EP.341/ can low b6 affect endo and period pain?
Today we’re continuing our series on nutrients and their effects on period pain and endo pain, and this episode is about B6.
Now, we’ve already talked a lot about the powers of B6 for hormonal health, but what about its effects on pain?
B6 can support us with pain reduction in a number of ways.
Firstly, as we’ve discussed before, B6 plays an essential role in progesterone production and also oestrogen metabolism. This is important from a pain perspective, because higher levels of oestrogen or oestrogen dominance is associated with more menstrual cramping, and research has observed that lower levels of B6 caused ineffective metabolism (or clearance) of oestrogen, and more menstrual pain. Why?
A couple of reasons, oestrogen is prolific - it helps the uterine lining to thicken, when we have a thicker uterine lining from oestrogen dominance, we can experience heavier bleeding and clots, which can worsen pain. However, oestrogen also has an effect on prostaglandins.
And just a reminder, it’s elevated levels of inflammatory prostaglandins like prostaglandin e2 and F-alpha 2 that cause period pain and endometriosis pain.
So, back to oestrogen. Oestrogen actually increases the production of these inflammatory prostaglandins, but it also increases the receptors for these prostaglandins. Receptors are like the lock to a key, so prostaglandins can be floating around our bodies, like keys, but they actually can’t do anything until they fit into their receptors, or their locks. It’s the fitting into these locks, which triggers their effects. And so increasing the amount of receptors, makes us more sensitive to their pain-inducing effects.
This is even more relevant to those of us with endometriosis, because we have both elevated levels of oestrogen and inflammatory prostaglandins in the endo cells, and they actually trigger the production of each other, creating a viscous cycle. These two are crucial factors in endometriosis growth and pain, so getting levels down can help us to manage the disease.
But B6 can work on prostaglandins in other ways too, not just through proper clearance of oestrogen, but because it helps to lower and regulate the production of inflammatory prostaglandins through various pathways.
In animal studies, lower levels of B6 were associated with higher prostaglandin levels, and inflammatory markers like C-Reactive Protein. And a study on human cells showed that treatment with B6 inhibited the inflammatory reactions to lipopolysaccharides. Lipopolysaccharides are toxins that come from certain bacteria, and they are found in high levels in people with endo, and actually trigger some of the inflammatory pathways that lead to endo growth and development (including the production of prostaglandins), so again, B6 is incredibly relevant for endo management.
This is echoed in a recent study of 4453 participants, which found that those with a higher intake of B6 had a reduced risk of endo development.
Finally, B6 plays a key role in the production of feel-good neurotransmitters dopamine and serotonin, and these can influence pain perception and how we experience pain.
In terms of period pain, studies on humans have shown that B6 can lower prostaglandin production and as a result, the severity of dysmenorrhea a.k.a period pain. Additionally, a 2023 study found that a lower dietary intake of B6 in 321 women, was shown to increase the severity of menstrual pain.
So what about treatment with B6?
There are multiple studies on the effects of B6 on dysmenorrhea and PMS. A systematic review concluded that more studies were necessary, but that B6 was was likely to help with PMS, including abdominal pain - though this review was from 1999.
A 2010 study combined B6 and magnesium for PMS (which included lower back pain and abdominal discomfort, lasting from the final week of the cycle to Day 4 of menstruation), and found that the combination significantly decreased symptoms.
A 2018 study found that 100mg of B6 for four days (assuming the first four days of menstruation, though it’s not specified, but this is a common method in studies on dysmenorrhea) significantly reduced period pain.
And another study I found particularly fascinating, showed 100mg, taken as 50mg twice a day, daily in the luteal phase for three months, significantly reduced nausea and vomiting caused by dysmenorrhea.
In terms of treatment of endo pain, we don’t have many studies trialing B6 intake or supplementation for endo pain, but as I shared earlier, there are many showing associations with low levels, and some of these suggest that B6 may be able to reduce the severity of endo symptoms and also manage disease progression.
Given that B6 has shown such improvements in period pain, and we know that it lowers prostaglandins, and prostaglandins are the key driver of endo pain, it’s reasonable to assume or hope, that B6 could be helpful in reducing endo related period pain.
However, when it comes to supplementing with B6, we do have to be careful. Research has shown that nerve toxicity can occur with prolonged use of B6 supplementation at doses of 200mg. This nerve damage causes tingling in the arms and legs, which in most cases, resolves after discontinuation but in some cases (though it’s less common), the results can be permanent, particularly if a high dose has been taken for a long time.
Recent updates have reported symptoms even at lower doses, depending on the individual. Typically however, doses of around 20-30mg tend to be well tolerated, but everyone is different, so speak to your doctor and if you experience symptoms, discontinue use. Several practitioners do use higher and see good results with between 30mg-50mg, but if you’re planning to take that dose, I do advise you work with someone. Finally, P5P (pyridoxal 5-phosphate), which is the active form of B6, meaning it is ready to use by the body, is less associated with these symptoms, though it’s still possible.
Of course, it’s also important we get sufficient amounts through food - especially as research has found a lower intake of B6 is associated with endo risk, and menstrual pain severity.
Some of the best sources of vitamin B6 include:
Chicken
Salmon
Tuna
Potatoes
Bananas
Chickpeas
Turkey
Spinach
Avocado
Okay, that’s it for this week! I hope you’ve found this episode helpful. Please remember to check in with your doctor before starting any new supplements.
Show notes
B6 pain relieving/anti-inflammatory properties
https://pmc.ncbi.nlm.nih.gov/articles/PMC4519769/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5902457/
https://www.fertstert.org/article/S0015-0282(08)01969-9/fulltext
https://pubmed.ncbi.nlm.nih.gov/39421613/
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.16096
https://pubmed.ncbi.nlm.nih.gov/8361989/
https://pubmed.ncbi.nlm.nih.gov/11401933/
https://www.sciencedirect.com/science/article/abs/pii/0090698074900549
https://www.researchgate.net/publication/328373051_Effect_of_Pyridoxine_on_Prostaglandin_Plasma_Level_for_Primary_Dysmenorrheal_Treatment
https://www.mdpi.com/2227-9059/11/9/2578
Period pain and B6
https://pmc.ncbi.nlm.nih.gov/articles/PMC10178419/
https://www.researchgate.net/publication/328373051_Effect_of_Pyridoxine_on_Prostaglandin_Plasma_Level_for_Primary_Dysmenorrheal_Treatment
Endo and low B6
https://pubmed.ncbi.nlm.nih.gov/39421613/
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.16096
https://www.mdpi.com/2673-4184/4/4/34
https://pmc.ncbi.nlm.nih.gov/articles/PMC10227355/
B6 and period pain relief
https://pmc.ncbi.nlm.nih.gov/articles/PMC27878/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3208934/
https://www.mdpi.com/2673-4184/4/4/34
https://pmc.ncbi.nlm.nih.gov/articles/PMC10227355/
B6 dosing safety
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/#:~:text=The amount of vitamin B6,mg a day for women
https://pmc.ncbi.nlm.nih.gov/articles/PMC10343656/
https://www.lareb.nl/en/news/nerve-damage-due-to-the-use-of-nutritional-supplements-with-vitamin-b6/#:~:text=Excessive intake of vitamin B6,in hands and/or feet.&text=Products containing vitamin B6 are,, pharmacies, supermarkets and online.
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Produced by Chris Robson