I am desperate!!  I am so tired of doctors telling me this isn't
possible.. referrals, colonoscopies, flex sigmoidoscopies (sorry...i'm
sure spelling is way off!!)  I have overdosed on Pantothenic Acid (in
an effort to cure Alopecia Areata) and have suffered severe GI
problems ever since...I know this is the cause, but no one has had a
solution.  I understand that Pantothenic Acid is water soluable and
doesn't accumulate in the body...but did my body quit producing it
after the massive doses I ingested (over several months), or did it
take something that my body needs for proper function with it on the
way out?  Bloating, explosive BM's, urgency...PLEASE HELP!!!  All
tests have come back inconclusive and I have no where else to turn!! 
I

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Request for Question Clarification by nancylynn-ga on 23 Nov 2003 10:07 PST

Hello dadoo9999-ga:

I'm attempting to answer your question. Could you tell me which
prescription medications you're taking for Alopecia Areata -- maybe
levodopa? Are you also taking any herbal remedies and, if so, which
ones?

Have you also been diagnosed with hyperactive thyroid? Have you been
given any underlying reason for the onset of Alopecia Areata, such as
thyroid or use of beta blockers, etc.?

Thanks,
nancylynn-ga

---

Clarification of Question by dadoo9999-ga on 24 Nov 2003 04:04 PST

My problem is no longer Alopecia Areata...(not taking any herbal or
perscribed medications) that seems to have gone in to
remission...tyroid tests came back negative.  I stopped taking the
Pantothenic Acid years ago, but the GI problems still persist...c

Hello dadoo9999-ga:

I am very sorry that you're in such distress.

I am not certain that I -- or any non-medical professional -- can
provide a definitive answer, but I did as much research as I could re:
various scenarios: the possibility that too much pantothenic acid
induced these problems; the possibility that your problems are being
exacerbated now by a deficiency of B vitamins, and the possibility
that you have developed yet another autoimmune disorder.

As a result of my research, I do have some suggestions for possible
causes and possible courses of action.

First, could too much pantothenic acid have caused your g.i. problems, as
you suspect?

According to the Nutrition Information Centre:
http://webhost.sun.ac.za/nicus/micronutrients/vitamins/pantothenic_acid.htm
"Toxicity - When you have too much: No toxic effects of pantothenic
acid are known, but excessively large amounts may cause diarrhoea,"
but the implication seems to be that once you stop taking it, those
problems should abate.

According to the University of Pennsylvania's Health System's report, at:
http://www.pennhealth.com/ency/article/002410sid.htm
"Large doses of pantothenic acid do not produce symptoms other than
(possibly) diarrhea. There are no known toxic symptoms associated with
biotin."

I also tried researching at NIH's CARDS (Computer Access to Research
on Dietary Supplements Database):
http://137.187.206.105/cards/ProxyServlet?objectHandle=Search&actionHandle=getSearchFields&nextPage=jsp/search/searchMain.jsp
but I couldn't find any studies now in progress attempting to link
pantothentic acid to g.i. disorders.

CNN Health allows easy searching of various vitamins and possible
repercussions from taking excessive amounts, yet the only side-effects
it reports for pantothentic acid:
http://www.cnn.com/HEALTH/indepth.food/vitamins.minerals/faqs/vitamins.
html#pant
are "Excess amounts: May cause occasional diarrhea and water retention."      

Discovery Health:
http://health.discovery.com/diseasesandcond/encyclopedia/1927.html
also declares "There are no toxic effects for pantothenic acid other
than diarrhea . . . .There are no toxic effects for biotin. Although
biotin
deficiency is rare . . . .*Deficiency symptoms* include: loss of
appetite · nausea ·  depression · muscle pain and weakness ·  fatigue
· hair loss, known as alopecia."

Food & Diet. com notes that an overdose of pantothentic acid will
result in a "failure of the body to metabolize other B vitamins" (the
closest I came to corroborating your theory):
http://www.foodanddiet.com/NewFiles/vitamin-B-5.html 

But the picture becomes cloudier and more complicated when perusing
this U.K. Foods Standards Agency's "Risk Assessment" of pantothenic
acid at:
http://www.foodstandards.gov.uk/multimedia/pdfs/evm_pantothenicacid.pdf

From that report:

First: "Pantothenic acid deficiency has been induced experimentally in
human subjects . . .  .Signs and symptoms exhibited by subjects given
he antagonist (not all of which were necessarily due to the
deficiency) included irritability and restlessness, fatigue, apathy,
malaise, sleep
disturbance, gastrointestinal complaints (such as nausea,vomiting and
abdominal cramps) . . . . Some earlier reports have suggested
that high dietary fat and low dietary protein may exacerbate
pantothenic acid deficiency."

