What effects do drugs have on a patient’s micronutrient balance?

Kirsten Soltau, Naturopath, Glinde, Germany

In 1900, average life expectancy was still about 49 years, today it is already over 80 years. This is certainly not just down to developments in the field of medicine, but this certainly has a significant part in it.

In 2010, every person over 65 years of age with statutory health insurance in Germany (27.2% of the total population) received an average of 3.6 daily doses of a drug as long-term treatment.

In a study on the frequency of multi-medication, it was found that in 2012, 42% of patients over 65 years of age received five or more active substances as long-term medication (Thürmann, 2013). The number of different active substances and drugs increased to six or more drugs in patients admitted to wards for internal medicine.

Medications prescribed by conventional medicine can, if taken regularly, trigger deficiency symptoms or an increased requirement for essential vitamins as well as micronutrients in addition to the largely unexplained interactions between the active ingredients. This deficiency is often the cause of drug-related side effects.

It has been proven in laboratory medicine and also by studies that the targeted administration of micronutrients can reduce these undesirable side effects of drugs and thus improve a patient’s quality of life. Furthermore, the effects of drugs can be enhanced by the administration of micronutrients, thus reducing the dose of the medication, also allowing drug costs to be saved.

A consideration of the interactions between micronutrients and drugs and the associated dose adjustment and targeted supplementation of the corresponding micronutrients is a quality criterion for good drug prescription practice, but is rarely followed.

The most frequently prescribed drugs in Germany include:

  • Ibuprofen, metamizole/novamin sulfone, diclofenac and acetylsalicylic acid from the group of analgesics and antirheumatic drugs
  • Pantoprazole/omeprazole – proton pump inhibitors/acid blockers
  • Ramipril and amlodipine – blood pressure-lowering drugs
  • Bisoprolol and metoprolol – beta-blockers
  • Simvastatin and atorvastatin – cholesterol-lowering drugs
  • Torasemide – diuretic

1. Anti-hypertension drugs

In Germany, over 50% of 35-64 year-olds suffer from arterial hypertension (>139/89mm Hg), a major factor in the development of atherosclerosis. High blood pressure also promotes stroke, dementia, myocardial infarction, kidney failure, peripheral arterial occlusive disease and myocardial hypertrophy, and thus the risk of heart disease.

Hypertension sufferers usually take several drugs at the same time that influence each other and thus increasingly cause side effects and deficiency symptoms. These include:

ACE inhibitors, AT1 blockers

ACE inhibitors such as ramipril, captopril as well as AT1 blockers interfere with the renin angiotensin aldosterone system (RAAS). They dilate the blood vessels, the resistance in the bloodstream decreases so that the heart needs to pump less and blood pressure drops.

Calcium antagonists

Calcium antagonists such as amlodipine reduce the influx of calcium into the cells and thus decrease the tone of the smooth vascular muscles.

Beta-blockers

Beta-blockers block the action of the “stress hormone” adrenaline and the neurotransmitter noradrenaline. The main effects of beta-blockers are to lower resting heart rate and blood pressure. The best-known and most frequently prescribed active substance is metoprolol, in addition bisoprolol or atenolol.

Effects on the micronutrient balance:

Potassium plays a central role in the regulation of blood pressure. A deficiency or surplus can cause symptoms such as muscle weakness and heavy legs, up to cardiac arrhythmia and cardiac arrest. Potassium levels may rise or fall under treatment for high blood-pressure.

Zinc: the complex build-up of zinc with ACE inhibitors, especially captopril, and increased renal excretion lead to an undersupply of zinc. Zinc should be taken at a later time in addition to an ACE inhibitor.

Magnesium (as a calcium antagonist) with its vessel-dilating effect can support the blood pressure-lowering effect of antihypertensive drugs and thus contribute to dose reduction. Patients with mild, uncomplicated high blood pressure can normalise their blood pressure by taking magnesium. Magnesium is also important for activating vitamin D.

