The Most Effective Form of Vitamin B6

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1 AOR CODE: AOR04173 Premium P-5-P The Most Effective Form of Vitamin B6 Protects the nervous and cardiovascular system Supports mood and hormone balance Enhances the immune system A B6 formula specifically for those with absorption issues Gluten Free Vegan Non-GMO Heart Health Mood AOR Code AOR04173 Variant 60 VEGI-CAPS Details Pyridoxal-5'-phosphate (P-5-P) is the bio-active form of vitamin B6, and is a catalyst for at least 113 known essential enzymatic reactions in the body. Studies show that people with compromised liver function and those with autism have an impaired ability to absorb conventional B6. Therefore, supplementing with P-5-P is imperative for these groups. P-5-P is known to reduce levels of homocysteine, a toxic protein linked to heart disease, making it an important addition for anyone concerned about their cardiovascular health. Additionally, it is required for the production of serotonin and GABA, neurotransmitters that lift mood and provide a sense of calm. P-5-P is known to help alleviate symptoms of PMS, due to its ability to help balance hormones. It supports immune function in those who are critically ill, and pregnant women may benefit from its anti-nausea effects. Anyone taking regular B6 should consider switching to P-5-P for enhanced absorption and effectiveness. P-5-P is essential for those with liver disorders, hormone imbalance, mood disorders, autism or anyone diagnosed with compromised B6 metabolism. Label Info Discussion Vitamin B6 helps the body to metabolize carbohydrates, proteins, and fats and helps in tissue

2 formation. Product Variation Product Code AOR04173 Size 60 VEGI-CAPS Supplements Facts Serving Size: 1 Capsule Vitamin B6 (Pyridoxal-5 -phosphate) Non-medical ingredients: Amount 50 mg microcrystalline cellulose, sodium stearyl fumarate. Capsule: hypromellose. Guarantees AOR guarantees that all ingredients have been declared on the label. Contains no wheat, gluten, corn, nuts, peanuts, sesame seeds, sulphites, mustard, soy, dairy, eggs, fish, shellfish or any animal byproduct. Adult Dosage Take 2 capsules daily with food, or as directed by a qualified health care practitioner. Cautions None known. Source Pharmaceutical synthesis Main Application Carpal tunnel syndrome PMS Hormone balance Immune system Elevated homocysteine levels Cognition Side effects associated with oral contraceptive Disclaimer The information and product descriptions appearing on this website are for information purposes only, and are not intended to provide or replace medical advice to individuals from a qualified health care

3 professional. Consult with your physician if you have any health concerns, and before initiating any new diet, exercise, supplement, or other lifestyle changes. Research Background Forms of Vitamin B6 Pyridoxal-5?-phosphate (PLP or P5P) is the biologically active form of vitamin B6 that is actually utilized by the body. Vitamin B6 is most commonly known as pyridoxine, but in fact B6 is comprised of three organic forms, namely pyridoxal, pyridoxine, and pyridoxamine. The three differ from each other slightly in their respective biochemical structures, but each represents a different stage in the body s metabolism of this important vitamin. P5P represents the advanced stage of this metabolism, the stage at which B6 has been converted into a coenzyme, a catalyst for at least 113 known essential enzymatic reactions in the body. Biological Roles of Vitamin B6 Indeed, a deficiency in vitamin B6 can lead to anemia, depression, dermatitis, hypertension, elevated levels of homocysteine and water retention, insomnia, premenstrual tension, irritability, muscle twitching, convulsions, and kidney stones. P5P is particularly active in the metabolism of amino acids, most notably in the transamination phase, whereupon the body synthesizes all endogenous amino acids, including such particularly crucial ones as tyrosine, glutamine, cysteine and glycine. P5P is also important for the proper metabolism of essential fatty acids as well as the formation of red blood cells and neurotransmitters, making P5P a factor in optimal cognitive function as well. Notable features of the latter include the fact that P5P is required to convert tryptophan into serotonin as well as to release glucose from glycogen. Research Studies have found P5P to have immune-boosting properties and may have beneficial effects on carpal tunnel syndrome (CTS), anemia, premenstrual syndrome (PMS), hyperhomocysteinemia and possibly even in autism. Regular B6 or Active B6? While the aforementioned studies used conventional B6 supplementation (mainly pyridoxine hydrochloride), it must be remembered that only the P5P converted from the pyridoxine can be used for nitrogen and protein metabolism and heme synthesis. This underlines the potential for P5P, especially in cases where the body s ability to synthesize it from its organic B6 forms is compromised in any way. In fact, it was found that in patients with impaired liver function, only 33% responded to pyridoxine hydrochloride supplementation with an increase in plasma P5P, whereas all of the patients receiving P5P supplementation experienced an increase. Immunity

