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5 Medications that May Deplete Essential Nutrients

September 22 2017

by Eric Madrid MD

Prescription medications and many over-the-counter drugs (those medicines which can be purchased without a prescription) can play an important role in symptom management and treatment of chronic health conditions. However, they are not without potential side effects.   

While the U.S. population accounts for only 4.3 percent of the world’s 7.5 billion population, Americans consume 25 percent of the world’s pharmaceutical drugs. This does not lead to better health outcomes.   

Despite the high use of pharmaceutical drugs, citizens of the United States rank 31st in the world with an average lifespan of 79.3 years according to Wikipedia.  Japan is at the top of the list, with a lifespan of 83.7 years, with Japanese women living for an average of almost 87 years. The Chinese have an average lifespan of 76.1 years and rank 53rd while those in Russia can expect to live 70.5 years and rank 110.

Minimizing one’s need for prescription and non-prescription drugs and choosing better nutrition and a healthier lifestyle should be the goal for all people around the world to improve quality of life.

We will review five common prescription drugs and learn about the vitamins and minerals they rob from your body.  Depending on your current health status,  these medications may be absolutely needed.  However, lifestyle changes, diet modification and routine exercise may improve chronic medical conditions. If you are unable to stop the medications after making lifestyle changes and consulting with your physician,  care should be undertaken to prevent nutrient depletion that may occur.

1.   Acid Reducers

A poor diet is the main reason many develop acid reflux symptoms. Acid reflux is also referred to by some as GERD (gastroesophageal reflux disease) or heartburn. Both refer to the same condition.

The sale of acid-reducing medications has become a billion dollar market industry worldwide. In 2013, prescription acid reducers generated over 10 billion U.S. dollars in sales. 

A few months ago, I had a new patient visit me for a consult.  She was 40 years old and about 50 pounds (22 kg)  overweight. She scheduled an appointment to see me so she could request medication refills. She told me that she needed a refill on her acid-reducing medication, omeprazole (Prilosec, Zegerid). She told me that she had been on it for several years and that she took it to control her acid reflux symptoms. Knowing that these medications could cause problems long term, I asked her some questions:

“Why do you get acid reflux?”

She replied, “Anytime I drink soda pop, eat chili cheese hot dogs and eat potato chips, I get heartburn symptoms.”

“What happens if you don’t eat those foods?” I asked.

“I do not get the acid reflux”

“To clarify, you want me to give you a refill on your medication, so you can continue to eat junk food?”

“Hmm! I never thought of it that way. I will change my diet and let you know how I do,” she told me. 

After six months, she was doing well and no longer needed the medication. In addition, she had lost about 10 pounds (4.5 kg) of weight.

Unfortunately, these medications give people “permission” to eat foods they should not eat.

The FDA originally approved these medications to treat stomach ulcers and symptoms of occasional acid reflux. However, they are supposed to be given for 4 to 8 weeks. Many take them for several months, years and possibly even decades. Those with precancerous changes in the esophagus, a condition called Barrett’s esophagus, should take the medication as long as advised by the doctor.

Two Main Classes of Acid Reducers 

These include: Histamine (H2) blockers (less strong); Ranitidine (Zantac), Famotidine (Pepcid , Pepcid AC); and Cimetidine (Tagamet); Proton pump inhibitors, sometimes called PPIs (strongest); Omeprazole (Prilosec, Prilosec OTC, Zegerid); Esomeprazole (Nexium); and Pantoprazole (Protonix).

Stomach acid is produced for a reason. It helps kills germs before they enter our intestinal tract, where they can cause illness and infection. In addition, acid helps us absorb nutrients. Acid also helps the stomach secrete a substance called “intrinsic factor”. This allows the intestines to absorb Vitamin B12 from the foods we eat.  

When the above medications are taken for periods longer than intended, nutrition deficiencies can result.

Nutrients Depleted:   

  • Magnesium
  • Calcium
  • Iron
  • Zinc
  • Vitamin D

In addition, these medications can lead to an overgrowth of “bad” gut bacteria and less healthy bacteria since the acid balance in the intestinal tract is altered. 

Supplements Recommended:

  • Magnesium chelate-125 mg to 500 mg
  • Calcium 500 mg daily (one needs adequate vitamin D to ensure absorption of calcium)
  • Zinc-10 mg to 25 mg  (also present in a quality multivitamin)
  • Vitamin D-2,000 IU to 5,000 IU daily
  • Probiotic supplement-5 billion units minimum

2. Diabetes Medications   

A common diabetic drug used to control blood sugar is metformin (Glucophage). While this medication does a good job lowering blood sugar, it may cause various nutrient deficiencies, including a Vitamin B12 deficiency. Ironically, vitamin B12 deficiency is associated with numbness and tingling in the lower legs, feet and toes. This is something doctors call peripheral neuropathy or diabetic neuropathy in those with diabetes. 

However, it is important to realize that diabetes and elevated blood sugar readings can also cause neuropathy symptoms.

If you are on metformin, ask your physician to measure your Vitamin B12 level. 

