The Science of Supplementation: Water-Soluble Vitamins, Part 2February 28, 2018
I've discussed vitamins B1, B2, and B3 in the "The Science of Supplementation: Water-Soluble Vitamins, Part 1" article. In this article, I will introduce you to the next three water-soluble vitamins.
To recap, water-soluble vitamins dissolve in water and are lost through bodily fluids. Because our body cannot properly store or recycle these water-soluble vitamins, we need to make sure that we consume them in our diet and via supplements. And because our bodies do not store these nutrients, toxicity from too much water-soluble micronutrients is rare.
Pantothenic Acid (B5)
Pantothenic acid functions in a variety of ways in the body. Its primary purpose is in utilizing fatty acids and carbohydrates for energy production, as well as in the formation of coenzyme A. Coenzyme A plays an important role in synthesizing amino acids (small proteins) among other compounds like cholesterol, and in the production of certain hormones and even red blood cells. Pantothenic acid also helps the body utilize other vitamins, particularly riboflavin (vitamin B2).
Pantothenic acid is often found in foods as a precursor that when digested releases the active form of pantothenic acid. Almost all food contains some amount of pantothenic acid, which is how it got its name. In Greek, pantothen means “from every side.” Some of the best sources include beef, chicken, egg yolks, broccoli, sunflower seeds, whole grains, beef and lamb liver, tomatoes, trout, root vegetables, and mushrooms. It can also be found in fortified breakfast cereals. As you can see, it is stored in a variety of foods!
Because it can be found in such a wide array of foods, deficiency is extremely rare. However, in extreme cases of malnutrition, deficiency can occur. Symptoms of such a deficiency are very generalized and can include irritability, numbness, burning feet, interrupted sleep and restlessness. Both deficiency and very high doses of pantothenic acid can also cause digestive issues (discomfort, diarrhea). No tolerable upper intake level (UL) has been established.
While some people may take pantothenic acid for certain symptoms such as dry eyes, arthritis and skin irritation, as of yet there is no evidence to support supplementation of pantothenic acid for such issues.
As pantothenic acid can be found in such a variety of foods, we are often able to get adequate amounts from diet alone. Therefore, there are no established guidelines for supplementation for pantothenic acid after WLS.
Vitamin B6 is actually a group of compounds that all get converted in the liver to the active form. It functions to help the body make neurotransmitters, which carry signals along the nerves. It also functions to make serotonin and norepinephrine, which are hormones that influence mood, as well as to make melatonin, which is a hormone that influences your body’s internal clock.
Like other B vitamins, it is required to release glucose from glycogen, the form our bodies use to store glucose. It also functions to support white blood cell formation, which boosts the immune system. One key role that vitamin B6 plays is in protein metabolism; increased vitamin B6 is recommended with increased protein intake.
Good sources of vitamin B6 include liver, tuna and salmon, sunflower seeds, chickpeas, pistachio nuts, pork, turkey, and potatoes. Like most B vitamins, it is fortified in breakfast cereals. Vitamin B6 is found in higher amounts in animal sources, rather than plant sources.
It is rare to experience a significant deficiency of vitamin B6. Those who drink high amounts of alcohol are at risk for deficiency. Symptoms of deficiency may include confusion, memory loss, depression, skin rashes, and muscle weakness. Some research has also shown a link between vitamin B6 deficiency and an increased risk of cancer and cardiovascular disease.
Vitamin B6 that occurs naturally in food sources has not been associated with adverse effects. However, very high doses of supplementation can lead to neurological disorders; when the high doses are stopped, there is often a full recovery by 6 months. High doses of supplementation can also affect the production of milk in breastfeeding women. The tolerable upper intake level (UL) has been established at 100mg/day.
While there are no established guidelines for supplementation for vitamin B6, some research suggests that us post-ops may need higher amounts than the Dietary Reference Intake (DRI) of 1.3-1.5mg/day for men, and 1.3-1.7mg/day for women. Luckily, most bariatric multivitamins and B-complex vitamins contain amounts higher than the DRI, yet well below the UL.
