Vitamin B5, The Basic Science in All Its Glory!
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Pantothenic acid is vitamin B5. You use it to make coenzyme A, a molecule that is central to energy metabolism, most famous for forming acetyl CoA, which lies at the intersection of all anabolic (building up) and catabolic (breaking down) reactions.

Alex Leaf and I team up again, this time to tackle B5.

This is what happens when you don’t have enough:

  • You get fatigue apathy, discomfort, uneasiness, or pain.
  • You get numbness and tingling in the hands and feet.
  • You may get depressed, quarrelsome, childish, or want to spend all day in bed.
  • Your pulse gets higher than you’d expect after minor exertion.
  • Your sleep gets trashed.
  • You get muscle cramps and abdominal cramps, you fart more, and when things get real bad you might throw up.

Much of this can be explained by pantothenic acid’s role in working all of this magic:

  • We use it break down fat, protein, and carbohydrate for energy.
  • We use it to synthesize fatty acids, ketones, and cholesterol.
  • We use it to synthesize all of the steroid hormones, including the sex hormones, the glucocorticoids that regulate blood sugar, and the mineralcorticoids that regulate electrolyte balance and blood pressure.
  • We use it to regulate our use of iron properly, including preventing its accumulation in the brain, where it can cause neurological damage.
  • We use it to make melatonin, which tells our body it’s time to sleep.
  • We use it to make acetylcholine, a neurotransmitter involved in learning, memory, and cognitive performance during periods of sustained, focused attention.
  • We use it to make mucin, which lubricates the eyes, ears, nose, mouth, vagina, penis, and internal organs.
  • We use it to regulate the fasting/feeding cycle by flipping on the genes for autophagy during fasting and flipping on the genes for repair and antioxidant defense during feeding.
  • We use it for quite a few other things too, like the detoxification of some drugs; the synthesis of hemoglobin to prevent anemia; switching on the urea cycle to help us burn protein for energy cleanly; using folate to synthesize DNA, all the major vitamin-derived carriers in the system of energy metabolism, and glycine, an amino acid that acts as a calming, sleep-promoting neurotransmitter, stabilizes blood sugar, and supports collagen synthesis to make your bones strong and your skin smooth.

Burning fat only requires 20% more B5 than burning carbs, which is small compared to how these macros affect riboflavin requirements, However, under conditions of stress you can burn carbohydrate without any B5 at all and you cannot do that with fat. In mice with severe deficiencies of coenzyme A, ketogenic diets dramatically worsen the neurological effects of deficiency.

Although pantothenic acid is named for its presence everywhere and in everything using the Greek word “pantos,” and the common dogma is that no one is deficient, Alex and I make the case in this two-part podcast that suboptimal pantothenic acid status might just be the norm.

And the crazy thing? Official recommendations suggest we only need about 5 milligrams per day. In the podcast we discuss why some people might need GRAMS per day.

Plus, why the FOOD forms might be superior to anything you can get in any supplements on the market.

In part 2, to be released on July 5, we’ll cover how to get pantothenic acid in foods, blood tests, and supplements.

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This episode is brought to you by Ancestral Supplements' “Living” Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, “living” collagen, bone marrow and more… in the convenience of a capsule. For more information or to buy any of their products, go to

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Pantothenic Acid Part 1 Show Notes

00:37 Cliff Notes

14:02 Symptoms of experimentally induced pantothenic acid deficiency

15:57 It is thought that pantothenic acid deficiency doesn’t occur naturally.

18:59 Experiments inducing pantothenic acid deficiency

26:06 Signs and symptoms of suboptimal pantothenic acid status

26:54 Is there pantothenic acid toxicity?

30:52 Hypothetical problems of taking high doses of pantothenic acid

31:53 What pantothenic acid is

35:28 Comparisons to niacin and riboflavin

37:14 Roles of coenzyme A

46:02 Roles of 4’-phosphopantetheine

48:12 Burning fat requires 20% more vitamin B5 than burning carbohydrate; and why in the context of severe deficiency of B5 or impairment in the metabolism of B5 a high-fat diet could have devastating consequences.

53:09 The importance of the ratio of acetyl-CoA to free CoA in regulating many metabolic pathways

01:01:02 There are metabolic disorders, such as fatty acid oxidation disorders, that compromise the pool of coenzyme A.

01:03:03 Synthesis of coenzyme A

01:06:47 How coenzyme A synthesis is regulated

01:11:38 Degradation of coenzyme A

01:15:44 The physiology of pantothenic acid absorption

01:25:29 A 2015 paper showed that 4’-phosphopantetheine can cross cell membranes via passive diffusion.

