Introduction
Pantothenic acid (vitamin B5) is a water-soluble vitamin that is widely distributed
in nature. In fact, the name comes from Greek "panthos," which means "everywhere"
or "ubiquitous." Pantothenic acid is essential to many animals for growth,
reproduction, and normal physiological function. Good sources of pantothenic
acid include liver and kidney, poultry, beef, pork, fish, shellfish, lobster,
eggs, milk, yogurt, soybeans, lentils, nuts, split peas, avocado, broccoli,
sweet potatoes, mushrooms, yeast, whole grains, and royal jelly, and it is
most bioavailable from animal sources. Pantothenic acid is easily destroyed
by heat, freezing, and canning.
In the body, pantothenic acid is used to form coenzyme A and 4'-phosphopantetheine,
both of which play important roles in over 100 metabolic reactions. Coenzyme
A (CoA) is involved in the metabolic release of energy from macronutrients
– especially fats – from the TCA cycle, metabolism of drugs and toxins in
the liver, and the synthesis of lipids, acetylcholine, steroid hormones,
porphyrins, hemoglobin, and melatonin. Because of the wide variety of roles
CoA plays in the body, the utilities of supplemental pantothenic acid are
many.
Deficiency vs. optimal levels
Deficiency of pantothenic acid is very rare in humans. One of the only instances
is World War II POWs, which experienced numbness and burning in their feet
which was relieved by administration of pantothenic acid. If humans are fed
a diet low in pantothenic acid, clinical signs of deficiency do not develop,
although nitrogen retention is impaired and some subjects complain of excessive
fatigue. This lack of a profound effect is presumably due to the fact that
bacteria in the intestine produce pantothenic acid, and it can to a large
extent be preserved and recycled. When human subjects are given a pantothenic
acid antagonist, headache, fatigue, insomnia, intestinal discomfort, numbness
of hands and feet, depression, cardiac instability, infections, and muscle
weakness develop. Animals fed a pantothenic acid free diet develop a wide
variety of symptoms, including damage to the adrenal glands, anemia, hypoglycemia,
rapid breathing and heart rate, convulsions, skin irritation, spinal nerve
damage, decreased exercise tolerance, reduced glycogen storage, greying of
fur (in mice), hair loss, growth retardation, diarrhea, paralysis, ulcers,
elevated serum triglycerides and free fatty acids, functional impairment
of all systems of the body, and death. These symptoms demonstrate that pantothenic
acid plays many roles in the body. In some cases, administration of an antibiotic
is necessary to produce a deficiency in animals.
The fact that deficiencies are very rare does not mean that pantothenic acid
supplementation will have no significant benefit. Increasing dietary pantothenic
acid above normal levels increases levels of both the vitamin and CoA in
many tissues in a dose-dependent manner, and as we shall see, this can have
a multitude of effects.
Pantothenic acid and acne
The most publicized benefit of pantothenic acid supplementation is acne reduction.
This is based solely on the many writings of Lit-Hung Leung, M.D., that espouse
the many benefits of pantothenic acid. His acne-reduction hypothesisis is
based on numerous faulty and outdated assumptions. His basic idea is that
synthesis of androgens and hormones as well as fatty acid metabolism "uses
up" CoA, which disallows it from metabolizing the lipids in the skin that
are responsible for acne. One of his supporting claims is that exogenous
androgen administration does not result in acne, and this is not the case.
Many of the other ideas on which his hypothesis is based are equally erroneous.
However, the hypothesis may have at least some merit, in that elevated CoA
may accelerate the breakdown of skin oils that play a role in the etiology
of acne.
Despite the faulty assumptions at the base of the hypothesis, many supplement
companies glorified it and this lead to the widespread use of pantothenic
acid for acne reduction. Additionally, Dr. Leung did a study in which large
doses of pantothenic acid were administered to 100 Chinese individuals, largely
between ages 13 and 23, with significant results. However, this study also
involved combined treatment with B5 cream (which many proponents neglect
to mention) and was also not controlled. Study conclusions, such as "more
beautiful skin," also call the scientific merit into question.
