Most interstitial cystitis sufferers know that vitamin C comes in many forms and understand that, for the majority of people, only the ascorbic acid form is irritating to the bladder. Other forms such as Ester-C and mineral ascorbates are usually perfectly safe for sensitive bladders, even in high doses. I get bladder pain from only tiny amounts of ascorbic acid, yet can take magnesium ascorbate all the way to bowel tolerance with no urinary side effects at all.

Far fewer people seem aware that vitamin B6, also often blamed for bladder irritation, also comes in different forms. The one most commonly used in multivitamin supplements or B-complexes is pyridoxine hydrochloride, although pyridoxal and pyridoxamine can also be found in some brands. Before these can be utilised by the body, they must be converted into the active form of vitamin B6 – Pyridoxine-5’-Phosphate (P5P). For many individuals this is not a problem and the conversions occur just fine. However, some people are unable to carry out the conversions efficiently enough and can therefore fail to absorb sufficient B6 from their supplements. Most IC sufferers avoid B6 anyway, relying only on food sources to get enough.

B6 is an extremely important vitamin which works in synergy with other B vitamins and helps to:

• Make neurotransmitters such as serotonin, dopamine and melatonin to regulate mood and sleep patterns;
• Metabolise carbohydrates to provide energy and keep blood sugar levels balanced;
• Metabolise proteins and fats;
• Regulate hormonal activity;
• Make red blood cells;
• Create antibodies to support a healthy immune system;
• Both create histamine and promote a proper body response to it;
• Normalise homocysteine, an amino acid associated with heart disease and impaired cognitive function.

It has been found that vitamin B6 levels tend to be lower in people who have inflammatory conditions – i.e. inflammatory diseases can eventually lead to a deficiency of B6 as the inflammatory response uses up so much of it. B6 deficiency can lead to a wide range of problems, including but not limited to:

• Irritability, anxiety, depression, difficulty concentrating and confusion;
• PMS;
• Insomnia;
• Low energy or fatigue;
• Anaemia;
• Digestive disturbances;
• Water retention;
• Skin inflammation;
• Nerve damage.

Because interstitial cystitis is an inflammatory condition and because it frequently coexists alongside other chronic, inflammatory health conditions, IC sufferers may have lower levels of B6 anyway. Couple that with the fact that IC sufferers tend to avoid supplemental B6 because of its bladder irritating properties and it’s not hard to see how a deficiency could develop over time.

For whatever reason, I seem to require quite high levels of B vitamins in order to feel good. I’ve had anxiety in some guise or another pretty much all my life, but around five years ago when I started taking a B-complex, this became markedly better. When I developed persistent genital arousal disorder (PGAD) subsequent to a bout of bacterial cystitis, I began taking a B-complex without B6 to ensure I was getting all of my other B vitamins, as I feel so rubbish when I stop taking a B-complex altogether. I was never exactly sure if normal B6 had contributed to the PGAD or not, but there is so little known about it and it is so awful to experience that I wasn’t going to take any chances.  (Update 2022:  we now sell a B-complex without B6, which also contains bladder-friendly vitamin C and magnesium!)

Over the last year or so, I’ve been concerned that my B6 levels may have dropped too low. To cut a long story short, I’ve been having an anxiety relapse and worsening PMS, accompanied by horrible insomnia which leaves me feeling very depressed and emotional, along with palpitations and blood sugar issues. While these are ongoing and still very much under investigation, I decided I wanted to introduce some B6 back into my daily regime. I had been aware of the active form of B6, P5P, for quite some time, but had never been able to find any definitive research into its effect on the bladder. Most of the warnings about B6 and bladder irritation are to do with pyridoxine hydrochloride or just ‘B6’ in non-specific form, while it is always emphasised that food sources of B6 pose no risk to IC sufferers at all. As P5P is the active form of B6 requiring no conversion, I instinctively felt that it might pose less problems. Dissatisfied with the findings of my internet research into the matter, I had my mum speak to one of her supplement suppliers about P5P and they said they had never heard of any cases of it causing bladder irritation. Admittedly, supplement companies have their own agendas, but she has a long standing relationship with this one and as she stipulated that she was asking on behalf of her daughter, for personal use, I feel they would have been honest if they did know of any connection. Furthermore, they offered to send a week’s trial of a P5P supplement so that I could see for myself.

I have now been taking 25mg of P5P on a daily basis for about six weeks and have noticed no worsening of PGAD symptoms and no bladder irritation. On the run up to my last period, I bumped this up to 75mg per day and felt I had got away with my PMS symptoms more lightly than in previous months. I intend to do the same in the second half of my menstrual cycle this month as well. It is early days to know to what extent the P5P is helping me, but I feel fairly confident that it is not causing me any problems so far and if that changes, I’ll make sure I post an update. Of course I am only one and so I can’t definitively say that the P5P form of vitamin B6 is bladder safe for everyone. If I were affected only by bladder/vaginal problems and nothing else, I would most likely have just stayed away from supplemental B6 for good. However, if you are wary of taking conventional B6, yet have other health issues that you feel it might benefit, you might want to consider doing some research of your own and trying P5P. If you do take any, I’d love to know how you get on!

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