How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and

16 Pages·2006·0.08 MB·English

by  Greg Schilhab

A Stone that Kills two Birds: How Pantothenic
Acid Unveils the Mysteries of Acne
Vulgaris and Obesity
Lit-Hung Leung. M.D. 1
Abstract In two previous articles1,2 the author
Acne vulgaris is the most common disease reported that both of these two conditions
of the skin. Obesity is arguably the common- are related largely to a deficiency in dietary
est of a clinical entities in the affluent soci- pantothenic acid. It is the aim of this
ety. The pathogenesis of these disorders is far present article to expand and to describe
from clear cut and they appear to have little in greater detail the reason and logic be-
in common. In the present paper it is hy- hind the hypothesis.
pothesized that the pathogenesis of both acne
vulgaris and obesity is largely due to a rela- The Pathogenesis of Acne Vulgaris: a
tive deficiency of the same agent, pantothenic Hypothesis
acid, a vitamin that is hitherto quite un- Over the years, the pathogenesis of
known to cause any deficiency syndromes in acne vulgaris has been extensively stud-
man. Furthermore, the evidence suggests that ied3,4,5 including, the structure and func-
surprisingly large doses of pantothenic acid tion of the pilosebaceous follicle,6 the
are required to overcome deficiency states as physiology of sebum secretion7,8,9 the com-
illustrated in the treatment of acne vulgaris position of sebum10-13 microflora in acne
and weight reduction. vulgaris,14 and abnormal follicular kerati-
nization15,16 considered to be one of the
Introduction earliest events in acne formation. Despite
In reviewing the numerous studies the concerted effort of many scientists,
that deal with the pathogenesis of acne internists, pathologists and dermatologists,
vulgaris, and one gets the impression of the pathogenesis of acne vulgaris remains
reading a detective story. There is the vic- largely elusive.
tim. The facts are all there. There are all In this paper, I would like to approach
the clues, as well as the suspects. But the this problem from a different perspective.
culprit cannot be identified. The identifi- My clinical observations suggest that acne
cation is made the more difficult because vulgaris may be closely related to the con-
the clues seem all tangled up. At times, sumption of diets which are rich in fat
they fit in with the suspects very well, other content. This impression, however, is by
times however, the same clues are contra- no means novel. Textbooks do briefly men-
dictory, and appear to lead to a hopeless tion this correlation17,18,19 though, more
situation. In the same way, it is quite a often than not, it is dismissed as irrelevant.
mystery that an over-weight person, with However, my observations have led to
an abundance of energy deposited as fat quite the contrary conclusions. Not only
depot, cannot efficiently use this stored fat is the fat content of food closely related to
in times of need as during dieting when acne vulgaris, but it forms some sort of
food intake does not meet the energy de- linear relationship with the disease proc-
mand. Not only is this precious stored ess. The more fat the patient consumes,
unavailable,in some cases it is actually the more severe will be the acne process.
squandered. This observation is in line with the opin-
ion of many dermatologists that chocolate,
1. Department of Surgery. Hong Kong Central Hospital.
which is composed mainly of the creamy
Hong Kong
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Journal of Orthomolecular Medicine Vol. 12, No. 2, 1997
part of milk, and has a high degree of fat tives of cholesterol, whose synthesis has
content, and is bad for acne.20-23 Signifi- much to do with lipid metabolism. A hy-
cantly, in this group of patients, any de- pothesis, therefore, which relates the acne
liberate attempt in trying to avoid a fatty process to lipid metabolism becomes
diet over a period of weeks, if not days, something that is worthwhile looking into.
will often result in an improvement of the Before detailing such a hypothesis in
clinical condition. This observation forms any depth, it is relevant to recapitulate very
the basis of my hypothesis that the disease briefly some of the main actions of the sex
process may be connected with fat metabo- hormones relating to the acne process, and
lism–or a deficiency of it. some of their apparent conflicting effects.
