Vitamin B5 (Pantothenic Acid) For Acne – Skeptical View

By Seppo | Quackery

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The web is full of rumors and hearsay about vitamin B5 (pantothenic acid) for acne, but there’s a gaping black hole when it comes to credible, evidence-based information. Let’s fix that now.

The point of this post is to take a critical look at the claims that you can treat acne with B5, and the paper by Dr. Leung that started it all. We’ll look at if there’s any good reason believe these vitamins can fix your skin.

So if you are tired of rumors and hype, you need to take a few minutes to read this post.

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Summary

This post turned out a bit longer than I expected. So for those with short attention span here are the keypoints:

  • The whole thing lays on a theory that vitamin B5 deficiency limits fat metabolism, and thus those excess fats are pushed through the skin as sebum.
  • There is no credible scientific evidence to back this up. Dr. Leung never published his study he bases this on, so we have no way to know. Furthermore, prior to publishing his hypothesis paper he applied and received a US patent for B5 acne treatment. So he has a direct financial interest in promoting this theory.
  • I could only find 1 ‘independent’ study on this. While the results were positive (50% reduction in acne) it was too small and poor quality to conclude anything, and it was sponsored by a company that sells B5 acne treatment.
  • Several lines of credible evidence disagree with Dr. Leung’s theory. For example, he says that when you eat more fat you get more acne, both anecdotal evidence and studies show acne is more affected by carbohydrate consumption. And people who reduce carbs and eat more fat tend to improve.
  • Furthermore, several studies show increased sebum production when skin cells are exposed to hormones (such as testosterone and insulin). This agrees with the hormonal nature of acne, but not with Dr. Leung’s theory. We also have the studies that show impressive reductions in sebum production with topical application of ‘androgen blockers’ (such as green tea and evening primrose oil).
  • While Dr. Leung’s theory appears to be spectacularly wrong, lot of acne patients see improvements with megadoses of B5. Perhaps there’s another way B5 works. Hard to say since user reviews are very unreliable as evidence. And users at acne.org forums have abandoned the treatment, with common consensus saying it only works temporarily.
  • All credible sources say supplementing with B5 is extremely safe. But there is anecdotal evidence of hair loss and even severe, very long lasting side-effects. Again, we can’t say for sure from anecdotes.
  • It’s possible B5 helps your acne, but we just can’t say for sure. There is no good reason to believe Dr. Leung’s theory is correct, and there’s plenty of reasons to believe it’s incorrect.

The theory

The whole thing started in 1997 when Dr. Lit-Hung Leung published his theory of how deficiency in Coenzyme A (CoA), a derivate of pantothenic acid, is responsible for acne. I should note that his paper was not a medical study, it was a hypothesis paper published in Journal of Orthomolecular Medicine.

The journal’s scientific standards may be less than rigorous. Given that it was created because other, reputable journals refused to publish their papers. From Wikipedia:

The Journal of Orthomolecular Medicine, founded in 1967 as the Journal of Schizophrenia, is the main publication of those involved in orthomolecular medicine. It was founded, as Abram Hoffer wrote, because of the alleged conspiracy:

“We had to create our own journals because it was impossible to obtain entry into the official journals of psychiatry and medicine.”

Wikipedia: Orthomolecular medicine

Orthomolecular medicine is the discredited idea that you can use megadoses of vitamins to cure many diseases.

Of course this doesn’t mean the theory is wrong, just that it keeps scientifically bad company.

Briefly described the theory goes like this.

CoA is required in both fat metabolism, production of hormones and countless other processes in the body. And because it’s needed in so many places Dr. Leung says deficiencies are likely, something mainstream medical science disagrees with.

Given that it’s a limited resource the body prioritizes usage, giving higher priority to production of sex hormones (since they are important in reproduction). This leaves less CoA available for lipid (fat) metabolism.

Because the body cannot effectively process (metabolize being the more scientific term) fat, it accumulates in the body. In the case of acne it’s being pushed through the skin. And this explains high sebum production in acne patients.

The dear doctor says that acne is not linked to sex hormones but rather to deficiency in Coenzyme A. And since CoA is derived from vitamin B5, you can fix it with megadoses of pantothenic acid.

And so the vitamin B5 acne connection was born.

Possible conflict of interest

The hypothesis paper aside, is there any real evidence to back up this theory? In the same paper Dr. Leung talks about his own study with 100 acne patients. The problem is that this study was never published anywhere, as far as I can tell. And he describes it in most unscientific terms, it actually reads more like a testimonial than a scientific study. So we have  no way to really know anything about this study. How good it was scientifically, or whether it even happened.

Another problem is that Dr. Leung applied and received a patent for his acne treatment prior to publishing his hypothesis papers. The patent was granted in 1996 and his paper was published in 1997, how convenient.

So he has a direct financial interest in promoting this theory. While there’s nothing illegal or wrong about this per se, this is not how real science works.

Independent evidence?

Aside from Dr. Leung’s research, I could find just one study looking at the effect of B5 on acne. I’m assuming it was sponsored by the company that produces Panthothen, a B5 supplemented marketed as an acne treatment. The study didn’t contain normal ethics statement, so I can’t say for sure. But it was done by Neutraceuticals Medical Research, a company that conducts outsources medical research for natural health companies. And it specifically mentions the brand Panthothen in the paper, so I’m assuming the company sponsored it.

The study showed 50% reduction in acne after 8 weeks. But it only had 10 participants and had no control group. This makes it scientifically more or less worthless – but great for marketing purposes.

So in summary, there’s no good scientific evidence to say that vitamin B5 helps acne. And the original theory itself is very shaky (I’ll talk about it more below).

Absence of evidence doesn’t mean evidence of absence

In the name of intellectual honesty I have to point out that lack of scientific evidence doesn’t mean B5 is useless for acne. It just means we can’t say either way.

Anecdotal evidence

Lack of scientific evidence hasn’t deterred acne patients from experimenting with megadoses of pantothenic acid. User reviews are generally very positive. At the acne.org review section it’s rated as 3.7 (out of 5).

