November 14th, 2022

To function at the highest and most optimal state requires providing our human engine with nutrients, both macro and micro types. By macro, I mean fats, carbohydrates and proteins. By micro, I mean minerals and vitamins which are cofactors for enzymatic activity driving the machine to normalcy of action whatever that action is. What dictates sufficiency?

In simplistic terms, it is based on the nutrient's intake, absorption, mobilization, requirement based on activity or exposure/disease/microbiome, elimination and utilization.

Any place along this continuum where a slow down occurs will lead to less function and action for health. Do you eat a rainbow of foods that optimizes intake? Does your alimentary canal absorb that which is ingested? Do you have single nucleotide genetic polymorphisms altering uptake or receptor activation or enzyme activity?

"The long-term use of prescription and over the counter (OTC) drugs can induce subclinical and clinically relevant micronutrient deficiencies which may develop gradually over months or even years. Unfortunately, nutrient deficiencies seldom present as classically described and, with the exception of the most common micronutrient issues, many health care providers are not knowledgeable about micronutrient deficiency or excess. This may lead to erroneous attribution of deficiency states to a disease state or the aging process itself and may delay diagnosis. Drug-induced micronutrient depletion may be the origin of otherwise unexplained symptoms, some of which might influence medication compliance.
Drug–nutrient interactions are defined as physical, chemical, physiologic, or pathophysiologic relationships between a drug and a nutrient, and typically involve multiple factors. Drugs can influence food intake, nutrient digestion, absorption, distribution, metabolism to active forms, function, catabolism and excretion. Additionally, the presence of compound-specific transport proteins, receptors, and enzymes in different tissues alters the pattern and location of where drugs and nutrients interact, creating scores of possible tissue-specific interactions, and makes prediction of clinical effects difficult. Ethanol and tobacco also influence micronutrients in ways similar to drugs, but discussion of this is beyond the scope of this review."(Mohn et. al. 2018)

For the purposes of this piece, we are going to focus on this question - Do you take medicines that alter one of these actions: absorption, mobilization, elimination and utilization? We have long known that medicines have side effects, yet we rarely talk about drug nutrient interactions in any meaningful way save for antibiotics and microbiome damage.

The key drugs that cause risk are those that are used for a long time like antacids, anticonvulsants, diuretics for blood pressure and oral contraceptives to name a few. If you or a loved on are on a long term medicine of these types, then this issue is real for you.

Let us look at the poster child for bad outcomes: proton pump inhibitors and antacid class medicines. Function of these meds - reduce the symptoms of heartburn associated with gastro-esophageal reflux. In effect, the medicine raises the stomach pH from 1-2 up to 4 and higher decreasing the acid burn on the reflux region of the esophagus. The side effect of these meds are many, but here it is a profound reduction of the action of the acid on micronutrients like vitamin B12 and C as well as minerals calcium, iron and magnesium. The effects are related to malabsorption of minerals and from the inability of the separation of vitamin B12 from food proteins. We all have a pH in our stomachs of 1-2 for very specific purposes, protection and digestion being of paramount importance. When the pH rises and becomes more basic, pathogens survive, food is poorly digested and the gut microbiome changes in a negative manner. Diversity decreases which is associated with all cause morbidity and the pathogens tend to be overrepresented by oral microbes. (Freedberg et. al. 2014)(Imhann et. al. 2016)

Another major class of drug commonly used that affects micronutrients is the oral contraceptive class, birth control pills. They are known to reduce the micronutrients: magnesium, most B vitamins, CoQ10, selenium and zinc. (Park et. al. 2016)

For a table of drug micronutrient interactions, go to this link page 4 table.

It is the chronic use that is the big risk for long term dysfunction. Any drug that you or your child takes should be explored for cofactor influences that could impair function.

The key is to be aware of the possibility. Then I would check levels with your provider and supplement where necessary while maximizing nutrient intake as whole foods based.


Dr. M

Mohn Phamaceutics
Freedberg Clin Lab Med
Imhann Gut
Palmery Eur Rev Med Pharm Sci
Chong Exp Res Clin Soc Phar
Park PLOSOne
Karadima EPMA