TL;DR

Vitamin B6 and thiamin (B1) work together to support energy metabolism and nerve function. Studies show their combination can improve nerve conduction in diabetic neuropathy. Clues of low B6 include MSG sensitivity, poor dream recall, and low AST/ALT on blood work.

Each B vitamin has its own structure and function, but in nature they occur together and often work synergistically. Thiamin (vitamin B1) and vitamin B6 both play critical roles in energy metabolism and nervous system health.

Combining B1 and B6 for Nerve Support

Several studies have examined the combination of thiamin and vitamin B6 in diabetic neuropathy [1,2].
In one double-blind, randomized controlled trial, researchers used benfotiamine—a lipid-soluble, highly bioavailable form of thiamin—along with vitamins B6 and B12 for 12 weeks in 24 patients with diabetic polyneuropathy.

The results showed significant improvement in nerve conduction velocity and trends toward better vibration perception. No adverse effects were reported.
Follow-up over nine months supported the findings, leading the authors to conclude that “the benfotiamine–vitamin B combination represents a useful starting point in the treatment of diabetic polyneuropathy.” [1]

Recognizing a Vitamin B6 Deficiency

Vitamin B6 doesn’t “treat” PMS, inflammation, carpal tunnel, or depression—it helps correct a deficiency that can contribute to those issues.
Clues that your patient may need vitamin B6 include:

  • Sensitivity to MSG. People who experience “Chinese restaurant syndrome” often respond well to B6 support.
  • Poor dream recall. Studies show that vitamin B6 supplementation can enhance dream vividness and improve sleep quality [3,4].
  • Blood chemistry markers.
    • Low AST (SGOT) or ALT (SGPT) may indicate inadequate B6, since these are B6-dependent enzymes.
    • An AST below 8 or MCV/MCH below normal with normal serum iron may suggest a B6 need.

Correcting mild, chronic insufficiency can support neurotransmitter synthesis, energy metabolism, and red-blood-cell function.

FAQ

Q: Why combine B6 and thiamin?
A: These vitamins work in overlapping metabolic pathways that affect nerve function and glucose utilization. Together, they may improve nerve conduction and reduce neuropathic discomfort.

Q: How can you tell if someone is low in vitamin B6?
A: Low AST/ALT, poor dream recall, MSG sensitivity, fatigue, or neurological symptoms may point to suboptimal B6 status.

Q: What’s benfotiamine?
A: Benfotiamine is a fat-soluble form of thiamin that’s more readily absorbed than standard thiamin. It’s often used in studies on diabetic neuropathy.

References:

  1. Exp Clin Endocrinol Diabetes. 1996;104(4):311-6. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy
  2. East Afr Med J. 1997 Dec;74(12):803-8 Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy
  3. Percept Mot Skills. 2018 Jun;125(3):451-462. Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep
  4. Percept Mot Skills. 2002 Feb;94(1):135-40 Effects of pyridoxine on dreaming: a preliminary study