Despite all of these objections, the overwhelming amount of positive user
feedback on message boards and non-commercial websites leads one to believe
that there may be something to this claim. Indeed, there are many other theoretical
reasons in support of this idea. For one, acne is an inflammatory condition,
and pantothenic acid has a pronounced antiinflammatory effect in skin tissue,
even after oral administration to humans. Pantothenic acid also increases
the level of zinc in injured and inflamed skin, and there is a wide research
base indicating that zinc causes significant acne reduction both orally and
topically. Pantothenic acid also effectively metabolizes many toxins, some
of which may possibly play a role in the formation of acne. These effects,
along with the possibility of accelerated lipid breakdown, provide a good
theoretical basis for the effects which are commonly reported. The only thing
that is missing is an adequately controlled study, but until then the present
data, combined with the low price and toxicity of pantothenic acid, justify
use for this condition in those that are searching for options.
Skin health
Perhaps the most well established benefit of pantothenic acid is accelerated
wound and scar healing, especially with skin wounds. This effect is more
pronounced when coadministered with vitamin C and has been determined using
many study designs, including cell cultures, animal studies, and oral administration
to humans. Evidence from both in vitro and in vivo studies indicates that
the effect is due to decreased levels of iron at the wound site (thus preventing
free radical formation) and facilitation of collagen and protein synthesis.
Pantothenic acid also promotes wound healing in the respiratory tract and
cornea.
Pantothenic acid may also protect against some of the effects of radiation.
When administered to rats, calcium pantothenate protects against or even
prevents many of the negative effects of irradiation on the epidermis. In
vitro, pantothenic acid is known to protect a variety of cell types from
UV radiation by increasing glutathione levels.
Exercise performance and weight loss
There is limited information on the use of pantothenic acid for the athlete,
and it is likely to have only a minimal effect if any. One study in rats
found the combination of pantothenic acid, propionyl-carnitine, coenzyme
Q10, nicotinamide, and riboflavin to increase muscular work capacity by 160%.
Because multiple ingredients were used, it cannot be determined what role
pantothenic acid played in the increased muscular performance. A study in
various athletes found that over 30% had blood levels of pantothenic acid
below the lower limit, and this could theoretically reduce the efficiency
of energy metabolism. In a double-blind study with six cyclists, a mixture
of 1.8 g of pantothenic acid and pantethine (a derivative of pantothenic
acid) and 1 g of allithiamin for seven days decreased the time to complete
a 2000-m time trial by 7.5 seconds, but this difference was not statistically
significant.
Dr. Leung (proponent of the acne hypothesis) has also proposed that pantothenic
acid will aid in weight loss. Unfortunately, his reasoning is skewed and
absurd and must be dismissed, along with his open study finding significant
weight loss in a group of individuals administered pantothenic acid and simultaneously
put on 1000 kcal diets.
Other benefits
Alcohol administration drastically lowers levels of pantothenic acid, which
can deplete the body of CoA and acetylcholine. Supplementation with pantothenic
acid reverses this, and also protects against some of the disturbances in
motor function caused by alcohol. Pantothenic acid also protects the body
from a variety of other toxins, including phenols and carbon tetrachloride.
Pantothenic acid has also been reported to protect the liver and heart from
injury due to oxidative stress (presumably by elevating glutathione levels).
Experimental and epidemiological studies have found a link between low levels
of pantothenic acid and the development of hypertension. Other possible benefits
identified in the literature are reduced stress and treatment of hepatitis
A, alopecia, deafness, hyperammonia, and osteoarthritis.
Dosage and safety
The Adequate Intake for pantothenic acid has been set at 5 mg daily, and
this is usually met through the diet, but this dose is miniscule compared
to supplemental dosages. The dosage most commonly used to treat acne is 5
g daily, although it can go as high as 15-20 g daily. Sometimes a loading
phase is employed followed by a smaller dose. For most other purposes the
dose is much lower. 1 g of pantothenic acid along with 3 g of vitamin C improved
wound healing. For general health, the recommendation is 100-500 mg daily.
One report classified pantothenic acid as a category C nutrient, meaning
it was harmless at doses far exceeding the RDA. Those who take large doses
(10-20 g) for acne treatment commonly report diarrhea and occasionally heartburn
or nausea. No serious adverse effects have been reported in this dosage range.
Pantothenic acid exhibits synergistic effects with vitamins C, B6, and B12,
and can improve utilization and may correct deficiency of these vitamins.
If you have any questions or comments regarding this article, please email
dvdtlsn@bulknutrition.com.
No part of this article may be reproduced in any form without the permission of David Tolson or Mike McCandless. 