Other arguments also support this Although the proposed hypothesis has
hypothesis. There is the composition of the little to do with the functional aspect of
sebum secretion which consists mainly of the hormones, it bears important associa-
lipid material.10,11,13 When lipids are depos- tion to these hormones as a whole. And
ited in the sebaceous glands and excreted remarkably enough, some of the conflict-
as sebum secretion, it does suggest some ing hormonal effect lend strong support
abnormality is going on and hint that some to the hypothesis.
form of fat metabolism may be at fault.
These fatty materials, after all, are energy- The effect of Sex Hormones on Acne
rich compounds. Under normal circum- Vulgaris
stances, they should be stored away in fat 1.The androgens
depots. To have them excreted with a con- Androgens have their effect on
comitant wastage of energy is not nature’s the acne process on several fronts. For a
way of handling excess energy. One possi- long time, it has been shown that an-
bility the body behaves in such a manner drogens exert great influences on sebum
is that it is simply unable to cope effectively secretion,24,25 which preceeds acne forma-
with all the fat that is being absorbed, re- tion. Equally significant is the observa-
sulting in some being dumped through tion that the severity of clinical acne is
some unusual venue. This perhaps helps to directly related to the rate of sebum ex-
explain the observation that an increase in cretion.26 Many studies have also re-
fat content of food appears to worsen acne. vealed that the development of the se-
Furthermore, there is the involvement baceous glands is influenced by andro-
of the sex hormones. The sex hormones, gens. Castrated men have smaller seba-
the androgens in particular, have long been ceous glands and a much lower level of
recognized as important causative factors sebum secretion as compared to a nor-
in the pathogenesis of acne vulgaris. A tre- mal man.27,28 That the sebaceous gland
mendous amount of very thorough work is a target-organ of androgens can be
has been done in relation to this subject, shown by administration of testosterone
and the conclusions of these studies are to subjects that have very low levels of
most intriguing. The findings, however, are testosterone in their blood, like children
often in conflict with one another, and no and post- menopausal women, when
reasonable explanations can be provided there is prompt increase in sebaceous
for all the observations that are made. The gland activity.29,30
sex hormones, aside from their established 2. The Estrogens
relationship with acne vulgaris, are of in- The consensus is that estrogens at
terest in another respect. This is their close physiological dosage have little effect on
relationship with the important com- sebaceous activity. Doses in excess of this
pound cholesterol. It has long been estab- dosage will reduce sebaceous gland activ-
lished that the sex hormones are deriva- ity, hence sebum secretion.31
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How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and Obesity
3.The Progestogens dence for this.
It is generally agreed that 2. Exogenous and Endogenous Androgens
progestogens have little effect on sebum There is another observation concern-
production. It seems that things look ing the relationship of acne and androgens
quite straight forward with these obser- that is difficult to explain. Administration
vations and conclusions, androgen is to of testosterone in prepubertal boys in-
be the predominant factor in the creases the size of the sebaceous glands, but
pathogenesis of acne. Or is it? It is here not so in the adult. Here, the glands would
that things start to look complicated and appear to be under stimulation by endog-
pose many problems. enous androgens rather than exogenous
androgens.28,29,32,34 This is an interesting
The Controversies and Contradin- phenomenon. The same compound, but
dications with a different origin, will carry with it a
1.Sex Distribution different response in the adult body.
Controversies abound in the realm In trying to provide an answer to this
of acne vulgaris and sex hormones. One observation, it is important to look beyond
of the fundamental questions to ask is the relationship of androgens and acne,
perhaps, if androgen is so closely related and perhaps look into other aspects relat-
to sebaceous gland activity, why is the sex ing to the androgens. The synthetic pro-
distribution of the disease process equal? duction of androgens, or the sex hormones
With androgen level so much higher in as a whole, for example, may be
the male than in the female, one would worthwhileto examine, because the only
expect the disease process should largely difference between the two hormones is
occur m the males. This is not true. This that one is synthesized in the body, whereas
is something of a riddle that proves diffi- the other is not.
