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Many people all over the world take prescription medications to control their condition. They faithfully take their pills two or three times a day, just like the doctor “ordered” and believe they are doing the best they can for their health.
In 2002, according to the US Center for Disease Control (CDC) 73% of American adults (aged 55-64) were taking at least one prescription medication a day. In addition, the CDC has found that the rate of multiple prescription use over the past 10 years has increased from 25% to 31%. The use of 5 or more drugs per day has increased from 6% to11%. And….in 2008, 1 out of every 5 children and 9 out of 10 adults had used at least one prescription drug in the past month! 

Well, the first question that pops into MY mind is….are we really all that sick?  20% of children and 90% of adults? Really?  But, let’s leave that for another time. For now, let’s look at what the most commonly prescribed drugs are and what nutrients they may be depleting….and how to protect your loved ones from these types of nutrient depletions.

So, what were the most common prescriptions? For children, they were asthma medications. For adolescents, it was central nervous system stimulants.  For the middle aged adult, antidepressants were the most prescribed drugs. For older adults, cholesterol lowering drugs won the prize. First we will cover general concepts—in another article, we will get more into the most commonly prescribed drugs.

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This is a real problem—one way you can tell is because there is a term (and acronym) for it—the term is Drug-induced nutrient deficiencies (DINDs). Many physicians are unaware of the problem—and the longer a person takes a medication, the greater the problem, and the danger. The situation isn’t limited to drugs, either. Recently, denture adhesive makers had to change their formulations because of this problem—zinc oxide was removed because the zinc was depleting copper in many people—and there are the lawsuits to prove it!

How do drugs deplete nutrients?

There are a number of ways that nutrients can be depleted by drugs. 

The first is by interfering with how a particular nutrient gets digested.  Orlistat (Xenical), for example is designed to decrease the amount of fat that can be absorbed.  The simple fact is we need certain fats in our diet and while it may aid in weight loss, the “good” fats don’t get absorbed either—and overall health may suffer. 

The second way DINCs occur is by decreasing the availability of the nutrient.  The aminoglycoside antibiotic, Neomycin, decreases the amount of vitamin K and zinc available. 

Third, a drug can also increase the loss of nutrients by increasing excretion by either the intestines or the kidneys. One example of a class of drugs that increase intestinal loss is the glucocorticoids, which increase the loss of calcium.  Diuretics (water pills) increase the loss of a variety of minerals in the urine.

The fourth way that DINCs occur is by impaired storage—zinc interferes with the storage of copper, for example. 

Finally, nutrients can be lost by the interference of a drug in the metabolism or the biochemistry of a particular nutrient—methotrexate, an anti-cancer drug and an immune suppressor, interferes with folate metabolism—and folate deficiency during pregnancy can lead to birth defects.  Folate deficiency can also result in diarrhea, depression, mental confusion and anemia. There is actually another way—but we don’t understand it, so we just call it “idiosyncratic actions”—meaning the way that nutrients are depleted are unique to that specific drug. Another factor to keep in mind is that some drugs (like Orlistat) interfere with macronutrients—like fats. Other drugs can interfere with micronutrients such as vitamins and minerals.
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Interference with Fat and Carbohydrate Absorption

I mentioned Orlistat and its interference with fat absorption.  Now, it should be remembered that this is the main goal of Orlistat—it is meant to help with weight loss by decreasing the amount of fats absorbed. Symptoms of DINC would include diarrhea and fatty stools (steatorrhea).  Along with the macronutrient loss of fats, patients on Orlistat need to be aware that they may be deficient in the fat-soluble vitamins such as vitamins A, E, K and D.

Another class of drug that affects a macronutrient includes the anti-diabetes drugs miglitol (Glyset)  and acarbose (Precose).  Both of these are inhibitors of enzymes that are required for carbohydrate digestion. Again, as they are meant to decrease blood sugar in diabetics, they are performing as they are supposed to.  The problem that occurs with both these classes of drugs is if you or your physician are unaware that they are working too well.

Fat soluble vitamins can be lost and a person can become deficient with a number of different drugs. Again, Orlistat (Xenical) can cause deficiencies in the fat soluble vitamins A, E, D and K. 

Mineral oil—used to aid in constipation can also decrease the amounts of these vitamins. 

Cholestyramine, a cholesterol lowering drug can do this as well—particularly affecting vitamins E and K. 

