07/05/2024
Biotin (vitamin B7) insufficiency can cause hair loss. Supplementation to resolve deficiency can improve the growth and quality of hair and nails. Trueb (2016) reports that, in one study, 38% of women complaining of hair loss were biotin deficient. Risk factors for biotin deficiency may include ketogenic diet (suggested in an animal study), lipoic acid supplementation, gastrointestinal disease, certain medications (isotretinoin, antibiotics, or antiepileptics), excessive alcohol consumption, consumption of raw egg whites, and certain genetic variants (Yuasa, et al. 2013); Garg, Smith, 2017). Once optimal biotin sufficiency has been reached, additional dosage offers no benefit for hair growth. Besides, there are many other factors that can cause hair loss, including stress, hypothyroidism, hyperparathyroidism, insufficient protein intake, decline in estrogen and progesterone, excess of dihydrotestosterone (DHT), and other factors. Increasing biotin will not mitigate these other factors.
Yet, high dose biotin is heavily marketed for hair growth. What I want to share with you today is that biotin supplementation can significantly interfere with certain laboratory biomarkers through its interaction with streptavidin, which is used in clinical immunoassays. It can cause significant errors in the lab values of TSH, T3, T4, PTH, calcium, estrogen, testosterone, ferritin, troponin, and certain cancer markers (Rosner, Rogers, Maddrey, Goldberg, 2019). With respect to the above thyroid markers, excessive biotin can falsely imply hyperthyroidism in a euthyroid (normal) patient or falsely imply euthyroidism in a hypothyroid patient. This is a big deal! Hypothyroidism causes hair loss. If excessive supplemental biotin is consumed, it could mask hypothyroid markers and delay treatment of the real root cause of the hair loss.
Biotin supplementation should be stopped for a minimum of 48 hours before drawing labs for affected markers, but ideally for a week (Luong, ashist, 2019). Extremely high doses may need longer to clear. Impaired kidney function can also slow clearance. I think it would be prudent to temporarily stop biotin for any lab test. Remember, a multivitamin contains biotin, too. Stop ALL supplements that contain any biotin.
And equally importantly, do you really need high dose biotin supplementation in the first place? People should *annually* be assessed for their nutrient status. Most people don't consume the optimal 7-9 servings of vegetables and fruits per day. Even given an optimal diet, genetic variants result in significant individual differences in nutrient requirements. Most people, especially as they age, needs at least a few nutrients supplemented to meet their body's requirements. If you would like to work with me to monitor and optimize your nutritional status, please fill out a consultation request: https://www.drsuzieama.com/contact/. I would then send you an invitation to create a login account on my HIPAA-compliant portal. And I would then send you some intake forms to complete. Then we can schedule to meet! I would really love to work you and help you feel your best. 💚💜
References
Garg, U., & Smith, L. D. (2017). Biomarkers in inborn errors of metabolism : clinical aspects and laboratory determination. Elsevier.
Luong, J. H. T., & Vashist, S. K. (2019). Chemistry of Biotin-Streptavidin and the Growing Concern of an Emerging Biotin Interference in Clinical Immunoassays. ACS omega, 5(1), 10–18. https://doi.org/10.1021/acsomega.9b03013
Rosner, I., Rogers, E., Maddrey, A., & Goldberg, D. M. (2019). Clinically Significant Lab Errors due to Vitamin B7 (Biotin) Supplementation: A Case Report Following a Recent FDA Warning. Cureus, 11(8), e5470. https://doi.org/10.7759/cureus.5470
Trüeb R. M. (2016). Serum Biotin Levels in Women Complaining of Hair Loss. International journal of trichology, 8(2), 73–77. https://doi.org/10.4103/0974-7753.188040
Yuasa, M., Matsui, T., Ando, S., Ishii, Y., Sawamura, H., Ebara, S., & Watanabe, T. (2013, Oct). Consumption of a low-carbohydrate and high-fat diet (the ketogenic diet) exaggerates biotin deficiency in mice. Nutrition, 29(10), 1266-1270. https://doi.org/10.1016/j.nut.2013.04.011
