How your daily prescription pills could be draining your body of vital VITAMINS . . . and what you can do about it

Around half of us now take prescription pills daily, with a quarter on three different types, and millions of pensioners taking five a day on average.

What many people may not realise is that their medication — while combatting chronic and even life-threatening conditions — could also be depriving them of vital minerals and vitamins, leading to symptoms such as fatigue, hair loss, depression, loss of sex drive and muscle pains.

They can even cause crumbly bones, as Julie Sharp discovered (see box below) — she has severe asthma, and at 32, she’s also just been diagnosed with osteoporosis. This is a condition usually associated with old age, but the high- dose oral steroids she needs for her asthma affected the absorption of vital bone minerals including calcium and vitamin d.

‘There’s no doubt I needed steroids,’ she says now, ‘but why did no one warn me I should also take calcium and vitamin d supplements to protect my bones?’

Vitamin and mineral deficiencies as sideeffects of medication don’t get as much attention from doctors, pharmacists or patients as they should, admits Heidi Wright, practice and policy lead for England at the royal Pharmaceutical Society. ‘This is particularly true where patients are on two or three drugs that inhibit the same pathway [have a similar mode of action], which a lot of elderly people are.

‘GPs and pharmacists should be aware of this when prescribing — it is part of undergraduate training for pharmacists.’

This problem is ‘so widespread we need specialist pharmacists specialising in nutritional and drug issues in GP practices, running clinics’, adds Anja St. Clair Jones, a consultant pharmacist in surgery and gastroenterology at Brighton and Sussex university nHS Trust and a spokeswoman for the royal Pharmaceutical Society.

‘Lots of older people are on multiple drugs, have absorption problems and don’t eat very much so may be deficient in vitamins and minerals. We just don’t know how many might be affected.’

Here we look at the commonly prescribed drugs that can potentially ‘drain’ your body of vitamins and minerals . . .

HEARTBURN TABLETS

YOU COULD BE MISSING OUT ON: Iron, calcium, magnesium, vitamins C and B12 ProTon pump inhibitors (PPI) such as omeprazole are taken by millions of Britons; omeprazole is the third most prescribed drug in the uK. It works by reducing stomach acid production and is often prescribed for heartburn and also to prevent stomach ulcers, bleeding and anaemia in patients who are taking non-steroidal antiinflammatory drugs for arthritis (see box top right).

Iron, calcium and magnesium, vitamins C and B12 ‘all need an acidic environment to be absorbed in the stomach and PPIs reduce acid production, so you can get absorption problems,’ explains Anja St. Clair Jones.

While there are warnings about these risks in some patient information leaflets, the problems ‘need to be flagged up more’, she says.

‘It’s particularly severe in people who are elderly — because they have absorption problems anyway and tend not to eat very much — and in those who don’t eat a wide enough range of foods.’

Lack of calcium can lead, in the long term, to osteoporosis and lack of magnesium can lead to muscle cramps and loss of appetite.

‘ Iron requires a very acidic environment to help absorption, so if you’re suppressing stomach acid secretion that can lead to iron deficiency and that is something patients should be aware of,’ says Toby richards, professor of surgery at university College London, who also runs The Iron Clinic.

‘ Low iron levels are a huge problem in the uK affecting around 3.5 million people and medication side-effects are a factor in this, along with heavy periods and lack of iron in the diet.’

Symptoms of iron deficiency anaemia include tiredness and fatigue, breathlessness, restless legs and hair loss. Patients who complain of fatigue tend to be tested for iron deficiency and anaemia, says Anja St. Clair Jones ‘but they are not tested so much for calcium and magnesium deficiency as symptoms aren’t so obvious, so problems can go undiagnosed’.

Ms St. Clair Jones says that PPIs are over-prescribed and that more patients with dyspepsia (indigestion) could be managed with lifestyle changes such as cutting out spicy food and losing weight, rather than taking a pill every day.

She adds that if you are taking a PPI you should ‘be aware of the nutritional risks and have regular blood tests to check for anaemia and other deficiencies’.

STATINS

YOU COULD BE MISSING OUT ON: Co-enzyme Q10 onE in seven Britons now takes a daily statin to lower cholesterol, a risk factor for a heart attack. Last year, atorvastatin was the most frequently prescribed drug in England, according to nHS digital.

A known side-effect of the drug is that it blocks the release of an enzyme called co- enzyme Q10, which is needed for energy production, particularly in muscles, including the heart. Low levels of CoQ10 can cause leg cramps and, less commonly, muscle weakness, memory problems and shortness of breath.

Sultan dajani, a community pharmacist in Eastleigh, Hampshire, says that leg cramps are the problem he sees most often among patients on statins ( although cramps are not common). ‘Leg cramps are a known side-effect of taking statins, we warn patients about it when they get their first prescription and tell them to go and see their GP,’ he says.

‘In the vast majority of cases, switching to another type of statin resolves the problem, so people shouldn’t just give up taking them because they do save lives.’

dr Louise newson, a Stratfordupon-Avon GP, says patients who experienced muscle cramps and took CoQ10 supplements to counter them are ‘very positive’ about the effects.

‘There isn’t much evidence that they work but that doesn’t mean they aren’t safe, just that the trials haven’t been done.’

CONTRACEPTIVES

YOU COULD BE MISSING OUT ON: Folic acid, vitamins B2, B6, B12, C, and E, magnesium, selenium and zinc WoMEn taking the Pill can lack key nutrients, according to a 2014 review published in the European review for Medical and Pharmacological Services by the university