culty to solve. There is another reason for looking
Some workers offer to explain this by into the synthesis of hormones. It has been
saying that it is not the amount of an- shown that pubertal boys with or without
drogens in the blood that matters, but the acne have about the same blood levels of
sensitivity of the target-organ, the seba- testosterone.35,36 On the face of it, there is
ceous glands, towards androgens that no basic difference between these two
counts.33 With this explanation, a few groups of boys. However, at this stage of
questions inevitably follow. The question their life, one particular feature stands out:
of sensitivity is an issue. Little is known They all need to start synthesizing andro-
about the nature of this sensitivity. With gens, probably a good amount of it, to
the incidence of the disease process di- cater to the development of the sex organs.
vided between male and female. it car- One possible reason that subsets within
ries with it the implication that the fe- these two groups of boys may have some
male sebaceous glands have to be much subtle differences in synthetic processes.
more sensitive towards androgens than Of course, the actual synthetic process will
the male glands. But apparently there is be the same, requiring the same enzymes,
little supporting evidence for this. coenzymes and basic building blocks for
Even more puzzling is the clinical con- the purpose. What constitutes the possi-
dition of premenstrual flare, in which fe- ble difference here is not so much as the
male patients have much more prominent nature, or quality, of these components,
acne eruptions premenstrually. For the ex- they should be the same, but rather some
planation to hold true. the sebaceous glands other factors. One possibility is the quan-
have to be particularly sensitive to andro- tity of the dietary components may differ.
gens premenstrually. Again. there is no evi- One group may be provided with a good
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Journal of Orthomolecular Medicine Vol. 12, No. 2, 1997
supply of all the components and the other reasonable ground to link up the acne proc-
with varied degrees of shortages. This dif- ess to Coenzyme A and to investigate the
ference could be significant and provide pathogenesis of acne vulgaris along this line.
the logical basis for looking into the syn-
thetic process. The Importance of Coenzyme A
The essential steps in the synthesis of In trying to link up acne vulgaris to
androgens and the other sex hormones are Coenzyme A, it is important to have a
well known. They are all derived from the hypothesis supporting some basic facts. A
important compound cholesterol, which closer look at Coenzyme A may provide
in turn is basically synthesized from units the evidence.
of acetyl-CoA. That is to say, the basic 1.A Sharing Scenario
constituents or building blocks of the sex As a coenzyme active in both fatty acid
hormones are acetyl- CoA. In the synthetic metabolism and sex hormone synthesis,
process, the body naturally is always try- Coenzyme A is shared between two dif-
ing not only to reach for a normal level of ferent metabolic processes. This is not
androgens, but an optimal level., so as to uncommon in biochemical reactions in
allow the body to function at its best. metabolism, where a coenzyme is often
However, this does not always possible, shared among a number of reactions. But
and the normal level reached may not rep- with Coenzyme A, it is somewhat differ-
resent the optimal level. This is nature’s ent. With its involvement in more than
flexible way of dealing with shortage of one hundred reactions.37,38 Coenzyme A is
essential dietary elements in any form–to arguably the most important coenzyme in
achieve a level that is just enough to man- the body, and when a coenzyme is involved
age the present situation, leaving a vari- in the metabolic process to such an extent
able degree of shortage from the optimal as this, it becomes legitimate to ask if a
level. In the present instance, in the two shortage and deficiency is possible. To an-
groups of boys, one group may have a nor- swer this, a brief look at the structure of
mal level of androgens that is falling short Coenzyme A is warranted.
of the optimum. One possible explanation 2. Pantothenic Acid
for this is that there is a lack of basic build- Coenzyme A is formed from adenos-
ing blocks, the acetyl-CoAs, which deter ine triphosphate, cysteine, and pan-
the body from operating at peak efficiency. tothenic acid. Of these pantothenic acid
If this is a viable possibility, it suggests that is the only component that is a vitamin,
a plentiful supply or a deficiency of acetyl- and must be provided from our dietary
CoA in the body may play a role in the intake. Can there be an insufficient intake
acne process. This is certainly possible. For, of pantothenic acid resulting in a defi-
aside from its role in the synthesis of the ciency in Coenzyme A which would leave
sex hormones, acetyl-CoA, of which the body unable to cope with all the reac-
coenzyme A is the important component, tions that it has to perform with that all
is also important in fatty acid metabolism- important coenzyme? Conventional wis-
as an acyl carrier in the lengthening and dom does not think so. It is suggested that
degradation of long chain fatty acids by pantothenic acid, being ubiquitous,
adding or removing acyl groups in the enough can be had from whatever kind of
metabolic process. food that is taken in, and that there is no
To sum up the events, the situation question as to its deficiency in our body.
