As we all know, prescription medications come with side effects. But did you know one of those side effects is depletion of essential nutrients?
When diagnosed with a chronic condition, many health-minded people search for natural solutions first. But, if the illness is caught in an advanced state, sometimes prescription medications are unavoidable. Yet few – if any – health care professionals inform you of the nutrients these medications deplete and the potential side effects that may result.
On the flip side, there are nutrients that may enhance the effectiveness of your medication, which you also may not be aware of. There are also nutrients that are health protective or simply increase your quality of life while you are taking certain medications. Let’s take a look at the nutrient interactions of the most common medications being prescribed, and the recommendations for restoring healthy levels.
Every major class of antibiotics, even when taken for a short time, can deplete all of the B vitamins, calcium, magnesium, potassium, zinc, vitamin K, and probiotics. The B vitamins can be supplemented – with their methylated forms for the best bioavailabity – during the course of the antibiotics. Probiotics are best supplemented at least 2 hours away from antibiotic doses, at least twice daily, with a high quality formulation like Flora-Key, and should be continued for several months after completing the antibiotics to rebalance your intestinal flora. The minerals like calcium, magnesium and zinc should be supplemented once you have completed the antibiotic course, because they can block the absorption of the antibiotic and limit its effectiveness.
Antidepressants – the SSRIs and SNRIs
We are heading into the season that is simultaneously known to be the most joyful yet also has an increase in suicide rates. Depression, whether it’s seasonal or situational, doesn’t discriminate; it strikes all ages, races, and cultures and can be truly devastating. Thankfully, the stigma around it has lessened in recent decades. As a result, prescription medication use is on the rise.
Far and away the most common class of these medications is the SSRIs and SNRIs, like Prozac, Lexapro, Cymbalta, Effexor, and many others. These medications slow the speed in which our neurotransmitters travel and leave the body. When they travel at the fast rate that’s commonly seen in depression, the neurotransmitters we use to maintain our moods are quickly depleted and the result is low moods, energy, and motivation.
The two nutrients these drugs deplete are folate and melatonin. Because of the prevalence of the MTHFR gene mutation, the most bioavailable form of folate to supplement with is the 5-MTHF form, and a dose of at least 400mcg is recommended. Melatonin has to be kept lower than normal for these medications to be effective, so if you are experiencing symptoms of depletion like insomnia, fatigue, and irritable bowels, then supplementing with 3 milligrams of a sublingual melatonin at bedtime and talking to your prescriber about taking your antidepressant in the morning is the best solution to increase levels without interfering with the effectiveness of your medications.
If you are taking one of these medications and it just isn’t enough to get you feeling good again, consider taking SAMe (S-Adenosyl Methionine) to increase the effectiveness of your medication. According to the American Academy of Family Physicians, studies show this methylation supporting supplement works together with your SSRI or SNRI to help increase your moods. St. Johns Wort and 5-HTP should not be used with these medications, however, and are not acceptable substitutes for the SAMe.
Antidepressants – Amitriptyline (Elavil)
The other commonly prescribed class of antidepressants is used not only for depression, but also for bipolar depression and insomnia, and is becoming more widely used for other health conditions like anxiety and chronic fatigue syndrome as well. These are the tricyclics, and the most common is Elavil, or amitriptyline. These medications have been around much longer than the SSRIs have, and as a result, have many side effects and nutrient depletions, some of which are very serious:
- Vitamin B1 (Thiamine) deficiency, which is associated with fatigue, worsening depression, irritability, memory loss, confusion, weakness, poor coordination, decreased stomach acid, low appetite, indigestion, and abnormal heart rhythm.
- Vitamin B2 (Riboflavin) deficiency, which leads to fatigue, indigestion, migraines, headaches, sensitivity to light, eye itching and irritation, cheilosis (cracked corners of the mouth), and seborrheic dermatitis.
