One of the most underappreciated aspects of taking a drug is its effect on the balance of your essential nutrients. Almost any prescribed drug or over the counter medication can cause significant and sometimes severe depletion of vitamins and nutrien
Indeed, many of a drug's so called 'adverse drug reactions' may not be side effects of the drug per se, but effects of the nutrient deficiencies caused by the drug.
The following are the nutritional losses caused by some of the most common drugs.
Proton pump inhibitors decrease vitamin B12 levels (Am J Med, 1998; 104: 422-30).
decrease calcium levels (Regul Pept, 1990; 28: 131-6)
decrease vitamin D levels (J Lab Clin Med, 1984; 104: 546-52)
decrease iron levels (Dig Dis Sci, 1993; 38: 950-4)
decrease zinc levels (J Am Coll Nutr, 1991; 10: 372-5)
decrease vitamin B12 levels (Ann Pharmacother, 1992; 26: 1283-6)
decrease folic acid levels (J Lab Clin Med, 1988; 112: 458-63).
Antacids containing magnesium/aluminium hydroxide;
decrease calcium levels (Gastroenterology, 1979; 76: 603-6)
decrease phosphate levels (BMJ, 1974; 3: 150-2).
decreases potassium levels (Haller F, ed, Antacids in the Eighties, Munich: Urban & Schwarzenberg, 1982: 99-102).
Laxatives and diuretics
decreases potassium levels (Clin Radiol, 1994; 49: 874-6).
decreases calcium, phosphorus, vitamins A, D, E, K and betacarotene (Am J Dis Child, 1987; 141: 1210-2).
Herbal laxatives and folk remedy saline purgatives;
increase excretion and decrease absorption of any nutrients, including minerals, vitamins, essential fatty acids and amino acids.
deplete potassium (Circulation, 1992; 85 [1 Suppl]: 170-6)
decrease coenzyme Q10 levels (Res Commun Chem Pathol Pharmacol, 1975; 12: 533-40)
decrease magnesium levels (Kidney Int, 1997; 51: 1008-17)
decrease zinc levels (S Afr Med J, 1982; 62: 373-5).
Loop and other diuretics;
cause continuing loss of potassium and may also cause excess calcium in the blood (BMA and Roy Pharm Soc GB, British National Formulary, March 1999: 62-5). Some patients seem able to compensate for the potassium loss and shouldn't take potassium supplements. For many of those who do need it, 'combination diuretics with potassium' should be avoided as they may not contain enough. To complicate matters further, 'diuretics with potassium' and 'potassium sparing diuretics' should not be taken together as the latter interact with ACE inhibitors, analgesics, chlorpropamide, cyclosporin, lithium and trilostane, while the oestrogens and progestogens used in combined oral contraceptives and in hormone replenishment therapy antagonise the diuretic effect.
increase excretion of potassium and water soluble vitamins, just like their orthodox counterparts. However, herbal diuretics can make good the potassium loss without supplementation. For example, dandelion root (Taraxacum officinalis), a natural diuretic, contains three times as much potassium as some supplements. Other herbal sources of potassium are alfalfa (Lucerne), chamomile, carrot leaves, kelp, nettles and plantain leaves
Demulcent diuretics like corn silk (Stigmata maidis), couch grass (Agropyron repens) or marshmallow root (Althaea officinalis) protect the kidneys against irritation or inflammation that may otherwise occur
To increase potassium levels, naturopathic physicians prescribe three bananas daily, or suggest a diet that regularly contains much of the following: meat, cream, wholegrain cereals, potatoes, fresh fruit particularly apricots and citrus fruits green vegetables, cider and cider vinegar
Horsetail shoots (Equisetum arvense) decrease vitamin B1 levels (Onderstepoort J Vet Res, 1989; 56: 145-6), and decrease potassium and sodium levels with prolonged use (Med Clin [Barc], 1996; 106: 639)
Liquorice root (Glycyrrhiza glabra) taken along with a botanical diuretic will moderate the diuretic action by its fluid and salt retaining properties. However, when taken in excessive dosages, it decreases potassium, and can cause sodium chloride and water retention (BMJ, 1997; 314: 731-2; Food Chem Toxicol, 1993; 31: 303-12)
Kavakava root (Piper methysticum) was suspected of decreasing vitamin B3 (niacin) with prolonged use, when it can cause a skin disorder (ichthyo-xanthosis), but a controlled clinical study reported no changes in vitamin B3 levels (Lancet, 1990; 335: 1442-5) with this herbal.
decreases vitamin B12 levels (Acta Med Scand, 1972; 191: 355-7).
Bile acid sequestrants
binds bile acids to prevent their reabsorption
used in the management of hyper cholesterolaemia, but decreases vitamins A and E (Paediatrics, 1980; 65: 243-50)
decreases vitamins D and E, carotenoids and folic acid (Arch Dis Child, 1996; 74: 157
decreases vitamin B12, folic acid and iron (Arzneimittelforschung, 1979; 29: 979-81).
decreases vitamins A, D, E, K and betacarotene, zinc, phosphorus, folic acid, lycopene, calcium, magnesium and iron (Arterioscler Thromb Vasc Biol, 1995; 15: 1057-63).
HMG CoA reductase inhibitors
inhibit biosynthesis of coenzyme Q10 (Mol Aspects Med, 1997; 18 [Suppl]: S137-44).
Next month: female hormones, bronchial decongestants and antibiotics.
Harald Gaier is a registered osteopath, naturopath and homoeopath
(c) 2001 Harald Gaier