Low serotonin can cause anxiety and panic attacks. Because vitamin B6 and iron are required raw materials for making serotonin, we know that low levels of these two nutrients often contribute to anxiety and panic attacks.
We have some pretty recent research supporting all this: Low serum concentrations of vitamin B6 and iron are related to panic attack and hyperventilation attack
Reduced serotonin level is known as one of the causes of panic attacks and hyperventilation attacks ….
In the serotonin synthesis system of the brain, vitamin B6 is a coenzyme for tryptophan hydroxylase, which is involved in the conversion of tryptophan into 5-hydroxytryptophan and iron serves as a cofactor for aromatic L-amino acid decarboxylase involved in the formation of serotonin from 5-hydroxytryptophan. Therefore, a reduction in vitamin B6 and iron levels can suppress the progression of the serotonin synthesis.
The study authors measured serum levels of vitamins B2, B6, and B12 and iron in 21 premenopausal women who had been admitted to the emergency room with panic attacks.
The results were compared with lab values from 20 volunteers, also premenopausal women, and this is what they reported:
We found that both vitamin B6 and iron levels were significantly lower in the panic attack/hyperventilation attack group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12.
These results suggest that low serum concentrations of vitamin B6 and iron are involved in panic attacks and hyperventilation attacks.
This certainly confirms what I see with my clients. When I’m working with someone with anxiety, we always assess for low serotonin, low iron and low vitamin B6 levels, and when we address low levels we almost always see improvements – both in the reduction of anxiety and panic attacks. We’ll often see a mood boost too, sleep improvements and a reduction in carb cravings.
Here are some additional factors to consider:
- Vitamin B6 can be challenging to measure in serum so I like to also use the pyroluria questionnaire and poor dream recall as a clue. The authors mention that serum pyridoxal 5-phosphate (PLP) is often used as an indication of B6 status, however they opted to use pyridoxal (PAL) after conversion from PLP.
- Supplementing with vitamin B6 can often lead to some improvements in a few weeks with many folks who have pyroluria reporting feeling less anxious and more social within a week.
- There is the potential for vitamin B6 toxicity. I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day. However, there are some individuals who have issues with very small amounts of vitamin B6. Unfortunately, I do not know why this happens.
- Testing ferritin levels are an excellent way to assess iron levels and iron should never be supplemented unless iron is low. Dr. Izabella Wentz, shares in her book Hashimoto’s Protocol and blog that the optimal ferritin level for thyroid function is between 90-110 ng/m. Addressing low iron levels can take awhile to see a shift in labs.
- Because zinc and magnesium are also cofactors for making serotonin, low levels may also need to be addressed. I would have loved to see these included in this study,
- As always, we assess for low serotonin levels using the amino acid questionnaire and start on tryptophan or 5-HTP right away, based on doing trials – so we can see anxiety reduction and relief from panic attacks right away, while the other changes are starting to provide the raw materials for serotonin production.
Keep in mind that low serotonin and low iron and/or low vitamin B6 – although very common with anxiety and panic attacks – are not the only root cause and many other factors may also need to be addressed.
We’d love to hear if addressing low iron and/or low vitamin B6 levels have helped you? Did you use tryptophan and/or 5-HTP at the same time?
If you’re a practitioner, are often do you see low iron and/or low vitamin B6 in your anxious clients/patients?
What B6 supplement do you Rx?
Raymond
You can find all the supplements I use with clients here https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/
Which vitamin B6 do you recommend?
Should we be wary of iron supplements as they are constipating as well?
BBev
You can find all the supplements I use with clients here https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/ The DFH iron is the non-constipating form iron bisglycinate
Thank you for this research. I take vitamin B6 and zinc and they help me feel more social but I still often feel anxious. I will get my iron and ferritin tested and would like to take tryptophan too. What is the starting dose please?