Unfortunately user reviews are just about the most unreliable form of evidence there is. No controls, no way to know what caused the effect, no way to know whether the effect was real (or just part of the cyclical nature of the condition). No way to know whether it was just a temporary effect, etc. This is why medical science is not based on anecdotes and user reviews.

Sidebar. Here’s a good article on why we need science to evaluate medical claims and why anecdotal reports can be very misleading: Why We Need Science: “I saw it with my own eyes” Is Not Enough.

There’s also the possibility that at least some of these reviews are written by companies that sell B5 acne treatments. This happens unfortunately often.

Safety

Vitamin B5 seems to be very safe. So even if it doesn’t help your acne, it’s unlikely to harm you either.

This is from the risk assessment of The Food Standards Agency in The UK.

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.

Risk Assessment Pantothenic acid (PDF)

Other regulatory agencies pretty much say the same thing. No evidence of toxicity.

Anecdotal evidence of harm

Though there’s no scientific evidence of harm, there are anecdotal reports of severe side-effects after vitamin B5 megadoses. Such as this one: Pantothenic Acid megadose – permanent side effects. Several people have also experienced hair loss from megadoses of B5: Vitamin B5 Hair Loss (acne.org forums). With more searching I could probably find evidence of other side-effects.

Of course these are anecdotal reports, and as such not very reliable.

Vitamins are bioactive compounds and in recent years rigorous studies have shown harm from regular use of some vitamins and supplements. Vitamin B5 shares pathways with other B vitamins. So megadosing on B5 may inhibit and lead to deficiencies in other B vitamins. Please don’t assume vitamins are automatically safe.

Closer look at Dr. Leung’s paper

At superficial level Dr. Leung’s theory makes sense, but starts to look shaky when you look at it closely. So let’s look at some problems with the theory.

Here’s a PDF of the full text study. Feel free to check it out and make sure I don’t take anything out of context.

This is from the beginning of the paper.

However, my observations have led to quite the contrary conclusions. Not only is the fat content of food closely related to acne vulgaris, but it forms some sort of linear relationship with the disease process. The more fat the patient consumes, the more severe will be the acne process.

This seems utterly ridiculous to me, and none of the diet acne studies support this. Anecdotal evidence from acne and diet forums suggests opposite. Acne often improves when people limit carbohydrates, either by going on a low-carb or paleo style diets.

Significantly, in this group of patients, any deliberate attempt in trying to avoid a fatty diet over a period of weeks, if not days, will often result in an improvement of the clinical condition. This observation forms the basis of my hypothesis that the disease process may be connected with fat metabolism– or a deficiency of it.

I don’t know where he pulls the observation that limiting fat improves acne. It’s true that limiting some fats improves acne, but that’s because trans-fats and other bad fats are highly inflammatory. But more often than not it’s the limiting of carbohydrates and/or reducing glycemic index of carbohydrates that improves acne, a fact that’s supported by both available diet studies and understanding of how hormones affect the skin. Regardless, it’s a ridiculously shaky ground to build a scientific hypothesis on.

Little bit later comes this gem.

When lipids are deposited in the sebaceous glands and excreted as sebum secretion, it does suggest some abnormality is going on and hint that some form of fat metabolism may be at fault. These fatty materials, after all, are energy rich compounds. Under normal circumstances, they should be stored away in fat depots. To have them excreted with a concomitant wastage of energy is not nature’s way of handling excess energy.

Honestly, reading this paper starts giving me headache. I seriously wonder what was going on his head as he wrote that sebum secretion is wasting precious energy resources. Has he never heard of the skin barrier function? That sebum in the skin prevents excess water loss, without which your water-rich internal organs would wither and die. That sebum forms a protective layer on the skin that protects you from inflammation and elements.

Yes, acne patients produce more sebum, but I would hardly say this is a waste of precious resources. And the fact that acne-prone skin produces more sebum is already explained with genetic sensitivity to androgen hormones.

Then he talks about how Coenzyme A is needed for both hormone production and fat metabolism and proposes the following.

The author’s proposed hypothesis for the pathogenesis of acne vulgaris is that the disease process is not caused by androgens, or any other sex hormones. But rather, the disease process results from a defects in lipid metabolism that is secondary to a deficiency in pantothenic acid, hence Coenzyme A.

Except that again facts don’t agree with him. Acne is a common side-effect of testosterone medications, and abuse of anabolic steroids by bodybuilders often also causes acne. Or the inconvenient fact that sex hormone levels are often elevated in acne patients.

Regardless of the cause, overproduction of either T or T precursors leads to exaggerated T action in target tissues such as skin. In skin, T is converted to DHT by the enzyme 5a-R, which acts directly on hair follicles and the sebaceous glands. The most frequent dermatologic manifestations of androgen excess are hirsutism, acne, and androgenic alopecia.

The 5 Alpha-Reductase Isozyme Family: A Review of Basic Biology and Their Role in Human Diseases.

Then he talks how the body prioritizes hormone production over fat metabolism.

Facing with the dilemma of a shortage of Coenzyme A, the body will tend to make a choice that is to the best advantage of the individual. The body does by largely maintaining the functionally more important reaction, while at the same time slowing down the lesser important one. The choice here is a relatively simple one. Nature will seek to take care of the synthesis of hormones first, because continuation of the species depends on the development of the sex organs.

If that’s the case, then why sex hormones levels are elevated in acne patients? He already established that CoA is the limiting factor here. Why would the body waste this precious resource producing excess sex hormones? Why not produce just what’s needed and save some CoA for fat metabolism?

Finally, he makes the statement that the difference between people with acne and clear skin is vitamin B5 status. Those with sufficient reserves remain clear.

The mechanism proposed above may be the reason why two groups of adolescent boys–both with a normal blood level of androgen–may exhibit differences in the incidence of acne. The group with acne is the one that has not enough of pantothenic acid in the body, whereas in the other group, pantothenic acid levels are not deficient.

This sounds like a claim that’s easy to test. So far it’s been shown that acne patients have higher levels of certain androgen hormones, insulin, insulin like growth factors and inflammatory chemicals and lower levels of antioxidants. But nobody has shown a difference in B5 levels. I wonder why Dr. Leung hasn’t bothered to test this, as it seems like a very easy way to support his theory.

