Bioton – will it Stop Hair Loss?

Sally Myers, RD, CPT

It is not unusual for bariatric surgery patients to experience some temporary hair loss around three months after surgery.  Although this is very distressing for many patients, it usually resolves within the first year. Hair loss will usually stop and regrowth begin around the six month mark.  Many patients want to know if there is anything they can do to prevent temporary hair loss from happening.  The author is not aware of anything that can keep temporary hair loss from occurring but ensuring adequate daily nutrition intake may help minimize this issue.  Some possible causes of temporary hair loss after bariatric surgery are rapid weight loss, inadequate nutrition, and hormone changes.  Inadequate nutrition can include, but is not limited to, lack of calories, protein, essential fatty acids, zinc, iron, and/or biotin.  This article will focus on biotin.

What is Biotin?
Biotin was initially discovered in 1927 but it took another 40 years of research before it became fully recognized as a vitamin (1). Biotin is a member of the B vitamin family and was originally referred to as Vitamin H or B7 (3).  Biotin plays an important role in energy metabolism as a catalyst enabling essential metabolic reactions in the production of fatty acids, in gluconeogenesis, and assists in metabolizing leucine.  Recent research indicates that biotin plays a role in gene expression and may also participate in DNA replication (5). Intestinal flora can make biotin but it is unknown how much is actually absorbed by the body (1).

Causes and Symptoms of Deficiency
Possible causes of deficiency are:

• Consuming large amounts of raw egg whites over a long period of time.  Avidin, a glycoprotein found in raw egg whites, binds biotin when eaten in large amounts.  Cooking egg whites will alleviate this issue (2).
• Prolonged use of antibiotics
• Anticonvulsant medications
• Total parenteral nutrition without biotin supplements
• Short gut syndrome
• Holocarboxylase synthetase deficiency (4)
• Alcoholism - alcohol inhibits absorption of biotin and interferes with metabolism. 
• Biotinidase deficiency (genetic defect) – biotin given in amounts of 50 to 150 mcg daily have been shown to prevent the symptoms seen in biotinidase deficiency (1).
• Ingesting high doses of pantothenic acid (4)

Biotin deficiency is usually identified by clinical symptoms.  Symptoms typically develop within 3 to 5 weeks of the onset of a biotin deficiency (2).  Clinical symptoms of biotin deficiency include dry skin, fine and brittle hair, fungal infections, hair loss, and a scaly red rash around the eyes, nose, mouth, and genital area.  One to two weeks later, neurogolic symptoms may develop.  Neurologic symptoms include depression, hearing impairment, change in mental status, generalized muscle pain, and numbness and tingling of the extremities.  Intestinal tract symptoms are nausea, vomiting, and anorexia. The red rash and unusual facial fat distribution have been termed “the biotin deficiency facies (1).”  Some laboratory studies that can be useful are serum ammonia levels and urine ketone levels (2).  Signs and symptoms should begin to disappear within 3 to 5 weeks and completely resolve within 2 to 3 months once treatment has begun (2).

Recent research suggests marginal or subclinical biotin deficiency during pregnancy may be relatively common (4). It is not known if decreased biotin is normal in pregnant women or indicate low biotin intake relative to need (1).  People on either type of kidney dialysis may be at higher risk of a biotin deficiency and require supplementation similar to a person with a genetic deficiency.
 
Current Usages
Diabetes

• Biotin supplementation has been found to improve glucose tolerance and decrease insulin resistance in diabetic mice models (5).  The mice studies suggest that the administration of supplementary biotin may improve the metabolism and /or utilization in of glucose in those with type 2 diabetes mellitus. Overt biotin deficiency results in impaired glucose utilization.  In one study, 9 mg a day for one month decreased fasting glucose levels by an average of 45% in type 2 diabetics.  Blood glucose levels in insulin dependent diabetics were reduced after one week of 16 mg of biotin per day.  Biotin may also play a role in preventing the neuropathy associated with diabetes, reducing the numbness and tingling. Further research is warranted in this area.

Brittle Nails

• Three uncontrolled trials have examined the effects of the use of  2.5 mg of biotin supplementation daily (usage up to 6 months) (5).  One of the trials found that fingernail thickness increased 25% and nail splitting decreased.  Large controlled studies are needed to assess the efficacy of high-dose biotin for treatment of brittle nails.

Cradle Cap

• Although large studies have not been done, biotin has been used to successfully treat cradle cap (2).

There is currently no scientific evidence that biotin can prevent or treat hair loss except in cases of severe biotin deficiency.  Supplementation with 200 mcg daily has resulted in a gradual regrowth of healthy hair in some patients (4).

Food Sources
The food sources containing the highest amount of biotin are Brewer’s yeast, cooked liver, cooked egg, wheat bran, and camembert cheese (5).  Multiple foods contain small amounts of biotin. There are no nationally representative estimates of the intake of biotin from food or a combination of food and supplements (1).

Recommended Amounts
The dietary reference intake (DRI) recommended by the Food and Nutrition Board is 30 mcg daily (1).  There is no known toxicity and no tolerable upper limit has been set secondary to insufficient information on biotin.  Oral biotin doses of up to 30 mg/day for people with hereditary disorders of biotin have been well tolerated (2).  In people without hereditary disorders, 5 mg/day for up to two years has been tolerated without adverse effects (5).
Discussion
It is not known if bariatric surgery patients have biotin deficiencies as research has only been done on a few select vitamins/minerals in this population.  It is not likely doctors will perform studies or tests as it is not routine and may not be cost effective.  Several patients the author has worked with claimed to have had good success with taking 2.5 to 5 mg of biotin daily the first year along with using nioxin shampoo.  The author has not seen overt biotin deficiency in any of the patients she has worked with.  Since there is no known toxicity, it will be up to the individual to decide if it will be useful to take supplemental biotin.

Future Research
It appears healthy people most likely get an adequate amount of biotin in their diets.  More information is needed on human requirements, especially in those other than the healthy population, intake from diet, bioavailability, toxicity, and metabolic effects (1).

RESOURCES

1. Food and Nutrition Board, Institute of Medicine.  Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline.  Washington D.C., National Academy Press, 1998:374-389.
2. http://www.emedicine.com/ped/topic238.htm
3. http://en.wikipedia.org/wiki/Biotin
4. http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/bio_0035.shtml
5. http://lpi.oregonstate.edu/infocenter/vitamins/biotin/