Vitamin B5 (Pantothenic Acid)

What is pantothenic acid and what does it do in the body?

Pantothenic acid (vitamin B5) is a water-soluble essential nutrient known for its main role in the synthesis of coenzyme A (CoA) and acyl carrier protein. CoA is required for fatty acid synthesis and breakdown, transfer of acetyl and acyl groups, and many synthetic and degradative reactions; the main job of acyl carrier protein is fatty acid synthesis. ^[1] EFSA likewise states that pantothenic acid is a component of CoA and acyl carrier protein, that it is ubiquitous, and that deficiency is rare. ^[2]

According to NIH, about 85% of the pantothenic acid in foods is in the form of CoA or phosphopantetheine; digestive enzymes convert these to pantothenic acid, which is absorbed in the intestine. Gut flora also produce pantothenic acid, but their contribution to the amount absorbed is unknown. Most pantothenic acid in tissues is in the form of CoA. ^[1]

How much pantothenic acid is needed daily?

There is no RDA for pantothenic acid; the US Food and Nutrition Board, on which NIH relies, found insufficient data to set an average requirement and therefore set adequate intake (AI) values based on usual population intakes: 5 mg for adults aged 14 and over, 6 mg in pregnancy, and 7 mg in lactation. ^[1] EFSA (2014) could not derive an average requirement or population reference intake because no suitable biomarker was available and data on intake–health outcomes were very limited, and set AIs instead: 5 mg/day for adults (same in pregnancy), 7 mg/day in lactation, 3 mg/day for infants older than 6 months, 4 mg/day for children, and 5 mg/day for adolescents; the values are based on intakes observed in the EU and the absence of deficiency signs. ^{[2] [3]}

In Türkiye, a 2008 book published on the HSGM (General Directorate of Public Health) website gives the daily requirement as 4–7 mg. ^[7] The three values come from different institutions and criteria; none is an individual dose. NIH writes that a typical mixed diet in the US provides about 6 mg per day, which suggests most people get enough; in New Brunswick, Canada, mean intake in 1996–1997 was found to be 4.0 mg in women and 5.5 mg in men. ^[1] EFSA, for its part, reports that in eight EU countries mean or median intake in adults (under about 65 years) was 3.2–6.3 mg/day. ^[3]

Which foods contain pantothenic acid?

According to NIH, it is found in almost every plant and animal food; the richest sources include beef, chicken, organ meats, whole grains, and some vegetables, and it is added to some breakfast cereals and beverages (including energy drinks). According to limited data, 40–61% (on average half) of the amount in foods is absorbed; food processing can cause losses from 20% to nearly 80%. ^[1]

The table uses NIH’s US servings and the US Daily Value (DV) of 5 mg for adults; 20% and above counts as a “high source,” so milk and egg are not high sources. ^[1] In Türkiye, the book on the HSGM website states that adequate intake is achieved by eating all animal and plant foods; it also writes that pantothenic acid dissolves in water, passes into cooking water, and is sensitive to acids and alkalis. ^[7]

How common is B5 deficiency?

According to NIH, because it is found in nearly all foods, deficiency is rare outside severe malnutrition and, when seen, is usually accompanied by other deficiencies; this makes it hard to separate effects specific to pantothenic acid. People known to develop deficiency are those fed a diet containing almost no pantothenic acid or given an antagonist of pantothenic acid metabolism. Based on the experience of World War II prisoners of war and on pantothenic acid–free diet–antagonist studies, deficiency has been associated with numbness and burning in the hands and feet, headache, fatigue, restlessness, disturbed sleep, and digestive disorders with loss of appetite. ^[1] EFSA also lists the symptoms as mood changes and sleep, neurological, cardiac, and gastrointestinal disorders. ^[2]

Status measurement is not routine. According to NIH, urinary levels are the most reliable indicator because they correlate closely with intake; urinary excretion on a typical US diet is about 2.6 mg per day, and excretion below 1 mg per day suggests deficiency. Whole-blood levels in the range of 1.6–2.7 µmol/L are considered normal and below 1 µmol/L low; plasma levels do not correlate well with intake. ^[1] EFSA states that no threshold value has been set for any biomarker and that no biomarker suitable for deriving an AR was found. ^[3] For this reason, the inference “I am tired, so I must have a B5 deficiency” cannot be made; the symptoms are nonspecific.

What is PKAN and how does it relate to B5?

Mutations in the pantothenate kinase 2 (PANK2) gene reduce the activity of the pantothenate kinase enzyme, which carries out the main step of CoA synthesis, and cause a rare inherited neurodegeneration called PKAN. According to NIH, the disease involves iron accumulation in the brain; dystonia, spasticity, and pigmentary retinopathy may occur, progression is rapid, and treatment is mainly aimed at relieving symptoms. Whether pantothenate supplementation is useful in PKAN is unknown; some anecdotal reports suggest that supplementation may reduce symptoms in atypical PKAN. ^[1] PKAN is described as an inherited enzyme disorder.