Here are some other problematic points I noticed in the paper:

  • It doesn’t make evolutionary sense that we would need such high doses of vitamin B5, doses you can never get from diet. It’s not likely that such a trait would have evolved through natural selection as it doesn’t seem to offer any reproductive advantage. Of course a lot of weird things happen in evolution, so this doesn’t prove anything.
  • This theory doesn’t jive with the fact that birth control pills usually help with acne?
  • What about the diet studies that show improvements in acne with low glycemic index and high-protein diets? We can explain this through the effect insulin has on the skin, but not though CoA.
  • If excess sebum production is a result of deficient fat metabolism and not hormones, then why do green tea and other 5-alpha reductase inhibitors (substances that reduce the effect testosterone has on the skin) reduce sebum production? See studies herehere and here.
  • This theory also doesn’t agree with petri dish studies that show skin cells produce more sebum when you increase the amount of androgen hormones they are exposed to.

Suffice to say that there are a lot of problems with B5-acne theory. In all fairness most of these things were not known when Dr. Leung published his paper. So perhaps his theory made somewhat more sense given the what we knew when the paper was published.

Conclusion

The theory of treating acne with megadoses of vitamin B5 supplements is based on a rather sketchy hypothesis paper published by a Chinese researcher Dr. Lit-Hung Leung. The theory makes superficial sense, but doesn’t agree with lot of the research published in the past 15 years, such as reduction in sebum production with low glycemic index diets or green tea creams.

There is no credible research to show pantothenic acid megadosing is helpful in acne. Lack of studies doesn’t mean anything itself, and there are anecdotal reports that B5 helps with acne – though many say it works for some months and then acne comes back.

Most credible sources say vitamin B5 is safe even in high doses, though again we have anecdotal reports of hair loss and even severe side-effects.

In the end I have to consider Dr. Leung’s theory thoroughly debunked. Of course this doesn’t mean that B5 wouldn’t work for acne. It’s possible it works through some other mechanism.

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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

Leave a Comment:

(44) comments

kate H. January 1, 2013

Appreciate your opinion. what are your thoughts on herbal supplements such as acnease? desparate to try natural alternatives.

Reply
    Seppo January 3, 2013

    Kate,

    The really short answer is that AcneEase is probably pure BS. But I think that a more detailed answer is in order.

    The website is a typical alt-med mishmash of sciency-sounding language and long-debunked myths. It’s very impressive and persuasive if you don’t have a good background understanding of medical science.

    Let’s start with their ‘clinical study’. This is typical marketing department study. There are many ways to rig a study to show what you want. Alt-med people commonly criticize drug companies for doing that. And they are right. But the same thing also happens at the other side of the fence. Occasionally when I talk about studies on this blog, and in my book in particular, I try to explain what we can and cannot conclude from that study.

    The history of science clearly shows that studies without rigorous controls and methodology almost always create false-positive results. From those studies it’s hard to say what % of the observed effect is really due to the intervention and what is due to bad research methods.

    Well, the AcneEase study is as bad as they come – and then some. First, they only used 30 people in the study. Small sample sizes tend to produce much more false-positive results, especially if the researchers did some cherry picking and data twisting.

    Second, the study ran only for 30 days. Highly unusual as most studies of this nature run for 8 to 12 weeks. It just takes more than 30 days to really get good results.

    Third, and this is by far the worst red flag, it looks like the researchers were ideologically biased to begin with. The study was done in a hospital dedicated to studying Traditional Chinese Medicine. We see the same thing in acupuncture research. Not that long ago a meta-analysis of acupuncture studies showed that 100% of the studies coming from China showed positive results. Whereas studies from other countries, mostly Western, showed much more realistic results. And that the more rigorous the study was the more the likely it was to be negative.

    This is very typical of alt-med, mind power and other such fields. The more you control, that is you reduce the chance of bias and false play, the less impressive the results get. And to be fair, the same thing happens with many pharmaceutical studies. When you allow biased people to spin things their way you can expect stellar ‘results’.

    To be fair, I haven’t seen the details of that AcneEase study. I’m just commenting based on what they write on their website. And that leads to me conclude the study is scientifically worthless but pure gold in marketing terms.

    I didn’t look into research on any of the ingredients. Generally, speaking there is some research showing some benefits from some herbs. But generally herbs only produce minor effects. And certainly NOTHING like what they talk at the website. And I’m fairly certain there’s no research indicating that the specific mixture of herbs would create some additional benefits.

    What they are doing is very typical in the alt-med/natural health world. Put a mishmash of herbs that have some plausibility and then claim that their proprietary formulation creates fantastic effects. But how do they know that? They haven’t tested different combinations. They haven’t tested different ratios of those herbs. At least nowhere they point to such research. And if such research would exist I’m sure they would feature it.

    So in the end the only ‘evidence’ is testimonials. And testimonials are massively unreliable. I recently came across a study that looked at studies on acne treatments are tried to determine how much of the positive effect was due to the active treatment and how much was due to placebo effect. The results were shocking, to put it mildly. They showed that 50 – 60% of the effect is due to placebo. And this is in studies for antibiotics and benzoyl peroxide, the stuff that actually works. The placebo is much more than the ‘mind over matter’ effect, but I won’t go into that now.

    So with placebo effect like that, ANYTHING can create enough positive testimonials. That’s one reason testimonials are so unreliable. But marketers like to use them because they are very compelling. Anytime I read a testimonial I sort of mentally connect with the person and think it’s me getting the results. That’s why testimonials work.

    I could go on and on about AcneEase, they have so many errors and outright distortions on their website. But I think I’ve made the point.

    In the name of intellectual honestly, I still have to say that none of this means AcneEase doesn’t work. It can work, although I seriously doubt it. I simply dismantled some of their marketing hype and nonsense.

    There are quite a few natural treatments that are both plausible and have much better research behind them. I’ve written many of them on this blog.

