Stem cell transplant 'game changer' for MS patients

Doctors say a stem cell transplant could be a "game changer" for many patients with multiple sclerosis.

Results from an international trial show that it was able to stop the disease and improve symptoms.

Fergus WalshMedical correspondent@BBCFergusWalshon Twitter

• 18 March 2018
 

It involves wiping out a patient's immune system using cancer drugs and then rebooting it with a stem cell transplant.

Louise Willetts, 36, from Rotherham, is now symptom-free and told me: "It feels like a miracle."

A total of 100,000 people in the UK have MS, which attacks nerves in the brain and spinal cord.

Just over 100 patients took part in the trial, in hospitals in Chicago, Sheffield, Uppsala in Sweden and Sao Paulo in Brazil.

They all had relapsing remitting MS - where attacks or relapses are followed by periods of remission.

The interim results were released at the annual meeting of the European Society for Bone and Marrow Transplantation in Lisbon.

Image copyrightTHINKSTOCK

Image captionNerve connections become damaged in people with MS

The patients received either haematopoietic stem cell transplantation (HSCT) or drug treatment.

After one year, only one relapse occurred among the stem cell group compared with 39 in the drug group.

After an average follow-up of three years, the transplants had failed in three out of 52 patients (6%), compared with 30 of 50 (60%) in the control group.

Those in the transplant group experienced a reduction in disability, whereas symptoms worsened in the drug group.

Prof Richard Burt, lead investigator, Northwestern University Chicago, told me: "The data is stunningly in favour of transplant against the best available drugs - the neurological community has been sceptical about this treatment, but these results will change that."

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Multiple sclerosis

• Multiple sclerosis (MS) is a condition which can affect the brain and/or spinal cord
• It can cause problems with vision, arm or leg movement, sensation or balance
• Average life expectancy is slightly reduced
• It is estimated that there are more than 100,000 people diagnosed with MS in the UK

Source: NHS

---

The treatment uses chemotherapy to destroy the faulty immune system.

Stem cells taken from the patient's blood and bone marrow are then re-infused.

These are unaffected by MS and they rebuild the immune system.

Prof John Snowden, haematologist and director of blood and bone marrow transplantation at Sheffield's Royal Hallamshire Hospital, told me: "We are thrilled with the results - they are a game changer for patients with drug resistant and disabling multiple sclerosis".

Prof Basil Sharrack, neurologist and director of MS research at Royal Hallamshire Hospital, told me: "This is interim analysis, but with that caveat, this is the best result I have seen in any trial for multiple sclerosis."

'Lived in fear'

Louise was diagnosed with MS in 2010 when she was only 28.

She told me: "MS ruled my life and I lived in fear of the next relapse.

"The worst time was not being able to get out of bed because I had no stability in my body - I struggled to walk and even spent time in a wheelchair.

"It also affected my cognition - it was like a brain fog and I misread words and struggled to keep up with conversations."

The BBC's Panorama filmed her undergoing her transplant in October 2015 and she is now back to full health.

She got married to her partner Steve, on the first anniversary of her transplant, and their baby daughter Joy is now a month old.

"I feel like my diagnosis was just a bad dream. I live every day as I want to, rather than planning my life around my MS."

The transplant costs around £30,000, about the same as the annual price of some MS drugs.

Doctors stress it is not suitable for all MS patients and the process can be gruelling, involving chemotherapy and a few weeks in isolation in hospital.

Dr Susan Kohlhaas, director of research at the MS Society, said the stem cell transplant HSCT "will soon be recognised as an established treatment in England - and when that happens our priority will be making sure those who could benefit can actually get it".

She added: "We've seen life-changing results for some people and having that opportunity can't depend on your postcode."

http://www.bbc.com/news/health-43435868#

More on this story

• Cancer treatment for MS patients gives 'remarkable' results

  18 January 2016
• Risky treatment can stop multiple sclerosis for years

  20 February 2017

Japan scientists grow drugs in chicken eggs

JAPANESE researchers have genetically engineered hens whose eggs contain drugs that can fight serious diseases including cancer, in a bid to dramatically reduce the cost of treatment, a report said Monday.

