Who is most likely to experience a biotin deficiency?

November 17, 2025 •

4 min read

While biotin deficiency is rare in the general population, affecting about 1 in 60,000 newborns with genetic disorders like biotinidase deficiency, several other groups are at increased risk. Chronic conditions, medication use, and certain life stages can impair absorption or increase the need for this vital B vitamin.

Quick Summary

Several factors increase the risk of biotin deficiency, including genetic disorders, pregnancy, chronic alcoholism, and long-term use of certain medications. Dietary issues, such as consuming excessive raw egg whites, and conditions like Crohn's disease also contribute to inadequate biotin levels.

Key Points

Genetic Factors: Inherited disorders, particularly biotinidase deficiency, are a primary cause and are detected via newborn screening.
Medication Use: Long-term use of certain anticonvulsants or antibiotics can interfere with biotin absorption and metabolism.
Pregnancy: A significant portion of pregnant women experience a marginal biotin deficiency due to increased metabolic demands.
Dietary Habits: Excessive consumption of raw egg whites can cause deficiency because the protein avidin binds to biotin and prevents its absorption.
Chronic Alcoholism: Heavy alcohol use impairs the body's ability to absorb and use biotin efficiently.
Absorption Issues: Chronic intestinal diseases like Crohn's and prolonged intravenous feeding without supplementation hinder biotin absorption.

Understanding Biotin and Its Importance

Biotin, also known as vitamin B7 or vitamin H, is an essential water-soluble vitamin that plays a crucial role in metabolism. It functions as a coenzyme for carboxylases, enzymes involved in the synthesis of fatty acids, glucose, and amino acids. Though it is synthesized by gut bacteria and found in various foods, deficiency can still occur in certain populations, leading to symptoms such as hair loss, skin rashes, and neurological issues.

Inherited Genetic Disorders

Genetic conditions are a primary reason why someone might experience a biotin deficiency, particularly from infancy. The most well-known is biotinidase deficiency (BTD), a rare inherited metabolic disorder where the body cannot recycle biotin effectively. All newborns in the U.S. and many other countries are screened for BTD, which, if left untreated, can lead to severe neurological and cutaneous symptoms. Another inherited condition is holocarboxylase synthetase deficiency, which also impairs the body's use of biotin and can lead to multiple carboxylase deficiency. Early diagnosis and lifelong biotin supplementation are critical for managing these genetic conditions.

Chronic Health Conditions and Treatments

Several medical conditions and long-term treatments can disrupt biotin metabolism and absorption.

Intestinal Issues: People with intestinal problems, such as Crohn's disease or short bowel syndrome, may have impaired nutrient absorption, which can lead to a deficiency.
Long-Term Parenteral Nutrition: Patients receiving prolonged intravenous (IV) feeding without proper biotin supplementation are at high risk. This is because they bypass the normal digestive process where biotin is absorbed and produced by gut flora. Modern hospital protocols now routinely include biotin in these preparations.
Chronic Alcoholism: Excessive and long-term alcohol consumption can inhibit the absorption of biotin in the intestines and interfere with its metabolism.

Certain Medications

Some medications can deplete the body's biotin levels by interfering with its uptake and metabolism.

Anticonvulsants: Long-term use of anti-seizure medications, such as carbamazepine and phenytoin, has been linked to lower biotin levels by inhibiting intestinal absorption and increasing its breakdown.
Antibiotics: Prolonged use of antibiotics can disrupt the healthy gut flora that synthesize biotin, reducing its overall availability.

Pregnancy and Lactation

During pregnancy, the body's metabolic demands increase significantly, which can lead to marginal biotin deficiency in many women. Research suggests that adequate biotin intake is crucial during pregnancy due to potential teratogenic risks, and supplementation may be recommended. Lactating women also have elevated biotin requirements, although the clinical significance of this marginal deficiency is still being investigated.

Dietary Factors

While dietary deficiency is uncommon with a balanced diet, certain eating habits can negatively impact biotin status. The most notable example is the excessive consumption of raw egg whites.

Avidin: Raw egg whites contain a protein called avidin that binds strongly to biotin, preventing its absorption in the intestines. Cooking egg whites denatures avidin, eliminating this binding effect. Consuming large quantities of raw egg whites (e.g., more than a dozen per day) over an extended period can lead to deficiency.
Severe Malnutrition: Individuals with severe malnutrition from any cause, such as eating disorders or poor diet, are at risk of inadequate biotin intake.