4 Recent research has also confirmed that levels of pyridoxal-5?-phospate in the blood are significant indicators of the immune response system. In fact, in one clinical trial conducted among critically ill patients, it was revealed that when plasma pyridoxal-5?-phophate levels were raised via supplementation, the patients total lymphocyte, T-helper and T-suppressor cell numbers all increased, as did the percentage of lymphocyte and T-suppressor cells. Lymphocyte, T-helper (or T4 cells) and T-suppressor cells (or T8 cells) are white blood cells that play integral roles within the immune response system. Autism High-dose vitamin B6 therapy has also been studied with regard to its effects on children and adults with autism spectrum disorder. The success of these studies has been traced to the fact that those suffering from autism have a compromised pyridoxal kinase, the enzyme that converts pyridoxal, pyridoxine, and pyridoxamine into P5P. This holds exciting promise for P5P supplementation, as the impaired enzyme would be by-passed. Carpal Tunnel Syndrome, Homocysteine and Heart Health Raising P5P levels through vitamin B6 supplementation has also been successfully studied for its beneficial effects on carpal tunnel syndrome (CTS), anemia, premenstrual syndrome (PMS), hyperhomocysteinemia and other conditions. Interestingly, in one long-term study, it was found that patients being given B6 to alleviate the conditions of CTS had a 73% lower risk of developing acute cardiac chest pain or myocardial infarction, compared with patients who had not taken vitamin B6. This may have been attributable to the role of B6 in converting homocysteine into glutathione as part of the methylation cycle. Market Trends Vitamin B6 supplementation is generally done in the form of Pyridoxine or Pyridoxamine. Pyridoxal-5- phosphate is not as common. Vitamin B6 as a single supplement is also not very common. AOR Advantage AOR recognizes that not everyone can assimilate regular vitamin B6, and that a greater percentage of the population can benefit therapeutically from vitamin B6 supplementation if taken in its active form, making enzymatic conversions unnecessary. AOR also recognizes that active B6 can be therapeutically beneficial in itself. Benefit more from B6 with P-5-P. References Adams JB, et al. Abnormally high plasma levels of vitamin B6 in children with autism not taking supplements compared to controls not taking supplements. J Altern Complement Med Jan- Feb;12(1):59-63.

