Pantothenic Acid

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 produce 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 the following:

• 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].

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.

*DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for pantothenic acid is 5 mg for adults and children age 4 years and older [8]. FDA does not require food labels to list pantothenic acid content unless pantothenic acid has been added to the food. 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) FoodData Central [7] lists the nutrient content of many foods and provides a comprehensive list of foods containing pantothenic acid arranged by nutrient content.

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 [9]. Some supplements contain pantethine (a dimeric form of pantetheine) or more commonly, calcium pantothenate [4,9-11]. 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 [9].

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 [12]. 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 [13].

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 [1,4,6,14,15].

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 [2,4,16]. Its progression is rapid and leads to significant disability and loss of function [16]. Treatment focuses primarily on reducing symptoms [17]. 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 [18].

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 [19].

Several clinical trials have shown that the form of pantothenic acid known as pantethine reduces lipid levels when taken in large amounts [20], 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 [20]. 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 [21]. 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 [19,22]. 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 [1,23].

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 2020–2025 Dietary Guidelines for Americans notes that "Because foods provide an array of nutrients and other components that have benefits for health, nutritional needs should be met primarily through foods. ... In some cases, fortified foods and dietary supplements are useful when it is not possible otherwise to meet needs for one or more nutrients (e.g., during specific life stages such as pregnancy)."

For more information about building a healthy dietary pattern, refer to the Dietary Guidelines for Americans and the USDA's MyPlate.

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

• Includes a variety of vegetables; fruits; grains (at least half whole grains); fat-free and low-fat milk, yogurt, and cheese; and oils.
  • Many vegetables, whole grains, and dairy products contain pantothenic acid.
• Includes a variety of protein foods such as lean meats; poultry; eggs; seafood; beans, peas, and lentils; nuts and seeds; and soy products.
  • ​​​​​​​Fish, beef, poultry, eggs, beans, and nuts contain pantothenic acid.
• Limits foods and beverages higher in added sugars, saturated fat, and sodium.
• Limits alcoholic beverages.
• Stays within your daily calorie needs.

Updated: March 26, 2021 History of changes to this fact sheet