Medication-Induced Nutrient Deficiencies
Author: Grant Hosking
Thanks to the commercials that provide a seemingly endless list of side effects for many medications, most people are aware that taking medications can cause changes in your body that are not the intended result of the medication.
These changes, called side effects, can take many different forms, including side effects caused by the drug itself, side effects caused by interactions between the drug and supplements you may be taking, and side effects caused by interactions between two different medications.
Although most people are aware that side effects can occur, many do not realize that medications can also cause nutrient deficiencies, which are less obvious.
Medication-induced nutrient deficiencies (MINDs), also known as drug-induced nutrient deficiencies (DINDs), are very common, particularly among people who take multiple medications.
Why Medication Side Effects Occur
As noted above, there are many different reasons why side effects occur. Side effects can be caused by the drug itself, caused by interactions between the drug and other supplements you may be taking, and caused by interactions between multiple medications. The human body is complex and interconnected, so making medications that impact just one part of the body without affecting other parts is very challenging.
Each individual has a different body composition and reacts to medications in a different way, so drugs that cause no side effects in one person may cause undesirable side effects in another. In order to be approved by the U.S. Food and Drug Administration (FDA), manufacturers must list all of the possible side effects of their medication.
How likely a side effect is to occur is influenced by four major factors:
- Dosage of the medication
- Individual reactions to certain ingredients in a medication
- A medication killing unwanted cells and also destroying healthy cells
- Interactions between drugs or substances
Side Effects Caused by the Drug Itself
Side effects caused by the medication itself are often linked to the dosage of the medication or individual reactions to certain ingredients. These include common side effects like vasoconstriction, nausea, gastrointestinal distress, dizziness, drowsiness, dry mouth, headache, skin rash, and more.
Sometimes, these side effects can be reduced by changing the dose of the medication or taking a different drug to address the condition. Certain medications can impact insulin resistance or sensitivity, which may cause a person to crave carbohydrates.
Side Effects Caused by Drug-Supplement Interactions
Although many people are familiar with interactions between two types of medications, not everyone is aware that supplements you may be taking and foods you may be eating can also cause side effects when combined with certain medications.
For example, statins are a class of medications that are used primarily to lower cholesterol levels. However, when eating a high fat diet while taking statins, your cholesterol levels are likely to increase.
Similarly, some herbs can cause interactions with medications. St. John’s Wort, a popular herb used to improve memory and support mood, can interact with antidepressant medications and provoke a hyperactive mood in people with bipolar disorder.
It’s important to give your doctor a complete history of all medications, herbs, and supplements that you are taking in order to prevent side effects and unsafe interactions.
Side Effects Caused by Drug-Drug Interactions
Interactions between medications can be serious. These drug-drug interactions occur when two drugs interact, potentially causing dangerous or inconvenient side effects.
Drugs can interact with both prescription medications and over the counter medications. Over the counter medications can be purchased without a prescription and are generally deemed safe for use by the public, but they can be harmful when taken in excess or in combination with other drugs.
For example, aspirin is an anti-inflammatory medication that can act as a blood thinner and shouldn’t be combined with certain other medications, like warfarin, because they increase the risk of experiencing bleeding and bruising.
One key component that impacts how a patient responds to certain medications is cytochrome P450, or CYP450, metabolism. CYP450 enzymes are used by the body to metabolize more than 90 percent of medications, and a patient’s ability to metabolize certain medications is linked to genetic variability in CYP450 enzymes.
Certain medications can either limit or increase the activity of CYP450 enzymes, which can cause potentially serious interactions between medications. CYP450 metabolism issues are often associated with warfarin, antidepressants, antiepileptic drugs, and statins.
As a result, use of these medications and certain other drugs can impact the absorption of some nutrients, causing medication-induced nutrient deficiencies.
Nutrient Deficiency and What It Looks Like
Nutrient deficiency is extremely common in the United States, even amongst people who eat plenty of calories.
While it is possible to be malnourished due to not eating enough food, most people experience nutritional deficiencies because they do not receive enough vitamins, minerals, and other nutrients through their daily diets.
