Biotin is a vitamin coenzyme (an enzyme facilitator) involved in energy metabolism and fatty acid synthesis. Among its functions, biotin activates acetylCoA carboxylase, a potentially rate-limiting enzyme in myelin synthesis.

      A pilot study in PPMS and SPMS patients found that high doses (100-600 mg/day) of biotin may positively impact disability in and progression of disease1. Most of the participants had previously been treated with drugs usually proposed in progressive MS (including steroids and chemotherapeutic agents) but that failed to improve their neurological condition, and were thus no longer being used (excepting consecutive pulses of IVMP in case of MS relapses). These results were repeated in a randomized, placebo-controlled, double-blind clinical study using the 300 mg dose (100 mg three times per day), which demonstrated sustained reversal of MS-related disability2. 

     A later randomized, placebo-controlled, double-blind clinical study using the same dose against visual loss from optic neuritis demonstrated benefit only among sufferers of progressive optic neuropathy3. Researchers from a larger and more recent randomized, placebo-controlled, double-blind clinical study found that high-dose biotin (300 mg/day) did not significantly improve disability in PPMS and SPMS patients and that there was potential for harmful side effects4.

     Despite the negative findings, a meta-analysis pooling the above studies came to the conclusion that high-dose biotin therapy showed promise5,6.

     The Institute of Medicine Food and Nutrition Board has not established safe upper limits for biotin intake because there is no evidence in humans that biotin is toxic at high intake7. However, in a rat model, a possible connection between of high-dose biotin and impaired reproduction was observed at a dose close to the therapeutic level applied against MS, the opposite of what was observed in chickens8. There is currently no data regarding high-dose biotin in lactation and nursing.

     Foods highest in biotin include organ meats, fish, eggs, seeds, nuts, legumes (particularly soybeans and peanuts), mushrooms, yeast (both nutritional and brewer’s), and sweet potatoes 9-13.

References

1. Sedel F, Papeix C, Bellanger A, et al. High doses of biotin in chronic progressive multiple sclerosis: a pilot study. Mult Scler Relat Disord. Mar 2015;4(2):159-69. doi:10.1016/j.msard.2015.01.005

2. Tourbah A, Lebrun-Frenay C, Edan G, et al. MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: A randomised, double-blind, placebo-controlled study. Mult Scler. Nov 2016;22(13):1719-1731. doi:10.1177/1352458516667568

3. Tourbah A, Gout O, Vighetto A, et al. MD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study. CNS Drugs. Jul 2018;32(7):661-672. doi:10.1007/s40263-018-0528-2

4. Cree BAC, Cutter G, Wolinsky JS, et al. Safety and efficacy of MD1003 (high-dose biotin) in patients with progressive multiple sclerosis (SPI2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. Dec 2020;19(12):988-997. doi:10.1016/S1474-4422(20)30347-1

5. Espiritu AI, Remalante-Rayco PPM. High-dose biotin for multiple sclerosis: A systematic review and meta-analyses of randomized controlled trials. Mult Scler Relat Disord. Oct 2021;55:103159. doi:10.1016/j.msard.2021.103159

6. Imler TJ, Jr., Petro TM. Decreased severity of experimental autoimmune encephalomyelitis during resveratrol administration is associated with increased IL-17+IL-10+ T cells, CD4(-) IFN-gamma+ cells, and decreased macrophage IL-6 expression. Int Immunopharmacol. Jan 2009;9(1):134-43. doi:10.1016/j.intimp.2008.10.015

7. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B(6), Folate, Vitamin B(12), Pantothenic Acid, Biotin, and Choline. 1998. The National Academies Collection: Reports funded by National Institutes of Health.

8. Wallig MA, Keenan, K.P. Safety Assessment including Current and Emerging Issues in Toxicologic Pathology. Haschek and Rousseaux’s Handbook of Toxicologic Pathology (Second Edition). Academic Press; 2013:chap 36.

9. Neela S, Fanta SW. Review on nutritional composition of orange-fleshed sweet potato and its role in management of vitamin A deficiency. Food Sci Nutr. Jun 2019;7(6):1920-1945. doi:10.1002/fsn3.1063

10. Staggs CG, Sealey WM, McCabe BJ, Teague AM, Mock DM. Determination of the biotin content of select foods using accurate and sensitive HPLC/avidin binding. J Food Compost Anal. Dec 2004;17(6):767-776. doi:10.1016/j.jfca.2003.09.015

11. Mock DM. Adequate intake of biotin in pregnancy: why bother? J Nutr. Dec 2014;144(12):1885-6. doi:10.3945/jn.114.203356

12. Biotin Fact Sheet for Health Professionals. Accessed July 7, 2022. https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/

13. Combs GF. Biotin. The vitamins: fundamental aspects in nutrition and health 5th Edition. Elsevier; 2016.