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Drug induced Nutritional Depletions

by Warren Cargal, L. Ac.


Recently the online store was updated to make it easier for you to shop for products and to check out faster.  As part of the update we added a health resources section containing articles, research, podcast of health issues and several online health data bases.

One of the data bases is called Drug Depletions and compiles research examining nutrient depletion resulting from prescription drug use. According to the Centers for Disease Control, the number of adults aged 55-64 taking at least one pharmaceutical in the last month rose from 62 percent in 1988-1994 to 73 percent in 1999-2002.1 The large number of individuals taking pharmaceutics suggests that the potential for drug-nutrient interaction is substantial.

The following discussion taken from the Drug Depletion Database looks at two common medications and the nutrient depletion considerations.

Hormone Replacement
In the U.S. from 1999 to 2002, approximately 15 million women were taking HRT annually accounting for 90 million prescriptions per year.2 Oral contraceptive pills (OCP) also contain estrogen/progestin combinations. Research suggests that estrogens significantly deplete several B vitamins. Oral estradiol decreases pyridoxines (vitamin B6) as well as albumin in postmenopausal women.3 This vitamin B6 deficiency is believed to be associated with a disruption in tryptophan metabolism.4 Proper tryptophan metabolism is essential for serotonin production, which is essential for proper mood stabilization and contentment in life.

Additional research indicated that oral contraceptives deplete riboflavin (vitamin B2), folic acid, cobalamin (vitamin B12), ascorbic acid (vitamin C), and zinc.5 Studies indicate a decrease by 40 percent of both folic acid and serum B12 levels with oral contraceptive use.6 Additionally, studies have shown that estrogen supplementation increases magnesium uptake into bone and soft tissue, causing lowered blood magnesium levels. This change leads to calcium and magnesium changes and can lead to an increase in coagulation and thrombosis seen with estrogen supplementation.7

Acid Blockers
Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2 blockers) are commonly prescribed for treatment of ulcers and gastroesophageal reflux disease (GERD). Lansoprazole, or Prevacid, is a PPI ranking third in top pharmaceutical sales in the U.S. in 2004.8 Acid blockers have been linked to significant increases in the risk of vitamin B12 deficiency.9 One small study showed a 53 percent decrease in protein-bound B12 absorption in individuals taking an H2 blocker.10 Research also indicated that folic acid absorption is decreased with supplementation of H2 blockers and other antacids.11 Studies have also linked H2 blockers, which decrease gastric acid secretion, with decreased absorption of iron and zinc.12-13 One study showed a direct correlation between increasing dosage of cimetidine, an H2 blocker, and decreasing dietary non-heme iron absorption ranging from 28-65 percent.14 Animal studies also have demonstrated that cimetidine significantly decreases intestinal calcium transport.15 In addition, it also alters vitamin D metabolism by altering the enzyme vitamin D 25-hydroxylase activity.16 A small study performed with the PPI omeprazole demonstrated that serum levels of beta carotene were decreased with increased gastric pH.17

1. Anonymous. Center for Disease Control. Available at: www.cdc.gov/nchs/data/hus/hus05.pdf#095. Accessed on: 07-08-2006.
2. Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA. 2004 Jan 7;291(1):47-53.
3. Smolders RG, de Meer K, Kenemans P, Jakobs C, Kulik W, van der Mooren MJ. Oral estradiol decreases plasma homocysteine, vitamin B6, and albumin in postmenopausal women but does not change the whole-body homocysteine remethylation and transmethylation flux. J Clin Endocrinol Metab. 2005 Apr;90(4):2218-24. Epub 2005 Jan 25.
4. Haspels AA, Bennink HJ, Schreurs WH. Disturbance of tryptophan metabolism and its correction during oestrogen treatment in postmenopausal women. Maturitas. 1978 Jun;1(1):15-20.
5. Webb JL. Nutritional effects of oral contraceptive use: a review. J Reprod Med. 1980 Oct;25(4):150-6.
6. Bielenberg J. [Folic acid and vitamin deficiency caused by oral contraceptives] Med Monatsschr Pharm. 1991 Aug;14(8):244-7.
7. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993 Aug;12(4):442-58.
8. Anonymous. NDC Health. Available at: www.rxlist.com/top200_sales_2004.htm. Accessed on: 07-08-2006.
9. Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol. 2004 Apr;57(4):422-8.
10. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol. 1982 Jan;17(1):129-31.
11. Russell RM, Golner BB, Krasinski SD, Sadowski JA, Suter PM, Braun CL. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med. 1988 Oct;112(4):458-63.
12. Sturniolo GC, Montino MC, Rossetto L, Martin A, D’Inca R, D’Odorico A, Naccarato R. Inhibition of gastric acid secretion reduces zinc absorption in man. J Am Coll Nutr. 1991 Aug;10(4):372-5.
13. Aymard JP, Aymard B, Netter P, Bannwarth B, Trechot P, Streiff F. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp. 1988 Nov-Dec;3(6):430-48.
14. Skikne BS, Lynch SR, Cook JD. Role of gastric acid in food iron absorption. Gastroenterology. 1981 Dec;81(6):1068-71.
15. Ghishan FK, Walker F, Meneely R, Patwardhan R, Speeg KV Jr. Intestinal calcium transport: effect of cimetidine. J Nutr. 1981 Dec;111(12):2157-61.
16. Odes HS, Fraser GM, Krugliak P, Lamprecht SA, Shany S. Effect of cimetidine on hepatic vitamin D metabolism in humans. Digestion. 1990;46(2):61-4.


This article was published on Tuesday July 20, 2010.
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