So, as siggy-ga suggests, and as you wondered, your symptoms may now
reflect a *deficiency* of pantothenic acid and biotin, though all the
research I found noted that such deficiencies are rare. (Blood work,
and I assume you've had quite a bit what with all these tests, would
reveal if you're low on any of the B vitamins.)

Re: the U.K. study: Secondly: "Interactions . . . Reports have
indicated a sparing effect of some other vitamins, such as ascorbic
acid and other B-vitamins, on pantothenic acid within the body. Biotin
and pantothenic acid may share a common carrier-mediated uptake
mechanism in the *gastrointestinal tract* . . . . Pantothenic acid is
readily absorbed throughout the gastrointestinal tract."

"Toxicity Human data Case reports and some much earlier non-controlled
studies describe a lack of acute or chronic toxic effects of
pantothenic acid compounds (calcium or sodium pantothenate, panthenol)
at very high doses (approximately 10,000 mg/day in some cases for a
number of years), although such levels have been associated with
diarrhoea and gastrointestinal disturbances. . . ."

This report also notes that "One non-blind, non-randomised,
non-placebo-controlled trial, designed to investigate the
effectiveness of
megavitamin therapy in improving the behaviour of 41 children with
attention deficit disorder,showed significant increases in serum
aspartate
transaminase levels (*indicative of liver damage*) in 17 children
after 12 weeks of multivitamin therapy (including doses of calcium
pantothenate increasing during the study period to a maximum of 1200
mg/day). This effect may have been associated with the nicotinamide
component of the multivitamin supplement, although this could not be
confirmed as the vitamins were not given separately."

Finally, "ESTABLISHMENT OF GUIDANCE LEVEL: There are insufficient data from
human or animal studies to establish a Safe Upper Level for pantothenic
acid.There are relatively few human data available on the oral toxicity of
pantothenic acid from controlled trials. *The limited available data have not
identified target organ toxicity and the adverse effects that were noted
were transient* . . . ."

So, I found no data linking long-term, chronic g.i. problems to this
or any B vitamin, but some trials are ongoing and we may know a lot
more about pantothentic acid down the road. Still, you may want to
show the above U.K. study to your doctor on the chance that he or she,
being a medical professional -- unlike myself -- may see a clue in
here that simply wouldn't be obvious to you or me. The study does
mention a possible correlation between vitamins and liver damage.

Possible Liver Damage:

I tried searching for "liver damage supplements," knowing that liver
problems, such as a benign cyst on the liver, or toxicity in the liver
from excessive drug or herb use, can present as g.i problems. Some
supplements have been known to cause liver damage:

About.com's "Herbs For Health" site contains a page on "Herbs and liver damage":
http://herbsforhealth.about.com/cs/toxicology/a/aa031103.htm 

So, I tried searching with the string "liver damage pantothenic acid,"
and found this at the runners' magazine, A Time To Run:
http://www.time-to-run.com/nutrition/vitamins.htm
"Consuming excess amounts of *water-soluble vitamins* can cause
dangerous side effects: Large amounts of niacin [vitamin B-3] can
cause severe flushing, skin disorders, liver damage, ulcers, and blood
sugar disorders, interfere with fat metabolism and speed up glycogen
depletion."

In March of 2002 the Canadian Liver Foundation released this very
generalized warning:
http://www.liver.ca/english/news/mar22.html
 "'I have seen countless patients whose liver problems can only be
attributed to the herbal remedies they were taking,'" says Dr. Gerald
Minuk, a hepatologist (liver specialist) and Professor of Medicine and
Pharmacology at the University of Manitoba. 'The best way to avoid
potentially life-threatening complications is to inform your physician
of all medications -pharmaceutical and herbal - that you are taking or
thinking of taking.'"

But, overall, my research revealed that it's nearly impossible to take
too much pantothentic acid; there aren't any documented,
generally-agreed-upon long-term complications from taking that
supplement. In fact, it seems not getting enough pantothentic acid and
biotin is more likely to cause gastrointestinal distress, than taking
"too much."

Autoimmune Disorders:

You've been tested with endoscopes so I presume diverticulitis,
inflammatory bowel disease (Crohn's and ulcerative colitis), and
Endometriosis of the bowel have been ruled out?