Thank you so much for what you do!! I suffer from anxiety and depression. I have your book and I came up elevated in low gaba, low serotonin, low catecholamines, low endorphins, and positive for Pyroluria. I’m still working on the trial of amino acids. I tried a pinch of pure gaba, but I felt my heart pounding, tight chest, and my anxiety was increased. Should I take even less of the gaba or is there something else you can recommend? I tried 5-HTP in the past and me heart rate increased to 180 if felt like I was going to have a heart attack… I stopped that right away. So, I’m trialing Ltryptophan 500 with the brand you suggested. I also took a pinch and felt my heart race. Should I take less of this as well? My anxiety, panic attacks, and depression that I’ve had for 3 years now is really getting to me and I’m now considering medication which I don’t want. Also, I’ve been on the keto diet for 5 months which I haven’t noticed a change in my mood except for weight loss yet my weight is not issue for me. I’m going to start my vitamin b6 at 100mg today and see if that will help. Any advice would be immensely appreciated!! Thank you!
Kristina
It’s challenging to have reactions like you describe and I have used a very very small amount with some clients. When the aminos don’t work we consider the product, how much is being used, past use of meds (benzos can cause issues), thyroid health and other root causes playing a role in anxiety/depression. Focusing on diet and gut health initially is always an option and using yoga/guided imagery/essential oils and other approaches are worth considering too
when seeing b6 toxicity, do you take into account the kind of b6 the person is using? studies seem to point the use of pyrodoxine as opposed to p5p which can lead to toxicity due to issues with conversion, which can then lead to b6 building up essentially not having anywhere to go. i havnt read studies that seem to indicate the same issue happens with p5p. any thoughts on this?
Silvia
Yes there is some research on the different forms but some folks report issues with both and yet many report no issues with either.
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
I was under a lot of stress and possible verbal abuse for a number of years. Found out I had breast cancer which led to cascade of emotional and physiological research; blood tests, organic acids, etc…I didn’t have panic attacks in the classic DSM way, but chronic stress and anxiety. I did test low in iron and B6. Have been taking P5P and easy iron since testing, not every day, but at least a few times a week. I have also taken a very low dose of Zoloft or Lexapro off and on. just wanted to mention that you don’t have to have full on panic attacks to have low serotonin, B6, iron.
Angie
You have been on quite the journey. Glad you are finding solutions. Thanks for sharing and I agree, the anxiety/panic can be mild or severe.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
It’s a comprehensive approach – amino acids AND diet. What is your diet like right now – gluten-free, sugar-free, caffeine-free, eating protein at breakfast for blood sugar control, real whole foods, grass-fed red meat, wild fish, fermented foods etc?
Dear Trudy –
Thank you so much for sharing your information on pyroluria. It has been incredibly helpful!!
I have a couple questions: Once one is supplementing with B6 (P5P) should ones blood test results stay within the normal range of say (5 – 50 ug/L) or is it safe for them to be higher?
Also, I have read that B6 can effect your progesterone and estrogen levels. Is this the case? Might you have any more information on this?
Again, thank you!
Jay
Jay
Lab tests for B6 are not reliable. Feel free to share a link about B6 and progesterone and estrogen and I’ll comment
Dear Trudy –
Thank you for your response. Could you please expand a bit more on B6 results being unreliable? Is this because with Pyroluria the B6 in your blood serum does not actually represent what your cells are able to utilize? What is the best way to get a true read on your B6 levels so you can be sure you’re not taking too much?
Here are some sites that mentioned B6 affecting progesterone and estrogen levels…. The one that several sites seem to reference is: https://pubmed.ncbi.nlm.nih.gov/6684167/
An example of a site referencing it would be: https://hormonesbalance.com/articles/5-ways-vitamin-b6-benefits-hormones/, where the writer states, “Part of reducing estrogen dominance involves restoring the balance between estrogen and progesterone. In a study of women with premenstrual tension who dealt with anxiety and irritability, vitamin B6 given at 200-800 mg per day was shown to reduce estrogen and increase progesterone, improving symptoms.”
Thank you so very much.
Jay
Jay
I use dream recall and other markers for B6 status.
Dear Trudy –
Thank you for sharing your incredibly helpful, important work. You have made a huge positive, hopeful and excellent difference in my life. You have helped me begin to solve pieces of my own health puzzle that I could not find answers to. I’m so grateful. May your holidays and new year be beautiful.
Jay
Jay
Wonderful to hear this – if you care to share more I’d love to hear what positive changes you’ve seen?