Most laboratories report vitamin B12 levels between 200 pg/mL and 1100 pg/ml being in the normal range. Many integrative medicine doctors and neurologists recommend blood levels of 500 pg/mL or more to optimize nerve and brain health.

Nutrients depleted:  

  • Vitamin B12
  • Vitamin B6
  • Co-enzyme Q10

Supplements Recommended:

3. Cholesterol Medications

Sales of prescription cholesterol-lowering drugs such as simvastatin (Zocor), atorvastatin (Lipitor) and lovastatin (Mevacor) are a billion dollar industry. Even though high cholesterol by itself does not cause heart attacks or strokes, it is a strong risk factor.   Fifty percent of those people who have heart attacks have normal cholesterol. Use of cholesterol medicines among those who have heart disease can prevent heart attacks from re-occurring according to studies. 

However, use of cholesterol-lowering drugs can also cause your body to produce less co-enzyme Q10, a nutrient critical for a cell’s mitochondria (the cell’s power generator).   Low levels of co-enzyme Q10 may lead to the commonly felt muscle aches noticed when some take this class of medicines. Frequently, supplementing with co-enzyme Q10  is enough to eliminate the aches if stopping the cholesterol medicine is not a good option.  Some patients report that supplementing with vitamin D also helps. Many who are unable to tolerate the side effects of statin medications take Red Yeast Rice, a more natural alternative.

Nutrients Depleted

  • Co-enzyme Q10
  • Possibly vitamin D (existing research inconclusive)

Supplements Recommended:

4. Diuretic Blood Pressure Medications-

Diuretics are a class of blood pressure medications. They are frequently used as first-line therapy for the treatment of high blood pressure.  These medications do a great job for most in lowering blood pressure values. They include hydrochlorothiazide, triamterene-hydrochlorothiazide (Dyazide, Maxzide), chlorthalidone and furosemide (Lasix).  Unfortunately, routine use can result in low blood levels of potassium and magnesium in addition to mild dehydration. 

Nutrients depleted:

  • Calcium (Ca)
  • Magnesium (Mg)
  • Potassium (K)
  • Vitamin C
  • Vitamin B1 (Thiamine)
  • Vitamin B6 (Pyridoxine)
  • Zinc

Supplements Recommended:

  • Calcium 500 mg daily (one needs adequate vitamin D to ensure absorption of calcium)
  • Magnesium chelate-125 mg to 500 mg
  • Potassium (also present in a quality multivitamin)
  • Vitamin C- 500 mg daily minimum
  • B-complex as directed on the label
  • Zinc-10 mg to 25 mg  (also present in a quality multivitamin)

Low levels of potassium and magnesium can cause muscle cramps and in some cases, irregular heartbeats, which may or may not cause symptoms. If you are taking these blood pressure medications, routine blood monitoring of electrolytes, at least once per year or more, is advised and adequate replacement of the nutrients.

Consider asking your health care provider if alternative blood pressure medications should be considered.  Some studies show Co-enzyme Q10 and Hawthorne berry supplementation may help lower blood pressure.

Low vitamin C can result in easy bruising while low levels of zinc can weaken the immune system, lead to skin rashes, and result in chronic diarrhea.

5. Birth Control Pills

Birth control pills were first approved in 1960 as a means of preventing pregnancy. When used appropriately, they are 99.7 percent effective. Worldwide, over 100 million women take them. These pills can deplete B vitamins and magnesium, so if they are prescribed to you, consider taking a daily prenatal vitamin at a minimum. Most women on birth control pills will also need to supplement magnesium if muscle cramps, headaches, and heart palpitations occur.

Nutrients depleted

  • Calcium
  • Magnesium
  • Vitamin C
  • Zinc
  • Folic Acid
  • Vitamin B2
  • Vitamin B6
  • Vitamin B12
  • Vitamin D


  • Calcium 500 mg daily (one needs adequate vitamin D to ensure absorption of calcium)
  • Magnesium chelate -125 mg to 500 mg daily
  • B-Complex multivitamin
  • Vitamin C-500 mg daily minimum
  • Zinc-10 mg to 25 mg (also present in a quality multivitamin)
  • Vitamin D-2,000 IU to 5,000 IU daily

If you have any concerns about whether your medication is affecting your nutritional status, consult with your physician.  Remember, this information is not routinely taught to physicians in Medical School. I recommend you show this article  to your physician if they are uncertain. Most basic nutritional blood tests are covered by insurance companies. 


  1. Supplement Your Prescription Copyright 2007  by Hyla Class, MD
  2. Drug Muggers by Suzy Cohen, RPh.  Copyright 2011, Rodale Publishing.  
  3. FDA warns PPIs  lower Magnesium - https://www.fda.gov/Drugs/DrugSafety/ucm245011.htm
  4. Statin Use and 25-Hydroxyvitamin D Blood Level Response to Vitamin D Treatment of Older Adults. J Am Geriatr Soc. 2017 Jun;65(6):1267-1273. doi: 10.1111/jgs.14784. Epub 2017 Feb 27.

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