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Pantothenic Acid
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In one pass The name pantothenic acid comes from a Greek word meaning from everywhere: B5 is in almost every food, and a true shortage is extremely rare.
Educational content, not medical advice — consult a clinician.
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Chapter 1
A part of coenzyme A
The name pantothenic acid comes from a Greek word meaning from everywhere: B5 is in almost every food, and a true shortage is extremely rare. Its job in the body is to build an all-purpose carrier called coenzyme A (CoA), which delivers the fragments broken off sugar, fat, and protein to the door of the energy factory.
Think of coenzyme A as a delivery truck. B5 forms most of a long arm on the truck, and at the tip of the arm is a sulfur atom (supplied by cysteine) on which the cargo hangs. Without B5 the arm cannot be fitted: the truck is still there, but it cannot hold anything.
The cargo coenzyme A carries is called an acyl group, and the most important piece is acetyl-CoA. Sugar, fat, and some amino acids all end up as acetyl-CoA when they are broken down, and acetyl-CoA then decides where they go next: into the energy factory to be burned, or off to build new fat and cholesterol. So B5 does not supply energy itself; it is the carrier platform at that crossroads of metabolism.
Think of coenzyme A as a delivery truck. B5 forms most of a long arm on the truck, and at the tip of the arm is a sulfur atom (supplied by cysteine) on which the cargo hangs. Without B5 the arm cannot be fitted: the truck is still there, but it cannot hold anything.
The cargo coenzyme A carries is called an acyl group, and the most important piece is acetyl-CoA. Sugar, fat, and some amino acids all end up as acetyl-CoA when they are broken down, and acetyl-CoA then decides where they go next: into the energy factory to be burned, or off to build new fat and cholesterol. So B5 does not supply energy itself; it is the carrier platform at that crossroads of metabolism.
Mechanism · Why acetyl-CoA is the hub
Acetyl-CoA is the most important two-carbon carrier in metabolism. Think of it as a central station: the main fuels all have to pull into this station first, and only then decide which line to take next.Pulling into the station:
Sugar: pyruvate is turned into acetyl-CoA by the pyruvate dehydrogenase complex (PDC, which needs B1)Fat: each turn of fatty-acid β-oxidation cuts off 1 acetyl-CoA (needing B2, B3, and B5)Ketones: β-hydroxybutyrate (BHB) in the blood can be turned back into acetyl-CoAAmino acids (leucine, lysine, phenylalanine, tryptophan, tyrosine, isoleucine, threonine): part of their breakdown leads to acetyl-CoA
Pulling out of the station:
The tricarboxylic acid () cycle: the main exit. Here acetyl-CoA combines with oxaloacetate to form citrate (the enzyme for this step is citrate synthase), and the electrons released as the cycle turns are ultimately used to make Ketone body synthesis: during fasting or very low carbohydrate intakeCholesterol and steroid hormone synthesisFatty acid synthesis: when carbohydrate is plentiful, after a mealAcetylcholine synthesis: a neurotransmitterHistone acetylation: controlling which genes get read
So what B5 holds up is more than a fuel transfer. The histones in the nucleus, the proteins DNA is wound around, have to loosen before a gene can be read, and they loosen when acetyl groups are hung on them. Those acetyl groups are handed over from acetyl-CoA by histone acetyltransferases (HATs). Experiments in cells and yeast show that this turns how much acetyl-CoA the cell has right now into a signal in its own right. Plenty of acetyl-CoA means raw material is abundant, so the cell leans toward building (anabolic) metabolism and the related genes are switched on. Little acetyl-CoA means supplies are short, so the cell turns to breakdown (catabolic) metabolism and autophagy, taking apart some of itself to burn. Many tumor cells take a shortcut here: they turn up ATP-citrate lyase (ACL), which keeps moving citrate out into the cytoplasm and turning it back into acetyl-CoA, so fatty-acid synthesis never stops and the epigenetic settings get rewritten along with it.
