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Biotin drug interactions. Biotin Supplement Interference: Impacts on Thyroid Tests and Medical Diagnoses

How does biotin affect thyroid test results. What are the potential consequences of biotin interference in medical diagnoses. Why are more patients taking high doses of biotin supplements. How can healthcare providers identify and address biotin-related test interference.

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The Rising Popularity of Biotin Supplements

Biotin, also known as vitamin B7, vitamin H, or coenzyme R, has gained significant popularity as a dietary supplement in recent years. Many individuals are turning to biotin supplements in the belief that they can improve hair, nail, and skin health. This trend has led to an increase in the number of people consuming biotin in doses far exceeding the recommended daily intake of 30 micrograms (mcg).

While a standard multivitamin may contain the recommended daily amount, some patients are taking biotin in milligram quantities – up to hundreds of times the suggested dose. The growing popularity of biotin supplements can be attributed to aggressive marketing strategies, including internet promotions and television advertisements. As a result, healthcare providers are encountering more patients who are unknowingly consuming high doses of biotin, often without considering it a medication worth mentioning during medical consultations.

Biotin Interference in Laboratory Tests

The increased consumption of high-dose biotin supplements has led to a concerning issue in medical diagnostics: biotin interference in laboratory tests. This interference can significantly impact the accuracy of various test results, particularly those related to thyroid function.

How Does Biotin Interfere with Lab Tests?

According to Dr. Stefan K. Grebe, professor of laboratory medicine & pathology at the Mayo Clinic, the problem lies in the fact that most modern immunoassays utilize biotin in their design. These assays rely on the strong attraction between biotin and streptavidin to either anchor antibodies to a capture surface or to capture them after they have reacted with a patient’s sample.

When a patient’s blood sample contains large amounts of biotin, it can interfere with this process, leading to inaccurate test results. The nature of this interference can vary depending on the type of assay:

  • In competitive immunoassays (used for measuring substances like T4, T3, and cortisol), biotin interference typically causes falsely high results.
  • In immunometric (sandwich) assays, biotin interference leads to falsely low results.

The extent of interference can also be influenced by factors such as the assay’s incubation time, with longer incubation periods increasing the opportunity for biotin to interfere with the results.

Impact on Thyroid Function Tests

Thyroid function tests are particularly susceptible to biotin interference, which can lead to misdiagnosis and inappropriate treatment of thyroid disorders. Dr. Cary N. Mariash, professor of clinical medicine at Indiana University, has encountered several cases where biotin supplementation caused confusing and inconsistent thyroid test results.

Case Study: Biotin-Induced Thyroid Test Abnormalities

Dr. Mariash presented a case at the International Thyroid Congress involving a patient with well-controlled hypothyroidism who suddenly showed abnormal thyroid function test results. The patient’s free T4 levels spiked despite normal thyroid stimulating hormone (TSH) levels. Further testing revealed elevated free T4 and total T3, but normal total T4, T4 index, and TSH.

The confusion was resolved when it was discovered that the patient had recently started taking 10 mg of biotin daily. Upon discontinuing the biotin supplement, the patient’s thyroid tests returned to normal, demonstrating that the abnormal results were due to biotin interference rather than an actual thyroid problem.

Potential for Misdiagnosis and Mistreatment

The biotin-induced interference in thyroid function tests poses a significant risk of misdiagnosis and inappropriate treatment. Dr. Carol Greenlee, an endocrinologist from Grand Junction, Colorado, has observed an increasing number of cases where biotin supplementation has led to confounding lab results.

Dr. Greenlee recounts a concerning example: “I saw somebody just yesterday who has had an extensive workup for hyperthyroidism. A lot of her tests look like she has Graves’, but she is taking massive doses of biotin. She probably doesn’t have any thyroid problem. We could be treating people for Graves’ disease who don’t have it, and that’s really scary.”

This scenario highlights the potential for serious medical errors resulting from biotin interference. Patients could be subjected to unnecessary treatments for conditions they don’t actually have, while their true health issues remain unaddressed.

