Vitamin B5

Vitamin B5, also known as pantothenic acid, is a crucial water-soluble vitamin essential for human health.  Its primary function involves aiding in the conversion of food into energy by breaking down proteins, fats, and carbohydrates. 

Additionally, it contributes to the synthesis of red blood cells and cholesterol, and plays a pivotal role in the formation of coenzyme A, which is integral to numerous biochemical reactions within the body. 

Vitamin B5 is indispensable for maintaining a healthy nervous system and adrenal glands, vital for the production and release of some steroid hormones. Fortunately, this essential vitamin is readily available in a diverse array of foods, ranging from animal products to vegetables, ensuring most individuals meet their dietary requirements. 

Alongside its numerous health benefits, understanding testing options and potential health effects associated with vitamin B5 is imperative for maintaining optimal well-being.

Overview of B Vitamin Family

The B vitamin family comprises a group of water-soluble vitamins that play critical roles in numerous physiological processes essential for human health. 

Comprising eight distinct vitamins, it includes riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folate (B9), and cobalamin (B12), these vitamins are intricately related and often function as coenzymes in various metabolic pathways. 

VItamin B12 is the only B vitamin that can be stored in the body, in the liver.  All other B vitamins are quickly excreted through the urine, therefore they require daily repletion.  

Individually, the B vitamins contribute to energy production, DNA synthesis, nervous system function, and red blood cell formation, among other vital functions. Collectively, the B vitamins are indispensable for maintaining overall health and well-being, underscoring their importance in supporting various physiological systems within the human body.

Pantothenic Acid (Vitamin B5)

What is Pantothenic Acid? 

Pantothenic acid, also known as vitamin B5, is a water-soluble vitamin that plays a crucial role in various metabolic processes within the body. 

It is an essential component of coenzyme A (CoA), which is involved in numerous enzymatic reactions necessary for energy metabolism, particularly in the synthesis and breakdown of fatty acids. 

Furthermore, pantothenic acid is integral to the production of acyl carrier protein (ACP), which is vital for fatty acid synthesis and the production of cholesterol. 

Beyond its role in lipid metabolism, vitamin B5 is also involved in many other essential physiological processes.  

Given its essential functions, pantothenic acid deficiency can lead to a range of symptoms, including fatigue, neurological dysfunction, and gastrointestinal disturbances. Therefore, ensuring an adequate intake of vitamin B5 through dietary sources is crucial for maintaining optimal health and well-being.

Functions of Pantothenic Acid: What Does Pantothenic Acid Do in the Body?

Vitamin B5 exerts a wide range of beneficial effects on human health.  

• Vitamin B5 is essential for the synthesis of coenzyme A (CoA), a molecule involved in numerous metabolic pathways and sustaining life.some text
  • Coenzyme A plays a critical role in the metabolism of carbohydrates, fats, and proteins, facilitating the breakdown of these macronutrients for energy production.
• Pantothenic acid is necessary for the synthesis of acetylcholine, a neurotransmitter crucial for proper nerve function and communication within the nervous system.  [22.]
• Vitamin B5 is involved in the synthesis and secretion of steroid hormones such as cortisol and progesterone, which regulate metabolism, stress response, and reproductive function.  [3., 18.]
• Pantothenic acid contributes to the synthesis of heme, a component of hemoglobin involved in oxygen transport in red blood cells.  [21.]
• It supports the production of lipids, including cholesterol and fatty acids, essential for cell membrane structure and hormone synthesis.  [2.]
• Vitamin B5 plays a role in the maintenance of healthy skin, hair, and nails, contributing to their structure and integrity.
• It aids in wound healing and tissue repair by promoting cell proliferation and collagen synthesis.  [6.]
• Pantothenic acid is necessary for the proper functioning of the adrenal glands, which produce hormones involved in stress response and metabolism.  [19.] 
• It supports immune function by participating in the synthesis of antibodies and other immune-related molecules.  [6.] 
• Vitamin B5 may have antioxidant and anti-inflammatory properties, helping to neutralize harmful free radicals and reduce oxidative stress in the body.  [11., 12.]

Recommended Daily Allowance (RDA) of Pantothenic Acid

The RDA for adult men and women is 5 mg/day.  In pregnancy the RDA increases to 6 mg/day, and it is set at 7 mg/day in lactation.  [10.]  

Sources of Pantothenic Acid  [17.]

Animal sources:

• Beef liver
• Chicken liver
• Pork
• Chicken
• Turkey
• Fish (salmon, trout, tuna)
• Shellfish (crab, lobster)
• Eggs
• Dairy products (milk, yogurt, cheese)

Plant sources:

• Avocado
• Mushrooms (shiitake, portobello)
• Sunflower seeds
• Legumes (chickpeas, lentils, split peas)
• Whole grains (brown rice, whole wheat)
• Fortified breakfast cereals
• Fortified plant-based milk alternatives (soy milk, almond milk)
• Vegetables (sweet potatoes, broccoli, corn)

Including a variety of these foods in the diet can help ensure an adequate intake of pantothenic acid to support overall health and well-being.