    Reply
John January 7, 2013

My hunch is that acne is not one disease by a variety of diseases, caused by a variety of factors. Just as cancer is not one disease, but can be classified into 9 different types; It could be likely that acne could be something similar, and these diseases manifests themselves as skin acne. I still think Dr Lit Hung’s paper does present more persuasuve evidence, by offering a more thorough explanation than other theories. I don’t think your way of ‘nitpicking’ on the way the paper is written can be used to refute his study (I think he did do a trial on patients, but you say he did not do a medical study – not sure how that’s different).

Let me explain your way of ‘refuting’ his evidence and why its not convincing. For example, let me quote one of your arguments: “If that’s the case, then why sex hormones levels are elevated in acne patients? He already established that CoA is the limiting factor here. Why would the body waste this precious resource producing excess sex hormones? “. If you have read the paper more carefully, I think you dont understand what he’s getting at (I think you must see the forest for the trees, instead of nitpicking on these small details). Implied in this paper is that acne is a disease. Certain individuals are more prone to producing excess sex hormones because its a genetic disposition/deficiency. That’s why you see some people producing excess sex hormones, over metabolizing the fats. I think the rest of your arguments follow the same logic – you’re failing to see the forest for the trees. Of course, there are simple assumptions the author makes that need not be explained word for word, because he assumes the reader is smart enough to figure it out.

Reply
    Seppo January 8, 2013

    John, I have no interest in turning this into a combative argument. You say that my way of nitpicking the way the paper was written is not a good way to refute his ‘evidence’. That may be true. Now that I think of this, I could have presented a much better case.

    First of all, you assume that he has some evidence to back up his claims. That’s the main problem. He doesn’t. It’s never been established that B5 is helpful in acne. In his hypothesis paper he talks about his own study. But where is that study. It doesn’t seem to be published anywhere. So we have no way to know anything about the study. No way for others to review his methodology and results. He’s just saying that he did a study and we are supposed to believe him. Sorry, but that’s not how science works.

    Furthermore, he has never shown that B5 is a limiting factor here. He refers to no studies that shows that B5 limits fat metabolism and so increases sebum production. He refers to no studies that show that restricting B5 intake increases sebum production – or vice versa. Nothing.

    He’s just hypothesizing about his own theory. I could just as well write a hypothesis paper about lack of fairy dust causing acne. But without any evidence to back it up it remains an empty theory. Just hot air.

    Not only that, but his theory contradicts established evidence. He clearly states in his hypothesis paper that androgen hormones don’t cause acne or increase sebum production. Sorry, but that’s wrong. There are plenty of cell culture studies that show when you expose sebocytes (sebum producing cells) to androgen hormones they produce more sebum.

    He states that endogenous androgens cause acne, because their synthesis requires B5, but exogenous androgens don’t require B5 and thus don’t cause acne. Sorry, but wrong again. Exogenous (externally derived) androgens do cause acne. Steroid abuse causes acne for some bodybuilders. Studies on female to male transvestites show that when women who want to become men start taking androgens they start breaking out in massive numbers.

    I could go on, but the point is that there’s no real evidence to back up his theory. And there is plenty of evidence to suggest his theory is wrong.

    So perhaps it’s you who can’t see forest from the trees, instead of nitpicking on one small part of my post.

    You said: I think he did do a trial on patients, but you say he did not do a medical study – not sure how that’s different.

    When I said his paper is not a study, I referred to his hypothesis paper, which is not a study but a paper outlining a hypothesis. What you are referring to is his trial he never bothered to publish anywhere.

    These are simple things that need not be explained word for word, because it’s assumed the reader is smart enough to figure it out.

    Finally, nowhere in the paper did Dr. Leung say anything about acne being a disease or that it would have a genetic component. He makes it quite clear that acne is a symptom of B5 deficiency and nothing else. This is what he wrote:

    The mechanism proposed above may be the reason why two groups of adolescent boys–both with a normal blood level of androgen–may exhibit differences in the incidence of acne. The group with acne is the one that has not enough of pantothenic acid in the body, whereas in the other group, pantothenic acid levels are not deficient.

    That doesn’t leave much room for confusion.

    Reply
Michael January 22, 2013

I found this article by searching for information about quite the opposite conclusion to Leung’s; because in my case, I am certain that taking too much vitamin b5 causes me to break out with pimples all over my face. I’ve tested this for the past year — and if I take more than 500mg of B5 within a 48 hour period, I am certain to break out with at least one large white head. Without taking B5, I almost never have pimples.

My other random observation of B5, for which I can find no information online: I first took the supplement about four years ago. When I would take it, I remember very clearly noticing a dramatic improvement in my cognitive abilities, particularly around complicated math and logic problems. One difference is that I happened to weigh about 20 lbs more than I do now. Though I have no idea if it is related, around the time I started losing weight I stopped feeling the B5 brain power boost I once did.

Reply
    Seppo January 22, 2013

    Sorry Michael, but I can’t add much to what you already know. By all accounts B5 is exceptionally safe, though there are some anecdotal reports of long-lasting side-effect. One of the known side-effects is diarrhea and apparently B5 has been used as constipation treatment. So perhaps it affects your gut health and that way can worsen your acne. I also think that B5 interacts with other B vitamins. So perhaps taking a lot of B5 you somehow cause deficiencies in other B vitamins.

    Reply
John January 23, 2013

Its a hypothesis without proof, but something without proof doesn’t mean its wrong. For example, Fermat’s Last Theorem didn’t have a proof for hundred’s of years until Andrew Wiles came along with the proof; a lack of proof doesn’t mean its wrong, unless something proves it to be wrong.

What it does, is to look at several observations that people have observed to result in acne, ranging from premenstrual flares, eating fatty foods, and other studies and use one single,elegant, theory to explain why this has been caused. Its much better than alternative theories, which do little to explain these “other” observations.

Of course, you can continue arguing about why didn’t he provide proof for his trial, etc, etc, but again, something not published does not mean it is wrong. It seems like what you are doing is doubting every word he says and assumes that is not credible, and that you need to provide proof. First of all, it is very impractical, to provide proof of everything he says. There’s an element of trust in writing journal papers, and often, it gives the benefit of the doubt to the author. Innocent until proven guilty, or guilty until proven innocent? You took the latter, in my opinion. The author of the paper graduated from the University of Hong Kong one of the most competitive, finest institutions in Asia (as you may or may not know, many of these graduates go on to study in top institutions in the U.S – Harvard, MIT, Caltech, etc), and in my opinion, the author can be given even a little benefit of the doubt.

