Caroline Bonds, Biochemistry & Molecular Biology
Prescription Support is best described as a formulated multivitamin and enzyme blend to replenish the body with vitamins that have been depleted by commonly prescribed medications to maintain the overall health of the patient. Some commonly prescribed medications rob the body of vitamins and minerals needed to perform specific tasks and functions. Listed below is a list of what these commonly prescribed medications are used to treat and the nutrients the drugs deplete from the body.
Metformin is the number one prescribed medication for diabetes and is a probable cause of vitamin B12 deficiency. One study concluded that Metformin was associated with an increase in Vitamin B12 deficiency and reduced serum levels of B12 (Niafar et al., 2015). Another study stated that using Metformin long-term is the known cause of cobalamin deficiency and is linked to decreased serum folic acid (B9) concentration (Mazokopakis & Starakis, 2012).
A direct target of metformin is complex I in the mitochondrial transport chain where NADH: ubiquinone oxidoreductase is inhibited (Kelly et al., 2015) thereby inhibiting the production of CoQ10. A study showed that supplementation of CoQ10 while on sulfonylureas decreased fasting blood glucose as well as A1c (Kadhim Mohammed-Jawad & Al- Sabbagh, 2014). Another study showed that CoQ10 improved glycemic control. Sulfonylureas are also known to affect the absorption of the vitamin B complex (Kang et al., 2014).
Another important point to make is that insulin robs the body of adequate amounts of magnesium (Barbagallo & Dominguez, 2007). Intracellular magnesium plays a huge part in regulating insulin pathways and without an effective amount of magnesium, tyrosine-kinase is inactive, worsening insulin resistance (Dubey et al., 2020).
The most prescribed medication for hypercholesterolemia is statins. Statins have been reported to increase muscle-related complaints or myopathies and this could be because statins block the biosynthesis of CoQ10 (York et al., n.d.). Statins are HMG-CoA reductase inhibitors and decrease precedents of cholesterol and CoQ10. The rate at which statins reduce CoQ10 is by about half (Caso et al., 2007). Again, statins deplete the body of CoQ10 with possible side effects that are due to the lack of cholesterol needed for neurons and hormone production (Cass, 2016). Supplemental CoQ10 helps to prevent memory loss, congestive heart failure, muscle aches, and fatigue.
High Blood Pressure medications
When on Hypertension medications such as betablockers, angiotensin-converting enzymes (ACE) inhibitors, angiotensin II receptor blockers (ARBs), or diuretic drugs, the body could be depleted of the following nutrients: CoQ10, Zinc, Calcium, Magnesium, B vitamins, and Folate. When used for 6 months or longer, ACE inhibitors are linked to zinc deficiency. Since zinc plays a role in more than 300 enzymatic reactions – including gene expression of immune cells – it is important to replenish the body of it (Mospan, 2019).
Another nutrient depletion caused by ACE inhibitors is one of the B vitamins, folate. Studies show that folate supplementation is efficient in treating hypertension, stroke, cardiovascular disease, cancer, renal disease, and hyperhomocysteinemia (BAŞ, 2022). Diuretic drugs increase urinary loss of thiamin (B1), folate (B9), and calcium (Mohn et al., 2018). Patients being treated for hypertension often have low amounts of CoQ10. When enough CoQ10 is taken orally, the negative effect of the beta-blocker on the heart vanishes (Langsjoen et al., 1994).
A common issue in patients taking a beta-blocker is the lack of sleep. Beta-blockers reduce the production of melatonin by blocking the beta-adrenergic receptors (Fares, 2011). Supplemented melatonin could lower the risk of sleep disorders.
Another supplement that plays a role is magnesium. Magnesium has additional anti-hypertensive effects when taken with other anti-hypertensive drugs (Houston, 2011). Further, diuretics increase urinary magnesium excretion, but are typically acute. Thiazide diuretics, however, have a longer-lasting effect as hydrochlorothiazide, chlorthalidone, and frusemide showed an increase in urinary magnesium excretion (Davies & Fraser, 1993).
Birth Control and/or Hormone medications
When on a medication such as Birth Control or Hormones, the body gets depleted of Vitamins B2 (riboflavin), B6 (pyridoxine HCl), B9 (folate), C (L-ascorbic acid), and E (α-tocopherol), as well as Magnesium and Zinc. Most patients do not understand the biochemical and metabolic pathways of vitamins and minerals; they do, however, know how they “feel” when taking (or not taking) their multivitamin. Let’s break down the vitamin deficiencies created by hormonal medications and compare with the symptoms and side effects listed above.
Many studies show that birth control negatively affects folate levels and concentrations in the serum as well as the vitamin B complex (Palmery et al., n.d.). Folate works to prevent anemia, memory loss, depression, cardiovascular disease, and stroke. Women using birth control pills have also shown diminished levels of Vitamins C, B2, B6, and B9 (folate) (Stark, 2021). Riboflavin helps to combat neuropathy, muscle aches, and aids in vision health. Pyridoxine HCl also aids in vision health as well as digestion and assists in the prevention of cardiovascular disease and anemia.
