Do I Need to Take Supplements with Medication?

Medications are powerful tools to help manage a range of illnesses and health conditions. However the impact of medication on our nutrient status is often overlooked. Whilst more common side effects e.g. drowsiness, nausea are recognised patients may not be aware of how medication can potentially lead to nutrient depletion of essential vitamins and minerals that are crucial for supporting bodily functions. In this article, nutrition advisor James Pugh explores how medication can reduce nutrient status factors that affect nutrient deficiency and optimising medication with effective supplements.

Introduction

Almost half of the UK population is taking some form of medication regularly. Medication can be crucial for managing both long-term and short-term health conditions. In England, the NHS spends nearly £10 billion every year on medication. Much of the need for medication is to support long term health conditions, such as diabetes, high blood pressure and high cholesterol. In fact, latest NHS statistics from 2021 show 40 of adults aged over 16 had at least one long-standing illness or condition.

What should we know about our medication?

Many of us are prescribed medication or over the counter (OTC) drugs without knowing the impact that they can have on our nutritional status. Whilst medications come with a Patient Information Leaflet (PIL) which outlines any potential side effects, they rarely detail nutrient deficiencies which may develop. However, growing scientific evidence suggests that certain medications can cause depletion of essential vitamins and minerals, something we all need to be aware of we should be aware of so that we can monitor potential risks to our health.

How do medications reduce our nutrient status?

Reducing our appetite This often comes when a medication increases feelings of nausea or gives us an unpleasant taste. We tend to eat less, which reduces our nutrient intake.
Decreasing nutrient absorption Some medications can affect how much of a nutrient is absorbed in the gut, meaning less nutrients in the body for use.
Interfering with nutrient use How the body metabolises or uses nutrients once they have been absorbed can also be affected.
Affecting nutrient excretion The rate at which the body processes and then excretes nutrient, for example via the urine can be increased or decreased by some medication.

Who is at risk?

Anyone taking medication could be at risk, but it does depend on the specific medication.

The older generation Older people tend to be more susceptible to medication-related nutrient deficiencies, often as a result of taking multiple medications which may each impact nutrient levels in the body.
Pregnant women Research has shown that 95% of pregnant women face nutrient deficiencies, due to increased nutritional demands, hormonal changes and dietary restrictions. This can be exacerbated when on some medication.
Long-term medication use. It is estimated that there are over 15 million people in the UK living with a long-term health condition, which can not only result in taking medication, but also depletion of nutrients.
Multiple medication use Differing medications can cause the same nutrient depletion, so increasing your risk of being low in these nutrients.
Those with poor nutrient intake. Eating an ultra-processed diet means you are much less likely to fulfil your nutrient needs with diet. It also makes it more likely you will have a long-term condition for which you need medication. So low levels of nutrients can become even lower.

Why does it matter?

Nutrients are vital for all processes in the body, from making energy, to making stomach acid for digestion, neurotransmitters for mood and cognition, maintaining healthy bones and teeth, to the function of our thyroid hormones, and making collagen in the skin, with lots more in between. To stay healthy, we need adequate supplies of these nutrients.

How to identify deficiency?

Nutrient depletion may not be immediately obvious, taking some time after medication is started to show, and may be mistaken for medication side-effects, or dismissed as a normal part of life, or ageing. Your GP can test for some such as iron, B12, folic acid and vitamin D, but others are often identified by considering symptoms of deficiency which show up in the body.

For example, B12 deficiency can show up as numbness and pins and needles most likely in your hands and feet, muscle weakness, fatigue or headaches, whilst low magnesium can present as fatigue, muscle twitching, low mood, increased blood pressure, or a poor resilience to stress.

Should we take supplements with medication?

This entirely depends on the medication you are taking. Some supplements can have a beneficial effect alongside medication. Generally, it is a good idea to take supplements at least 4 hours apart from prescribed medication. This means they are much less likely to interfere with each other’s absorption.

What should we look for in a supplement?

