Common Medications that Deplete B Vitamins: Why it happens and how to prevent deficiency

Several medications — including antibiotics, acid blockers, and oral contraceptives — can interfere with absorption and increase excretion of B vitamins. When vitamins like B6, B12, folate, and biotin are depleted, you feel the effects in your immune system, cognitive function, energy levels, and more.

In this article, we’ll cover the most common drug-induced B vitamin depletions. These frequently prescribed or over-the-counter medications are known to deplete all or some of the vitamins in the B family.

What Medications Deplete B Vitamins?

All drugs have the potential to interfere with nutrient absorption or circulating levels. The drugs are formulated to “block,” “inhibit,” or kill the process or pathogens that are causing a condition. Unfortunately, some of the processes they block are beneficial to your body, including the absorption of B vitamins.

• Proton Pump Inhibitors
• Antibiotics
• Anticonvulsants
• Anti-inflammatories
• Diuretics
• Metformin
• Oral Contraceptives
• Hormone Replacement Therapy
• GLP-1
  

How Medications Deplete B Vitamins

Why Medications Deplete B Vitamins

Medications Can Reduce Absorption

For a vitamin to do its jobs in the body, it must absorb in the bloodstream and the cells. Certain medications interfere with the absorption process in various ways that can lead to deficiency over time.

• Example: PPIs block the stomach acid required to absorb B12 from food.
  
  

Medications Can Increase Excretion

B vitamins are water-soluble, which means your body can’t store any extra. When medications increase urination, vital B vitamins are lost. 

• Example: Diuretics increase urinary flow rates, pushing Thiamine (Vitamin B1) out of the body without absorbing.
  
  

Medications Can Reduce B Vitamin Synthesis

Microbiome disruption due to medications can interfere with the gut bacteria some B vitamins depend on gut bacteria for synthesis and absorption.

• Example: Antibiotics can kill the gut bacteria that synthesizes B7 (Biotin), B5, and B12 from food.
  
  

Medications Can Increase B Vitamin Requirements

Fluctuating hormones and other major changes in the body due to medications often demand more B vitamins.

• Example: Rapid weight loss increases the toxic load on the body, demanding more B vitamins to support detox and cell healthy while GLP-1 users are often not consuming enough to catch up.
  
  

WHICH MEDICATIONS DEPLETE B VITAMINS?

PROTON PUMP INHIBITORS

• Ranitidine
• Cimetidine
• Esomeprazole
• Famotidine
• Lansoprazole
• Omeprazole
• Aluminum and Magnesium Antacids
  

PPIs treat hyperacidity of the stomach by blocking an enzyme to preventing the proton pump from secreting acid into the stomach. 

While this lowers the acidity, it also inhibits effective protein digestion that requires stomach acid. Since digested protein is a major source of dietary B12 and folate, deficiencies in these two critical nutrients for brain, metabolic, and cardiac health is a known risk.

Since this particular drug class can prevent proper extraction of B12 and folate from food, increasing consumption of B vitamin-rich foods may not be effective, making high-absorption B vitamin supplements an appealing option.

ANTIBIOTICS

• Aminoglycides
• Amoxicillin
• Cephalosporins
• Fluouroquinolones
• Macrolides
• Penicillins
• Sulfonamides
• Tetracyclines
  

Antibiotics kill bacteria that are causing illness, but they’re not quite as smart as we’d like them to be. A lot of friendly gut bacteria that you need for healthy digestion; absorbing B1, B2, B3, B6, B12, and folate; and to synthesize some of our required Biotin are lost to friendly fire.

Taking a probiotic during short courses of antibiotics can support the gut microbiome, but long-term use requires special attention to avoid B vitamin deficiency.

ANTICONVULSANTS

Long-term use of medications to treat epilepsy have been linked to Biotin excretion and reduce folate absorption from foods. Other B vitamins, including B12 and B6, are also reduced.

ANTI-INFLAMMATORIES

• Non-Steroidal Anti-Inflammatories (Ibuprofen, naproxen)
• Corticosteroids (hyrdocortisone, fluticasone)

It’s not the recommended NSAID doses to relieve acute pain, but high-dose, chronic use that can interfere with B6 and Folate absorption. Long-term corticosteroid use can have similar effects, additionally depleting B12. 

DIURETICS

Diuretics increase urine production to help rid the body of salt and water, taking Thiamine (B1) along. Chronic use can lead to Thiamine deficiency, particularly in the elderly, making supplementing important as food consumption declines with age.

METFORMIN

The higher the dose and longer the treatment, the more Metformin can lower B12 levels. In addition to interfering with absorption, Metformin often causes diarrhea that leads to nutrient loss. 

HORMONAL BIRTH CONTROL AND HORMONE REPLACEMENT THERAPY

Hormones can change how the body processes nutrients and increase the demand, which may be why studies have repeatedly shown lower B6, Folate, and B12 levels in women taking oral contraceptives and undergoing HRT. 

Because demand is increased, supplements formulated for absorption can guard against deficiency. 

GLP-1

GLP-1 medications slow digestion, which can alter how B12 is absorbed from food. Metabolic changes due to weight loss can compound this effect. Meanwhile, toxins stored in rapidly shrinking fat cells release into the body and need more B2, B6, and Folate to prevent damage. 

