Strip and Replace: The Myth of Fortification and why Vitamin B6 Is Not the Enemy

“It is a huge sense of relief when you finally connect the dots between your genetics, your symptoms (like neuropathy and carpal tunnel), and specific natural medicine that actually work for your body. Using the active forms (P5P and 5-MTHF) removes the guesswork.”

We have written about it before, how folic acid has been vilified, and now the same is being done to vitamin B6—interestingly only to its supplement form as they will continue to allow B6 to be added to fortify foods. This way vitamins will take the full impact while the fortification of food and beverages will remain. They admit why it is being done, apparently, they “only permit or require that specific foods be fortified to restore the nutrients lost during processing, storage or handling for example, by adding B vitamins to white flour.”[1]

According to What About Wheat, which is “Canada’s trusted source for science-based information about wheat nutrition,” whatever that means, “[f]ortification and enrichment of wheat flour means that Canadians are getting key nutrients that may be lacking in their diets.”[2] Right, instead what they do is strip the bran, germ and fiber in the milling process, and what is left is about 80% of starchy endosperm to make the final product last longer on the shelves. The bread-like substance is void of nutrients, the commercial white flour needs to be enriched to mimic the nutrient levels of the original whole grain. And then people are told they have a gluten intolerance or allergy to wheat; instead, what they have is an intolerance to highly processed grains.

They can spin that with the average person but in reality, the product they label as food should not be classified as food since it cannot sustain life; it is empty nutrients and the way they get around it is by adding B vitamins, folic acid, and fiber. When added they have the nerve to call it Wonder Bread—it is a “wonder” indeed.

What we have in the marketplace is highly processed, refined food and sugary drinks; manufacturers process and alter them, and they need to fortify the product so the nutrient guide on the package does not show only starch, sugar, and a bit of protein. It needs to be enriched to meet minimum public health standards. The most commonly added nutrients are iron, folic acid, and B vitamins, such as thiamine or folic acid; essentially, this turns a “refined” (stripped) food into a “functional” one that satisfies both the consumer’s desire for shelf stability and cost effectiveness, while also providing basic nutritional needs.

This is why they will not remove B6 or folic acid from foods, but they have no issues removing them from vitamins so that vitamin companies will need to add new warnings to be placed on vitamin product labels containing B6 based on the following: “Health Canada expects license holders to update the risk information on product labels for all licensed vitamin B6-containing NHPs with a daily dose of 10 mg vitamin B6 or higher to: include information about the warning signs and symptoms of peripheral neuropathy, including sensory nerve problems (numbness, tingling and pain in the extremities), and advise consumers to stop using these NHPs and consult a healthcare professional if these symptoms occur.”[3]

Something similar has been happening in Australia as well, where the “drug regulator has ordered that supplements with high levels of vitamin B6 be removed from general sale in response to hundreds of reports of nerve damage and other side-effects linked to long-term use.”[4]

The difference between B6 and derivates of phosphoric acid

We meet the same problem that we have before: somehow the bio-active form of the vitamin has been interchanged with the inactive one (and/or with the chemical compound) and treated as if the two were the same. Why is this a problem? Because we at Life Choice do not formulate our products with these forms of vitamin B6—pyridoxine, pyridoxamine, pyridoxal and their phosphate derivatives (chemical compounds derived from phosphoric acid)—instead, we use P5P (pyridoxal-5′-phosphate) the bio-active, coenzyme methylated form of vitamin B6, and this form does not cause neuropathy.

Vitamin B6 is absorbed in the small intestine via transporter proteins and then sent to the liver, where it is converted into its active form, P5P. This conversion happens in two main steps: first, the enzyme pyridoxal kinase (from the PDKX gene) initiates the process, and then pyridoxine phosphate oxidase (PNPO) completes it. The active P5P form is used in cellular reactions, and it makes up about 70–90% of the vitamin B6 circulating in the blood.

B vitamin metabolism, which involves converting folate and vitamin B12 into their active forms, is essential for optimal health; this process depends on key enzymes, including MTHFR (methylenetetrahydrofolate reductase), to function properly. When MTHFR variants are present, they can disrupt this conversion and impair B vitamin metabolism, leading to elevated homocysteine levels in the blood. This imbalance has been associated with increased risks of heart disease, stroke, and cognitive decline.

B6 in its phosphate form can interact with the MTHFR gene mutations to impair the body’s ability to process folate and convert homocysteine, often requiring active B-vitamin supplementation. Unfortunately, most of the vitamin B6 are forms that cannot be utilized, the patient needs the active P5P form instead. These mutations can lead to elevated homocysteine, increasing risks of cardiovascular, neurological, and pregnancy-related issues yet medical doctors continue advising pregnant women to use B6 in its phosphate forms not knowing they should be advised to use only the P5P form of B6.

