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Dorothy was an active 88-year-old. Still taking care of her own flower beds and still driving her own car, she had increasing problems with stiff and painful joints caused by rheumatoid arthritis. The doctor wanted her to try a medication she simply could not afford, but he eventually convinced her to take a drug called penicillamine.
The drug worked great. Dorothy found she could still put on her knee pads and pull the weeds out of hydrangeas without pain keeping her up all night.
But about three weeks after Dorothy started taking penicillamine, she started to notice strange blemishes at the corner of her mouth. Her smile line seemed be replaced by a rash. Then she got a sore throat that just wouldn't go away. She noticed crusts from her eyes in the morning and she started feeling tired all the time. She went back to the doctor to complain.
Fortunately, Dorothy's doctor was aware of nutritional medicine, and he recognized that the arthritis medication had caused a vitamin B6 deficiency. He gave her a prescription for 100 mg of B6 a day (so her Medicare part D would pay for it, although Dorothy could also have bought her B6 at a health products store) and her energy picked up and her face went back to normal in about a week.
Here are three things everyone, even if you aren't yet 88 years old, needs to know about vitamin B6 deficiency:
1. Many medications can cause vitamin B6 deficiency.
The medications that most commonly cause vitamin B6 deficiency are cycloserine, hydralazine, Isoniazid, D-penicillamine, and pyrazinamide. Vitamin B6 deficiency can also occur in severe malnutrition, such as many alcoholics experience, and when babies are born to mothers who suffer severe malnutrition from any cause.
2. Many health conditions can cause vitamin B6 deficiency.
Any inflammatory disease can trigger B6 deficiency. Dorothy both had an inflammatory disease, rheumatoid arthritis, and took a medicine for that inflammatory disease that also caused B6 deficiency, peincillamine. Other diseases that cause B6 deficiency include:
Smokers, drinkers, and people over 80 are also more likely to develop B6 deficiencies.
3. The symptoms of vitamin B6 deficiency overlap the symptoms of many other diseases. Just a few of the symptoms of B6 deficiency include:
Diagnosis of B6 deficiency, however, is very straightforward. Vitamin B6 is a water-soluble vitamin. When we're getting enough, it spills over into the urine. When we don't get enough, it's not found in the urine.
It doesn't take a lot of vitamin B6 to correct a deficiency. In certain long-term conditions like kidney failure, as little as 5 mg a day is enough. Most conditions require 100 to 200 mg a day until a second urine test shows vitamin B6 levels have been built back up. (read more about vitamin B6 dosage)
Bender DA. Vitamin B6 requirements and recommendations. Eur J Clin Nutr. May 1989;43(5):289-309.
Chiang EP, Smith DE, Selhub J, et al. Inflammation causes tissue-specific depletion of vitamin B6. Arthritis Res Ther. 2005;7(6):R1254-62.