According to the Centers for Disease Prevention and Control (CDC), micronutrients are vitamins, minerals, and other nutrients that are critical for healthy development, disease prevention, and wellbeing but are only required in relatively small amounts. The body cannot produce most micronutrients on its own and must receive them from diet.
Unfortunately, as noted above, certain medications can impact the body’s ability to effectively absorb nutrients from the foods that we eat, potentially causing nutrient deficiencies even in people who receive plenty of nutrients through their daily diets.
The Most Common Nutrient Deficiencies
Nutritional deficiencies vary around the world as a result of the availability of different types of foods, and they vary from person to person based on age, diet, and a number of other factors.
However, some nutrient deficiencies are especially common.
Common nutrient deficiencies include:
- Vitamin D
- Vitamin B12
- Vitamin A
Iron deficiency affects more than 25 percent of the population worldwide, making it one of the most common nutritional deficiencies. Women and children, particularly pregnant women, are especially likely to experience iron deficiency, as are those that consume a plant-based diet.
People deficient in iron are most likely to experience anemia, which is a condition in which the number of red blood cells and your body’s ability to carry oxygen decreases. Symptoms include feelings of fatigue, weakness, reduced brain function, and a weakened immune system.
Approximately one third of the world’s population is deficient in iodine. Countries that mandate the enrichment of table salt with iodine have reduced rates of iodine deficiency, but it is still common. The most common symptom of low levels of iodine is an enlarged thyroid gland, or goiter. Some people with iodine deficiency can also experience weight gain, an increased heart rate, or shortness of breath.
Approximately 42 percent of people in the United States are estimated to be deficient in vitamin D. Vitamin D deficiency is especially common in people who live far from the equator, as the body can create vitamin D when exposed to enough sunlight (about 15 minutes per day). Vitamin D deficiency is usually experienced as muscle weakness, bone loss, and an increased risk of fractures, and children may experience stunted growth or soft bones.
Vitamin B12 deficiency most commonly occurs in people who follow a plant-based diet and older adults. An estimated 80 to 90 percent of vegans and vegetarians are deficient in vitamin B12 because the vitamin is only found in large quantities in animal products, so receiving enough can be difficult on a plant-based diet. An estimated 20 percent of older adults are deficient in vitamin B12 because the body’s ability to absorb the vitamin decreases with age. The most common symptoms of a vitamin B12 deficiency include megaloblastic anemia (a condition in which the red blood cells become enlarged), impaired brain function, and elevated homocysteine levels.
Calcium is one of the most important minerals in the body, but low calcium intake is common. The body uses calcium to create strong bones and teeth and to maintain bone strength, as well as signal the heart, muscles, and nerves to function properly. The most common symptom of calcium deficiency is reduced bone density, including osteoporosis or osteopenia.
Vitamin A deficiency is more common in some parts of the world than others. While most people in the United States receive enough vitamin A from their diets, vitamin A is extremely common in developing countries. The body uses vitamin A to help create and maintain healthy skin, bones, teeth, and cells and also promotes healthy vision. Vitamin A deficiency can cause eye damage that can be permanent is the world’s leading cause of blindness. Deficiency can also suppress immune function.
It is estimated that about half of the population in the United States does not receive enough magnesium through their daily diets. The body uses magnesium to create strong and healthy bones and teeth, and the mineral is used for hundreds of different cellular reactions in the body. Because magnesium is involved in so many different cellular reactions, deficiency can cause a wide range of symptoms, including abnormal heart rhythm, restless leg syndrome, migraines, muscle cramps, and fatigue.
Other Factors That Contribute to Nutrient Deficiencies
In addition to taking in too few nutrients through diet alone or taking a medication that impacts how nutrients are absorbed, different lifestyle factors can also contribute to nutritional deficiencies.
Many of the medications that impact nutrient absorption and utilization are taken for chronic diseases that can substantially impact lifestyle, including dietary restrictions and health.
For example, people taking statins for high cholesterol may need to modify their dietary choices in order to control their fat intake, which can impact the receipt and absorption of fat-soluble vitamins. Someone suffering from depression and taking antidepressants may have difficulty getting out of bed to spend time outside in the sun, limiting vitamin D intake, and may struggle to find the energy to exercise.
