Medications That Deplete Nutrients and How to Minimize the Damage

It’s been nearly 15 years since licensed pharmacist Suzy Cohen wrote her groundbreaking book, Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients — and Natural Ways to Restore Them. A member of the Institute of Functional Medicine, the American College for Advancement in Medicine, and the American Association of Anti-Aging Medicine, Cohen effectively focused our attention on over-the-counter and prescription medications that deplete the body of essential nutrients.

In this post, I build on Cohen’s work by highlighting some of today’s common medications associated with nutrient depletion and provide guidance on how to restore the nutrients they are known to affect.

While it’s important to point out in a post like this one that some over-the-counter and prescription medications can be helpful in treating and managing various illness and relieving symptoms, it’s similarly important to acknowledge that many people don’t realize that some of these same medications can deplete their body of essential vitamins and minerals. The resulting nutrient depletion can lead to a number of health issues, creating a cycle of dependency on more medical interventions that often involve some over-the-counter and prescription medications. Being able to recognize the medications that can rob your body of what it needs to thrive and knowing how to address this issue proactively will help you maintain optimal health while managing your health.

Common Nutrient-Depleting Medications

Many medications are known to deplete nutrients. Most of these are prescription medications, but some are available over the counter, including proton-pump inhibitors (PPIs) — medications used to reduce stomach acid.

Statins (Cholesterol-Lowering Drugs)¹

• Nutrient Depleted: Coenzyme Q10 (CoQ10)
• Why It Matters: CoQ10 affects energy production in your cells and has properties that protect your heart. A deficiency in CoQ10 can cause fatigue, muscle pain, and even an increased risk of heart failure, so don’t wait for symptoms to develop before acting.
• What You Can Do: If you are taking a statin, speak to your healthcare provider about supplementing with CoQ10. If your healthcare provider prescribed a statin medication and did not recommend a CoQ10, consider finding a physician who understands the pros and cons of statins and can explore additional options to treat cardiovascular disease and its associated risk factors.

If you experience muscle pain or weakness, work with your healthcare provider to switch to a different statin medication or explore alternative treatments. Here at PPROVOKE Health, we have patients who had experienced weakness for years during which neither the patient nor doctor was aware this was a side effect of a statin medication. As an aside, I can’t imagine ignoring, dismissing, or failing to address a patient’s years-long experience of weakness and fatigue. Weakness and fatigue are not normal and should be treated just as you would treat heart disease. An increase in energy and strength is usually a sign of improved health and fitness.

Proton Pump Inhibitors (PPIs) (Acid Reflux Medications)²

• Nutrients Depleted: Calcium, Vitamin B12, and Magnesium.
• Why It Matters: Long-term use of proton pump inhibitors may lead to low magnesium levels, which is associated with muscle cramps, irregular heartbeat, and seizures. Vitamin B12 deficiency can lead to cognitive issues, nerve damage, and anemia . A deficiency in calcium may increase the risk of bone fractures.
• What You Can Do: If you are taking a proton pump inhibitor such as dexiansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex), the best thing you can do is work to resolve the underlying problem in your digestive tract. At PROVOKE Health, we have been working with patients for many years on resolving gastrointestinal problems using comprehensive diagnostic testing and integrative treatments to get to the root of the problem.

Our approach may include testing for food allergies or sensitivities, comprehensive stool testing, checking for fungal overgrowth in the gut, assessing gallbladder function, checking for parasites, and more. While you and your healthcare provider are working to fix the underlying problem causing indigestion, you should be monitoring your levels of vitamin B12, calcium, and magnesium, and addressing any deficiencies with medical-grade supplementation and/or dietary adjustments.

Here at PROVOKE Health, we provide IV vitamin therapy that can be administered in the Lutz clinic to prevent bone loss, improve immunity, and build resilience.

How many people on long-term treatment with Dexilant, Nexium, Prevacid, Prilosec, Protonix, or Aciphex are monitoring the levels of key nutrients in their blood? The answer is few to none. This is one of the most dangerous classes of medications to be using long term. Consequences of long-term use increase your risk of the following conditions:

• Fractures: A heightened risk of fractures in the spine, wrist, and hip, , particularly in individuals over the age of 50.
• Infections: A greater likelihood of developing COVID-19 (which can lead to Long Covid), community-acquired pneumonia, and Clostridioides difficile infection (a bacterial infection in the colon).
• Kidney disease: A 2016 study indicated that prolonged use of proton pump inhibitors is associated with a higher chance of developing end-stage renal disease and chronic kidney disease (CKD).
• Dementia: An increased likelihood of dementia, including Alzheimer’s disease.
• Other conditions: Liver disease, gastric cancer, and cardiovascular disease are additional risks of long-term use of proton pump inhibitors like the ones mentioned above.

