Candida/SIBO most probably have a multitude of causes, but as a person who have tried absolutely everything (and have at times been bed-ridden and almost reached insanity in the valley between hope and despair; MADRS: 20-40), biotin in high doses has been nothing but revolutionary. Not just because of its possible interactions with candida itself - it is assumed to have dehyfinating effects - but because of metabolic and mucosal health reasons.
I have never been able to tolerate fasting well, and I currently blame that on biotin deficiency, since it is crucial for gluconeogenesis and possibly causes CoA-sequestration that disrupts fatty acid metabolism. As a kid I fainted several times because of what I now think was hypoglycemic episodes, and as an adult I have tried fasting up to 60 hours, without having a single ketone in my blood or urine, and feeling utmost shit. 5 mg of biotin gets me into ketosis within 3 hours, given that I am in a fasted state. This might be mediated through many pathways, but possible ones are the mentioned CoA sequastration, or the high amounts of succinyl-coa needed to convert the ketones AcAc into BHB (I will spare the rest of the details, because I don't have them right now, hehe). I would love some suggestions for why biotin deficiency would hinder ketosis, as everything I have found says the opposite would happen. Namely that ketones should go drastically up when acetyl-CoA loses its biotin-dependent oxaloacetate to enter the TCA-cycle with. Anyways, my experiments contradicts this. And also, since 5 mg of biotin only gets me into ketosis 24-36 hours before it tapers off to eventually zero again, tells me that there is something wrong with recycling, not mere uptake. I also think the malonyl-CoA pathway, which creates fatty acids essential to barrier function, that biotin engages, is of great importance in allowing candida to thrive.
Biotinidase is responisble for this recycling, and if one lacks the enzyme, this will reduce the amount of biotin available. Biotinidase deficiency in its most harrowing form causes a less than 10% effect of the enzyme, but less extreme cases, partial deficiencies, said to still be rare, range from 10-30% enzyme function. Chris Masterjohn (nutritionist) nevertheless posits that about 1/30 people could benefit from high doses, so the partial deficiency pool might be broader and more frequent than assumed. These kinds of deficiencies is said to not normally present symptoms before one has a grave infection or reaches adulthood. Where the former is exactly what happened to me. But no doctor/practioner, in my country (Scandinavic) at least, tests for these deficiencies, and the bio-markers it gives are vague or non-existent, in my experience. Also, I am born way before they started to check new-borns for it in 2012.
Since getting an infection more than 10 years ago (food poisoning that really messed with my gut), in my late teens, I have never been quite the same, and my stomach has just gotten worse each year. The light in me slowly perished; I thought I was depressed, that I was living out of touch with myself or whatever. I thought existentialism would fix it, or sleep, meditation, or working out, light therapy, etc etc, behaviour behaviour behaviour. After some years of diminishing health, I started nutritionally optimalizing all that was in my control; from thyroid stuff, methylation, vitamin A through K, minerals, proteins, fats, herbs, anti-biotics, anything really. Which variably helped, but I was still brain fogged, with mild to moderate candida infections on my tongue, thighs, genitals, peri-anal area, etc., smelling funny under my arms, hair oily as hell, stomach most of the time feeling bad, full, nervous, etc., feeling overall depressed and exhausted, could not read a book if I tried (this is perhaps the saddest thing, cannot even watch a movie as distraction). Sex life was (have not tried in a while, so might still be, for other reasons hehe) horrible, and filled with shame due to lack of physical sensation, or if anything pain, with a mucosa as dry as Death valley. Prescribed topical anti-fungals would work for the duration I used them, before coming back a couple days later. Sugar was never a part of my diet (although I craved carbs such as popcorn, potato chips), have never been overweight (rather always been the lanky type), and do live quite thruthfully, to be frank:-)
My thought was, still is, that there are no good reasons that a seemingly healthy body and immune system should have candida indefinitely, especially after anti-fungal cures (MCT-oil, garlic, black seed oil, oregano oil etc.). And it is somewhat absurd to think that one has to take anti-fungals daily to keep it in check - there must be something underlying, a blockade. This is a point somewhat tangible to Chris Masterjohn's idea that energy metabolism governs everything - that is, fix your own resources, and the body will recover itself (anti-fungals might be needed to catalyze it, or not). Anyways, having a low energy output that causes 10-30% cognitive/physical endurance function surely must reflect somewhat in the gut as well (in addition to the fatty acid component of biotin mentioned). After having tested several times to get into ketosis with many different tactics, and also, prior to that, randomly experimenting with biotin from time to time (hypothesized an oxalate issue, and as I said, I tried everything just to be sure), I suddenly went from zero ketones after 27 hours of fasting, to "low" (which is decent) amounts on the urine stick within the next three hours - confirmed by me feeling a lot better. The benefits from experimenting with biotin was not clear to me when I was filled with carbohydrates, as I judged the die off symptoms as something that was wrong, or as a transient oxalate dumping (see Chris Masterjohn's substack for that connection).