It’s easy to assume all supplements are equal and beneficial, but it is essential to always read the ingredients list on the label. Many supplements have added fillers, binders, preservatives and bulking agents. These ingredients are included to help speed up the manufacturing process and make the product cheaper. They have no added health benefits, and some have evidence of negative health impacts. So, look for a supplement with active ingredients, a therapeutic dose and a clean formulation.

Medications

Antibiotics

Antidepressants

Antiepileptics

Blood pressure medication

Combined contraceptive pill

HRT

Hypoglycaemics

Inhalers

Painkillers

Proton Pump Inhibitors (PPIs) and Antacids - Digestion Medication

Statins

Steroids (Oral Corticosteroids)

Weight loss medication

Antibiotics

One of the most commonly prescribed medications, antibiotics, help us to get rid of bad bacteria in our system. However, this can also kill many of the friendly bacteria that are present in our digestive tract. As a result, this can cause an imbalance in our gut microbiome, with side effects such as stomach upset and nausea, but also reduced capacity for making some of the B vitamin and vitamin K which are normally made by gut bacteria. Disrupted gut flora can influence many aspects of health including immunity, digestion and even mental wellbeing.

It is known that minerals can bind to antibiotic medication, reducing their absorption in the gut. In the short-term depleting minerals such as zinc and magnesium may not have much impact other than to perhaps the immune system, and our energy levels. Long-term antibiotic use, however, could deplete magnesium and calcium levels over a longer period, potentially impacting our bones and muscles.

TIP: Certain probiotic strains, such as Saccharomyces boulardii can be taken with antibiotics. This strain is resistant to antibiotics and can be given alongside treatment and in the following weeks or months to improve outcomes and minimise side effects. In terms of minerals, just taking your supplement at a different time of day is likely to prevent depletion for a short antibiotic course, but if long term, a mineral supplement should be considered.

Antidepressants

Depression, anxiety and other mental health conditions are becoming increasingly prevalent in the UK. Therefore, the need for antidepressant medication is higher than ever. The most commonly prescribed class of antidepressants is the selective serotonin reuptake inhibitors (SSRIs) which have been shown to influence sodium regulation in the kidneys, which can cause water retention and reduced urination.

TIP: SSRIs haven’t been linked to folic acid depletion, but research does suggest folic acid supplementation may improve their effectiveness, especially in those who have low levels.

Antiepileptics

This prescribed medication is used to prevent the occurrence of seizures. Research has shown that antiepileptic medication can reduce calcium absorption in the gut as well as lowering vitamin D levels. This could lead to bone weaknesses and increase the risk of fracture and osteoporosis.

TIP: Supplementing vitamin D could decrease levels of antiepileptic medications in the body, increasing the risk of seizures, so check with your GP on the right way to increase your levels before choosing to supplement. Additionally, folic acid supplementation is also recommended for those taking antiepileptic medication.

Blood pressure medication

High blood pressure, or hypertension, has many contributary factors such as poor diet, stress, smoking, alcohol intake and a sedentary lifestyle. The risk of high blood pressure increases with age and those who are overweight are also more likely to have hypertension. Combating high blood pressure can be done through both supplementation and medication.

There are several types of blood pressure medication, which work via different mechanisms. The different types include beta blockers which are used to reduce heart rate and decrease blood pressure by blocking the effects of adrenaline on beta receptors, and ACE inhibitors which reduce the activity of the enzyme angiotensin-converting enzyme (ACE), an enzyme which narrows blood vessels, causing increased blood pressure.

Diuretics are also used as they lower blood pressure by ensuring the body excretes excess water.

Beta Blockers Beta blockers are known to cause a depletion in Co-Enzyme Q10 by interfering with its recycling in the body. Depletion of Co-Q10 is linked to many degenerative diseases including cardiovascular disease but can also cause fatigue and muscle weakness. Co-Q10 is essential for ATP production, the cellular energy currency of the body.

TIP: Co-Q10 could also lower blood pressure. If supplementing, it is important to monitor blood pressure regularly. Taking it under the supervision of a pharmacist or healthcare professional is advised.