Identifying and Addressing Biotin Interference

Given the prevalence of biotin supplementation and its potential impact on medical testing, healthcare providers must be vigilant in identifying and addressing this issue. Here are some strategies to mitigate the risk of biotin-related test interference:

  1. Patient history: Always inquire about supplement use, specifically asking about biotin or supplements for hair, skin, and nail health.
  2. Education: Inform patients about the potential impact of biotin on lab tests and the importance of disclosing all supplement use.
  3. Temporary discontinuation: If biotin interference is suspected, consider asking patients to temporarily stop taking biotin supplements before laboratory tests.
  4. Alternative testing methods: In cases where biotin interference is confirmed or suspected, explore alternative testing methods that are not susceptible to biotin interference.
  5. Collaboration with laboratories: Work closely with laboratory professionals to understand which tests may be affected by biotin and what alternatives are available.

The Broader Implications of Supplement Interference

The issue of biotin interference in medical tests raises broader concerns about the potential impact of unregulated dietary supplements on healthcare. As the supplement industry continues to grow, it’s crucial for both healthcare providers and patients to be aware of the potential interactions between supplements and medical diagnostics.

Regulatory Considerations

The biotin interference issue highlights the need for improved regulation and oversight of dietary supplements. Unlike prescription medications, supplements are not subject to the same rigorous testing and approval processes. This lack of regulation can lead to unforeseen consequences, such as the widespread use of high-dose biotin supplements without full understanding of their potential impacts on medical testing.

Patient Education and Communication

Addressing the biotin interference problem also underscores the importance of effective patient-provider communication. Many patients may not consider supplements as “medications” and therefore fail to report their use during medical consultations. Improving patient education about the potential impacts of supplements on their health and medical care is crucial.

Advances in Laboratory Testing

The biotin interference issue has spurred efforts to develop more robust laboratory testing methods that are less susceptible to such interferences. Researchers and diagnostic companies are working on new assay designs and technologies that can provide accurate results even in the presence of high biotin levels.

Biotin-Insensitive Assays

Some laboratories have begun to implement biotin-insensitive assays for certain tests, particularly those commonly affected by biotin interference. These assays use alternative methods that do not rely on the biotin-streptavidin interaction, thus eliminating the potential for biotin-related inaccuracies.

Improved Detection and Correction Methods

Research is ongoing to develop methods for detecting and correcting biotin interference in existing assays. This includes the use of additional steps in the testing process to remove excess biotin from samples or to mathematically correct for its presence.

The Future of Personalized Medicine and Supplement Use

The biotin interference issue serves as a reminder of the complex interplay between dietary supplements, medical diagnostics, and patient care. As we move towards more personalized approaches to medicine, understanding and accounting for the impact of individual supplement regimens on diagnostic testing will become increasingly important.

Integrating Supplement Information into Electronic Health Records

One potential solution to the biotin interference problem and similar issues is the integration of comprehensive supplement information into electronic health records. This could allow for automated flagging of potential interactions between a patient’s supplement use and planned diagnostic tests or treatments.

Personalized Testing Protocols

As our understanding of supplement interactions grows, we may see the development of more personalized testing protocols. These could take into account an individual’s supplement regimen, adjusting testing methods or interpretation of results accordingly.

The issue of biotin interference in medical tests serves as a cautionary tale about the unintended consequences of seemingly harmless dietary supplements. It highlights the need for ongoing research, improved regulation, and better communication between healthcare providers and patients. As the landscape of personalized medicine and supplement use continues to evolve, staying informed and vigilant about potential interactions will be crucial for ensuring accurate diagnoses and appropriate patient care.

By addressing the biotin interference issue head-on, the medical community can not only improve the accuracy of thyroid function tests but also set a precedent for how to handle similar challenges that may arise in the future. This proactive approach will ultimately lead to better patient outcomes and a more robust, adaptable healthcare system.

January: Thyroid Month | Beware of Biotin

More patients are taking the dietary supplement biotin, which could be throwing off a number of test results from thyroid cancer to Graves’ disease.