Posted on 9 October 2017 - 02:26pm

If the scientists are able to safely produce "interferon beta", a type of protein used to treat illnesses including multiple sclerosis and hepatitis, by rearing the hens, the price of the drug – currently up to 100,000 yen (RM3758) for a few microgrammes – could fall significantly, said the English edition of the Yomiuri Shimbun.

Researchers at the National Institute of Advanced Industrial Science and Technology (AIST) in the Kansai region kicked off the process by introducing genes that produce interferon beta into cells which are precursors of chicken sperm, the newspaper reported.

They then used these cells to fertilise eggs and create hens which inherited those genes, meaning the birds were able to lay eggs containing the disease-fighting agent.

The scientists now have three hens whose eggs contain the drug, with the birds laying eggs almost daily, the report said.

The researchers plan to sell the drug to pharmaceutical companies, halving its price, so the firms can use it first as a research material, the newspaper said.

Consumers may have to wait a while, as Japan has strict regulations concerning the introduction of new or foreign pharmaceutical products, with screening processes that routinely take years to complete.

But the team hopes that the technological breakthrough will eventually help drive down the cost of the drug to 10% of its current price, the newspaper reported.

Officials at the institute could not be reached for comment. — AFP

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http://www.thesundaily.my/news/2017/10/09/japan-scientists-grow-drugs-chicken-eggs

High-fat diet could increase risk of multiple sclerosis relapse in kids

Research in the United States has found that a high-fat diet may increase the risk of children with multiple sclerosis (MS) experiencing a relapse, whereas a diet rich in vegetables could lower it.

Children and young people with multiple sclerosis could be at a higher risk of a relapse if they eat a
high-fat diet suggests new research. Image: unzelkorn/shutterstock.com via AFP Relaxnews

AFP Relaxnews / 04:09 PM October 11, 2017

The study analyzed the diets of 219 children and young people from 11 children’s MS centers across the U.S. to look at the potential effect of diet on children with the condition, as they are already at a higher risk of experiencing relapses than adults.

Each of the participants had been diagnosed before the age of 18 and had had either the relapsing-remitting form of MS or clinically isolated syndrome (which describes the first episode of neurological symptoms associated with the disease) for less than four years.

The researchers asked participants to complete a questionnaire on the quantity and frequency of specific foods and drinks that they had consumed over a one-week period.

They also tracked their neurological health until the next relapse occurred, with participants followed on average for just under two years.

The results showed that for every 10 percent increase in calorie intake that came from fat, there was an associated 56 percent increased risk of a relapse.

Saturated fat appeared to have an even greater effect, with every 10 percent increase in calories from this type of “bad” fat associated with tripling the risk of a relapse.

However, the results also suggested that diet could help in managing the condition, with the team finding that each additional cup of vegetables appeared to halve the risk of relapse, and independent of fat consumption.

The findings also held true even after vitamin D levels, a potential risk factor for MS, were taken into account and other influencing factors such as age, gender, race, ethnicity, duration of disease, weight (BMI) and drug treatment.

No association was found between other nutrients in the children’s diet, such as sugar, iron, fruit and fiber, and risk of relapse.

Several genetic and environmental factors have already been found to be linked to an increased risk of MS, including previous infection with Epstein Barr virus, exposure to cigarette smoke and low vitamin D levels.

However, the role of diet has been so far been largely unexplored. The researchers suggest that a high fat diet could increase the risk of relapse as fat boosts cell metabolism, including the release of inflammatory chemicals, and also influences the gut microbiome and its associated immunity.

Animal fat, a source of saturated fat and often linked to a high calorie intake, is already thought to be a factor in various long term inflammatory conditions.

The study is also an observational one, meaning no firm conclusions can be drawn about cause and effect, though the researchers believe that their findings do provide some early evidence to suggest that making dietary recommendations to patients with MS could have some benefits. For example, it has already been suggested that fish oil may be particularly beneficial for those with MS. However, more research is now needed, including looking at the effects of long-term diet.

