Pantothenic acid is the forgotten B vitamin. This may be because it is very easy to get from the diet if you are eating real food (and even if you’re eating not great food). Its name reflects this – pantothenic comes from the Greek word “pantothen”, which means “from everywhere”. Pantothenic acid is widely available in many dietary sources—and the body can recycle it from other molecules, helping maintain adequate levels even when intake from the diet is low. For this reason, it can even be hard to create pantothenic acid deficiency in an experimental, controlled setting.

Just because it’s rare, though, doesn’t mean that deficiency isn’t possible—it has been seen in prisoners of war, and several studies have created conditions to examine what happens when we don’t have it. Symptoms include a generalized feeling of malaise, irritability, numbness and tingling in the hands and feet, insomnia, elevated heart rate, cramps, nausea, accumulation of fat in the liver and around the kidneys, and damage to the brain. In fact, a 2020 study described a case of dementia very similar to Alzheimer’s disease in which the cause was pantothenic acid deficiency. When the B5 was replenished, the symptoms resolved. And while we think that pantothenic acid deficiency is very rare, some groups may be at higher risk. For example, alcohol is kind of like an anti-B5 toxin; drinking may decrease B5 levels. If absorption in the gut isn’t working properly, from dysbiosis or inflammation, this might also affect B5 levels. Highly restrictive diets might lead to B5 deficiency. Rare genetic disorders can affect pantothenic acid metabolism (specifically, a condition called pantothenate kinase-associated neurodegeneration, or PKAN). Certain medications might affect B5 absorption (for example, broad spectrum antibiotics). And periods of rapid growth and cell turnover can increase need for pantothenic acid—recovery from surgery or illness, pregnancy, growth spurts, etc.

What does pantothenic acid do? It does a lot of things. Most importantly, it is a precursor for two proteins, called coenzyme A (CoA) and acyl carrier protein (ACP), both of which play critical roles in numerous processes. These include fatty acid synthesis and breakdown, carbohydrate metabolism, synthesis of myelin in the brain, transformation of serotonin to melatonin (the sleep hormone), making hemoglobin, building acetylcholine (a neurotransmitter), and clearing toxins from the body (especially ammonia, which is a byproduct of protein metabolism). It works very closely with the other B vitamins to support these processes.

How much pantothenic acid do you need? The recommended daily allowance (RDA) for most adults is 5 mg per day (it’s a bit higher for pregnant and lactating women). This can be reached with lots of foods: meat, fish, other animal products (liver, kidneys, and eggs especially), whole grains and legumes, vegetables, dairy products, nuts and seeds…remember it is “from everywhere”. Half a teaspoon of unfortified nutritional yeast provides enough pantothenic acid for a day. But while pantothenic acid is everywhere, some foods don’t have much. Refining flours removes about half of it, and it isn’t added back in (unlike other B vitamins). In general, heavily processed foods or heavily cooked foods have very little pantothenic acid.

If you don’t get enough pantothenic acid in your diet (which is the easiest way to get it), it is safe to supplement, and it has no upper limit of tolerability (unlike niacin). Most multivitamins and B complexes contain pantothenic acid, and several forms are available. Pantothenate is the most commonly used form and is one of the forms available in food. Pantethine is another one, though it is typically used at higher doses to lower cholesterol levels or treat fatty liver—in one study, doses of 600 mg daily helped reduced liver and visceral fat. Dexpanthenol is another one, though this is usually used topically—it is good for supporting the skin barrier, moisturizing, and wound healing. If you aren’t sure if you are getting enough, you can check your levels. Since deficiency is quite rare, it isn’t included in common micronutrient tests like the Nutreval, but pantothenate levels can be checked through Quest or Labcorp.

In summary, pantothenic acid—B5—is everywhere. That doesn’t mean it isn’t important, and while deficiency is rare, it isn’t impossible. Minimally processed foods are great sources, and it is safe to supplement if needed. If you have any signs that could be linked to deficiency (fatigue, irritability, numbness and tingling, etc) it may be worth checking your levels, or just trying to make sure you are getting enough in your diet (maybe by adding a few teaspoons of nutritional yeast to your salad).

Are you getting enough B5?

References

1.         Masterjohn, C. Vitamin B5: Pantothenic Acid. Harnessing the Power of Nutrients. Published June 27, 2022. https://chrismasterjohnphd.substack.com/p/vitamin-b5-pantothenic-acid

2.         FoodData Central. https://fdc.nal.usda.gov/fdc-app.html#/food-details/719244/nutrients

3.         Cao D, Heughebaert L, Boffel L, Stove C, Van Der Straeten D. Simultaneous quantification of seven B vitamins from wheat grains using UHPLC-MS/MS. Food Chem. 2024;453:139667. doi:10.1016/j.foodchem.2024.139667

4.         The Effects of Pantethine on Fatty Liver and Fat Distribution. 2024. https://www.jstage.jst.go.jp/article/jat1994/7/1/7_1_55/_article

5.         Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol. 2002;3(6):427-433. doi:10.2165/00128071-200203060-00005

6.         Tahiliani AG, Beinlich CJ. Pantothenic acid in health and disease. Vitam Horm. 1991;46:165-228. doi:10.1016/s0083-6729(08)60684-6

7.         Xu J, Patassini S, Begley P, et al. Cerebral deficiency of vitamin B5 (d-pantothenic acid; pantothenate) as a potentially-reversible cause of neurodegeneration and dementia in sporadic Alzheimer’s disease. Biochem Biophys Res Commun. 2020;527(3):676-681. doi:10.1016/j.bbrc.2020.05.015

8.         Shibata K, Fukuwatari T, Higashiyama S, Sugita C, Azumano I, Onda M. Pantothenic acid refeeding diminishes the liver, perinephrical fats, and plasma fats accumulated by pantothenic acid deficiency and/or ethanol consumption. Nutr Burbank Los Angel Cty Calif. 2013;29(5):796-801. doi:10.1016/j.nut.2013.01.002

9.         Moiseenok AG, Kanunnikova NP. Brain CoA and Acetyl CoA Metabolism in Mechanisms of Neurodegeneration. Biochem Biokhimiia. 2023;88(4):466-480. doi:10.1134/S000629792304003X