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A Practical Approach to Avoiding Drug-Nutrient Depletions

Article at-a-glance:

  • Fifty-five percent of Americans now take at least one drug and almost 12% take five or more prescriptions drugs.
  • Doctors and pharmacists almost never discuss drug-induced nutrient depletions with patients even though the fix is easy–simply take dietary supplements to replenish what’s lost.
  • Nutrients stripped from the body by medications can cause depression, anemia, increase osteoporosis and fracture risk, and is the number one cause of non-alcoholic liver failure.
  • Since your doctor isn’t likely going to be the one to tell you this information, you need to educate yourself.

by Dr. John Neustadt

More people than ever are taking medications. In 2017, pharmacies filled more than 4 billion prescriptions. Fifty-five percent of Americans now take at least one drug and almost 12% take five or more prescriptions drugs.

Pharmacists and doctors talk about the obvious side effects of medications, such as nausea, potential increase risk of fractures (some osteoporosis medications) and weight gain (antidepressants). However, drug-induced nutrient depletions are almost never discussed. Since nutrients are what the body’s biochemistry uses to function, loss of nutrients creates other side effects. Worse, when new symptoms appear, most healthcare providers don’t recognize that they’re being caued by a drug-induced nutrient depletion.

Instead, the typical reaction is to prescribe another drug to suppress the symptom without actually correcting the underlying cause. Then the patient is put at further risk of more nutrient depletions and more side effects.

While not an exhaustive list, here are some problems caused by specific nutritional deficiencies:

  • Peripheral neuropathy (numbness and tingling in your hands or feet), anemia and depression: Low vitamin B12
  • Anemia and depression: Low folic acid 
  • Irregular heartbeats and muscle spasms: Low magnesium
  • Brittle nails and hair: Low biotin
  • Fatigue, depression, difficulty processing and retaining information, hair loss and anemia: Low iron 
  • Bone loss, osteoporosis and fractures: Decreases in vitamin K  
  • Weaker bones, imbalance and decreased immunity: Low vitamin D

Because this issue isn’t on the radar of most doctors and pharmacist don’t tell you about it when you fill your prescriptions, it’s up to you to educate yourself. Here are some of the most commonly prescribed medications and the nutrients they deplete.

NSAIDS (non-steroidal antiinflammatory drugs)

Examples: Tylenol (Acetaminophen), Asprin, Advil (Ibuprofen), Aleve (Naproxen), Celebrex (Celecoxib)

Nutrients depleted: Folic acid, glutathione, iron, potassium, vitamin C

Most people probably aren’t aware that the number one cause of non-alcoholic liver failure in this country is acetaminophen, which is the active ingredient in Tylenol. As an easy-to-get over the counter medication, people in chronic pain are taking like it’s candy.

How does it cause liver failure? It depletes the liver of glutathione. Glutathione is a nutrient and antioxidant required by the liver to detoxify Tylenol and many other substances. When your body lacks enough glutathione to process toxins (and acetaminophen is a toxin), free radicals that and free radical damage increase. This starts a cascade of damage to the liver that can result in liver failure.

Ideally, people will deal with their pain and there are many great, integrative ways to do that to not take Tylenol chronically, but glutathione is available as a dietary supplement, and there are other nutrients like probiotics that support healthy glutatione.

Acid Blockers 

Nutrients depleted: Calcium, chromium, iron, zinc, vitamin D, vitamin B12

There are two classes of acid-blocking medications, proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (“H2 blockers”). PPIs include Prilosec, Nexium, Prevacid. H2 blockers include Zantac, Prilosec and Tagamet. Despite the fact that these medications are approved only for short-term use, people are taking them for years.

These drugs work by suppressing your stomach’s acid production, which changes its pH. In doing so, they decrease the ability of your body to digest and absorb nutrients. These medications deplete people of vitamin D, vitamin B12, folic acid, minerals such as magnesium, iron and zinc. They’ve also been shown increase hip fracture risk in people with osteoporosis, dementia and cancer. I think that these side effects alone are reason enough for you to have a discussion with your healthcare provider or with your pharmacist about what nutrients are being depleted by those medications.

Even better, can you do something naturally to treat the reason you’re taking the drug in the first place so you won’t even need it anymore? There are effective, natural approaches to many of the most common diseases, including heart disease, diabetes, osteoporosis, back and joint pain, heartburn, insomnia that may help you reduce your risk of getting these or help you avoid or get off your medications. It’s important to work with an integrative clinician to help you navigate natural approaches and medications.

Antibiotics

Examples: Amoxicillin, Penicillin, Erythromycin, Tetracycline, Gentamicin, Ciprofloxacin (Cipro), Levofloxacin (Levaquin), Trimethoprim

Nutrients depleted: Probiotics (eg, Bifidobacteria bifidum, Lactobacillus acidophilus), vitamin K, potassium, inositol, B complex vitamins (B1, B2, B6, B6, B12 and biotin)

Antibiotics can deplete the body of vitamin K, B complex vitamins like vitamin B2, vitamin B6 and biotin. Taking broad-spectrum antibiotics can reduce vitamin K production in the gut by nearly 74% in people compared to those not taking these antibiotics.

