Question for Hans on P5P for stroke prevention

Hi Hans,

Thanks for giving me the link to the article from your newsletter on supplements for stroke prevention. Below is a quote on P5P from that article. The article seems to say that 50 mg of P5P will prevent 90% of strokes. Is that what you understand it to say? I just want to be sure I am reading it correctly. If this is true, shouldn't we all be taking P5P everyday?

Thanks much,
Windstar (Nancy)

"Italian researchers have noted that people with low levels of vitamin B6 (less than 33.2 nanomol/L of PLP) have twice the risk of developing deep vein thrombosis than do people with levels above 46.5 nanomol/L[6]. The finding that high vitamin B6 levels may be protective against deep vein thrombosis is of particular interest to afibbers. It is highly likely that the mechanism (blood coagulation or inadequate fibrinolysis) involved in deep vein thrombosis is very similar to the mechanism involved in thrombus formation in the left atrial appendage. Thus, if vitamin B6 is protective against deep vein thrombosis, it may also be protective against thrombosis and stroke in atrial fibrillation.

Canadian researchers have found that supplementation with 100 mg/day of vitamin B6 for 10
weeks is associated with a 146% improvement in endothelial function in heart transplant patients[18]. More recently, researchers at the Harvard Medical School and the Massachusetts General Hospital discovered a strong association between stroke risk and blood level of PLP. This increased risk of stroke with low PLP levels was entirely independent of homocysteine levels confirming that vitamin B6, on its own, has significant stroke prevention properties. The researchers found that study participants with a plasma level of PLP of more than 80 nanomol/L had a 90% lower risk of stroke and transient ischemic attacks (TIAs) than did participants with a level below 20 nanomol/L. The risk decrease was independent of the presence of other risk factors such as hypertension, diabetes, and atrial fibrillation[15]. The researchers also noted a strong inverse correlation between C-reactive protein level and PLP level indicating that vitamin B6 may also have strong anti-inflammatory properties – an added plus for afibbers.

The 90% relative reduction in stroke risk among people with high PLP levels is very significant and compares extremely favourably with the oft-quoted relative risk reduction afforded by warfarin (64%) and aspirin (25%). Clearly, ensuring adequate blood levels of PLP is a must for all afibbers. Vitamin B6 is converted to its active metabolite PLP in the liver and there is some evidence that the liver can only handle about 50 mg of vitamin B6 at a time. Experiments have shown that the plasma concentration of PLP does not increase further if 100 mg rather than 50 mg of pyridoxine is ingested at any one time. So it is assumed that the conversion to PLP is limited by the liver’s conversion capacity[19]. Other experiments have shown that supplementing (orally) with 40 mg of vitamin B6 will increase average plasma concentration from about 23 nmol/L (range: 18-37 nmol/L) to about 230 nmol/L within 3 days of beginning supplementation. No further increases were observed with 40 mg/day supplementation for a 12-week period[20].

The 230 nmol/L concentration achieved is well above the 80 nmol/L concentration associated
with the 90% reduction in stroke risk observed by the Harvard researchers[15]. So 40-50 mg/day would seem to be sufficient for stroke protection and is considered entirely safe[20].

Vitamin B6 itself is, however, water-soluble and any excess is totally eliminated in the urine within about 9 hours. To keep the vitamin B concentration up, it would be necessary to take two or three 50 mg doses per day. However, in the case of stroke protection, one 50 mg dose per day is likely to be quite adequate, as PLP concentration does not vary much during the day once steady state conditions are achieved. Adequate amounts of vitamin B2 and magnesium are required in order to convert vitamin B6 to PLP. NOTE: If taking the vitamin B cocktail, there is no need for additional vitamin B6 in order to reap the benefits of its stroke prevention properties. "

Just in case anybody else was as confused by all these letter and number terms as i was,here is wikipedia's explanation:
"Pyridoxal-phosphate (PLP, pyridoxal-5'-phosphate, P5P) is a prosthetic group of some enzymes. It is the active form of vitamin B6, which comprises three natural organic compounds, pyridoxal, pyridoxamine and pyridoxine."

PeggyM

Nancy,

Absolutely! I am a great believer in Vitamin B6 (P5P) for stroke prevention and has been taking it for years in the form of a sublingual tablet (you can find this tablet at [www.afibbers.org] under vitamin B6). Here are links to the two most important articles quoted in my stroke prevention article.

[stroke.ahajournals.org]

[circ.ahajournals.org]

Hans

Thanks, Hans.

I went on iHerb's site as you suggested. Is this the one you take? Source Naturals, Coenzymated B-6, 25 mg Sublingual , 120 Tablets.

Do you take two, since this is only 25 mg and the article said to take 50 mg?

Windstar (Nancy)

Nancy,

Yes, that is the one. I only take one as I am taking quite a few other natural stroke-preventing supplements.

Hans

Thanks, Hans.

What other natural stroke preventing supplements are you taking and how much of each, if I may ask? I know we are all different, but it's helpful to know what experts like you consider the best ones to take. We all want to prevent a stroke!

Jackie mentioned gingo biloba in an earlier post but didn't say how much to take to prevent stroke. I know Dr. Blaylock has written about that in his newsletter. I will try to look that up since I am a subscriber.

Nancy (Windstar)

Nancy,

Here is my current intake of stroke prevention supplements. The percentage given in brackets after each supplement indicate the estimated relative reduction in risk of ischemic stroke.

Coenzymated vitamin B6 (90% with an intake of 50 mg/day) - One 25 mg sublingual tablet of PLP per day
Vitamin B Complex (80%) - One 50 mg strength capsule/day
Vitamin C (50%) - 600 mg 3 times daily in the form of calcium ascorbate (Ester-C)
Vitamin E (30%) - 250 mg/day of gamma tocopherol + 125 IU og alpha-tocopherol
Potassium (40-50%) - 500 mg (elemental) 3 times daily
Magnesium (56%) - 200 mg (elemental) 3 times daily
Fish oils (40-50%) - 1740mg/day of EPA+DHA (Coromega)
Green tea extract (70%) - 725 mg/day
Resveratrol (45%) - 20 mg/day

The above supplements are all available in the afibbers.org online vitamin shop at [www.afibbers.org]. By buying through this link you are contributing to the maintenance of the Bulletin Board. Please note that ordering directly from iherb does not do so.

Hans