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ARE MEDICINES STRIPPING YOU OF NUTRIENTS?

As you reach the menopause, you may have to take medicines for the first time or take more medicines, such as antacids, blood pressure tablets or diabetes drugs. But have you realised that these medicines may be affecting nutrient levels in your body? And if your diet is already poor and unbalanced, your nutrient status could suffer, affecting your health?

This article was included in issue 85 (summer 2020) of The Menopause Exchange newsletter.

The lowering of certain essential nutrients in your body by taking certain medicines is called ‘drug-nutrient depletion’. Here I’ve outlined some of the common medicines that may do this. I’ve suggested how much extra nutrient you may need to correct your lowered nutrient levels. You should always try to get this in a food source if you can, but could take a supplement if this is difficult.

Stomach acid reducers
Antacids, proton pump inhibitors and H2 antagonists (such as cimetidine) are often prescribed to people over 50. These can decrease your body’s levels of vitamin B12, vitamin D, calcium, magnesium, and other minerals. Also, the good bacteria in your gut help you to absorb many nutrients (as well as a host of other useful roles in your body) and these are ‘killed off’ if you use these medicines. To counteract this, it’s suggested that you take an extra 25 to 1000 mcg of vitamin B12 and 250 to 400 mg of magnesium each day.

Antibiotics
Antibiotics such as amoxicillin can lower your levels of calcium, magnesium, potassium, certain B vitamins and vitamin K. They don’t just wipe out any nasty bacteria you may be harbouring but also reduce your levels of friendly bacteria. Most doctors are now extra careful to only prescribe antibiotics where strictly necessary. An extra 500 to 1000 mg of calcium and 250 to 400 mg of magnesium daily is recommended.

Drugs for anxiety
Anxiety drugs such as benzodiapezines decrease calcium absorption. While you’re taking them, it’s recommended to take an extra 500 mg of calcium every day.

Blood pressure tablets
Angiotensin-Converting Enzyme (ACE) inhibitors reduce the levels of zinc in your body so it’s recommended that you take an extra 11 mg of zinc every day. Calcium-channel blockers reduce potassium levels so it’s recommended to take an extra 100 mg of potassium every day but check with your doctor if you have kidney problems.

Cholesterol-lowering medicines
Statins can lower your coenzyme Q10 and fat-soluble vitamins D and E levels. It’s suggested you take extra vitamin D (1000 to 2000 iu) plus 100 to 200 mg CoQ10 and a fish oil (500 to 1000 mg EPA & DHA) every day.

Diuretics
‘Water pills’ such as furosemide, remove excess water from your body to lower high blood pressure. They can reduce your magnesium, potassium (although some can spare it) and zinc levels. Extra magnesium (250 to 400 mg), potassium (100 mg) and zinc (11 mg) is suggested every day. If you’re taking potassium-sparing diuretics, extra folic acid (240 mcg) is recommended every day.

Diabetes medicines
Diabetes medicines, such as metformin, can deplete your levels of vitamin B12 and folic acid, so an extra 120 to 240 mcg of folic acid and 25 to 1000 mcg of vitamin B12 is recommended every day.

Corticosteroids
These medicines, including prednisolone, are used to reduce inflammation, pain and discomfort caused by various health conditions such as arthritis. They can deplete your calcium and magnesium levels, so it’s recommended that you take an extra 500 mg of calcium and 250 to 400 mg of magnesium every day.

HRT
Hormone replacement therapy (HRT) can lower your folic acid, magnesium, vitamin B6 and B12 levels. It’s suggested that the following extra nutrients should be taken every day: folic acid (240 mcg), magnesium (250 to 400 mg), vitamin B6 (5 mg) and vitamin B12 (25 to 1000 mcg).

A special note on calcium
Many medicines seem to lower calcium levels. You’re better off getting calcium from your diet, e.g. yogurt, cheese and/or milk. One third of a pint of milk, a small pot of yogurt or a 30 g piece of cheese provides 220 g of calcium. You need enough vitamin D to absorb calcium so, in winter months in particular, you should take a vitamin D supplement.

Safeguarding yourself
How much your nutrient levels are reduced will depend on how much of the medicine you’re taking, and for how long. It’s normally a slow process unless your nutrient levels were already very low. You can lower the risk by eating a healthy well-balanced, wide-ranging diet.

If you’re prescribed medicines, it’s essential that you do take them, but read the leaflet that comes with them. Also ask your GP or pharmacist:

  • Will the medicines interact with certain nutrients in my diet or with any supplements I take?
  • Will any of my medicines react badly with other medicines (prescribed and bought over the pharmacy counter) I have to take?
  • How should I take my medicines?
  • Can we check my nutrient levels?
  • Are there any supplements I should be taking?

Certain medicines, such as proton pump inhibitors, are used widely by people over a certain age. It’s worth asking your GP if you definitely need them or if there’s something else you can do to reduce or minimise the reason you’re taking them.

Final note
Some nutrients, supplements (especially herbal products), tea, coffee and alcohol can affect the absorption of medicines and how they act in your body; some boost the medicine’s effects and some reduce them.

Reference

W Reilly, J Ilich (2017) Prescription Drugs and Nutrient Depletion: How Much is Known? Advances in Nutrition volume 8 (1) p23

About the author
Gaynor Bussell is an award-winning dietitian and nutritionist who specialises in women’s health, gut health and weight issues.

Created Summer 2020

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