When I say acne is a disease or genetic component, it seems like you still don’t get it. The b5 deficiency itself, is the genetic component. Its already implied that people with b5 deficiency have a genetic disposition. The very first line “Acne vulgarsis is a common disease of the skin”, already implies that it is a disease. I don’t think the author is required to spell it out word-for-word any of the thousands of questions that a critic might have, especially with the very simple ones; Its just too impractical.

Reply
John January 23, 2013

Also, on you part about evidence contradicting that he’s wrong. I disagree. You said “There are plenty of cell culture studies that show when you expose sebocytes (sebum producing cells) to androgen hormones they produce more sebum.” You also said steroid abuse causes acne, and that contradicts evidence.

This doesn’t prove its wrong. Let me explain:

1. All it does it to show that ANOTHER factor is at work that causes the cells to produces sebum (For the sake of the argument, lets call this factor A). Given the complexities of the human body, its not wrong to assume there are not just one factor the causes the excess sebum. You’ve only shown that factor A causes sebum, but how about other factors? Proving factor A causes sebum does not mean that another factor cannot also produces sebum.

2.The theory is about coenzyme A helping to REDUCE (metabolize) the sebum, not produce it. All the evidence you are giving to refute his study is about how X and Y INCREASES sebum.

3. Also, when your talking about “cell culture” studies, it really doesn’t mean a thing. A cell in the laboratory may behave very differently in a human body. As lots of drug makers can tell you, many drugs that work in cell cultures wont work properly if given to a human being.

Reply
    Seppo January 24, 2013

    Thanks for rational arguments John, I always appreciate an honest debate.

    You said that a hypothesis without proof doesn’t mean it’s wrong. True enough. But when the proposed hypothesis contradicts both observations and our current understanding (derived from those observations), then what reason I have to believe into the proposed hypothesis?

    Actually, I think you are mistaken about the way science handles new claims. Science is inherently skeptical, and the burden of proof is on the person who proposes the new hypothesis. If you can’t provide evidence to support your claims then why should we throw away our existing view of the world, one that works reasonably well?

    I’m actually willing to give Dr. Leung the benefit of the doubt regarding his trial. I actually don’t think he’s lying about it. I do think that he conducted the trial and reported the results as he measured them. But that in itself doesn’t prove really anything yet. Acne trials have a massive placebo component. A review paper I read recently analysed the trials done on oral antibiotics and concluded that over 60% of the measured benefits were due to placebo effect. Because of this we need to conduct blinded and placebo-controlled trials. I seriously doubt that his trials was that rigorous.

    One of the things that irks me the most of his paper is that he never provided any supporting preliminary data. As I mentioned in the previous comment he has never established that B5 deficiency exists and that it indeed does limit metabolism of fatty acids, which then leads to excessive sebum production. This should be very easy to demonstrate first in cell culture studies and then in animal studies where B5 intake is restricted. Had he presented such evidence I would be much more willing to cut him more slack. Because at least he would have established his theory plausible.

    Compare Dr. Leung’s paper to this another hypothesis paper about acne:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012032/

    Had he written anything resembling that, even in absence of human trials, I would have called his theory plausible, and, given that there’s quite a bit of anecdotal reports about B5, might have recommended people try it.

    The fact that he graduated from a prestigious university doesn’t in itself mean anything. That’s argument from authority. All humans, regardless of their intelligence or education, are fallible to the known human cognitive biases. There’s a string of Nobel price winners and laureates that have gone off the deep end and started endorsing the most implausible quackery. Skeptic’s even have a name for it, Nobel disease.

    You say:

    All it does it to show that ANOTHER factor is at work that causes the cells to produces sebum (For the sake of the argument, lets call this factor A). Given the complexities of the human body, its not wrong to assume there are not just one factor the causes the excess sebum. You’ve only shown that factor A causes sebum, but how about other factors? Proving factor A causes sebum does not mean that another factor cannot also produces sebum.

    Yes, it’s possible that some other factor affects sebum production. But what you are really doing is special pleading away contradicting evidence. One could always plead to some unknown factor at play. But I’ll give you the benefit of the doubt, so let us assume that there indeed is a such factor at play. But the possibility of it existing doesn’t mean it does exist. We are again back where we started. What evidence has he provided for this? Nothing as far as I can tell.

    Again I have to state that I would be much more willing to cut him some slack had he provided even some preliminary evidence to back up his theory, see the paper about lipid peroxidation in acne for an example of what I mean. That’s how science should be done.

    But the reason I pointed out those things because they directly contradict what Dr. Leung stated in his paper. He stated that external androgens don’t affect sebum production. I provided evidence that contradicts his claim. That they indeed do affect sebum production the same way that endogenous androgens do. And my evidence included more than just cell culture studies, which alone are not sufficient.

    The bottom line is that Dr. Leung proposes something that contradicts established knowledge about how acne happens. Knowledge that’s based on several decades of observations and hundreds and hundreds of studies. He wants us to throw away all that knowledge yet doesn’t provide us with any evidence to back up his claim – aside from a single, uncontrolled and unpublished trial.

    There is a known mechanism that explains increased sebum production in acne. He hasn’t provided us with any evidence to show that the current knowledge is wrong or incomplete. It’s possible another mechanism exists, but until evidence for it is provided, we have no reason to believe it does.

    In my mind a far more credible explanation for this whole thing is motivated reasoning from Dr. Leung’s part. He has a very strong reason to believe his theory is correct. As I mentioned in the post, he applied and received a patent for B5 acne treatment before his paper was published. It looks to me he started with the end goal in mind and tried to ‘prove’ it in his paper. I’m not saying this is necessarily how it happened, but to me it’s a far more plausible explanation than there being some breakthrough mechanism that only Dr. Leung has discovered and yet remains ignored by all the other dermatological scientists in the world.

