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Pantothenic Acid

Fact Sheet for Health Professionals
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Introduction

Pantothenic acid (also known as vitamin B5) is an essential nutrient that is naturally present in some foods, added to others, and available as a dietary supplement. The main function of this water-soluble B vitamin is in the synthesis of coenzyme A (CoA) and acyl carrier protein [1,2]. CoA is essential for fatty acid synthesis and degradation, transfer of acetyl and acyl groups, and a multitude of other anabolic and catabolic processes [3,4]. Acyl carrier protein’s main role is in fatty acid synthesis [2].

A wide variety of plant and animal foods contain pantothenic acid [1]. About 85% of dietary pantothenic acid is in the form of CoA or phosphopantetheine [2,4]. These forms are converted to pantothenic acid by digestive enzymes (nucleosidases, peptidases, and phosphorylases) in the intestinal lumen and intestinal cells. Pantothenic acid is absorbed in the intestine and delivered directly into the bloodstream by active transport (and possibly simple diffusion at higher doses) [1,2,4]. Pantetheine, the dephosphorylated form of phosphopantetheine, however, is first taken up by intestinal cells and converted to pantothenic acid before being delivered into the bloodstream [2]. The intestinal flora also produces pantothenic acid, but its contribution to the total amount of pantothenic acid that the body absorbs is not known [4]. Red blood cells carry pantothenic acid throughout the body [4]. Most pantothenic acid in tissues is in the form of CoA, but smaller amounts are present as acyl carrier protein or free pantothenic acid [1,4].

Pantothenic acid status is not routinely measured in healthy people. Microbiologic growth assays, animal bioassays, and radioimmunoassays can be used to measure pantothenic concentrations in blood, urine, and tissue, but urinary concentrations are the most reliable indicators because of their close relationship with dietary intake [1,4]. With a typical American diet, the urinary excretion rate for pantothenic acid is about 2.6 mg/day [3,5]. Excretion of less than 1 mg pantothenic acid per day suggests deficiency [1,6]. Like urinary concentrations, whole-blood concentrations of pantothenic acid correlate with pantothenic acid intake, but measuring pantothenic acid in whole blood requires enzyme pretreatment to release free pantothenic acid from CoA [1]. Normal blood concentrations of pantothenic acid range from 1.6 to 2.7 mcmol/L, and blood concentrations below 1 mcmol/L are considered low and suggest deficiency [1,4]. Unlike whole-blood concentrations, plasma levels of pantothenic acid do not correlate well with changes in intake or status [1].

Recommended Intakes

Intake recommendations for pantothenic acid and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine [3]. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:

  • Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
  • Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
  • Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
  • Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects.

When the FNB evaluated the available data, it found the data insufficient to derive an EAR for pantothenic acid. Consequently, the FNB established AIs for all ages based on usual pantothenic acid intakes in healthy populations [3]. Table 1 lists the current AIs for pantothenic acid [3].

Table 1: Adequate Intakes (AIs) for Pantothenic Acid [3]
Age Male Female Pregnancy Lactation
Birth to 6 months 1.7 mg 1.7 mg    
7–12 months 1.8 mg 1.8 mg    
1–3 years 2 mg 2 mg    
4–8 years 3 mg 3 mg    
9–13 years 4 mg 4 mg    
14–18 years 5 mg 5 mg 6 mg 7 mg
19+ years 5 mg 5 mg 6 mg 7 mg
 

Sources of Pantothenic Acid

Food
Almost all plant- and animal-based foods contain pantothenic acid in varying amounts. Some of the richest dietary sources are beef, chicken, organ meats, whole grains, and some vegetables [4]. Pantothenic acid is added to various foods, including some breakfast cereals and beverages (such as energy drinks) [4]. Limited data indicate that the body absorbs 40%–61% (or half, on average) of pantothenic acid from foods [5].

Edible animal and plant tissues contain relatively high concentrations of pantothenic acid. Food processing, however, can cause significant losses of this compound (20% to almost 80%) [1].

Several food sources of pantothenic acid are listed in Table 2.