The findings can be found published online in the Journal of Neurology Neurosurgery & Psychiatry.

 http://lifestyle.inquirer.net/275527/high-fat-diet-increase-risk-multiple-sclerosis-relapse-kids/

How Roche Tweaked an Aging Drug to Keep Profits Rolling In

 The pharma company reformulated a cancer drug to treat MS and jacked up the price.

August 23, 2017

By 

Naomi Kresge

 

PHOTOGRAPHER: SIMON DAWSON/BLOOMBERG

In the remote forests of northern Sweden, Anders Svenningsson’s multiple sclerosis patients have benefited from a drug he’s been prescribing for the past eight years. It doesn’t require weekly injections, doesn’t leave patients feeling achy and feverish; and most important, halts their disease. That drug, Rituxan—originally developed to treat cancer—has become Sweden’s most prescribed medicine for MS, in which the body attacks its own central nervous system. Swedish doctors have great freedom to prescribe treatments they believe are appropriate, but few MS patients elsewhere can get the drug. That’s because its maker, Roche Holding AG, has never tried to sell it for the disease. Instead, Roche this year introduced a nearly identical medication that it markets under a new name and at 10 times the cost.

The tale of the two drugs highlights how pharmaceutical companies tweak aging medications to keep the profits rolling in. With Rituxan facing the expiration of its patent starting in the middle of this decade and another drugmaker due a share of the profit from the medication, Roche didn’t pursue it as a treatment for MS despite studies indicating it probably works. Instead, Roche invested in the offshoot medicine, which would take years to reach the market but enjoy longer protection against generics. That strategy began paying off in July, when the new drug, Ocrevus, wildly outperformed expectations in its first quarter of sales. 



Stephen Hauser, a neurology professor at the University of California at San Francisco who led MS trials for both drugs, says the two have some minor differences. But doctors and patients must decide whether it’s worth buying Ocrevus, which he says is “10 percent more effective, 10 percent easier to administer, but 10 times more expensive.” Ocrevus runs $65,000 a year, while Rituxan costs about $2,400 annually in Sweden and $8,000 to $10,000 in the U.S. for patients who can get it prescribed for MS.

Roche argues that there are significant differences between Rituxan and Ocrevus. Because the newer formula is composed mostly of human genetic components, it has fewer side effects and patients won’t develop as much resistance to it, the company says. “Ocrevus was specifically engineered for long-term use in patients with chronic diseases,” says Daniel O’Day, head of Roche’s pharmaceutical unit.

When Roche decided to abandon Rituxan as a treatment for MS about a decade ago and focus on Ocrevus instead, “I felt it was immoral, because we had very good data” showing the older medication worked, says Timothy Vollmer, a neurology professor at the University of Colorado’s health sciences center. Vollmer says some insurers will pay for Rituxan, so he prescribes the one that will be cheaper for patients, because “I don’t have a reason to distinguish between them other than cost.”

It’s not uncommon for drugmakers to bolster their profits by reformulating medications and charging more for the new versions—though the companies always say they’re safer and more effective. Ocrevus is one of at least 10 MS drugs that have been revamped to boost their moneymaking potential, according to the Blizard Institute, a medical research center in London. Insulin producers have for decades made small improvements to keep prices high. Johnson & Johnsonin 2007 rejiggered an antipsychotic formula to extend its patent protection. And Roche a decade ago developed an eye drug similar to its cancer medicine Avastin but priced about 40 times higher.

In the U.S., where the Multiple Sclerosis Foundationestimates that more than 400,000 people have the disease, neurologists have embraced Ocrevus. Since it got U.S. Food and Drug Administration approval in March, Ocrevus has generated almost $200 million in sales, the best drug launch in Roche’s history. Approval in Europe is expected this year, and analysts predict it will top $3.5 billion annually by 2021. By contrast, Rituxan, which is widely prescribed for lymphoma, was never cleared for multiple sclerosis and probably never will be. A few thousand Americans with MS take the drug because their doctors prescribe it anyway.

