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Drug-Induced Nutrient Depletions


Every day physicians write millions of prescriptions and patients dutifully go to their local pharmacies to get their medications. People trust their doctors and expect that the drugs they are instructed to take will make them well. Frequently things go as planned and people get better. On the other hand, the United States is the sickest country in the world. Our health care budget is approaching $2 trillion annually and in 1998 Americans spent $94 billion on prescription drugs. Instead of gaining health from all this money that is spent, we have the highest rate of chronic degenerative disease in the world. Obviously something is drastically wrong. One aspect of the problem may be explained in a recently published book titled The Drug-Induced Nutrient Depletion Handbook.

Medications deplete one or more nutrients in humans This book alerts health professionals and consumers to the fact that approximately 1,000 commonly prescribed prescription drugs and many over-the-counter (OTC) medications deplete one or more nutrients in humans. Could it be possible that millions of people are taking medications that unknowingly deplete their bodies of essential nutrients, which in turn creates more health problems? This article will discuss some of the issues surrounding this problem and review the major categories of drugs that cause nutrient depletions.

Studies reporting drug-induced nutrient depletions have been appearing in the scientific literature for decades. However, most of this information did not get publicized to health professionals or the general public. Literally hundreds of scientific studies remained buried in a myriad of scientific journals throughout the world. Now that all this research has been rounded up, organized and reported in one book, the topic of drug-induced nutrient depletions is beginning to receive the recognition that it deserves.

Commonly prescribed drugs that cause nutrient depletions include oral contraceptives, estrogen replacement therapy medications, anticonvulsants, anti-diabetic, anti-hypertensive, anti-inflammatory and antiulcer drugs, cholesterol-lowering drugs, beta blockers, phenothiazines, tricyclic antidepressants, benzodiazepines and antibiotics. In fact, last year's survey of prescription drug use reveled that 12 of the top 20 drugs prescribed in the United States in 1998 are drugs that cause nutrient depletions. Thus it is evident that this problem is affecting the lives and health of millions of people. Time and space limitations do not permit a thorough coverage of the health issues related to all of the drug-induced nutrient depletions. In this article we limit our in-depth coverage to two categories of commonly prescribed drugs, oral contraceptives and the antiulcer medications.

Fast-food restaurants provide nutritionally deficient meals Many people who regularly take medications may not be adversely affected by the nutrient depletions. However, consider the following facts. Millions of people regularly eat nutritionally-deficient meals at fast food restaurants. A nutritional survey sponsored by the U.S. Department of Agriculture reported that 80 percent of Americans do not consume the recommended dietary allowance (RDA) for one or more of the essential nutrients on a daily basis. Results from the government-sponsored National Health and Nutrition Examinations Survey (NHANES-II) revealed that 91 percent of Americans do not eat the suggested three servings of vegetables and two servings of fruits on a daily basis. In addition to these nutritional problems, many people also lead fast-paced, high-stress lifestyles, can't find time to exercise and live in a world where environmental pollution is at an all-time high. Now if we give drugs to people who are sick, which drugs further deplete their bodies of nutrients, it just increases the likelihood that additional health problems will develop. Now that I've provided an overview of the topic, let's take a detailed look at some of the drugs that cause nutrient depletions.

Oral Contraceptives

Back in the mid-1970's studies reporting that oral contraceptives depleted a variety of nutrients began appearing in the scientific literature. Numerous studies now document the fact that oral contraceptives deplete the following nutrients: folic acid, vitamin B6, vitamin B12, vitamin B2, vitamin C, magnesium and zinc.

Folic acid is one of the most commonly deficient nutrients in the American diet. This is partially due to the fact that people don't eat enough fresh green leafy vegetables. Folic acid plays a critical role in the production of DNA, which is our genetic code, and the manufacturer of new cells in the body. A deficiency of folic acid causes abnormal cells to be produced. Thus problems associated with folic acid deficiency are more likely to develop in areas of the body that have a high rate of cellular turnover. The bone marrow, which produces red blood cells, is one of these areas. Red blood cells have a life span of about 120 days. That means that our bone marrow must continually manufacture enough red blood cells to reproduce our entire blood supply every four months. If a woman becomes folic acid deficient, she is not able to produce enough red blood cells, which results in anemia. The symptoms of anemia include tiredness, weakness and lethargy.