Vitamin B6 plays a key role in processes affected by MTHFR, particularly in managing homocysteine levels, where B6, along with B12 and folate, helps convert homocysteine into methionine and supports cardiovascular and cognitive health; when MTHFR mutations are present, this balance can be disrupted. B6 is also essential for neurotransmitter production, including dopamine, serotonin, and GABA, and impaired conversion to its active form (P5P) may further affect mood and nerve function, increasing the risk of neuropathy, especially when combined with conditions like diabetes. In its active form, P5P supports multiple systems in the body, contributing to neurotransmitter synthesis, hemoglobin formation for oxygen transport, glucose production for brain energy, proper methylation and homocysteine balance, and the metabolism of tryptophan into niacin, highlighting its broad importance in maintaining overall metabolic and neurological health.

P5P in neuropathy and carpal tunnel syndrome treatments

At first glance, there seems to be a catch-22 type of situation with vitamin B6 and peripheral neuropathy as vitamin B6 deficiency is one of the common causes of this condition. On the other hand, according to research, excess consumption of vitamin B6 supplements for longer periods (months to years) has caused neuropathy or movement disorders in a few individuals. Why? Because it comes down to the type of vitamin B6 used as a supplement: pyridoxine or P5P. Based on research we know that “the neuropathy observed after taking a relatively high dose of vitamin B6 supplements is due to pyridoxine. The inactive form pyridoxine competitively inhibits the active pyridoxal-5′-phosphate. Consequently, symptoms of vitamin B6 supplementation are similar to those of vitamin B6 deficiency.”[5]

Current findings[6] also suggest that high levels of pyridoxine may inhibit the enzyme pyridoxal kinase (PDXK), disrupting normal vitamin B6 activation and impairing GABA neurotransmission in peripheral tissues. This disruption appears to selectively damage sensory neurons, potentially causing excitotoxicity and neurodegeneration, while sparing the brain due to limited pyridoxine penetration across the blood–brain barrier. Overall, PDXK inhibition and altered GABA signaling are considered the most plausible explanation for pyridoxine-related neuropathy. This is why someone with peripheral neuropathy should supplement with the active P5P form of vitamin B6 and not pyridoxine.

P5P is also helpful for treating carpal tunnel syndrome (CTS) since it is essential for nerve health—vitamin B6 deficiency can exacerbate CTS symptoms. “A 12-week trial with 50–200 mg/day of pyridoxine is recommended for most CTS patients, with monitoring for neurotoxicity at doses above 200 mg/day. Post-improvement, the dosage can be tapered to a maintenance level of 50–100 mg/day. While pyridoxal phosphate (PLP) has shown effectiveness in some non-responders to pyridoxine, it is less studied. A combination of 50–100 mg/day of pyridoxine and PLP may be reasonable for initial treatment. A series of uncontrolled and double-blind trials demonstrated that pyridoxine, at 50–300 mg/day doses, relieved CTS symptoms in over 90% of patients. Most patients showed clear improvement after 12 weeks, with some responding sooner.”[7]

Please Note: The studies mentioned were conducted using pyridoxine, a form of vitamin B6 that needs to be converted into its active form, pyridoxal phosphate (PLP), in the body to be effective. This conversion primarily occurs in the liver. For vitamin B6 to work efficiently, this conversion process must be optimal. Therefore, purchasing the active form of P5P would be beneficial, especially for individuals with liver conditions or compromised liver function, as it bypasses the need for conversion and is immediately usable by the body.

So many things are not as they seem, a consumer today needs to do their own homework. Unless you pay close attention to reading labels, you may not have noticed that we add the methylated forms of B6 (P5P), folate (5-methyltetrahydrofolate. 5-MTHF) and B12 (methylcobalamin). Those with MTHFR mutations often benefit from active, methylated B-vitamins, including P5P for B6, rather than synthetic chemical forms.

For producing our fermented and branded L-Tryptophan we add 50mg of pure P5P; this ensures that L-Tryptophan can cross the blood-brain barrier and enter the brain. Without adequate B6 in the bloodstream this cannot happen.

The raw material methylated forms are much higher priced, sometimes up to 5 to 8 times higher, but they are designed to be true natural medicines, “body-ready” active forms that bypass the need for conversion before absorption. The products we use P5P in are Super Multi-Vitamin From Nature, Balanced, Fiery Male, L-Tryptophan, Neurotransmitter Support, Opti Cal/Mag with K2, and Thymus Gland.

It is a huge sense of relief when you finally connect the dots between your genetics, your symptoms (like neuropathy and carpal tunnel), and specific natural medicine that actually work for your body. Using the active forms (P5P and 5-MTHF) removes the guesswork. Yes, they cost a bit more, but you are no longer asking your liver to do a job that your MTHFR mutation makes difficult. You are giving your system exactly what it needs to clear out homocysteine and support those nerves. Doesn’t that bring peace of mind?

 

References:

 

[1] Government of Canada. 2025.

[2] What About Wheat. n.a.

[3] Government of Canada. 2026.

[4] Davey, Melissa. 2025.

[5] Vrolijk Misha F et al. 2017.

[6] Hadtstein, Felix and Vrolijk, Misha. 2021.

[7] Functional Medicine Consulting. 2024.