Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
ARP [N-(aminooxyacetyl)-N-(D-biotinoyl) hydrazine], B vitamins, biocytin, bioepiderm, bios II, biotín, biotin cadaverine, biotin nitrilotriacetic acid, biotin NTA, biotina, biotină, biotin-alkaline phosphate, biotin-PEO2-PPO2-amine, biotin-PEO3-maleimide, biotin-PEO4-amine, biotin-PEO4-propionate succinimidyl ester, biotinidase, biotyna, biyotin, carboxylic acids, cis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid, coenzyme R, cofactors, D-biotin, cis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid, Diachrome®, dUTP biotin, factor alpha, shēngwù sù (Chinese), tripotassium salt (BNTA), vitamin B7, vitamin H, W factor.
Note: This monograph does not include the use of biotin as a laboratory or diagnostic reagent. The monograph does not discuss analytical methods for measuring biotin, e.g., in biological fluids.
Biotin is an essential water-soluble B vitamin, also known as vitamin B7. Biotin binds to a number of enzymes and other proteins. Without biotin, these enzymes do not function properly. Biotin is available in a wide variety of plant- and animal-based foods. Among the richest sources are milk and liver. Biotin can also be obtained from bananas, brewer's yeast, cauliflower, cooked eggs, legumes, nuts and nut butters, sardines, and whole grains.
Biotin deficiency is rare. This is because daily biotin requirements are relatively small. Biotin is found in many foods, bacteria in the intestine also make biotin, and the body is able to recycle much of the biotin it has already used. Reports of significant toxicity with biotin are lacking, even with doses 600 times greater than the estimated daily intake of approximately 30 micrograms in a healthy adult.
Some populations are at greater risk of developing biotin deficiency. These include malnourished children in developing countries, those taking anticonvulsants or broad-spectrum antibiotics (such as sulfa drugs), and those who consume large amounts of raw egg white over months or years. Raw egg white contains the protein avidin. Avidin binds biotin very tightly and prevents its absorption in the digestive system. Marginal biotin deficiency, which is not severe enough to cause classic symptoms, may develop in up to 50% of women during normal pregnancies.
Biotin deficiency can be the result of inborn errors of metabolism, such as defects in any of the enzymes that bind to or process biotin in the body. The symptoms of biotin deficiency are similar, regardless of the underlying cause. Symptoms include conjunctivitis, developmental delay in infants and children, hair loss, low muscle tone, metabolic changes (such as impaired glucose tolerance), skin lesions around the mouth and other body openings, seizures, and uncoordinated body movements. Biotin deficiency due to inborn errors of metabolism can generally be treated with very high doses of biotin without adverse effects.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Biotin deficiency is rare in developed countries. The symptoms of biotin deficiency are similar, regardless of the underlying cause. Symptoms include conjunctivitis, developmental delay in infants and children, hair loss, low muscle tone, metabolic changes, skin lesions around the mouth and other body openings, seizures, and uncoordinated body movements. Biotin deficiency may generally be treated by biotin supplementation without adverse effects.
Biotin-responsive inborn errors of metabolism
Inborn errors of metabolism, such as defects in any of the enzymes that bind to biotin, can cause functional biotin deficiency. Biotin-responsive basal ganglia disease has been reported. Biotin deficiency due to inborn errors of metabolism can generally be treated with very high doses of biotin without adverse effects.
Total parenteral nutrition (TPN)
Biotin has been routinely included in parenteral nutrition for over 25 years. Biotin deficiency associated with parenteral nutrition has not been reported since this practice was adopted.
Biotin has been used as a treatment for brittle fingernails. Additional studies are needed before a conclusion can be made.
Cardiovascular disease risk (in diabetics)
Treatment with biotin and the nutritional supplement chromium picolinate reduced cholesterol and blood lipids in patients with diabetes mellitus type 2 who were also taking standard blood sugar-lowering agents by mouth. Additional research on the effect of biotin alone is needed.
Diabetes mellitus (type 2)
Biotin may play a role in maintenance of glucose tolerance. Treatment with biotin and the nutritional supplement chromium picolinate improved glycemic control in overweight and obese individuals with diabetes mellitus type 2 who were also taking standard blood sugar-lowering agents by mouth. Additional research on the effect of biotin alone is needed.