ACE Inhibitors ACE inhibitors can cause increased excretion of zinc, leading to depletion and deficiency. This is a key mineral for immune health, but also brain, skin and skeletal health and is a powerful antioxidant. Rich zinc foods include nuts, seeds, fish, but interestingly research also shows that a nutrient dense diet, consisting of wholefoods, fruit and vegetables with limited saturated fat and sugar can support better outcomes in those taking ACE inhibitors, and a significant reduction in blood pressure.

TIP: Supplementing supportive nutrients including zinc alongside a nutritious wholefood diet may give you the best chance of improving your blood pressure levels.

Diuretics

Diuretics decrease blood volume, meaning the heart has less to pump with each beat, which lowers blood pressure.They can deplete potassium and magnesium as they lower sodium (salt) in the body, which can impact the nervous system and muscles.

There are three main types of this medication. Loop diuretics, thiazide diuretics, and potassium-sparing diuretics. It is only the first two which are associated with potential nutrient deficiency.

Loop Diuretics: Loop diuretics regulate sodium levels. They are predominantly used for fluid accumulation in the lungs due to heart problems.

TIP: These diuretics are known to deplete magnesium and potassium. These nutrients are needed for healthy heart and nervous system function and are essential electrolytes. Supplementing these minerals can help fill nutrient shortfalls.

Thiazide Diuretics: This type of diuretic is used to relieve oedema, swelling caused by excess fluid trapped in the body’s tissues due to chronic heart failure. It is primarily prescribed though to reduce blood pressure.

TIP: It is known that Thiazide diuretics often deplete calcium, vitamin B1 and potassium. In addition, it can also reduce zinc, and some research suggests folic acid too. Supplementing can help narrow nutritional gaps.

N.B Whilst they can reduce sodium in the body you should speak with your GP regarding the use of sodium containing supplements. Most of us get enough sodium in our diet, and it can increase blood pressure.

Combined contraceptive pill

Oral contraceptives are a hormonal form of birth control which prevent ovulation and therefore pregnancy. They are also commonly prescribed for those having problems with their menstrual cycle including PMS, heavy periods or endometriosis. It is estimated that around 40% of women aged 16-50 are taking oral contraceptives. The contraceptive pill is linked to depletion in a wide variety of nutrients including folic acid, vitamin B2, B6 and B12. As well as vitamin C, E and the minerals zinc and magnesium.

The contraceptive pill is often taken for many years so taking a multivitamin to provide a broad array of nutrients may be helpful in supporting optimal nutritional status.

If coming off the contraceptive pill to plan pregnancy, this is especially important regarding folic acid which is recommended preconceptually to help prevent neural tube defects in the developing baby. In this case it is best to choose a multivitamin specially formulated for pregnancy to ensure the correct intake of folic acid.

Diuretics

Diuretics promote the removal of excess water from the body, helping to manage conditions such water retention. They can deplete potassium and magnesium as they lower sodium (salt) in the body, which can impact the nervous system and muscles.

There are three main types of this medication. Loop, thiazide, and potassium-sparing diuretics. Only the first two are associated with potential nutrient deficiency.

Loop Diuretics These are predominantly used for fluid accumulation in the lungs due to heart problems.

TIP: These diuretics are known to deplete magnesium and potassium. These are needed for healthy heart and nervous system and are known as essential electrolytes. Supplementing these minerals can help prevent nutrient shortfalls.

Thiazide Diuretics This type of diuretic is used to relieve oedema, swelling caused by excess fluid trapped in the body’s tissues due to chronic heart failure. It is mostly prescribed for its action in reducing blood pressure, which helps to relieve workload on the heart.

TIP: Thiazide diuretics often deplete calcium, vitamin B1 and potassium. They may also reduce zinc, and some research suggests folic acid too. Supplementing can help support any nutritional gaps.

HRT

Hormonal replacement therapy (HRT) is a treatment used by women during the menopause to help relieve symptoms and/or strengthen bones by replacing the hormones oestrogen, often in combination with progesterone that the body no longer produces itself.

Despite its obvious benefits for menopausal symptoms, as with the contraceptive pill, HRT may reduce the amount of zinc transported in the body and deplete many nutrients including B vitamins, folic acid vitamin C and vitamin E.