5 Cheng CH, et al. Vitamin B6 supplementation increases immune responses in critically ill patients. Eur J Clin Nutr Oct;60(10): Epub 2006 May 3. Ellis JM. Prevention of myocardial infarction by vitamin B6. Res Commun Mol Pathol Pharmacol Aug;89(2): Labadarios D, et al. Vitamin B6 deficiency in chronic liver disease evidence for increased degradation of pyridoxal-5?-phosphate. Gut Jan;18(1):23-7. Parker TH, et al. Effect of acute alcohol ingestion on plasma pyridoxal 5?-phosphate. Am J Clin Nutr Jun;32(6): Vitamin B6 (pyridoxine and pyridoxal 5?-phosphate) monograph. Altern Med Rev Feb;6(1): Abstract Plasma pyridoxal-5-phosphate and high-sensitivity C-reactive protein are independently associated with an increased risk of coronary artery disease. Nutrition. 2008;24; Chien-Hsiung Cheng, Ping-Ting Lin, Yung-Po Liaw, Chien-Chang Ho, Tsung-Po Tsai, Ming- Chih Chou, and Yi-Chia Huang. Objective: Whether vitamin B6 exerts an independent or a synergic effect in combination with inflammation for the risk of coronary artery disease (CAD) is unclear. The purpose of this study was to investigate whether plasma pyridoxal 5=-phosphate (PLP) is dependent on or independent of the inflammation marker C-reactive protein (CRP) to associate with the risk of CAD. Methods: This was a hospital-based case-control. Patients were identified with cardiac catheterization as having at least 70% stenosis of one major coronary artery were assigned to the case group (n 184). The control group (n 516) was comprised of healthy individuals with normal blood biochemical values. All subjects height, weight, blood pressure, plasma PLP, homocysteine, high-sensitivity CRP (hs-crp), and lipid profiles were measured. Results:Plasma PLP concentration was only negatively associated with hs-crp level in the control group (0.001, P 0.03) but not in the CAD or pooled groups. The magnitude of the risk of CAD for low plasma PLP (odds ratio [OR] 2.39) and high hs-crp (OR 3.37) was very similar. Low plasma PLP concentration combined with low hs-crp level (OR 2.34) and high plasma PLP concentration combined with high hs-crp level (OR 3.61) were independently associated with risk for CAD. However, the combined presence of low PLP and higher hs-crp levels enhanced the risk of CAD and the magnitude was substantially greater (OR 4.35).

6 Conclusion:Plasma PLP and hs-crp are independently associated with an increased risk of CAD, the combined presence of low PLP and high hs-crp enhanced the risk of CAD, and the magnitude was almost double. Pyridoxal phosphate prevents progression of diabetic nephropathy. Nephrol Dial Transplant Aug;22(8): Nakamura S, Li H, Adijiang A, Pischetsrieder M, Niwa T. BACKGROUND: We have demonstrated that pyridoxal 5?-phosphate (PLP), an active form of vitamin B6, inhibits formation of advanced glycation end-products (AGEs) by trapping 3-deoxyglucosone. The present study aimed to clarify if PLP could exert beneficial effects on nephropathy in diabetic rats. METHODS: Streptozotocin (STZ)-induced diabetic rats were treated by oral administration of PLP or pyridoxamine (PM), another active form of vitamin B6, at a dose of 600 mg/kg/day for 16 weeks. AGEs [imidazolone, N(epsilon)-(carboxymethyl)lysine (CML) and N(2)-carboxyethyl-2'- deoxyguanosine (CEdG)], transforming growth factor-beta1 (TGF-beta1), type 1 collagen and fibronectin were detected in the kidneys using immunohistochemistry. Gene expression of TGF-beta1 and receptor for AGEs (RAGEs) in the kidneys was determined using real-time quantitative polymerase chain reaction. RESULTS: Administration of PLP significantly inhibited albuminuria, glomerular hypertrophy, mesangial expansion, and interstitial fibrosis as compared with diabetic rats. PLP markedly inhibited accumulation of AGEs such as imidazolone, CML and CEdG, a DNA-linked AGE, in glomeruli. PLP significantly inhibited expression of TGF-beta1, type 1 collagen, fibronectin and RAGE in the kidneys. PLP was superior to PM in inhibiting accumulation of AGEs, expression of TGF-beta1, type 1 collagen, and fibronectin, and the development of diabetic nephropathy. CONCLUSIONS: PLP prevented progression of nephropathy in STZ-induced diabetic rats by inhibiting formation of AGEs. PLP is considered a promising active form of vitamin B6 for the treatment of AGE-linked disorders such as diabetic nephropathy. Vitamin B6 supplementation increases immune responses in critically ill patients. European Journal of Clinical Nutrition. 2006;60: C-H Cheng, S-J Chang2, B-J Lee, K-L Lin and Y-C Huang. Objective: To investigate whether vitamin B6 supplementation has a beneficial effect on immune responses in critically ill patients. Design: A single-blind intervention study. Setting: The study was performed at the Taichung Veterans General Hospital, the central part of