Folic acid deficiency is also a major cause of birth defects such as spina bifida and cleft palate. Thus women who take oral contraceptives for years may be increasing their risk of giving birth to a malformed infant. In fact, the author of a study published in 1982 made the following statement: "Clinicians are advised to ensure that women who stop taking 'the pill' because they wish to conceive, have adequate stores of folic acid before becoming pregnant."

Another area of a woman's body with a high rate of cellular turnover is the uterus. Every month after menstruation the body must generate new cells to reproduce the uterine lining. If a woman is folic acid deficient, she likely to produce abnormal cells in the lining of uterus. What happens all too frequently is that women who go in for their annual PAP smear are told that abnormal cells have been identified. These abnormal cells represent a precancerous condition, which is called cervical dysplasia. Over 600,000 hysterectomies are performed on women in the United States each year. Many of these surgeries could probably be prevented if women were adequately nourished with folic acid. Since oral contraceptives are known to deplete folic acid, this obviously increases a woman's risk of developing cervical dysplasia, which could possibly result in a hysterectomy.

Folic acid is also one of three B vitamins that are necessary to metabolize homocysteine, which is an amino acid produced during the metabolism of methionine. Homocysteine is a toxic amino acid that normally gets converted to other substances very quickly. Inadequate folic acid causes blood levels of homocysteine is capable of damaging the arteries, which leads to atherosclerosis. In fact, elevated homocysteine is now recognized as one of the most serious risk factors to cardiovascular disease. Thus women who take oral contraceptives for years may be increasing their risk to heart disease. Other problems associated with folic acid deficiency include depression and increased risks to breast cancer and colorectal cancer.

Oral contraceptives deplete many essential nutrientsVitamin B6 is also depleted by oral contraceptives. Vitamin B6 functions as a cofactor in more than 100 enzyme reactions in the body. One of the reactions requiring vitamin B6 is the conversion of the amino acid tryptophan into the neurotransmitter serotonin. A deficiency of serotonin is strongly associated with depression. One study evaluating vitamin B6 depletion related to the use of oral contraceptives reported that one-third of the women were suffering from depression.

In another important biochemical pathway, serotonin is converted into melatonin. Melatonin is a hormone produced in the pineal gland that induces sleep and regulates the sleep/wake cycle. Thus a deficiency of vitamin B6 will also inhibit a woman's ability to synthesize melatonin, which is likely to cause insomnia. Vitamin B6 is also another one of the B vitamins required for homocysteine metabolism. Thus the depletion of vitamin B6 also increased a woman's risk of developing atherosclerosis.

Vitamin B12, which is also depleted by oral contraceptives, is the third of the B vitamins that is required for homocysteine metabolism. Thus birth control pills deplete all three of the B vitamins that are required for the metabolism of homocysteine. This means that if women who take oral contraceptives for an extended period of time are not adequately nourished with these B vitamins, they are likely to have a much greater risk of developing atherosclerosis later in life. This disease is a silent killer, which means there are usually no symptoms or warning signs until a heart attack or stroke happens. Other problems associated with vitamin B12 deficiency include anemia, depression, memory loss and neurological degeneration.

Oral contraceptives deplete many essential nutrientsStudies have reported that oral contraceptives use causes a significant decline in vitamin C levels. In one study women taking both high-dose and low-dose oral contraceptives were evaluated. The results revealed that these women had a decrease in serum levels of vitamin C ranging from 30 percent to 42 percent. Some of the problems associated with vitamin C deficiency include a weakened immune system, poor wound healing and easy bruising. Vitamin B2 is also depleted but its consequences seem to be minor compared to the potential problem depletions.

