Nutrient reference
Depletions
What medications may be using up or interfering with.
Search a medication, supplement, food, beverage, or substance to see how it can affect nutrient absorption, nutrient loss, appetite, digestion, metabolism, and long-term health.
A depletion can occur through reduced absorption, increased urinary loss, intestinal bleeding, microbiome disruption, altered metabolism, reduced food intake, or increased nutritional demand.
Drug Side Effects and Depletions
Drug Side Effects and Depletions — author's original categories
Author-supplied class associations; not proof that every medication in a class causes every listed effect. Existing drug-specific findings remain separate.
1. Anti-inflammatory Medications — NSAIDs
Listed depletions:
- Iron
- Zinc
- Folic acid
- Melatonin
2. Antibiotic Medications
Listed depletions:
- Vitamin B2 (Riboflavin)
- Vitamin B12
- Vitamin H (Biotin)
- Vitamin K
3. Anticonvulsant Medications
Listed depletions:
- Vitamin A
- Vitamin B9
- Vitamin D
- Calcium
4. Antidepressant Medications
Listed depletions:
- Protein and amino acids
- Melatonin
- Coenzyme Q10
- Riboflavin
5. Antidiabetic Medications
Listed depletions:
- Vitamin B9 (Folic Acid)
- Vitamin B12 (Cobalamin)
- Coenzyme Q10
6. Antihypertensive Medications
Listed depletions:
- Coenzyme Q10
- Magnesium
7. Cardiovascular Medications
Listed depletions:
- Coenzyme Q10
- Magnesium
8. Cholesterol-Lowering Medications
Listed depletions:
- Vitamin B1 (Thiamine)
9. Corticosteroids and Diuretics
Corticosteroids — original combined chart:
- Protein and amino acids
- Calcium
- Magnesium
- Zinc
- Folic acid
- DHEA
- Melatonin
Additional nutrients in the original combined chart:
- Vitamin B6 (Pyridoxine)
- Vitamin C
- Vitamin D
Diuretics — nutrients and electrolytes in the original chart:
- Potassium
- Electrolytes
- Calcium
- Magnesium
Additional nutrients are retained from the original combined chart; their allocation between corticosteroids and diuretics remains under author review.
10. Gastrointestinal Medications
Listed depletions:
- Calcium
- Iron
- Folic acid
- Vitamin B12
- Vitamin D
- Zinc
11. Oral Contraceptives
Listed depletions:
- Vitamin C
- Zinc
- Magnesium
- Riboflavin
- Vitamin B6
- Folic acid
- Vitamin B12
12. Osteoporosis Medications
Listed depletions:
- Calcium
- Phosphorus
13. Psychotherapeutic Medications
Listed depletions:
- Coenzyme Q10
- Riboflavin
Footnote — CDC Reporting and Medication-Related Deaths
On April 16, 2025, Reuters reported that CDC staffing and budget cuts were ending support for a national emergency-department injury surveillance program. Among the categories affected was adverse drug effects.
Three important facts deserve attention:
1. Adverse drug-effect surveillance was cut. The affected program collected emergency-department injury information, including adverse drug effects.
2. Drug-related deaths have not been removed from CDC mortality coding. The CDC's 2025 instructions still include ICD-10 codes Y40–Y59 for adverse effects of medications used therapeutically.
3. The underlying-cause-of-death system can obscure the role of medication. CDC instructions allow the condition being treated to be recorded as the underlying cause even when a drug complication contributes to the death.
A person can die following a serious adverse drug reaction without that reaction appearing as the underlying cause in the headline mortality rankings.
This distinction matters when evaluating the full impact of prescription medications on illness and mortality.