Risk Factors for Biotin Deficiency: A Comparison


Risk Factor	Mechanism of Deficiency	Onset of Symptoms	Reversibility with Treatment
Biotinidase Deficiency (BTD)	Inability to recycle biotin due to genetic mutation.	Infancy (1 week to 1 year).	Excellent if treated early; can prevent irreversible damage.
Chronic Alcoholism	Impaired intestinal absorption and increased metabolism.	Chronic; gradual onset.	Improves with supplementation and cessation of alcohol use.
Pregnancy/Lactation	Increased metabolic demand and excretion.	During gestation or lactation.	Often resolves postpartum; supplementation is effective.
Long-Term Medication Use	Increased biotin breakdown and inhibited absorption.	Develops over prolonged use.	Resolves with supplementation or discontinuation of medication.
IV Nutrition	Bypasses gut absorption and production.	Develops over time without supplementation.	Fully reversible with biotin supplementation in the IV mixture.

Conclusion

While a true biotin deficiency is rare in the healthy population, a number of specific factors significantly increase the risk. These include inherited genetic conditions like biotinidase deficiency, which is identified through newborn screening programs, as well as acquired issues from chronic health problems and treatments. Individuals with certain gastrointestinal diseases, chronic alcoholism, or those on specific long-term medications are particularly vulnerable. Additionally, physiological states such as pregnancy and lactation can lead to marginal deficiency due to higher metabolic demands. For those identified in these at-risk groups, early recognition and appropriate supplementation, often lifelong in genetic cases, can effectively reverse symptoms and prevent long-term complications. A healthcare professional should always be consulted for proper diagnosis and management. For more information on the role of biotin, you can refer to the National Institutes of Health's fact sheet on biotin for health professionals.

Inherited and Acquired Factors for Deficiency

Biotinidase Deficiency: The most common inherited cause of biotin deficiency, where the body cannot properly recycle biotin.
Chronic Alcoholism: Impairs biotin absorption and increases the rate of biotin breakdown in the body.
Pregnancy: Increased maternal metabolic demands and potential for decreased plasma biotin levels put pregnant women at risk of marginal deficiency.
Long-Term Medications: Certain anti-seizure drugs and broad-spectrum antibiotics can disrupt biotin status through altered metabolism or gut flora imbalance.
Raw Egg White Consumption: Consuming large, frequent amounts of raw egg whites introduces avidin, a protein that binds to and prevents the absorption of dietary biotin.
Intestinal Malabsorption: Conditions like Crohn's disease, or situations like long-term intravenous feeding, interfere with normal biotin absorption.

Frequently Asked Questions

The most common genetic cause of biotin deficiency is biotinidase deficiency (BTD), a rare inherited disorder where the body cannot recycle biotin effectively. In the broader population, however, severe deficiency is extremely rare, with acquired cases often linked to specific risk factors rather than dietary intake alone.

Yes, at least one-third of pregnant women develop marginal biotin deficiency due to increased metabolic demands during gestation. While often not severe, ensuring adequate intake is important for maternal and fetal health.

Consuming excessive amounts of raw egg whites can cause biotin deficiency because they contain a protein called avidin that binds to biotin, preventing its absorption. Cooking the eggs denatures avidin, eliminating this risk.

Chronic alcoholism can lead to biotin deficiency by inhibiting the absorption of biotin in the intestine and negatively affecting its metabolism. This, combined with often poor dietary habits, increases the risk for those with alcohol dependence.

Long-term use of certain medications, including anticonvulsants (e.g., phenytoin, carbamazepine) and broad-spectrum antibiotics, can lead to deficiency. Anticonvulsants can inhibit biotin absorption, while antibiotics may destroy biotin-producing bacteria in the gut.

Yes, chronic intestinal conditions like Crohn's disease and short bowel syndrome can prevent the proper absorption of nutrients, including biotin, thereby increasing the risk of deficiency.

Biotinidase deficiency is treated with lifelong oral biotin supplementation. If diagnosed and treated early, before symptoms appear, the prognosis is excellent and irreversible complications can be prevented.