A Practical Approach to Avoiding Drug-Nutrient Depletions

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 prescription drugs.

Pharmacists and doctors talk about the common side effects of medications, such as nausea, potential increased risk of fractures (some osteoporosis medications), and weight gain (antidepressants). However, drug-induced nutrient depletions are rarely 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 caused by 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 at further risk of more nutrient depletions and 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 pharmacists 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 anti-inflammatory 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 it like it’s candy.

How does it cause liver failure? It depletes the liver of glutathione. Glutathione is a nutrient and antioxidant the liver requires to detoxify acetaminophen (Tylenol) and many other substances. When your body lacks enough glutathione to process toxins, free radicals, 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 without taking Tylenol chronically. However, glutathione is available as a dietary supplement, and other nutrients, like probiotics, support healthy glutathione.

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. Even though these medications are approved only for short-term use, people have been taking them for years.

These drugs suppress 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 vitamin D, B12, folic acid, and minerals such as magnesium, iron, and zinc. They’ve also been shown to increase hip fracture risk in people with osteoporosis, dementia, and cancer. 

Antibiotics

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

Nutrients depleted: Probiotics (e.g., 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 and 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). Tetracyclines deplete calcium and magnesium 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. One study showed that gentamicin increased calcium excretion by 5% and magnesium excretion by 8.4%.

Antibiotics can disrupt the body’s microbiome, which is the mix of bacteria in the gut. They indiscriminately kill bacteria, so along with the bad bacteria, good bacteria are 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 antipsychotics (Abilify, Zyprexa, Seroquel, Risperdal) 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, increasing your sugar cravings. 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, it can cause nutrient depletion.

Beta-blockers

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

Nutrients depleted: Melatonin

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

Melatonin helps us fall asleep, is an antioxidant, and plays essential roles in immune health. When melatonin decreases, people have trouble falling asleep. 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. 

Bisphosphonates

Examples: Alendronate, risedronate, ibandronate, pamidronate, and zoledronic acid.

Nutrients depleted: Vitamin K (specifically, the MK4 form of vitamin K2). CoQ10, and vitamin E (as gamma-tocopherol).

Nitrogen-containing bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronate (Reclast, Zometa) block the biochemical pathway that produces MK4, CoQ10, and vitamin E. Studies have shown that women taking these medications have low vitamin K, and decreased CoQ10 and gamma-tocopherol (a specific type of vitamin E).

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

Cholesterol medications are prescribed to lower cholesterol and reduce cardiovascular disease risk. They fall into two categories. Those that block the production of cholesterol include statin medications (e.g., atorvastatin, lovastatin, etc.) and those that block the intestinal absorption of cholesterol. This category contains statin medications, such as Lipitor (atorvastatin), Crestor, Zocor, and Mevacor. While they are effective at decreasing cholesterol, 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 various conditions, including inflammatory and autoimmune diseases, including lupus, Crohn’s disease, ulcerative colitis, rashes, asthma, and arthritis. They’re also now used to treat the acute phase of coronavirus infections.

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, Osteo-K Minis, and Osteo-MK4 provide calcium and vitamin D, plus the clinically validated amount of MK4 (45 mg/day) shown to stop  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, including drugs like furosemide and hydrochlorothiazide, are prescribed to treat high blood pressure. They increase urine production and excretion, but with the urine also come lots of nutrients. These include B vitamins, vitamin C, magnesium, calcium, and zinc. To help, take Supreme Multivitamin to supplement these nutrients with healthy amounts. A note of caution is warranted here. Do not take potassium or magnesium with any diuretic without first speaking with your healthcare 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 your medications and talk to our pharmacist and doctor. Pharmacists are some of the most underutilized healthcare resources in our medical system. They are incredibly well-educated, knowledgeable professionals who usually sit behind the counter, filling prescriptions. From my many conversations with pharmacists over the years, I can tell you that they love when people ask them questions 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. 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, and for the clinical trial dose of MK4 take one my bone support products, which I created for my patients.

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Last updated January 19, 2025.