The thyroid test results made no sense, so the patient’s primary care physician sought help from an endocrinologist. 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 Cary N. Mariash, MD, 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.”

Carol Greenlee, MD, an endocrinologist practicing in Grand Junction, Colo., concurs that she is encountering an increasing number of confounding lab results caused by patients taking large doses of biotin.

“I saw somebody just yesterday who has had an extensive workup for hyperthyroidism. A lot of her tests look like she has Graves, but she is taking massive doses of biotin. She probably doesn’t have any thyroid problem. We could be treating people for Graves’ disease who don’t have it, and that’s really scary.” — Carol Greenlee, MD, endocrinologist, Grand Junction, Colo.

“I saw somebody just yesterday who has had an extensive workup for hyperthyroidism. A lot of her tests look like she has Graves’, but she is taking massive doses of biotin. She probably doesn’t have any thyroid problem. We could be treating people for Graves’ disease who don’t have it, and that’s really scary,” Greenlee says.

An Unregulated Supplement
Many people have begun taking biotin mainly in the belief that it is a key contributor to keratin, and therefore can improve hair, nails, and skin. It is marketed under a number of names, including vitamin B7, vitamin H, and coenzyme R, and sometimes may be listed only as an unnamed supplement to improve hair and nails.

It is a B vitamin, and the Institute of Medicine recommends a daily intake of 30 mcg. That’s what a multivitamin such as Centrum Silver contains. But some patients, like the one Mariash treated, are taking milligram amounts, and might not consider it a medication, so not worth mentioning. It is marketed over the Internet, and Mariash recently saw a television advertisement for it, so its popularity could continue to grow.

An Issue with Assays
The problem is that almost all immunoassays today contain biotin because they rely on the biotin–streptavidin attraction to either anchor the assay’s antibodies to a capture surface or capture them once they have reacted with a patient sample, according to Stefan K. Grebe, MD, PhD, professor of laboratory medicine & pathology and co-director of the endocrine laboratory at the Mayo Clinic in Rochester, Minn.

Biotin At A Glance

  • Many patients are taking megadoses of biotin that can cause falsely high and falsely low results in a variety of laboratory tests, including thyroid tests.
  • Patients are taking these supplements mainly to improve their hair, skin, and nails — and might not consider them medications to report on their list.
  • Biotin interference with lab tests could be causing misdiagnoses — and even mistreatment — in an unknown number of patients. [/pullout-wide]

Large amounts of biotin in a patient sample can interfere with this process. However, the effects can be confusing because, depending on the particular assay, biotin can skew the results to be either falsely high or falsely low. 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.

At the laboratory Mariash uses, the free T4 and total T3 assays use a biotin-streptavidin fluorescent detection system, so biotin can cause falsely elevated results, but the TSH and total T4 assays are not affected. In contrast, at Greenlee’s lab, biotin can lead to falsely low TSH results, but free T3 and free T4 tests are not affected. Biotin can also cause her lab’s assay for thyrotropin receptor antibodies (TRAb) to be falsely positive, which could lead to a misdiagnosis of Graves disease.

Mariash says that even though he suspected what was causing the questionable results, getting to the bottom of the problem was not easy: “I had to make a lot of phone calls to our laboratory. Finally a supervisor told me what platform they were using. Then I called the test manufacturer to get additional details, and they gave me enough information to know what was going on. But of course, they don’t give you every detail because some of it is proprietary.” Mariash’s laboratory director was unaware that biotin could be a problem.

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.

Puzzling Tests and a Revelation
Greenlee had an example of these confusing results when a patient was referred to be evaluated for a possible diagnosis of adrenal carcinoma. The patient had presented complaining of fluid retention and weight gain. Her face was red and she was growing hair on her face while losing hair on top of her head. Her cortisol and testosterone test results were elevated off the charts. Her thyroid tests were also confusing, with low TSH but normal T4 and T3.