Rituxan was among the first therapies to fight cancer by attaching to a specific protein. Its target is found on a type of white blood cell called a B cell. After it was shown to help people with various autoimmune diseases, researchers surmised it might also prevent the immune systems of MS patients from attacking the brain, spinal cord, and nerves. It was a new theory—doctors had thought another type of white blood cell played a bigger role—but the medicine worked. In 2007, a decade after Rituxan was first approved for blood cancer, a Roche trial showed that MS patients who took the drug had about 90 percent less scarring in their brains than people who took a placebo. Although a second study a year later failed in the toughest-to-treat type of MS, the results were encouraging enough to spur hopes that it would be effective for some of those patients, too.

Annette Langer-Gould, a former assistant medical director at Genentech Inc., the Roche biotech affiliate where Rituxan and Ocrevus originated, helped create a development plan for the two drugs. “How the medications work is exactly the same,” says Langer-Gould, now a researcher at health giant Kaiser Permanente, which has about 1,000 MS patients taking Rituxan. While both use proteins from humans and mice, she says, Ocrevus is “a little less mouse.” Genentech decided to push forward with Ocrevus mostly because the company could charge a higher price, according to Langer-Gould. Rituxan and other treatments for lymphoma were significantly cheaper than MS drugs, she says, but Roche couldn’t arbitrarily increase the price for cancer patients. Roche says the decision “was based on scientific and medical considerations so people with MS could have the medicine with the highest potential benefit.”

Even as Roche was backing away from Rituxan for MS, neurologists began to embrace it on their own. While running an MS center in the Swedish city of Umea, Svenningsson was impressed by trial results. He started prescribing Rituxan and saw a notable improvement in patients’ day-to-day lives. Some 3,500 Swedish MS patients take Rituxan, which has proved more effective than many rival drugs designed for MS, according to the Karolinska Institutet, the Swedish research center where Svenningsson now works. Unlike older treatments that cause flu-like symptoms and sometimes must be administered every other day, Rituxan is given via injection once or twice a year. “As patients got to the end of the trial, they said, ‘Please don’t give me back that old stuff again,’ ” Svenningsson says. “ ‘Let me continue with this.’ ” —With Susan Decker

BOTTOM LINE - Roche declined to pursue research showing cancer drug Rituxan can treat MS, instead focusing on an offshoot the company says is more effective—but costs 10 times as much.

https://www.bloomberg.com/news/articles/2017-08-23/how-roche-tweaked-an-aging-drug-to-keep-profits-rolling-in

Does Echinacea Prevent colds? | BBC FUTURE

Echinacea is often advised for warding off the winter sniffles, says Claudia Hammond, but does it actually work?

• By Claudia Hammond | BBC FUTURE

5 November 2014

If you find yourself about to go down with a cold this winter, the chances are that at some point a friend will suggest you take echinacea. Some swear by it to ward off a cold when they feel the first stirrings of a sore throat. Others take it once a cold is full-blown, in the hope that it will speed their recovery. Native Americans have long valued echinacea for its medical properties, but in the 20th Century its use spread to many countries after it became popular in Germany. In today’s health food shops ­ you can see dozens of different kinds of preparations. The question is, does it work?

Every couple of years a new study is published showing that echinacea either does or doesn’t reduce your risk of contracting a cold. Part of the reason for this mixed picture is that it comes in so many forms. Of the nine different species, all from the daisy family, there are three which are often used medicinally - the pinky-purple echinacea purpurea, the pale purple coneflower and the slightly shorter echinacea angustifolia. To complicate things more, some preparations use the root, others the flower, the leaves or the whole plant and then it can be pressed for its juice, made into a tincture or dried and put into tablets. Different research studies use different preparations, making them hard to compare.

(Thinkstock)

No one is even agreed on exactly which ingredients in echinacea might prevent or aid recovery from a cold, or whether it’s the combination of ingredients that’s crucial. Echinacea contains four types of compounds which might boost the immune system: alkamides, glycoproteins, polysaccharides and caffeic acid derivatives, but not all these substances are found in every species of echinacea, nor in every part of the plant.

