Biotin and Biomarkers

With the recent hype over skin food for luscious hair and longer, stronger nails, biotin is becoming a common supplement in our multivitamin drug cupboard. Have you ever wondered how safe biotin is and whether it has any long-term implications for our health?

In this article, we explore the role of biotin in the human body and the benefits and potential drawbacks of this supplement.

What is Biotin?

Biotin, also known as Vitamin B7, Vitamin H, and Coenzyme R, is a water-soluble protein that facilitates the production of energy for the body by acting as a catalyst in the metabolism of protein, carbohydrates, and fats.

It can be found in meat, salmon, eggs, innards such as liver, dairy products, cereal and grains, soy flour, fruits and vegetables such as bananas, carrots, cauliflower, etc. Biotin, when consumed, is absorbed in the small intestine and stored predominantly in the liver.

Currently, there are no blood tests that enable us to monitor the level of biotin in our body.

What are the medical benefits of Biotin?

Biotin plays an essential role in the growth of skin, hair, and nails. Biotin deficiency is known to be associated with brittle nails, skin rash, or hair loss. Furthermore, low biotin can be associated with cardiovascular consequences such as high cholesterol and heart disease.

There are ongoing medical studies and research on the role and benefits of biotin in skin conditions such as seborrhoeic dermatitis, acne, or eczema and neurological conditions such as multiple sclerosis. However, there is insufficient clinical evidence to prove its efficacy in these conditions.

Does Biotin interact with other medications?

Patients who are on anti-convulsants (epilepsy medication) can be associated with lower biotin levels in their bodies.

What happens if a person is deficient with Biotin?

Biotin deficiency is uncommon in healthy people with a regular, varied diet.

Biotin can be lower in chronic alcohol drinkers or pregnant or lactating mothers. Rarely, one can be genetically predisposed to biotin deficiency due to biotinidase enzyme deficiency (an enzyme that allows the release of free biotin in the body).

Biotin deficiency can be associated with hair loss, brittle nails, and skin rash, particularly over the mouth, eyes, nasal hole, and perianal region). In more severe cases, one can develop neurological symptoms such as seizures, numbness in the limbs, and psychiatric symptoms such as depression and hallucination.

Will I get an overdose with a high dose or excessive amount of Biotin?

Thankfully, no major side effects have been reported for overdosing on biotin. However, informing your healthcare provider before starting the supplement is still good practice.

As high biotin intake can lead to falsely high or low biochemistry laboratory test results, which can lead to misdiagnosis and mismanagement of a person’s health condition, it is always prudent to check with your doctor about your biotin dose.

What medical biomarkers can be affected by Biotin?

There is slowly emerging medical evidence of biotin interference with laboratory test results. Most laboratory immunoassays (tests) use the biotin-streptavidin system to run samples, as this system allows high affinity and sensitivity (the ability of chemical proteins to bind together and pick up abnormalities). It is found that a high amount of biotin (>1mg/day) can cause false test readings.

Abnormal thyroid hormone blood tests and Vitamin D serum levels are found in patients who consume high biotin levels. There have been reports of false hyperthyroidism or inappropriate diagnosis and treatment of Grave’s disease in patients who are taking high-dose biotin (30-100 mg biotin/day). Aside from this, some reports reveal biotin can interfere with blood markers for heart failure (such as pro-BNP {brain natriuretic protein}), both female and male hormones, cortisol, parathyroid hormone readings, folate, vitamin B12, iron readings, etc.

The concern and danger here:

• Firstly, there is no way to test a person's biotin level.
• Unless informed, the physician in charge cannot determine if the patient is on high-dose biotin levels when running and interpreting the test results. This can lead to a wrong interpretation of test results, which can result in patients being misdiagnosed and mistreated and receiving unnecessary procedures and treatment.

You are encouraged to inform your doctor on the supplement(s) that you are taking prior medical tests to ensure the tests is run and interpreted appropriately.

Thought for the day…

The interference of biotin with our daily biomarkers raises a few new questions to ponder:

• With the recent trend toward better skin, hair, and nails, biotin supplements can be found ubiquitously available anywhere as over-the-counter supplements. How regulated is the supplement?
• Are consumers aware of the potential interference of blood tests and the implication of false and wrong reading of results?
• What is considered a high-dose biotin supplement?

A more pragmatic approach is to educate ourselves as both patients and consumers on the supplement that we are delving into. On the other hand, physicians have a role in screening patients' drug and supplement lists. Those who are on biotin should be counselled on the potential interference with laboratory results before blood testing.

References

1.      Gifford JL, Sadrzadeh SMH, Naugler C. Biotin interference: Underrecognized patient safety risk in laboratory testing. Can Fam Physician. 2018 May;64(5):370. 

2.      Elston MS, Sehgal S, Du Toit S, Yarndley T, Conaglen JV. Factitious Graves’ disease due to biotin immunoassay interference—a case and review of the literature. J Clin Endocrinol Metab. 2016;101(9):3251–5.

3.      Piketty ML, Polak M, Flechtner I, Gonzales-Briceño L, Souberbielle JC. False biochemical diagnosis of hyperthyroidism in streptavidin-biotin-based immunoassays: the problem of biotin intake and related interferences. Clin Chem Lab Med. 2017;55(6):780–8.

4.      https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/#ref