Evidence Level
Biotin's evidence base is surprisingly thin for such a popular supplement. Patel et al. (2017) conducted a systematic review and found only 18 reported cases of biotin use for hair and nails, none from rigorous RCTs, concluding there is insufficient evidence for biotin supplementation in non-deficient individuals. Colombo et al. (1990) showed nail thickness improvement in patients with brittle nails, but the study lacked a control group. The most important clinical concern is the 2017 FDA safety communication warning that biotin can significantly interfere with laboratory tests, including troponin assays used to diagnose heart attacks — a potentially life-threatening issue if results are misinterpreted.