Calcium and iron are reduced by fluoroquinolones and floxacins, including ciprofloxacin (Cipro). Calcium and magnesium are depleted by tetracyclines deplete calcium and magnesium. Folic acid is reduced by trimethoprim-containing antibiotics (Trimpex, Proloprim or Primsol). Penicillin depletes potassium.

Aminoglycosides, such as gentamicin, cause imbalances of magnesium, calcium and potassium.9 One study showed gentamicin increased calcium excretion by 5% and magnesium excretion 8.4%.

Antibiotics can disrupt the body’s microbiome, which is the mix of bacteria in the gut. Antibiotics indiscriminately kill bacteria, so along with the bad bacteria, good bacteria are the collateral damage. Good bacteria include Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium bifidum (B. bifidum). If people are prescribed antibiotics, many doctors recommend taking a dietary supplement, called a probiotic, that helps replenish healthy bacteria.

Antipsychotics

Examples: Chlorpromazine, Haloperidol, Risperidone, Lithium, Seroquel, Invega, Abilify

Nutrients depleted: Coenzyme Q10 (CoQ10), folic acid, inositol, iron, vitamin B2, vitamin D

Since all medications have potential side effects, prescribing a drug always entails a risk-benefit analysis. And with the antipsychotics (Abilify, Zyprexa, Seroquel, Riperdal) and corticosteroids (prednisone, methylprednisone), the risks are high.

Antipsychotic medications are used to treat people with bipolar disorder and schizophrenia. According to a 2010 article in the journal American Academy of Family Physicians, “The use of antipsychotic medications entails a difficult trade-off between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects.”  

The antipsychotics and corticosteroids can deplete nutrients by shifting your cravings for certain foods. They can promote insulin resistance and metabolic syndrome, which can increase your cravings for sugar. If you’re eating more calories as sugar and craving those sweet treats, you’re likely consuming less nutrient-dense foods, such as fruits and vegetables. Over time can cause nutrient depletion.

Beta blockers

Examples: Atenolol (Tenormin), Metoprolol (Lopressor, Toprol-XL)

Nutrients depleted: Melatonin

Approximately 22 million American take beta blockers. These drugs are used to treat arrhythmias (irregular heartbeats). These are the “-ol” drugs because their names end in “ol,” like propranolol and metoprolol. Beta-blockers deplete melatonin and cause insomnia.

Melatonin helps us fall asleep, is also an antioxidant and plays important roles in immune health. When melatonin is decreased, people have trouble falling asleep. And while replenishing melatonin in someone taking beta-blockers has been shown to improve sleep, many people with insomnia discover that they have to take more and more melatonin to get the same effect. 

Cholesterol Lowering Medications

Examples: Atorvastatin, Lovastatin, Rosuvastatin, Questran, Fenofibrate, Pravastatin, Colestipol

Nutrients depleted: Beta-carotene, calcium, folic acid, iron, vitamin A, vitamin D, vitamin E, vitamin K, zinc

Cholsesterol medications are prescribed to lower cholesterol and reduce cardiovasccular disease risk. They fall into two categories. Those that block the producxtion of cholsterol, which includes the statin medications (eg, atorvastatin, lovastatin, etc) and those that block the intestinal absorption of choleterol. This category includes the statin medications, such as Lipitor (atorvastatin), Crestor, Zocor and Mevacor. While they are effective at decreasing cholserol, they also can reduce your fat-soluble vitamins such as vitamin A, vitamin D, vitamin E and vitamin K

Corticosteroids

Examples: Betamethasone, Budesonide, Cortisone, Dexamethasone, Prednisone

Nutrients depleted: Calcium, folic acid, magnesium, potassium, selenium, vitamin C, vitamin D, zinc

Corticosteroids, also called glucocorticoids, are powerful anti-inflammatory and immune-modulating drugs. Prednisone, methylprednisolone, betamethasone, prednisolone, and dexamethasone are examples of corticosteroids. These medications are prescribed for a wide range of conditions inflammatory and autoimmune diseases, including Lupus, Crohn’s disease, ulcerative colitis, rashes, asthma, and arthritis. They’re also now being used to treat the acute phase of coronavirus infections. 

And with corticosteroids, studies show that prednisone causes osteoporosis and these drugs are so dangerous for bones that 30-50% of people taking them long-term suffer fractures. Taking these medications for only a few months increases fracture risk up to 75%. Osteo-K or Osteo-K Minis provide, plus calcium and vitamin D, plus the clinically validated amount of MK4 (45 mg/day) shown to stop and reverse bone loss from prednisone. 