01:29:00 The physiology of pantothenic acid transport in the blood

01:32:11 Cellular uptake of pantothenic acid from the blood

01:33:21 Tissue distribution of pantothenic acid

01:36:00 There may be a particularly high need for pantothenic acid in adolescence.

01:37:01 Mothers actively transfer pantothenic acid to their fetuses and into their milk at their own expense.

01:39:29 Pharmacokinetics of supplementation

01:48:20 A case for why food is superior to supplements for vitamin B5

01:52:41 Inborn errors of coenzyme A metabolism include pantothenate kinase-associated neurodegeneration (PKAN).
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Pantothenic Acid Links and Research

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  26. Hogarth P, Kurian MA, Gregory A, Csányi B, Zagustin T, Kmiec T, Wood P, Klucken A, Scalise N, Sofia F, Klopstock T, Zorzi G, Nardocci N, Hayflick SJ. Consensus clinical management guideline for pantothenate kinase-associated neurodegeneration (PKAN). Mol Genet Metab [Internet].; 2017 Mar;120(3):278–287. Available from: PMID: 28034613
  27. Di Meo I, Carecchio M, Tiranti V. Inborn errors of coenzyme A metabolism and neurodegeneration. J Inherit Metab Dis [Internet]. Wiley Online Library; 2019 Jan;42(1):49–56. Available from: PMID: 30740736
  28. Aggarwal A, Schneider SA, Houlden H, Silverdale M, Paudel R, Paisan-Ruiz C, Desai S, Munshi M, Sanghvi D, Hardy J, Bhatia KP, Bhatt M. Indian-subcontinent NBIA: unusual phenotypes, novel PANK2 mutations, and undetermined genetic forms. Mov Disord [Internet]. 2010 Jul 30;25(10):1424–1431. Available from: PMID: 20629144
  29. Zano SP, Pate C, Frank M, Rock CO, Jackowski S. Correction of a genetic deficiency in pantothenate kinase 1 using phosphopantothenate replacement therapy. Mol Genet Metab [Internet]. Elsevier; 2015 Dec;116(4):281–288. Available from: PMCID: PMC4764103
  30. Di Meo I, Colombelli C, Srinivasan B, de Villiers M, Hamada J, Jeong SY, Fox R, Woltjer RL, Tepper PG, Lahaye LL, Rizzetto E, Harrs CH, de Boer T, van der Zwaag M, Jenko B, Čusak A, Pahor J, Kosec G, Grzeschik NA, Hayflick SJ, Tiranti V, Sibon OCM. Acetyl-4’-phosphopantetheine is stable in serum and prevents phenotypes induced by pantothenate kinase deficiency. Sci Rep [Internet].; 2017 Sep 12;7(1):11260. Available from: PMCID: PMC5595861
  31. Fox HM, Linkswiler H. Pantothenic acid excretion on three levels of intake. J Nutr [Internet].; 1961 Dec;75(4):451–454. Available from: PMID: 13894371
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  33. Gominak SC. Vitamin D deficiency changes the intestinal microbiome reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a “pro-inflammatory” state associated with atherosclerosis and autoimmunity. Med Hypotheses [Internet]. Elsevier; 2016;94:103–107. Available from:
  34. Schroeder HA. Losses of vitamins and trace minerals resulting from processing and preservation of foods. Am J Clin Nutr [Internet]. 1971 May;24(5):562–573. Available from: PMID: 5578515
  35. Cheng TS, Eitenmiller RR. EFFECTS OF PROCESSING AND STORAGE ON THE PANTOTHENIC ACID CONTENT OF SPINACH AND BROCCOLI. J Food Process Preserv [Internet]. Wiley Online Library; 1988 Jun;12(2):115–123. Available from:
  36. Friend BA, Shahani KM, Long CA, Vaughn LA. The effect of processing and storage on key enzymes, B vitamins, and lipids of mature human milk. I. Evaluation of fresh samples and effects of freezing and frozen storage. Pediatr Res [Internet].; 1983 Jan;17(1):61–64. Available from: PMID: 6835716
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  39. Sibon OCM, Strauss E. Coenzyme A: to make it or uptake it? Nat Rev Mol Cell Biol [Internet]. Nature Publishing Group; 2016;17(10):605. Available from:
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  42. Ebino KY, Suwa T, Kuwabara Y, Saito TR, Takahashi KW. [Analyses of constituents of feces and the effect of a vitamin B12 fortified diet on coprophagy in the mouse]. Jikken Dobutsu [Internet]. 1986 Oct;35(4):381–386. Available from: PMID: 3803425
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  44. Koch MA. Chapter 18 – Experimental Modeling and Research Methodology. In: Suckow MA, Weisbroth SH, Franklin CL, editors. The Laboratory Rat (Second Edition) [Internet]. Burlington: Academic Press; 2006. p. 587–625. Available from:


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  1. 4500 mg pantothenic acid (b5) in the human body total seems highly unlikely. Maybe you miscalculated by an order of magnitude? I would assume b5 content of human body is somewhat comparable to that of pig when adjusted for weight, and with the exception of pork liver which is richest in B5 (about 7 mg/100 gram), and skin and bones which has very little B5, I’d assume average for the organs (based on is about 2-3 mg/100 gram or less (lungs – which weights more than heart and kidneys combined has just 1 mg/100 gram). Muscle pork meat is much less, i.e. 0.5-1 mg/100 gram.

