Fears Vitamin B6 levels in energy drinks like Red Bull and Monster could contribute to rise in B6 toxicity cases

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5 days ago

Concerns are mounting over an ingredient in energy drinks that has been linked to a growing number of life-altering blood toxicity cases.
Vitamin B6 is considered an essential vitamin and is widely available in a balanced diet, with a recommended daily intake of just 1.3mg — 1.7mg per day for adults.
But debilitating health problems can occur when a manufactured form of B6 — also known as pyridoxine hydrochloride, pyridoxamine, or pyridoxal — is consumed in excess.
A 250ml can of Red Bull contains 5 milligrams of Vitamin B6, a 500ml can of Mother 4.3 milligrams per serve and a 500ml can of BSC Energy 10mg.
"There's no good reason why energy drinks need to have six times the recommended daily intake of B6 in them," George Institute food policy researcher, Associate Professor Alexandra Jones told 730.
"And while it's unlikely that you would exceed the upper limit by drinking energy drinks alone, there is a subset of the population that are likely to be simultaneously consuming energy drinks and other supplements which could also contain high levels of B6," she said.
B6 is added to thousands of vitamin supplements and fortified food products — from magnesium and zinc to breakfast cereals and protein bars.
Blood test data obtained by 7.30 from Australian pathology labs Sullivan Nicolaides has revealed more than 2,700 'probable' cases of neuropathy or other health issues attributed to B6 blood toxicity have occurred since January this year.
"Typical consumption patterns mean people are getting much higher doses, not just from the individual products but multiple products," Dr Terri-Lynne South, a dietitian and GP said.
Dr South is one of several health practitioners advocating for tighter regulations — as more cases of B6 toxicity emerge.
"For the energy drinks containing 10mg of B6 — if they were vitamin supplements — they'd have to show a warning on the label," Dr South told 7.30.
"There's only one reason to have a supplement for B6 — and that's if there is proven deficiency or risk of deficiency."
The Australian and New Zealand Food Standards agency (FSANZ) set the limit for B6 in energy drinks at 10mg per day, around the time Red Bull entered the Australian market.
"Formulated caffeinated beverages must carry an advisory statement that no more than a 'one-day quantity' should be consumed if they contain certain substances, including vitamin B6," a spokesperson told 7.30.
Last month the country's medicines regulator, the Therapeutic Goods Administration (TGA), made several recommendations
It called for vitamin supplements with more than 50mg of B6 to be taken off shelves and moved behind pharmacy counters.
A TGA delegate last month wrote that FSANZ should consider the "appropriateness of the 10 mg limit for vitamin B6 in formulated caffeinated beverages, considering the risks from the use of multiple products containing Vitamin B6."
The same delegate also described the benefits of synthetic B6 as 'negligible', said labelling is 'inconsistent' and 'confusing' and called on the multi-billion-dollar complementary medicines sector to initiate education campaigns.
A spokesperson for FSANZ said: "If evidence emerges that consumers are regularly exceeding safe intake levels, FSANZ would consider raising a proposal to review the current permissions."
FSANZ did not answer questions regarding how it monitors such evidence.
Ms Jones said the agency typically prioritises cases where the adverse effects are immediate, not cumulative.
"They're very focused on the immediate health risks of a product, so whether it would make you sick overnight, for example," she said.
Geoff Parker, the CEO of the Australian Beverages Council issued a statement on behalf of Australia's energy drinks companies.
He didn't answer 7.30's questions and instead compared his sector's products against complementary medicines.
"Laws regulating energy drinks in Australia are among the most stringent in the world," he told 7.30.
"Some popular multivitamin supplements contain about 25 mg of B6 — at least five times the average B6 in energy drinks sold in Australia.
"The ... upper level of safe intake [is] 50 mg a day for adults. The average level of B6 in energy drinks sold in Australia is approximately 2.1mg for a 250ml serve."
The regulations however don't prevent unprecedented or unlikely cases.
Matthew* began taking Berocca daily last August after a colleague recommended it for an afternoon energy boost.
The 56-year-old has a prominent public profile and asked 7.30 not to use his real name.
"I work in a high-pressure environment ... by mid-afternoon, the energy levels start to wane ... one of my colleagues was having a Berocca — he said 'it gives you a boost', so I tried it, and it turned into a habit."
What started as a daily pick-me-up soon escalated — at times, he was having two Beroccas in one drink.
Then came the symptoms.
"I felt a tingle — some pins and needles — in my left hand, it moved up my arm, then to my right hand, then into my legs, there were terrible burning sensations."
Concerned about stroke or heart problems, he underwent tests for blood cancer and multiple sclerosis. His doctor eventually suggested a neurologist.
"I was poisoning myself while [I was] trying to work out how I've poisoned myself."
Still, he continued taking Berocca but concedes he was likely taking too much of the product.
After months of suffering came the call from his GP.
"He said 'you have to stop taking vitamin supplements'… I said, 'what are you talking about? I've never taken vitamins' And he said 'it's Vitamin B6'."
Tests revealed Matthew had nearly three times the toxic level of B6 in his bloodstream. He stopped taking Berocca immediately.
And while his symptoms improved within weeks, some burning sensations remain.
"I haven't had any peripheral neuropathy for a month," he said.
The mental toll though has been severe.
"I am so careful about the food that I put in my mouth, the restrictions I have on drinking, the fact I exercise religiously.
"I've never had serious mental issues — I'm a glass-half-full person — I don't think I've got a propensity towards depression or anything like that.
"But I certainly was depressed about this — this has rocked my world, mentally."
There are no warnings on Berocca packaging. Instead, it claims to improve physical energy "when consumed daily for 28 days."
Berocca's parent company, pharmaceutical giant Bayer, said it is "committed to consumer safety and regulatory compliance".
"All our over-the-counter products ... comply fully with TGA labelling requirements, including ingredient disclosure, dosage, and safety warnings. We will continue to abide by TGA rules and requirements."
In 2020 Monique's blood became toxic after consuming protein shakes and multivitamins, she never realised the combined B6 levels were extreme.
"It took about a year to be diagnosed," the 35-year-old told 7.30.
"The worst state that I was in was being bed-bound for about six months, once the vestibular migraine started and I lost my balance completely.
Monique believes during her recovery her symptoms were exacerbated when unwittingly consuming small amounts of B6 in a fortified drink.
"I was doing really well, I was exercising again, and carefully checking everything I was eating, but after nine months of improvement I became complacent — I didn't think to check the back of the label," she said.
Monique could not provide evidence concluding the fortified drink was a causal factor.
Dr South believes much of the marketing around B6 is misleading.
"Most of these products, promoting B-vitamins, are marketed as 'energy-giving', and that comes from the understanding that a lot of these vitamins are co-factors of generating energy in cells," she told 7.30.
"We're starting to see it in multivitamin minerals from the chemist, but we need better regulations in these higher food products, especially energy drinks.
"This increases the impetus for regulators like Food Standards Australian New Zealand the Therapeutic Goods Administration to coordinate together, because it's about the cumulative risks of this amount of B6 being in our food supply.
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