So does it make a difference to your chances of contracting a cold? After years of mixed results, in 2007 scientists at the University Of Connecticut in the US conducted a meta-analysis, combining and reanalysing the data from the 1600 participants in previous trials. The results seemed good news for echinacea fans, with newspapers proclaiming that supplements could halve your chances of getting a cold. The problem is that the plant is so versatile that the original studies involved not only different species of echinacea, but different parts of the plant, extracted in different ways. You could argue that this is like pooling the results of studies measuring different treatments, since chemically not every species of part of the plant is the same.

Full review

Then earlier this year came the most comprehensive review so far – a Cochrane review that scanned the literature and included only the very best studies. They looked for randomised controlled studies where people were given either echinacea or a placebo and neither they nor the staff administering the preparations knew which they were getting. From the 82 trials they assessed they ended up with 24 which fulfilled the criteria, mostly from the US and Germany. Still, they weren’t always convinced that the people wouldn’t guess what they were taking. One trial used capsules containing vegetable oil as a placebo. Another used the manufacturers’ own staff who might be familiar with the taste of their own product.

Various parts of echinacea are used for remedies and it's unclear which ones work best, if at all (Nomadic Lass/Flickr/CC BY-SA-2.0)

In some studies people were given echinacea and then deliberately exposed to a cold virus to see whether they became infected. In others, people had the echinacea on hand and were instructed to start taking it the moment they felt a tickle in their throat or starting sneezing.

Their results were slightly disappointing for those hoping to avoid colds in the future. They found that when you looked at these well-conducted trials, none of them showed on their own that echinacea prevented colds. But on a more positive note, when they pooled the results of the best studies, giving them a much larger group of people, those who took echinacea did turn out to be less likely to get a cold, even if only 10 to 20% less likely. The authors suggest that perhaps the reason that these effects didn’t show up in individual studies, is that they had such small numbers of people taking part in them. Of course with the pooled result there’s still the problem that the people in different studies took different forms of echinacea.  

Immune trigger

We also need to bear in mind that these studies all excluded people with an underlying illness. Not everyone wants to boost their immune systems. A healthy immune system has been described to me as a dog on a lead that’s out in the park. It’s straining at the leash ready to shoot off at any moment if it can get free. You want it to keep on walking at a steady pace with you, not to break free and go rushing off too far. Similarly, you want the immune system to work reliably, but not to go too far. Auto-immune diseases like multiple sclerosis and rheumatoid arthritis involve an immune system that has become too active and organisations such as the National Institute of Health in the US advise patients with these conditions not to take echinacea. 

So the next time you feel your throat getting a bit sore and fear you’re going down with a cold, you could try taking some echinacea, but bear in mind no one yet knows exactly which kind you should take. And until they do, then on average there’s an 80-90% chance you will still get the cold. It might make a difference, but only a small one.

http://www.bbc.com/future/story/20141104-does-echinacea-prevent-colds

Beware: Biotin Supplements May Alter Your Thyroid Test

Make sure you avoid this vitamin for at least a day or two when getting your thyroid tested as it can produce false highs or lows. Other than that, it can be useful for helping to regulate your blood sugar and healthy LDL cholesterol levels, and the proper function of your nervous system. Do you really need to take a supplement?

November 21, 2016 

Story at-a-glance

• Biotin plays a role in energy production, and is commonly used to remediate neurological problems, hair loss (alopecia) and skin conditions (such as acne and eczema) associated with a lack of certain enzymes
• Recent research suggests biotin may be a helpful adjunct in the treatment of multiple sclerosis (MS), by improving myelin repair and facilitating cellular energy production
• Taking a biotin supplement can throw off your thyroid test results, producing false highs or lows, so avoid taking any biotin supplements at least a day or two before your thyroid test to ensure accurate results

By Dr. Mercola

Biotin (vitamin B7) — an essential water-soluble micronutrient — is a member of the B complex group of vitamins.1 Other names sometimes used for biotin include vitamin H, coenzyme R and d-biotin.2

Biotin plays a role in energy production, and since your body does not synthesize biotin, you must obtain it from your food. It's commonly used to remediate neurological problems, hair loss (alopecia) and skin conditions (such as acne and eczema) associated with a lack of certain enzymes.

Adequate intake levels are set at 5 micrograms (mcg) per day for infants and 30 mcg for adults,3 and since this amount is fairly easy to obtain from food, deficiencies are thought to be rare.

