Increase in Prevalence of Over-the-Counter Biotin Supplementation May Lead to Inaccuracies in Lab Results

By Jessica Pyhtila, PharmD, BCGP, BCPS

A recent article in the Journal of the American Medical Association examined trends in biotin supplementation in US adults from 1999 to 2016 (1). Patients often take biotin, a widely available over-the-counter supplement, in hopes of stronger and healthier hair, skin and nails (2). However, high doses of biotin are known to interfere with some lab results, causing falsely low troponin levels that may interfere with diagnosis of a myocardial infarction. High doses of biotin have also been linked to falsely low BNP levels, interfering with heart failure monitoring, and falsely high TSH levels, erroneously indicating hyperthyroidism or Graves Disease. Vitamin D serum results may also be skewed by high biotin doses.

The study characterized the prevalence of biotin at total daily doses of 1 mg daily or higher and 5 mg daily or higher. The researchers chose these thresholds as total daily doses of 1 mg daily are unlikely to interfere with lab tests. However, many over-the-counter supplements are available in doses exceeding 1 mg daily and may, therefore, lead to inaccurate lab tests.

The study was conducted via repeated cross-sectional surveys from the National Health and Nutrition Examination Survey. The number of survey participants ranged from 4,580 to 6,145, depending on the year. Participants were asked about supplement intake over the previous month in in-person interviews and were asked to show their supplement bottles. Total biotin supplement intake was then calculated by the researchers, including biotin in multivitamin supplements. Participants were excluded if they were younger than age 20, were pregnant, or if the researchers did not have adequate information on their supplements.

The study showed a statistically significant increase in biotin supplementation at doses of 1 mg daily or higher and 5 mg daily and higher over the study period. This was notably true in adults over the age of 60 years as well as in women. Over the study period, the prevalence of 1 mg daily or higher biotin use increased from 0.1% (95% CI, 0.0%-0.5%) in 1999–2000 to 2.8% (95% CI, 1.9%-3.9%) in 2015–2016. Further, the prevalence of 5 mg or higher biotin use increased from 0.1% (95% CI, 0%-0.2%) in 2007–2008 to 0.7% (95% CI, 0.5%-1.0%) in 2015–2016.

Clinicians should consider educating patients who take biotin supplements about the potential interference with lab tests. This is particularly important for troponin and BNP tests, where time may be of extreme essence in successfully treating any cardiac problems. Clinicians should educate patients that the recommended daily intake for non-lactating adults over age 19 is a mere 30 mcg daily, and that deficiency is rare. Further, few studies exist to support biotin supplementation for hair, skin and nails in healthy adults.

References:

1. Li, Danni; Rooney, Mary R; Burmeister, Lynn A; et al. (2020). “Trends in Daily Use of Biotin Supplements Among US Adults, 1999–2016.” Retrieved from: https://jamanetwork.com/journals/jama/article-abstract/2769254

2. National Institutes of Health. (2020). “Biotin.” Retrieved from: https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/