More than 66% of Adults in the US take at least one prescription drug, accounting for $73 billion of total health care dollars as of 1998. The medication cost has continued to increase since then, but there is an often under-recognized higher cost associated with many popular pharmaceuticals. Both prescription and over-the-counter medications can affect the way your body absorbs nutrients.
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How Do Prescriptions Block Nutrient Absorption?
According to Oklahoma State University, "A drug-nutrient interaction is the effect of a medication on food or a nutrient in food." Medications interact with foods and nutrients in several ways including:
- Decreasing appetite by reducing the total nutrients obtained from a diet.
- Impacting the absorption of nutrients in the digestive tract.
- Accelerating the metabolism of certain nutrients.
- Impacting the excretion of nutrients.
10 Commonly Prescribed Medications & The Nutrients They Deplete
Pharmaceutical drugs can affect the nutritional status of patients and contribute to nutrient depletions, even when prescribed according to the label instructions. Our bodies require micronutrients (vitamins and minerals) for healthy cell function, immunity, growth, metabolism, and development. Micronutrient depletion can potentially cause the development of other underlying ailments and increased doctor visits if overlooked.
1. PPIs
PPI drugs target proton pumps and inhibit stomach acid production. These may temporarily reduce heartburn, but many patients heartburn returns due to lower stomach acid levels (hypochloridria), causing a continuous cycle of overprescribing different types of acid blocking medication.
Common Nutrient Depletions
Vitamin B12
Gastric acid inhibitors interfere with vitamin B12 absorption from food by slowing the release of hydrochloric acid (HA) into the stomach, leading to vitamin B12 deficiency.
Vitamin B12 needs proper hydrochloric acid levels to separate from dietary protein for intestinal absorption. Once separated, the freed vitamin B12 combines with a protein made by the stomach, called intrinsic factor, and the body absorbs them together. When HA is reduced, vitamin B12 can no longer be absorbed.
Luckily for us, the form of vitamin B12 in fortified foods and dietary supplements does not require gastric acid and proteolysis to liberate it from protein binding. Therefore B12 supplements are commonly recommended when on prescription antacids.
Folic Acid, Iron, and Zinc
Gastric acid secreted by the stomach is required for the body to absorb folic acid, iron, and zinc from food. When acid-reducing medications are used long-term, this decreases stomach acid production leading to deficiencies in these essential nutrients.
Calcium
Calcium is absorbed in the small intestine and requires stomach acid for the absorption process. Low stomach acid levels can have downstream effects, especially in the duodenum. A few observational studies have found an association between Proton-pump inhibitors (PPIs) and an increase in osteoporosis and bone fractures, particularly with the prolonged use of the medications.
Magnesium
Case reports of hypomagnesemia with chronic PPI use have been widely documented. In many cases, magnesium supplementation alone was not successful in reversing hypomagnesemia until PPI therapy was discontinued. The mechanism underlying hypomagnesemia secondary to PPI use is unknown, and no well-designed studies have been conducted to determine PPIs' effect on magnesium status accurately.
2. Antibiotics
Antibiotics can disrupt the bacteria in the gut, killing the "good" bacteria. These bacteria are beneficial and required for absorbing nutrients in the food we eat and manufacturing various enzymes and hormones. These disruptions can lead to micronutrient deficiencies due to decreased absorption from the food consumed.
Common Nutrient Depletions
B Vitamins, Potassium, and Biotin
Disruptions in the gut flora can cause low B vitamins, potassium, and biotin levels due to decreased absorption of these in the GI tract.
Calcium, Iron, Magnesium, and Zinc
When taken concurrently with antibiotics, absorption of both can be affected due to the formation of insoluble complexes.
Vitamin K
Vitamin K is made by the bacteria in the gut. Therefore imbalances in the gut bacteria can directly affect vitamin K levels.
3. Antipsychotics
Antipsychotic medications alter brain chemistry to help reduce psychotic symptoms like hallucinations, delusions, and disordered thinking. Most antipsychotic drugs block some of the dopamine receptors in the brain. This reduces the flow of these messages, which can help to reduce psychotic symptoms.
Common Nutrient Depletions
B Vitamins & Folic Acid & Inositol
For antidepressants to work optimally, an ongoing supply of the B vitamins must be available as co-factors to help manufacture the needed neurotransmitters, such as serotonin and dopamine. Antipsychotics, like lithium, can inhibit the absorption of B vitamins and folic acid, leading to lower levels in the body. There are many studies being done to figure out why this happens.
4. Anxiety Medications (Benzodiazepines)
Anti-anxiety medications help reduce anxiety symptoms, such as panic attacks or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night.
Common Nutrient Depletions
Calcium
These medications decrease calcium absorption by increasing vitamin D metabolism, which is needed for calcium absorption.
Melatonin
Long-term benzodiazepine therapy may impair the endogenous melatonin rhythm, which may induce or aggravate sleep disturbances.
5. Birth Control (Oral Contraceptives)
Hormonal contraceptives all contain a small amount of human-made estrogen and progestin hormones. These hormones inhibit your body's natural hormones to prevent pregnancy.
Common Nutrient Depletions
Vitamin B6
Tryptophan metabolism, an indirect measure of vitamin B6 status, is abnormal in oral contraceptive users. The theory is that estrogens may influence tryptophan metabolism.
