Drug-induced nutrient depletion – a cautionary tale

Today I will tell you about Angie and her story of drug-induced nutrient depletion.

When Angie was a kid, she ate like most of us did. There were copious amounts of ultra-processed foods marketed to her and her parents as nutritionally complete but weren’t. So while Angie was trying to grow, she was at a constant insufficiency. Her immune system would get compromised, and her doctor would put her on several courses of antibiotics throughout her childhood.

Broad-spectrum antibiotics deplete B vitamins, which are crucial for unlocking energy that the nervous system can use to keep cells healthy and build neurotransmitters. Vitamin B deficiencies have numerous effects on many systems of the body, but particularly the nervous system and brain function.

As a child, Angie was already experiencing insufficient stores of important B vitamins and other nutrients. When Angie hit the biologically demanding puberty stage, any nutrient stores that she had managed to build depleted further. This was when she developed some mild depression and anxiety and started to have problems paying attention in school.

She went on hormonal birth control when she was 16-years old, which depleted her nutrient stores even further. Hormonal birth control is a well-known promoter of drug-induced nutrient depletion. Micronutrients depleted on hormonal birth control include selenium, magnesium, vitamin D, vitamin B, and zinc. These nutrient deficiencies exacerbated her mood and cognitive symptoms. She didn’t have enough B6 to convert the amino acid tryptophan into the neurotransmitter serotonin. This means she would sometimes be low-grade sad, sometimes anxious, and other times she would get a bit impulsive.

Because Angie did not have sufficient micronutrients, she could not make adequate levels of neurotransmitters or enough enzymes that are important for neuronal cell functions, like knowing when to break down neurotransmitters or let them hang out longer in the synapse. Her brain wasn’t working properly.

If Angie had presented her mood issues to her doctor, she would have been given an SSRI. But that would not have likely worked, at least not for long. Because without adequate micronutrients, she would not have been able to make enough neurotransmitters to hang out in the synapse. SSRIs would have been ineffective without adequate iron, B6, and zinc levels. So a prescribed SSRI’s paltry attempts to have her already inadequate amounts of serotonin hang out longer in the synapse would not have fixed the problem.

Angie instead led with her ADHD-like symptoms, obtained a diagnosis of ADHD, and began taking stimulant medication. I think we are all relieved and glad that Angie felt better! She deserves to feel amazing. But the story does not end there.

Eventually, her ADHD stimulant medication stopped working so well, and she had to increase it. And some of the ADHD-like symptoms did not improve with the increase in the stimulant. Why was this happening? Why wasn’t the medication working well anymore? We often call this effect building tolerance. But it is much more likely something else.

The stimulant medication we prescribe for ADHD depletes the body of magnesium and many other nutrients. So as Angie increased her stimulant medication, her magnesium stores went down. She began to develop allergies as a result, and later that same year, she had an asthma attack. Both of these conditions can occur as a result of severe magnesium depletion.

It would have been great if she could have been evaluated for nutrient insufficiencies in the beginning when she presented with ADHD-like symptoms. She could have perhaps fixed them with diet or even just additional supplementation to offset what her diet and ADHD medications were doing. Dietary change or supplementation might have reduced her chances of developing those additional chronic conditions. It would have been nice if Angie could have made decisions about medications while knowing their role in nutrient depletion and how it would affect her health and symptoms. It would have been nice if the potential for drug-induced nutrient depletion was at the forefront of her doctor’s mind during her visit.

After Angie developed allergies and asthma, her doctor prescribed corticosteroids and antihistamines.

The nebulizer she took home in her purse contained corticosteroids that further depleted her of vitamin B6, magnesium, zinc, and B12. This reduced her ability to make serotonin even more. She noticed her mood worsened.

And because she didn’t have enough serotonin, there was not enough to convert into melatonin. Melatonin helps you sleep, but it is also a big antioxidant. Other detoxification nutrients were also depleted while taking corticosteroids, like selenium, Vitamin D (which will also affect immune health, neurotransmitters, and sleep), and chromium. Chromium helps your blood sugar stay stabilized.