Vitamin C is said to improve all aspects of diabetes and is depleted due to increased urination. Vitamin C supports the immune system. The depletion of vitamin, magnesium, and zinc are associated with hormonal birth control as well (Stark, 2021). Vitamin E is a preventative of atherosclerosis, cataracts, easy bruising, dry hair and/or skin, and promotes quicker wound healing, energy, and cardiovascular health. Magnesium helps with muscle cramps and opposes insulin resistance. Zinc aids in wound healing and is involved in many enzymatic reactions, playing a role in gene expression of immune cells.
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BAŞ, Z. (2022). Investigation of inhibition effect of folic acid (vitamin B9) on angiotensin-converting enzyme activity purified from human plasma. Journal of the Institute of Science and Technology, 1607–1614. https://doi.org/10.21597/jist.1109149
Caso, G., Kelly, P., McNurlan, M. A., & Lawson, W. E. (2007). Effect of Coenzyme Q10 on Myopathic Symptoms in Patients Treated With Statins. American Journal of Cardiology, 99(10), 1409–1412. https://doi.org/10.1016/j.amjcard.2006.12.063
Cass, H. (2016, December 11). A Practical Guide to Avoiding Drug-Induced Nutrient Depletion. Nutrition Review.
Davies, D., & Fraser, R. (1993). Do diuretics cause magnesium deficiency? British Journal of Clinical Pharmacology, 36(1), 1–10. https://doi.org/10.1111/j.1365-2125.1993.tb05883.x
Dubey, P., Thakur, V., & Chattopadhyay, M. (2020). Role of minerals and trace elements in diabetes and insulin resistance. In Nutrients (Vol. 12, Issue 6, pp. 1–17). MDPI AG. https://doi.org/10.3390/nu12061864
Fares, A. (2011). Night-time exogenous melatonin administration may be a beneficial treatment for sleeping disorders in beta blocker patients. In Journal of Cardiovascular Disease Research (Vol. 2, Issue 3, pp. 153–155). Medknow Publications. https://doi.org/10.4103/0975-3583.85261
Houston, M. (2011). The role of magnesium in hypertension and cardiovascular disease. In Journal of Clinical Hypertension (Vol. 13, Issue 11, pp. 843–847). https://doi.org/10.1111/j.1751-7176.2011.00538.x
Kadhim Mohammed-Jawad, N., & Al- Sabbagh, M. (2014). Role of L-carnitine and Coenzyme Q10 as Adjuvant Therapy in Patients with Type 2 Diabetes Mellitus. American Journal of Pharmacological Sciences, 2(5), 82–86. https://doi.org/10.12691/ajps-2-5-2
Kang, D., Yun, J. S., Ko, S. H., Lim, T. S., Ahn, Y. B., Park, Y. M., & Ko, S. H. (2014). Higher prevalence of metformin-induced vitamin B12 deficiency in sulfonylurea combination compared with insulin combination in patients with type 2 diabetes: A cross-sectional study. PLoS ONE, 9(10). https://doi.org/10.1371/journal.pone.0109878
Kelly, B., Tannahill, G. M., Murphy, M. P., & O’Neill, L. A. J. (2015). Metformin inhibits the production of reactive oxygen species from NADH: Ubiquinone oxidoreductase to limit induction of interleukin-1β (IL-1β) and boosts interleukin-10 (IL-10) in lipopolysaccharide (LPS)-activated macrophages. Journal of Biological Chemistry, 290(33), 20348–20359. https://doi.org/10.1074/jbc.M115.662114
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Mazokopakis, E. E., & Starakis, I. K. (2012). Recommendations for diagnosis and management of metformin-induced vitamin B12 (Cbl) deficiency. In Diabetes Research and Clinical Practice (Vol. 97, Issue 3, pp. 359–367). https://doi.org/10.1016/j.diabres.2012.06.001
Mohn, E. S., Kern, H. J., Saltzman, E., Mitmesser, S. H., & McKay, D. L. (2018). Evidence of drug–nutrient interactions with chronic use of commonly prescribed medications: An update. In Pharmaceutics (Vol. 10, Issue 1). MDPI AG. https://doi.org/10.3390/pharmaceutics10010036
Mospan, C. M. (2019). Drug-Induced Nutrient Depletions: What Pharmacists Need to Know. US Pharmacist.
Niafar, M., Hai, F., Porhomayon, J., & Nader, N. D. (2015). The role of metformin on vitamin B12 deficiency: a meta-analysis review. In Internal and Emergency Medicine (Vol. 10, Issue 1, pp. 93–102). Springer-Verlag Italia s.r.l. https://doi.org/10.1007/s11739-014-1157-5
Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (n.d.). Oral Contraceptives and Changes in Nutritional Requirements. 2013.
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Stark, G. E. (2021, January 6). Hormonal Birth Control Depletes Your Body of Key Nutrients. Natural Womanhood.
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