Nutrient Loss from Common Drugs: JM Lorentzen, D.O. Internal Medicine, PC
Type of drug
Name brand examples
Nutrients depleted
Acid reducing drugs:
Antacids
Ulcer treatment
Maalox, gaviscon, mylanta
Prilosec, prevacid, nexium tagamet,
zantac, pepcid, axid
Calcium, phosphorus, vit. D
Vit. B12
Iron, zinc, folic acid
Antibiotics:
penicillins (amoxicillin)
cephalosporins (Keflex)
quinolones (cipro)
tetracyclines (doxycycline)
Beneficial intestinal bacteria
Biotin, inositol, potassium vit.k,
Vitamins B1 B2 B6 B12
Calcium, magnesium, iron
Anti-inflammatories:
NSAIDs
Steroids
aspirin (bayer, ascription, bufferin)
ibuprofen (advil, motrin), naproxen
(aleve, anaprox, naprosyn) voltaren,
dolobid, lodine
prednisone, cortisone,
dexamethasone
Vitamin C, folic acid, iron, potassium
Cardiovascular drugs:
ACE inhibitors
Beta blockers
altace, capoten, monopril, lotensin,
zestril, vasotec
corgard, Inderal, lopressor,
tenormin, betapace, zebeta
Zinc
Diuretics:
Loop diuretics
Thiazide diuretics
Potassium sparing
Potassium sparing +
Thiazide diuretic
lasix, burinex, edecrin
hydrochlorothiazide, diurel,
lozol, microzide, zaroxolyn, enduron
triamterene (dyrenium),
spironolactone (aldactone)
triamterene & hydrochlorothiazide
(dyazide, maxzide)
Calcium, magnesium, potassium,
sodium, B1, B6, zinc, vitamin C.
Coenzyme Q10, magnesium,
phosphorous, potassium, sodium,
zinc.
Calcium, folic acid, zinc.
Calcium, coenzyme Q10, folic acid,
magnesium, sodium, B6, zinc.
Cholesterol lowering:
Statins
Bile acid sequestrants
Fibrates
Lipitor, crestor, Zocor, pravachol,
lescol
questran, colestid
lopid, tricor, gemcor
Coenzyme Q10
Beta-carotene, calcium, folic acid,
iron, magnesium, phosphorous, vit
A, B12, D, E
Coenzyme Q10, vitamin E
Anti-Diabetic Drugs:
Metformin (Glucophage,
glucovance)
Sulfonylureas (diabinese, amaryl,
Glucotrol, diabeta, micronase,
glynase)
Vitamin B12, folic acid, coenzyme
Q10
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Vitamin C, D, folic acid, calcium,
magnesium, potassium, selenium,
zinc
coenzyme Q10, reduced production
of melatonin
Coenzyme Q10
Hormone therapy:
HRT
Oral contraceptives
Conjugated estrogens (Premarin,
prempro, ogen) estradiol (climara,
vivelle, divigel, estrogel, evamist)
Ortho-novum, triphasil, alesse ,
ortho-cept, lo/ovral
Magnesium, B2, B6, vitamin C, zinc
Folic acid, magnesium, tryptophan
& tyrosine, B2, B3, B6, B12, Vitamin
C, zinc
*Data adapted from: Drug-Induced Nutrient Depletion Handbook, 2nd edition
Drug Type
Acid reducing drugs
Antibiotics
Anti-inflammatories
Cardiovascular drugs
Diuretics
Anti-Diabetic Drugs
Potential Problems and Symptoms Associated
Anemia, weakness, fatigue, increased cardiovascular disease risk,
osteoporosis, irregular heartbeat, elevated blood pressure birth defects,
hearing loss, hair loss, brittle nails, slow wound healing
short term use may not cause significant nutrient depletion however
alteration in gut microflora can lead to dysbiosis hampering digestion
and absorption of nutrients and weakening of immune health
Birth defects, cervical dysplasia, anemia, cardiovascular disease, blood
pressure abnormalities, anemia, muscle weakness, fatigue, edema,
lowered immunity, easy bruising, poor wound healing, osteoporosis
ACE inhibitors: (depletion of zinc) slow wound healing, loss of sense of
smell & taste, lowered immunity
Beta-blockers: (depletion of Q10) high blood pressure, congestive heart
failure, low energy
Calcium depletion with all except thiazide type; osteoporosis, irregular
heartbeat, blood pressure changes.
