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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). Drug-induced nutrient depletions are almost never discussed. And yet they can be equally dangerous as the medications strip the body of crucial nutrients.

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 due to a drug-induced nutrient depletion. Their reaction? Prescribe another drug to suppress the symptom without actually correcting the underlying cause.

For example, decreases in some nutrients such as tryptophan, tyrosine, magnesium, iron, vitamins B6 and B12 and folic acid can cause depression. You may be taking medications that deplete the body of some of these nutrients. Your mood starts decreasing and no matter what you try to do to cheer yourself up, you realize you’re depressed.

So you make an appointment with your doctor. Instead of the doctor looking at a database or it even dawning on her or him that one of the medications you’re already taking depletes the body of nutrients and that low levels of those nutrients could be the underlying cause of your depression, you’ve prescribed an antidepressant.

The antidepressant then exacerbates the problem because those can have their own side effects, such as weight gain and decreased libido. When all along the easy fix was to simply to replenish the nutrients the original drug depleted.

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

  • Low vitamin B12 can cause peripheral neuropathy (numbness and tingling sensation in your hands or feet), anemia and depression.
  • Low folic acid causes anemia and depression.
  • Low magnesium causes irregular heartbeats and muscle spasms.
  • Low biotin causes brittle nails and hair.
  • Low iron causes fatigue, depression, difficulty processing and retaining information, hair loss and anemia.
  • Decreases in vitamin K can promote bone loss and osteoporosis. To learn more, read my article, Vitamin K and Fractures.

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 about the nutrients your drugs deplete.

Here are some of the most commonly prescribed medications and the nutrients they deplete.

Acetaminophen (Tylenol)

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 N-acetyl-cysteine that increase glutathione as well.

Acid Blockers

There are different ways that drugs deplete nutrients. They can decrease the absorption of nutrients, like acid-blocking medications. 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, thus changing its pH. But in doing so, they decrease the ability of your body to digest and absorb nutrients. These medications deplete people of vitamin B12, folic acid, minerals such as 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.

ADHD Medications

ADHD medications such as Ritalin and Concerta decrease appetite, and again can result in decreased consumption of nutritious foods. Over time that can set you up for nutritional deficiencies. These medications can also cause insomnia and rare heart arrhythmias (irregular heartbeats) that have been fatal. For more information on ADHD, see my article, 4 Simple Steps to Fix ADHD.

Antibiotics

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 deplete potassium.

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

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 and Corticosteroids

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.”11  

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%.

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

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,14 many people with insomnia discover that they have to take more and more melatonin to get the same effect. To learn more, read my article, Why Melatonin isn’t Enough.

Diuretics

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.

Hypoglycemics

Metformin (Glucophage, Glucophage XR and Glucovance) is used to regulate blood sugar in people with diabetes. Metformin has been shown to deplete vitamin B12 and cause anemia.

If none of the medications that I mentioned are ones you’re taking, I encourage you to do a quick Google search on the medication you’re taking and talk to our pharmacist. 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 my local pharmacists over the years, I can tell you that they love when people actually come up and ask them questions that they can go 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 good, broad-spectrum protection against many of these nutritional deficiencies, take a good multiple vitamin and mineral dietary supplement, such as Supreme Multivitamin, which I created for my patients.

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]

Zhao C, Shichi H. Prevention of acetaminophen-induced cataract by a combination of diallyl disulfide and N-acetylcysteine. J Ocul Pharmacol Ther. 1998;14(4):345-355. [Article]

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