Vitamin D is inversely proportional to blood pressure. Vitamin D levels can optimise blood pressure regulation in hypertensive patients and reduce the required dose of blood pressure-lowering drugs. Vitamin D also counteracts inflammatory processes and improves the elasticity of the vessel walls. It reduces the synthesis of the blood pressure-raising hormone renin and is an antagonist of the atherothrombotic parathyroid hormone.

Q10 status is disturbed by antihypertensive drugs such as clonidine, metoprolol. The consequence is a disturbance of the mitochondrial energy metabolism with negative effects on cardiac bioenergetics.

This also applies to vitamin B6 in the form of P-5-P when taking dihydralazine.

L-arginine has a vascular and cardiac supportive effect and can increase the effectiveness of the blood pressure-lowering drugs when taken.

Omega-3 fatty acids, vitamin C, coenzyme Q10, folic acid and vitamin B12 support the vessel wall protective effect of L-arginine.

2. Diuretics

Diuretics are diuresis-promoting drugs used for the treatment of arterial hypertension, heart failure and cardiac-, hepatic- and renal-related oedema. Loop diuretics such as furosemide, torasemide and thiazides, such as hydrochlorothiazide (HCT), and xipamide are mainly used.

Effects on the micronutrient balance:

The increased excretion of water and electrolytes, especially of water-soluble vitamins and minerals, leads to deficiencies in minerals such as magnesium, potassium and zinc.

Magnesium deficiency is of particular importance because it results in a potassium deficiency. It also disrupts the vitamin D balance and lipid metabolism.

The water-soluble vitamins C and B are also increasingly depleted.

The loss of B6/B12/folic acid with the concomitant increase in homocysteine levels plays a particularly important role with regard to cardiovascular diseases.

3. Lipid- and cholesterol-lowering drugs

Cholesterol performs many tasks in the body: it is an important component of the cell walls and serves as a building block in the production of various hormones. Cholesterol is also a precursor of bile acids, which are important for the digestion of fat.

Statins, the dominant drug group among lipid-lowering drugs, are among the most frequently prescribed drugs worldwide and in Germany. In 2017, 5 million Germans took statins on a daily basis.

Lipid lowering drugs reduce total and LDL cholesterol levels as well as triglyceride levels slightly. Cardioprotective HDL increases slightly. Common drugs are pravastatin, lovastatin, simvastatin and atorvastatin.

Its use is intended to protect people with elevated cholesterol levels from heart attack and other cardiovascular diseases, as statins are believed to slow the progression of atherosclerosis.

Since cholesterol-lowering drugs have been on the market, almost everyone knows their cholesterol level. The limits for cholesterol levels have been steadily reduced over the last 50 years. Most laboratories have now set a maximum limit of 200 mg/dl, down from a total cholesterol of 280 mg/dl. This has led to mass prescription.

There are initial studies of patients who have been taking cholesterol-lowering drugs for 10-15 years. Side effects such as diabetes II, myopathies, memory loss, dementia and even Alzheimer’s are attributed to this medication. There are studies that show that deaths from heart attacks and strokes have not been demonstrably reduced by taking cholesterol-lowering drugs. In particular, taking them without a previous heart attack or stroke is considered problematic.

Studies to the contrary show that coronary heart disease is positively influenced by cholesterol-lowering agents. The fact is that the side effects and signs of deficiency are massive and rarely receive attention during treatment.

Effects on the micronutrient balance: The synthesis of the coenzyme Q10 is disturbed by the intake of cholesterol-lowering drugs. Q10 deficiency causes, among other things, a disturbance of the muscular energy metabolism. Fatigue, weakness, muscle pain and myopathy are associated with Q10 deficiency.

Selenium metabolism is also impaired. Selenium-dependent cytosol is responsible for the regeneration of Q10 outside the mitochondria.

Omega-3 fatty acid shave a triglyceride-lowering effect and enhance the lipid-lowering effectiveness of statins.Vitamin D also has a triglyceride-lowering effect.