TIP: A multivitamin and a nutrient dense diet are a good way to support women taking HRT. B vitamins are found in foods such as leafy green vegetables like spinach and kale, lentils, beans and eggs so these should be included in the diet regularly.

Hypoglycaemics

This category of medications is used for lowering or regulating blood sugar levels. Hypoglycaemics can be essential for those who are diabetic or pre-diabetic. A diet which is high in sugar, refined fats and calories, increases the risk of type II diabetes. Obesity is another risk factor for diabetes. The number of people affected is growing, with an estimated 3.8 million people aged 16+ in England having type II diabetes. By 2035, the prevalence of diabetes is expected to increase to 4.9 million people in the UK.

Research shows hypoglycaemic medication can cause decreased absorption of vitamin B12 and folic acid in the intestine, which can over time increase your risk of fatigues and neuropathy (numbness, tingling or pain often in the hands and feet).

TIP: Hypoglycaemics have also been shown to reduce the recycling of CoQ10 in the body. The depletion of this nutrient may contribute to low energy levels, but it is also a vital fat-soluble antioxidant in the brain and body.

Inhalers

Steroid inhalers are a type of medication, typically used over a long period of time to improve symptoms of inflammation and to dilate the airways, known as bronchodilators. They are used to deliver medication directly to the lungs to improve breathing, most commonly in those who suffer from asthma.

Whilst they are low dose compared to oral corticosteroid medication, they may over longer periods impact calcium absorption and increase calcium excretion. Over a lifetime this could lead to the potential for increased risk of bone loss/fracture and osteoporosis.

Steroid inhalers also increase chromium and zinc excretion. Chromium is involved in blood sugar control, whilst zinc is essential for tissue repair and function of the immune system and brain, and a key antioxidant.

TIP: Supplementing with the above minerals can fill nutrient shortfalls.

Painkillers

Common painkillers like paracetamol, codeine and Ibuprofen all work in different ways to reduce signals of pain in the body for a wide range of conditions. Studies suggest that paracetamol and codeine do not affect nutrient status however non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen commonly taken or prescribed for relieving pain, reducing inflammation and managing a fever may do if taken over longer periods.

This group of medicines has been shown to reduce the amount of folic acid being transported to the tissues that need it. NSAIDs can also reduce the tissue uptake of vitamin C and may lower vitamin B12. They can also affect the gut lining, which if damaged can increase iron loss with the potential for deficiency and anaemia. They may also lower B12. Typically, this nutrient depletion is caused by longer term use of NSAIDs rather than just short-term use for a fever.

TIP: Supplementing vitamin C, folic acid, B12 and iron (this should be tested for by the GP) may help to prevent any medication related deficiencies. These nutrients have numerous roles in the body from immune function to cognition. Folic acid and B12 are two of the nutrients needed for helping keep damaging homocysteine in check.

N.B Taking vitamin C alongside aspirin can increase the amount of medication in the body which may increase blood thinning and bleeding risk so check before you supplement.

Proton Pump Inhibitors (PPIs) and Antacids - Digestion Medication

Stomach acid lowering medication is typically used by those who suffer from high levels of gastric acid, chromic indigestion or hiatus hernia, or sometimes alongside medications which can damage the gut lining. Common symptoms of high stomach acid can include bloating, nausea and heartburn. Examples of stomach acid lowering medication include Proton Pump Inhibitors (PPIs) and Antacids. PPIs work by inhibiting the enzyme, commonly known as the proton pump, located on the parietal cells of the stomach lining. This inhibition leads to a significant reduction in stomach acid production. Antacids (aluminium hydroxide) work by neutralizing stomach acid.

PPIs are taken long-term and are associated with low levels of magnesium, known as hypomagnesemia. Lowering stomach acid levels reduces the absorption of minerals, so magnesium, iron, calcium and zinc absorption can all be affected.

TIP: Antacids inhibit absorption of the minerals chromium, iron and calcium, as well as folic acid. Therefore supplementing can help fill nutrient shortfalls.

