Did you know that some drugs can cause you to lose nutrients from your body? Some side effects of prescription drugs may not be directly due to the drug itself, but may instead be caused by a nutritional deficiency caused by the drug over time.
While much research has been done in this area over the past 50 years, the results of many of these studies are not widely known… If you are aware of these potential deficiencies, you can then adjust your diet or take a supplement to replace what is being lost, and this may improve your tolerance of the medication and avoid some negative health effects.
Here are some examples:
Antibiotics – Broad spectrum antibiotics, those that kill a wide range of bacteria, also kill the good bacteria in your digestive system that help digest food, and protect us from harmful infections. These good bacteria, lactobacillus and bifidus, also produce a range of B vitamins and vitamin K. This interaction is of particular concern in those taking the blood thinner, warfarin, which works by blocking vitamin K’s action to promote blood clotting. Less good bacteria, means less vitamin K, which increases the effect of warfarin, leading to an increased tendency to bleed. B vitamins have many functions in the body, so a lack of these may have many effects.
Acid suppressing drugs – Stomach acid is necessary to absorb many nutrients, so suppressing or neutralizing acid long-term can cause depletion of various vitamins and minerals. Simple antacids can reduce absorption of calcium and phosphorus; histamine-2 receptor inhibitor drugs like ranitidine (Zantac) can deplete calcium, folic acid, iron, vitamin B12 and zinc; proton pump inhibitor drugs, such as omeprazole (Losec), pantoprazole (Tecta) and esomeprazole (Nexium) can reduce absorption of vitamins C, B6, B12, folic acid, magnesium and zinc.
Diuretic blood pressure medications – Hydrochlorothiazide, the most widely prescribed “fluid pill”, can deplete potassium, magnesium, Vitamin B6, coenzyme Q10, and zinc. Pharmacists will often advise to drink orange juice or eat a banana a day when taking these to replace lost potassium but potatoes actually contain more potassium than bananas… In extreme cases, potassium supplements are necessary, but changing to a different fluid blood pressure medication is a simpler approach to correcting the problem.
Birth control pills – Hormonal birth control medications deplete vitamins B2, B6, B12 and C, folic acid, magnesium and zinc. Low folic acid is associated with the birth defect, spina bifida, and this is one reason it is advised to stop birth control pills a few months before trying to become pregnant.
Beta-blockers and “statin” cholesterol drugs – Both of these classes of medications, often used together in heart patients, can reduce production of coenzyme Q10. CoQ10 is used in the mitochondria, the energy factories inside our cells, to produce the energy that is needed for all body functions, and it is an important antioxidant as well. Low coQ10 can affect many functions, in particular heart function. It is widely used in Japan as a treatment for various cardiovascular problems. Although coQ10 is present in small amounts in many foods, it would be difficult to get an amount comparable to what is normally produced by the body, making supplementation the best way to prevent coQ10 depletion.
Metformin – This drug, used to treat type-2 diabetes, depletes vitamin B12, a vitamin that is necessary for producing red blood cells and nerve growth and repair. One of the long-term consequences of diabetes is numbness of the extremities, due to nerve damage, known as peripheral neuropathy. In one study, nursing home residents with peripheral neuropathy who were taking metformin were given vitamin B12 supplements – 30% reported that their neuropathies improved, suggesting that lack of B12 was the cause. Deficiencies of B12 in the elderly can also cause moodiness, confusion, abnormal gait, memory loss, agitation, delusions, dizziness, dementia and hallucinations. Vitamin B12 is also depleted by numerous other drugs, as noted above. A simple blood test can readily identify low B12.
Mineral oil and stool softeners – Used for treating constipation, mineral oil is poorly absorbed from the digestive system and it works by creating a lubricant effect in the bowel. Stool softeners also stay in the bowel where they mix with stool, preventing it from hardening and causing constipation. However, vitamins A, D, E and K as well as the vitamin A precursor, betacarotene, tend to dissolve in these laxatives, reducing their absorption into the system and, instead, being excreted in the stool. Laxatives containing mineral oil or stool softeners can deplete these fat-soluble vitamins, especially if taken multiple times daily with meals. For this reason, they are best taken at bedtime, away from meals.
These are just a few examples of nutrients that can be depleted by medication. So, if you are taking medications regularly, ask your pharmacist to research whether you may need to replace any particular nutrients. To ensure they have sufficient time to research your question properly, I would suggest leaving your request and checking back in a day or two, rather than expecting them to give a quick answer from memory.
Not all nutrient depletions will occur in all individuals, however; ask your doctor to include tests for nutrients that may become depleted due to medication you are taking, along with your regular annual blood tests, to avoid taking unnecessary supplements. Also ask whether simply adjusting your diet would be adequate, given the degree of nutrient depletion found in testing.
Reference: Drug-Induced Nutrient Depletion Handbook; R Pelton, JB LaValle
