There are times when medication is essential and we are in no doubt about their efficacy in certain conditions. But it is important to realise that many drugs, particularly those taken over the longer term, can deplete levels of certain nutrients in the body, or increase our needs for the same.

Armed with this knowledge we can help buffer ourselves from some of the side effects that are in fact simply effects of nutrient depletion. Equally we can protect ourselves from other conditions that are associated with the same nutrient deficiencies.

The information in this article is not to be used for diagnosis purposes but to give an idea of the nutrients that might be needed by those people on some of the more commonly prescribed medications that are taken over the long term. It is not exhaustive but covers the main nutrient depletions in each drug class and to help it make sense the mechanism for the “nutrient steal” is also identified, and the common names of drugs found in each category. It does not cover drug side effects or conditions that can arise from nutrient depletions.

Let us look at some of the most commonly prescribed drugs and the nutrients that are so often depleted as a result of taking them.

Statins

Statins are drugs that reduce the production of cholesterol in the body by switching off the enzyme that is responsible for this. They are used in people who have “elevated blood cholesterol” levels as this is thought to be a risk factor in heart disease thus explaining their regular prescription as agents to help reduce cholesterol levels.

The first problem arises because the enzyme (HMA Co-A reductase) mentioned above is involved in one of the key steps in the production of COQ10 - an important nutrient in energy production of the body - as well as mediating cholesterol production.

One of the most common side effects noticed by people taking statins is muscle weakness and the inability to exercise to the level that they were able to before taking the drug. This is wholly attributable to the reduction in COQ10 production as normally COQ10 would facilitate the energy production in muscles as they are used.

Reduced COQ10=Reduced production of ATP= reduced muscle energy potential, and significantly reduced muscle recovery post exercise.

One of the largest drug companies recently took out a patent to add COQ10 to its statin drugs – but by virtue of the cost (COQ10 costs £3,000 a kilo), this was never put into production. Shame I say – and many Doctors have since echoed the fact that most of the side effects associated with statin use would be negated if only COQ10 were an integral part of the drug or treatment programme in users.

So – if you are taking statins you would be wise to supplement with around 60mg of COQ10 a day in order to protect yourself from the drug inhibition of COQ10 production in your body. Ubiquinol is the most bioeffective form of COQ10.

It is also worth considering supplementing with some of the fat soluble vitamins – Vitamin D in particular, as storage of this can also be reduced when cholesterol is reduced in your body.

If you still experience side effects from the statins even after supplementing as above it is worth talking to your Doctor about Red Rice Yeast which is a natural statin that can be used instead. We can let you have information on this to take to your Doctor if required.

Common statins: atorvastatin, lovastatin, pravastatin, simvastatin, in fact most drugs in this category are affixed with “statin”.

Antibiotics

Antibiotics are used during bacterial infections to help the body kill off the bacterial infection that is present. Whilst they kill pathogenic bacteria, at the same time they kill many of the friendly bacteria that inhabit our GI tract, and are necessary for vital activities including: immune support, production of B vitamins and vitamin K, and digestion of food.

The health of the digestive system is critically balanced by levels of native friendly bacteria and if these levels are in any way disrupted then opportunistic pathogens such as candida albicans are able to multiply.

If the course of antibiotics is only a few days and one is able to take a live native bacteria supplement ( formerly called Probiotics - please follow the link to the relevant blog) it is usually easy to restore balance without adverse effects.

But if the course is prolonged and/or repeated then there is a greater risk of imbalance and also depletion of the nutrients that are produced by the gut bacteria.

A good live native bacteria supplement will help prevent the disruption of native bacteria. This can be taken during the course of antibiotics without adverse effect on the action of the antibiotics and should also be taken for a few weeks after the course of antibiotics. Ideally choose a supplement with a good number of strains and from a reputable company. It is also helpful to increase your intake of fermented foods and live yoghurts during this time.

If you have to take antibiotics over the long term or require more than one course in close proximity, you would be wise to also consider supplementing with B vitamins and vitamin K, and also check your iron levels as infection and antibiotic use can reduce iron stores in the body.

There are obviously too many antibiotics to list here but your Doctor will tell you if he or she is prescribing antibiotics for you. If you are taking antibiotics over the long term you would be wise to look at the individual nutrients that may be depleted by the specific antibiotic as this can differ.

We also have a recent blog titled Antibiotic Resistance – ‘The Ticking Time Bomb’ that goes into depth on the frequent over-use of antibiotics and the implications on nutrient depletion.

Proton pump inhibitors (PPi’s) (acid blockers),H2 Blockers

This is a widely prescribed class of drugs, most often used to help with acid reflux but can also be used for a wide ranging list of conditions involving gastric discomfort. Plus they are often prescribed concomitant with other drugs such as steroids or non steroidal anti inflammatory drugs, as these can damage the stomach lining in the presence of stomach hydrochloric acid.

The drug reduces the level of stomach acid which may benefit the immediate symptoms, but this action disrupts a number of other body processes. Stomach hydrochloric acid serves a number of essential purposes including:

• Playing a pivotal role in the digestion of proteins
• Production of intrinsic factor to enable B12 uptake
• Destruction of bacteria in food to protect the host and providing the correct medium for mineral absorption.

Long term use of this class of drug will predispose one to widespread nutrient deficiencies of almost every nutrient by virtue of the dysbiosis described above. This in turn can directly lead to many different diseases.