Magnesium depletion with all except triamterene; cardiovascular
problems, asthma, osteoporosis, cramps, PMS.
Potassium depletion with loop and thiazide types; irregular heartbeat,
muscle weakness, fatigue, edema.
B1 deficiency with loop diuretic; depression, irritability,
Memory loss, muscle weakness, edema. B6 deficiency (loop, HCTZ &
triamterene); depression, sleep disturbance, increased cardiovascular
disease risk. Vitamin C (loop diuretic); weakened immune system, easy
bruising, poor wound healing. Zinc (all classes); slow wound healing, loss
of sense of smell and taste, lower immunity. Co-Q10 (all but loop type);
high blood pressure, congestive heart failure, low energy. Folic acid
(triamterene); birth defects, cervical dysplasia, anemia, cardiovascular
disease. Phosphorous (thiazide only); stunted growth, skeletal
problems, increased tooth decay.
Deplete Co-Q10; high blood pressure, congestive heart failure, low
energy. Vitamin B12 depletion; anemia, fatigue, weakness, increased
cardiovascular disease risk. Folic acid depletion; birth defects, cervical
dysplasia, anemia, increased risk of cardiovascular disease.
*Data adapted from: Drug-Induced Nutrient Depletion Handbook, 2nd edition.
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Female Hormones:
A few words about oral contraceptives and nutrient depletion are in order given the large
number of women taking these products. There is a large body of literature published on the
nutrients depleted by the ingestion of the estrogen in oral contraceptives. Unfortunately there
is much less research on hormone preparations used to treat the symptoms associated with
menopause.
Based on what we do know we should be diligent to replace these lost nutrients as many of the
reported adverse outcomes can be directly related to nutrient depletion. In addition, all
hormones are not the same, the type of estrogen product, other hormones given with the
estrogen product and the way the hormone is given all impact outcomes. People are different,
what works for one individual may cause unwanted symptoms, minor or more severe, in
another. There is no short cut to making certain that the hormone product you are taking is the
right one for you. Your body knows the answer to this question, trust it. If you don’t feel right,
something is not right.
Estrogen enhances magnesium utilization and uptake by soft tissues and bone. This may be
one mechanism by which estrogen promotes cardiovascular and bone protection. This
mechanism can have deleterious outcomes when estrogen is high (in estrogen dominance
states induced by the use of hormones or in states of hormone imbalance) and magnesium
intakes are low or excessive losses of magnesium are occurring. The lowering of magnesium
can alter the calcium/magnesium ratio favoring blood clotting. Suggesting menopausal women
(or women on oral contraceptives) take calcium supplement without also supplementing
magnesium increases the potential risk of thrombosis (inappropriate blood clotting).
Intake of the estrogen used in oral contraceptives (ethinyl estradiol) and women using
conjugated estrogens (premarin, prempro, ogen) lead to a disturbance in tryptophan
metabolism and to a deficiency of B6. The resulting symptoms are depression, sleep
disturbances and an increase in cardiovascular disease risk.
Depression is a fairly common symptom among oral contraceptive users. In addition to the
multiple nutrient losses (if left without replenishment), is the loss of testosterone. This
happens because oral contraceptives increase a protein called sex hormone binding globulin,
this protein attaches to testosterone keeping it from binding to its receptor – basically
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rendering it useless – resulting in a loss of well-being and depression. Testosterone is thought
of as a male hormone but women make testosterone and need it to help support healthy
hormone balance. It is particularly important for energy and stamina, lean body mass, skin
health and of course interest in sex. Women may suffer from similar symptoms even if they are
not taking hormones. Aging and stress (among other things) can decrease testosterone and its,
companion, DHEA. These two hormones are collectively referred to as androgens and are an
important part of hormone balance.