Pantothenic Acid Forms and Supplementation Indications

Pantothenic Acid Supplement Forms

Pantothenic acid is available as a single-vitamin supplement, or as part of a B vitamin complex.   

Indications for Pantothenic Acid Supplementation  [10.]

Vitamin B5 Deficiency

Deficiency of vitamin B5 is rare but may occur in cases of severe malnutrition, presenting symptoms such as fatigue, headache, malaise, numbness, muscle cramps, nausea, and impaired muscle coordination.

Mutations in the pantothenate kinase 2 (PANK2) gene can lead to pantothenic acid inadequacy, causing symptoms associated with pantothenate kinase-associated neurodegeneration (PKAN), including dysarthria, dystonia, poor balance, spasticity, and muscle rigidity.

Dermatological Conditions

Vitamin B5, particularly in the form of dexpanthenol, is used in dermatology for treating conditions like atopic dermatitis and managing mucocutaneous side effects of isotretinoin therapy.

Clinical studies have shown promising results of dexpanthenol in wound healing applications, especially in postoperative endotracheal intubation, endoscopic sinus surgery, and tonsillectomy.

Hyperlipidemia

Pantethine, a derivative of vitamin B5, is involved in lipid metabolism.  Therefore, it has been studied for its potential in dyslipidemia management, showing the ability to lower cardiovascular disease risk markers such as LDL, HDL, and total cholesterol.

Neurological Conditions

Pantothenate deficiency may be implicated in conditions like acetylcholine deficiency, neurodegeneration, myelin loss, and age-related dementias, but further research is needed to determine the clinical efficacy of vitamin B5 in these conditions.

Adrenal Fatigue or Adrenal Insufficiency [3., 18.]

Pantothenic acid supplements have been explored for potential use in adrenal insufficiency and adrenal fatigue due to vitamin B5’s role in supporting the health and function of the adrenal glands.

While adrenal fatigue is not a universally accepted medical condition, pantothenic acid offers clear health benefits to adrenal glands.  [18., 19.]

Testing Options for Pantothenic Acid Levels  [10.]

Blood Tests

Blood tests are commonly used to measure pantothenic acid levels in the body. These tests typically involve drawing a blood sample from a vein, which is then analyzed in a laboratory to determine the concentration of pantothenic acid present. 

This test may assess levels of pantothenic acid in whole blood, serum, plasma or red blood cells.  Whole blood may be the most accurate assessment of pantothenic acid levels.  [17.]

Whole Blood: Normal concentrations range from 1.57 to 2.66 μmol/L, with levels decreasing during prolonged dietary deprivation and remaining stable with supplementation.

Serum or Plasma: Plasma concentrations are lower than those in whole blood and do not reflect changes in intake or status well, as they contain various pantothenic acid-containing compounds.

Erythrocytes: Erythrocyte concentrations correlate strongly with whole-blood levels but not with urinary excretion. While theoretically more reflective of status, no clear advantage over whole-blood levels is evident, likely due to factors like absorption variability and tissue utilization discrepancies.

Urine Tests

Urinary excretion of pantothenic acid is approximately 2.6 mg/day in individuals on a typical American diet, but it varies based on intake levels.

Studies show a correlation between pantothenic acid intake and concentration in urine, with levels dropping significantly after prolonged dietary deprivation of the vitamin.  [10.]

Research suggests that high pantothenic acid intake may lead to increased urinary excretion, indicating potential storage of the vitamin when intake is elevated, although this may indicate impaired intestinal absorption.  [10.]

Test Procedure and Preparation Guidelines

The procedure for testing pantothenic acid levels typically involves a blood draw.  Alternatively, urine samples may be collected at home or in a lab setting.  

Before undergoing pantothenic acid testing, individuals may be instructed to fast for a certain period and avoid consuming pantothenic acid-rich foods or supplements to prevent interference with the results.

It's essential to follow any preparation guidelines provided by the healthcare team to ensure accurate test results and to discuss any medications or supplements being taken that could affect pantothenic acid levels.

Interpretation of Pantothenic Acid Testing

While individual labs may report different reference ranges, the reference ranges for pantothenic acid testing from one lab are:  [1.]

Serum or plasma: 12.9−253.1 ng/mL

Whole Blood/Erythrocyte: contact lab for reference ranges used.

‍Urine: contact lab for reference ranges used.