Since alopecia is the result of an autoimmune disorder, it's quite
possible that your gastrointestinal problems are being caused by yet
another autoimmune problem that you've developed. It is possible that
-- just by sheer coincidence -- an entirely new condition happened to
onset while you were taking pantothentic acid and there's no real
connection between the two events.

I tried searching with strings like "autoimmune gastrointestinal" and
here are some of the problems and conditions I found that wouldn't
have been revealed by a colonoscopy:

It's possible that you've developed an aversion to fructose or lactose:
http://my.webmd.com/content/article/71/81164.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
http://my.webmd.com/content/healthwise/65/16242.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

Celiac Disease, which is linked to gluten-intolerance:
http://my.webmd.com/content/healthwise/11/2611
(Or did a biopsy from your endoscopies rule out that possibility for you?)

Fibromyalgia:
http://www.4woman.gov/faq/fibromya.htm

Lupus:
http://www.4woman.gov/faq/lupus.htm

Sjögren´s syndrome:
http://www.sjogrensyndrom.se/100-site/spdfs/S6.pdf
" Chronic atrophic gastritis is associated with . . . low levels of
vitamin B12 . . . ."

Read more about Sjögren´s at Webmd.com:
http://my.webmd.com/content/article/44/2945_503.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
"Less common features of Sjogren's Syndrome" include "gastrointestinal problems."

Irritable Bowel Syndrome:
http://my.webmd.com/content/healthwise/63/15654.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

If you and your doctor think your problem may be IBS, you may want to try
the new IBS drug, Lotronex. See:
http://my.webmd.com/content/article/22/1728_55974.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

Read more about the drug, which survived a controversial fight to be
approved by the FDA in 2002:
http://www.lotronex.com/

Also see sufferers of intense cramping and other g.i. distress singing
the praises of Lotronex during the brief period when the FDA took it
off
the market in the spring of 2001:
http://my.webmd.com/content/pages/10/3734_5517.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
(According to these users, the drug is a near-miracle cure.)

Could it be "Leaky Gut Syndrome," a condition so controversial, some
doctors insist it simply doesn't exist. Its proponents insist that
chronic g.i. problems are the result of bacteria leaking into the
digestive system.

Here's a good overview of Leaky Gut, posted by England's University of Sunderland:
http://osiris.sunderland.ac.uk/autism/gut.htm
"The leaky gut or LGS is a poorly recognised but extremely common
problem. It is rarely tested for. Essentially, it represents a
hyperpermeable intestinal lining. In other words, large spaces develop
between the cells of the gut wall, and bacteria, toxins and food leak
in. The official definition is an increase in permeability of the
intestinal mucosa to luminal macromolecules, antigens and toxins
associated with inflammatory degenerative and/or atrophic mucosal
damage."

For a good overview on various possible causes of intestinal distress, see
Diagnose-Me.com:
http://www.diagnose-me.com/cond/C22114.html

It could even be that your water supply is contaminated and that's
what's making you ill:
http://www.epa.gov/safewater/mcl.html
(If your drinking water comes from a well, you really need to have
that water tested.)

What The Heck Can You Do?  

So, from my research it appear that your misery may correlate to
having stopped the pantothenic acid, not taking too much of it; and
/or, very possibly, another condition, such as IBS, cropping up at the
same time, creating an overlap that suggested you were reacting to the
pantothentic acid. Because you're still sick, even after stopping the
B5, I think you really need to wonder if something else is going on
that has nothing to do with vitamin supplements.

I suggest you ask your doctor if you can resume taking pantothentic
acid and other B vitamins. With your doctor's permission, you may want
to start taking the B vitamins again, in recommended doses. See U.S.
RDA guidelines for daily dosages at:
http://www.daily-vitamins.com/rda.html

See if your symptoms abate when you re-introduce the B vitamins,
including B5 (pantothentic acid). Frankly, I'm surprised your doctor
didn't just suggest you just cut back on the amount of pantothentic
acid you were taking, to see if that worked.

Also ask your g.p. if you can try Lotronex, or the anti-spasmodic
Levsin -- both are prescription only -- right now in hopes of
achieving some relief ASAP.
 
But I also really think you should seek an opinion from another
gasterioentologist. If that doesn't lead anywhere, ask your primary
physician to refer you to an endocrinologist who can explore the
possibility of an autoimmune problem, or a hepatologist who can
examine you for a possible problem with your liver.

If your general practioner is dismissive of your desire to keep
seeking an explanation and remedy, please seek help from another g.p.
It's important that your symptoms be properly diagnosed and that you
receive any help available.

