One of the first things you might hear about regarding nutrition tools for autism, besides special diets like GF CF or SCD, is vitamin B6 (pyridoxine). Why is it one of the most studied treatments for autism? Here’s what you should know.
– B6 is a vitamin – which means, we need to eat it. We can’t make our own supply. It has various metabolic forms that our body uses, including pyridoxal-5-phosphate (P5P), another popular supplement. Among its many jobs is supporting production of neurotransmitters like dopamine and serotonin – both of which have shown altered status in persons with autism.
– There is a long pedigree for B6’s success in treating seizures; about a third of persons with autism have seizure disorders. Deficiency of this vitamin can cause seizures or other neurological symptoms.
– There is also a long pedigree for using vitamin B6 therapeutically for psychiatric disorders, like schizophrenia, along with other nutrients.
– B6 is a water soluble vitamin, which means the body doesn’t store it. Whatever is not used is excreted in urine, usually within hours. If you’ve ever noticed bright yellow urine after taking a multivitamin with extra B6 in it, you are likely seeing some of this in your toilet!
– Bernard Rimland PhD, founder of the Autism Society of America and the Autism Research Institute, pioneered the use of B vitamins in the 1960s for his own son, who was affected by autism.
– B6 has low toxicity, with a good track record of being safe to use. High doses are usually well tolerated, with any side effects resolving once it is stopped.
So should your child supplement it? Will it help autism features? As always, the best strategy is to ask an experienced and licensed health care provider to help you assess your child’s total nutrition needs. B vitamins work en suite – together – with other nutrients and with food to support brain chemistry, extract energy from food, and help nerve impulse transmission. Giving just B6 alone in a high dose – without other B vitamins, magnesium, or adequate diet – may fail to produce any results. That said, it’s one of the safest nutrients to supplement. Here’s the scoop on B6 and autism:
– Children with autism may well need higher doses of vitamin B6 than healthy typical peers, for many reasons: Picky diets that lack vitamins, gut inflammation that impedes absorption of B vitamins, or gut microbial infections that eat up B vitamins before your child can absorb them. Mitochondrial disorders (inherited or acquired) can trigger higher need for B’s too, as can an inability (inherited or acquired) to convert B6 to its active form in cells. One study noted that indeed, children with autism had high levels of B6 but low levels of its metabolically active form P5P. This would mean that dozens of enzyme actions needed to balance neurotransmitters in the brain would not function to potential.
– A number of studies testing high dose B6 have showed benefits. In a survey of 7256 parents, 49% reported symptoms of autism improved in their children with B6 and magnesium supplement.
Where to start? Begin with a high purity, high potency multivitamin and mineral supplement for your child. Reputable brands are Kirkman Labs, ProThera, Pure Encapsulations, and many others. You can browse products I choose in my practice, in the NutritionCare.net virtual dispensary (use access code MyNCFC and PW 80303 – my office zip code – to set up your own account and start browsing.)
1) Decide on the format your child can accept: Liquid, powder, capsules, or chewables.
2) Choose a product that provides the entire B group of vitamins (B1, B2, B6, niacin, folic acid or folacin, B12 as a blend of methyl and cyanocobalamin, pantothenic acid, biotin) at potencies of at least 100% of daily recommended value. Make sure that this product also contains magnesium to at least 100 mg; more may be preferable. Some multi’s add P5P, such as Kirkman’s Spectrum Complete and Klaire Labs VitaSpectrum.
3) Let your child trial this multivitamin and mineral daily for 2 weeks, withdrawing if you note reactions or side effects.
4) Once it’s clear that your child is tolerating this well, consider adding a product that adds more P5P and magnesium, such as P5P with Magnesium from Klaire Labs or Kirkman Labs.
5) Give the additional P5P early in the day with the multi, not toward evening, as B vitamins are usually energizing and may keep kids awake if taken too late. A reasonable starting dose is 5 mg P5P for a 30 pound child; older children may benefit from 25mg P5P, which is well above usual intakes from food or ordinary supplements, but possibly beneficial for those with metabolic disorders that prevent conversion of B6 to P5P in the body.
6) Continue if you note benefits. Reported benefits include improved communication, less stereotypical behavior, less sound sensitivity, improved expressive language, improved attention, and less hyperactivity.
Caveat: Some children become hyper and agitated when given very high doses of P5P. Start low and go slow; withdraw if you see worsening hyperactivity. Your child may do fine on a lower dose, or may benefit from B6 more after treating bowel infections for yeast and other microbes (which also use B vitamins).
B6 is a promising, easy-to-test option for any child on the autism spectrum. Get input from parents who have succeeded and from your child’s health care team. If your child is using medications, it’s especially important to check with your doctor and pharmacist about drug-nutrient interactions.
Hi,i find this information so valuable but dont know where to begin.my son is 13 and has autism.he is not on any B viitamns.where should i start?
Hi Devika, there has been research available on B vitamins and autism going back decades. Many books are available – start with my comprehensive book on nutrition supports for autism here. Be sure to also check out a great site called TACAnow.org, for resources and information on every aspect of raising children with autism.
Hi Judy, we did Genova nutra evaluation test and found my 4 year old (36 lbs) is very deficient in all b vitamins. He is having ADHD and autism. I have used seeking health b minus (just a sprinkle) and his hyperactivity, stimming got so worse. Seeking health B minus has all the b vitamins except b12 and b9. My son is already getting MB12 shots and folinic. He also gets 300 mg magnesium daily. Should I give b vitamins or stopped? Pls help. He also gets fish oil and on gfcf diet.
