Drug-Induced Nutrient Deficiencies

Your patients may or may not know that the medications they’re taking could be harming them. In fact, a large number of prescription medications deplete the body of vital nutrients. This can lead to unwanted side effects and can potentially worsen chronic conditions.

You are in an ideal position to counsel patients on prescription and over-the-counter (OTC) medications that cause nutritional deficiencies. You can help your patients who are on these medications maintain a healthy nutritional status by recommending the appropriate OTC products to boost levels of nutrients.

Here are the 10 most common types of nutrient-depleting medications along with the nutrients your patients should look for in OTC products to get their levels back on track.

Proton Pump Inhibitors (PPIs)

PPI medications target proton pumps and inhibit stomach acid production. While they might temporarily reduce heartburn, many patients’ heartburn returns due to lower stomach acid levels and causes a continuous cycle of overprescribing different types of acid-blocking medication.

The common nutrient depletions from taking PPIs are:

  • Vitamin B12: Gastric acid inhibitors slow the release of hydrochloric acid (HA) into the stomach and interfere with vitamin B12 absorption from food.
  • Folic Acid, Iron, and Zinc: Long-term use of acid-reducing medications decreases stomach acid production and leads to deficiencies.
  • Calcium: Calcium is absorbed in the small intestine and requires stomach acid for the absorption process. Some studies have found an association between proton-pump inhibitors (PPIs) and an increase in osteoporosis and bone fractures, especially with prolonged use of the medications.
  • Magnesium: Chronic PPI use has shown reports of hypomagnesemia. Supplements weren’t successful in reversal until PPI therapy was discontinued.


The “good” bacteria inside the gut can be killed off by taking antibiotics. These bacteria are beneficial for nutrient absorption in the food we eat. Therefore, disruptions can lead to micronutrient deficiencies due to decreased absorption from the food consumed.

The common nutrient depletions from taking antibiotics are:

  • B Vitamins, Potassium, and Biotin: Disruptions in the gut flora can cause low B vitamins, potassium, and biotin levels due to decreased absorption of these in the GI tract.
  • Calcium, Iron, Magnesium, and Zinc: Taken concurrently with antibiotics, absorption of both can be affected.
  • Vitamin K: Because vitamin K is made by the bacteria in the gut, imbalances in the gut bacteria can affect vitamin K levels.


These medications alter brain chemistry to help reduce psychotic symptoms, such as hallucinations, delusions, and disordered thinking. Because antipsychotic drugs block some of the dopamine receptors in the brain, the flow of these messages is reduced, which can help to reduce psychotic symptoms.

The common nutrient depletions from taking antipsychotics are:

  • B Vitamins, Folic Acid, and Inositol: Antipsychotics, like lithium, can inhibit the absorption of B vitamins and folic acid and lead to lower levels in the body. So, an ongoing supply of B vitamins need to be available as co-factors to help manufacture the needed neurotransmitters, such as serotonin and dopamine.

Anxiety Medications (benzodiazepines)

For patients who suffer from panic attacks or extreme fear and worry, anxiety medications reduce those symptoms. Benzodiazepines enhance the activity of the neurotransmitter GABA, a brain chemical that helps you feel calm. However, their effect also produces drowsiness, which makes it easier to fall asleep and stay asleep.

The common nutrient depletions from taking anxiety medications are:

  • Calcium: Anxiety medications decrease calcium absorption by increasing vitamin D metabolism. Vitamin D is needed for calcium absorption.
  • Melatonin: Taking benzodiazepine long term can impair the endogenous melatonin rhythm. This can induce or aggravate sleep disturbances.

Birth Control (oral contraceptives)

All hormonal contraceptives contain a small amount of human-made estrogen and progestin hormones. These hormones inhibit the body’s natural hormones to prevent pregnancy.

The common nutrient depletions from taking oral contraceptives are:

  • Vitamin B6: Tryptophan metabolism, an indirect measure of vitamin B6 status, is abnormal in those who take oral contraceptives.
  • Vitamin B12: Lower levels are found in oral contraceptive users. The medical theory is they affect circulating protein levels.
  • Folate: Levels decrease due to increased metabolism and urinary excretion of folate.
  • Magnesium: Estrogen is responsible for depleting magnesium.

Blood Pressure Medications

These medications work in different ways to lower blood pressure, so there are several types of depletions that can take place.

The common nutrient depletions from taking blood pressure medications are:

  • CoQ10: Statin treatment lowers serum CoQ10 levels in hypercholesterolemic patients, especially the elderly. It’s still unclear why.
  • Melatonin: Beta-blockers have been shown to reduce melatonin production through specific inhibition of adrenergic beta 1 receptors. Central nervous system side effects of sleep disorder and nightmares while on beta blockers are related to reduced melatonin levels.
  • Zinc: ACE inhibitors may increase the risk of zinc deficiency. The effect is more pronounced with captopril than with other ACE inhibitors.
  • Iron: Due to the downregulation of nitric oxide synthesis, ACE inhibitor use can decrease iron levels.
  • Potassium: Calcium channel blockers, beta-blockers, and ACE inhibitors are known to deplete potassium levels.


Statin drugs slow down the liver’s production of cholesterol and lower LDL cholesterol. They’re also known for increasing the liver’s ability to remove LDL cholesterol already in the blood.

The common nutrient depletion from taking statins is:

  • CoQ10: The depletion of CoQ10 can lead to serious side effects, including muscle pain and weakness, depression, and heart failure.


Corticosteroids relieve inflammation, pain, and discomfort resulting from various health conditions.

The common nutrient depletions from taking corticosteroids are:

  • Calcium and Vitamin D: Corticosteroids decrease the number and function of bone cells. They also prevent the absorption of calcium and vitamin D.
  • Electrolytes: Electrolytes like sodium and potassium are depleted with steroid use due to increased elimination of these minerals.

Oral Hypoglycemics

Oral hypoglycemic drugs are used to treat type 2 diabetes.

The common nutrient depletion from taking oral hypoglycemics is:

  • B12: Metformin blocks the absorption of vitamin B12. However, it hasn’t yet been established how.


Diuretics deplete the body of nutrients through increased excretion of these minerals through their diuretic effect on the kidneys.

The common nutrient depletions from taking oral diuretics are:

  • Sodium: Diuretics depend on sodium to help remove water from your blood and increase sodium in the urine.
  • Magnesium, potassium, and zinc: Loop and thiazide diuretic action interferes with magnesium, potassium, and zinc.
  • Folic acid: One study has shown that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.
  • Calcium: Thiazide diuretics reduce calcium excretion by the kidneys and might increase the risk for hypercalcemia, metabolic alkalosis, and possible renal failure.

(Source: rupahealth.com)

By setting yourself up as the drug expert and recommending the appropriate vitamins, your pharmacy’s front-end sales will increase, and word of mouth will spread throughout your town.

More articles from the June 2024 issue:

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