Biotin

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Biotin

Common Names

  • Vitamin H
  • Vitamin B7
  • Coenzyme R
  • D-Biotin
  • W Factor

For Patients & Caregivers

How It Works

Biotin is widely available in foods. Biotin supplements are used to promote nail, skin, and hair health, but evidence is limited. Some people also use it for nerve, muscle, and diabetic symptoms. Patients should discuss use of this supplement beforehand with their doctor.

Biotin is an important coenzyme involved in sugar and fat metabolism. It is found in a variety of foods such as meat, vegetables, and eggs.

Some studies show that taking biotin can benefit patients with multiple sclerosis or may improve diabetic nerve pain. Patients with diabetes may have a greater chance of being biotin-deficient. Consuming large amounts of egg whites or taking epilepsy drugs may also lead to biotin deficiency. However, there is very limited evidence to suggest benefits with biotin supplements. In addition, too much biotin may weaken immune response and reduce the number of white blood cells.

Biotin was found to interfere in some lab tests leading to inaccurate results. Therefore, patients should discuss supplement use with their physician.

Purported Uses
  • To treat multiple sclerosis
    Preliminary data suggest that biotin is safe and may reduce symptoms in some patients.
  • To treat diabetic peripheral neuropathy
    A small clinical study supports this claim. Larger studies are needed to confirm the effects.
  • To treat brittle nails
    A small survey indicates that biotin may be effective. Further studies are needed.
  • To treat hair loss
    Evidence is limited. According to one study, some women with hair loss may have lower biotin levels in their blood. It is unclear if biotin is effective in preventing or treating hair loss in otherwise healthy people or in cancer patients due to chemotherapy.
  • To treat infantile seborrheic dermatitis (a skin disorder)
    A small study showed that biotin was not effective in treating itchy, scaly skin.
Do Not Take If
  • You are undergoing lab tests: Biotin supplementation has been reported to cause inaccurate test results with some blood tests. Therefore, it is important to tell your healthcare provider about any use of biotin supplements before the tests.
  • You are taking a pregnancy test: Taking biotin supplements may cause an invalid test result.
Side Effects

Although biotin is generally safe, supplementation has been reported to interfere with certain lab tests.

Case Reports

Missed diagnosis of heart disease due to high intake of biotin: A patient death was related to false low troponin test results that were due to high intake of biotin. Additional reports have shown the susceptibility of cardiac troponin assays to biotin interference at levels achievable with over-the-counter supplements.

Tardive Reactivation of Progressive Multiple Sclerosis (MS): In a 41-year-old patient suffering from primary progressive MS following treatment with high doses of biotin. His expanding disability status scale (EDSS) score worsened along with appearance of a symptomatic new T2 pseudo-tumoural lesion on brain MRI, suggesting tardive inflammatory reactivation likely due to biotin.

 

Special Point

Taking biotin supplements can interfere with certain lab tests. This may result in the masking of disease states, inaccurate measures of response to therapies, or unnecessary diagnostic procedures. Therefore, it is important to tell your healthcare provider about any use of biotin supplements.

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For Healthcare Professionals

Scientific Name
Cis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid
Clinical Summary

Biotin is an essential B vitamin that acts as an important coenzyme in carbohydrate and lipid metabolism. It is often taken alone or in combination with other vitamins for skin, nail, and hair health. It is also thought to benefit patients with diabetes and neuromuscular disorders. Biotin is abundant in foods including meat, vegetables, and eggs. True deficiency is rare but can be caused due to genetic disorder (13) or due to malabsorption syndromes. Long-term use of certain anticonvulsant drugs can also induce biotin deficiency (11). However, these deficiencies can be treated with biotin supplementation. 

Low serum levels of biotin have been associated with hair loss in some women (16), although the evidence demonstrating the efficacy of biotin for hair growth is limited  (23) (24).
A small study showed utility of biotin for strengthening brittle nails (3); and preliminary findings suggest benefits of high-dose biotin for multiple sclerosis (17), but a review cited insufficient evidence to support this use (30).

Additional exploratory studies reported that biotin may benefit patients with severe diabetic peripheral neuropathy (4); and when taken with chromium, it may improve glycemic control in patients with type 2 diabetes (5). Randomized trials are needed to validate these observations. Some case reports also suggest utility of biotin for reducing skin rash due to chemotherapeutic agents, gefitinib and erlotinib (18). But it was ineffective against seborrheic dermatitis in infants (2); and the overall evidence to support biotin use for dermatological disorders has been deemed inadequate (31).

Several case reports have shown that consumption of biotin supplements can cause clinically significant errors in select biotinylated immunoassays.The American Association of Clinical Chemistry has issued a guidance document to help laboratories and clinicians identify and address biotin interference in laboratory testing (32).