is such that acne vulgaris is related to lipid However, a deficiency is still possible. Af-
metabolism as well as the sex hormones, ter all, when so many reactions are depend-
both of which have a lot to do with ent on the same agent, its demand must
Coenzyme A. This relationship provides a be tremendous. Shortage under such cir-
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How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and Obesity
cumstances is not entirely impossible. the glands and little sebum will be excreted
3.The Crucial Question and the New to cause acne vulgaris.
Theory The Mystery Revealed
If the question of deficiency of The mechanism proposed above
Coenzyme A does come up, how does it may be the reason why two groups of ado-
affect acne, knowing its importance in fatty lescent boys–both with a normal blood
acid metabolism and sex hormone synthe- level of androgen–may exhibit differences
sis? This is the crucial question. This is in the incidence of acne. The group with
where the new hypothesis on the acne is the one that has not enough of pan-
pathogenesis of acne vulgaris is based, and tothenic acid in the body, whereas in the
this is where it diverges from conventional other group, pantothenic acid levels are not
medical ideas. The author’s proposed hy- deficient.
pothesis for the pathogenesis of acne vul- This new theory seems to work well
garis is that the disease process is not caused here, and can be tested in other metabolic
by androgens, or any other sex hormones. situations. In the case in which endog-
But rather, the disease process results from enous androgen stimulates acne, whereas
a defects in lipid metabolism that is sec- exogenous does not, the reasoning for the
ondary to a deficiency in pantothenic acid, observation is the same. Any endogenous
hence Coenzyme A. Coenzyme A, in car- androgen synthesis will require the partici-
rying out its function efficiently both as an pation of extra amount of pantothenic
agent in fatty acid metabolism and an agent acid. This will channel off some of those
in androgen and sex hormone synthesis, has that are doing the work of fatty acid me-
to be present in sufficient amounts, and tabolism. Consequently, fatty acid metabo-
anything that is less than sufficient will re- lism becomes less efficient and the indi-
sult in some compromise of the work. vidual is more prone to have acne. Exog-
4.Mother Nature’s Choice enous androgen, on the other hand, does
Facing with the dilemma of a short- not affect the pantothenic acid pool (which
age of Coenzyme A, the body will tend to is a term used to represent the total pan-
make a choice that is to the best advan- tothenic acid in the body) in any manner,
tage of the individual. The body does by hence no effect on acne. This explains the
largely maintaining the functionally more seemingly mysterious nature of this
important reaction, while at the same time observation.
slowing down the lesser important one. What about premenstrual flare? In the
The choice here is a relatively simple one. luteal phase of the menstrual cycle, pro-
Nature will seek to take care of the syn- gesterone in is secreted abundantly by the
thesis of hormones first, because continu- corpus luteum. This naturally will take up
ation of the species depends on the devel- a lot of pantothenic acid in the body’s pan-
opment of the sex organs. Fatty acid me- tothenic acid pool, leading to a re-distri-
tabolism is for the time being at least in bution of the vitamin and putting enor-
part halted, Lipid in the sebaceous glands mous pressure on fatty acid metabolism.
starts to accumulate, sebum excretion is When this metabolic process is not per-
increased, and acne begins to appear. forming satisfactorily, lipid begins to ac-
When there is enough pantothenic acid cumulate in the sebaceous glands, an in-
in the body, however, both reactions will crease in sebum is excreted, and acne fol-
be well taken care of. There is enough sex lows. That is why, even though progester-
hormones for the sex organs to develop. one has no effect on sebaceous gland ac-
The lipids in the sebaceous glands are com- tivity, an increasing level of progesterone
pletely metabolized by sufficient Coezyme in the late stage of the luteal phase leaves
A, and there will be no unwanted lipid in the acne patient with a prominent flare.
