Biotin Interference in Lab Tests?

On July 22, CNBC published an article entitled “Don’t waste money on biotin or collagen supplements, dermatologists say: The better way to get ‘beauty’ nutrients” [1]. In it, they warn against the potential danger of biotin supplements interfering with certain lab tests. They also state that “Claims that suggest biotin is good for hair, skin and nail health are mostly anecdotal…”, and that only preliminary data shows that collagen may make your skin healthier. In my opinion, this article is very one-sided. Let’s examine the facts.

The FDA’s communication

It all began in 2017 when the FDA posted a communication to inform the public, health care providers, lab personnel, and lab test developers that biotin can interfere with certain lab tests resulting in falsely low levels of troponin, a clinically important biomarker that aids in the diagnosis of heart attacks. The implication is that the false low levels may lead to a missed diagnosis.

Since FDA’s 2017 communication, some lab test developers have been successful at mitigating the biotin interference of their assays, while others have not yet addressed it. So, does that mean everyone should avoid supplements with biotin?

Answering that question

In answering that question, let’s start with the fact that Biotin is not known to be toxic. While the daily value for biotin is 30 mcg, in people without disorders of biotin?metabolism, doses of up to 5 mg/day (5,000 mcg) for two years were not associated with adverse effects [2]. Oral biotin supplementation has been well tolerated in doses up to 200 mg/day (200,000 mcg) in people with hereditary disorders of biotin metabolism [3]. Daily supplementation with a highly concentrated formulation of biotin (100-600 mg) for several months was also found to be well tolerated in individuals with progressive?multiple sclerosis [4-5].?

Second, while not all manufacturers have made assays less vulnerable for biotin interference, such assays are not the be all and end all of determining risk of heart attack. For example, in doubtful cases, it is helpful to determine testosterone in females and estrogen in males. Both are elevated if biotin interference is present [6].

Third, the FDA’s recommendation [7] regarding risk mitigation includes letting your doctor know if you are currently taking biotin supplements. This will allow your physician to take this into account when examining your lab reports and comparing them to other diagnostic tools.

Other considerations

In any case, the discontinuation of biotin is not advisable in some situations. For example, this is impossible in MS patients needing biotin [8]. Discontinuation would also be a problem in people with hereditary disorders of biotin metabolism [9]. In addition, at least one-third of women develop marginal biotin deficiency during pregnancy [10].?Furthermore, it has been shown that people with the following disorders require and/or benefit from biotin supplementation:

• Biotin-responsive basal ganglia disease [11]
• Multiple sclerosis [12]
• Brittle fingernails (onychorrhexis) [13]
• Hair loss in children treated with the?anticonvulsant?valproic acid [14]

Given biotin’s documented record of safety and non-toxicity, it seems unnecessary to avoid biotin supplementation or the use of biotin in dietary supplements by brand owners. Furthermore, consumers do not appear to be concerned about it. The biotin supplement market was valued at $583.4 million in 2021 and is projected to reach $1.41 billion by 2031, registering a CAGR of 9.1% from 2022 to 2031 [15].

Biotin for hair and nails?

What about CNBC’s position that there is only anecdotal evidence that biotin is good for hair, skin and nail health? This is partially true. Despite popular perception, there are no published human clinical trials showing that biotin itself will help prevent hair loss or promote hair growth. Likewise, I am not aware of any research indicating that biotin is beneficial for skin—although I have never seen any claims that it was. Regarding nails, there are (in fact) studies [16-18] showing that supplementation with 2,500 mcg/day of biotin may support firmer and harder nails.

What about collagen?

The CNBC article also commented: “While preliminary data shows that collagen may make your skin healthier, Hartman says more research is required to solidify that claim”. This is an incredibly inaccurate statement. There are dozens of published human clinical trials demonstrating the effectiveness of collagen supplementation for improving the appearance of aging skin [19-35].

Conclusion

In my opinion, the CNBC article demonstrated a bias against dietary supplements. A fair and balanced presentation of the facts would have been a better approach.

References

1.??????Don’t waste money on biotin or collagen supplements, dermatologists say: The better way to get ‘beauty’ nutrients. Onque R. CNBC. July 22, 2023. Retrieved July 30, 2023 from https://www.cnbc.com/2023/07/22/natural-ways-to-get-beauty-nutrients-like-biotin-and-collagen-in-food.html.

2.??????Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother.1990;44(10):511-514.?

3.??????Food and Nutrition Board, Institute of Medicine. Biotin. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academy Press; 1998:374-389.?

4.??????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. 2016;22(13):1719-1731.

5.??????Tourbah A LFC, Edan G, Clanet M, Papeix C, Vukusic S, et al. Effect of MD1003 (high doses of biotin) in progressive multiple sclerosis: results of a pivotal phase III randomized double blind placebo controlled study. Paper presented at: American Association of Neurological Surgeons (AANS) Annual Scientific Meeting 2015; Washington, D.C.

6.??????Moerman A, Delanghe JR. Sense and nonsense concerning biotin interference in laboratory tests. Acta Clin Belg. 2022 Feb;77(1):204-210.

7.??????https://public4.pagefreezer.com/content/FDA/16-06-2022T13:39/https://www.fda.gov/medical-devices/safety-communications/update-fda-warns-biotin-may-interfere-lab-tests-fda-safety-communication

8.??????Moerman A, Delanghe JR. Sense and nonsense concerning biotin interference in laboratory tests. Acta Clin Belg. 2022 Feb;77(1):204-210.

9.??????Food and Nutrition Board, Institute of Medicine. Biotin. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academy Press; 1998:374-389.?

10.???Mock DM. Biotin. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th?ed: Lippincott Williams & Wilkins; 2014:390-398.

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18.???Hochman LG, Scher RK, Meyerson MS. Brittle nails: response to daily biotin supplementation. Cutis. 1993;51(4):303-305.

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