Case Presentation: Micronutrient Testing: The Key to Optimization

by Gael Wheeler, DO

Harold presented to the office with complaints of pain and numbness in his legs and feet. This had been increasing over the last few years to the point he was beginning to have difficulty walking. He had tried different medications in an attempt to address these symptoms but did not find adequate relief. He was concerned that the cause had not been identified and that his symptoms were getting worse.

He had his Real Health Discovery lab panel done and, upon reviewing his results, it was noted his vitamin B6 level was close to 400% sat., with the optimal range being 42-89% sat. Vitamin B6 is a water soluble vitamin, so you can’t get too much, right? How could this be related to his symptoms?

Vitamin B6 (Pyridoxine) cannot be synthesized in the body and so must be obtained from either foods or supplements. Adverse effects have only been documented from supplement sources, never from food, as supplements can provide a much higher dose. Although vitamin B6 is a water soluble vitamin and is excreted in the urine, the long term use of high dose supplementation may result in a painful sensory neuropathy. Symptoms can include pain and numbness of the extremities and even difficulty walking. While doses as high as 1000 mg/day have been associated with the development of neuropathy, occasionally this may develop while taking doses of 500 mg/day over a period of months. None of the studies have shown sensory nerve damage at doses below 200 mg/day. The level of tolerance may be related to the individual’s renal function and ability to clear excess vitamin B6.

Vitamin B6 is an essential cofactor to over 100 enzymes that catalyze important chemical reactions in the human body. In the nervous system, vitamin B6 is responsible for the production of the neurotransmitters serotonin and dopamine. Vitamin B6 functions as a coenzyme in the production of heme, the iron containing component of hemoglobin, carrying oxygen in the red blood cells. Vitamin B6 plays a role in immune function, cardiovascular health, preservation of cognitive function and mood, and other roles too numerous to name here.

The important takeaway I learned from Harold’s situation is that we may be missing something important if we supplement based on assumptions. Each person is unique in how they metabolize and use different nutrients. Micronutrient testing gives us a clear picture of exactly where an individual stands regarding nutritional sufficiency. In his case, we were able to identify an imbalance that contributed to, or possibly even caused, his debilitating symptoms.

If you’ve not had nutrient testing in a few years, or are working to therapeutically adjust your nutrient dosing, I recommend having testing done. Our nutrient needs change as we move through life, and testing is an essential tool for optimizing our micronutrients to best address our requirements.