For example, 50 grams (gm) of butter (about 3.5 tablespoons) or 50 grams of sunflower seeds contain 47 mcg and 33 mcg of biotin respectively. Still, some take high-dose biotin supplements to improve their hair, skin or nails, and it's important to realize that this can skew test results for thyroid hormones.

Common Signs and Symptoms of Biotin Insufficiency

While more rare than other nutrient deficiencies, biotin insufficiency or deficiency can certainly occur. Since biotin is water-soluble, your body will not store it. Hence, your intake must remain consistent. Pregnant women are also at heightened risk for insufficiency or deficiency, which could have adverse effects on the developing fetus.

Hair loss and red, scaly rashes (especially on your face) are common signs you may need more biotin. Other signs and symptoms of biotin deficiency include:

• Depression
• Loss of appetite
• Nausea
• Muscle pain
• Paresthesia

In your body, biotin plays an important role in:4,5

Metabolizing fats, carbohydrates and amino acids	Proper function of your nervous system
Maintaining healthy LDL cholesterol	Regulating blood sugar
Strengthening hair and reversing hair loss by reacting with enzymes to make amino acids, building blocks for proteins such as keratin, which your hair is made of	Strengthening your nails. In one study, 2.5 mcg of biotin per day for at least 6 months improved nail thickness by 25 percent6
Maintaining healthy skin	Preventing age-related cognitive impairment or decline

Biotin May Benefit Multiple Sclerosis Patients

Interestingly, recent research suggests biotin may be a helpful adjunct in the treatment of multiple sclerosis (MS).7 As reported by Authority Nutrition:8

"In MS, the protective covering of nerve fibers in the brain, spinal cord and eyes is damaged or destroyed. This protective sheath is called myelin, and biotin is thought to be an important factor in producing it. A pilot study9 in 23 people with progressive MS tested the use of high doses of biotin.

Over 90 percent of participants had some degree of clinical improvement … Randomized controlled trials have been carried out in people with progressive MS10,11,12 The final results have not been published, but the preliminary results are promising."

As explained by Multiple Sclerosis News Today:13

"[Biotin] acts in MS by increasing a route of cellular energy production, protecting against the breakdown of nerve cell axons. It also activates enzymes that are setting the pace on myelin repair by being involved in the production of myelin constituents."

In one of these trials, nearly 13 percent of the patients diagnosed with progressive MS reported improvement after taking a pharmaceutical grade, high-dose biotin (referred to as MD1003) for nine months.

None of the patients taking a placebo reported improvements. After two years, 15.4 percent of the treatment group demonstrated less disability. According to professor Ayman Tourbah:14

"Full results of the MS-SPI study are especially remarkable. This is the first time that a drug has reversed the progression of the disease in a statistically significant proportion of patients.

In addition, if we look at the mean Expanded Disability Scale (EDSS) change, the data compare very favorably with all previous trials that looked at the same endpoint. Almost no progression was observed in patients treated with MD1003 for 24 months, and this has never been observed before …

Results … point to the fact that targeting neuron and oligodendrocyte metabolism represents a promising and novel disease modifying therapy approach in progressive MS, particularly in patients with a not-active progressive disease."

Beware: Biotin Supplements May Alter Thyroid Tests 

For all its benefits, there are drawbacks to biotin supplements that you really need to be aware of. As it turns out, taking a biotin supplement could throw off your thyroid test results, producing false highs or lows. As reported in Endocrine News:15

"The physician had been treating the patient's hypothyroidism successfully with levothyroxine for some time, when suddenly her free T4 levels spiked despite a normal thyroid stimulating hormone (TSH) level.

The physician referred the patient to [Dr.] Cary N. Mariash, professor of clinical medicine at Indiana University in Indianapolis, where additional laboratory tests had inconsistent results: her free T4 and total T3 were elevated, but her total T4, T4 index and TSH were normal.

Fortunately, Mariash could clear up the confusion by asking the patient a simple question: 'Are you taking biotin?' Yes, she replied, she had recently started taking 10 mg a day in hopes of improving her hair and nails.

