Biotin and your Skin, Hair and Nails
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What is Biotin?
Biotin, also known as vitamin B7, is a required cofactor for the function of carboxylase enzymes. Carboxylase enzymes are responsible for various metabolic pathways including the production of fatty acids, the breakdown or catabolism of amino acids, and the production of glucose called gluconeogenesis.
Do we need to take supplemental biotin?
All of these pathways are essential for healthy skin and nails, however, most people do not benefit from taking supplemental biotin as we find adequate amounts are obtained from our diet and produced by bacteria in our gut. Biotin from our diet is found in eggs (yolk in particular), spinach, milk and milk products, apple, tomato, potato, beef, chicken, pork, carrots, and lettuce. Our intestinal bacteria are thought to produce adequate amounts of biotin in addition to the biotin found in our diet.
How can supplemental biotin benefit scalp health?
Biotin taken in supplements may be beneficial in cases where an individual has evidence of biotin deficiency. Supplemental biotin will only benefit those with a biotin deficiency. The reality is that biotin deficiency is not the most common cause of hair loss.
How do I know if I have a Biotin deficiency?
Biotin deficiency can be acquired or congenital.
Acquired biotin deficiency is when someone develops a secondary biotin deficiency to another cause that makes them absorb less biotin from their diet or affects the way bacteria in our gut can make biotin. This is considered rare. It can be the result of :
- Excess raw egg consumption (Avidin in the white of the egg binds to biotin preventing absorption): often with desquamative dermatitis in addition to hair loss
- Medications such as Valproic acid can inhibit biotin absorption
- After gastric bypass
- Malabsorption from Inflammatory bowel disease or other conditions affecting intestinal absorption
- Pregnancy (possibly due to increased nutritional need)
- Prolonged antibiotic use (impacts gut bacteria’s ability to produce biotin)
Congenital causes of biotin deficiency are the result of enzyme deficiencies such as holocarboxylase synthase or biotinidase deficiency. Holocarboxylase deficiency presents in the first 3 months of life and is severe and life-threatening. Biotinidase deficiency presents during infancy as muscle weakness, rashes, hair loss, and difficulty breathing amongst other symptoms. The most important point to make here is that these are not likely to be diagnosed in an adult with new-onset hair loss. Congenital causes are screened during newborn screening.
To diagnose a biotin deficiency, checking bloodwork for biotin levels alone may not be a reliable method of diagnosis. However, although some studies indicate that checking the urine for biotin and other metabolites may be more helpful, these tests are not found at some of the larger laboratory providers making them more difficult to use.
Generally speaking, however, biotin deficiency does not necessarily present with hair loss alone. Rashes, vision and hearing loss, and muscle weakness should be evaluated for as well.
Is shine simply a feature of healthy hair? If so, how can biotin support said hair shine?
The shine of hair is often perceived as a quality that people seek for the appearance of healthy hair. This is most often achieved through the use of hair products applied externally to the surface of the hair to assist in the ability of light to reflect evenly from the surface of the hair. Hair with structural support through lipid content, keratin, vitamins, minerals, and pigments will help the hair appear healthy as well.
If an individual has a biotin deficiency, there is the possibility that supplemental biotin can help the structural integrity of the hair to support its appearance. However, I could not find a medical study supporting the role that biotin could play in assisting with the shine of the hair.
Shine is generally studied through the use of polarization imaging. Anecdotally some patients have commented on the shine of their hair with supplementation but it is difficult to say if it is biotin alone as most of my patients that have approached hair loss is taking a wide array of vitamins in an attempt to support hair growth.
What is the recommended dosage of biotin for hair health?
The recommended daily intake of biotin for health is 30mcg. Since supplemental biotin is not routinely recommended for hair health by Dermatologists there is not a specific dosage to consider as there is not a specific dosage that has had any testing to prove success in hair growth without evidence of biotin deficiency.
In terms of hair health, how long does it generally take to see results?
If an oral supplement for hair growth were to show benefit, it would influence the new hair growing in and not necessarily impact the hair already present. For this reason, it would likely take months to appreciate a difference if one were to occur.
When used in hair care products, does biotin have different results?
Although biotin is added to topical hair formulations, I could not find any medical studies that support a benefit to use. It is difficult to say how it could work when its primary function is at an enzymatic level in the scalp and not inside the hair itself. It is likely harmless but difficult to say if it does anything.
Are there any risks with taking supplemental Biotin?
The most important message to convey is that before the FDA’s warning in 2017 on biotin, taking supplemental biotin was considered of questionable effectiveness but likely harmless. The FDA issued a warning in 2017 on biotin’s ability to interfere with hundreds of laboratory tests. This can result in false lab results when obtaining bloodwork.
In a 2020 study reviewing “skin, hair, and nail” supplements found over the counter, several had biotin in dosages of 10,000 mcg with no FDA warnings listed for laboratory testing interference. The FDA warning was based on people taking 10,000 mcg of biotin for one week.
Which laboratory tests can be affected by Biotin supplements?
The reason laboratory testing can be impacted by taking supplemental biotin is simply because some laboratory tests use biotin technology to determine test results. Biotin may be used by laboratories to bind to proteins in the blood to test for specific parameters.
Specific tests that could be impacted by supplemental biotin:
- Syphilis, hepatitis, rubella or toxoplasmosis: potential for False Negative test results with excess biotin intake
- Thyroid hormone, steroid hormones (including cortisol, progesterone, testosterone, dehydroepiandrosterone sulfate, estradiol) can be falsely interpreted as low, normal, or high with supplemental biotin
- Vitamin B12 and folic acid can be falsely interpreted as low, normal, or high with supplemental biotin
- Cardiac enzymes such as troponin: used to determine if someone has had a heart attack. Supplemental biotin can affect this result.
Should people take supplemental Biotin?
These supplements are so widely available with popular press outlets, celebrities, and advertisements supporting the use based on anecdotal evidence and without regard to actual effectiveness. When I see patients for hair loss, the majority of the time these patients are already on one of these supplements with laboratory results in hand telling them that their blood tests are “normal” wondering why the supplement is not working and what to do if their bloodwork is normal. This is such a difficult scenario and takes so much time to discuss as we must first tackle misinformation, then recognize that the bloodwork they have had may be inaccurate, then recheck after stopping the supplements, then start a therapeutic plan to address the actual cause of their hair loss. This loses valuable time, contributes to a negative impact on the emotional and social well-being of our hair loss patients who are already vulnerable to marketing tactics, and potentially delays treatment from underlying conditions that could lead to bigger health challenges well beyond hair loss.
Are there any supplements you would recommend for hair loss instead of Biotin or skin, hair, and nail formulas?
The two vitamin supplements I do tend to recommend as I recognize that many patients are seeking and can benefit from a vitamin that can address potential deficiencies are Viviscal (has 100 mcg (not 10,000!!) or Inner Glow Vitamins (30mcg of biotin- the actual recommended dosage).