Hey Chris. Good afternoon. Good afternoon. How are you doing? Great. Hope you are. I have a
followup to a question I asked in the December AMA regarding potential biotin deficiency.
Okay. The quick recap of that previous question
is that I have red scaly rashes around my mouth and nose that flare up every two to three weeks
and I treat with hydrocortisone cream. And in that context I eat one whole egg and nine
whites, all cooked, per day. I had a biotin test done previously and it was the serum
one. You suggested, because it was in the bottom 10%, to potentially pursue a organic acid test.
Yeah, I remember. Beta-hydroxyisovaleric acid. Okay.
So I did that. I did that. And I had the integrative health doctor that I've recently
engaged order that for me. And unfortunately, although I asked that it would have...
Beta-hydroxyisovaleric acid. Thank you. Thank you.
So I asked that it had that on it, and unfortunately I didn't verify that the Great
Plains Labs test he ordered had it, and it did not, what it had instead was methyl citric acid,
which from a pubmed study, that sounds is also not as sensitive as beta-hydroxyisovaleric acid.
Yeah. Beta-hydroxyisovaleric acid is well-established to be the most sensitive
marker of biotin status. And actually typically it's done after leucine challenge, which is,
no one does that. And so, generally in my experience, the way they have the reference ranges
set on that should, on the ones that do have it, so the ION panel has it, the Genova panel has it,
and the way they set the reference ranges, I think it works without the leucine challenge. But,
I prefer the Genova ION panel because it has more, I just had a spreadsheet made up of the different
markers that I wanted and the ones that were on the different organic acid panels and the ION
panel has the most that line up with what, what I was looking for. So that's why I used that one.
But anyway, so I guess you're stuck with this one that doesn't have it. And what's your question?
Yeah. So, the result that I got for the mental citric acid was like in 47%
of the range and the, the biotin test, the serum test was 10%. So given based on your experience,
based on that result with the methyl citric acid in your experience, if you have any with it
and biotin status do you recommend that I continue to pursue another organic acid test that includes
Beta-hydroxyisovaleric acid to get a definitive answer considering potential costs involved?
Well, I don't think that you really need that because
you're eating one egg yolk for every nine egg whites. Residual avidin in cooked egg whites
is high enough that that would be expected to cause a biotin deficiency. The symptoms line
up with biotin deficiency and even, just having biotin the lower 10% of the range with a dietary
factor that would be expected to cause biotin deficiency and symptoms that line up with it,
to me that's a biotin deficiency and that's especially true if supplementing biotin
resolves it. The big evidence against the biotin deficiency would be if you
supplement with biotin or you change your diet to make the egg yolks to egg whites one-to-one.
If that does nothing, then I'm going to have to go back to the drawing board. Preliminary
to having a result on the intervention, being biotin supplementation or dietary biotin,
my suspicion that that's biotin deficiency is just too strong to
say go get another organic acids test. That makes sense. If so, let's say,
what would you consider a good approach to the diet change? I mean, obviously, reduce the egg
white or the ratio to egg yolks, but let's say I did that. How long would you think it would take
for there to be some change associated with that. Say, I go to two whole eggs or three
whole eggs. I've got a cholesterol thing I have to manage as well, but if I did that.
What's, what's the rationale for having the egg white to yolk ratio of 9 to 1?
Just to get the protein in with the breakfast. It's kind of
a convenient thing that I've done just as an easy way to get the protein level. I'm doing like a 50%
carbs, 30% protein, 20% fat now, to try to pursue LDL reduction and keeping the fat
lower. And so that was a convenient way or has been a convenient way to get the protein in.
Yeah. I would just do like two scoops of whey protein and a whole egg.
And so at that point you have, definitely have the protein way up there and there's no need given
the issues that you have, you're trying to manage your cholesterol and you're trying not to
have a biotin deficiency and given the diet. It's a lot easier to induce a biotin
deficiency with nine egg whites than it is with zero egg yolks. So, just one whole egg
is it is already what you have in terms of yolks. And it gets rid of all the excess egg whites.
I would just take a five milligram biotin supplement every day for a couple of weeks.
That should really help get your biotin stores up a lot faster.
That will also help you avoid the problem of wondering how long it's going to take, if you have
like a very sort of marginally adequate biotin intake because alternatively you
could eat nine egg yolks a day and zero egg whites, but that's going to totally destroy
your other dietary goals. Is avoiding all supplements, one of your dietary goals?
No, not at all. In fact, I take several. So the biotin supplement if that would be helpful,
but it's not something I'm trying to avoid. I think it would be helpful both because
it should help you get better a lot faster than, a five milligram biotin supplement has
orders of, like two orders of magnitude,
more biotin than an egg yolk does. You're not going to absorb all of it, but you're going to
probably saturate your absorption. Actually, high-dose biotin has surprisingly high absorption.
You're going to exceed your absorption capacity. Most likely you're going to saturate your biotin
stores much more rapidly than with one yolk a day. You're not going to have any more egg
yolks than you do now that are detracting from your other goals, with your cholesterol and your
protein and fat proportions. So I would do that, but I, I think the big thing is the information,
right? Like you will probably, if the biotin hypothesis is correct, you'll get better a lot
faster than it would take you even to get another organic acids test and get the results back.
I would give it four weeks, but I think you would see improvement a lot faster than that.
It doesn't take much time or effort to take one capsule of five milligrams biotin.
I would just do that. If you see nothing by four weeks, then, got to go back to the drawing board.
This is something I'm going to be covering in my book that I haven't covered anywhere before:
A high protein diet radically increases the biotin requirement and no one talks about it. So
your biotin requirement might be sort of like triple what you would think it
would be based on the RDA, just because you're eating a higher-protein diet...
... but anyway, point being, maximizing your biotin intake through a supplement is going to
give you information a lot more quickly. And I think you would benefit a lot from having that
information quickly because if the hypothesis is wrong, you'll know faster and you'll be able to
move on and look for something else. But if the hypothesis is right, you don't have to take the
supplement forever, but now the issue is biotin and so you can manage your diet accordingly and
just go back to eating a whole foods diet to maintain your biotin intake over time.
That makes sense. One related question to that, I think I've read somewhere that biotin
supplementation could affect some other testing markers. If that's true, I'm in the process of
working through Testing Nutritional Status: The Ultimate Cheat Sheet and having some related
tests. How concerned would you be about that? Yeah, you got to cut biotin out for four days
before you run any tests. Okay. Well, that's great.
Thank you, Chris. That helps a lot. You're welcome, Danny. Great talking to you.