Sources:
Reuters, April 16, 2025: https://www.reuters.com/business/healthcare-pharmaceuticals/us-consumer-safety-agency-stop-collecting-swaths-data-after-cdc-cuts-2025-04-16/
CDC, Instructions for Classifying the Underlying Cause of Death, 2025: https://www.cdc.gov/nchs/nvss/manuals/2025/2a-2025.html
CDC, Instructions for Classifying the Multiple Causes of Death, 2025: https://www.cdc.gov/nchs/nvss/manuals/2025/2b-2025.html
Drug side effects and nutrient depletions — from the book
| Drug / Class | Nutrient or Issue | What to Notice |
|---|---|---|
| Metformin | Vitamin B12 | Long-term use can lower B12 status; unexplained anemia or neurologic symptoms deserve investigation. |
| Proton-pump inhibitors | B12, magnesium; iron/calcium concerns in selected patients | Suppressing stomach acid can change nutrient absorption. |
| H2 blockers | Vitamin B12 | Lower stomach acid can reduce release of food-bound B12. |
| Loop diuretics | Potassium, magnesium, calcium; thiamine reported | The drug changes renal excretion; nutrients can leave with fluid. |
| Thiazide diuretics | Potassium, magnesium, sodium | Electrolyte balance can change. |
| Long-term corticosteroids | Bone/mineral and protein metabolism | Can affect calcium/vitamin D balance, muscle, glucose and bone. |
| Some anticonvulsants | Folate; vitamin D/bone health | Certain agents alter vitamin metabolism. |
| Sulfasalazine | Folate | Can interfere with folate absorption/metabolism. |
| Bile-acid sequestrants | Vitamins A, D, E, K | Binding in the intestine can reduce absorption of fat-soluble vitamins. |
| Orlistat | Vitamins A, D, E, K; carotenoids | Blocking fat absorption can also reduce fat-soluble nutrient absorption. |
| Broad-spectrum antibiotics | Microbiome; selected vitamin K risk | Antibiotics can alter normal microbial ecology. |
| Aspirin / NSAIDs | Iron indirectly | Chronic gastrointestinal blood loss can contribute to iron deficiency in some people. |
| Statins | CoQ10 levels may fall | The cholesterol synthesis pathway also participates in CoQ10 synthesis; clinical significance varies. |
These are only some of the depletions. More exist for each of these drugs, to varying degrees.
Do not create another pill problem. The point of a depletion chart is not to send you to the pharmacy or the naturopath for more pills to cover the depletion. That is not my goal. The point is to show the real cost of the drug, ask why the deficiency exists, correct the cause when possible, and replace only what is actually needed.
Mineral Depletions
Supplement excess & nutrient interference
Mineral Deficiency & Depletion — Scientific Reference Appendix
Author-supplied scientific reference appendix. General subject references are distinct from evidence for specific depletion mechanisms.
Calcium balance
Heaney RP et al. “Effects of caffeine on bone and calcium economy.” Am J Clin Nutr (2002). Devine A et al. “A longitudinal study of the effect of sodium and calcium intakes on bone density.” J Bone Miner Res (1995). Tucker KL et al. “Cola consumption and bone mineral density in women.” Am J Clin Nutr (2006).
Magnesium loss & stress
Pickering G et al. “Magnesium status and stress: the vicious circle.” Nutrients (2020). Galland L. “Magnesium and stress: a clinical review.” J Am Coll Nutr (2010).
Potassium & sodium imbalance
He FJ and MacGregor GA. “Beneficial effects of potassium.” BMJ (2001). Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academies Press (2005).
Zinc absorption inhibitors
Gibson RS. “Zinc deficiency and human health.” Am J Clin Nutr (2012). Hambidge KM. “Bioavailability of zinc and phytate–zinc interactions.” Nutr Res Rev (2000).
Iodine displacement & thyroid interference
Tonacchera M et al. “Thiocyanate, perchlorate, and nitrate interference with iodide uptake.” Endocrine Rev (2004). Zimmermann MB and Boelaert K. “Iodine deficiency and thyroid disorders.” Lancet Diabetes Endocrinol (2015).