Also included on the list of drugs that can cause deficiencies of fat soluble vitamins are the anti-seizure drugs phenytoin (Dilantin), carbemazepine (Tegretol) and phenobarbital—these mainly decrease vitamin D.

Drugs that can deplete water-soluble vitamins

The water-soluble vitamins include all the B-complex vitamins and vitamin C.  These can be depleted by a variety of drugs including diuretics (water pills) such as furosemide, bumetanide, ethacrynic acid and torsemide; proton pump inhibitors (PPIs) and H2-blockers used to treat acid reflux and GERD; the anti-seizure drugs and drugs that are used to treat rheumatoid arthritis such as methotrexate and sulfasalazine. 

The symptoms involved in these depletions depend on the specific vitamin that is depleted. For example, if thiamin (vitamin B1) is depleted, one symptom may be congestive heart failure—a new case or a worsening condition.

If vitamin B12 is depleted, the symptoms can range from anemia to gastrointestinal to neurological symptoms. Niacin deficiency can range from outright pellagra (red, glossy tongue, sensitivity to sunlight, hair loss, skin rashes, confusion, heart conditions, dementia) to skin rashes and insomnia and muscle weakness. 

Pyridoxine (vitamin B6) deficiency symptoms can include anemia, nerve disorders (tingling and/or numbness), seizures, skin rashes, and mouth sores.

Drugs that can deplete minerals

The main culprits here are the water pills (diuretics) that many people take to control their blood pressure, antiviral medications such as Foscarnet (phosphonoformate),  and immune suppressors such as tacrolimus and cyclosporine. 

The minerals most commonly depleted are sodium (Na), magnesium (Mg) and potassium (K) by diuretics, and magnesium by immune suppressors and antivirals. 

Symptoms again may vary depending on which mineral is depleted but can affect the muscles, the nerves, the heart and the lungs.  Calcium (Ca) levels, in particular, must be kept within very narrow ranges by the body. 

A number of different drugs can affect calcium levels—these include the bisphosphonates used to treat osteoporosis, anti-seizure medications, aminoglycosides (antibiotics), and proton pump inhibitors.

In recent years, it has become increasingly obvious that the minerals a human needs is critical not only for strong bones and teeth, the nervous system or for the cardiovascular system but for overall health and well-being. 

Vitamin B6 for example is used to treat PMS  and migraines —but it works much better if magnesium levels are sufficient. The immune system is also critically dependent on sufficient mineral levels. 

Trace Minerals: Zinc, Copper and Selenium and How to Tell if the Medications Deplete Nutrients?

Diuretics, corticosteroids and other drugs can deplete some of the vital trace minerals as well.  Three of these important trace minerals are zinc, copper and selenium.

Zinc and copper are “competitors” in the sense that too much zinc in the diet can decrease copper levels. Zinc deficiency, on the other hand can lead to sleep and behavior disturbances, delays in wound healing, skin disorders, hair loss, loss of taste and/or smell and a host of symptoms related to the immune system—problems in GI immunity (inflammatory bowel diseases have an immune component), increased allergies, an under-reactive immune system and other inflammatory disorders.

Copper deficiency can show up as general fatigue, paleness, skin sores and rashes, edema, loss of appetite, slowed growth, hair loss and diarrhea. A deficiency in copper can result in blood disorders, a type of anemia and bone problems. 

Yet another mineral, selenium, is particularly important as the immune system fights off vital infections. Certain antioxidant proteins require selenium as part of their structure to function properly. Selenium and iodine are also required by the thyroid gland—and without an optimally functioning thyroid gland, a whole host of problems, including immune problems can often occur.  Selenium deficiency is widespread - often in areas where the soil is deficient and therefore produce grown in that soil is deficient. If selenium is then depleted by various drugs, serious immune problems, increased inflammation (because of a decrease in antioxidant activity) and possibly seizures can result.


How can I tell if the medications I am using are depleting nutrients?

First, talk to your doctor—also, talk to your pharmacist.  I have found that pharmacists are an absolute goldmine of information and these are areas that they would have loads of information on.

There are a number of databases out there with this sort of information—often, they are only available by subscription to professionals, so talk to a doctor or pharmacist willing to do the research for you! If you and your doctor have determined that the medication is necessary, often, all that you need to do is to supplement with the particular nutrient that is depleted. 

Knowledge is power, and in this case, knowledge can be a health-saver!