When you have indigestion or acid reflux, the logical approach is to try to reduce stomach acid. However, the stomach has a high concentration of acid for a reason . . . actually, two reasons: acid kills pathogens (disease-causing bacteria, fungi, viruses, and parasites), and it helps break down food into nutrients that the body can absorb. Reducing stomach acid increases your risk of infection and your body’s ability to extract nutrients from food. Some patients who are experiencing indigestion or acid reflux actually have low stomach acid! (See our previous post “Is Your Antacid Making You Sick?”)

Oral Contraceptives (Birth Control Pills)³

• Nutrients Depleted: Vitamin B12, Vitamin B6, and Folate.
• Why It Matters: Folate plays a role in DNA synthesis and repair, and a deficiency in folate can raise the risk of birth defects in future pregnancies. Vitamin B6 and B12 are essential for supporting energy levels, maintaining brain health, and regulating mood. Vitamin B12 is essential for metabolic health and weight maintenance. Low levels of B6 or B12 can lead to anemia.
• What You Can Do: Taking a B-complex vitamin supplement or consuming more leafy greens, legumes, and lean meats can be beneficial.

At PROVOKE Health, we often work with women to balance or replace hormones naturally. Many women are using birth control due to painful cycles, polycystic ovary syndrome (PCOS), Premenstrual Dysphoric Disorder (PMDD), heavy bleeding, acne, or other conditions related to hormonal imbalances that are  solved conventionally with a one-sided approach,  the use of birth control. If you are taking birth control not for the intended use and have unwanted symptoms, consider other options. (See our previous post “The Unintended Side Effects of Birth Control: A Doctor’s Case Study.”)

Diuretics (Water Pills)⁴

• Nutrients Depleted: Calcium, Magnesium, and Potassium.
• Why It Matters: Diuretics, which help reduce fluid retention, are known to induce the loss of important electrolytes including magnesium and potassium . Low potassium levels can cause irregular heartbeat, cramps, and muscle weakness. Calcium and magnesium and are important for nerve function and bone health.
• What You Can Do: Work with your healthcare provider to identify the root cause of why you have been prescribed a diuretic. At the same time, increase your intake of potassium-rich foods, such as bananas, oranges, and spinach, and consider taking quality magnesium and calcium supplements. Doctors may prescribe diuretics for weight loss or to lower blood pressure, but effective protocols are available for managing weight and blood pressure that do not require the use of diuretics.

At PROVOKE Health, we work with our patients to reduce reliance on prescription medications. If your doctor has prescribed a diuretic and is not looking for the root cause or providing a proactive plan of care, you will likely be adding more medications as time goes on and further depleting vital nutrients.

Metformin (Diabetes Medication)⁵

• Nutrient Depleted: Vitamin B12.
• Why It Matters: Vitamin B12 plays an important role in proper neurological function and the production of red blood cells. A deficiency can result in cognitive decline, nerve damage, and anemia.
• What You Can Do: When your doctor recommends it, treatment with metformin should include Vitamin B12 injections.

Consider using a glucagon-like peptide-1 (GLP-1) receptor agonist, such as Ozempic, Wegovy, or Rybelsus, to improve weight and insulin resistance and ultimately avoid metformin if possible. Medications in this class are commonly used in the treatment of type 2 diabetes and, more recently, obesity. They help manage blood glucose levels and support weight loss by boosting insulin secretion, reducing glucagon release, and slowing gastric emptying (the process of moving food from the stomach into the small intestine).

As of the latest research, GLP-1 receptor agonists have not been directly associated with nutrient depletion. However, they can deplete nutrients indirectly. Consider the following:

• Nutrient Absorption: GLP-1 receptor agonists slow down gastric emptying, which can theoretically affect the absorption of certain nutrients, which could alter the timing or efficiency of nutrient absorption in some individuals.

• Weight Loss and Nutrient Needs: GLP-1 receptor agonists can reduce appetite and the consumption of food overall, which can lead to a lower intake of vitamins and minerals.

• Gastrointestinal Side Effects: Some people who take GLP-1 receptor agonists experience diarrhea, vomiting, and nausea, especially when starting the medication. If these side effects are severe or persistent, they could lead to deficiencies over time.

• Bone Health: GLP-1 receptor agonists may negatively impact bone metabolism, particularly in individuals who experience rapid weight loss. The impact on bone health could be related indirectly to reduced calcium, magnesium, or Vitamin D.

Overall, GLP-1 receptor agonists do not have a well-documented effect on vitamin or mineral depletion. However, if you are taking one of these medications, maintain a balanced diet and work closely with your provider to monitor levels of vital nutrients, especially if you experience significant weight loss or gastrointestinal side effects, such as vomiting or diarrhea.