Does pantethine lower cholesterol?

According to NIH, the role of pantothenic acid in triglyceride synthesis and lipoprotein metabolism has led to the hypothesis that supplementation might reduce lipids in hyperlipidemia. In some clinical studies, pantethine (a dimer of pantetheine, a derivative of pantothenic acid) lowered lipids when taken in large amounts; pantothenic acid itself does not appear to show the same effect. In a 2005 review reported by NIH, 28 small clinical trials (mean sample size 22 people) examined the effect of pantethine supplements (median daily dose 900 mg, mean 12.7 weeks) in a total of 646 adults with hyperlipidemia; on average, triglycerides were reported to fall by 14.2% at month 1 and 32.9% at month 4. ^[1] The studies are small (mean 22 people) and short; the results are therefore not considered definitive.

In more recent double-blind studies, the effect is small. In the 120-person randomized study by Rumberger et al. (North Americans at low-to-moderate cardiovascular risk; therapeutic lifestyle change diet maintained, 60 people in each group), pantethine produced significant reductions compared with placebo at 16 weeks of 6 mg/dL (3%) in total cholesterol, 4 mg/dL (4%) in LDL, and 4 mg/dL (5%) in apolipoprotein B; the authors note that the absolute effect is small. Among the authors are two people (Azumano and Kamiya) who are reported as company employees in the Evans article. ^[4] In the three-blind, 32-person study by Evans et al., LDL cholesterol was significantly lower than placebo at weeks 8 and 16 (an 11% fall from baseline with pantethine, a 3% rise in the placebo group). According to the disclosures in the PMC full text, the study was run with a company’s support and three authors are employees of two companies. ^[5] NIH reports that two studies by the same research group (152 people in total) found small but significant reductions in total, LDL, and non-HDL cholesterol at 16 weeks, that raising the dose from 600 to 900 mg/day did not increase the effect, and that the diet-independent effect of pantethine is uncertain. ^[1]

In a double-blind study in China comparing pantethine with CoA in 216 adults with hypertriglyceridemia, triglycerides fell 16.5% from baseline in the pantethine group, but NIH notes that part of this reduction may have come from the dietary counseling given to participants. ^[1] For this reason, grade C has been given for pantethine and grade E for pantothenic acid itself.

Is B5 good for acne?

In the 12-week double-blind, placebo-controlled study by Yang et al., adults with mild-to-moderate facial acne received “a pantothenic acid–based dietary supplement” or placebo; 48 people were enrolled and 41 could be evaluated. At week 12, total lesion count decreased significantly compared with placebo (p=0.0197); inflammatory lesions and a quality-of-life measure also changed in the same direction. The authors noted that more randomized studies are needed. ^[6] According to the PMC full text, the study’s sponsor is a marketing company, the article processing fee was paid by another company, and the authors reported no conflict of interest; the product’s contents are described in the article only as “pantothenic acid–based,” so it is unclear whether the effect can be attributed to pantothenic acid alone. ^[6]

B5 safety and interactions

According to NIH, the Food and Nutrition Board could not set a tolerable upper intake level (UL) for pantothenic acid because there are no reports of toxicity at high intakes in humans; some people taking high doses such as 10 g per day develop mild diarrhea and gastrointestinal discomfort, and the mechanism is unknown. ^[1] EFSA reports that SCF (2002) found low toxicity and that, although a UL could not be derived, clinical studies using doses up to 2 g per day show that amounts far above observed intakes do not pose a health risk for the general population; it adds that biotin and pantothenic acid share a common transport mechanism in vitro, but that the nutritional impact is unknown. ^[2]

NIH writes that pantothenic acid has no known clinically significant drug interactions. In supplements, pantothenic acid is found alone, in B-complex products, or in multivitamin-mineral products; calcium pantothenate or pantethine is mostly used, and there are no studies comparing the bioavailability of these forms. The amount ranges from about 10 mg in multivitamin products to 1,000 mg in B-complex or single-ingredient products. ^[1]

What is B5’s status in Türkiye?

As a supplement, pantothenic acid falls under the Ministry of Agriculture and Forestry’s Turkish Food Codex Communiqué on Dietary Supplements (2013/49). According to the current consolidated text with its amendments, the Communiqué requires that only those vitamins and minerals listed in Annex-1 be used, in the forms specified in Annex-2, and that daily maximum limits comply with Annex-3; it does not permit statements on labels, presentation, or advertising that claim to prevent, treat, or cure disease; and it prohibits the production and marketing of dietary supplements for infants and young children under 2 years (before the amendment of November 21, 2015, this limit was 4 years); products aimed at the 2–4 age group are evaluated separately by the Ministry. ^[8] Presenting a supplement as a treatment for a condition such as acne cannot appear on labels and in advertising within this framework.

Evidence table: claim, population, and limits

This guide does not recommend personal doses; use of pantethine or high-dose pantothenic acid, lipid-lowering medications, and unexplained complaints are evaluated with a physician.