Vitamin B6 toxicity doesn’t just happen to people taking megadoses. Tingling feet, insomnia, anxiety, heart palpitations, and mysterious nerve symptoms can appear even at low daily intakes—sometimes without any supplements at all. This guide breaks down the full spectrum of B6 toxicity symptoms, from subtle sensory changes to life-altering neurological dysfunction, and explains why “normal” blood levels and doses may not be safe for everyone.

Even doses of vitamin B6 as low as 2 mg per day—commonly found in multivitamins—have triggered severe nerve symptoms in genetically or metabolically susceptible individuals. This article walks through the science, symptoms, and lab patterns behind B6 overload without high-dose supplementation.

Can You Get B6 Toxicity Without Supplements? And what causes it?

Yes, you can. B6 toxicity without supplements occurs when plasma pyridoxal-5′-phosphate (PLP) rises due to impaired metabolism, poor clearance, cofactor imbalances, subtle genetic deficits, insidious overconsumption, and more. And it’s much more common than most clinicians realize. This often leads to symptoms like tingling, anxiety, or autonomic dysfunction, even in the absence of any direct B6 supplement use. Here’s what causes it and what to do about it:

Vitamin B6 is everywhere—multivitamins, B-complexes, prenatal supplements, even hydration powders. It’s recommended for everything from PMS to anxiety to neuropathy. But for a growing number of people, it’s making things worse.

Burning feet, vivid dreams, facial tension, and inexplicable panic episodes aren’t random—they’re often early signs of B6 overload. This isn’t a simple case of “too much of a good thing.” It’s a genuine biochemical derailment that can mimic everything from MCAS to mold illness.

In this article, I’ll walk you through the actual physiology of B6 sensitivity—why standard blood tests are misleading, why P5P (i.e. PLP) often worsens symptoms, and what it really takes to recover. This is for the people who were told B6 was safe and now cannot sleep, think, or feel like themselves.

~ Dr. Malek

Dear Slow COMTer,

The goal of this roadmap is to give you the most direct, straightforward, actionable slow COMT plan possible.

If you've already run genetic testing (like 23andMe or AncestryDNA), you may want to confirm that you're carrying the COMT V158M variant, especially the homozygous (Val/Val) or heterozygous (Val/Met) form, though the latter is less of a concern unless you have symptoms associated with slow COMT.

This roadmap assumes you do, and that you’ve either seen classic symptoms

Cataracts are Ubiquitous, But Not Inevitable

Cataracts are, by far, the number one cause of blindness globally.

According to the World Health Organization, around 94 million people are affected by cataracts, and in the USA, around 70% of people over age 75 have cataracts.

Getting cataracts is extremely likely. But this overwhelming likelihood does not mean that one must resign oneself to such inevitability. It is possible to delay (and sometimes prevent—over the course of a normal human lifespan) significant cataract development.

But doing so requires targeted effort (and I do mean real effort), far beyond the usual “wear sunglasses and hope for the best.”

70–80% of pregnant women experience the nausea and/or vomiting of morning sickness, with the severe form—hyperemesis gravidarum—affecting as many as 1 in 50.

B6 is very commonly prescribed worldwide for such morning sickness. It’s considered by many doctors and regulatory agencies to be the first-line agent, often prescribed as a mixed B6 + doxylamine and in dosages often up to 100 mg per day total.

ACOG, for example—a major medical regulatory agency—recommends 10-25 mg B6 three to four times daily, taking you close to that 100 mg per day.

That’s a lot of B6.

I want to start this article by immediately making it clear that not everyone requires supplemental B6. This is a very common mistake—and not an innocent one either.

Taking B6 when you don’t need it can lead to “toxicity” symptoms (for the record, I don’t agree with the mainstream understanding of B6 “toxicity” and absolutely believe it can be reversed much more quickly and effectively than by simply “waiting it out” and supporting hydration/vasodilation—the prevailing approach—but that’s another story).

Those “toxicity” symptoms generally begin as neuropathy, like the kind you get with diabetes: tingling in your toes and so on.

But some people absolutely do need B6 supplementation…

“Common Ingredient in Energy Drinks May Increase Risk of Cancer”

”Ingredient in Energy Drinks Linked to Blood Cancer Risk”

You’ll have seen popular new outlets blaring these titles over the last several days. I’d like my readers to know that these titles are entirely misleading and potentially even harmful.

Yet another article is titled:

“This popular drink may increase the risk of blood cancer, warn doctors”

I, for one, am not of those “doctors.”

Something's been on my mind lately, and I wanted to share it with you all:

What is it that really plagues the medical field today? What makes the medical field so endlessly incapable of truly healing, rather than just keeping people locked into a self-perpetuating system?

Why Anxiety, Insomnia, and Fatigue May Come from Hidden Iron-Based Catecholamine Overload: “Wired but Tired” Syndrome.

A surprisingly common scenario these days: anxiety, poor sleep, feeling overstimulated yet exhausted, "wired but tired," and daytime fatigue despite restless nights.

Sleep is undoubtedly one of those lingering mystery of modern science. It’s tempting to say that it’s one those “last frontiers”—i.e. those things that we still don’t really understand, despite how much we apparently know—like the trenches of the ocean, or deep outer space…

But, of course, that’s not true.

Methylfolate has dramatically increased in popularity over the past few years. While most multivitamins and B-complex supplements used to contain only folic acid—the synthetic and potentially harmful form that I strongly discourage—many brands now include the so-called "methylated" form of folate instead. This shift is largely driven by the skyrocketing interest in MTHFR gene testing and the assumption that methylfolate is always better.

But is it really?

Multivitamin supplementation is extremely common. Probably somewhere around one in three U.S. adults takes some form of multivitamin on a regular basis, hoping to improve their health. That hope is often directed toward reducing the risk of disease—namely chronic illnesses like Alzheimer’s disease, heart disease, and so on—or simply improving day-to-day functioning (i.e., “feeling better”).

The problem is: I do not recommend multivitamin supplementation for the vast majority of people—for the vast majority of multivitamin formulations on the market.

Managing slow COMT variants requires a tailored mix of (balanced) methylation-supporting strategies, neurotransmitter-modulating strategies, and so on. However, these measures may at times clash with those required for the management of sulfur intolerances.

Starting with the most general question—i.e. how much protein should someone with slow or fast COMT function consume—my answer is pretty straightforward…

There is a society-level push to distance humans from human nature.

Consider the claim commonly made by health influencers and media pundits that “just because something is ‘natural’ it doesn’t mean that it’s ‘better.’”

Then just look at the sheer number of articles written…