- Vitamin B6 deficiency, which can cause fatigue, irritability, worsening depression, poor concentration, memory loss, carpal tunnel, PMS, and heart disease.
- Tyrosine deficiency, which is associated with worsening depression, fatigue, mood disorders, weakness, weight gain, dry hair, low blood pressure, low body temperature, hypothyroid, joint pain, apathy, edema and swelling, flu-like symptoms, hoarse voice, and PMS.
- CoQ10 deficiency can lead to muscle pain, periodontal disease, high blood sugar, high cholesterol, high blood pressure, congestive heart failure, and cardiomyopathy.
This is probably one of the best examples of how a medication can simultaneously help and harm you. The longer you take this medication, the more depleted you can become in these nutrients, several of which cause worsening depression. So, by taking this antidepressant, you can actually become more depressed over time as these nutrients are depleted. In the case of this medication, micronutrient testing through SpectraCell Labs or the NutrEval from Genova Diagnostics would be very helpful to guide how much to supplement with.
Anxiety Medications – the Benzodiazepines
These medications are some of the most commonly used, and unfortunately, are addictive and easily abused. These medications increase the metabolism of Vitamin D, which also decreases calcium absorption. If you are taking Xanax, Ativan, Valium, Restoril, or another “benzo” for either insomnia or anxiety, have your Vitamin D blood levels checked before supplementing, and take Osteo-Key to supplement calcium and support calcium absorption.
Also depleted is melatonin, which will cause worsening insomnia, fatigue, ADHD, and irritable bowel, as well as increasing the risk of breast cancer. Supplementing with 3 milligrams of melatonin is recommended to maintain healthy levels while on these medications.
Hormone Replacement and Birth Control Pills
Whether you take hormonal contraception (e.g. birth control pills) or hormone replacement therapy, these medications cause the same deficiencies. Magnesium should be supplemented with at least 400 milligrams per day in divided doses. Vitamin B6 (at least 5 milligrams), Folate (at least 400 micrograms), and vitamin B12 (1000 micrograms) should be taken daily in their methylated forms for best absorption. Calcium and vitamin D may increase the absorption of these hormones, so it’s important to supplement with these consistently if you plan to supplement them at all. Changing the amounts you take of these nutrients may change the hormone dose you need.
Stomach Acid Reducing Medications
Any time stomach acid levels drop, the pH of the stomach increases, and several nutrients aren’t absorbed as well, leading to depletion. In the case of H2 agonists like Zantac and Pepcid, the nutrients depleted include folate, vitamin B12, vitamin D, iron, calcium, and zinc, and protein digestion is also affected. Proton pump inhibitors (PPIs) like Nexium, Prevacid, and Prilosec deplete all of these nutrients plus magnesium. When you look at the list of what’s not absorbed and becomes depleted, it’s easy to see how osteoporosis and anemia are common side effects of taking these medications long term.
So many nutrients are depleted that a good multivitamin plus Mag-Key and Osteo-Key are recommended together, all taken with a teaspoon of apple cider vinegar to temporarily increase acidity for better absorption. Do not supplement iron unless your healthcare provider recommends it based on blood testing. Interestingly, 6 milligrams of melatonin is known to help normalize stomach acid levels, as well or better than Prilosec taken alone, and does not interfere with the effectiveness of the medications. It can take up to 6 weeks for melatonin to be effective, but may be the natural solution you’re looking for to balance healthy stomach acid levels and prevent nutrient depletions.
How to Find Which Nutrients Your Medication May Deplete
If you are taking a medication that hasn’t been listed here and want to know which nutrients you may need to supplement, there’s a website you need to know about. Jeffrey Gladd, MD, created mytavin.com, a free research-based website where you can enter the names of the medications you are taking and generate a list of nutrients depleted by those medications and what symptoms they may be causing. Other good resources include the American Academy of Family Physicians (AAFP) and the National Center for Complementary and Integrative Health (NCCIH) websites.