Her tests returned to normal when she stopped taking biotin. The problem had nothing to do with the patient's thyroid — the biotin was interfering with the tests.

Mariash presented this case at the recent International Thyroid Congress because he has recently encountered several patients whose abnormal thyroid test results were caused by taking biotin and 'most endocrinologists don't know about this problem.'"

If Thyroid Test Results Are Mismatched to Clinical Observations, Consider Biotin Interference

The ramifications of this kind of test result interference could be severe. As noted by Dr. Carol Greenlee, an endocrinologist in Colorado, people may be treated for hyperthyroidism, Grave's disease or even cancer, even though they do not actually have a thyroid problem — they're simply taking large doses of biotin, which is throwing off the test results.

The reason for this discrepancy in the test results is related to the fact that most immunoassays rely on biotin–streptavidin attraction, and when your blood sample contains mega-doses of biotin, it interferes in this process, rendering the results either artificially high or low. According to Endocrine News:

"In the case of competitive immunoassays — usually used for low molecular weight targets (such as T4, T3 and cortisol) — biotin interference causes a falsely high result. In immunometric (sandwich) assays, it gives a falsely low result.

Other characteristics of the assay can also make a difference. For instance, a longer incubation time increases the opportunity for interference. Different assays for various analytes, even from the same manufacturer, can therefore vary in their susceptibility to biotin interference …

[Co-director of the endocrine laboratory at the Mayo Clinic, Dr. Stefan] Grebe says it may fall to the physician ordering the test to be vigilant: 'When your lab results don't make sense in terms of the clinical picture, or in terms of the constellation of lab results you have received, you should always think first of an assay interference — one of which is biotin — before you think of really exotic reasons for this to have happened, such as TSH-secreting pituitary tumors.'"

The remedy is simple. Since biotin is water-soluble, it flushes out of your body fairly quickly. Simply avoid taking any biotin supplements at least a day or two before your thyroid test to ensure accurate results. Biotin does not actually alter your thyroid hormones, it only affects the test results, so it's not contraindicated for thyroid health in general.

Dietary Sources of Biotin

Also, the concern with biotin altering test results refers to high-dose biotin supplements only, not food, and since biotin is readily found in many foods, this is your best bet if you believe you need more of it. That said, biotin supplements are, in and of themselves, quite safe, even at the mega-doses used in MS studies, which used upwards of 300 mg per day.

There are two forms of biotin found in food: free biotin (found in plants) and protein-bound biotin (found in protein-based animal foods). Your body can use either of these forms, but the free version is more readily absorbed as it does not need to be converted into a bioavailable form. Foods high in free biotin include:16,17

• Sunflower seeds
• Green peas and lentils
• Walnuts and pecans
• Carrots, cauliflower and mushrooms
• Avocados

Protein-bound biotin is found in:

• Organic, free-range/pastured eggs yolks
• Organ meats such as liver and kidneys
• Dairy products such as milk, butter and cheese (ideally organic raw milk from grass-fed cows)
• Seafood (just make sure it's low in mercury and other contaminants, and wild caught, not farmed)

Pastured egg yolk is one of the best source of biotin, yet many warn against eggs, for the fact that the egg white contains avidin, a glycoprotein that binds to biotin. The idea is that eating egg whites could potentially lead to a biotin deficiency. However, cooking the egg white will deactivate the avidin, making this a non-issue. (Biotin, on the other hand, is unaffected by cooking.)

Moreover, if you consume the whole egg (both yolk and egg white) there is more than enough biotin in the yolk to compensate for the avidin binding, making biotin deficiency a highly unlikely outcome of eating eggs. On the other hand, if you regularly consume egg whites only (perhaps tossing the yolk for fear of cholesterol and fats), you really are putting yourself at risk for a biotin deficiency unless you eat a lot of other biotin-rich foods or take a biotin supplement.

So to be clear, I recommend eating the whole egg. Not only will this give you plenty of biotin, but egg yolks also contain valuable fats, cholesterol and protein needed for optimal health.

http://articles.mercola.com/sites/articles/archive/2016/11/21/biotin-deficiency.aspx