While diet plays an important role in your nutrition, living an overall healthy lifestyle is also important in order to ensure overall health and wellbeing.
Examples of Common MINDs
Now that you know that taking certain medications can cause nutrient deficiencies, it’s time to explore some of the most common medication-induced nutrient deficiencies. Some of the most commonly used medications on the planet, and especially in the United States, are prone to causing medication-induced nutrient deficiencies, including metformin, statins, and warfarin.
Metformin and B12
Metformin, a generic medication that is sometimes sold under the brand name Glucophage, is the most commonly prescribed medication in the world for the treatment of Type 2 diabetes, and it can induce a nutrient deficiency of vitamin B12. Metformin belongs to a class of medications called biguanides and works in three ways to lower the blood sugar of patients with diabetes.
First, metformin lowers the liver’s production of glucose. Next, the medication increases target cell insulin sensitivity. Finally, it reduces the absorption of glucose by the gastrointestinal tract. Each of these mechanisms increases the body’s sensitivity to insulin, a hormone that helps the body convert glucose in the blood to energy and lowers blood sugar levels.
Vitamin B12 is essential for the proper formation of red blood cells in the body and also plays a role in maintaining normal brain and nerve function.
When metformin is used long term, it can contribute to increased levels of homocysteine and a deficiency in vitamin B12.
One study found that the risk of experiencing a vitamin B12 deficiency increases by 13 percent each year of total metformin use and elevated levels of homocysteine are likewise increased.
Symptoms of a vitamin B12 deficiency can include numbness, tingling in the feet, memory problems, fatigue associated with anemia, loss of appetite, and weight loss.
Statins and CoQ10
Statin medications are another of the most commonly prescribed classes of drugs in the world; they are used to lower the activity of HMG CoA, an enzyme that is responsible for producing cholesterol.
Thanks to their action on HMG CoA, statins are effective at lowering the levels of low-density lipoprotein, or LDL, which is a type of cholesterol that can cause damage to the blood vessels and cardiovascular system. People also use statins to reduce the risk of cardiovascular disease and stroke, even if they do not have high cholesterol.
While statins are helpful, life-saving medications for many people, they can also reduce a patient’s ability to synthesize coenzyme Q10, or CoQ10.
CoQ10 is an antioxidant that is naturally produced by the body as a byproduct of cellular respiration, and it helps protect the cells and DNA from damage caused by free radicals.
Patients without adequate levels of CoQ10 can experience a condition called oxidative stress, in which chronic inflammation and many serious diseases are more likely to occur.
Because statins inhibit the HMG CoA reductase enzyme to lower cholesterol levels, CoQ10 levels can also be impacted because HMG CoA is also needed to synthesize CoQ10.
This is especially problematic because our body’s ability to produce CoQ10 declines as we age, and older people are more likely to take statin medications.
CoQ10 deficiency is commonly associated with symptoms like muscle weakness, low energy levels, reduced cognitive ability, and premature signs of aging on the skin, like fine lines, wrinkles, and sunspots.
Warfarin and Vitamin K
One potentially dangerous interaction between medications and nutrients is the interaction between warfarin and vitamin K. Warfarin, sold under the brand name Coumadin, is one of the most common blood thinners on the market and is popular because of its effectiveness and low cost. People take warfarin to reduce their risk of developing blood clots, which can cause a heart attack, stroke, deep vein thrombosis, or pulmonary embolism.
Vitamin K is an essential vitamin that helps clot the blood to prevent wounds from bleeding excessively.
Vitamin K and warfarin work against each other, as warfarin tries to prevent the blood from clotting excessively and vitamin K encourages the blood to clot.
When taking warfarin, it is essential to take the same amount of vitamin K each day and limit excessive intake of foods that are high in vitamin K, such as kale, spinach, broccoli, brussels sprouts, and other leafy greens. Changing the amount of vitamin K that you take in can cause warfarin to work differently in the body, which is why doctors recommend keeping your vitamin K intake consistent.
