Medications and Nutrient Depletion

According to a YouGov survey, there are currently over 30 million people in the UK taking prescribed medications – this equates to 56% of the population.

Medications and Nutrient Depletion

According to a YouGov survey, there are currently over 30 million people in the UK taking prescribed medications – this equates to 56% of the population.1 It has been established that some medications can affect the absorption or utilisation of vitamins, minerals and other nutrients, which can lead to nutrient deficiency and some of the short- and long-term side effects.

Statins

Statins are prescribed for high cholesterol and work by affecting the production of cholesterol in the liver. However, several studies have also shown that they can deplete the production of a substance called co-enzyme Q10 (CoQ10).2,3 This depletion of CoQ10, which is essential for the production of energy in cells, is associated with the development of muscle pain, tenderness and fatigue in around a third of those using these medications.4 Supplementing with CoQ10 has been shown to help maintain CoQ10 levels without affecting the benefits of statins.5

Paracetamol

Paracetamol when used chronically for pain can lead to the depletion of glutathione in the liver. Glutathione is required to bind to a toxic by-product of paracetamol and convert it to a harmless compound which can easily be excreted.6 When glutathione levels are depleted, this can lead to a build-up of the toxic metabolite, which can damage liver cells.7 N-acetyl cysteine (NAC) is commonly used for paracetamol overdose in hospitals as it increases glutathione.8 Some medical professionals have raised concerns about paracetamol toxicity, even at normal therapeutic levels, and there have been calls to package paracetamol with NAC to reduce toxicity.9

The contraceptive pill

The contraceptive pill has been linked to lower levels of some of the B vitamins including B2 (riboflavin), B6, B9 (folate) and B12.10,11,12 This appears to be due to a number of factors including reduced absorption and conversion and increased excretion and requirements.13 The contraceptive pill may also affect the gut microbiome,14 which may also have an effect on nutrient absorption. Some of the side effects of depletion include migraine and headaches (B2),15 fatigue (B12) and PMS and breast tenderness (B6).16,17 The biggest concern however is for those who stop the contraceptive pill when they start trying to conceive; evidence indicates that 90% of women of childbearing age have folate levels low enough to increase the risk of neural tube defects,18 and levels will be further depleted by the use of the contraceptive pill.

Antibiotics

Antibiotics work by either killing bacteria, or by inhibiting their replication, affecting cell walls and DNA.19 However, they will affect good bacteria in the gut as well, and this can cause symptoms with up to a third of the people who take an antibiotic developing antibiotic associated diarrhoea (AAD).20 Whilst symptoms are normally mild, they can still be disruptive and can even occur up to 2 months after medication use.21 Probiotic yeasts such as Saccharomyces boulardii are relatively unaffected by antibiotics22 and studies have suggested that they can reduce the incidence of AAD by 50%, with reductions of 47% in duration of AAD and 37% in symptom severity.23

Anti-depressants

Anti-depressants work in different ways depending on the class they belong to. Some, such as SSRIs or tricyclic antidepressants (TCAs) work by increasing the level of the mood hormone serotonin in the brain by stopping its uptake, whilst others such as MAO-inhibitors prevent the breakdown of serotonin. Both SSRIs and TCAs are correlated with lower levels of active vitamin D in the body,24,25 suggesting their use might affect the processing of this nutrient. Furthermore, those with low mood may spend less time outside,26 therefore leading to a decrease in synthesis of vitamin D in the skin and may have a poor diet or appetite leading to a decreased intake.26 There certainly seems to be a bidirectional relationship between mood and vitamin D, as low vitamin D has been associated with low mood and supplementation appears to be beneficial.27

Insulin

Those taking insulin for diabetes have been shown to be lower in magnesium,28 as both high glucose and high insulin will increase urine volume and reduce the ability of the kidneys to reabsorb minerals. General population data shows that 70% of women and 50% of men do not consume enough magnesium in their diets and having low magnesium has been linked to poorer glucose control, decreased insulin sensitivity and an increased risk of developing complications. Magnesium deficiency has been linked to the development of atherosclerosis where plaque (fats, cholesterol, calcium) builds up, hardening and narrowing arteries, significantly increasing risks for heart attacks, strokes, and peripheral artery disease, especially in people with long-standing diabetes.

Metformin

Metformin, a medication used for type-II diabetes, has been shown to reduce the absorption and use of vitamin B12 in the body29,30 via several different mechanisms including affecting a compound called intrinsic factor which is essential for B12 absorption.29 Low B12 can be linked to nerve health issues, and those on metformin have an increased risk of developing this condition,30,31 which is already a common side effect of diabetes. Studies suggest that taking B12 alongside metformin may reduce this risk.30,31

Antacids and proton pump inhibitors (PPIs)

Antacids and proton pump inhibitors (PPIs) such as omeprazole are frequently used to decrease stomach acidity: antacids work for short periods by neutralising acid, whilst PPIs reduce stomach acid production for longer periods. Adequate acid is required for the assimilation and absorption of several nutrients: it facilitates the conversion of dietary iron to a more readily absorbed form;32 it is required for the release of B12 from food and for B12 to be absorbed;33 and minerals such as calcium, magnesium and zinc require an acidic environment to be released from food, made soluble and absorbed. Studies have shown that deficiencies of these nutrients may be an issue for those taking PPIs long term,33,34,35,36 which may then affect energy, nerve health, cognition and bone health.

If you have concerns it is advisable to speak with your Healthcare Professional, GP or Pharmacist, who can advise you further on using supplements alongside your medications.

References

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