N.B Supplementing calcium alongside antacids could increase aluminium absorption (which they are composed of) in the gut, Calcium supplementation should therefore be discussed and taken under supervision of a GP or pharmacist.

Statins

Statins are prescribed to individuals to reduce their cholesterol levels. Statins are known to reduce the absorption of fat-soluble vitamins by binding to transport proteins that normally carry fat-soluble vitamins through the intestine and into the bloodstream.

Statins are well established to reduce the production of Co-enzyme Q10, a fat-soluble antioxidant. A depletion of CoQ10 is well-known to play a role in muscle weakness, but can also impact energy production. CoQ10 has long been advised to help prevent symptoms associated with statin use.

Statins also reduce the other fat-soluble nutrients beta-carotene, vitamin E and vitamin D, as they too are transported via cholesterol in the blood.

TIP: Supplementation of CoQ10 and fat-soluble vitamins could be necessary alongside statins, as well as increasing dietary sources. CoQ10 is found primarily in meat, but oily fish, sesame and pistachio seeds also contain some. Oily fish is also a source of dietary vitamin D, whilst nuts, seeds, avocados, and leafy greens are good sources of vitamin E.

N.B Vitamins E and D could reduce the amount of statin medication in the body, which could potentially cause the medication to be less effective. With this in mind, vitamin E and D supplementation should be discussed and taken under supervision of a GP or pharmacist.

Steroids (Oral Corticosteroids)

Corticosteroids are used to reduce inflammation and suppress the immune system. They are often used for those with autoimmune conditions, or for those with inflammatory types of arthritis. They provide the body with anti-inflammatory hormones such as cortisol which dampens the immune system response, reducing swelling, and redness.

Corticosteroids cause a decrease in vitamin D and calcium absorption, leading to an increased risk of bone loss, fractures and osteoporosis. Some research also suggests zinc and chromium might also be depleted. Zinc is needed for numerous systems and processes in the body including the immune system, skin, brain chemistry and tissue repair, whilst chromium is involved in blood glucose control. Taking corticosteroids can increase vitamin C excretion, which is a nutrient that is essential for contributing to the normal function of the immune system. Potassium excretion is also increased.

Good to know:If you are taking corticosteroids for a long time your GP will usually prescribe both calcium and vitamin D to help prevent deficiency and support your bones, but you can choose a different form or format if you prefer, or a formulation specifically for bone health.

TIP: Vitamin D is made in the body following sun exposure but at least 400iu is always recommended during the autumn and winter months when the sun in the UK is not strong enough to trigger its synthesis. Calcium can be found in many diary products but also nuts, seeds, wholegrains and leafy greens. These are also good sources of zinc. Whole-grains, green beans, broccoli, nuts, and eggs are good sources of chromium. Including plenty of vegetables is an excellent way to increase vitamin C and potassium.

N.B Supplemental vitamin D may reduce the amount of corticosteroid medication in the body, making it less effective. Vitamin D supplementation should be discussed and taken under the supervision of a GP or pharmacist.

Weight loss medication

Weight loss medications are becoming more prevalent in modern society. One of the most well-known of this type of medication is ‘Ozempic’. This group of medications have been shown to provide effective results and can be helpful in some instances, but it is essential to implement a change of diet and lifestyle alongside. Improving your diet can be done with small changes such as ensuring you are not in a calorie surplus regularly and reducing the intake of ultra-processed foods with high fat and high sugar content. Consuming a nutrient dense diet with fruits, vegetables, proteins, beans and legumes is a great way to eat a more balanced and nutritious diet.

Lipase inhibitors These reduce fat breakdown and absorption in the gut, so they pass through rather than being absorbed. This action means fat soluble vitamins can also pass straight through and can lead to deficiency in vitamins A, D, E and K as well as beta-carotene. These are needed for multiple functions in the body from skin and eye health to strong immunity and bones.

TIP: Supplementing with vitamins A, D, E and K as well as beta-carotene, can help to increase your intake.