Epilepsy (in infants)
Biotin has been included in a therapeutic treatment plan for newborn infants with convulsions and epileptic syndromes. Additional research is required.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Acne, antioxidant, cancer, cardiac conditions, cavities, cosmetic uses (nail care, slow graying of hair, uncombable hair syndrome), Crohn's disease, eczema, energy metabolism, exercise capacity improvement, general health maintenance (musculoskeletal and nervous systems, hair loss, hepatitis (in alcoholics), hyperlipidemia (high cholesterol or triglycerides), metabolic disorders (3-methylcrotonylglycinuria), muscle pain, Parkinson's disease, peripheral neuropathy (diabetic and uremic), Rett syndrome, seborrheic dermatitis (skin condition), skin care, thyroid disorders, vaginal yeast infections, weight loss, wound healing (periodontal), yeast infections (intestinal).
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
General: The U.S. Food and Drug Administration (FDA) has not established a recommended dietary allowance (RDA) for biotin. The Food and Nutrition Board of the Institute of Medicine of the National Academies recommends a daily adequate intake (AI) of 30 micrograms in adults 19 years of age and older. In pregnant women 14 years of age and older, a daily AI of 30 micrograms is recommended. In breastfeeding women 14 years of age and older, a daily AI of 35 micrograms is recommended. Most healthy nonpregnant individuals with regular diets obtain these amounts of biotin through dietary consumption.
Treatment of biotin deficiency or inborn errors of metabolism should only take place under medical supervision.
In human research, single doses that are 600-fold greater than the normal dietary intake have been taken by mouth (2.1, 8.2, or 81.9 micromoles) or intravenously (18.4 micromoles) by healthy adults. Daily injections of at least 150 micrograms have been used to reverse experimental biotin deficiency. Five to 10 milligrams of biotin per kilogram daily has been used to treat biotin-responsive basal ganglia disease. A daily dose of 2.5 milligrams of biotin has been used to treat brittle nail syndrome. Biotin has been used as a skin- and hair-conditioning agent in cosmetic products at concentrations ranging from 0.0001% to 0.6%.
Children (younger than 18 years)
General: The U.S. Food and Drug Administration (FDA) has not established a recommended dietary allowance (RDA) for biotin. The Food and Nutrition Board of the Institute of Medicine of the National Academies recommends a daily adequate intake (AI) of five micrograms daily in infants 0-6 months of age; six micrograms in infants 6-12 months of age; eight micrograms in children 1-3 years of age; 12 micrograms in children 4-8 years of age; 20 micrograms in children 9-13 years of age; and 25 micrograms in adolescents 14-18 years of age. The daily AIs for pregnant and breastfeeding women 14 years of age and older are 30 micrograms and 35 micrograms, respectively. Most healthy nonpregnant individuals with regular diets obtain these amounts of biotin through dietary consumption.
Treatment of biotin deficiency or inborn errors of metabolism should only take place under medical supervision.
Six milligrams daily for nine years has been used.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Reports of allergy or anaphylaxis to biotin supplementation are rare.
Side Effects and Warnings
Biotin is a water-soluble, B-complex vitamin that is required in the human diet. It is likely safe at levels typically found in food. Supplementation with pharmacological doses of biotin is considered safe and has been associated with minor (mild gastrointestinal upset) or no side effects. One case of hives has been reported. Biotin is considered safe in cosmetic formulations.
Use cautiously in patients, including children, taking anticonvulsants (such as carbamazepine, phenytoin, phenobarbital, primidone (Mysoline®), or valproic acid), as anticonvulsant therapy may accelerate biotin breakdown and cause biotin deficiency.
Use cautiously in patients taking broad-spectrum antibiotics, such as sulfa drugs, as these may alter the intestinal bacteria that synthesize biotin.
Use cautiously in patients taking cytochrome P450-modifying agents.
Use cautiously in patients taking isotretinoin, as isotretinoin (Roaccutane®) may reduce biotinidase activity and cause biotin deficiency.
Use cautiously in pregnant or breastfeeding women, due to a lack of available scientific evidence.
Note: Consumption of large amounts of raw egg white over months or years is likely to result in biotin deficiency. Raw egg white contains the protein avidin, which binds biotin tightly and prevents its absorption in the intestine.
Note: Smoking may increase biotin breakdown in women and cause biotin deficiency.
Pregnancy and Breastfeeding
Use cautiously in pregnant or breastfeeding women, due to lack of available scientific evidence.
The U.S. Food and Drug Administration (FDA) has not established a recommended dietary allowance (RDA) for biotin. The Food and Nutrition Board of the Institute of Medicine of the National Academies recommends a daily adequate intake (AI) of 30 micrograms of biotin in pregnant women 14 years of age and older and of 35 micrograms in breastfeeding women 14 years of age and older. This level of intake should not be exceeded unless under medical supervision. Information on biotin's effects on lactation is currently lacking in the National Institute of Health's Lactation and Toxicology Database (LactMed).
