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Failure to Diagnose Pyridoxine Deficiency

Vitamin B6 or pyridoxine  is a known cofactor in several types of enzymatic processes, including:

• Transamination reactions
• Decarboxylation reactions
• Glycogen hydrolysis
• Numerous synthetic pathways
• Neurotransmitter metabolism

Without vitamin B6, we would not survive and yet idiopathic pyridoxine deficiencies are very uncommon. More commonly are acquired deficiencies seen in inflammatory disorders and when taking certain medications. Conditions related to pyridoxine include pyridoxine dependent seizure disorder, which is an autosomal recessive disorder and pyridoxine-responsive sideroblastic anemia.

People at risk for pyridoxine deficiencies include people who live in countries that have unenriched grain, the elderly and women from China who are of childbearing age. It is important, especially in these populations to diagnose pyridoxine deficiency as this vitamin is so important to many enzymatic pathways. In order to diagnose pyridoxine deficiency, a complete history, including a dietary history must be taken. Genetic causes of pyridoxine deficiency can be ruled out. A physical examination in pyridoxine deficiency might show a peripheral neuropathy and changes in the blood, nerves and skin.

Finally the level of pyridoxine must be assessed to see if a true deficiency exists.

Pyridoxine is required for the synthesis of neurotransmitters, which is why nerve problems and brain problems show up in pyridoxine deficiency. It is necessary for the synthesis of myelin, and for the making of serotonin and norepinephrine. In adults, deficiencies affect the peripheral nerves, the skin, mucus membranes and the circulatory system. In kids, the central nervous system or CNS is also a part of the deficiency. It can be seen with patients who have severe kidney disease, cirrhosis, alcoholism, malabsorption syndrome, CHF and in those taking certain medications.

In looking for those that do not have pyridoxine deficiency, look for a diet rich in cereal grains, vegetables, legumes, potatoes, milk, eggs, cheese, fish, meat and flour. It is often used along with B complex vitamins.

High homocysteine levels are associated with heart disease. As it turns out, taking pyridoxine supplements along with folate and vitamin B12 lower the homocysteine and may be related to damage by heart disease or congestive heart failure. It is also use to treat genetic sideroblastic anaemia. This must be screened for in at risk neonates.

There are many specific uses for pyridoxine. These include the following:

• It is used to treat hereditary sideroblastic anemia, an X-linked genetic disorder.
• It is used to treat patients on cycloserine that causes neurological problems by being a pyridoxine antagonist.
• It treats idiopathic pyridoxine deficiency or deficiency due to penicillamine use or isoniazid use.
• Pyridoxine is used to treat the mental symptoms of premenstrual syndrome.
• Neuroleptics have untoward side effects that seem to get better with pyridoxine.
• Pyridoxine is use for Alzheimer’s disease prevention by counteracting the effects of homocysteine on Alzheimer’s disease.
• There are conflicting reports on the beneficial effect of taking folate plus pyridoxine plus vitamin B12 following an angioplasty.
• There are limited studies on vitamin B6 and anxiety. More studies are needed.
• There has been some research to suggest that pyridoxine has a therapeutic effect on patients with ADHD. More research is necessary on this issue.
• Birth outcomes seem better when the pregnant mom takes pyridoxine but the results on this are mixed.
• Vitamin B6 seems to lower the risk of getting colon cancer and lung cancer in males who smoke. Breast cancer is not apparently affected.
• Pyridoxine seems to block high levels of homocysteine, which adversely affects heart disease, blood clotting, atherosclerosis, ischemic stroke and heart attack. It seems better if taken along with folic acid.
• It is thought that asthmatic children are deficient in pyridoxine. Theophylline, used to treat asthma is believed to suppress pyridoxine levels. Further research is necessary to see whether kids on theophylline do better with pyridoxine.