GLP-1 drugs are seldom taken alone. Many GLP-1 users are also taking diuretics for blood pressure, Metformin for diabetes, or a PPI to control stomach acid. All this drugs together coupled with the increased demand and lower food intake creates a perfect storm for B vitamin depletion. 

Supplements that target the cells can be an important part of maintaining B vitamin levels while consuming fewer calories.

B VITAMIN DEFICIENCY SYMPTOMS

• Low energy
• Low mood
• Elevated homocysteine
• Hair loss
• Pins and needles
• Nausea
  
  

WHO IS AT RISK FOR B VITAMIN DEPLETION?

• People taking multiple medications: Each may deplete B vitamins by a different mechanism.
• Older adults: Lower food intake and declining stomach acid makes seniors prone to B12 deficiency. 
• People with digestive problems: Anything that interferes with digestion can prevent optimal B vitamin absorption. 
• Vegetarians and vegans: B12 and other B vitamins are prominent in animal-based food. 
  
  

HOW TO PREVENT B VITAMIN DEFICIENCY WHILE TAKING MEDICATIONS

TESTING

Blood tests can confirm low B vitamins. Certain biomarkers, like elevated homocysteine and methylmalonic acid, can indicate a deficiency.

NUTRITION

The B vitamins are a family of family of eight vital nutrients that your body cannot produce on its own. A whole food, omnivorous diet provides all the B vitamins (though potentially not in the required amounts when any aspect of absorption is challenged).

Small amounts of B vitamins are found in a wide range of foods, with the following list including some common foods that offer the highest amounts.

• B1 (thiamine): Pork, trout, black beans
• B2 (riboflavin): Oats, yogurt, milk
• B3 (niacin): Chicken, turkey, salmon
• B5 (pantothenic acid): Shiitake mushrooms, sunflower seeds, avocado
• B6: Chickpeas, tuna, banana
• B7 (biotin): Egg, sweet potato, beef
• B9 (folate): Spinach, rice, asparagus
• B12: Tuna, oysters, nutritional yeast
  
  

SUPPLEMENTS

B Complex supplements include the entire B vitamin family, as deficiencies in multiple B vitamins are common. 

These supplements are everywhere, but when it comes to combatting depletion due to medications, taking a supplement formulated for absorption is critical.

Most supplements use the same biological pathways as food. A system that cannot process and absorb nutrients from food may have the same trouble with standard B Complex pills.

Liposomal B Complex supplements can bypass these pathways using protective spheres that deliver the vitamins to the cells for absorption. Because your body can’t store extra B vitamins, absorbing as much as possible from every dose makes a difference. 

Lypo-Spheric® B Complex Plus delivers the entire family of B vitamins for absorption in the cells — even during medication use.

WHAT WE LEARNED

By depleting B vitamins by preventing absorption or increasing excretion, some of the most common medications may put you at risk for deficiency. B vitamins aren’t just nice to have; they are required to make the cellular energy that keeps you alive. So medication depletion doesn’t become deficiency, it’s important to monitor levels, eat foods rich in B vitamins, and use a smart supplementation strategy that delivers at the cellular level. 

FREQUENTLY ASKED QUESTIONS

What drugs cause B12 deficiency?

PPIs, antibiotics, anticonvulsants, hormone replacement therapy, hormonal birth control, metformin, and GLP-1s (indirectly) can deplete B12. If not addressed with nutrition and supplements, this medication-induced depletion can lead to deficiency.

How do medications interfere with absorption of B vitamins?

Medications can alter metabolism, stomach acid, and gut bacteria in ways that prevent normal absorption of B vitamins from food and traditional supplements. 

What medications cause low folate?

PPIs, antibiotics, NSAIDs, corticosteroids, hormone replacement therapy, hormonal birth control, diuretics, and GLP-1s (indirectly) can deplete folate. If not addressed with nutrition and supplements, this medication-induced depletion can lead to deficiency.

Does GLP-1 deplete B12?

Yes. GLP-1 changes to the digestive system can interfere with B12 absorption. Lower food intake and potential digestive side effects can also lead to low B12 while weight loss increases the need for the vitamin.

Resources

1 Preckshot, John, RPh, CCN. “Drug-Induced Nutrient Depletion: The Pharmacist’s Responsibility.” America’s Pharmacist. December 2013: 43–53. Print.

2 Cohen, Suzy, RPh. Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients—and Natural Ways to Restore Them. Rodale, 2011.

3 Mohn, E.S., Kern, H.J., Saltzman, E., Mitmesser, S.H., McKay, D.L. Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics, 2018, 10, 36; doi:10.3390/pharmaceutics10010036.

4 Palmery, M., Saraceno, A., Vaiarelli, A., Carlomagno, G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 2013; 17; 1804-1813.

5 Pelton, Ross, RPh, PhD, CCN, LaValle, James, RPh, DHM,, NMD, CCN, Hawkins, Ernest, RPh, MS, Krinsky, Daniel, RPh, MS. Drug-Induced Nutrient Depletion Handbook Volume 2. Lexi-Comp, 2001.