Clinical Significance of High Pantothenic Acid Levels 

High levels of pantothenic acid, while uncommon, may have clinical significance although precise implications are not well-documented.  Excess pantothenic acid intake is generally considered safe, as it is water-soluble and excess amounts are excreted through urine.  [17.]

However, prolonged high intake may lead to potential adverse effects such as gastrointestinal discomfort or allergic reactions in some individuals.  [17.]

Moreover, excessively high levels of pantothenic acid in the body could theoretically interfere with the metabolism of other B vitamins or nutrients, although conclusive evidence supporting this is lacking. 

One study found an increased risk of mortality with increasing levels of pantothenic acid in people with hypertension, implicating pantothenic acid excess with increased risk of mortality in this population.  [12.]

Monitoring pantothenic acid levels in individuals with unusually high intake or supplementation may be prudent to ensure overall nutritional balance and prevent potential adverse effects.

Clinical Significance of Low Pantothenic Acid Levels  [10.]

Low levels of pantothenic acid, although relatively rare due to its widespread presence in foods, can have clinical significance and lead to various symptoms associated with deficiency. 

Pantothenic acid deficiency can manifest as fatigue, headache, malaise, personality changes, numbness, muscle cramps, and gastrointestinal disturbances. 

Severe deficiency may result in more pronounced neurological symptoms such as paresthesia, impaired muscle coordination, and even neurological disorders like pantothenate kinase-associated neurodegeneration (PKAN), characterized by movement disorders and iron accumulation in the brain. 

Additionally, pantothenic acid is essential for the biosynthesis of coenzyme A (CoA), which plays a crucial role in various metabolic processes, including energy metabolism and fatty acid synthesis. Therefore, low levels of pantothenic acid can impair these metabolic functions, leading to disruptions in cellular energy production and overall physiological processes. 

Regular monitoring of pantothenic acid levels and prompt intervention in cases of deficiency can help prevent associated health complications and ensure optimal nutritional status.

Natural Ways to Optimize B Vitamin Status

Dietary Sources of B Vitamins

Incorporate a variety of foods rich in B vitamins such as:

• Whole grains like brown rice, oats, quinoa, and barley
• Leafy greens such as spinach, kale, and Swiss chard
• Legumes including lentils, chickpeas, and black beans
• Nuts and seeds like almonds, sunflower seeds, and flaxseeds
• Lean meats such as chicken, turkey, and beef
• Dairy products like milk, yogurt, and cheese
• Eggs, particularly the yolk which contains B vitamins
• Seafood such as salmon, tuna, and mackerel which are rich in B12
• Include fortified foods like fortified cereals, bread, and plant-based milk alternatives to increase B vitamin intake.

Lifestyle Strategies to Optimize B Vitamin Status

• Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to ensure adequate B vitamin intake.
• Avoid excessive alcohol consumption as it can interfere with the absorption and utilization of B vitamins, particularly B1 (thiamine), folate and vitamin B6.  [9.] 
• Manage stress levels through relaxation techniques such as deep breathing exercises, meditation, yoga, or mindfulness practices, as chronic stress can deplete B vitamin stores.  [26.] 
• Get regular physical activity, which can help improve overall metabolism and enhance the body's utilization of B vitamins.  Increasing exercise increases vitamin B needs, so supplementing may be desirable in some individuals.  [14.] 

Medications That Lower Vitamin B Levels in the Body

Individuals taking the following medications may want to discuss their B vitamin needs with their healthcare provider:

• Metformin: Used to treat type 2 diabetes, metformin can reduce vitamin B12 absorption and increase the risk of deficiency over time.  [13., 15.]
• Proton pump inhibitors (PPIs): These medications, such as omeprazole and esomeprazole, are commonly used to treat acid reflux and peptic ulcers. Long-term use of PPIs can interfere with the absorption of vitamin B12.  [7., 15.]
• Histamine H2-receptor antagonists: Drugs like ranitidine and cimetidine, used to reduce stomach acid production, may also impair vitamin B12 absorption.  [15.]
• Anticonvulsants: Some antiepileptic drugs like phenytoin, phenobarbital, and primidone can lower levels of folate and vitamin B12 in the body.  [20.] 
• Chemotherapy drugs: Chemotherapy medications can affect the body's ability to absorb and utilize B vitamins, leading to deficiencies.  [5.] 
• Oral contraceptives: Some birth control pills can deplete levels of B vitamins, particularly folate and vitamin B6.  [25.] 
• Diuretics: Certain diuretic medications, including loop and thiazide diuretics, can increase urinary excretion of B vitamins, particularly vitamin B1 (thiamine) and folate.  [16., 24.]

It's important to consult with a healthcare professional if you're taking any of these medications to discuss potential nutrient deficiencies and appropriate supplementation, if needed.

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