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B Vitamins: How Much Is Too Much?

Quick question – how many pills did you take this morning? At our last private retreat, the average pill count of the attendees was 26! We were excited to work with them and bring that number down to a handful.

I remember starting on my own health journey, I would read a blog or listen to a podcast and I would hear about the newest research on a new supplement. I would rush to my nearest natural store and pick up a bottle. After a while, my kitchen counter was full of bottles and I even started organizing my supplements with a pill organizer!

One day, I decided that taking a supplement for a condition was not getting me deeper into discovering the underlying cause of my problem. Let me explain, when I talked to friends and family they would complain about their doctor spending little time with them and just writing prescription after prescription. Sometimes, some of the drugs would counteract the effects of other drugs, this problem with medicine is known as polypharmacy.

The reality is that just like polypharmacy can cause undesirable effects, so can what we call polysupplementation. We have talked about the most misunderstood supplement iodine in previous articles (1) (2). Today we are going to dig deep into other overutilized nutrients: the B vitamins.

Water-Soluble Vitamins

The B vitamins are water soluble, which means that excess is eliminated in our urine and does not hang around the body for very long. It is a misconception that because of their ease of elimination, they are not harmful in large doses. We are going to look at some common vitamins and the way they can affect your health if taken in excess.1,2

Niacin (Vitamin B3)

Niacin, otherwise known as vitamin B3, is widely used as a cholesterol-lowering supplement. It helps with fatty acid metabolism and it prevents pellagra, a disease which includes symptoms such as:

  • Scaly skin
  • Diarrhea
  • Dementia

Key Insight: Pellagra is rare now because of fortification of grains and easily avoided if you consume a nutrient-dense diet.3

Interested in getting more nutrients from your diet? Here’s a great place to start…

Daily Reset Packs - Complete Nutrition - Dr. Alan Christianson

A common symptom of too much B3 is “flushing”, which causes:

  • Skin itching
  • Redness
  • A sense of tingling or burning

Although this flushing goes away, it is very uncomfortable. A more serious side effect of excess B3 is liver damage, this is a serious complication specially with people that have fatty liver disease or hepatitis.

Key Insight: Other side effects are higher blood sugars, heart palpitations and even birth defects.

As for niacin’s cholesterol-lowering effects, studies show that simply reducing cholesterol does not benefit the individual’s health.4 In fact, since niacin makes the liver work harder to get rid of cholesterol, which taxes the liver and is the reason niacin is considered liver toxic.5,6

Getting Enough Niacin

Per day, you only need about 16 mg of niacin. A single serving of fish can have as much as 18 mg, and a serving of portabella mushrooms has 6 mg. Even rice can have between 3 – 10 mg in a single serving.7

Bottom Line: The truth is that consuming a nutrient dense diet will provide you enough niacin for a healthy life, and that lowering cholesterol with niacin shows no benefit towards heart health in the long term.

Pyridoxine (Vitamin B6)

Pyridoxine, or vitamin B6, deficiency can include symptoms like skin rashes, pink eye and even seizures. Other uses for B6 have been to help with nausea and depression. Fortunately, in the United States, B6 deficiencies are rare.8

On the other hand, over supplementation of vitamin B6 can lead to nerve damage. Your doctor could prescribe you vitamin B6 after carefully examining your labs. You might have a need for a little extra, but a little goes a long way.

There are reports that show that B6 can be neurotoxic.9 In one cell study, it was observed that high levels of B6 block the ability of nerves to accept B6 and leads to eventual B6 deficiencies.10

Bottom Line: For this reason, you should never just add vitamin B6 to your supplement list without first consulting with your doctor. Your doctor should take into consideration other supplements like multivitamins and adrenal support supplements since both of these will likely have some B6.

Getting Enough Pyridoxine

Receiving vitamin B6 from food is not dangerous. In fact, there has never been a case of vitamin B6 toxicity from food.

The daily recommended intake of B6 is about 1.5 mg for adults and 2 mg for breastfeeding women. A single serving of Salmon has about 0.9 mg of B6 and a cup of chickpeas has about 1.1 mg.7

Bottom Line: Taking excess B6 blocks the absorption of this vitamin, and B6 toxicity mimics B6 deficiency (which includes symptoms like numbness or tingling in your hands and feet).

Folate (Vitamin B9)

In the past couple of years, we have seen an increase of patients taking folate for pregnancy health and even genetic mutations of the MTHFR gene. Taking supplemental folate is a step in the right direction from taking synthetic folic acid, but even over-supplementation of folate can cause problems.

Folate is necessary for the proper formation of the spine in babies during pregnancy. For this reason, in 1998 the food and drug administration required the fortification of grains to help fight birth defects. The problem is that instead of folate (the naturally occurring form of B9), folic acid was added to our food (which is the synthetic form of B9).11

Unfortunately, this had some unexpected effects. There have been some studies showing that some cancer risks increased folic acid fortification.12,13 This is important to note, because folic acid is the man-made form of folate. Folate is the active form found in foods, and this form of the supplement is generally well tolerated.

