Biotin Deficiency: Symptoms and Treatment

Clinical Biotin Deficiency is not very common nowadays or maybe it is not diagnosed because of the subtle symptoms and signs of mildly reduced biotin.

Biotin is also called Vitamin B7 or Vitamin H. It is abundant in various plant and animal food sources; hence, deficiency is not commonly seen except in certain high-risk individuals.

Food sources of Biotin:

Animal sources of Biotin:

Egg yolk, Liver, and Dairy items contain biotin with liver containing the highest amounts per 100 gm.

The table below shows the amount of biotin per serving and the daily value (in percentage) provided by these foods [Ref]:

Plant sources of Biotin:

Cereals (Wheat, Oats), Nuts and seeds, Vegetables (Mushrooms, Spinach), and Rice contain Biotin. Nuts and seeds have the highest amount per 100 gm.

Here is a table showing the amount of biotin per serving and their daily value:

In one study, pumpkin seeds and sesame seeds were found to have the highest amount of biotin per 100 gm. Pumpkin seeds contained 64 mcg while sesame seeds contained 97 mcg per 100 gm.

Who is at risk of developing Biotin Deficiency?

Because Biotin is present in both animal and plant sources, deficiency is not very common. However, certain high-risk groups may develop Biotin deficiency, including:

• Individuals who consume raw eggs:

Raw eggs contain a protein, Avidin which inhibits the absorption of biotin from the intestines. In the early 1900s, signs and symptoms of Biotin deficiency were seen in people who consumed large amounts of raw eggs.

The term, egg-white-injury-syndrome, was used to describe their clinical presentations. Later on, it was found that consuming raw eggs in large quantities such as a dozen or more per day results in biotin deficiency.

Bodybuilders who consume a high-protein diet may be at risk if they are consuming raw eggs.

• Alcoholics and smokers:

Smokers are at risk of developing biotin deficiency because of the increased metabolism of biotin while alcoholics have impaired absorption of nutrients including Biotin.

In chronic alcoholics, it has been estimated that 15% of them have Biotin deficiency.

• People on prolonged oral antibiotics:

Prolonged use of oral antibiotics can lead to a change in the bacterial flora.

One explanation of biotin deficiency in these individuals is that some intestinal bacteria can produce biotin. Hence, clearing the gut can lead to biotin deficiency.

Another explanation is that the overgrowth of harmful bacteria can metabolize Biotin resulting in Biotin deficiency.

• Pregnancy and Lactation:

Pregnant and lactating women require higher amounts of biotin compared to non-pregnant women. Subclinical biotin deficiency is very common in lactating and breastfeeding women.

Some researchers think that marginal or subclinical Biotin deficiency may result in a teratogenic effect. Hence, supplementing Biotin during pregnancy and lactation is considered essential by some experts.

• Biotin Malabsorption:

Biotin malabsorption is common in individuals who have problems absorbing nutrients. These include:

• Celiac disease
• Crohn’s disease and Ulcerative colitis
• Short-gut syndrome and individuals who have a bowel resection such as gastric bypass and gastric sleeve surgery.
• Individuals on multiple medications

Some patients who have congestive cardiac failure, kidney disease, and liver disease may also develop biotin deficiency as a result of impaired absorption and poor nutritional status.

• Epileptic patients:

Biotin deficiency has been seen in patients who are on anti-convulsants such as phenobarbital, phenytoin, primidone, and carbamazepine.

The possible explanations of biotin deficiency in these patients are:

• Impaired absorption of Biotin
• Impaired renal reabsorption
• Accelerated metabolism of Biotin

Certain epileptic individuals have poor nutrition and are neglected by their families and hence are at an increased risk of Biotin Deficiency.

What are the signs and symptoms of Biotin Deficiency?

Biotin Deficiency is not associated with any specific disease. However, it can affect neurological functions, skin, and hair.

The signs and symptoms of Biotin deficiency are listed here:

Skin and Hair-related Symptoms:

• Dry skin
• Dandruff and Seborrheic Dermatitis
• Scaly and red rash around the nose, mouth, eyes, and genitals
• Hair loss and alopecia
• Fine and brittle hair
• Brittle nails
• Conjunctivitis
• Fungal infections, particularly candidiasis

Biotin deficiency, if severe and untreated, can cause brain damage. Symptoms may include:

• Limb weakness, fatigue, and loss of muscle tone.
• Difficulty walking
• Delayed milestones
• Depression, listlessness, altered mentation, drowsiness, and coma
• Muscle pains
• Hallucinations
• Numbness and tingling sensations
• Hyperesthesias and oversensitive skin
• Fits
• Spasticity in the limbs and myelopathy
• Optic atrophy
• Hearing loss (sensorineural)

Biotin deficiency may also affect the gastrointestinal system. Symptoms related to the intestinal tract include:

• Nausea
• Vomiting
• Loss of appetite

Respiratory symptoms are uncommon and include:

• Stridor (a harsh sound when taking a breath usually because of upper respiratory obstruction)
• Apnea
• Hyperventilation

Metabolic problems associated with biotin deficiency include:

• Organic aciduria
• Ketolactic acidosis
• Mild hyperammonemia

Biotin Supplementation: Effect on Laboratory Tests:

Biotin supplements can interfere with laboratory tests, especially thyroid, troponins, and vitamin D.

Individuals who were taking Biotin were wrongly treated for Graves disease and hyperthyroidism.

These laboratory interactions can occur even if a person is taking very low doses such as 10 mg. In addition, the effect may occur even after a single dose, if taken within 24 hours.

The FDA has warned healthcare providers to consider Biotin supplementation if a person with a strong clinical history of a heart attack has negative tests.

The warning came after a person died of a heart attack because of falsely negative blood tests [Ref].

What tests are done to diagnose Biotin Deficiency?

Biotin deficiency is diagnosed based on clinical signs and symptoms, hearing and visual testing, and laboratory confirmation.

Serum biotin ranges from 133-329 pmol/L and urinary excretion of biotin is 18-127 nmol/24 hours [Ref].

In addition, urinary biotin may be an early indicator of subclinical biotin deficiency.

Children with biotinidase deficiency can have their serum levels of biotin and biotinidase enzymes checked for early detection.

How to treat Biotin Deficiency?

The treatment of biotin deficiency depends on the cause. It is important to treat any concomitant medical conditions that might be leading to biotin deficiency.

Patients on long-term antibiotics may need to stop them or add biotin supplements to their diet.

The usual dose of biotin supplements is 5 to 10 mg per day. However, people with severe deficiency and those with neurological signs and symptoms may require higher doses of up to 20 mg per day.

Individuals with a genetic disorder of biotinidase deficiency may require lifelong treatment.

Some people take biotin supplements for hair and nails despite having adequate biotin stores in their body.

The usual recommended dietary allowance is 1 to 30 mcg per day (depending on the age of the person). However, biotin supplements available in the markets contain 10000 mcg or more biotin.

Biotin is a water-soluble vitamin and toxicity in these individuals has not been reported, however, significant laboratory interactions may occur resulting in false negative and false positive laboratory tests.