Marginal biotin deficiency has been found to commonly occur during pregnancy. This finding may be cause for concern, because this level of biotin deficiency causes birth defects in many animals. It has been suggested by some experts that biotin supplements should be considered for widespread use in pregnant women, although there is not enough available scientific information to make this recommendation. Smoking may lead to marginal biotin deficiency in women by accelerating biotin breakdown.
One case of biotin deficiency in an infant fed formula lacking biotin has been reported. Symptoms resolved following daily supplementation with biotin.
Human breast milk is rich in biotin and contains 0.81 micrograms of biotin per 100 milliliters of milk.
Maternal biotin supplementation has been used to treat biotin-responsive inborn errors of metabolism in utero.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Biotin may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Biotin may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Biotin may also interact with broad-spectrum antibiotics (such as sulfa drugs, sulfathalidine), anticonvulsants (such as carbamazepine, phenytoin, phenobarbital, primidone (Mysoline®), or valproic acid), isotretinoin (Roaccutane®), or lipid- or cholesterol-lowering agents.
Note: Smoking may lead accelerate biotin breakdown in women and cause marginal biotin deficiency.
Interactions with Herbs and Supplements
Biotin may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Biotin may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
Biotin may also interact with chromium picolinate, lipid- or cholesterol-lowering agents, lipoic acid, pantothenic acid (vitamin B5), or raw egg whites.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Albarracin C, Fuqua B, Geohas J, et al. Combination of chromium and biotin improves coronary risk factors in hypercholesterolemic type 2 diabetes mellitus: a placebo-controlled, double-blind randomized clinical trial. J Cardiometab Syndr 2007;2(2):91-7. View Abstract
Baumgartner ER, Suormala T. Multiple carboxylase deficiency: inherited and acquired disorders of biotin metabolism. Int J Vitam Nutr Res 1997;67(5):377-384. View Abstract
Friebel D, von der Hagen M, Baumgartner ER, et al. The first case of 3-methylcrotonyl-CoA carboxylase (MCC) deficiency responsive to biotin. Neuropediatrics 2006;37(2):72-8. View Abstract
Geohas J, Daly A, Juturu V, et al. Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Am J Med Sci 2007;333(3):145-53. View Abstract
Lean IJ, Rabiee AR. Effect of feeding biotin on milk production and hoof health in lactating dairy cows: a quantitative assessment. Dairy Sci 2011;94(3):1465-76. View Abstract
Mock DM, Mock NI, Nelson RP, et al. Disturbances in biotin metabolism in children undergoing long-term anticonvulsant therapy. J Pediatr Gastroenterol Nutr 1998;26(3):245-250. View Abstract
Mock DM, Stadler DD, Stratton SL, et al. Biotin status assessed longitudinally in pregnant women. J Nutr 1997;127(5):710-716. View Abstract
Neiva RF, Al-Shammari K, Nociti FH Jr, et al. Effects of vitamin-B complex supplementation on periodontal wound healing. J Periodontol 2005;76(7):1084-91. View Abstract
Revilla-Monsalve C, Zendejas-Ruiz I, Islas-Andrade S, et al. Biotin supplementation reduces plasma triacylglycerol and VLDL in type 2 diabetic patients and in nondiabetic subjects with hypertriglyceridemia. Biomed Pharmacother 2006;60(4):182-5. View Abstract
Seymons K, De Moor A, De Raeve H, et al. Dermatologic signs of biotin deficiency leading to the diagnosis of multiple carboxylase deficiency. Pediatr Dermatol 2004;21(3):231-235. View Abstract
Singer GM, Geohas J. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial. Diabetes Technol Ther 2006;8(6):636-43. View Abstract
Stewart S, Prince M, Bassendine M, et al. A randomized trial of antioxidant therapy alone or with corticosteroids in acute alcoholic hepatitis. J Hepatol 2007 Aug;47(2):277-83. View Abstract
Strom CM, Levine EM. Chronic vaginal candidiasis responsive to biotin therapy in a carrier of biotinidase deficiency. Obstet Gynecol 1998;92(4 Pt 2):644-646. View Abstract
van den BH. Bioavailability of biotin. Eur J Clin Nutr 1997;51 Suppl 1:S60-S61. View Abstract
Zempleni J, Wijeratne SS, Hassan YI. Biotin. Biofactors 2009;35(1):36-46. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017