Biotin Causes a Multitude of False Lab Tests

[Mito]

The Bottom Line​

Doses of biotin greater than one milligram per day can interfere with dozens of different lab tests.

There are reasons to believe that interference is worse in live humans than suggested by test tube studies and by the assay manuals published by lab manufacturers. There are not enough human supplementation studies to clarify how long interference lasts using different doses of biotin for different durations in different contexts. Therefore, we should err on the side of caution.

The worst thing you can ever, ever do regarding this issue is to take biotin the morning of a lab test. Never, ever do this.

While many lab tests will normalize hours after taking a biotin supplement for many people, many will take 24-48 hours, and some tests will take some people up to seven days. The tests that appear to be impacted the most are thyroid-related antibodies.

Therefore, we should approach this as follows:

• Never take any biotin supplement before a lab test on the same day as the test.
• Always stop taking biotin supplements that have doses larger than 1 milligram for at least two days and preferably four days before any lab tests.
• Before measuring thyroid-related antibodies, cut out the supplement if you have been taking it for months or years or if you have impaired kidney function.
• Physicians should always ask their patients about biotin supplementation, advise them to stop biotin for 2-4 days before lab tests, and be aware of biotin interference as an explanation for anomalous results.
• If you have been taking biotin in doses higher than one milligram per day, even if you have followed the above, do not make any major medical decisions without either repeating immunoassay tests with liquid chromatography to confirm their accuracy or cutting out the biotin supplement for 2-4 weeks to confirm the results are repeatable.

With all this said, how necessary are these high doses?

In High Protein? You Need More Biotin, I made the case that many people need 150-300 micrograms per day, depending on how much protein they eat. My simple food-based recommendations for getting enough biotin are found in my Cliff Notes (free for Masterpass members here).

Certainly milligram doses are needed for genetic metabolic disorders in biotin absorption and utilization. But do most people taking high-dose supplements need them?

Biotin Causes a Multitude of False Lab Tests | Here is What to Do

High-dose biotin supplements can cause a multitude of false lab tests, masking recent heart attacks, pregnancies, or allergies, giving false signals about tumors, and far more. Here is what to do.

open.substack.com

 

[Rinse & rePeat]

But do most people taking high-dose supplements need them?

Good post Mito. I wonder how any blood test can be accurate considering people’s intake of supplements, sleep quality and stress levels which changes from day to day and may other factors.

 

[exile]

Good article thanks. I knew about the difference it could make for thyroid labs, but it’s pretty interesting the other labs it can make a difference on as well. I’ll definitely keep in mind in the future.

 

[Mito]

Among the most commonly reported interferences in the literature are the following:

• Thyroid Function: False decreases in TSH and thyroglobulin; false increases in free and total T4, free and total T3, and anti-thyroid antibodies. This could lead to a false diagnosis of hyperthyroidism, the masking of hypothyroidism, or a false diagnosis of an autoimmune condition.
• Other Hormones: False decreases in parathyroid hormone (PTH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone, insulin, C-peptide, adrenocorticotropic hormone (ACTH). False increases in testosterone, DHEA-sulfate, estradiol, progesterone, and cortisol. This could lead to a false diagnosis of hypoparathyroid hormone, wrong suspicion a pituitary problem, or wrong suspicion of a hormone-secreting tumor.
• Cardiac Markers: False decreases in troponin and creatine kinase-MB, the form of creatine kinase abundant in heart muscle; and NT-proBNP, a marker of heart failure. False increases in digoxin, a medication used for heart problems. This can lead to masking of a recent heart attack, a recent case of heart failure, or a mistake in dosing medication.
• Viral Serology: False positives for HIV and markers for hepatitis A, B, and C.
• Tumor Markers: False increases of alpha-fetoprotein, cancer antigen 125, carbohydrate antigen 19-9, and free and total prostate specific antigen (PSA).
• Vitamin Markers: False increases in vitamin D, B12, and folate.
• Pregnancy: Invalid results or false negatives on home pregnancy tests in women who are pregnant.
• Allergies: False negatives for IgE allergies regardless of the allergen, including in patients with anaphylaxis

Biotin Causes a Multitude of False Lab Tests | Here is What to Do

High-dose biotin supplements can cause a multitude of false lab tests, masking recent heart attacks, pregnancies, or allergies, giving false signals about tumors, and far more. Here is what to do.

chrismasterjohnphd.substack.com

 

[xeliex]

Most, I think B complexes don't have too high of riboflavin to cause trouble. Chris believes for lower doses like 0.5mg, just skip taking it before the tests.

But yes, that was eye opening. I only was aware of its effect on thyroid labs, but it goes beyond that since the labs are eggy.

 

[Blossom]

Thanks for the valuable information @Mito.

 

[exile]

I had been taking energin, 20 drops (800mcg biotin) for months before a tsh test and took 5 drops (200 mcg) the morning of about an hour before the test, next test about a month and a half later I stopped taking energin for 2 days before and did not take on the day before the test and the second test had a tsh .12 higher for what it’s worth. Could be a lot of factors for the change, but just fyi.