7 Taiwan. Subjects: Fifty-one subjects who stayed over 14 days in the intensive care unit completed the study. Subjects were not treated with any vitamin supplement before the intervention. Interventions: Patients were randomly assigned to one of three groups, control (n¼20), a daily injection of 50mg vitamin B-6 (B6-50, n¼15), or 100mg vitamin B-6 (B6-100, n¼16) for 14 days. Main outcome measures: Plasma pyridoxal 50-phosphate (PLP), pyridoxal (PL), 4-pyridoxic acid (4- PA), erythrocyte alanine (EALT-AC) and aspartate (EAST-AC) aminotransaminase activity coefficient, and urinary 4-PA were measured. The levels of serum albumin, hemoglobin, hematocrit, highsensitivity C-reactive protein (hs-crp) and immune responses (white blood cell, neutrophils, total lymphocytes count (TLC), T- (CD3) and B-(CD19) lymphocytes, T-helper (CD4) and suppressor (CD8) cells) were determined. Results: Plasma PLP, PL, 4-PA and urinary 4-PA concentrations significantly increased in two treated groups. T-lymphocyte and T-helper cell numbers and the percentage of T-suppressor cell significantly increased on day 14 in the B6-50 group. Total lymphocyte count, T-helper and T-suppressor cell numbers, the percentage of T-lymphocyte cells and T-suppressors significantly increased in the B6-100 group at the 14th day. There were no significant changes with respect to immune responses in the control group over 14 days. Conclusions: A large dose of vitamin B6 supplementation (50 or 100 mg/day) could compensate for the lack of responsiveness of plasma PLP to vitamin B6 intake, and further increase immune response of critically ill patients. Low pyridoxal 5-phosphate is associated with increased risk of coronary artery disease. Nutrition. 2006;22: Ping-Ting Lin, Chien-Hsiang Cheng, Yung-Po Liaw, Bor-Jen Lee, Tsung-Wen Lee, and Yi-Chia Huang. Objective: The purpose of this study was to investigate the association between plasma pyridoxal 5=phosphate (PLP) status and lipid profiles and to estimate the relation to the risk of coronary artery disease (CAD). Methods: Patients who were identified by cardiac catheterization as having 70% stenosis of one major coronary artery were assigned to the case group (n 184). The control group (n 516) was comprised of healthy individuals with normal blood biochemical values. Plasma PLP, homocysteine, high-sensitivity C-reactive protein, lipid profiles (total cholesterol, low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, and triacylglycerol) were determined. Results: Subjects with a plasma PLP level 30 nmol/l exhibited a significantly increased risk of CAD compared with subjects with a plasma PLP level 30 nmol/l (odds ratio, 1.85; 95% confidence interval, ) after adjusting for homocysteine and high-sensitivity C-reactive protein. The association between PLP and the risk of CAD remained significant after each lipid profile was additionally

8 adjusted. In addition, the combined presence of low PLP level and an abnormal lipid level increased the risk of CAD to an even greater degree. Conclusions:A borderline vitamin B6 deficiency (plasma PLP concentration 30 nmol/l) is strongly associated with the risk of CAD. The combined presence of low PLP and abnormal lipid levels increased the risk of CAD even further. Prevention of myocardial infarction by vitamin B6. Res Commun Mol Pathol Pharmacol Aug;89(2): Ellis JM, McCully KS. Vitamin B6 is effective in the treatment of carpal tunnel syndrome and related disorders in patients with vitamin B6 deficiency. Hyperhomocysteinemia, a risk factor for atherosclerosis, is associated with deficiencies of vitamin B6, folate, and cobalamin. Patients who were given vitamin B6 for carpal tunnel syndrome and other degenerative diseases were found to have 27% of the risk of developing acute cardiac chest pain or myocardial infarction, compared with patients who had not taken vitamin B6. Among elderly patients of the author (JE) expiring at home, the average age at death from myocardial infarction was 8 years later in those who had taken vitamin B6, compared with those who had not taken vitamin B6. The preventive effect of vitamin B6 on progression of coronary heart disease may be related to increased formation of pyridoxal phosphate, the coenzyme that is required for catabolism of the atherogenic amino acid, homocysteine.

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