If you are taking the medication over the short term you can help protect yourself by taking a well formulated multivitamin and mineral formulation with a good level of vitamin B12. If you are taking over the long term you would be well advised to seek the help of a qualified nutritionist who can help design a diet and supplement programme for you to reduce the risk of both nutrient deficiencies and medication-associated symptoms.

Common names of this drug: Omeprazole; ranitidine lansoprazole, famotidine etc

The main nutrients that are depleted, and hence would be wise to supplement, during long term us of the above drugs are:

• Live native bacteria (probiotics)
• Magnesium
• Calcium
• Zinc
• B vitamins (particularly vitamin B6)
• Vitamin C.

Beta Blockers for Blood Pressure

Beta blockers are among the oldest classes of antihypertensive drugs. They lower blood pressure by reducing the effects of catecholamines (hormones that increase the heart rate in response to exercise and/or fright). This prevents sudden changes in heart rate from adrenaline surges which causes stress on the heart, a common factor in heart attacks.

But Beta (adrenergic) blockers deplete CoQ10 by interfering with the production of this essential enzyme for energy production. Lack of CoQ10 is particularly risky, considering that the target condition is cardiovascular disease. Since the heart muscle is particularly rich in CoQ10-hungry mitochondria, it is unable to function properly when in short supply.

To offset this negative side effect you can take CoQ10 (as described below). These drugs also reduce production of Melatonin, produced from serotonin at night in the pineal gland by stimulating adrenergic beta1- and alpha1-receptors, this neuro-hormone regulates circadian rhythm and promotes sound sleep.

By blocking beta receptors, these drugs may inhibit the release of the enzyme serotonin-N-acetyltransferase, which is necessary for the synthesis of melatonin, resulting in sleep disturbance.

You can supplement with COQ10 @ +60-100mg a day for the first problem. Melatonin is not legally available in the UK except on prescription, but if you are experiencing sleep disturbance your Dr can prescribe it or review your medication in total.

Names of beta blocker drugs include: atenolol, metoprolol,timolol, nadolol, sotalol.

ACE inhibitors for blood pressure

An Angiotensin-Converting-Enzyme inhibitor (ACE inhibitor) is a pharmaceutical drug used primarily for the treatment of elevated blood pressure and congestive heart failure.

This group of drugs cause relaxation of blood vessels, as well as a decreased blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart.

ACE Inhibitors prevent the uptake of zinc and to a lesser degree magnesium, potassium and calcium.

Often ACE inhibitors are prescribed along with a diuretic which can increase excretion of electrolytes and nutrients including potassium, magnesium, Vitamin B1 and calcium.

Non Steroidal anti Inflammatory Drugs (NSAID’s)

These are usually prescribed for short term use as they are recognised to reduce pain and inflammation. In their action they inhibit an enzyme that creates inflammation but at the same time inhibit an enzyme that facilitates the turnover of the gut lining. The gut epithelium is in a state of continual turnover which enables fresh active tissue to line the gut.

If this process is inhibited the lining is far more susceptible to ulceration which is one of the main side effects of NSAID’s when they are used for longer than a few days.

Often drugs to reduce stomach acid secretions ( PPI’s meds listed above) are used to reduce the risk of ulceration but as we have seen above these carry their own risks.

However, NSAID medicines can cause increased urinary excretion of Vitamin C and inhibition of folate dependent enzymes, thus reducing levels of both of these nutrients. They are also known to decrease iron levels via microscopic GI bleeding. So all these nutrients should be supplemented during a course of NSAID medication.

Commonly used NSAID drugs: Diclofenac, Etodolac, Ibuprofen, Indomethacin, Naproxen

Medication for an Underactive Thyroid

Thyroid hormones pay a critical role in bone turnover and density. Thyroxine can increase bone turnover and concomitantly increase calcium loss vie the urine. The amount lost may be insignificant but it is worth being aware of this risk. Levothyroxine is the most commonly used drug in this category.

If you do supplement with calcium it should be taken at a different time of day from thyroxine as calcium can interfere with the uptake of the drug. Iron is another nutrient, often taken by those with low thyroid function and this should be taken several hours away from thyroxine.

The other things to note here is that thyroid insufficiency itself can be caused by low levels of selenium, copper, manganese and iodine. All these minerals are vital for thyroid health, production of thyroid hormones and in particular conversion of T4 (thyroxine) to T3 the metabolically active thyroid hormone. So it is always in your favour to supplement with selenium particularly if you have an underactive thyroid gland. If you are low in selenium even thyroxine will not work well to increase your metabolic rate as the conversion of T4 to T3 is a key factor in healthy thyroid function. We have a fairly recent blog that explains Thyroid function in more detail, titled Metabolism & Thyroid Function.

Finally..

Obviously the list of commonly prescribed drugs is far too comprehensive to exhaust here. There is however a database that matches the drug you are taking to the nutrient that it most commonly depletes. Please follow the link for more information.

Nutrient Depletion Database

If you have any questions regarding any of the health topics raised in this article, or any other health matters please do contact me (Amanda) by phone or email at any time.

Amanda Williams, Cytoplan Ltd

amanda@cytoplan.co.uk, 01684 310099

Relevant Cytoplan Blogs

Cytoplan & ‘The Nutrition Gap’

Thyroid Problems – the difference between ‘form’ and ‘function’

Metabolism & Thyroid Function

Antibiotic Resistance – ‘The Ticking Time Bomb’

Food-Based Supplements – Bridging your ‘Nutrition Gap’