Can biotin supplementation elevate liver enzymes?

Biotin Supplementation Does Not Elevate Liver Enzymes

Biotin supplementation does not elevate liver enzymes, even at pharmacological doses, as no adverse effects have been shown for both oral and IV administration of biotin up to 5 mg/day for prolonged periods. 1

Safety Profile of Biotin

Biotin (vitamin B7) is considered a remarkably safe micronutrient with an excellent toxicity profile:

• The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines explicitly state that "toxicity of biotin is unlikely" and no upper limit (UL) has been established 1
• Even at pharmacological doses significantly higher than typical supplementation, biotin has not shown evidence of liver toxicity
• Biotin is routinely administered at doses of 30-60 μg/day in enteral and parenteral nutrition without safety concerns 1

Biotin and Liver Function

While biotin does interact with liver metabolism, research shows:

• Biotin serves as a cofactor for several carboxylase enzymes in the liver that are involved in gluconeogenesis and fatty acid metabolism 2, 3
• A 2016 study in mice found that while biotin supplementation did modify some aspects of liver morphology (altered portal triad, increased vascularity), these changes were not associated with any markers of liver damage or oxidative stress 4
• Biotin supplementation increased the activity of pyruvate carboxylase in the liver of dairy cows but did not affect liver function negatively 2

Relationship Between Liver Disease and Biotin

Interestingly, the relationship between biotin and liver function appears to work in the opposite direction:

• The liver is the major source of plasma biotinidase (the enzyme that recycles biotin), and chronic liver diseases can lead to decreased serum biotinidase activity 5
• Patients with cirrhosis, particularly decompensated cirrhosis and fulminant hepatitis, show significantly lower biotinidase enzyme activity 5
• This suggests that liver disease affects biotin metabolism, rather than biotin affecting liver function

Clinical Applications and Safety

For clinical practice, it's important to note:

• Biotin is routinely administered at doses of 30 μg/day in enteral nutrition and 60 μg/day in parenteral nutrition without safety concerns 1
• For therapeutic purposes, doses up to 10 mg/day are used for malabsorption and short bowel syndrome, and up to 200 mg/day IV for deficient patients dependent on parenteral nutrition 1
• No liver toxicity has been reported even at these higher therapeutic doses

Special Populations

• Pregnant and lactating women may have higher biotin requirements, with breastfeeding mothers recommended to receive at least 35 μg biotin per day 1, 6
• Even in these populations with increased needs, there are no reports of biotin supplementation causing liver enzyme elevations

In conclusion, biotin supplementation is considered safe and does not elevate liver enzymes, even at doses significantly higher than typical daily requirements. The relationship appears to work in the opposite direction, with liver disease potentially affecting biotin metabolism.