    And so based on this maybe 300 mg for the muscle B5 and 150 mg for the rest/organs, total 450 mg in the human body. Organs ex skin/bones only represent a small part of the total, most is muscle.

    This said, I agree that b5 is likely a very underrated nutrient that most people need more of, especially with the consumption of egg whites rather than egg yolks, cheese rather than milk, and muscle meat rather than organ meats, which is nowadays so common. And yes, eating more liver and other organ meats would be a good way of meeting B5 requirement. If not I think substituting cheese for milk (fermented or lactose reduced if not tolerated) is an easy way of increasing both b5 and b2 (and other nutrients like choline) intake. I.e. the recommended average 2 1/2 servings of dairy products in the form of milk supplies about 2.2 mg B5 and 1.2 mg b2 (vit B2), while the same servings of dairy from hard cheese/swiss cheese supplies just 0.6 mg B5 and 0.4 mg B2. And so milk can supply maybe 2-5 times more B2 and B5 relative to protein compared to most muscle meats or hard cheeses.

    Obviously when comparing different foods for their nutrient content we should take into account their caloric value, whether they are dried and so on, not only the weight. So comparing 100 grams of milk with 100 grams of cheese and then conclude that milk is a poor source of B5 or B2 while cheese is a good source, is misleading.

    For this reason I believe white mushrooms are one of the best sources of B5 and B2 given that they are mostly water and supplies just 22 calories per 100 gram, yet 1.5 mg B5 and 0.4 mg B2. To put this in perspective, it’s about 10 times more B2 and almost 100 times more B5 per calorie than almonds. Some other mushrooms can supply more B5, and obviously dramatically more if dried. For example 100 grams of dried shiitake mushrooms supplies 22 mg B5 according to (but isn’t such a great source of B2).

    The combo of 2-3 glasses of milk, 2 egg large yolks and 100-200 grams of white mushrooms could supply a total of about 2 mg b2, 6 mg b5 and 400 mg choline, which along with other foods should be more than enough in just about all cases even if organ meats are not consumed. This is about the amount of b5 (and choline) found in 2000 kcal human milk. I think if the human body had massive amounts of b5 as you suggest, human milk would also have a higher content.

    What we can learn from human milk is however that it’s low in most nutrients, but higher in some than in others, and we should indeed focus on the latter as they can give some important clues to what we’re missing and if this also correlates with changes in diet (as mentioned using egg whites rather than egg yolks, muscle meat rather than organs and so on) we should pay even more attention. Such nutrients in human milk include among others vitamin A, vitamin C, riboflavin, choline, calcium, copper, selenium, arachidonic acid, and, yes, pantothenic acid.. Note also that human milk is very rich in fat (often 50-60% of energy).

    I also think that human milk composition can reflect requirement for someone that wants to rebuild their organs. Perhaps older people who are less efficient in doing so/or need more rebuilding than than for example the healthy middle aged person, in particular. Nevertheless the composition of human milk is likely not optimal for most people. However, at present the choline requirement of 425-550 mg is based largely on the content of 2000-2500 kcal human milk. Using the same logic the requirement for B5 would be about 6-8 mg and the requirement for B2 about 1-1.3 mg.

  2. I wonder if B5 deficiency has anything to do with Fibromyalgia?
    Grain is milled differently than past generations and B5 is deficient in content.
    I don’t understand why my annual physical exam checks cholesterol, and CBC, but none of the vitamins and minerals that keep our bodies in optimal condition. All the signs of Fibromyalgia and Chronic Fatigue Syndrome, plus thyroid disorder seem to overlap.

  3. Hi,

    I can take B5 one or two days in a row – the it seems to be helpful. But after that, it stops giving me energy and makes me really angry, to the point. I’ve tried this several times over 2 years and it’s always the same. Any idea what this means?

  4. I remember reading in some old blog that pantethine (not pantothenic acid) was good for alcohol hangover prevention/treatment, because it helps the body process aldehyde. If you google “pantethine aldehyde”, a few studies pop up, but I’m not knowledgeable enough to interpret them.

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