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Matt February 23, 2013

Interesting article, First off, I was on Accutane due to SEVERE ANCE about 3 years ago, it cleared up my skin but 3 months after I finished, it all came back with vengeance. I started B5 and took 5 500mg every 2 hours (I know, it was a lot). I was very desperate because I’m a generally very outgoing happy person but my severe acne does a complete 180 on my personality and I wanted to be content with the person I once knew. So what did I do? I took massive amounts of B5 and it did wonders for my skin!!! I was completely clear for 7 months. But I stopped taking B5 because I have very very very thick hair and I noticed my hair becoming extremely thin. I’ve never experienced it before, and my hair started to recede (I’m a 20 year old male). I should also mention that my diet and proper hydration where never that great while I was on B5 so I partly blame myself for the lack of equilibrium. Now to date, my skin is AWFUL since I stopped taking it in August 2012. I just started taking it today, but this time around I plan on eating more healthy (becoming a raw vegan) and drinking more H20. Instead of taking 5 500mg every 2 hours, I’m going to take 4 500mg every 3.5 hours.

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    Seppo February 24, 2013

    Thanks for sharing your story, Matt.

    Quite hard to know what to make of stories like yours. It’s possible that B5 affects acne through some mechanism we haven’t yet discovered. Unfortunately we just don’t enough yet. I did a quick search on PubMed for vitamin B5 and androgens, but that returned only one animal study. Obviously B5 has some connection to androgens (that’s probably why it affects hair growth), but beyond that it’s hard to know.

    We also can’t rule out a placebo effect. I recently read a systematic review of studies of oral antibiotics on acne, and the review concluded that about 60% of the observed benefits were due to placebo. So the placebo is very strong in acne.

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Liam May 4, 2013

I tried SkinB5 for a while and followed their regime. The only thing I got out of it was a depressive episode. I’ve never heard of anyone else experiencing this from vitamin B5 but that’s exactly what happened to me.

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Mo July 24, 2013

Pantothenic acid works for most people. It definetely worked for me when I tried it. Only downside is that I have to swallow 20 pills a day. I’m a 32 yo and my acne is terrible. I always have one or two huge zits. I started taking it again yesterday. I can already feel it working and I will post results next week. From my research you start at 10 grams a day and can go down to 4 grams a day maintenance dose when it clears up. It works by attacking the root cause which is the oil in the skin.

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Mo July 24, 2013

Forgot to check the box on follow up comments

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jay September 2, 2013

There probably is a subset of conditions that B5 works on. I know that for me, my acne flares up when I eat an excess of dairy fat (repeatable, sample size: 1) and that supplementing B5 in small amounts (~1g) prevents that.

Family members and friends have also had good results (with nowhere near megadosing). A close relative with worse skin has stopped and started many times and has noticed it correlates directly with breakouts.

I’d recommend starting with a low dose and increasing slowly – taking massive amounts of a vitamin right away is bound to cause a certain amount of adjustment. But I guess people are too impatient to do it the ‘slow’ way.

Cost/profit arguments seem kind of strange to me – it’s cheaper than prescription medicine and not ‘patented’ since it’s just a known vitamin. Since it’s cheap and low-risk, I’d really encourage people to try it if nothing else has worked.

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Donovan September 4, 2013

Thanks for the info, i suffered with acne from my teens and im now 32, still battling with it ….i have tried many creams, tablets, diets….with no much help…… i was then put on Retin A cream which worked in reducing alot of my acne, but it became too expensive to keep purchasing. i was off the cream for about 3 months and my acne came back even worse than i had…

i found one blog where people where talking about vit b5, so i said what the hell lets try it out.
i read people where taking 20 tablets a day of this stuff, i didnt want to try that many tablets.
i purchased vit b5 100mg tablets, i took 2 with breakfast, 1 with lunch and 2 with supper.
after 3 days, i noticed a huge difference, the amount of oil on my face vanished, normally i have to keep wiping my face otherwise i look like an oil factory, now i dont have to do that, and my pimples have almost all gone…..i do notice that my lips tend to dry out alot and now im left with alot of blemishes left behind from years of acne problems………

i am quite happy to say vit b5 works….and if you are an acne sufferer, you know what its like to always feel uncomfortable, embarrassed, insecure and your confidence levels take a dive!!!! its just painful being an acne sufferer, try it out, its working for me and its a price i can afford to buy constantly.

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    Seppo September 4, 2013

    Thanks for sharing your experience, Donovan. If B5 works, I’m sure it’s because of some other mechanism than the one proposed by Dr. Leung. A quick search at PubMed brings up some test tube and animal studies showing B5 can increase glutatione (strong antioxidant enzyme) levels and protect against oxidative damage. If the same happens in humans, then it’s very plausible that B5 could be helpful in acne.

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      Donovan September 4, 2013

      thank you for good info, if you know of ways to help with the blemishes would greatly appreciate it

      Reply
        Seppo September 4, 2013

        I have published over 100 posts on this blog about that. Feel free to explore :)

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Adel-Alexander Aldilemi September 14, 2013

I guess this post is a load of bull right?

http://www.wellandgoodnyc.com/2010/11/18/the-vitamin-that-can-give-you-acne/

Just wanted to hear your opinion regarding it ^

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    Seppo September 16, 2013

    It’s not complete bull. I do remember one study showing B6 and B12 could cause acne. But if my memory serves me right it was just a case study or other low quality evidence. I wouldn’t try limiting foods that contain B5 or B12.

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      Adel-Alexander Aldilemi September 16, 2013

      It just seem weird how an essential vitamin would cause acne.. But I haven’t had any problems regarding that so I guess I’m good.

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jen October 28, 2013

Yikes high dosages. The doctor used these doses and found them effective but, this was a clinical trial. I have found more information. I read to take the B5 with N-acetylcysteine on multiple websites including those of a pharmacist and other medical professionals. This is the combination that forms pantethine (not pantothenic acid), the precurssor to CoA. That is Pantothene + pantothenic acid plus n-acetyl cysteine. The recommendation was 1500 B5 with 1200 mg n- acetylcysteine. . No super high dose of B5.