For all the above reasons while using a GLP-1 receptor agonist, it’s best to discuss nutrient depletion with a healthcare provider who can provide personalized advice based on your health status and dietary habits. At PROVOKE Health we use Sermorelin and B12 in many of our patients on GLP- receptor agonists including Wegovy, Semaglutide, and Ozempic. For additional details, see our previous post “Weight Loss Benefits — and Side Effects — of Semaglutide and Ozempic.”

How to Maintain Healthy Nutrient Levels

Regardless of whether you are taking any medication, you should strive to maintain healthy nutrient levels. In addition to macronutrients (protein, carbohydrates, and fats), your body needs micronutrients (including vitamins and minerals). Here are four steps to take to ensure that you are providing your body what it needs for optimal health and function:

1. Monitor your nutrient levels on an ongoing basis. Work with your healthcare provider to check your vitamin and mineral levels regularly, especially if you are on long-term medication. Early detection of deficiencies can help prevent more serious health issues. At PROVOKE Health, we work with patients to order labs that check vitamin, mineral, and antioxidant levels. This is not typically done in most conventional practices or hospital settings, despite its relevance to generating an accurate plan of care. Part of the reason is that insurance companies often don’t recognize the medical necessity, as they have been inadequately trained. However, some vitamin tests are covered, and patients can opt to pay out of pocket for a more comprehensive understanding of their vitamin levels without breaking the bank.
2. Adopt a nutrient-rich diet. Incorporate a nutrient-rich diet that includes a variety of vegetables, fruits, lean proteins, and healthy fats. Foods high in the nutrients you’re at risk of losing should be a regular part of your meals. The Mediterranean diet is a good start (see our previous post “What Does Functional Medicine Say About the Mediterranean Diet?”). Avoid sugar and other simple carbs (such as baked goods), processed foods, fried foods, and trans fats.
3. Take quality dietary supplements as needed. In the cases discussed above concerning proton pump inhibitors and birth control pills, malabsorption of nutrients is common. Supplementing with a quality vitamin prescribed by an integrative healthcare provider like those here at PROVOKE Health can be a reliable way to replenish nutrients. In some cases, however, supplements may not be well absorbed, making intravenous (IV) injections the most effective form of treatment. It’s obvious to see digestive issues like GERD causing malabsorption. However, hormone imbalances, particularly in women, impact digestive function and notably metabolism of hormones including estrogen in the liver. This causes bloating, distention, and a change in the microbiota of the vaginal tract and intestines. As a result, we see yeast overgrowth, small-intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS). In these cases, vitamin therapy injections or intravenous (IV) delivery restores nutrients faster.
4. Make healthy lifestyle choices. A healthy lifestyle includes regular exercise, adequate sleep, and stress management. These practices, along with a healthy diet, can help you maintain optimum nutrient levels and improve your overall well-being.

While medication may be essential for managing certain health conditions, they can also deplete nutrients that are essential for health and fitness. By being aware of the potential risks and adopting a proactive approach, you can ensure that your body has the vitamins and minerals it needs to function optimally. Stay informed, remain vigilant, and always consult your healthcare provider before making any changes to your medications or supplements.

If you’re concerned about how your medications might be affecting your nutrient levels, we’re here to help. At PROVOKE Health, our team can assess your current health, identify any nutrient deficiencies, and work with you to develop a personalized plan of care to restore balance. Don’t wait until symptoms arise — schedule a free consultation today to see how we can support your health and well-being.

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References

1. Stroes, E. S., Thompson, P. D., Corsini, A., et al. (2015). Statin-associated muscle symptoms: Impact on statin therapy—European Atherosclerosis Society Consensus Panel statement on assessment, etiology, and management.European Heart Journal.

2. Targownik, L. E., Fedorak, R. N., Gregor, J., et al. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: Evidence and clinical implications. Therapeutic Advances in Drug Safety.

3. Shojania, A. M., Hornady, G., Barnes, P. H. (1968). Influence of oral contraceptives on folate and vitamin B12 status.Canadian Medical Association Journal.

4. Reilly, R. F. Jr. (2011). Diuretic-induced hypokalemia: Incidence, prevention, and management.Journal of Clinical Hypertension (Greenwich).

5. Reinstatler, L., Qi, Y. P., Williamson, R. S., et al. (2012). Vitamin B12 deficiency with metformin therapy: Is it clinically relevant?Journal of Clinical Endocrinology & Metabolism.

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Disclaimer: The information in this blog post about medications that deplete nutrients and how to minimize the damage, is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this blog post should be construed as medical advice from Dr. Matthew Lewis, Functional Healthcare Group, PLLC, or PROVOKE Health, nor is this blog post intended to be a substitute for medical counsel on any subject matter. No reader of this blog post should act or refrain from acting on the basis of any information included in, or accessible through, this blog post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.

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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP^® specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing at PROVOKE Health in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), Dr. Lewis has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa and elsewhere.