A Harvard Health Letter notes that long term use of protein pump inhibitors, diuretics, and statins can deplete the body of key nutrients, such as vitamins B6 and B12, magnesium, calcium, CoQ10.
Dr Laura Carr, a pharmacist at Harvard-affiliated Massachusetts General Hospital, is quoted: “If your doctor doesn't tell you that it may be a possibility, or if you're not reading medical literature to stay up to date, you might not know that some medications can cause nutrient deficiency with long-term use.”
Duffy MacKay, ND, Sr VP of scientific and regulatory affairs for CRN, told us he was impressed by the letter. “Far too often in the discussion of drug-supplement interactions there is a focus on negative interactions. Drug-nutrient depletions are well established but they don’t get the discussion or have the awareness they should,” he said.
PPIs
The article notes that proton-pump inhibitors (PPIs) are used to treat heartburn and acid reflux, but long term use of these can reduce the absorption of vitamin B12, leading to confusion and muscle weakness, as well as calcium and magnesium levels.
“PPIs – from a naturopathic perspective, these set off alarm bells,” said Dr MacKay. “Digestion starts in the stomach acid and if you throw in a PPI then you’re shutting down the first phase of digestion. Also, they are designed for short term use but people stay on these things forever.”
Data from both the UK and the US indicated that prescription of proton pump inhibitors (PPIs) are increasing, with researchers from University College London writing: “PPI prescribing rates among inpatients are high, and frequently not evidenced-based. There is also lack of consideration given to review of therapy and limiting provision to short courses.” (Owen at al. Gut 2014; Vol. 63:A37 doi:10.1136/gutjnl-2014-307263.75)
The article also cites statins for lowering CoQ10 levels, while some diuretics (to lower blood pressure) can deplete calcium, magnesium, and potassium levels.
Anticonvulsants and corticosteroids may also reduce calcium and vitamin D levels, while metformin (for diabetes) may reduce levels of folic acid and vitamin B12.
Dr MacKay noted that the article omitted birth control pills, which can affect B vitamin levels.
Supplementation?
The Harvard Health Letter does not recommend correcting the depletion with a dietary supplement, however. “Even though we know some drugs can cause deficiency, the evidence does not show that taking supplements always makes it better,” states Dr Carr.
“If your doctor feels you have a deficiency that can be corrected with supplements, rely on his or her supervision,” adds the article.
Such statements are an “oversight”, said CRN’s Dr MacKay. “Often, when you get into a population of multiple medications, the ability to effect dietary changes is tough. It’s easy to say, you have low magnesium levels so eat some leafy greens, but ensuring these changes are complied with are difficult.”
Dr MacKay said that pharmacists have a key role to play moving forward. “The future of pharmacy is going to have experts in drug-drug / drug-supplement / drug-diet interactions who can point you towards trusted high-quality products. Who is better positioned to help people than their pharmacist?”
Source: Harvard Health Letter
September 2016