I’ll be honest – I don’t love that lab test. It can show some micronutrient deficits, but misses a lot of what growing children need for nutrition evaluation and for ADHD. Lacking a few B vitamins is easy to see from a food diary, signs/symptoms, and a complete blood count too – you don’t need the NutrEval to show this stuff. As you are seeing, just fiddling with the B group isn’t solving the problem. There are many other facets to review and manipulate, and the best way for me to help is to work with me to assess what the missing pieces are and how to sequence all the steps. You can do this remotely or in person – click here to get started.
If the starting dosage is approx. 5mg/30 lbs, where is a product that offers this…? The products you recommend are 30-33mg of P5P per capsul and since they are are capsules I am not sure how this would be able to be usable for a smaller child.
Thanks so much for your article!
Lots of options in many formulations from several manufacturers. You can start with Kirkman Group and peruse their options, for example: http://www.kirkmangroup.com/index.php/snt-green-apple-w-p5p-l.html
My son’s psychiatrist discovered through a cheek swab that my son had “low activity” for the enzyme that breaks down folic acid into its active form. Suspecting this may be the root cause of my son’s aggression and irritability, he prescribed L-methylfolate, in a specially-formulated capsule that includes Methyl B12, NAC, and Vitamin D3. We get the supplement through Bellevue Pharmacy. After taking for over a month, my son’s mood is starting to improve. He’s smiling more and looks more relaxed. His aggression is way down, from over 50 incidents per week to less than 5. Given that my son needs active forms of B9 and B12, do you think it would be worth adding active B6 (P5P) to the mix?? Seems worth trying…if he’s an undermethylator, it would make sense that active B6 would be easier to absorb. I’m planning to ask the psychiatrist at our next appointment in a couple of weeks. Perhaps P5P (with magnesium) would zap the remaining irritability we are still seeing. I’m hoping his doctor can prescribe a sensible dose of P5P that will be compatible with what he’s already taking, if he indeed needs it. Also, we took him off his OTC multivitamin as we weren’t sure how these might interact. I’m planning to ask his doctor, but what’s your opinion on building in a multivitamin when you need prescription vitamins? Thank you.
Hi Debra, that’s great that your doctor is interested in nutrigenomics! It’s where the action is for supporting kids like your son, and in my opinion, much more effective than Russian-Roulette drug prescribing. Just like your psychiatrist though, I can’t give free patient protocol advice over the internet, so it’s best to ask him at your next visit, as you’ve already planned. If you need more input on this supplement protocol and nutrition, set up an appointment soon and I’d be happy to help. You’re smart to be thoughtful about mixing supplements. FYI: One of the biggest drivers in my practice of irritability and aggression is low intakes for total protein, fats, and calories, along with inflammatory trigger foods featuring too big in a child’s day. So if the supplement protocol doesn’t cover all the behavior, I’d invite to look there with me in an appointment.
I see I am not the only one who’s connecting this with mitochondrial dysfunction. We also found an enzyme deficiency but with beta-glucuronidase! We are all awaiting the extensive and expensive full panels and I’m trying to support as best I can through eliminating as much bad and Dr Greenblatt recommends 50mg b6 with magnesium. My daughter obviously cannot methylate properly and that’s why we saw severe hyperactivity and insomnia with smarty pants. Any recommendations yes for easily methylated smaller doses?
50 mg B6 (pyridoxine) is a high dose and in my experience, many kids don’t tolerate this very well, even teens. It’s generally safe and non toxic, but at this dose I have observed many children become very hyper and agitated, and/or can’t fall asleep well or stay asleep. I’d suggest starting at a much lower dose – even 5 or 10 mg is many times the usual need for this vitamin – and you can gradually increase to find the right spot. If there is a background fungal burden, high dose B6 may also flare that as this is one of the nutrients that Candida loves to eat up. The Smarty Pants kids “Cherry Berry” is methylated with both a methyl folate and a methylcobalamin, and they are not at very high doses – so it should be ok for kids who are weak methylators. Smarty Pants Kids “Cherry Berry” multi (like virtually all kids chewable multivitamins) does also have cane sugar and tapioca syrup, and possibly some phenols from the food based ingredients like black carrot and maqui berry. This isn’t necessarily bad, it just may not be easy for your daughter to tolerate. You may need to move to a capsule without all the flavors, sugars, and bright colors (even if these come from organic foods, they can still have phenols in them). Ask the person ordering labs for you to fine tune this to your daughter’s needs.
You say that b6 can flare a candida problem? I just stated my son but I heavily suspect candida
Because Candida itself uses B6, if a child has a high burden of Candida in the intestine, then using a high dose B6 can trigger more hyperactivity as it feeds the Candida as well as the host.
My child’s special needs peds took her off b6/mg as he felt it was causing hyperactivity. however, she is still hyperactive and I feel that she is less focused now. Do you think she would benefit from b6 in the form of P5P instead? She is a very picky eater.
B6 can indeed cause hyperactivity in some kids. Removing it isn’t necessarily the right step. I’d suggest working on deeper underlying causes of hyperactivity: Gut infections? Candida? Inflammation? Does she use a good dose of DHA/EPA (fish oils)? Is your daughter on a GFCFSF diet (these proteins can trigger hyperactivity in some kids on the spectrum)? How is her mineral status? Using nutrition in the same way that doctors use drugs is often a fail – it is an ensemble, not a solo; a process, not a pill. Your daughter may do really well with the right dose pyridoxine (B6) once other nutrition measures are also addressed. One thought – if you were using Kirkman Labs Super Nu Thera, then try a lower dose B6 product. That is an especially high dose which does work well for some but many in my practice became hyper on that product because the dose was simply too high. P5P may work nicely too – but if this alone is her only nutrition measure, it may not move planets.