Dispelling Myths About Hair Supplements

When it comes to hair loss or hair thinning, who doesn’t want a quick, easy, and affordable fix? Too often our patients are turning to influencers or celebrities who tout the benefits of biotin supplements for hair and nail health, but does clinical evidence and scientific data support these claims? As evidence-based clinicians, it is our job to set the record straight. Let’s examine the science!

Biotin is a water-soluble B vitamin (aka B7 or vitamin H), which helps the body break down fat, carbohydrates, and protein into energy. It is involved in keratin synthesis and helps to maintain a healthy nervous system. It is found in many foods (nuts, legumes, whole grains, egg yolk, milk, yeast, fish, sweet potatoes, and organ meats) and is produced in the digestive tract by normal gut bacteria. While symptoms of biotin deficiency include eczematous skin changes, brittle nails, and hair loss, congenital and acquired cases of biotin deficiency are very rare. Do individuals with self-perceived or clinical hair loss, who have normal or elevated biotin levels, benefit from additional biotin supplementation? To date, there are no randomized, controlled trials utilizing biotin for healthy individuals with hair thinning/loss. Only case reports support these claims and nearly all these reports involve children with uncombable hair syndrome (Boccaletti; Shelley) or infants with “rash or dermatitis” and mild alopecia (Mock; Fujimoto). Moreover, Patel et al. (2017) conducted a systemic review of 18 reported cases of biotin supplementation for hair changes and found that all patients had an underlying health condition known to contribute to poor hair or nail growth. While all cases showed clinical improvement, the authors ultimately reported, “research demonstrating the efficacy of biotin is limited. In cases of acquired and inherited causes of biotin deficiency as well as pathologies, such as brittle nail syndrome or uncombable hair, biotin supplementation may be of benefit. However, we propose these cases are uncommon and that there is a lack of sufficient evidence for supplementation in healthy individuals.”

In dermatology education, there is very little focus on nutrition science. Therefore, we often find ourselves making supplement or vitamin recommendations with limited knowledge and/or with a mindset that says, “I don’t think it will help, but I don’t think it will hurt.” Because there is no evidence that high intake of biotin is toxic to humans (Inst. of Med), it may be justifiable to think this way; but supplementing biotin beyond daily recommended doses can cause a different health risk—clinically significant alterations in certain laboratory test results.

Biotin supplementation over 1 mg/day can interfere with thyroid tests including free thyroxine, free triiodothyronine, thyroid-stimulating hormone (TSH), and thyroid-stimulating hormone receptor antibiotics), causing a patient to be misdiagnosed with Graves’ disease (Kummer). It has also been reported that high-dose biotin supplementation can interfere with parathyroid hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone binding globulin (SHBG), estradiol, progesterone, testosterone, cortisol, folate, B12, and ferritin levels (Biscolla).

Perhaps more concerningly, biotin supplementation can cause troponin levels to appear falsely low. Specifically, the high-sensitivity cardiac troponin T test (hs-cTnT) results can be decreased while taking biotin supplements. (Vroemen, et al., 2019) This is of particular importance in emergency situations.

In summary, biotin is a popular, cheap treatment for hair growth, despite a dearth of scientific evidence to support its use. Future studies are needed to determine whether biotin supplements might improve hair, nail, and skin health, especially among healthy individuals. While high intake of biotin seems to have no direct dire consequences on health, even small supplemental doses can result in inaccurate lab results which can lead to misdiagnoses and potentially dangerous outcomes. Let’s educate our patients about these potential pitfalls!

References:

Biscolla RPM, Chiamolera MI, Kanashiro I, Maciel RMB, Vieira JGH. A single 10 mg oral dose of biotin interferes with thyroid function tests. Thyroid 2017;27:1099-1100.

Boccaletti V, Zendri E, Giordano G, Gnetti L, De Panfilis G. Familial Uncombable Hair Syndrome: Ultrastructural Hair Study and Response to Biotin. Pediatr Dermatol 2007;24:E14-6.

Fujimoto W, Inaoki M, Fukui T, Inoue Y, Kuhara T. Biotin deficiency in an infant fed with amino acid formula. J Dermatol 2005;32:256-61.

Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.

Kummer S, Hermsen D, Distelmaier F. Biotin treatment mimicking Graves’ disease. N Engl J Med 2016;375:704-6.

Mock DM, Baswell DL, Baker H, Holman RT, Sweetman L. Biotin deficiency complicating parenteral alimentation: Diagnosis, metabolic repercussions, and treatment. The Journal of Pediatrics 1985;106:762-9.

Patel DP, Swink SM, Castelo-Soccio L. A Review of the Use of Biotin for Hair Loss. Skin Appendage Disord. 2017 Aug;3(3):166-169. doi: 10.1159/000462981. Epub 2017 Apr 27.

Shelley WB, Shelley ED. Uncombable hair syndrome: observations on response to biotin and occurrence in siblings with ectodermal dysplasia. J Am Acad Dermatol 1985;13:97-102.

Vroemen, WM, van Doorn, WPT, Kimenai, DM, Wodzig, WKWH, de Boer, D, Bekers, O, & Meex, SJR. Biotin interference in high-sensitivity cardiac troponin T testing: a real world evaluation in acute cardiac center. Cardiovascular Research 2019; 115;14;1950-1.

Victoria Garcia-Albea, BSN, MSN, RN, PNP, DCNP, is a medical dermatology nurse practitioner at Lahey Clinic in Burlington, MA. She is the director of the Lahey Clinic Dermatology NP Training Program. She spends most of her free time with her husband and two school-aged boys, and volunteers at her public library.

Douglas DiRuggiero, PA-C has been in clinical practice for 26 years. He loves to teach, lecture, and mentor. He and his wife currently live in a dormitory on the campus of Berry College in Rome, Georgia. He is a certified master gardener, a chaplain for the local jail, and the owner of an impressive collection of over 30 airline barf bags (all unused).