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Journal of Orthomolecular Medicine Vol. 12, No. 2, 1997
A similar explanation may why eu- portant factors. What is important is the
nuchs rarely exhibit acne.27,28 This may be availability of extra pantothenic acid to
because so few sex hormones are secreted, discharge the function of fatty acid me-
the pantothenic acid pool can deploy a tabolism on top of the synthesis of the sex
more significant portion of its reserve to hormones. That is why, in conditions in
metabolize fatty acids. When the job is which there is an increase in secretion of
efficiently done, little sebum is excreted, any hormone whose synthesis requires the
and no acne is formed. participation of pantothenic acid, acne
This theory will also serve to explain may erupt This is frequently seen with
the paradoxical problem of equal sex dis- those hormone secreting tumour of the
tribution of acne incidence. It is not the ovary, testis and the adrenals. The rapid
male hormone androgen that is important, decline in incidence of acne after adoles-
but rather the absolute amount of sex hor- cence, say in the late teens and early twen-
mones that counts. Both males and females ties, can also be explained. After the sex
will need sex hormones for the develop- organs are fully developed, probably not
ment of sex organs and the secondary as much sex hormones are required, leav-
sexual characteristics. The only difference ing an adequate supply of pantothenic acid
is that in the male, androgens predomi- to serve the function of fatty acid metabo-
nates, whereas in the females, the female lism. When this function is cleanly accom-
sex hormones. Apparently the synthesis of plished, sebum secretion dries up, and acne
sex hormones, which probably ranks high starts to fade.
up in the various reactions served by pan-
tothenic acid, takes away a rather big por- Deficiency in Lipid Metabolism
tion of the pantothenic acid pool, leaving In linking the pathogenesis of acne
a relative shortage of it to efficiently me- vulgaris to a deficiency in lipid metabo-
tabolize fatty acids. The result is that acne lism and pantothenic acid, it is worthwhile
starts to erupt, right at the time the sex to remember that fatty acid metabolism is
organs begin to develop—at puberty. The not the sole domain of pantothenic acid.
reason acne first erupts at puberty is not, There are some other essential dietary fac-
therefore, endocrinological, but rather sec- tors that are also of importance in the same
ondary to the deployment of a substantial process. Together they form a system that
amount of pantothenic acid for the pur- will make the whole metabolic process as
poses of synthesis of sex hormones, leav- efficient as possibly. Preliminary studies by
ing a relative deficiency for fatty acid me- the author suggest that, together with pan-
tabolism. The size of this pantothenic acid tothenic acid, biotin as well as nicotina-
pool and the ability with which the indi- mide help to further improve the thera-
vidual can deploy any reserve from the peutic results. By themselves alone, they
common pool probably varies in different are far less effective in helping acne pa-
individuals and is likely to be influenced tients than pantothenic acid, and this, in
by genetic and dietary factors. That is why, a way, serves to support the suggestion that
in some individuals with little pantothenic pantothenic acid plays a central role in li-
acid in reserve, acne begins to appear early pid metabolism. Lipid metabolism is a
on at puberty, whereas in some others, complicated process, and is often inter-
those with a large reserve, have their acne twined with other metabolic processes,
to appear relatively late, or not at all. sharing with them common coenzymes in
This hypothesis thus offers an expla- widely different reactions. When there is
nation as to the relationship of the sex an increase in level of some of these
hormones and acne. It is suggested that coenzymes, there may be a shift in the di-
sex hormones and androgens are not im- rections of some on-going reactions, and
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How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and Obesity
may affect lipid metabolism as a result. will draw on the pantothenic acid pool.
This can manifest clinically as acne vul- Lipid metabolism may therefore be com-
garis. To illustrate this, there are re- promised, rendering the body more prone
ports39,40 saying that acne may be induced to acne.
by administration of large doses of vita- If pantothenic acid deficiency is in-
min B 12 alone or in combination with deed the main causative agent in the
B6. Cessation of the administration of pathogenesis of acne vulgaris, it is logical
these vitamins will bring a halt to the acne to ask how much pantothenic acid patients
eruptions. This may also be explained. If are lacking in absolute amounts.