Biotin (Vitamin B7)
Also known as vitamin H because of the German word haut for “skin,” biotin is often sold as the wonder vitamin for skin, hair, and nails. However, there is a significant lack of evidence to support these “miraculous” benefits. Biotin’s true function is a coenzyme that is required for fatty acid synthesis, the formation of glucose, and metabolism of amino acids. Basically, like most other B vitamins, it is essential for energy metabolism. Biotin is important in the production of keratin, which is important for healthy hair and nails; however, biotin deficiency is rare so supplementation is often not beneficial for hair and nail health.
There is less information available on the biotin content in foods. However, known good sources include liver (surprise again!), mushrooms, fish and meat, nuts, cauliflower, egg yolk, legumes, dairy products and leafy greens. Small amounts of biotin are also created by gut bacteria.
Biotin deficiency, as mentioned above, is rare. Deficiency is typically found in formula-fed infants and those with Leiner’s disease or other conditions that genetically predispose people to deficiency.
Symptoms of biotin deficiency include dry, scaly or red skin, brittle hair and/or hair loss, insomnia, depression, fatigue, upset stomach, muscle pain, changes in walking, and even seizures.
The most common reason I’ve seen post-ops take biotin is to prevent alopecia (hair loss) after surgery. However, there is little evidence to support the use of biotin to prevent hair loss when there is no deficiency present. If, however, your diet does not include adequate biotin, you are not getting enough protein, and/or you are genetically predisposed to deficiency, you *may* benefit from biotin supplementation to mediate hair loss.
Many post-ops experience hair loss 3-6 months after surgery. I like to caution people about biotin for this purpose, as hair loss is often caused simply by the shock of surgery, rapid weight loss, and sometimes, inadequate protein intake. For those who get their hopes up about the beneficial effects of biotin, they may or may not see the results that they desire. Oftentimes, the hair loss resolves on its own after a period of time, with adequate protein and a varied diet. There is, however, some observational research to support biotin supplementation to improve brittle nails for women, but further research is still needed.
There are no known adverse effects from high doses of biotin, as there is no evidence to support that toxicity can occur from a high intake and a tolerable upper limit has not been established. However, there is the risk of biotin interference with high intake, specific to certain lab tests drawn, and the FDA recommends that clinicians "consider biotin interference as a possible source of error if laboratory test results do not match the clinical presentation of the patient." The symptoms are not directly caused/affected by biotin intake, it is just the tests results that are influenced. As practically all B complex and multivitamins contain biotin, this highlights the importance of disclosing all medications and supplements to your doctors.
With the many sources of biotin and the relatively rare occurrence of biotin deficiency, there are no established guidelines for supplementation for biotin. However, if you feel like your hair loss has been particularly prolonged and that your diet isn’t adequate, you *may* benefit from biotin. If you feel like taking biotin anyways, that’s fine too, but just take caution with recommending it to others as the “cure-all” for hair loss.
While these three vitamins don’t have established supplementation values from ASMBS, they are still very important micronutrients for energy metabolism. Pantothenic acid is so widely available that supplementation is typically not needed. Vitamin B6 is important to increase when we increase our protein intake, and us post-ops may benefit from increased amounts. And finally, biotin plays an important role in our health, but it may not work to prevent hair loss if you are not already deficient.
These are just three of the water-soluble micronutrients. Please stay tuned for my next article, which will be looking at folic acid (vitamin B9), vitamin B12, and vitamin C!
UL: tolerable upper intake level, DRI: dietary reference intake, AGB: adjustable gastric band, SG: sleeve gastrectomy, RYGB: Roux-en-Y gastric bypass
ABOUT THE AUTHORBec McDorman, MS, RDN discovered her passion for health and wellness after undergoing Roux-en-Y Gastric Bypass surgery in 2010 to lose more than 100lbs. Bec has received her masters from Cal Poly Pomona and completed her dietetic internship at Johns Hopkins Bayview Medical Center. She has reached her goal of being a registered dietitian so she can help pre- and post-op bariatric patients with their journey.
Read more articles by Bec!