“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.” — Stefan K. Grebe, MD, PhD, professor, laboratory medicine & pathology; co-director, endocrine laboratory, Mayo Clinic in Rochester, Minn.

A normal adrenal CT scan ruled out cancer. Greenlee asked the woman to come back the next morning for fasting blood tests. This time her tests were normal. Greenlee thought that perhaps there was some mix-up at the lab, and the original tests were not this patient’s.

The solution to the mystery only emerged over time. The patient’s problems stemmed from her home remedies for her hair loss — minoxidil and biotin. Not knowing her hair loss was not unusual for an older woman, and despite warnings that it should not be used by women, she was putting minoxidil on the top of her head — resulting in a red, hairy face.

The final piece of the puzzle fell into place when Greenlee was preparing a talk and came across a reference to biotin interfering with a parathyroid hormone assay. Her research following up this clue led her to literature reports of other biotin interferences. In the case of this patient, because she had been told to fast before she was tested again, she had not taken biotin, so those results reflected her true status. The biotin interference contributed to her out-of-kilter cortisol, testosterone, and TSH results. In unraveling the mystery, Greenlee consulted with Grebe to learn more about the ins and outs of immunoassays and worked closely with her lab — making them aware of the potential interference.

Biotin Vigilance
Greenlee is now making sure her practice identifies any patients taking the supplement: “We have huge signs in my office that ask people if they are taking biotin — in each exam room, over the phlebotomy chair, and at the front desk. We had all these nice pictures on our walls, but the biotin thing alarmed us so much that we don’t care about our decorations in our office anymore.”

“It can be dangerous not to recognize it,” Mariash agrees. He also notes that clinicians need to be vigilant because laboratories can change the test platform without notice.

For the interference to occur, the patient’s biotin level needs to be high — at least three times the upper limit of the healthy adult reference range, according to Grebe. But that level is easy to achieve with the megadoses many are taking.

Grebe suggests that a clinician can ask the lab to try using another manufacturer’s test, but an easier route is to ask the patient to stop the biotin then get retested. Biotin is water soluble, so it washes out of the body quickly — even a single day can make a big difference in the test results.

And although literature reports mostly focus on problems with parathyroid and thyroid hormone tests, biotin interference could be considered as a potential contributor to almost any suspicious immunoassay result.

Published by the Endocrine Society, Endocrine News is a monthly publication that offers an in-depth look at endocrinology trends and research, from reproductive issues to biotin concerns to thyroid problems. When you’re looking for the latest studies, interviews and commentary on endocrinology, you can find it on our site. With that in mind, if you’re interested in reading additional content with timely, accurate information on thyroid issues, check out our other articles such as “Fairytales: Dispelling Pediatric Thyroid Cancer Myths” and “Thyroid Cancer and Radioiodine.

Seaborg is a freelance writer based in Charlottesville, Va. He wrote about expanding the definition of osteoporosis in the December issue.

Benefits And Side Effects · HealthKart

Using biotin for hair is a popular option these days when it comes to hair growth & nutrition. But what is biotin and what are other benefits of biotin? Let’s read to find out!

Don’t we all dream of luscious healthy hair? But daily damage, heat, pollution, chemicals, and styling can damage your hair. Another damaging factor is not eating a healthy balanced diet. We need the right amount of vitamins and minerals in our diet for our skin and hair to be healthy. One such vitamin is biotin.

Table of Contents

What Is Biotin? 

Biotin, or Vitamin B7, is a part of the vitamin B complex group. It is a water-soluble vitamin and is associated with healthy hair and skin, cardiovascular, nerve, and digestive functions. The word biotin comes from the Greek word ‘biotos’ which means life or sustenance. Since it is a water-soluble vitamin, our body doesn’t store biotin.

Image Source: www.medme.pl

Biotin is a nutrient that helps us look young and attractive. It plays a pivotal role in maintaining your hair, skin, and nails. It has gained popularity in recent times and is easily available in supplement form as well. You can biotin tablets online or from a pharmacy, but consult your dermatologist to know whether biotin will suit you or not.

The daily requirement of biotin varies at every stage of life. 