I have read but not experienced that taking super high doses of B5 has the potential to cause hair loss and who knows what else. I think it increases androgens at super high doses. B5 also uses the same transporter as biotin which is involved in hair and skin so there is also that issue. The other issue is that CoA is formed due to B5 and CYSTEINE. Guess what one of the main components of hair is? Cysteine. My guess that you can get hair loss at super high doses by depleting cysteine. Or maybe it triggers MPB?

I would bet that taking even lower doses of B5 and n-acetylcysteine would work too. I suspect you have to restore the depleted pools of CoA and once that happens you can just have a maintenance dose. So trying something low like 500-1000 mg B5 and 200-600 mg of n acetyl cysteine for a few months and just waiting it out then upping if necessary. I doubt you need to go much higher than 1500 B5 and 1200 mg N acetyl cysteine though, but prehaps it depends on the person.. The ratio of B5 to n-acetyl cysteien should be about 2 to 1 due to the proportion it uses to make acetyl co A

My personal opinion is that for most people b5 plus n acetyl cysteine will work. I wonder if some people have a genetic defect that they just dont process b5 and cysteine correctly when making CoA? who knows? I could be wrong though and please take everything I say with a grain of salt and investigate this info yourself. This is information that I believe is correct but do not use for your own medical purposes- investigate this yourself if you wish.

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    Seppo October 29, 2013

    Thanks for sharing your thoughts.

    N-acetylcysteine has been shown to be quite effective against acne. So I would expect people taking B5 and NAC to get better, but they would probably get better even without B5.

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Pat October 30, 2013

Well, I’m 42 and have been in this acne struggle for 15 years and I’m over it. I’ve tried everything as well including lazor surgery. Nothing cured it. I just read his study last week so of course I purchased the Pantothenic Acid and Evening Primrose. I take 4 500mg capsules every 3 hours (12G a day) and 1 1300mg capsule of Evening Primrose in the morning and 1 at night. I hope to God this works, acne is distroying my skin and being in my 40’s I’m sick of dealing with it. I’m willing to try anything at this point!

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    Seppo October 31, 2013

    Best of luck and hope B5 has some effect for you. If you want something that’s more likely to work, I recommend you check out this post.

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aileen smith May 22, 2014

I have been taking B5 for 3 mnths already, at high doses because that’s what I heard would make acne disappear. I stopped using it a couple days ago because my hair became EXTREMELYthin, i lost a lot of hair. I was wondering if this is a permanent side affect, or will hair begin to grow back after a couple of months?

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Michael June 27, 2014

Seppo Puusa loses a ton of credibility in his article here right off the bat, when he calls out conflict of interest. He clearly doesn’t understand patents or IP. EVERY Western university inventor files for IP rights before publishing anything, because publishing first before filing makes it “public domain”, rendering the IP non-proprietary. It seems like Seppo starts off skeptical due to this main idea which he clearly doesn’t understand at all, and the rest of his arguments aren’t very convincing.

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    Seppo Puusa June 29, 2014

    Yes, you are correct that it’s not uncommon for university researchers to protect intellectual property, and there’s nothing wrong with that. Were this the only problem with Dr. Leung’s hypothesis, I wouldn’t even bother to criticize it. But the fact is that almost everything that he suggests goes against the vast majority of research on acne.

    It seems like Seppo starts off skeptical due to this main idea which he clearly doesn’t understand at all, and the rest of his arguments aren’t very convincing.

    And this is where you make a strawman argument by assuming I’m skeptical because of potential conflict of interest. While in fact I only learned about his patent much later on. And the financial conflict of interest is only a very small part of my argument against his hypothesis. My argument would stand perfectly well even without it.

    I also didn’t say his hypothesis is wrong because of conflict of interest. But he does have a vested interest in ‘proving’ that B5 can treat acne, and, it seems to me, he strings together a very implausible hypothesis to support his idea.

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James June 29, 2014

I been taking Vitamin B5 since about July 2006 going down to 4g and then taking it back to 10grams throughout the whole time. My hair is as thick as ever. I still get pimples here and there but it definitely helps.

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Kat August 2, 2014

I’m a 33 year old female that has suffered with sever cystic nodular acne from when I was 12. I’ve been on accutane twice, every topical/oral prescription med available from dermatologists, I never experienced A SINGLE DAY without a cyst. Ever. After a bout with the worst flare up I ever had (basically, a golf ball size cyst coming out of my chin), I desperately started searching for alternatives. When I read about taking mega doses of Pantothenic Acid, I was skeptical, but it was cheap enough and readily available to try. Within 2 weeks of taking 10 1000mg pills per day (5 in the morning, 5 before bed), my skin went from being completely covered in cysts to NOTHING. This was the first time in my life I experienced the feeling of clear skin. This was two years ago.

Since then, I’ve stayed true to the regimen, and changed nothing else with my diet. I am happy to say my skin is generally always at 90-100% acne free. The only time I ever have a flare up is if I skip a dose (ie, falling asleep before taking it, running out of pills, laziness). And it happens almost immediately! Generally, if I miss 1 dose of 5 pills, I’ll get 1-2 cysts within 24 hours. If I miss any more doses, the cysts pop up to how they were before ever starting the regimen. So, lesson learned: don’t skip doses! However, the cool thing is as soon as I get back on the regimen, the cysts heal far faster than if I were taking nothing at all.

Anyway, just wanted to share an unbiased opinion here from someone who has had their life changed significantly from this simple vitamin regimen. I don’t know why it works, but it does. For me, the key is consistency- take the pills the same time daily, and DON’T SKIP!

I hope this information will help others out there suffering from this awful condition. Best of luck to you, and I’m happy to provide more details if needed.

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Eskil J. September 27, 2014

As a skeptic I totally agree with this article. However there definitely needs to be more studies on this. Personally B5 is thus far the only thing that has helped treated my long lasting acne for about 6 years. Unfortunately it doesn’t seem to cure it though. But better than nothing, and it is unlikely to be anything but positive for several functions (with a few exceptions like decreased antibiotic effectiveness and more susception to bleeding from what little I found on some articles).