Food Sources

Liver, kidney, eggs, almonds, sweet potato, soy beans, peanuts, wholegrain cereals, brewer’s yeast, dairy products

Purported Uses
  • Acne
  • Brittle nails
  • Dermatitis
  • Diabetic neuropathy
  • Hair loss
  • Multiple sclerosis
Mechanism of Action

Biotin is an essential component in carbohydrate and lipid metabolism. It is converted to the free active form by the enzyme biotinidase (1).

Studies have shown that biotin induces microtubule formation in neurons (7), and deficiency slows myelination (8), which may result in neuropathy. Biotin may also reduce the activity of interleukins and interferons, decreasing the number of leukocytes (9).

Adverse Reactions

Although biotin is generally safe, supplementation has been reported to interfere with certain lab tests, which may mask disease states, overestimate response to therapies, or subject patients to additional unnecessary diagnostic procedures (29).

Case Reports

Missed diagnosis of heart disease due to high intake of biotin: A patient death was related to false low troponin test results that were due to high intake of biotin (22). Additional reports have shown the susceptibility of cardiac troponin assays to biotin interference at levels achievable with over-the-counter supplements (28).

Tardive Reactivation of Progressive Multiple Sclerosis (MS): In a 41-year-old patient suffering from primary progressive MS following treatment with high doses of biotin. His expanding disability status scale (EDSS) score worsened along with appearance of a symptomatic new T2 pseudo-tumoural lesion on brain MRI, suggesting tardive inflammatory reactivation likely due to biotin (33).

Herb Lab Interactions

Immunoassay interference caused by high-dose biotin supplementation: Incorrect test results during routine follow-up of a 54-year-old female patient with progressive multiple sclerosis and Hashimoto’s thyroiditis (29).

Inaccurate troponin test results: Due to consumption of high dose biotin (22).

Free Thyroxine and Thyroid Stimulating Hormone (FT4/TSH) assay: False-high values were attributed to high serum biotin levels in a neonate (12).

Qualitative urine hCG tests: Biotin supplementation may cause an invalid test result with some pregnancy tests (25).

Immunoassay interference: Biotin taken in moderate to high doses can result in either false-high or -low values (19).

Clinically significant lab errors: In a 67-year-old female with a history of multiple endocrine issues following biotin supplementation. Blood tests showed low thyroid stimulating hormone (TSH), low parathyroid hormone (PTH), and mildly elevated calcium levels. These were normalized after discontinuing biotin (34).

Thyroid function tests consistent with hyperthyroidism and a positive radioactive iodine uptake (RAIU) scan: In a 34-year-old female with a history of anxiety and depression, while taking biotin supplements. Her labs normalized after stopping biotin (35).

Erroneous elevations of results in some commercial serum 25-hydroxyvitamin d (25OHD) assays: Due to biotin supplementation (36).