Because Angie’s selenium was additionally depleted by the corticosteroids (in addition to the hormonal birth control she was still taking), she was set up for the development of a future thyroid disorder. Also, less selenium impaired her body’s ability to detox, increasing brain inflammation and exacerbating her mood and cognitive symptoms.

The antihistamines she was told to go buy over the counter (OTC) have special depletions for the people taking them. As Angie took her antihistamines, her body was depleted of essential fatty acids that are, well, essential for brain health!

This was the last thing that Angie needed.

People low in essential fatty acids show symptoms of ADHD, and ADHD symptoms are the very thing that poor Angie went in seeking help for. So the fact that the antihistamines worsened her ADHD symptoms is both ironic and sad. Taking the antihistamines depleted magnesium (yet again! along with her hormonal birth control, ADHD stimulant medication, and now antihistamines – can you see the compounding effect?)

Not surprisingly, Angie developed additional cognitive and mood issues. Brains need lots of fatty acids to repair, and when we see people have fatty-acid insufficiencies, we often see depression and, in very severe cases, increased suicidality.

Angie’s health and sense of well-being were going down quickly. She blamed her work environment, which was no more stressful than other work environments. Still, her resiliency to stress was low because of her nutrient deficiencies, and she felt like she couldn’t cope. Her ability to cope with stress would have been much better if she didn’t have such a bad case of drug-induced nutrient depletion.

Her magnesium levels continued to deplete due to the stimulant medication for ADHD, and the corticosteroids in her nebulizer were reducing important nutrients she needed to upkeep cell function. This means her neuroinflammation was steadily and insidiously rising, exacerbating her psychiatric and cognitive symptoms to a whole new level.

Angie was now in her early 30s. She had a family, a partner, a mortgage, and a couple of kids. She felt overwhelmed all the time, scatterbrained, and somewhat sleep-deprived. She laughed it off to being a working mom. She had changed jobs but was still feeling overwhelmed. She went back to her doctor.

Her doctor prescribed SSRIs to treat what he identified as anxiety and depression. Angie accepted the diagnosis as accurate.

But her new SSRI began to displace her iodine. SSRIs are one of many drugs that contain fluoride or other halogen structures that displace iodine absorption in the tissues. So any time you take one of these medications (this site as a good list) containing a strong halogen, it is going to deplete your already inadequate stores of iodine and begin to set the stage for thyroid dysfunction.

Her SSRI began to fill up the iodine receptors in her glandular tissues (thyroid, ovaries, breasts, and brain). And without writing a whole other blog post on iodine, I can tell you that this is a very bad thing. Iodine insufficiency can cause histological changes to these glandular tissues, which in turn set the tissue up for the development of cancer.

SSRIs are also associated with lower levels of melatonin. So now Angie began having worsening insomnia. Sometimes she had problems falling asleep or staying asleep. But she and her doctor blamed her sleep issue on her mood disorders, and she received another medication to treat it.

If you had experienced what Angie had, your doctor might have given you a benzodiazepine, clonidine, or another antidepressant commonly prescribed for this purpose called Trazadone. Angie received Trazadone, but because she was already not making enough serotonin to convert into melatonin reliably, the effectiveness of the new medication was hit and miss at best. Over time, this medication depleted her melatonin further.

So she began to consistently not sleep well, and over time, this caused increased insulin resistance, which disrupted her leptin, a hormone that helps her know when she is full. She began to eat more and gain weight, even though she was on stimulants for her ADHD. She blamed it on her hormones. The insufficient sleep revved up insulin resistance neuroinflammation and hasted a cycle of neuronal aging, worsening her mood and cognitive symptoms.

Because Angie was never taught human nutrition based on solid nutritional biochemistry science but instead was told what to eat by commercials, big food, and the government allowing those influences, her insulin resistance worsened. Her eating habits got worse, and she focused on comfort food as opposed to nutrient density.