the body is in a relative deficiency state
in B6 and B12, administration of the vi- Deficiency syndromes
tamins will enhance the reactions that in- For decades, the medical profession
volve the participation of these vitamins. has tied their hands with a fiction of
This will set up a chain of events, some their own device. They held, contrary to
of which will likely to entail the partici- the facts, that nutritional requirements
pation of pantothenic acid. With the to- can be met through a well balanced diet,
tal pantothenic acid pool fixed relative to and that dietary supplements, including
an increase in other vitamins, emphasis vitamins, are not required. It is the be-
of any reaction involving pantothenic lief of the medical profession that vita-
acid will automatically mean a cutting mins, though essential to life and not
back on other reactions that require the synthesized in the body, are not required
same vitamin as a coenzyme. This will in great amounts. To them, the impor-
often include those involving lipid me- tance of vitamins lies mostly in ridding
tabolism, resulting in a certain degree of patients of deficiency syndromes. To
deficiency in that metabolic process, keep individuals in good health does is
hence the increased incidence of acne not accepted as the major role of vita-
vulgaris in these studies. It is probably the mins. This view was challenged, nota-
same reason that in clinical practice, it is bly by Linus Pauling. In his book, How
not uncommon to find acne patients de- to live longer and feel better, Pauling
veloping a flare when given muti-vitamin provided vigorous proof, through com-
tablets. parative studies in animals and from an
evolutionary point of view, that vitamin
Stress Related Acne C supplements are needed if an optimal
It is perhaps relevant here to con- state of health is to be achieved. Not only
sider another common factor–stress–that is supplementation necessary, but the
is known to affect acne adversely. Stress amount required is far greater than most
in many forms poses as an aggravating people believe, as with the case of vita-
factor in acne lesions. Lack of sleep at min C where the optimal dose is 10 or
night, pre-examination tension, and any more grams a day.41
psychological problem that may worry This issue was a point of heated
the patient will bring on new acne le- debate in the 70s and 80s. Though
sions.33 To explain this, one should re- Pauling has quite a large following, by and
call that in combating stress, the body will large, the issue was dismissed by the main-
secrete glucocorticoids from the adrenal stream medical profession,42 because of a
glands as a means to adapt to stress, what lack of theoretical support and a general
is commonly known as the fight-or-flight bias against nutritional and vitamin
reaction. The glucocorticoids, like the sex therapy. But, in view of the new evidence
hormones, are derivatives of cholesterol, suggested in this paper, it seems appro-
and increased demand for this hormone priate that the issue be raised again.
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Journal of Orthomolecular Medicine Vol. 12, No. 2, 1997
How Much Pantothenic Acid? is impressive. There is a noticeable de-
In trying to determine the actual crease in sebum secretion on the face usu-
amount of pantothenic acid necessary to ally 2-3 days after initiation of therapy.
relieve acne patients of their symptoms, the face becomes less oily. After 2 weeks,
Linus Pauling’s experience with vitamin C existing lesions start to regress while the
provides a good guideline. Pauling had for rate of eruption of new acne lesions be-
a long time recommended vitamin C in gins to slow down. In cases with moder-
high dosages to achieve optimal health. ate severity, the condition is normally in
Radically different from what is recom- complete control in about 8 weeks, with
mended by the Food and Nutrition Board most of the lesions gone and new lesions
of the National Research Council (who only to erupt occasionally. In those pa-
recommended 60 mg daily), Pauling’s rec- tients with severe acne lesions, complete
ommended daily intake of vitamin C control may take months, sometimes up
amounts to several grams a day. The rec- to six months or longer. In some of these
ommendation was stepped up to 15-20 cases, in order to get a more immediate
grams a day in his later years. Using these response, it may even be necessary to step
recommendations as a background, it be- up the dose to 15-20 grams a day. In any
comes somewhat easier to arrive at a proper event, the improvement is normally a
dosage for pantothenic acid in the treat- gradual and steady process, with perhaps
ment of acne vulgaris. minor interruptions by premenstrual
Pantothenic acid, which acquires its flare or excessive intakes of oily food.