In practical terms: enough B5 is one of the preconditions for all of metabolism running normally, but it is not the switch for any special state. B5 is almost never short in an ordinary diet, so there is no such routine practice as taking B5 to optimize metabolism.
Chapter 2
Needed to burn and to store fat
Burning fat and storing fat run in opposite directions, and coenzyme A (CoA) is present on both sides.
To burn fat, a fatty acid first has to be joined to coenzyme A to form an acyl-CoA, and then it is ferried into the mitochondria with the help of carnitine. Inside, a series of enzymes trims it round after round (the dehydrogenase among them uses FAD, supplied by B2); each round releases one acetyl-CoA and leaves the chain two carbons shorter.
To store fat, fatty acid synthase (FAS) has a part called the acyl carrier protein (ACP). Its prosthetic group is phosphopantetheine, the same long arm that contains B5, and the growing fatty-acid chain hangs on that arm.
So B5 does not decide whether you gain or lose weight: burning fat needs it, and so does storing fat. It is a structural part of the toolchain, not the steering wheel.
To burn fat, a fatty acid first has to be joined to coenzyme A to form an acyl-CoA, and then it is ferried into the mitochondria with the help of carnitine. Inside, a series of enzymes trims it round after round (the dehydrogenase among them uses FAD, supplied by B2); each round releases one acetyl-CoA and leaves the chain two carbons shorter.
To store fat, fatty acid synthase (FAS) has a part called the acyl carrier protein (ACP). Its prosthetic group is phosphopantetheine, the same long arm that contains B5, and the growing fatty-acid chain hangs on that arm.
So B5 does not decide whether you gain or lose weight: burning fat needs it, and so does storing fat. It is a structural part of the toolchain, not the steering wheel.
Myth · Does panthenol repair hair?
Panthenol (also called provitamin B5) is a regular ingredient in shampoos, skin care, and wound-care ointments. It is the alcohol form of B5's precursor, and on skin or hair it is slowly converted into pantothenic acid.The one thing it really does is moisturize. Like glycerin, panthenol is a humectant: it pulls water in and holds it in the outer layer of the skin, and the improvement in skin water content is real. A few small trials used preparations with 5% panthenol on eczema, burns, and surgical wounds and saw slightly faster healing, but the effect was mild and showed no clear advantage over an ordinary moisturizer.
On hair, the marketing runs ahead of the evidence. Panthenol briefly soaks into the hair shaft and adds a little water, so hair looks smoother and shinier. That is a physical improvement of the conditioner kind, not feeding the hair. Claims that it thickens hair, makes it grow faster, or grows new hair have no evidence behind them.
Oral B5 for hair loss and acne does not hold up either. The often-cited Leung 1995 is an article proposing a hypothesis (published in Medical Hypotheses) in which the author claimed high-dose B5 cured acne, but it had no control group, and no large randomized trial has confirmed it since. The acne treatments with real evidence are topical retinoids (tretinoin, adapalene), oral isotretinoin, antibiotics, hormonal treatment, and light therapy when needed; B5 is not on that list.
So: treat cosmetics with panthenol as ordinary moisturizers and do not expect anything special. For real acne, see a dermatologist rather than counting on miracle ingredients such as B5 or biotin. For real hair loss, have a doctor find the cause first; that matters more than anything you could take.
leung-1995-b5-acne-hypothesis
Chapter 3
Steroid hormone origin
Cortisol, testosterone, estrogen, progesterone, and aldosterone all look alike because they are all remodeled from cholesterol. And when the body makes its own cholesterol, the starting point is acetyl-CoA, which passes through intermediates such as hydroxymethylglutaryl-CoA (HMG-CoA) and mevalonate on its way to becoming cholesterol.
Follow that line and B5 (through coenzyme A) takes an indirect part in the adrenal cortex hormones (cortisol is central to the stress response), the sex hormones, and the raw material for vitamin (a cholesterol precursor in the skin).