You're clearly in pain and these problems are undoubtedly affecting
your lifestyle. You have a right to explore every possibility and try
every possible remedy.

I do have a call in to a noted expert on vitamins and supplements
asking her if she is aware of any case like yours and the possible
repercussions of pantothentic acid. As soon as I hear back from her --
likely, within the next few days -- I will post that information as an
"Answer Clarification."

I hope my research has helped you. If you have difficulty navigating
the links I've provided, or if you need clarification, please post a
Request For Clarification and I'll be glad to help you.

Other Search Strings:

"'pantothenic acid too much'"
"'pantothenic acid' 'side-effects'"
"'pantothenic acid' causes'"
"'pantothenic acid' damages'"
"'pantothenic acid' AND chronic"
"bowel problems"
"autoimmune gastrointestinal"
"autoimmune bowel"
"overdose pantothenic acid"
"liver problems gastrointestinal" 

Sincerely,
nancylynn-ga

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Clarification of Answer by nancylynn-ga on 26 Nov 2003 15:08 PST

Hello dadoo9999-ga: 

I heard back from herb & vitamin expert and author Karyn Maier, owner
of Herbal Musings Web site:
http://herbalmusings.com/

I'd asked Ms. Maier if high doses of pantothentic acid could have caused your
continuing problems. She informed me: "I know of no long-term affects at
all. In fact, GI distress is often associated with low HCL [B
vitamins] acid levels in the stomach and/or the presence of H. Pylori,
a bacteria often found in well water and - believe it or not - even in
bottled water, that is a leading cause of ulcers. The subscription
form of Prilosec is given to ease symptoms and to check this
bacteria." She added, "But, I'm not sure if the new
Prilosec OTC is in a concentration strong enough to kill it."

Among several other possibilities I'd listed in my answer to you, I'd
suggested that you have your drinking water tested, and I would re-emphasize
that, as it's possible that your drinking water is infected with a common
parasite, such as giardia.

You might also want to check this site about the parasite Cyclospora, which
"infects the small intestine (bowel) and usually causes watery diarrhea,
with frequent, sometimes explosive, bowel movements."

Several outbreaks of Cyclospora have recently been reported throughout North
America. See the Centers For Disease Control's page on Cyclospora, at:
http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/factsht_cyclospora.htm

If your stool samples test negative for such infection, the only other
suggestion I can come up with is gallbladder disease, which can present with
a variety of g.i. problems.  While most gallstones are readily visible via
ultrasound, "sludge" or "crystals" in the gallbladder are tougher to detect.

See New York Methodist Hospital's symptoms of "Chronic Cholecystitis or
Dysfunctional Gallbladders":
http://www.nym.org/healthinfo/docs/010/doc10symptoms.html

And diagnosis:
http://www.nym.org/healthinfo/docs/010/doc10diagnosis.html

I'm sure the last thing you want is another round of medical testing, but I
do think more testing is needed to determine exactly what is making
you ill. I would also again advise you to ask your doctor about slowly
re-introducing B vitamins into your diet.

I certainly hope you get a precise diagnosis, and that you feel much
better, very soon.

Regards,
nancylynn-ga

It seems likely that you have completely overbalanced your body -- in
the direction of one of the B vitamins, pantothenic acid -- and that
now you might do well to try to replenish the others.

The B vitamins are:
    Vitamin B1 (Thiamin) 
    Vitamin B2 (Riboflavin) 
    Vitamin B3 (Niacin) 
    Vitamin B6 (Pyridoxine) 
    Pantothenic Acid  
    Biotin 
    Folic Acid  

(I think some people include inositol and perhaps one or two other
things, but the list above is adequate for these purposes.)

Vitamin B-12, but it is a special one -- because it contains cobalt at
its center, it is both a vitamin and a mineral.  We won't consider it
today.

Of the list above, may I suggest that you get a B complex which
includes all of them and take a small amount with each meal?  Also,
consider getting additional biotin as a sublingual (the label will say
"lozenge") and taking some in the morning -- by letting it dissolve
under the your tongue.

As a general comment . . . there seem to be a lot of "one vitamin" (or
"one substance") cures.  But they have to be wrong, it can never be
just one thing -- in this case pantothenic acid -- because in the
human body, there are all sorts of interconnections.

Pantothenic acid, for instance, especially works with thiamin,
riboflavin, and niacin.  But I'm suggesting that you replenish all of
them because they all work together in various ways.