What Is Pantothenic Acid Deficiency?

Introduction

Pantothenic acid, also known as vitamin B5, is one of the vitamins from the B group of vitamins. It is an essential nutrient which is needed by the body to function properly. 

All animals, including humans, require pantothenic acid for the metabolism of carbohydrates, protein, and fats.¹

Pantothenic acid is derived from the Greek word pantothen which means ‘from everywhere’ as it is present in small quantities in all food items. 

Deficiency of vitamin B5 (also known as hypovitaminosis B5) is very rare and is only found in cases of extreme malnutrition.

In this article, we will discuss pantothenic acid deficiency in detail. 

Causes 

Having a deficiency in vitamin B5 alone is very rare as it is generally accompanied by other B vitamin deficiencies. The following can be some causes of pantothenic acid deficiency:

Severe malnutrition

Malnutrition is rare in developed countries. Malnutrition also leads to multiple nutrient deficiencies hence analysing the specific symptoms of isolated vitamin B5 deficiency is hard in such cases.^1,

Consumption of pantothenic acid metabolic antagonist

Calcium homopantothenate (or hopantenate) is a compound that is a known metabolic antagonist to pantothenic acid. It is used for the treatment of Alzheimer’s disease in Japan. If you consume calcium homopantothenate, then you will have a high chance of pantothenic acid deficiency. This was confirmed when the side effects of calcium homopantothenate (hepatic encephalopathy, abnormal brain function due to reduced excretion of toxins in the blood as a result of liver malfunction) were reversed with the administration of pantothenic acid.^2,3

Pantothenate kinase-associated neurodegeneration (PKAN)

PKAN is a rare genetic disorder that leads to iron accumulation in the brain.^6.7 Symptoms include:

• Visual impairments
• Behavioural changes
• Speech abnormalities
• Jerky movements
• Personality changes 

Reduced absorption of vitamin B5

In malabsorption disorders like Crohn’s disease, coeliac disease and ulcerative colitis, the patient has generalised vitamin deficiency if they are not taking proper treatment prescribed by the doctor, which includes:

• Medications
• Supplements
• Medical procedures

Other conditions

Pantothenic acid has also shown a protective role in heart disease and immunotherapy.^4,5 Many conditions can manifest as pantothenic acid deficiency, they can be:

• Chronic alcoholism
• Chronic kidney disease
• Post-bariatric (weight-loss) surgery patients

Symptoms

There are many symptoms associated with pantothenic acid deficiency. Most of the symptoms are very vague and nonspecific to the disease. You must consult a healthcare provider before concluding that you have this deficiency. The symptoms are:

• Lethargy (tiredness)
• Fatigue (weakness)
• Insomnia (sleeplessness)
• Abdominal pain
• Irritability
• Vomiting
• Burning and numbness of hands and feet
• Throat infections
• Headache
• Restlessness
• Anorexia
• Muscle cramps

Diagnosis

Pantothenic acid deficiency is diagnosed after checking the vitamin levels in the blood. This can be done using a blood test. A thorough history, physical examination and lab work can help find out the diagnosis and the cause of the deficiency.¹

Treatment

The first step in managing pantothenic acid deficiency involves the treatment of the underlying cause. You will be given a vitamin B complex dose, as in most cases, people are deficient in all the B vitamins.¹  Pantothenic acid can also be supplemented by incorporating foods rich in vitamin B5.

For conditions such as pantothenate kinase-associated neurodegeneration (PKAN), a type of pantothenic acid known as pantothenate phosphate is utilised alongside other medications such as:⁷ 

• Intramuscular botulinum toxin
• Intrathecal or oral baclofen
• Ablative pallidotomy or thalamotomy
• Oral trihexyphenidyl
• Deep brain stimulation
• Physical therapy
• Occupational therapy to maintain joint mobility

PKAN treatment also involves referral for adaptive aids like a walker or wheelchair, which is recommended for gait abnormalities, along with speech therapy and/or assistive communication devices. Ophthalmological treatment for retinopathy is advised, and referral to community resources including financial services, services for the visually impaired, and educational programs is also beneficial.⁷

In malabsorption syndromes, regular treatment and follow-up with a doctor can help prevent vitamin deficiencies.

Prevention

Here are some ways you can prevent pantothenic acid deficiency: 

A balanced diet

Ensure your diet includes foods rich in vitamin B5, such as:¹

• Meats
• Whole grains
• Dairy products
• Legumes
• Vegetables

Supplementation

Consider taking vitamin B supplements if you are at risk of deficiency and cannot get enough from your diet alone.

Avoid excessive alcohol

Excessive alcohol consumption can interfere with the absorption of vitamin B5, so moderate your alcohol intake.

Limit processed foods

Processed foods often lack essential vitamins, including B5. Eating a diet rich in whole foods can help prevent deficiencies.

Manage underlying conditions

Some health conditions can interfere with the absorption or utilisation of vitamin B5. Managing these conditions can help prevent deficiency.

Avoid smoking

Smoking can deplete certain vitamins, including B5. Quitting smoking can improve overall health and nutrient absorption.

Regular health check-ups

Regular visits to a healthcare provider can help monitor your nutrient levels and address any deficiencies early.

FAQs

Can vitamin B5 deficiency be prevented?

Vitamin B5 deficiency can be prevented by maintaining a balanced diet rich in foods that are good sources of vitamin B5, such as:

• Meats
• Whole grains
• Dairy products
• Legumes
• Vegetables

Avoiding excessive alcohol consumption, smoking, and processed foods can also help prevent deficiency.

Are there any risks associated with vitamin B5 supplementation?

Vitamin B5 is generally considered safe when taken in recommended doses. However, excessive supplementation can cause diarrhoea and other gastrointestinal issues. It's important to consult with a healthcare provider before starting any supplementation regimen.

Summary

Pantothenic acid, also known as vitamin B5, is a vital nutrient required for proper bodily function, particularly in the metabolism of carbohydrates, proteins, and fats. Pantothenic acid deficiency, also known as hypovitaminosis B5, is very rare and typically occurs in cases of severe malnutrition or in conjunction with other B vitamin deficiencies. 

Causes of isolated vitamin B5 deficiency can include severe malnutrition, consumption of pantothenic acid metabolic antagonists, such as calcium homopantothenate, or conditions like pantothenate kinase-associated neurodegeneration (PKAN), a rare genetic disorder. Symptoms of deficiency are often nonspecific and can include lethargy, fatigue, insomnia, abdominal pain, irritability, and others. 

Diagnosis is typically made through blood tests to check vitamin levels. Treatment involves addressing the underlying cause, along with vitamin B complex supplementation in most cases. For PKAN, a specific form of pantothenic acid, pantothenate phosphate, is used along with other medications and therapies to manage symptoms. Prevention strategies include maintaining a balanced diet rich in vitamin B5, limiting processed foods, avoiding excessive alcohol and smoking, managing underlying health conditions, and regular health check-ups.