That is also where a common claim comes from: B5 fights stress and supports the adrenals. It does not hold. B5 has to be present on this line, but being present is not the same as setting the pace: when a bakery is short of ovens, delivering more flour will not make more bread. What sets the strength of the stress response is the regulation between the brain and the adrenal glands (the axis), not whether B5 is sufficient.
Follow that line and B5 (through coenzyme A) takes an indirect part in the adrenal cortex hormones (cortisol is central to the stress response), the sex hormones, and the raw material for vitamin (a cholesterol precursor in the skin).
That is also where a common claim comes from: B5 fights stress and supports the adrenals. It does not hold. B5 has to be present on this line, but being present is not the same as setting the pace: when a bakery is short of ovens, delivering more flour will not make more bread. What sets the strength of the stress response is the regulation between the brain and the adrenal glands (the axis), not whether B5 is sufficient.
Myth · Adrenal fatigue is not a diagnosis
Adrenal fatigue is one of the supplement industry's favorite diagnoses and one that medicine does not recognize, and B5 gets pulled into it almost every time.The story sounds smooth. Modern life is stressful, the adrenal glands work overtime every day, and after long enough they get tired. Cortisol output drops, so you have chronic fatigue, low blood sugar, strong salt cravings, trouble getting up in the morning, and cannot function without caffeine. If the adrenals are tired, the story goes, feed them: high-dose B5, plus adrenal extract (which really is animal adrenal tissue) and licorice extract, and in severe cases cortisol itself.
The trouble is that this story has not survived testing. A 2016 systematic review by Cadegiani and Kater examined 58 studies and found no methodologically sound evidence that adrenal fatigue exists as a real condition; the tests used to diagnose it, such as salivary cortisol rhythms and 24-hour urinary cortisol, gave conflicting results across studies and cannot tell supposed sufferers from healthy people. Endocrinology does not treat it as a diagnosis.
Real adrenal disease looks different. Addison's disease (primary adrenal insufficiency) usually happens when the immune system destroys the body's own adrenal cortex. It is rare but anything but vague: cortisol really is too low, blood pressure can fall to the point of shock, blood potassium rises, and people lose weight fast. It requires lifelong glucocorticoid replacement (Bornstein 2016, the Endocrine Society guideline). Sudden severe weakness, vomiting, abdominal pain, dizziness to the point of being unable to stand, or confusion, especially in someone known to have adrenal insufficiency, may be an adrenal crisis: go to the emergency department immediately.
At the other end is dysregulation of the hypothalamic-pituitary-adrenal () axis. It is genuinely linked to depression, post-traumatic stress disorder (PTSD), and long-term high stress, but what goes wrong is the rhythm and the feedback. What needs treating is the underlying illness and situation, and taking B5 will not shift it.
Why, then, does the idea sell so well? The three things it borrows are all solid. The symptoms are vague enough (tired, stressed, craving salt) that almost everyone recognizes themselves. Having an explanation feels far better than not knowing why you feel bad. And buying a bottle of supplements gives you a sense that I am doing something.
B5's real place in this picture: it is a structural unit of coenzyme A and of the acyl carrier protein (ACP), used at every node of metabolism. It is also the true cause of a rare deficiency (seen in experiments that restricted intake and in severe malnutrition). But it is not an adrenal supplement, not a cure for stress, and not an energy booster.
What really helps chronic fatigue and low energy is unglamorous: 7-9 hours of sleep on a steady schedule; a diet built on whole foods, low in added sugar, with enough protein and a wide variety of foods; strength training plus moderate aerobic exercise; and attention to mental health, social connection, and a sense of purpose. If you do all of that and are still tired, the things to check are an underactive thyroid (hypothyroidism), anemia, vitamin D deficiency, B12 deficiency, sleep apnea, and depression, not another bottle of B5.
