Extemporanometer: at my desk, some source material
Level of Evidence: between 3-6 but closer to 6
I. More Is Not Always More
I promised in the last post (the first post) that I would write something more interesting. This post is not that. This is more of a PSA about what we have discovered so far about the role that B6 / pyridoxine has in bariatric (and non-bariatric supplements).
Usually the issue after bariatric surgery is getting enough of things. Enough iron, enough zinc, enough calcium etc. Hence a range of supplements are made available that have extra micronutrients in them. They are called micronutrients because they are only present in small amounts in food, and when you can't eat volume you need to take a tablet that has them in concentrated amounts.
Turns out there is one exception (there always has to be one guy who needs to be different). For some reason, amounts of B6 that would be ok for non-bariatric people to consume, are not ok after surgery. Probably it has something to do with less gastric acid breakdown of the B6 resulting in a higher "effective" dose reaching the small bowel for absorption.
The problem is that like your uni friend who promised to only stay on your couch for a couple of weeks while he finds a new flat, there is no active way to remove it. You just have to stop the intake and let the level naturally come down on its own.
II. Sources of B6
Multivitamins seem to be the main culprit. I have flipflopped around about which is best but until basically every other multi lowers their levels of B6, I have my penny down on BN as being the best. Good levels of most things, low levels of B6 and doesn't break the bank.
Hair skin nail formulations and energy drinks are the two other main culprits, especially when you start combining these things together.
Read the labels, and don't drink anything you don't need to if it has B6 or pyridoxine in it (these are the same thing by different names).
III. Good News Bad News
This is a game I like to play with my kids. Usually there is only bad news and I have to make up the good news. They are slowly learning that if you squint hard enough you can usually see a silver lining, even if its only because the squinting has given you a migraine.
The bad news is that B6 overload causes initially vague symptoms like tiredness and brain fog, and then moving onto things like weakness, vertigo, clumsiness, touch hypersensitivity (like putting on a shirt feels painful) and skin rashes.
The good news is that we have seen through the practice that once you get rid of the sources of B6, your blood level and the symptoms resolve after a few weeks.
IV. What To Do
If you are with our practice, we are doing routine testing. If you haven't had a routine test and think you have these symptoms, please let us know. If your test comes back high, we will send you a handout and a questionnaire to check about how you are getting on, and then will follow up with you if there are concerning symptoms.
If you are not with our practice, and think you have some of these symptoms, discuss with your bariatric practice or your GP about whether you should have a B6 test. Don't change your multivitamin without getting advice, but definitely get rid of the non-essential sources (non prescribed or recommended over the counter supplements, the energy drinks and the like).
Ngā mihi Ben