Vitamin D is the antagonist of the parathormone. Vitamin D levels below 30 ng/ml favour a rise in parathyroid hormone levels and thus, among other things, calcification of the artery walls and an increase in blood pressure.

4. Antacids and acid blockers

After statins, proton pump inhibitors are among the most frequently prescribed drugs. Prescriptions in Germany increased more than fivefold between 2008 and 2018.

Proton pump inhibitors such as omeprazole, pantoprazole and esomeprazole reduce acid secretion in the stomach.

H2 blockers (ranitidine, famotidine, cimetidine) block receptors on the stomach mucosa and thus inhibit the secretion of gastric acid.

Medications containing aluminium/magnesium against hyperacidity of the stomach lead to an increase in pH values and to a poorly soluble complex formation of micronutrients and medicines. Acids from citrus fruits and tartaric acid lead to an increased dissolution of the aluminium ions and thus to intoxication.

Antacids and acid blockers are mainly used in the treatment of helicobacter pylori, re-flux disorders and ulcer conditions. Furthermore, they are used as so-called stomach protection when other, usually several allopathic medicines, are prescribed. They are often taken for years. One of the consequences is a change in the bacterial colonisation of the intestine due to a shift in pH values.

Effects on the micronutrient balance:

As a result of the pH-value shift, resorption is disturbed, bacterial colonisation of the stomach is disturbed and the intrinsic factor required for vitamin B12 absorption is inhibited.

Resorption of the neurotropic micronutrients magnesium, calcium, zinc, iron, vitamin D, folic acid, vitamin B12 and vitamin C, which are effective on bones, is reduced by taking antacids. This is associated, for example, with a reduction in bone density with the consequent increased risk of fracture. In addition, studies show a significant reduction in cognitive performance after just seven days of use. Diabetes II and dementia are discussed as long-term consequences.

5. Oral antidiabetics

Diabetes is (along with depression) one of the most progressive diseases of our time. Risk factors for diabetes are obesity, lack of exercise, dietary errors, stress and many others.

The main impairments of quality of life are progressive vascular damage, microangiopathy and angiopathy, damage to eyes, kidneys and nerves and progressive atherosclerosis.

Oral antidiabetics such as metformin or glitazones are prescribed besides insulin.

An adequate supply of micronutrients and vitamins plays an essential role in the prevention and also in the therapy of the diabetes disease. In addition to the deficiencies caused by the medication, micronutrient deficiencies are caused by increased renal excretion and increased nutrient requirements.

Effects on the micronutrient balance

B vitamins are lost through increased urination. Metabolic and therapeutic factors (metformin is often prescribed in combination with proton pump inhibitors) can also increase the need for B vitamins. In particular, the resulting increased homocysteine levels with the consequence of inadequate blood circulation, especially in the small vessels, and the resulting eye and kidney problems, as well as the associated break-down of brain substance, represent a major risk.

Metformin does not usually trigger weight gain and hypoglycaemia like insulin, but it does trigger a reduction in B12 levels while increasing homocysteine levels. Metformin should therefore only be taken together with B12, folic acid and B6.

Magnesium plays an important role in the development of diabetes. A deficiency (diuresis/intake) is the main cause for the development of insulin resistance.

Moreover, studies have shown that depression in diabetics can be treated with magnesium as effectively as with the antidepressant imipramine. CRP, an inflammation marker, increases significantly under magnesium deficiency. The result is an increased risk of thrombosis and heart attack.

Vitamin D deficiency promotes inflammatory processes and is thus a causal factor for type I diabetes dues by cell death. An adequate supply can protect the existing beta cells from destruction. Vitamin D counteracts high parathyroid hormone levels and high triglyceride levels. Sensitivity to oral antidiabetics such as metformin is improved by optimising vitamin D levels.

Diabetics exhibit too low chromium concentrations due to increased excretion. Substitution improves the values for fasting blood sugar and HbA1c. Oral antidiabetics are more effective with an optimum chromium supply.