Oral contraceptives also deplete two minerals, magnesium and zinc. Magnesium is another nutrient that is frequently deficient in U.S. diets. One study reported that approximately 75% of Americans do not get the RDA for magnesium on a daily basis. Thus women taking birth control pills will be increasingly susceptible to becoming magnesium deficient. Magnesium deficiency can result in cardiovascular problems, osteoporosis, muscle cramps, weakness, insomnia, anxiety and depression.

One of the most frequent side affects associated with the use of oral contraceptives is the increases risk of blood clots. Magnesium depletion increases the risk of forming blood clots. Actually calcium and magnesium, working together, are one of the key mechanisms that regulate the blood clotting process. Calcium increases clotting while magnesium decreases clotting. Since oral contraceptives deplete magnesium, this creates an imbalance in the calcium/magnesium ratio, increasing the likelihood of creating side effects associated with clotting problems. As excess of calcium relative to magnesium can also cause skeletal problems. This is because the body beings to each magnesium out of the skeleton in an effort to keep the calcium/magnesium ration in the extra cellular fluid in balance.

Oral contraceptive-induced zinc depletion can result in a weakened immune system, poor wound healing and a loss of the sense of smell and taste. This concludes our review of the nutrient depletions associated with oral contraceptives.

Antiulcer Medications

In 1998 antiulcer medication was the largest selling category of drugs in the pharmaceutical industry, accounting for over $6 billion in sales in the United States. There are two main classes of anitulcer medications. The first group (cimetidine, ranitidine, famotidine and nizatadin) belong to a class of drugs known as the H-2 Receptor Antagonists or H-2 Blockers. More recently a class of drugs known as the proton pump inhibitors (omeprzole and lansoprazole) have become very successful. In 1998 omeprazole was the top selling prescription drug in the United States, accounting for nearly $3 billion in sales.

Antiulcer medications inhibit absorption of nutrients into the GI tractThese drugs function by lowering the amount of stomach acid, which can relieve the pain associated with heartburn, acid indigestion and ulcers. However the level of acidity in the gastrointestinal tract is a critical factor that regulates the absorption of many nutrients in the process of making the GI tract less acidic, antiulcer medications inhibit the absorption of various vitamins and minerals. Studies have reported that H-2 Receptor Antagonists deplete vitamin B12, folic acid, vitamin D and the minerals calcium, iron and zinc. Because of the proton pump inhibitors are a newer class of drugs, fewer studies have been conducted regarding nutrient depletions. To date vitamin B12 is the only drug that has been documented to be depleted by the proton pump inhibitors. There is an added concern regarding the H-2 Receptor Antagonists because the FDA has allowed them to be taken off prescription-only status. This means people can have unlimited access to these medications without any monitoring or advice from health professionals.

The possible health problems related to the depletion of folic acid, vitamin B12, and zinc> were mentioned earlier during the discussion of oral contraceptives. Additional nutrient depletions associated with antiulcer drugs include the following. Depletion of vitamin D could result in skeletal problems such as osteoporosis as well as muscle weakness, tooth decay and hearing loss. Problems associated with calcium depletion include osteoporosis, heart and blood pressure irregularities and tooth decay. Depletion of iron could result in hair loss, brittle nails and anemia, with accompanying feelings of weakness, fatigue and low energy.

The likelihood of developing health problems resulting from drug-induced nutrient depletion is compounded when an individual takes more tan one drug that depletes the same nutrients. For example, consider the plight of a woman on birth control pills who begins to regularly rely on H-2 Blocker drugs to treat her acid indigestion or an ulcer. Both drugs deplete folic acid, vitamin B12 and zinc. This just increases the risk that the depletion of these nutrients might become severe enough to create additional health problems.

We have been able to evaluate only two classes of drugs in this article. However each class of drugs has its own unique profile of depleted nutrients. Health professionals and people taking medications should become familiar with this topic. Nutritional supplementation can be used to prevent or overcome drug-induced nutrient depletions. In many case this can increase the effectiveness of a medication, reduce the incidence of side effects and contribute to a longer, healthier life.

[Ross Pelton, R.Ph.,Ph.D.,C.N.N., co-author of The Drug-Induced Nutrient Depletion Handbook, Total Health for Longevity, Vol. 21, Number 5]

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