name from the Greek word meaning ubiq- With this form of treatment, another
uitous, is present in all tissues. Its univer- striking feature is the size of the facial skin
sal presence is an indication of its impor- pore. The pore size becomes noticeably
tance. This is further reflected by the many smaller within 1-2 weeks, very often
reactions that it catalyzes. Given all these, much sooner. Like sebum excretion, the
it should not come as a surprise if the pores will continue to shrink until the
amoumt of pantothenic acid required to skin becomes much finer, giving the pa-
for optimal health is of the same order of tient a much more beautiful skin.
that of vitamin C. Based on this argument, This decrease in skin pore size is pre-
the dose of pantothenic acid administered sumably related to sebum excretion.
to the acne patients was up to 10 gm a When an acne lesion is formed, there is
day, and the result of these studies were in the epithelial cell of the hair follicle an
first reported in Medical Hypotheses.1 accumulation of lipids, leaving the epi-
thelial cells bulky and the lumen of the
The Effect of Pantothenic Acid on Acne gland narrowed. When there is a con-
Vulgaris comitant increase in sebum flow, the fol-
One hundred patients of Chinese de- licle has no choice but to hypertrophy to
scent were included in the study, 45 males accommodate the changes, resulting in an
and 55 females. The age ranged from 10- enlarged skin pore and coarse skin. With
30, and with about 80% between 13 and the administration of pantothenic acid,
23. The severity of the disease process var- the whole process is reversed Lipid me-
ied. They were given 10 g of pantothenic tabolism becomes normal and efficient.
acid a day in 4 divided doses. To enhance The epithelium is no longer laden with
the effect, the patients were also asked to fat droplets, there is a decrease in sebum
apply a cream consisting of 20% by excretion, the hypertrophy process is not
weight of pantothenic acid to the affected required. The skin pore reverts to a much
area, 4-6 times a day. With this treatment smaller size The skin becomes smooth and
regimen, the response is as prompt as it fine.
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How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and Obesity
Is a Maintenance Dose Necessary?As To keep this situation in check is difficult,
acne lesions tend to subside spontaneously but not insurmountable with a conscious
after puberty, technically speaking, most effort, conviction and perseverance. But
patients do not need a maintenance dose. more troublsome and difficult to manage
But, if a patient is in his mid-teens, when is the weakness, sweating, dizziness and
the sexual characteristics are yet to fully fainting episodes that follow the sensation
develop, it becomes necessary that a re- of hunger. Under such circumstances, the
placement therapy be implemented. This dieter will have little choice except to start
maintenance dose, though, can be lowered, eat ing again, gaining back the weight that
or be titrated with the clinical symptoms. he has tried so hard to shed.
It is, however, a good idea to put all pa-
tients on a maintenance dose. This will not The Paradox
only act as a Preventive measure against The key question to the whole prob-
sporadic eruption, but the extra pan- lem of weight reduction is why is one hun-
tothenic acid will help to ease the relative gry and compelled to eat when one has
deficiency state, hopefully improving the enough of stored fat in the body? In other
general heal th of the patient. words, why is one not able to convert,
freely, one’s storage fat into energy? Stor-
Pantothenic Acid and Weight Reduction age fat, as the story of evolution will tell,
With pantothenic acid so closely re- is meant as an energy reserve in t me of
lated to lipid metabolism, it raises the ques- need. Famine is a typical example of such
tion if it has anything to do with obesity, a needy time. So, why can’t one make use
and hence weight reduction. In the rest of of the storage fat at a time when one needs
this article, the author will try to explore it most? Or can one do it? This is the key
the problem of weight reduction which is question which needs to be examined very
equally, if not a more mysterious problem, carefully,
than acne vulgaris. It is not strictly true to say that the
Regarding negative calorie balance body is not able to utilize its stored fat
and dieting, the only guiding principle be- when the situation warrants it. Not only
hind weight reduction is that the calorie can ti burn fat stores, but it can do it with
intake must be less than the calorie out- great efficiency, initially at least. The trou-
put, so that there is a negative calorie bal- ble is that this ability does not last. When
ance. The body will try to make up for the body is deprived of its food and en-
this negative balance by burning the fat ergy is not forthcoming from the external
that is stored in the fat cells, the so-called source, glycogen that is stored in the liver
depot fat. With such a process, fat in the is first called on to furnish the energy defi-