Vitamin C, as a scavenger of radicals and cell protection, is degraded in diabetics. HbA1c values are inversely proportional to vitamin C values.

Coenzyme Q10 is also an important antioxidant that is lowered by antidiabetic drugs. A good level has a positive influence on overall cell health, the heart and oxygen supply in the tissues.

Alpha lipoic acid improves glucose utilisation and may have a beneficial effect on diabetic polyneuropathy.

6. Analgesics

For pain, many people resort to over-the-counter painkillers such as aspirin, ibuprofen and paracetamol. Painkillers suppress the feeling of pain in the brain.

Disorders in the gastrointestinal tract caused by acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen and naproxen are among the most common side effects of drugs in industrialised countries. Acetylsalicylic acid (ASA) is the most important because of the high rate of self-medication.

A significant proportion of all side effects of acetylsalicylic acid affect the gastrointestinal tract. They range from mild symptoms such as dyspepsia and superficial erosions of the stomach lining to bleeding, gastritis and stomach ulcers. Taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac at the same time doubles the risk.

Effects on the micronutrient balance:

Vitamin C levels drop when taking ASA. Vitamin C protects the stomach lining through its protective antioxidant effect. The taking of vitamin C at the same time increases the effect of ASA and protects the stomach lining.

B12 and folic acid deficiency is caused by absorption disorders in the gastrointestinal tract, disorders in the formation of intrinsic factor due to gastric mucosa erosion and increased excretion of folic acid in the gastrointestinal tract.

Iron deficiency can be caused by bleeding when taking acetylsalicylic acid.

Therapeutic application

We work with whole blood mineral analyses in order to determine mineral supplementation. Some metals such as zinc and magnesium are primarily present within cells. Others, however, such as copper accumulate in the extracellular space.

Mineral analysis in EDTA whole blood allows the simultaneous determination of intra- and extracellularly localised metals and therefore gives a better view of the supply situation of the organism. Normal serum values do not preclude intracellular deficits.

The examination of the vitamin and amino acid status is performed by means of serum diagnostics. I need the results of these tests to determine the patient’s status and to monitor treatment.

The values and reference ranges determined in this way do not completely reflect the patient’s individual situation. The need for micronutrients is also dependent on other factors such as:

  • Patient’s age
  • Diet
  • Existence of a chronic disease
  • Poor resorption
  • Stress
  • Intensive sport
  • Parallel medication

That is why I test all substances on patients before prescribing them (A programme 171.0).

To improve the absorption of the micronutrients, they are used via therapy with an A program (198, 192) or in the 2nd channel alongside a tested symptom-related treatment program. When doing this, the micronutrients from the input, with the patient as the output of the BICOM device.

From practical experience

In 2009, Marija Djukic et al. conducted research on the frequency of treatable dementia in a study in the geriatric ward of the Evangelisches Krankenhaus in Göttingen (Djukic et al., 2015).

Patients between the ages of 75 and 85 took an average of over 11 drugs simultaneously as permanent medication. The patients were examined with regard to thyroid dysfunction, diabetic metabolism and the supply of vitamins and minerals. The blood tests revealed that the patients exhibited noticeably high deficits in vitamins and minerals.

Over 50% had too little folic acid, 40% too little vitamin B12 and Vitamin D levels were virtually always too low. Furthermore, levels of magnesium and selenium were too low in a large number of patients. A significant improvement in cognitive abilities was observed in over 30% of the patients after a targeted substitution of the deficient micronutrients.