The results have not disappointed, and I am of course terrified of falling back into it - 10 years of emptiness is enough. I still probably have a couple of weeks until the rest of the fog vanishes, and a month or two to go fixing my gut, but I have nonetheless six full days with 1.5-3.0 levels of ketones in my blood behind me, and a gradual, but significant increase in mood, energy and skin symptoms (mucosal skin is drastically better). I would never have been able to write this in that former exhausted, terrifying state - I actually felt like a nine year old kid, cognitively. And I maintain that the die offs are also directly caused by the timing of the dose, so if you don't have a biotin recycling problem, it can still be of value to try for the possible candida-weakening effect (assuming that die offs actually are a positive sign. I do, hehe). The assumed die offs have been ghoulish, but surely decreasing each day. I find that molybdenum, vitamin C and vitamin A helps the most in managing symptoms.
Yesterday I cried of joy because I was feeling again. That is real, unexpected internal movements that seems almost electric and spontanous. I have found myself ruminating on problems or thinking of other people's gestures again, laughing about how I would usually deem that as something negative, but now as mere potentials I could canalize or regulate! Oh, and that sensation of managing intensities, increasing or decreasing my enthusiasms, like ripples in a pond, where I am the one holding the rocks. I had forgotten it existed. All this is to say, I/we am/was/were/are not brain damaged! And that there are still layers beneath the sheath.
I am not saying this is your case: MMC, immune-function, anti-fungals and other deficiencies might be the solution or reason for your pathology. For me, all of those supporting and killing mechanisms have helped. But if you have had some similar metabolic problems, or not for that matter, then a week, or a month, or indefinent use of 5 mg biotin has no known toxicity risks. Chris Masterjohn speaks anectdotally of him getting clumsy after a couple of weeks of high doses, and some small increase in lactate, so that is that. Just remember to take it 3-4 hours away from your B5-intake, as they share the SMVT transporter.
For the ones I have sparked some hope in, but to your despair it does not or have not worked - I am terribly sorry. I feel ambigous about these exclamations of betterment, and self-aware about the lack of control I have, better yet the road to go - I should speak conservatively. What has been the most help for me is this community, posts like these, where I have seen other people struggling or finding betterment. In my view, do not give up the hope, you have the right to feel okay, even though people think you are trying to optimize. That goes to all of you that are struggling, even myself, who feel totally lost: it feels like battling something as bad as cancer imo - it just does not kill you fast enough. There are very few places were one can find validation for this, and I would say the condition has this double whammy of loneliness; it does not make sense to most people, and you therefore have to hold onto it on your own. But then again, "you" are not even there for yourself.
I wish you all the best!
Tl;dr: Biotin in doses of 5 mg have solved my fasting intolerance and metabolic issues, and seems to rapidly have changed my gut, mood and skin issues for the better in six days. The assumed direct anti-candida effect is dose-respondent (100 mg gives more die off than 5 mg) and possibly mediated through anti-hyphinating effects, in addition to fixing metabolic issues and possibly barrier function.
I'll update in a month or so, and try to answer if anything is unclear.
Should not need to say, but only carbon-based flesh has been used to create this text.