body is consumed, and the individual loses cit. Unfortunately, the glycogen store is
weight. This sounds rather simple, and the very limited, and very soon, even before
goal should therefore easily be achieved. the glycogen store is totally depleted, the
In practice, however, this is quite a differ- body will have to mobilize its stored fat
ent story. By taking in less than what is from its fat depot to supplement its en-
actually needed, the dieter in fact faces two ergy requirement
hurdles that may prove too difficult to For a short time, the body can freely
overcome. There is the problem of hun- derive its energy from its stored fat All the
ger. It takes enormous self- restraint and fat that is mobilized will be completely
determination to keep the appetite in burnt with no wastage. But very soon, very
check, and when hungry, there is the con- occasionally within hours, for unknown
stant temptation to satiate this primitive reasons, the body can no longer maintain
instinct by grabbing whatever is available. this rate of functioning. It can still burn
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Journal of Orthomolecular Medicine Vol. 12, No. 2, 1997
its mobilized fat, but no longer as effec- fasting is prolonged, this mechanism will
tively and as efficiently as before, with ke- become even more inefficient and more
tone bodies representing partially burnt ketone bodies will build up as the body
fatty acids appearing in the blood stream loses more of its precious stored energy
and urine. With time, if food is still not through the urine and the breath.
forthcoming, the accumulation of ketone Judging from what actually happens
bodies will significantly increase, an indi- after the onset of fasting, there is little
cation that the power to metabolize stored doubt that the body is empowered with a
fat is further being eroded. The individual mechanism to metabolize mobilized fat.
begins to feel hungry, with the concomi- The only question is why this mechanism
tant symptoms of weakness, dizziness, fails to last. If only one can identify the
sweating emerging. problem, and prolong the mechanism of
It has been recognized that the time fat burning, then weight reduction will be
taken from the start of fasting to the onset simple. One can just fast or semi-fast the
of ketosis varies, sometimes to a consider- individual, and set the mechanism at work,
able extent among different individuals. then all the calorie deficit will be provided
While some may become weak within a by energy converted from the body’s stored
matter of hours, others can get on very well fat. The stored fat will be steadily depleted,
without food for more than one to two and the individual will gradually and
days. In laboratory animals, it is not un- slowly lose weight.
common for some to stay active and yet
free of ketosis for 2-5 days after the onset The New Hypothesis of Ketone Body
of fasting.43,44 Formation
It seems that the crux of the matter
Ketosis and the Loss of Energy rests on the formation of ketone bodies.
Here, two most important points are So long as mechanism is working effi-
raised. Why is it that some people can tol- ciently, no ketone bodies will emerge, and
erate fasting better than the others in the the first sign of failure of the mechanism
sense that they can go on with their activ- is the appearance of ketone bodies in the
ity without ketosis for a much longer pe- blood stream. What then, is the reason for
riod of time? And more important, why is the failure of the mechanism that leads to
the body, with the development of keto- the formation of ketone bodies? There is
sis, losing precious stored energy at a time no conclusive answer, but there are some
when the body needs it most? It appears clues. It is known that ketone bodies only
that the body, resisting the onslaught of appear when the body is asked to catabolize
fasting, has installed a mechanism whereby a large amount of fat, as when the energy
fat can readily be converted into energy. requirement of the body is largely provided
But this mechanism is far from perfect, and by its stored fat.45,46,47 At the point where
fails to keep engaged for very long in some the body can no longer cope with effi-
individuals, although in others the mecha- ciently breaking down this large amount
nism can maintain its function for several of fat, ketone bodies appear. To understand
days. Still, the mechanism gets blunted ketone body formation, it seems pertinent
with time, and is unable to efficiently per- to have a good look at the catabolism of
form its function-to completely burn off fat and fatty acids.48,49 Briefly, fat catabo-
all the mobilized fat and provide the body lism is a process in which the stored fat in
with energy, with no ketogenic wasting of the form of triglycerides is first broken
stored energy. This eventual blunting of down into glycerol and long-chain fatty
the metabolic mechanism applies to every acids. These long-chain fatty acids are then
individual, without exception. In time, if serially broken down by a process called
108