Vitamin B12
Several studies have consistently reported serum B12 levels are lower in OC users compared to non-users. It is not entirely understood why but the medical theory is oral contraceptives affect circulating protein levels. They may alter circulating B12 binding proteins, indicating a "redistribution" of B12 rather than a depletion of B12.
Folate
Folate levels are decreased due to increased metabolism and urinary excretion of folate.
6. Blood Pressure Medications
Blood pressure medicines work in different ways to lower blood pressure:
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) keep your blood vessels from narrowing as much.
- Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels. This allows the blood vessels to relax.
- Diuretics remove extra water and sodium (salt) from your body. This lowers the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.
- Beta-blockers help your heart beat slower and with less force. This means that your heart pumps less blood through your blood vessels. Beta-blockers are typically used only as a backup option or if you also have certain other conditions.
Common Nutrient Depletions
COQ10
Several studies have consistently reported that statin treatment lowers serum CoQ10 levels in hypercholesterolemic patients, particularly the elderly, but the reasoning is still unclear.
Melatonin
Beta-blockers have been shown to reduce melatonin production via specific inhibition of adrenergic beta1-receptors. Beta-blockers induced central nervous system (CNS) side effects and the nightly urinary excretion of melatonin, demonstrating that the CNS side effects (sleep disorder, nightmares) while on beta blockers are related to reducing melatonin levels.
Zinc
ACE inhibitors may increase the risk of zinc deficiency. This effect is more pronounced with captopril than with other ACE inhibitors. The underlying mechanism may be due to the thiol-radical group in captopril that can chelate serum zinc and enhance its excretion.
Iron
ACE Inhibitor use can decrease iron levels. This is due to the down-regulation of nitric oxide synthesis. One study of people experiencing an "ACE Cough," a common side effect of the medication. Supplementation with iron ameliorated the cough.
Potassium
Calcium channel blockers, beta-blockers, & ACE inhibitors are known to deplete potassium levels. Although the medical community is not sure why many studies are currently observing the effects and treatments are based on individualized results.
7. Statins
Statin drugs lower LDL cholesterol by slowing down the liver's production of cholesterol. They also increase the liver's ability to remove LDL cholesterol already in the blood.
Common Nutrient Depletions
COQ10
Statins inhibit the HMG CoA reductase enzyme, a key enzyme in the synthesis of coenzyme Q10 (CoQ10). There is some evidence that supplementation can help boost levels and lessen the effects of statins on Coenzyme Q 10 levels.
8. Corticosteroids
Corticosteroids are synthetic compounds that mimic the effects of hormones naturally produced in the body by adrenal glands. They relieve inflammation, pain, and discomfort resulting from various health conditions.
*Note: If you have troublesome side effects after taking corticosteroids, don't stop taking your medication until your doctor says it's safe to do so because of the possibility of these unpleasant withdrawal effects. Your dose may need to be reduced slowly over a few weeks or months, and you may have to have tests to ensure that your adrenal glands are still working correctly before stopping corticosteroids altogether if you have been taking them for a long time.
Common Nutrient Depletions
Calcium & Vitamin D
Corticosteroids decrease the number and function of bone cells and inhibit the intestinal absorption of calcium and Vitamin D. Decreased calcium and vitamin D levels further increase the risk of bone fractures, which is more common in people with chronic steroid use.
Electrolytes
Electrolytes like sodium and potassium are depleted with steroid use due to increased excretion of these minerals.
9. Oral Hypoglycemics
Oral hypoglycemic drugs are used to treat type 2 diabetes, a disorder involving resistance to secreted insulin.
Common Nutrient Depletions
B12
Metformin blocks the absorption of vitamin B12 through a mechanism that has not been established, but scientific theories say it interferes with the calcium-dependent binding of the intrinsic factor vitamin B12 complex to the receptor in the terminal ileum.
10. Diuretics
Diuretics deplete the body of nutrients through increased excretion of these minerals through their diuretic effect on the kidneys. Supplementation is often required to maintain normal electrolyte and mineral balance.
Common Nutrient Depletions
Sodium
Diuretics are one of the most common causes of severe hyponatremia.
Diuretics depend on sodium to help remove water from your blood and increase sodium in the urine. This decreases the amount of fluid flowing through your veins and arteries and reduces blood pressure.
Magnesium, Potassium, and Zinc
Loop and thiazide diuretics deplete magnesium, potassium, and zinc.
Folic acid
Amiloride is a potassium-sparing (prevents excess loss of potassium) diuretic drug. One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.
Calcium
Thiazide diuretics reduce calcium excretion by the kidneys and may increase the risk for hypercalcemia, metabolic alkalosis, and possible renal failure.
How to Lower the Risk of Drug-Nutrient Interactions
Mytavin is an evidence based website created by medical professionals that can help you identify which nutrient depletions are commonly caused by pharmaceuticals. Knowing your risk can help you have a better conversation with your healthcare professional about the possibility of testing for micronutrient deficiencies as well as continuous monitoring to help prevent and treat any deficiencies uncovered.
Summary
Pharmaceutical medications not only carry the risk of side effects but can also deplete vital nutrients from the body.
Understanding the interactions between drugs and nutrients can help prevent nutrient depletions in patients. Further, optimizing the nutritional status of patients may positively impact the intended therapeutic effects of the medications administered, improving outcomes.
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