Patients who take in large amounts of vitamin K are more likely to need extra warfarin to work effectively, while patients who eat less may need to take less warfarin.
Patients who become deficient in vitamin K can experience excessive bleeding, poor bone development, osteoporosis, and an increased risk of cardiovascular disease.
Common MINDS Reference Chart
Although the medications listed above are some of the most commonly experienced medication-induced nutritional deficiencies, other medications can also cause nutrient depletion.
- Proton pump inhibitors like Nexium, Prevacid, and Prilosec and vitamin B12 and magnesium
- H2 antagonists like Tagamet and calcium, folic acid, iron, vitamin B12, and vitamin D
- Antibiotic medications and calcium, magnesium, potassium, vitamin K, and some B-complex vitamins
- Antipsychotic medications and vitamin B2 (riboflavin)
- Benzodiazepines like Ativan and Xanax and calcium
- Oral contraceptives (birth control) and folic acid, magnesium, and vitamin B6
- ACE inhibitors and zinc
- Calcium channel blockers and potassium
- Corticosteroids and calcium and magnesium
- Diabetes medications and folic acid
- Digoxin and calcium, magnesium, phosphorous, potassium, and vitamin B1
- Diuretics and magnesium, potassium, and sinz
- Hormone replacement therapy and folic acid, magnesium, vitamin B6, and vitamin B12
The Solution to MIND
If you’re just now learning about the impact that medications can have on nutrients in your body, you’re not alone. Medication-induced nutrient deficiencies have been a recognized problem for years, but many patients are unaware of the nutritional challenges that can come with taking their medication.
However, the solution to managing medication-induced nutrient deficiencies isn’t to stop taking your medication. After all, many of the medications mentioned above, including statins, warfarin, and metformin, are life-saving medications that patients need to take in order to stay healthy.
Instead, the first step in managing medication-induced nutrient deficiencies is to educate yourself about possible deficiencies.
When speaking to your doctor or pharmacist about your medication, make sure to ask if there are any nutrient deficiencies associated with your medication that you should be aware of.
Speak to your healthcare provider about your current diet, and ask them if supplementing your existing diet with a nutritional supplement designed to address your medication’s specific nutrient deficiencies might be right for you. While talking to your healthcare provider is the first step in preventing medication-induced nutrient deficiencies, it isn’t the last.
Make Sure You Know What Nutrient Deficiencies You’re At Risk For
As noted above, make sure that you talk to your healthcare provider about any new or existing medications that you are taking. However, doctors and pharmacists may not always be aware of medication-induced nutrient deficiencies, particularly when it comes to the interactions between multiple medications and your body’s nutrients.
Therefore, it is critical that you keep a running list of prescriptions and over the counter medications that you are currently taking, as well as any herbs or dietary supplements that you are consuming.
As noted above, your diet can also play a role in how your medications work in your body, so be prepared to consider and evaluate your daily nutrient intake for different vitamins and minerals, such as vitamin K.
Regardless of what your healthcare provider has to say about possible nutrient deficiencies that could result from your medication, it’s recommended that patients do their own research as well. New studies are constantly being produced to evaluate medication-induced nutrient deficiencies, and it is unrealistic to expect your healthcare provider to be completely up to date on all the new studies for every medication that they prescribe.
By doing your own research (using data from reputable sources) and keeping track of your medications, you may notice connections between your medications and nutrient deficiencies that your doctor could miss.
If you note anything that could have an impact on your health, don’t hesitate to ask your healthcare provider about what you may have found. Registered dietitians may also be able to help identify potential interactions and possible nutrient deficiencies caused by your medications.
Use Supplements with Pure, Clean, High-Quality Ingredients
Once you’ve identified potential medication-induced nutrient deficiencies for which you might be at risk, it may be time to consider adding a dietary supplement to address any deficiencies and help you feel your best.
While taking a supplement is easy, not all supplements are created equally.
If you want to get the most for your money and ensure that your body is getting the vitamins and minerals it needs, take the time to research supplements and choose one that contains only pure, high-quality, clean, bioavailable ingredients that your body can actually use.