Diuretics

Examples: Lasix (Furosemide),Hydrochlorothiazide (HCTZ), Spironolactone, Triamterene

Nutrients depleted: Calcium, potassium, magnesium, sodium, vitamin B1, vitamin B6, vitamin C, zinc

Diuretics are prescribed to treat high blood pressure. These include drugs like furosemide and hydrochlorothiazide. They increase the production and excretion of urine, but out with the urine also comes lots of nutrients. These include B vitamins, vitamin C, magnesium, calcium and zinc. To help, take Supreme Multivitamin to supplement with healthy amounts of these nutrients. A not of caution is warranted here. Do not take potassium or magnesium with any diuretic without first speaking with your healthare provider. 

Hypoglycemics

Examples: Metformin (Glucophage, Glucophage XR and Glucovance), Metformin, Insulin, Glipizides, Actos, Victoza, Januvia

Nutrients depleted: CoQ10, folic acid, iron, magnesium, potassium, vitamin B12, vitamin D, vitamin E, zinc

These medications help regulate blood sugar in people with diabetes. Metformin has been shown to deplete vitamin B12 and cause anemia.

This is not a complte list, so do a quick Google search on the medications you’re taking and talk to our pharmacist and doctor. Pharmacists are some of the most underutilized healthcare resources in our entire medical system. They are incredibly well-educated, highly intelligent professionals who most of the time are just sitting back behind the counter filling prescriptions. From the many conversations I’ve had with pharmacists over the years, I can tell you that they love when people ask them questions that they can look up and research.

Since your doctor isn’t likely going to be the one to tell you this information, you need to educate yourself. Utilize your local pharmacist. Ask them questions. Ask them about this issue. Let them help you so that you don’t suffer the easily avoided or easily corrected side effects caused by drug-induced nutrient depletions. And for a good, broad-spectrum dietary supplement that provides healthy amounts of these nutrients, take a good multiple vitamin and mineral dietary supplement like Supreme Multivitamin, which I created for my patients.

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References
Arendt J, Bojkowski C, Franey C, Wright J, Marks V. Immunoassay of 6-hydroxymelatonin sulfate in human plasma and urine: abolition of the urinary 24-hour rhythm with atenolol. J Clin Endocrinol Metab. 1985;60(6):1166-1173. [Article]

Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761. [Article]

Chen YS, Fang HC, Chou KJ, et al. Gentamicin-induced Bartter-like syndrome. Am J Kidney Dis. 2009;54(6):1158-1161. [Article]

Clayton JA, Rodgers S, Blakey J, Avery A, Hall IP. Thiazide diuretic prescription and electrolyte abnormalities in primary care. Br J Clin Pharmacol. 2006;61(1):87-95. [Article]

Conly J, Stein K. Reduction of vitamin K2 concentrations in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med. 1994;17(6):531-539. [Article]

Elliott C, Newman N, Madan A. Gentamicin effects on urinary electrolyte excretion in healthy subjects. Clin Pharmacol Ther. 2000;67(1):16-21. [Article]

Khedun SM, Naicker T, Maharaj B. Zinc, hydrochlorothiazide and sexual dysfunction. Cent Afr J Med. 1995;41(10):312-315. [Article]

Muench J, Hamer AM. Adverse effects of antipsychotic medications. Am Fam Physician. 2010;81(5):617-622. [Article]

Neeral L. Shah FDG. N-acetylcysteine for acetaminophen overdose: When enough is enough. Hepatology. 2007;46(3):939-941. [Article]

Number of Retail Prescription Drugs Filled at Pharmacies by Payer. 2018; Accessed October 18, 2018. [Report]

Officers A, Coordinators for the ACRGTA, Lipid-Lowering Treatment to Prevent Heart Attack T. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288(23):2998-3007. [Article]

Osland ST, Steeves TD, Pringsheim T. Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders. Cochrane Database Syst Rev. 2018;6:CD007990. [Article]

Pak CY. Correction of thiazide-induced hypomagnesemia by potassium-magnesium citrate from review of prior trials. Clin Nephrol. 2000;54(4):271-275. [Article]

Scheer FA, Morris CJ, Garcia JI, et al. Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial. Sleep. 2012;35(10):1395-1402. [Article]

Table 79. Prescription drug use in the past 30 days, by sex, race and Hispanic origin, and age: United States, selected years 1988–1994 through 2011–2014. [Report]

van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000;39(12):1383-1389. [Article]

Wilens TE, Prince JB, Spencer TJ, Biederman J. Stimulants and Sudden Death: What Is a Physician to Do? Pediatrics. 2006;118(3):1215-1219. [Article]

Yan M, Huo Y, Yin S, Hu H. Mechanisms of acetaminophen-induced liver injury and its implications for therapeutic interventions. Redox Biol. 2018;17:274-283. [Article]

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Disclaimer: The information provided on this website is for educational purposes only and does not constitute medical advice; the Content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a physician or other qualified healthcare professional with questions you may have regarding a medical condition. 

These statements have not been evaluated by the Food and Drug Administration.
These products are not intended to diagnose, treat, cure, or prevent any disease.

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