GLP-1 These are injectable drugs that mimic the hormone GLP-1, which are responsible for reducing blood sugar and weight by activating the GLP-1 receptor which increases the action of insulin. They are used for type 2 diabetes, obesity and other cardiovascular related conditions.

These agonists can reduce food intake by suppressing appetite. Naturally, this can lead to lower intake of essential nutrients and may lead to numerous deficiencies in key vitamins and minerals, but also macronutrients like protein and fats. This medication can also slow down gastric emptying and reduce the production of stomach acid, which can impact nutrient absorption.

These are new medications and have no evidence yet over and above reducing appetite and therefore nutrient intake. Some very recent research suggests that nutrients most at risk of depletion are iron, magnesium, potassium, choline and vitamin D, but as these foods can also be low in the general population from poor diet more research is needed to clarify.

TIP: If your appetite is significantly reduced, and or you suffer from side-effects such as vomiting, or if your diet still relies fairly heavily on ultra-processed foods, you could look to take a multivitamin and an additional magnesium to help plug any nutrient gaps.

Manage your lifestyle to maximise your nutrient status

The fundamentals of being healthy come from a variety of habits in our daily routine, with our nutrition being a key factor. Eating a varied and nutrient dense diet will help provide your body with the beneficial levels of micronutrients it needs, supporting the brain, heart, energy levels and more. The addition of a multivitamin can also help to fill any nutrient gaps in your diet.

Limiting our exposure to caffeine, alcohol and tobacco is also crucial, as is our intake of sugar. Sugar and alcohol are both anti-nutrients, meaning they use up more nutrients for the body to process them than they provide. They can also impact our diet, energy levels and mental health. Research has shown that smoking decreases bioavailability of some nutrients and is inversely correlated with many vitamins and minerals including vitamins, C, E, D, calcium, iron, zinc and many more.Tannins found in tea bind to minerals in the diet, preventing them from being absorbed. If you drink a lot of tea your mineral status might be low.

Ensuring we stay physically active is important for maintaining and improving our cardiovascular health. This can help to regulate heart rate, improve blood pressure and cholesterol levels, influence our mental health, blood glucose control and maintain a healthy weight.

Stress uses up nutrients, and many of us live busy and stressful lives which can have an impact on our health. Stress is known to cause nutrient depletion of key vitamins and minerals such as magnesium, iron, vitamin C and B vitamins, especially B5. So, taking a supplement such as a multivitamin, and extra magnesium can be a good idea to combat these potential nutrient deficiencies and ensure we are getting the right nutrition to support our lifestyle.

Where should I go for support?

For more information, speak with your GP or practice pharmacist who can deal with medication queries and potential interactions with supplements, as well as carry out a medications review. The NHS recommends regular medication reviews, at least once per year and states they are particularly important if taking multiple medications. This will help to identify and address side effects and other impacts, as well as highlight medicines which are no longer clinically indicated, appropriate or optimised.

Conclusion

Whilst prevention is always better than cure, medication is essential for many of us. If you take one or more medications, be aware that some common medications may reduce your nutrient status with potential knock-on implications for your future health. Dig deeper into your medication to see what you might need to pay more attention to including or reducing in your diet and choose supplements which can help you top up your levels and fil the gaps. Use your local pharmacist or your GP for advice on your medications and how to take supplements alongside and seek out suitable supplements from your independent health food store.

It’s easy to assume all supplements are equal and beneficial but it’s always worth reading the ingredients list on the label. Many supplements have added additives, fillers and binders as well as preservatives, glazing agents and anti-caking agents. These ingredients are there to help speed up manufacture and make the product cheaper. They have no added health benefits, and some have evidence of negative health impacts. Look for supplements with active ingredients and a clean formulation.

Author: James Pugh, BSc, is a Nutrition Advisor at Viridian Nutrition. He holds a BSc honours degree in Sport & Exercise Nutrition.

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The information contained in this article is not intended to treat, diagnose or replace the advice of a health practitioner. Please consult a qualified health practitioner if you have a pre-existing health condition or are currently taking medication. Food supplements should not be used as a substitute for a varied and balanced diet.