Why Bioavailability is Important
One of the most important things to consider when choosing a nutritional supplement is the bioavailability of the ingredients. Bioavailability can be defined as the proportion of the nutrients that are digested, absorbed, and metabolized through normal pathways.
To put it in simpler terms, it is the amount of the nutrient that your body is actually able to use compared to the amount that is delivered.
There are a variety of factors that influence the bioavailability of specific ingredients, but among the most important is the form in which the nutrients are delivered.
Unfortunately, it is common for dietary supplement manufacturers to use the least expensive, synthetic, commonly available form of nutrient in their products because it keeps costs down while making the labels of their products look impressive. After all, if a label claims that a supplement contains 500 percent of the daily value of a particular vitamin or mineral, that must be a good thing, right?
If the body is unable to properly absorb and metabolize the nutrient, it is meaningless. That’s why it is essential to choose a dietary supplement that includes bioavailable forms of the nutrients you need.
When choosing a dietary supplement, look for supplements that contain nutrients in the following forms:
- Vitamin K2 instead of vitamin K1
- Active vitamin D3 instead of inactive vitamin D2
- Folate or methylfolate instead of folic acid
- Methylated B-complex vitamins instead of synthetic B-complex vitamins
As a rule of thumb, look for supplements that list vitamins and minerals in their chelated forms (i.e. folate versus folic acid), as these forms facilitate better absorption of the nutrients by the body.
Choosing High Quality Ingredients
Once you’ve made the decision to invest in your health by taking a dietary supplement to address medication-induced nutrient deficiencies, you want to maximize the benefit to your body by choosing a supplement that is made with high quality ingredients.
However, many supplement labels are intentionally vague in order to prevent consumers from knowing the origin of the ingredients. This is because most supplement manufacturers use synthetic ingredients that are not readily absorbed by the body.
The first step to choosing a high quality supplement with pure, clean ingredients is to check out the label.
Look for products that clearly list the sources of their nutrients and are free of artificial flavors, sweeteners, chemical binders, additives, and colors that serve as filler.
With food sensitivities on the rise worldwide, it also makes sense to look for products that are free of common allergens like yeast, dairy, gluten, soy, corn, caffeine, and peanuts.
Look for products that are produced in an FDA-registered facility in order to facilitate transparency, and consider choosing products that are stamped with a CGMP or GMP logo, which guarantees that the product has been manufactured in accordance with the FDA’s Current Good Manufacturing Practices. These practices were created by the FDA in order to promote quality manufacturing, avoid the presence of contaminants, ensure accurate labeling, and provide added accountability for the consumer.
If you’re one of the millions of people who takes medications each day to keep you healthy, you may be at risk of experiencing medication-induced nutrient deficiencies. While taking your medication may be essential to your health, you don’t have to live with nutrient deficiencies as a result.
Common medication-induced nutrient deficiencies include:
- Vitamin B12 deficiency caused by metformin
- CoQ10 deficiency caused by statin medications
- Vitamin K deficiency caused by warfarin
By educating yourself about possible medication-induced nutrient deficiencies that you could be at risk for experiencing, it is possible to make dietary changes or add dietary supplements in order to address these concerns and ensure optimum health.
Before running to the pharmacy to pick up the first multivitamin you can find, however, it’s necessary to do your research and learn about your medications, possible nutrient deficiencies, and supplements that can help.
When choosing a dietary supplement to address medication-induced nutrient deficiencies, make sure you choose a product that contains only high-quality, pure, clean, bioavailable ingredients. Choosing a supplement that contains vitamins and minerals in their active forms will help your body more readily absorb and utilize these ingredients, helping to address your nutrient deficiency in the process.
Talk to your healthcare provider about nutrient deficiencies that could be caused by your medications, but make sure to do your own research as well and keep a running list of the medications you are currently taking, including both prescription and over the counter medications, as well as herbs and supplements.
You might need your medications to stay healthy, but you don’t need the nutrient deficiencies that can accompany the long term use of certain medications.
Your health is in your hands, and it is possible to find a supplement to address any medication-induced nutrient deficiencies you might be experiencing.