Table 2: Selected Food Sources of Pantothenic Acid [7]
Food Milligrams
(mg) per
serving
Percent
DV*
Breakfast cereals, fortified with 100% of the DV 10 100
Beef liver, boiled, 3 ounces 8.3 83
Shitake mushrooms, cooked, ½ cup pieces 2.6 26
Sunflower seeds, ¼ cup 2.4 24
Chicken, breast meat, skinless, roasted, 3 ounces 1.3 13
Tuna, fresh, bluefin, cooked, 3 ounces 1.2 12
Avocados, raw, ½ avocado 1.0 10
Milk, 2% milkfat, 1 cup 0.9 9
Mushrooms, white, stir fried, ½ cup sliced 0.8 8
Potatoes, russet, flesh and skin, baked, 1 medium 0.7 7
Egg, hard boiled, 1 large 0.7 7
Greek yogurt, vanilla, nonfat, 5.3-ounce container 0.6 6
Ground beef, 85% lean meat, broiled, 3 ounces 0.6 6
Peanuts, roasted in oil, ¼ cup 0.5 5
Broccoli, boiled, ½ cup 0.5 5
Whole-wheat pita, 1 large 0.5 5
Chickpeas, canned, ½ cup 0.4 4
Rice, brown, medium grain, cooked, ½ cup 0.4 4
Oats, regular and quick, cooked with water, ½ cup 0.4 4
Cheese, cheddar, 1.5 ounces 0.2 2
Carrots, chopped, raw, ½ cup 0.2 2
Cabbage, boiled, ½ cup 0.1 1
Clementine, raw, 1 clementine 0.1 1
Tomatoes, raw, chopped or sliced, ½ cup 0.1 1
Cherry tomatoes, raw, ½ cup 0 0
Apple, raw, slices, ½ cup 0 0

*DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of products within the context of a total diet. The DV for pantothenic acid used for the values in Table 2 is 10 mg for adults and children age 4 years and older [8]. This DV, however, is changing to 5 mg as the updated Nutrition and Supplement Facts labels are implemented [9]. The updated labels must appear on food products and dietary supplements beginning in January 2020, but they can be used now [10]. FDA does not require food labels to list pantothenic acid content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

The U.S. Department of Agriculture’s (USDA’s) National Nutrient Databaseexternal link disclaimer [7] lists the nutrient content of many foods and provides a comprehensive list of foods containing pantothenic acid arranged by nutrient contentexternal link disclaimer and by food name.external link disclaimer

Dietary supplements
Pantothenic acid is available in dietary supplements containing only pantothenic acid, in combination with other B-complex vitamins, and in some multivitamin/multimineral products [11]. Some supplements contain pantethine (a dimeric form of pantetheine) or more commonly, calcium pantothenate [4,11-13]. No studies have compared the relative bioavailability of pantothenic acid from these different forms. The amount of pantothenic acid in dietary supplements typically ranges from about 10 mg in multivitamin/multimineral products to up to 1,000 mg in supplements of B-complex vitamins or pantothenic acid alone [11].

Pantothenic Acid Intakes and Status

Few data on pantothenic acid intakes in the United States are available. However, a typical mixed diet in the United States provides an estimated daily intake of about 6 mg, suggesting that most people in the United States consume adequate amounts [14]. Some intake information is available from other Western populations. For example, a 1996–1997 study in New Brunswick, Canada, found average daily pantothenic acid intakes of 4.0 mg in women and 5.5 mg in men [15].

Pantothenic Acid Deficiency

Because some pantothenic acid is present in almost all foods, deficiency is rare except in people with severe malnutrition [1,4]. When someone has a pantothenic acid deficiency, it is usually accompanied by deficiencies in other nutrients, making it difficult to identify the effects that are specific to pantothenic acid deficiency [1]. The only individuals known to have developed pantothenic acid deficiency were fed diets containing virtually no pantothenic acid or were taking a pantothenic acid metabolic antagonist [3].

On the basis of the experiences of prisoners of war in World War II and studies of diets lacking pantothenic acid in conjunction with administration of an antagonist of pantothenic acid metabolism, a deficiency is associated with numbness and burning of the hands and feet, headache, fatigue, irritability, restlessness, disturbed sleep, and gastrointestinal disturbances with anorexia [1,4,6,16,17].

Groups at Risk of Pantothenic Acid Inadequacy

The following group is most likely to have inadequate pantothenic acid status.

People with a pantothenate kinase-associated neurodegeneration 2 mutation
Pantothenic acid kinase is an enzyme that is essential for CoA and phosphopantetheine production. It is the principle enzyme associated with the metabolic pathway that is responsible for CoA synthesis. Mutations in the pantothenate kinase 2 (PANK2) gene cause a rare, inherited disorder, pantothenate kinase-associated neurodegeneration (PKAN). PKAN is a type of neurodegeneration associated with brain iron accumulation [4]. A large number of PANK2 mutations reduce the activity of pantothenate kinase 2, potentially decreasing the conversion of pantothenic acid to CoA and thus reducing CoA levels [2].