Chapter 4
Found in almost every food
Pantothenic comes from the Greek pantothen, meaning from everywhere. The name alone tells you where it is found.
The richest sources are liver, beef, chicken, fish (salmon), and egg yolk. Among plants, mushrooms (button and shiitake), avocado, broccoli, sweet potato, and whole grains all have a fair amount, and almost every other common food adds a little. So you do not need to go looking for B5: as long as your diet is not severely monotonous and your calories are not extremely low, it adds up on its own.
Being everywhere brings a problem of its own: nobody needs to worry about it, and sellers cannot package it as a solution, so B5 is the least known of the B vitamins.
The richest sources are liver, beef, chicken, fish (salmon), and egg yolk. Among plants, mushrooms (button and shiitake), avocado, broccoli, sweet potato, and whole grains all have a fair amount, and almost every other common food adds a little. So you do not need to go looking for B5: as long as your diet is not severely monotonous and your calories are not extremely low, it adds up on its own.
Being everywhere brings a problem of its own: nobody needs to worry about it, and sellers cannot package it as a solution, so B5 is the least known of the B vitamins.
In practice · How cooking and milling lose B5
Among the B vitamins, B5 is fairly stable. What really drains it is water and milling. The US Office of Dietary Supplements (ODS) gives only one overall range: food processing can cause losses of 20% to almost 80%, with no separate figures for baking, freezing, canning or storage.B5 dissolves in water, so boiling and steaming do not destroy much of it in themselves, but it leaches into the cooking liquid: pour out the liquid and the B5 goes with it. Canning's high-pressure sterilization and long storage of dried foods take away a further share. Acidity and alkalinity during cooking also break it down: long simmering of acidic dishes such as tomato soup or food with vinegar (pH < 5) breaks down part of it, and cooking grains in alkaline water (the traditional Mexican limewater treatment of corn, or some European breads made with added alkali, pH > 7) breaks down more.
Milling costs even more. B5 sits mainly in the bran and germ, so polishing rice into white rice and grinding wheat into white flour strip that part away. And most countries' flour-fortification programs add back only B1, B2, B3, and folate, not B5. That is the one situation in which B5 intake can become marginal: three meals a day of almost nothing but refined staples.
Even then, there is a wide margin. The US adequate intake () for adults is 5 mg/day, and most people's everyday diet already provides 4-7 mg/day. In other words, an ordinary diet lands around that line on its own, without any single food carrying the load. Falling short takes several conditions at once: eating almost nothing but polished rice for a long time, very little variety, high calorie needs, and older age. So B5 does not need to be supplemented. Its biggest risk is really that it is everywhere and nobody pays attention to it, which is itself a sign that your diet has a steady foundation.
Chapter 5
Real deficiency is rare and vague
True B5 deficiency shows up almost only in three situations: research volunteers whose B5 was deliberately restricted, people with severe malnutrition who are short of many vitamins at once, and historical cases such as prisoners of war and famine survivors.
The symptoms are very non-specific: fatigue, abnormal sensations (typically burning soles of the feet, called burning feet syndrome), headache, digestive discomfort, and irritability. Do not work backward from this list to I must be short of B5: far too many things can cause these feelings, and outside extreme situations an isolated B5 deficiency is extremely rare.
Two claims common in supplement circles do not hold up either. B5 supports the adrenals: being present is not the same as setting the pace, and B5 does not control how much hormone is made. B5 clears acne: the evidence is very weak. The claim began with an article proposing a hypothesis, with no control group, and no large trial has confirmed it since. A claim that spreads widely does not have evidence behind it just because it spreads.
The symptoms are very non-specific: fatigue, abnormal sensations (typically burning soles of the feet, called burning feet syndrome), headache, digestive discomfort, and irritability. Do not work backward from this list to I must be short of B5: far too many things can cause these feelings, and outside extreme situations an isolated B5 deficiency is extremely rare.