Case

Patient, PJ, journalist, 71 years old

Anamnesis July 2019:

  • Mentally alert man working actively as a journalist
  • Shaking, especially of the hands; can no longer write, cannot bring a coffee cup to his mouth; “golf arm” that recurs repeatedly after discontinuing cortisone
  • Numbness in the area of the loins, feels nothing that disturbs him very much; bladder and stool incontinence
  • Skin itching
  • Shortness of breath at the slightest exertion
  • Osteoporosis with the consequence of various vertebral fractures/hernias
  • Difficult-to-manage hypertension, 8 stents after myocardial infarction
  • Belly fat – “pot belly” – within a year, previously had a flat stomach
  • Sleep apnoea/insomnia

Medication on initial visit

Anticoagulant: ASA

Blood pressure regulators: valsartan, moxonidine

Beta-blocker: bisoprolol

Diuretic: torasemide

Against tremors: propranolol

Cholesterol reducer: atorvastatin

For sleeping: bromazepam

“Stomach protector”: pantoprazole

After consultation with the prescribing doctor reduction of medication to: ASA, bisoprolol, torasemide, Entresto (for valsartan) and unfortunately still bromazepam.

My prescription after blood tests and evaluation with the BICOM device:

  • Selenium, magnesium, chromium, copper, iron, molybdenum
  • Vitamin D, B12, B6, B3, B2, folic acid
  • L-carnitine, alpha lipoic acid, L-arginine
  • Coenzyme Q 10

In addition, in a total of 6 sessions:

  • Bioresonance treatment (shock, vegetative dystonia, detoxification, bowel development)
  • Probiotic treatment of the intestine
  • Interval fasting, milk- and wheat-free diet

The patient was already generally satisfied with the improvements in his condition af­ter the 2nd session, the tremor had greatly improved, he was able to drink coffee again with one hand without spilling anything and to write again to some extent.

At our last meeting in November he reported that he now had a new girlfriend and he could “feel something again”. Much-loved bicycle tours were possible again. He did not run out of breath so fast.

His hands lay tremor-free on the armrest. Writing was “natu­rally” no longer a problem. Skin itching had completely disappeared and his sleep had improved. Whilst he could not yet do without bromazepam, he was in the process of phasing it out.

He has now finished his therapy and only comes to check and adjust his medication. The goal is a further reduction of the medication prescribed by conventional medicine. I think there is certainly a lot more to do, but what is crucial for me is how he feels and his need for support.

He has returned to a life that he likes and where he can pursue his interests and needs. We will continue when the time comes.

Bibliography

Djukic, M. et al., 2015. Frequency of dementia syndromes with a potentially treatable cause in geriatric in-patients: analysis of a 1-year interval. European Archives of Psychi­atry and Clinical Neuroscience, 1 August, 265(V).

Gröber, U., 2018. Arzneimittel und Mikronährstoffe: medikationsorientierte Supple­mentierung. [Medicines and micronutrients: Medication-oriented supplementation]. 4th Edition Stuttgart: Wissenschaftliche Verlagsgesellschaft.

IMD Institut für Medizinische Diagnostik Berlin-Potsdam GbR, 2019. Die Vollblutmineralanalyse [The whole blood mineral analysis]. [OnlineL https://www.imd-berlin.de/spezielle-kompetenzen/mikronaehrstoffe/ mineralstoffanalyse.html [Accessed 5 December 2019€.

Kisters, K. & Gröber, U., 2017. Arzneimittel als Mikronährstoff-Räuber: Was Ihr Arzt und Apotheker Ihnen sagen sollten [Medicines as micronutrient scavengers: What your doctor and pharmacist should tell you]. 2nd Edition Stuttgart: Wissenschaftliche Ver­lagsgesellschaft.

Löffler, B.-M., 2015. Sie leiden an einer “stillen” Entzündung?! [Are you suffering from “silent” inflammation?!]. Berlin: ImM-Verlag.

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Schmiedel, V., 2019. Nährstofftherapie: Orthomolekulare Medizin in Prävention, Diag­nostik und Therapie [Nutrition therapy: Orthomolecular medicine in prevention, diag­nostics and therapy]. 4th Edition Stuttgart: Thieme.

Thürmann, P. A., 2013. Weniger wäre tatsächlich mehr – die Arzneimittelversorgung alter Menschen [Less would actually be more – the provision of medicines for old pe­opleL. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen (ZEFQ), December, 107(II), pp. 148 – 152.