Selenium & oxidative stress
Brigelius-Flohé R and Flohé L. “Selenium and redox regulation.” Nutrients (2020). Steinbrenner H et al. “Selenoproteins and oxidative stress.” Free Radic Biol Med (2013). Bjørklund G et al. “Interactions between mercury and selenium in health and disease.” Environ Res (2017).
Alcohol-related mineral depletion
Classen HG. “Magnesium and alcoholism.” Alcohol Clin Exp Res (1992). Sullivan J et al. “Zinc deficiency in alcoholic liver disease.” Am J Clin Nutr (1986).
Medication-induced depletion
Hess MW et al. “Drug-induced nutrient depletion: mechanisms and evidence.” Pharmacotherapy (2021). FDA Safety Communication: “Proton pump inhibitors and hypomagnesemia.” (U.S. Food and Drug Administration, 2011).
Environmental & dietary excess
Razzaque MS. “Minerals and human health: from deficiency to toxicity.” Nutrients (2025). Linus Pauling Institute. “Micronutrient inadequacies in the US population.” (lpi.oregonstate.edu, 2024).
Polyunsaturated seed oils & oxidative demand
Yin H et al. “Mechanisms of lipid peroxidation and implications for cell injury.” Free Radic Biol Med (2011). Ingold KU et al. “Autoxidation of lipids and antioxidants.” Chem Rev (2017). Imai H and Nakagawa Y. “Biochemistry of phospholipid hydroperoxide glutathione peroxidase (GPx4).” Free Radic Biol Med (2019).
Heat, exercise, and sweat loss
American College of Sports Medicine. “Exercise and fluid replacement.” Med Sci Sports Exerc (2007). Sawka MN et al. “Human water and electrolyte balance during heat stress.” J Appl Physiol (2005).
Recreational Drug Depletions
Alcohol, Tobacco, Cannabis and Other Substances
Food & Lifestyle Depletions
How Daily Consumption and Lifestyle Can Affect Nutrient Status
Alcohol — Recreational Drug DepletionsBinders & Chelation
What Else Might Be Lost?
Chelation and binding are not automatically selective processes. Some agents used to remove unwanted substances can also increase the loss of essential minerals or interfere with nutrient and medication absorption. The effects depend on the agent, dosage, frequency, duration and the individual's nutritional status.
A. Chelation and Mineral Loss
Chelating agents bind certain metals and help the body eliminate them. Depending on the agent, essential minerals can also be lost.
Important: These are agent-specific concerns, not proof that every course causes a deficiency. Some listed DMPS effects reflect increased urinary mineral excretion in challenge studies.
B. Binders and Nutrient Absorption
Binders act primarily in the digestive tract. Some can interfere with nutrient or medication absorption.
Removing unwanted substances and preserving essential nutrients are two different goals.
Long-term chelation or binder use may require attention to mineral status, vitamin absorption, medication interactions and overall nutritional intake.
Research & References
- EDTA: Edetate calcium disodium prescribing information
- DMSA (Succimer): Human DMSA urinary element study
- DMPS: Torres-Alanís et al. — urinary mineral excretion following DMPS
- Activated Charcoal: Ekins et al. — charcoal and oral N-acetylcysteine absorption
- Zeolite: PMA-zeolite clinical mineral monitoring
- Cholestyramine and Other Bile-Acid Binders: QUESTRAN prescribing information
About Dr. Mark & Clinical Services
For food planning, nutrient review, hormone health, enzyme and digestive support, lifestyle guidance, and individualized care, learn more about Dr. Colafranceschi’s clinical approach.
About Dr. Mark & Clinical ServicesEducational Information. This app shares the clinical perspectives and educational work of Mark D. Colafranceschi, D.C., to help you better understand health, nutrition, lifestyle, and wellness. Every person is unique. Health decisions — including medications, nutrition, supplements, and fasting — should be based on your individual health history and circumstances.