Is Carpal Tunnel Syndrome Caused by Inadequate Vitamin B-6 and B-2?
by Jack Challem
Ten years ago, carpal tunnel syndrome was most often seen in factory workers, secretaries, and supermarket cashiers whose jobs required them to repeat the same hand and wrist movements thousands of times a day. Instead of suffering from simple soreness, CTS patients progressively developed finger stiffness in the morning, a weakened grip, and crippling pain in the hands and wrists.
With the widespread use of personal computers, the incidence of carpal tunnel syndrome-referring specifically to an injured nerve in the wrist-has soared across professions. Surgery is considered the primary treatment among conventional physicians, just as it was 10 years ago.
But surgery doesn't treat the cause of CTS. And the mainstream medical theory that repetitive movement causes CTS is mere "ergonomics talk," says John Ellis, M.D., of Mt. Pleasant, Texas, and an expert in vitamin B-6. "There are big dollars tied up in surgery for carpal tunnel syndrome. For $3, I can cure CTS in better than 90 percent of patients."1
His $3 cure is a bottle of vitamin B-6 (pyridoxine) tablets, available at any health food store. Indeed, several well-controlled studies-some conducted by Ellis himself-show that severe B-6 deficiency causes CTS. Repetitive movement, however, may aggravate the condition.
Ellis made the connection between B-6 deficiency and CTS more than 20 years ago. Women who were either pregnant or taking oral contraceptives were known to have increased requirements for B-6, as were diabetics. All three groups also had a higher than average incidence of CTS.
One of Elliss patients was a 40-year-old man with hands crippled by CTS. His diet left a lot to be desired: he skipped breakfast, ate only a sandwich and soft drink for lunch and, for dinner, a soup made from vegetables and hamburger. To assess his patient's B-6 intake, Ellis measured blood levels of erythrocyte glutamic oxaloacetic transminase (EGOT), an enzyme that reflects B-6 activity in the body. At first, the man's EGOT levels were near rock bottom, typical of CTS patients.
Ellis started him on 2 mg. of B-6 daily, the Recommended Dietary Allowance. After two months, the patient's EGOT levels increased a little and he showed "slight clinical improvement." When Ellis increased the dose to 100 mg daily, his patient's EGOT levels zoomed, peaking after two months. At the same time, his CTS symptoms receded-and completely disappeared.
Then Ellis slipped the patient an identical-looking placebo but didn't tell him. Within days, "the patient strongly complained that pyridoxine was no longer effective...(and) his symptoms returned." After resuming the B-6 supplements, his symptoms again disappeared.2
However, vitamin B-6 is not an overnight cure for CTS. Taking the vitamin long enough is as important as taking the right dose. In fact, Ellis learned his lesson when a six-week study failed to help patients. "You need 90 days' running room," he explained to Natural Health. "It takes four to six weeks to get these enzymes loaded to get them functioning well biochemically, and another four to six weeks for the symptoms to recede-roughly three months.
"For 90 days, you need to take 100 mg. after breakfast and 100 mg. after dinner, adding up to 200 mg daily. If you're a diabetic age 11 or older, you need a total of 300 mg daily. All of this has been proved safe, including for people with diabetes or who are pregnant. I have taken at least 50 mg. B-6 daily for 30 years, starting in 1962. A few years ago, I crept up to 100 mg daily. And over the last two years, I began taking 300 mg daily, so I can tell a patient to take 200 mg. daily and that it's safe."
Although Ellis has successfully treated CTS patients with only B-6, vitamin B-2 (riboflavin) may also help, according to Karl Folkers, Ph.D. "People are rarely deficiency in only one nutrient," said Folkers, a researcher at the University of Texas Institute for Biochemical Research, Austin, and frequent collaborator with Ellis. "Most forms of pyridoxine are inactive. They need B-2 to be converted to the active form, pyridoxal 5'-phosphate."3,4
In fact, while Folkers found B-2 helpful in reducing CTS symptoms, a combination of B-2 and B-6 was most effective. In one case, Folkers gave a 32-year-old man 50 mg. of B-2 for 5 months. Although the patient's condition improved significantly, he still suffered occasional symptoms. Then Folkers added 500 mg. of B-6 daily to the patient's regimen. After another three months, his CTS symptoms disappeared completely.5
While the precise biochemical link between B-6 and CTS isn't clear, Ellis does have a general idea of how it helps. Vitamin B-6 is essential for the body's production of 18 of the 20 most important amino acids and for 118 known enzymes-"for life itself," said Ellis. He added that a B-6 deficiency reduces the effectiveness of collagen and elastin fibrils, needed to cement tissues together. Impaired collagen and elastin synthesis could make tissues more susceptible to injury.
Although Ellis has not seen any side effects of high doses of B-6 in CTS patients, there is some risk of peripheral neuropathy. Ironically, peripheral neuropathy includes the same tingling, numbness, and weakness characteristic of CTS. When these symptoms are caused by excessive B-6, they do go away within a few months of stopping the supplement. And because B-6 is a diuretic-it reduces the edema also associated with CTS-it's probably worthwhile to add magnesium (100 mg.) and potassium (50 mg.) supplements while taking B-6.
Because CTS symptoms can range from simple stiffness to crippling of the hands, it's probably best to work with a physician. However, Ellis has no qualms about people treating themselves, as long as they try B-6 for the requisite 90 days. He insists it's safe.
"The problem (CTS) will continue as long as people eat overcooked, over-baked, canned, bottled, packed foods that are deficient in B-6," Ellis said. "We need to change how we eat. People need more B-6."
1 Telephone interview, February 4, 1993. 2 Folker, K, and Ellis, J, Annals of the New York Academy of Sciences, 1990;585:295-301 3 Telephone interview, February 4, 1993. 4 Pyridoxal 5'-phosphate is pronounced "pyridoxal 5-prime phosphate." 5 Folkers, K, Proceedings of the National Academy of Sciences, 1984;81:7076-78.
This article originally appeared in Natural Health magazine. The information provided by Jack Challem and The Nutrition Reporter™ newsletter is strictly educational and not intended as medical advice. For diagnosis and treatment, consult your physician.
Copyright 1994 by Jack Challem, The Nutrition Reporter