  • 5 micrograms daily for infants
  • 6–8 micrograms daily for infants ages 1–3 years
  • 12 micrograms daily for children ages 4–8 years
  • 20 micrograms daily for children ages 9-13 years
  • 25 micrograms for adolescents (14-18)
  • 30 micrograms for male and female adults over 19
  • 30 milligrams for pregnant women and 35 milligrams for women who are breastfeeding

Start with a lower dose and gradually increase the dosage as per your doctor’s recommendation.  The one important thing about taking biotin capsules or biotin supplements is that they shouldn’t be taken on an empty stomach. Always take biotin tablets with meals.

5 Health Benefits of Biotin 

Biotin is known for its benefits and for hair growth. But there are various other health benefits of biotin –

Image Source: mind, body and food

  1. It is used by the body to metabolize carbohydrates, amino acid supplements, and fats.
  2. Is beneficial in fetal development during pregnancy. It is also an important nutrient that is needed during breastfeeding. During pregnancy, the biotin requirement goes up, and this is one reason that a large number of women tend to get biotin deficiency during pregnancy.
  3. Can regulate blood sugar. People with type 2 diabetes usually have low biotin level, taking biotin supplements will help them regular their blood sugar.
  4. It is important for energy production in the body. Various enzymes need biotin for proper functioning.
  5. Can solve the problem of brittle nails.

Image Source: img.grouponcdn.com

Biotin for Hair

It is a common myth that biotin is the sole ingredient needed for hair growth. Although biotin for hair growth is extremely important, but the biotin isn’t the only nutrient needed. A balanced mix of vitamins and minerals promotes hair growth.

How does biotin help in hair growth?

Our hair is made up of keratin, a type of protein. Proteins are formed by amino acids. And these amino acids are formed on reaction of enzymes with biotin. The biotin present in our body contributes to give healthy hair, skin, and nails. When ingested, either from food sources or from biotin supplements, it reacts with cell enzymes and produces amino acids, the building blocks of protein. This helps in hair growth. But apart from biotin, you need to eat food with a healthy balance of vitamins supplements and minerals, follow the stress-free lifestyle, and take proper care of your hair. If any one of these factors is missing, it may affect your hair. Hair loss and thinning of hair are commonly seen. A major cause is an erratic lifestyle – junk food, harsh chemicals, heat styling, hair coloring, pollution, and heat all cause hair damage in more than one way.
Biotin can be found in food. There are various sources of biotin. But a lot of people fall short of the daily requirement and take biotin supplements for healthy hair. It is essential that you talk to your doctor and then take biotin tablets.
If you want thick luscious hair, then biotin is the answer for you. Consume biotin rich food or biotin tablets. But keep in mind not to exceed the prescribed dosage. An overdose of biotin may cause medical complications.
Read on to find out what are the side effects of biotin.

Biotin Deficiency 

Biotin deficiency is very rare. But when it occurs the most common symptoms are –

  • Dry flaky skin
  • Hair loss
  • Brittle hair
  • Brittle nails
  • Digestive tract issues
  • Cramps
  • Muscle pains
  • Tingling in limbs
  • Mood changes
  • Nerve damage

Image Source: healthline

20 Food Sources of Biotin 

There are actually eight forms of Vitamin B7. But only one form occurs naturally, the one found in food sources. Thus, getting your daily dose of vitamins and minerals from food is always a good idea.

  1. Liver
  2. Egg yolk
  3. Salmon
  4. Cheese
  5. Avocado
  6. Cauliflower
  7. Raspberries
  8. Whole wheat bread
  9. Mushroom
  10. Cucumber
  11.  Oats
  12. Wheat germ
  13. Nuts
  14. Strawberry
  15. Chicken
  16. Carrot
  17. Banana
  18. Soy flour
  19. Leafy greens
  20. Legumes – soybean

Other Rich Sources of Biotin

  • Safflower seeds
  • Oyster mushroom dried
  • Paneer
  • Onion stalk
  • Capsicum
  • Broad beans
  • Parsley
  • Dates (processed)
  • Broad beans
  • Litchi
  • Papaya

Biotin Side Effects 

A lot of people take biotin tablets for hair or biotin capsules. But we recommend that you talk to your doctor before taking biotin capsules.
Here are some of the biotin side effects that you must know.