She began to eat less meat because she was zinc deficient and could not make the digestive enzymes she needed to eat real food and feel good afterward with her digestion. She began to lean her diet heavily to more processed food products.

This way of eating aligned with her poor sleep to negatively affect her metabolism, and she left her doctor’s office once with a pre-diabetes diagnosis. The insulin resistance she developed increased her risk exponentially for the development of other chronic diseases that would inhibit her quality of life and sense of well-being.

At age 42, Angie’s thyroid gave out. It took a long time to happen, so nobody made the connection. They blamed her low mood, cognitive issues, sleep problems, and weight gain on her broken thyroid. Even though Angie kept telling them she had all those problems long before.

In what way Angie’s thyroid went out doesn’t really matter. It could have been from accumulated iodine and selenium deficiency from all the medications. It could have been due to an autoimmune issue that developed because her zinc levels were never high enough to maintain and balance her own immune system.

Angie’s doctor proceeded to prescribe thyroid medication. Sometimes the medication was not adjusted right, and Angie didn’t feel well. She didn’t like to have to go back to her doctor for regular testing, and she always had to make sure she had her thyroid medication for the rest of her life.

In her 50s, Angie finally went off hormonal birth control and went through menopause. Because of her nutrient deficiencies, she found this stage of life to be particularly difficult for her, with lots of mood swings, hot flashes, and a huge exacerbation of her insomnia.

It didn’t have to be like that for Angie. But it was. And so she went to her doctor and was put on hormone therapy. Unfortunately, this caused additional depletion of her already low vitamins B6 and B12, folic acid, and, you guessed it, magnesium.

Her hormone therapy should have helped protect Angie from developing mild cognitive impairment or early dementia symptoms. And it helped a little, I am sure. But the fact that Angie had insufficient micronutrients to upkeep her brain or quell her neuroinflammation continued the cycle of neurodegenerative aging that happened. And when Angie developed symptoms of mild cognitive impairment, she just blamed it on her ADHD, and her having her first “senior moments” and so didn’t get an evaluation.

When Angie’s husband finally decided something was really wrong, and she was diagnosed with Alzheimer’s disease, Angie was put on another medication. But as we know, there are no effective medications for Alzheimer’s disease. Pharmaceutical companies have been attempting medications to treat it unsuccessfully for decades. And so, we will end our story about Angie, her drug-induced nutrient depletion story, and its effects on her life here.

You may write the ending as you see fit.

There really isn’t a moral to this story, although you may come up with one that you will decide to take away from it.

The goal of telling Angie’s story was to allow you to see how nutrient deficiencies, when they are not corrected, and medications are used, a cycle of further nutrient depletion can occur that drives chronic disease and mental illness. After this post, you may better understand why drug-induced nutritional deficiencies can exacerbate problems. And you may more readily consider treating your symptoms using a different framework that may not lead to cycles of these deficiencies like Angie went through.

The story of Angie manifesting her beginning struggles could have gone in any direction. Another Angie may have presented with an eating disorder, or a mysterious illness, or stomach aches. Why? Because everyone has genetic predispositions that determine in what body system will begin to show symptoms first.

So while your story may be different from Angie’s, in terms of presenting symptoms, type of mood disorder, etc., it would have likely unfolded similarly. You would have gone to a doctor, got prescriptions that worsened underlying factors over several decades, and developed new chronic illnesses that don’t seem connected to your presenting problem, but really are.

I hope you found this blog post helpful. I write more about medication-induced nutritional deficiencies in the article below:

Ketogenic Diets for ADHD

You may also enjoy understanding more about micronutrients and how they affect serotonin, and their role in fighting neuroinflammation in any of these other posts on the Mental Health Keto blog.

Neuroinflammation and depression

Nutrition and supplements for antidepressant withdrawals

As always, this blog post is not medical advice, and I am not your doctor.

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This blog post was inspired by and based on an imaginary client created to educate about Drug-Induced Nutrient Depletion by Suzanne Keyes, PharmD, FACA, IFMCP. You can watch the original here.

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