Other well documented nutrient depletions include: folic acid (oral contraceptives) with a
potential for birth defects, cervical dysplasia, anemia and increased risk for cardiovascular
disease; vitamin B2 (oral contraceptives, estrogen replacement) problems with skin, eyes,
mucous membranes and nerves; vitamin B3 (oral contraceptives) skin, gastrointestinal, nervous
system problems; vitamin B12 (oral contraceptives) anemia, tiredness, weakness, increased
cardiovascular disease risk; vitamin C (oral contraceptives, estrogen replacement) weakened
immune system, easy bruising, poor wound healing; zinc (oral contraceptives, estrogen
replacement) slow wound healing, loss of sense of taste and smell and lowered immunity.
From this list it is easy to see why it is important to take a good multiple vitamin and mineral
supplement. A high quality product will contain the proper balance of B vitamins, C, zinc,
magnesium and calcium.
Menopausal women need extra calcium and magnesium. (Calcium 1000 - 1200mg and
magnesium 400 – 600mg). I recommend calcium citrate as an inexpensive easy to absorb form.
Magnesium may cause loose stools particularly if taken in one dose. If loose stools occur when
using one of the more absorbable types the dose should be divided and taken 2 or 3 times daily
instead. There are a number of different forms of magnesium with variable absorption.
Magnesium glycinate and magnesium amino acid chelate are examples of easily absorbable
types. It is usually suggested that the calcium/magnesium ratio be 1 to 1 or 2 to 1, depending
upon individual needs. I frequently ask people to take their additional calcium and magnesium
at bedtime because it helps with relaxation making it easier to fall asleep.
To this recommendation I would also add: supplement with vitamin D 400 IU – 4,000 IU (or
more with medical supervision). The amount needed will depend on sun exposure, stress, body
weight); an omega 3 fatty acid supplement (specifically to obtain EPA & DHA in the amount of
1,000 – 2,000mg daily) unless you eat fish 3 times weekly. Also, you may benefit from
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additional iodine if you have fibrocystic breasts or uterine fibroids. A probiotic supplement or
foods containing live active cultures of friendly bacteria (fermented or cultured foods, kefir, and
yogurt) are also essential to maintaining a healthy happy body.
Foods that heal: Foods containing a compound called indole-3-carbinol facilitate the favorable
metabolism of estrogen breakdown by increasing the formation of the cancer-inhibiting
metabolite 2-hydroxyestrone, and decreasing the formation of the carcinogenic metabolite, 16alpha-hydroxyestrone. (This is true if you are using some type of estrogen containing product or
are producing your own). Human papilloma virus (HPV) infection increases the production of
estradiol to the cancer promoting estrogen metabolite, 16-alpha-hydroxyestrone. There is a
strong association between cervical dysplasia (cervical intraepithelial neoplasia – CIN) and HPV.
A number of published studies demonstrate improvement with the use of indol-3-carbinole.
One human study showed complete remission of the abnormal cells in approximately 50% of
the women with cervical dysplasia. Studies used 200 and 400mg/day: 200mg would be 7
ounces of raw cabbage or Brussels sprouts daily. Cauliflower and broccoli are rich sources of
indole-3-carbinol as well but there is no quantitative data available on their indole-3-carbinol
content. Note: approximately 20% of the indol-3-carbinol is lost after boiling the vegetables for
10 minutes.
Even if you are not concerned about estrogen metabolism, cruciferous vegetables are felt to
enhance the removal of carcinogens by enhancing certain liver enzymes. Now these are foods
that heal – so don’t forget to add these vegetables to your daily diet! I recommend two
servings or more daily for healthy liver function.
Restoring lost nutrients:
Probiotics: Antibiotics designed to kill harmful bacteria also kill the “innocent bystanders” in
your intestinal track. The friendly bacteria are essential for proper digestion and production of
key nutrients and the maintenance of a healthy immune system. Healthy bacterial flora also
helps process cancer causing toxins from the body. It has been said that there is approximately
3 pounds of bacteria living in the human intestine. Lactobacillus acidophilus is the primary
beneficial bacteria in the small intestine and Bifidobacteria Bifidum or Bifidus is the primary
bacteria inhabiting the large intestine. When there is an imbalance in the beneficial bacteria
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from antibiotic use, diets low in fiber, high in sugars, alcohol and processed grains, a condition
called dysbiosis develops. This is a chronic condition that insidiously steals good health and
promotes a multitude of chronic medical maladies by promoting inflammation and altering
immune health. I see very few people in my practice that are not impacted in some way by
this. Symptoms include bloating, gas, diarrhea or constipation, bad breath, chronic or recurrent
yeast infections, fatigue, headaches, muscle pain, joint pain, weight gain, food sensitivities, and
skin problems such as eczema and acne.