Dosage (OneMSK Only)
References
  1. Mason P. Dietary Supplements. London: Pharmaceutical Press; 2001.
  2. Keipert JA. Oral use of biotin in seborrhoeic dermatitis of infancy: a controlled trial. Med J Aust. 1976;1:584-5.
  3. Hochman LG, Scher RK, Meyerson MS. Brittle nails: response to daily biotin supplementation. Cutis 1993;51:303-5.
  4. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother. 1990;44:511-4.
  5. Albarracin CA, Fuqua BC, Evans JL, et al. Chromium picolinate and biotin combination improves glucose metabolism in treated, uncontrolled overweight to obese patients with type 2 diabetes. Diabetes Metab Res Rev. Jan-Feb 2008;24(1):41-51.
  6. Debourdeau PM, et al. Life-threatening eosinophilic pleuropericardial effusion related to vitamins B5 and H. Ann Pharmacother. 2001;35:424-6.
  7. Braguer D, Gallice P, Yatzidis H, et al. Restoration by biotin of the in vitro microtubule formation inhibited by uremic toxins. Nephron. 1991;57(2):192-196.
  8. Desai S, Ganesan K, Hegde A. Biotinidase deficiency: a reversible metabolic encephalopathy. Neuroimaging and MR spectroscopic findings in a series of four patients. Pediatr Radiol. Aug 2008;38(8):848-856.
  9. Zempleni J, Helm RM, Mock DM. In vivo biotin supplementation at a pharmacologic dose decreases proliferation rates of human peripheral blood mononuclear cells and cytokine release. J Nutr. 2001;131:1479-84.
  10. Said HM, Redha R, Nylander W. Biotin transport in the human intestine: inhibition by anticonvulsant drugs. Am J Clin Nutr. 1989;49:127-31.
  11. Mock DM, et al. Disturbances in biotin metabolism in children undergoing long-term anticonvulsant therapy. J Pediatr Gastroenterol Nutr. 1998;26:245-50.
  12. Henry JG, Sobki S, Arafat N. Interference by biotin therapy on measurement of TSH and FT4 by enzyme immunoassay on Boehringer Mannheim ES700 analyser. Ann Clin Biochem. 1996;33 (Pt 2):162-3.
  13. Raha S, Udani V. Biotinidase deficiency presenting as recurrent myelopathy in a 7-year-old boy and a review of the literature. Pediatr Neurol. 2011 Oct;45(4):261-4.
  14. Singhi P, Ray M. Ohtahara syndrome with biotinidase deficiency. J Child Neurol. 2011 Apr;26(4):507-9.
  15. Komur M, Okuyaz C, Ezgu F, Atici A. A girl with spastic tetraparesis associated with biotinidase deficiency. Eur J Paediatr Neurol. 2011;5(6):551-3.
  16. Trueb RM. Serum Biotin Levels in Women Complaining of Hair Loss. Int J Trichology. Apr-Jun 2016;8(2):73-77.
  17. Tourbah A, Lebrun-Frenay C, Edan G, et al. MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: A randomised, double-blind, placebo-controlled study. Mult Scler. Nov 2016;22(13):1719-1731.
  18. Ogawa Y, Kiba T, Nakano K, et al. [Prospective study of biotin treatment in patients with erythema due to gefitinib or erlotinib]. Gan To Kagaku Ryoho. Apr 2014;41(4):517-522.
  19. Elston MS, Sehgal S, Du Toit S, et al. Factitious Graves’ Disease Due to Biotin Immunoassay Interference-A Case and Review of the Literature. J Clin Endocrinol Metab. Sep 2016;101(9):3251-3255.
  20. Siddiqui U, Egnor E, Sloane JA. Biotin supplementation in MS clinically valuable but can alter multiple blood test results. Mult Scler. Apr 2017;23(4):619-620.
  21. Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference I, its Panel on Folate OBV, Choline. The National Academies Collection: Reports funded by National Institutes of Health. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press (US), National Academy of Sciences; 1998.
  22. U.S. Food and Drug Administration. The FDA Warns that Biotin May Interfere with Lab Tests: FDA Safety Communication. Statement issued November 28, 2017.
  23. Patel DP, Swink SM, Castelo-Soccio L. A Review of the Use of Biotin for Hair Loss. Skin Appendage Disord. Aug 2017;3(3):166-169. 
  24. Soleymani T, Lo Sicco K, Shapiro J. The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity. J Drugs Dermatol. May 1 2017;16(5):496-500. 
  25. Williams GR, Cervinski MA, Nerenz RD. Assessment of biotin interference with qualitative point-of-care hCG test devices. Clin Biochem. Mar 2018;53:168-170.
  26. Katzman BM, Lueke AJ, Donato LJ, et al. Prevalence of biotin supplement usage in outpatients and plasma biotin concentrations in patients presenting to the emergency department. Clin Biochem. Sep 2018;60:11-16.
  27. John JJ, Cooley V, Lipner SR. Assessment of biotin supplementation among patients in an outpatient dermatology clinic. J Am Acad Dermatol. Aug 2019;81(2):620-621.
  28. Frame IJ, Joshi PH, Mwangi C, et al. Susceptibility of Cardiac Troponin Assays to Biotin Interference. Am J Clin Pathol. Apr 2 2019;151(5):486-493.
  29. Mrosewski I, Neumann I, Switkowski R. Interference of High Dose Biotin Supplementation with Thyroid Parameters in Immunoassays Utilizing the Interaction between Streptavidin and Biotin: a Case Report and Review of Current Literature. Clin Lab. Jan 1 2019;65(1).
  30. Parks NE, Jackson-Tarlton CS, Vacchi L, Merdad R, Johnston BC. Dietary interventions for multiple sclerosis-related outcomes. Cochrane Database Syst Rev. 2020 May 19;5:CD004192.
  31. Thompson KG, Kim N. Dietary supplements in dermatology: A review of the evidence for zinc, biotin, vitamin D, nicotinamide, and Polypodium. J Am Acad Dermatol. 2020 Apr 29:S0190-9622(20)30744-1.
  32. Li D, Ferguson A, Cervinski MA, Lynch KL, Kyle PB. AACC Guidance Document on Biotin Interference in Laboratory Tests. J Appl Lab Med. 2020 May 1;5(3):575-587.
  33. Demas A, Cochin JP, Hardy C, Vaschalde Y, Bourre B, Labauge P. Tardive Reactivation of Progressive Multiple Sclerosis During Treatment with Biotin. Neurol Ther. 2020 Jun;9(1):181-185.
  34. Rosner I, Rogers E, Maddrey A, Goldberg DM. Clinically Significant Lab Errors due to Vitamin B7 (Biotin) Supplementation: A Case Report Following a Recent FDA Warning. Cureus. 2019 Aug 23;11(8):e5470.
  35. Latif Z, Crupie MJ. Aberrant Thyroid Function Tests in a Patient Taking Biotin Supplements. Cureus. 2019 Aug 1;11(8):e5297.
  36. Carter GD, Berry J, Cavalier E, et al. Biotin supplementation causes erroneous elevations of results in some commercial serum 25-hydroxyvitamin d (25OHD) assays. J Steroid Biochem Mol Biol. 2020 Jun;200:105639.
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