The manifestations of PKAN can include dystonia (contractions of opposing groups of muscles), spasticity, and pigmentary retinopathy [2,4,18]. Its progression is rapid and leads to significant disability and loss of function [18]. Treatment focuses primarily on reducing symptoms [19]. Whether pantothenate supplementation is beneficial in PKAN is not known, but some anecdotal reports indicate that supplements can reduce symptoms in some patients with atypical PKAN [20].

Pantothenic Acid and Health

Hyperlipidemia
Because of pantothenic acid’s role in triglyceride synthesis and lipoprotein metabolism, experts have hypothesized that pantothenic acid supplementation might reduce lipid levels in patients with hyperlipidemia [21].

Several clinical trials have shown that the form of pantothenic acid known as pantethine reduces lipid levels when taken in large amounts [22], but pantothenic acid itself does not appear to have the same effects [1]. A 2005 review included 28 small clinical trials (average sample size of 22 participants) that examined the effect of pantethine supplements (median daily dose of 900 mg for an average of 12.7 weeks) on serum lipid levels in a total of 646 adults with hyperlipidemia [22]. On average, the supplements were associated with triglyceride declines of 14.2% at 1 month and 32.9% at 4 months. The corresponding declines in total cholesterol were 8.7% and 15.1%, and for low-density lipoprotein (LDL) cholesterol were 10.4% and 20.1%. The corresponding increases in high-density lipoprotein (HDL) cholesterol were 6.1% and 8.4%.

A few additional clinical trials have assessed pantethine’s effects on lipid levels since the publication of the 2005 review. A double-blind trial in China randomly assigned 216 adults with hypertriglyceridemia (204–576 mg/dl) to supplementation with 400 U/day CoA or 600 mg/day pantethine [23]. All participants also received dietary counseling. Triglyceride levels dropped by a significant 16.5% with pantethine compared with baseline after 8 weeks. Concentrations of total cholesterol and non–HDL cholesterol also declined modestly but significantly from baseline. However, these declines might have been due, at least in part, to the dietary counseling that the participants received.

Two randomized, blinded, placebo-controlled studies by the same research group in a total of 152 adults with low to moderate cardiovascular disease risk found that 600 mg/day pantethine for 8 weeks followed by 900 mg/day for 8 weeks plus a therapeutic lifestyle change diet resulted in small but significant reductions in total cholesterol, LDL cholesterol, and non-HDL cholesterol compared with placebo after 16 weeks [21,24]. Increasing the amount of pantethine from 600 to 900 mg/day did not increase the magnitude of reduction in the lipid measures.

Additional studies are needed to determine whether pantethine supplementation has a beneficial effect on hyperlipidemia independently of, and together with, eating a heart-healthy diet. Research is also needed to determine the mechanisms of pantethine’s effects on lipid levels.

Health Risks from Excessive Pantothenic Acid

The FNB was unable to establish ULs for pantothenic acid because there are no reports of pantothenic acid toxicity in humans at high intakes. Some individuals taking large doses of pantothenic acid supplements (e.g., 10 g/day) develop mild diarrhea and gastrointestinal distress, but the mechanism for this effect is not known [1,25].

Interactions with Medications

Pantothenic acid is not known to have any clinically relevant interactions with medications.

Pantothenic Acid and Healthful Diets

The federal government's 2015–2020 Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. ... Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts."

For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture's MyPlateexternal link disclaimer.

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

  • Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.
    Many vegetables, whole grains, and dairy products contain pantothenic acid.
  • Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.
    Fish, beef, poultry, eggs, beans, and nuts contain pantothenic acid.
  • Limits saturated and trans fats, added sugars, and sodium.

  • Stays within your daily calorie needs.

