in the synthesis of neurotransmitters such as:

  • Dopamine

  • Serotonin

  • GABA

  • Norepinephrine

  • Histamine

“B6 deficiency can lead to lowered dopamine and serotonin, contributing to depression, fatigue, and irritability.”
– Mind Lab Pro – B6 and Neurotransmitters

B6 Deficiency and Autoimmunity

Autoimmune conditions, especially those affecting the gastrointestinal tract, can interfere with B6 absorption:

  • Celiac disease

  • Ulcerative colitis

  • Crohn’s disease

  • Rheumatoid arthritis

“Autoimmune inflammatory disorders can increase the risk of B6 deficiency through impaired absorption or chronic inflammation.”
– NIH: Vitamin B6 and Health

Diagnosis and Treatment

Diagnosis

  • Clinical symptoms assessment

  • Plasma PLP (pyridoxal 5'-phosphate) measurement (active form of B6)

Treatment

  • Oral supplementation: Typically 25–100 mg/day depending on severity

  • Address underlying causes: Malabsorption, medications, etc.

  • Monitor for toxicity, especially with high-dose B6 (>200 mg/day long-term)

B6 in Diet

The average adult needs around 1.3–2.0 mg/day of B6, depending on age and sex. Good dietary sources include:

  • Poultry, fish, and organ meats

  • Potatoes and other starchy vegetables

  • Bananas, fortified cereals

Vegetarians may need to monitor intake closely, as animal products are the richest sources.

 Conclusion: Lessons from the Case

This case demonstrates how vitamin B6 deficiency can be an overlooked but critical factor in unexplained fatigue, neurological symptoms, and poor response to B12 therapy. A narrow focus on one nutrient can delay diagnosis and recovery. Clinicians must evaluate diet, genetics, and comorbid conditions to build a complete nutritional picture—especially in populations at risk, such as vegetarians.

The ALPL gene plays a role in breaking down vitamin B6 from complex to simpler forms. It produces enzymes that help in clearance of B6. A particular variant (type) of the gene can cause 12-18% lowered vitamin B6 rates in the body. Individuals with this type are likely to require more vitamin B6 levels.
https://www.xcode.life/genes-and-nutrition/genes-vitamin-b6-requirements/

ALDH7A1 (also referred to as PDE-ALDH7A1, ALDH7A1 deficiency, or antiquitin deficiency), PNPO deficiency, and PLPBP deficiency are the most common genetic causes of vitamin B6-dependent and vitamin B6-responsive epilepsies presenting in neonates, infants, and children ...
https://www.ncbi.nlm.nih.gov/books/NBK589231/

Vitamin B6 deficiency is often associated with other vitamin B deficiencies, such as folic acid and vitamin B12. Low plasma levels of active vitamin B6 are found in individuals with chronic alcohol dependence, obesity, and protein-energy malnutrition.
https://www.ncbi.nlm.nih.gov/books/NBK470579/

What autoimmune disease causes low B6 levels?
Certain conditions can increase the risk of developing a deficiency by interfering with the absorption of vitamin B6: Kidney disease. Autoimmune intestinal disorders like celiac disease, ulcerative colitis, and Crohn's disease. Autoimmune inflammatory disorders such as rheumatoid arthritis.
 
Does B6 deplete dopamine?
Vitamin B6 is a key player in the synthesis of many neurotransmitters, including GABA, serotonin, dopamine, noradrenalin, and histamine. B6 thus helps increase brain serotonin and dopamine levels, decreasing symptoms of anxiety, depression, fatigue, and pain.
https://www.mindlabpro.com/blogs/nootropics/b6-and-dopamine

B6 in food: https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9 

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