Two claims common in supplement circles do not hold up either. B5 supports the adrenals: being present is not the same as setting the pace, and B5 does not control how much hormone is made. B5 clears acne: the evidence is very weak. The claim began with an article proposing a hypothesis, with no control group, and no large trial has confirmed it since. A claim that spreads widely does not have evidence behind it just because it spreads.
Background · Burning feet in wartime camps
Burning feet syndrome is the syndrome most closely tied to B5 deficiency, and it was common in the prisoner-of-war camps of the Far East during World War II.This is what it looked like (the classic clinical description comes from the Indian physician Gopalan, 1946). After months of very poor nutrition, the soles of the feet began to burn severely, worst at night, so that people could neither sleep nor walk. It came with numbness, abnormal sensations, an unsteady gait, and loss of appetite, and if it dragged on it progressed to peripheral neuropathy.
Diagnosis took a detour at the time. Doctors thought it was a combined B-vitamin deficiency, but giving thiamine (B1) alone did nothing. Later case observations found that switching to calcium pantothenate (a B5 supplement) brought clear improvement within a few weeks. The camp diet was mostly polished rice with a few vegetables, which over time ran down B5 along with several other B vitamins. So the syndrome came to be attributed mainly to B5 deficiency. Know how much weight that carries: it comes from uncontrolled case observations plus later experiments that deliberately induced B5 deficiency, not from randomized trials.
The proposed mechanism: B5 and the coenzyme A it builds are key parts in making nerve sphingolipids and neurotransmitters. When supply is cut, the first to fail may be the longest peripheral nerves. The feet are farthest from the spinal cord, with the longest supply line, so symptoms start at the soles, the same longest nerves go first pattern as the sensory neuropathy of B1 and B12 deficiency. This step is reasoning; it has not been measured directly.
But if your feet burn today, it is almost certainly not B5. The most common modern cause is diabetic peripheral neuropathy (#1), followed by B12 deficiency, alcohol-related neuropathy, neuropathy after chemotherapy, chronic kidney disease, and small fiber neuropathy with no cause found (idiopathic). In developed regions today, isolated B5 deficiency essentially does not occur; it takes severe shortages of several B vitamins at once.
So do not self-diagnose burning soles as B5 deficiency. What you need is a full neuropathy workup (blood glucose, B12, kidney function, alcohol use, thyroid, autoimmune causes). Until the cause is clear, taking B5 on its own has no evidence behind it for these patients.
gopalan-1946-burning-feet
References · 4
- National Institutes of Health, Office of Dietary Supplements. (2021). Pantothenic Acid — Fact Sheet for Health Professionals. The May 1, 2026 update (Wayback snapshot 16 September 2026) says only that food processing can cause significant losses of pantothenic acid (20% to almost 80%); it gives no separate figures for dry-heat cooking, freezing, canning or storage (fact sheet). ods.od.nih.gov/factsheets/PantothenicAcid-HealthProfessional
- Institute of Medicine. (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academies Press. nap.nationalacademies.org/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids
- Bornstein, S. R., et al. (2016). Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. JCEM, 101(2), 364–389. Endocrine Society guideline (GRADE): short corticotropin test (250 micrograms) as the diagnostic gold standard, morning ACTH plus cortisol as a screen if that is not possible; 21-hydroxylase autoantibodies for the cause; hydrocortisone 15-25 mg/day (or cortisone acetate 20-35 mg/day) in two to three doses plus fludrocortisone (median 0.1 mg); stress-dose education, a steroid card and an emergency injection kit. The abstract gives no prevalence figure (abstract, PMID 26760044). 10.1210/jc.2015-1710
- Cadegiani, F. A., & Kater, C. E. (2016). Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders, 16, 48. Systematic review of 58 studies finding no methodologically sound evidence that 'adrenal fatigue' exists as a medical condition, and that salivary cortisol tests cannot distinguish supposed sufferers from healthy people. 10.1186/s12902-016-0128-4