References

  1. Miller JW, Rucker RB. Pantothenic acid. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition. 10th ed. Washington, DC: Wiley-Blackwell; 2012:375-90.
  2. Sweetman L. Pantothenic acid. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:604-11.
  3. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.
  4. Trumbo PR. Pantothenic acid. In: Ross AC, Caballero B, Cousins RJ, et al., eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:351-7.
  5. Tarr JB, Tamura T, Stokstad EL. Availability of vitamin B6 and pantothenate in an average American diet in man. Am J Clin Nutr 1981;34:1328-37. [PubMed abstract]
  6. Hodges RE, Ohlson MA, Bean WB. Pantothenic acid deficiency in man. J Clin Invest 1958;37:1642-57. [PubMed abstract]
  7. U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28. external link disclaimerNutrient Data Laboratory Home Page, 2015.
  8. U.S. Food and Drug Administration. Guidance for Industry: A Food Labeling Guide external link disclaimer(14. Appendix F: Calculate the Percent Daily Value for the Appropriate Nutrients). 2013.
  9. U.S. Food and Drug Administration. Food Labeling: Revision of the Nutrition and Supplement Facts Labels.external link disclaimer 2016.
  10. U.S. Food and Drug Administration. Food Labeling: Revision of the Nutrition and Supplement Facts Labels and Serving Sizes of Foods That Can Reasonably Be Consumed at One Eating Occasionexternal link disclaimer; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments; Proposed Extension of Compliance Dates. 2017.
  11. National Institutes of Health. Dietary Supplement Label Database.external link disclaimer 2017.
  12. Kelly GS. Pantothenic acid. Altern Med Rev 2011;16:263-74. [PubMed abstract]
  13. Horvath Z, Vecsei L. Current medical aspects of pantethine. Ideggyogy Sz 2009;62:220-9. [PubMed abstract]
  14. Iyenga GV, Wolfe WR, Tanner JT, et al. Content of minor and trace elements, and organic nutrients in representative mixed total diet composites from the USA. Sci Total Environ 2000;256:215-26. [PubMed abstract]
  15. Provincial Epidemiology Service, New Brunswick Department of Health and Wellness. New Brunswick nutrition survey; 1997.
  16. Glusman M. The syndrome of burning feet (nutritional melalgia) as a manifestation of nutritional deficiency. Am J Med 1947;3:211-23. [PubMed abstract]
  17. Hodges RE, Bean WB, Ohlson MA, et al. Human pantothenic acid deficiency produced by omega-methyl pantothenic acid. J Clin Invest 1959;38:1421-5. [PubMed abstract]
  18. Hayflick SJ. Defective pantothenate metabolism and neurodegeneration. Biochem Soc Trans 2014;42:1063-8. [PubMed abstract]
  19. Gregory A, Hayflick SJ. Pantothenate Kinase-Associated Neurodegeneration. In: Adam MP, Ardinger HH, Pagon RA, et al., eds. GeneReviews. Seattle, WA: University of Washington, Seattle; 2017.
  20. Kurian MA, Hayflick SJ. Pantothenate kinase-associated neurodegeneration (PKAN) and PLA2G6-associated neurodegeneration (PLAN): review of two major neurodegeneration with brain iron accumulation (NBIA) phenotypes. Int Rev Neurobiol 2013;110:49-71. [PubMed abstract]
  21. Rumberger JA, Napolitano J, Azumano I, et al. Pantethine, a derivative of vitamin B(5) used as a nutritional supplement, favorably alters low-density lipoprotein cholesterol metabolism in low- to moderate-cardiovascular risk North American subjects: a triple-blinded placebo and diet-controlled investigation. Nutr Res 2011;31:608-15. [PubMed abstract]
  22. McRae MP. Treatment of hyperlipoproteinemia with pantethine: A review and analysis of efficacy and tolerability. Nutrition Research 2005;25:319-33.
  23. Chen YQ, Zhao SP, Zhao YH. Efficacy and tolerability of coenzyme A vs pantethine for the treatment of patients with hyperlipidemia: A randomized, double-blind, multicenter study. J Clin Lipidol 2015;9:692-7. [PubMed abstract]
  24. Evans M, Rumberger JA, Azumano I, et al. Pantethine, a derivative of vitamin B5, favorably alters total, LDL and non-HDL cholesterol in low to moderate cardiovascular risk subjects eligible for statin therapy: a triple-blinded placebo and diet-controlled investigation. Vasc Health Risk Manag 2014;10:89-100. [PubMed abstract]
  25. Chawla J, Kvarnberg D. Hydrosoluble vitamins. Handb Clin Neurol 2014;120:891-914. [PubMed abstract]

Disclaimer

This fact sheet by the Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.

Updated: September 17, 2018 History of changes to this fact sheet