Image Source: healcure

1. May cause acne 
The one thing that we all dread is acne. One of the worst side effects of biotin, if taken in high dosage is that it may cause cystic acne.
Biotin increases the production of sebum which causes dirt, oil, and grime to accumulate on your face. If you feel cystic acne, especially along your jaw line and chin, then biotin intake may be a cause of it.
The acne does fade away after a few weeks when you stop taking biotin. But it may leave some nasty marks and acne scars, which nobody is a fan of.

2. Can cause complications during pregnancy 
If you’re pregnant, you should avoid taking biotin. If you already take biotin for hair growth or biotin supplements, it is recommended to talk to your doctor. High dosage of biotin may increase the risk of miscarriage.

3. Allergic reactions
There are chances that some people may suffer from allergic reactions on intake of biotin capsules. Since each of us is different, the way each body reacts to biotin also varies.
The allergic reactions may include –

·    Feeling of nausea
·    Tightness in throat
·    Chest pain
·    Itchy rashes
·    Swelling of face and throat
If you see any of these signs after taking biotin capsules, it is best to consult a doctor immediately.

4. Nausea
A lot of people complain of nausea during the early stages of intake of biotin supplements. This isn’t a major cause of concern, because with time nausea with ease off.

5. Drug interactions 
Studies reveal that biotin has a negative interaction with anti-seizures and cholesterol-lowering medications. An increased dosage of biotin can interfere in the efficiency of these drugs. It can also have adverse effects for diabetes.
Talking to your doctor before starting to take biotin supplements is what should help.

6. Diarrhea 
Stomach cramps and diarrhea are common in individuals who take a high dosage of biotin. If you are taking biotin supplements and notice diarrhea or have stomach cramps, it is best to stop taking biotin tablets and talk to your doctor immediately.

7. Frequent urination 
In some cases, high dose of biotin may increase the need for urination. Apart from excessive urination, increased use of biotin may also cause excessive sweating.

So, here’s all that you want to know about biotin – biotin for hair, biotin benefits, biotin side effects, and lots more. It’s now time to take your first step towards healthy hair and overall fitness. 

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Hair, Skin & Nails , Healthy At Home , Vitamins and Minerals , Weight Management

Chicken egg (boiled) 13-25 mcg
Liver (beef) 9037 4

27 mcg
Mushrooms (champignons, raw) 22 mcg

Product name
Biotin content per 100 g
Percentage of daily requirement
Soy (grain) 60 mcg 120%
Egg yolk 56 mcg 112%
Chicken egg 20.2 mcg 40%
Oatmeal 20 mcg 40%
Oat flakes “Hercules” 20 mcg 40%
Peas (shelled) 19.5 mcg 39%
Non-fat milk powder 15.3 mcg 31%
Oats (grain) 15 mcg 30%
Rice (grain) 12 mcg 24%
Wheat (grain, durum) 11. 6 mcg 23%
Barley (grain) 11 mcg 22%
Wheat (grain, soft grade) 10.4 mcg 21%
Wheat groats 10 mcg 20%
Powdered milk 25% 10 mcg 20%
Meat (chicken) 10 mcg 20%
Cod 10 mcg 20%
Meat (broiler chickens) 8.4 mcg 17%
Curd 2% 7.6 mcg 15%
Curd 5% 7.6 mcg 15%
Low-fat cottage cheese 7.6 mcg 15%
Egg white 7 mcg 14%
Corn grits 6.6 mcg 13%
Rye (grain) 6 mcg 12%
Camembert cheese 5. 6 mcg 11%
Green peas (fresh) 5.3 mcg 11%
Curd 18% (fatty) 5.1 mcg 10%
Curd 9% (bold) 5.1 mcg 10%