Foods that heal: Yogurt – containing “live active cultures”, plain – without added sweeteners
or fruits. Add your own fresh fruit, not only is it packed with vital nutrients but you will avoid
the sweeteners that can actually upset healthy intestinal flora. Sweetened yogurts are not
good sources of beneficial bacteria. Kefir is a type of fermented milk that contains good
bacteria strains. Fermented or cultured foods like sauerkraut also promote healthy flora and
proper digestion.
Magnesium: The importance of this mineral cannot be over stated, it is sited as the most
common nutrient deficiency in this country. Magnesium is responsible for over 300 enzymatic
reactions in the body. It is essential for the conduction of nerve impulses, muscle activity,
temperature regulation, detoxification and the formation of healthy bone and teeth. It plays a
critical role in the body’s production of energy.
Deficiency symptoms can include weakness, muscle cramps, osteoporosis, anxiety, depression,
fatigue, high blood pressure, headaches, irregular heart rhythm – from simple to life
threatening, kidney stones and insomnia. Magnesium deficiency is sited as a cause of heart
attack occurring in people with normal hearts (Magnesium deficiency allows levels of calcium to
increase, which can cause heart muscle spasm). It is reported to be a common deficiency in
diabetics, supplementing with magnesium can improve blood glucose control. Other symptoms
and conditions that may improve with supplemental magnesium include: asthma, menstrual
pain and cramping, hypoglycemia, leg cramps, migraines and premenstrual syndrome.
Foods that Heal: Green vegetables are excellent sources of magnesium, nuts and seeds, whole
unrefined grains and certain legumes – beans and peas – are also good sources. Kelp,
blackstrap molasses, brewer’s yeast, tofu and beet greens contain significant amounts of
magnesium.
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Supplement: 300 – 600mg daily for most people with doses up to 1000mg for some depending
upon depletion of this nutrient. It is available in pill form, powder, liquid and injection.
Magnesium can also be absorbed through the skin as a lotion or gel – or my personal favorite is
to use Epsom salt in my bath (magnesium sulfate). Just poor 1 – 2 cups in your tub, this is great
for sore muscles, relaxation and sleep. Try this 1 – 2 hours before bed for a great night’s sleep.
Calcium: The body contains more calcium than any other mineral. The majority is used in
the development and maintenance of teeth and bone tissue, the rest plays a critical role in
blood clotting, muscle contraction and nervous system function. The body goes to great
lengths to keep adequate calcium available which may cause removal of calcium from the bone
where greater than 95% of calcium is stored in the body. Calcium absorption decreases with
age beginning at around age 60 which is felt to be largely due to vitamin D deficiency. Although
excreted mostly through urine and feces, calcium is also excreted in the sweat and highly active
individual can lose significant amounts through that route.
Deficiency symptoms include muscle cramps, heart palpitations, brittle or soft bone, tooth
decay, insomnia, nervous disorders, rickets, osteoporosis and osteomalacia. Deficiency may
also contribute to or improve the following: high blood pressure, obesity, premenstrual
syndrome, brittle nails, periodontal disease, hypercholesterolemia and vulvodynia (calcium
citrate).
Foods that Heal: Good nondairy sources include kelp, bok choy, mustard, collard and turnip
greens, almonds, sesame seeds, sunflower seeds, broccoli, brewer’s yeast, ripe olives,
garbanzo beans, soybeans and tofu. Fish such as salmon – mackerel - sardines canned with
bones contain significant amounts of calcium.
Supplement: Calcium citrate and calcium gluconate are easy to digest and can be taken
without a meal. In general people supplementing with calcium should also supplement with
magnesium. There is considerable conflict in medical literature concerning optimal calcium
intake. Plaque formation in arteries - calcium deposits in other tissues, are likely due to excess
doses taken alone - without adequate magnesium, vitamin D (or excess D) K and other
supportive nutrients. Mother Nature does not like monopolies. Adequate intake for calcium
developed by the food and nutrition board recommends 1,200mg per day for males and
females 51 and older. Age 19 – 50, 1,000mg per day. The amount needed as supplement
depends upon diet and factors that may be robbing the body of calcium. Certain prescription
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drugs as well as excess carbonated beverages and caffeine need to be considered in calcium
balance.