Bottom Line: Even though folate from food is not harmful, excess folate can hide B12 deficiencies.14 A B12 deficiency is a common cause of anemia and other neuronal problems.11

Getting Enough Folate

Adults should aim to get about 400 mcg of folate per day. Folate is found in green leafy vegetables. Unfortunately, folate breaks down during freezing. For this reason, fresh is the name of the game!

A single serving of spinach has 58 mcg of active folate, while spinach has about 58 mcg. A nice salad a day can help you keep your activated folate at optimum levels.7

Bottom Line: Although folate is safe, there are studies showing that folic acid might be harmful. Eating salads is a good and easy way to get your daily folate.

The Truth About B Vitamins

As you can see, even water-soluble vitamins in high doses can hide other nutritional deficiencies and at worse, they can cause health problems. Although supplements can be very useful to your health, over supplementation can be a real problem.

You should only use these supplements in doses that are close to those found in food.15 For this reason, it is very important to be careful when adding new supplements to your health regimen.

Key Insight: At Integrative Health, we have designed our Daily Reset Packs to supply you with the nutrients that are hard to get with diet alone.

Depending on your health journey, you might need a little more help with some accurate supplementation, your doctor should be careful to look at your nutritional deficiencies and decide how to supplement appropriately.

1. Health NRC (US) C on D and. Water-Soluble Vitamins. 1989. https://www.ncbi.nlm.nih.gov/books/NBK218756/. Accessed July 7, 2018.
2. Said HM. Water-Soluble Vitamins. In: ; 2014:30-37. doi:10.1159/000362294.
3. Kirkland JB, Meyer-Ficca ML. Niacin. In: ; 2018:83-149. doi:10.1016/bs.afnr.2017.11.003.
4. Garg A, Sharma A, Krishnamoorthy P, et al. Role of Niacin in Current Clinical Practice: A Systematic Review. Am J Med. 2017;130(2):173-187. doi:10.1016/j.amjmed.2016.07.038.
5. Lewis JH. The rational use of potentially hepatotoxic medications in patients with underlying liver disease. Expert Opin Drug Saf. 2002;1(2):159-172. doi:10.1517/14740338.1.2.159.
6. Schaffellner S, Stadlbauer V, Sereinigg M, et al. Niacin-Associated Acute Hepatotoxicity Leading to Emergency Liver Transplantation. Am J Gastroenterol. 2017;112(8):1345-1346. doi:10.1038/ajg.2017.171.
7. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academies Press; 1998. doi:10.17226/6015.
8. Brown MJ, Beier K. Vitamin, B6 (Pyridoxine), Deficiency. StatPearls Publishing; 2018. http://www.ncbi.nlm.nih.gov/pubmed/29261855. Accessed July 7, 2018.
9. Schaumburg H, Kaplan J, Windebank A, et al. Sensory Neuropathy from Pyridoxine Abuse. N Engl J Med. 1983;309(8):445-448. doi:10.1056/NEJM198308253090801.
10. Vrolijk MF, Opperhuizen A, Jansen EHJM, Hageman GJ, Bast A, Haenen GRMM. The vitamin B6 paradox: Supplementation with high concentrations of pyridoxine leads to decreased vitamin B6 function. Toxicol Vitr. 2017;44:206-212. doi:10.1016/j.tiv.2017.07.009.
11. Ortbauer M, Ripper D, Fuhrmann T, et al. Folate deficiency and over-supplementation causes impaired folate metabolism: Regulation and adaptation mechanisms in Caenorhabditis elegans. Mol Nutr Food Res. 2016;60(4):949-956. doi:10.1002/mnfr.201500819.
12. Mason JB, Dickstein A, Jacques PF, et al. A temporal association between folic acid fortification and an increase in colorectal cancer rates may be illuminating important biological principles: a hypothesis. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1325-1329. doi:10.1158/1055-9965.EPI-07-0329.
13. Hirsch S, Sanchez H, Albala C, et al. Colon cancer in Chile before and after the start of the flour fortification program with folic acid. Eur J Gastroenterol Hepatol. 2009;21(4):436-439. doi:10.1097/MEG.0b013e328306ccdb.
14. Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr. 2007;85(1):193-200. doi:10.1093/ajcn/85.1.193.
15. Clase CM, Ki V, Holden RM. Water-soluble vitamins in people with low glomerular filtration rate or on dialysis: a review. Semin Dial. 2013;26(5):546-567. doi:10.1111/sdi.12099.

Written by Dr. Guillermo Ruiz of Integrative Health. Dr. Ruiz is an Associate Physician with Integrative Health, interested in the treatment of endocrine disease with a focus on thyroid health. Under the mentorship of Dr. Alan Christianson, Dr. Ruiz expanded his knowledge on the treatment of Hashimoto’s and Grave’s disease and has completed advanced endocrinology training in order to better address and resolve endocrine disease.

Learn more about Dr. Ruiz here

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