For me; some initial side effects were extremely dry hands the first month but after that I recall no other side issues. Arguably it somehow limited how oily the skin gets which made the hands dry (I don’t know the medical nomenclature). It is very difficult to consider it a placebo as well seeing as I for three periods eliminated it completely just to see if the acne had been cured but within 1-2 weeks it all went downhill from there until I started with B5 again (about 6000 mg/day).

As for Dr. Leung’s hypothesis, I’m no medical researcher and I haven’t looked at all other factors so I can’t tell how probable it is. But there’s likely something going on, arguably there are several factors involved with acne. I have noticed that sucrose has a tiny effect on acne as evidence shows. E.g. drinking a whole liter of soda yields perhaps 1 or 2 pimples the next day (I very rarely eat or drink sugary foods though). But I haven’t noticed anything like that from complex carbohydrates or other short chained carbohydrates like fructose when I eat lots of fruits or pasta. So unless there’s evidence for it you probably shouldn’t say “carbs cause it”. It’s too vague and misleading. Cow’s milk appears to contain hormones that may initiate acne at a young age which is supported by evidence. [1] So it isn’t all about foods that cause temporary acne.

[1] http://www.ncbi.nlm.nih.gov/pubmed/15692464

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    Seppo Puusa September 28, 2014

    Thanks for your reply. A month or two ago a new study came out that showed B5 supplementation actually reduced acne. It seemed fairly rigorous and am inclined to believe the results. I haven’t read it in detail yet, but from what I remember the paper mentioned something about B5 supplementation increasing skin moisture and softness. All of which suggest it improves skin barrier function and makes it more resilient against external oxidative damage. I have to update this post to reflect that.

    Yes, there are several factors involved with acne. If you read my other posts you’ll see I’ve covered many of them. Acne is a complicated mixture of hormones, genetics, environmental irritant, diet, stress and inflammation. There’s rarely one big thing that helps everybody. Dairy products are an issue for some people, but, for example, I have no problems eating dairy. It has no effect on my acne, but eating onions causes a huge breakout the next day.

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Joe October 17, 2014

Hmmm… who to believe… a doctor or a blogger… tough choice.

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John Doe November 5, 2014

I wouldn’t completely discount this guy. In my own research that is more than 10 years worth, I have continually arrived at the same general thing: metabolism. Specifically, the american diet is high in PUFA consumption. If these fats are not metabolized and dealt with, they can oxidize in bad ways. How the mechanism works precisely, no one can say…but one thing is for sure: Zinc also plays a role in metabolism of carbohydrates and fats, as well as protein. And Zinc is very well known to be effective for acne.

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    Seppo Puusa November 6, 2014

    Thanks for your comments.

    I guess everything is possible. But the thing is that in science we can’t look at things and theories in isolation. There is plenty, and I mean a lot, of evidence to show acne is caused by a mixture of hormones and inflammation. And that hormones increase sebum production at the skin and that this has really nothing to do with serum (blood) fatty acids. Any new theory on acne has to take into account all this existing experimental evidence. This paper doesn’t.

    Anyway, I’d be interested of hearing more about PUFAs. The paleo circles like to demonize them. I’m not that sure what to think of them. I understand that chemically they are unstable and have the potential to oxidize. I just haven’t seen any good data to show that eating more PUFAs would cause health problems. I’ve looked at several large studies on heart disease and I haven’t found any good evidence to show eating more PUFAs would cause more inflammation and heart disease. Anyway, I’m not an expert on this and would be interested of hearing your thoughts of this. As it’s potentially relevant to acne.

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    Seppo Puusa November 9, 2014

    The discussion PUFAs and omega-6 fats and how they affect acne is off topic for this post, so I’ve created a placeholder post for us to discuss this further. I also moved your comments to that post. You’ll find the post here: http://www.acneeinstein.com/pufa-omega-6-acne/

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John Doe November 5, 2014

Also, one more thing. There are probably a lack of studies on the effectiveness of B5 because there’s no incentive to do so. If B5 actually was effective, do you think dermatologists who make a killing off of this disease and the companies at large are in a rush to throw away a multi-billion dollar industry over night? I highly doubt it.

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    Seppo Puusa November 6, 2014

    Actually I believe they would. While what you say could be applicable to drug companies, I don’t think the same could be said of dermatologists and doctors. Doctors don’t usually make any money from the drugs they prescribe to you.

    Furthermore, on this site alone I’ve documented hundreds of studies that go against what you say. Scientists have studies diet, various supplements and natural skin creams on how they affect acne. All of which have the potential to reduce drug sales. Lot of this research is funded by the government and thus independent of what drug companies think.

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John Doe November 9, 2014

I also think you seem to be more concerned with making money by selling books than you are with actually helping anyone.

“Read This Book And You’ll Know Exactly What You Have To Do To Banish Acne From Your Life – Forever”

That’s a pretty outrageous and ridiculous claim to make. It is no better than the commercials on TV selling products that don’t work. The fact is, there is no known cure to completely erradicate the disease. That’s why you keep writing articles.

Tone that down a notch.

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    Seppo Puusa November 9, 2014

    Funny enough, I get plenty of positive feedback from people who have bought the book. They don’t feel in anyway deceived.

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Melanie November 13, 2014

It works! My son had horrible acne and a friend of mine told me about Vitamin B5. I was told he would have to take a large dose, so I started him on 40 grams a day (15 pills at breakfast, 15 pills at dinner, and 10 for lunch of 500 mg caplets). It took a month or maybe longer, but his face cleared up to almost nothing! He used to have black heads all over his nose and they completely disappeared and his forehead and cheeks cleared up completely. I think a lot of people don’t 1) take high enough of a dose for it to work 2) wait long enough for it to work. You have to give it time for it to get into your body and start working. At first, it will seem like it’s doing nothing, but it literally takes a month or more. I was shocked at how the blackheads just go away. This is not a joke – and several people at our church now take it for their kids acne and have had great results. It’s a shame more people don’t know about it and are suffering with acne!

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Dave December 23, 2014

Guys I took b5 for around a year about 4 years ago, I’ve now lost 60-70% of my hair! this stuff has ruined my life aswell as many others! feel free to good b5 hair loss, thousands of people are losing hair from this and nobody has found the cure. If anyone can help please do.

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