Vitamin B12: This vitamin can be stored in the liver so deficiency states develop slowly. B12
deficiency might not be recognized until it is severe enough that anemia results although
deficiency states lead to many neurologic changes and increase cardiovascular disease risk.
Individuals at highest risk for B12 deficiency are the elderly; strict vegetarians and those taking
medication that inhibit B12 absorption.
Deficiency symptoms include depression, confusion, and memory loss, fatigue, peripheral
neuropathy, and numbness, sensation of “pins and needles” in the arms and legs, poor blood
clotting, loss of appetite, nausea, vomiting, and dermatitis. B12 works reduce homocysteine (in
cooperation with folic acid). Elevated homocysteine, an inflammatory product of metabolism,
contributes to heart attack risk, stroke high blood pressure and dementia.
Foods that Heal: Fruits, vegetables, grain and legume do not contain B12. Organ meats are the
best source of B12, followed by clams, oysters, beef, eggs, cow’s milk and blue cheese.
Fermented foods may contain small amounts of B12 depending upon manufacturing practices
observed in producing the particular product – the content will vary. Nutritional yeast (brewer’s
yeast), spirulina (micro-algae loaded with nutrients including protein) and wild blue-green algae
are other sources.
Supplement: purchase as the “active” form – methylcobalamin. This is available as an oral
supplement or the type that dissolves under the tongue. Other forms are transdermal patches,
gels or injectable forms. Dose recommendations: 500 mcg – 1000 mcg for general health; for
those on medications depleting B12, use 1,000 – 2,000 mcg per day. It is difficult to overdose
on B12, but make sure to take a good multiple vitamin or quality B-complex supplement while
supplementing with B12.
Coenzyme Q10: One of the most important nutrients in the body it is synthesized in the cells
of all living organisms, there are ten coenzyme Q compounds in nature, only Q10 is synthesized
in humans. The biosynthesis of CoQ10 is a 17 step process requiring several B vitamins, vitamin
C and numerous trace elements. A deficiency in any of the necessary nutrients can impair
production. It is likely that anyone with chronic health problems is suffering from a deficiency
of CoQ10.
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Deficiency symptoms include: congestive heart failure, high blood pressure, stroke, heart
arrhythmias and cardiomyopathy. Deficiency states negatively affect the heart as the heart
muscle is the most energy demanding muscle in the body. Other symptoms include fatigue,
gingivitis, and weakening of the immune system.
This is a major concern; people that have a tendency to receive prescriptions for drugs that
deplete oQ10 likely have diminished ability to produce CoQ10 in the first place. Nutrient
deficiencies from poor diet over time coupled with significant stress lead to inflammation and
health problems like high blood pressure, diabetes and elevated cholesterol. The prescription
drugs further deplete CoQ10 production leading to a metabolic free fall. How is a body to heal?
This is a great supplement to take if you suffer from symptoms of most any type chronically.
Once you supplement with CoQ10 (and companion nutrients found in a good multiple vitamin)
you may need lower doses of your prescription medication.
Foods that Heal: Copper containing foods including organ meats, oysters, shellfish, dark green
leafy vegetables, unrefined whole grains, legumes, nuts and chocolate.
Supplement: For general health, 30 – 50mg once or twice daily. Individuals taking drugs that
deplete Co Q10 have gingivitis or fibromyalgia take 100 – 200mg daily. Most CoQ10 comes in
an oil based capsule for better absorption make sure to take with meal(s).
Ubiquinol is the easiest form of CoQ10 to absorb but is more difficult to locate and costs more.
The other form is ubiquinone; it is converted by the body to the active form, Ubiquinol. It is
difficult to take too much CoQ10 as it is considered quite safe even in large doses (up to 800mg
or more in some studies)
For more information about prescription drugs and the nutrients they deplete:
Supplement Your Prescription, What Your Doctor Doesn’t Know About Nutrition. Hyla Cass, M.D.
Drug Muggers. Suzy Cohen, RPh
Drug-Induced Nutrient Depletion Handbook. 2nd Edition
Nutritional Medicine. Alan Gaby, M.D.
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