- Ace Inhibitors
- Chlorthalidone
- Clonidine
- Hydralazine
- Loop diuretics
- Potassium-Sparing Diuretics
- Thiazide Diuretics
ACE Inhibitors
Example ACE inhibitors that deplete nutrients1
Captopril, enalapril, lisin opril, quinapril, ramipril, tranopril, fosinopril
Nutrients depleted by ACE Inhibitors/h3>
Zinc
ACE Inhibitor-Induced Zinc Depletion
ACE inhibitors relax and widen blood vessels to allow blood to flow through, and lowers your body’s water retention. Some research indicates that they can deplete zinc, and that different ACE inhibitor blood pressure medications have varying effects on zinc levels. “Two separate studies that compared the effects of captopril and enalapril on markers of zinc status found that, although both ACE inhibitors decreased zinc status compared to untreated hypertensive patients or healthy controls, chronic captopril use had a larger effect on zinc status than enalapril. In a different randomized, double-blind study, both captopril and benazepril lowered serum zinc and increased urinary zinc in patients with essential hypertension after four weeks. However, after eight weeks, serum zinc decreased more significantly with captopril use,” write the authors of a literature review.2
Clonidine
Nutrients depleted by Clonidine
CoQ10
Clonidine-Induced CoQ10 Depletion
The evidence is extremely limited on this interaction, but one study from 1975 indicates that clonidine “inhibited CoQ10-NADH-oxidase.”3
Hydralazine
Nutrients depleted by Hydralazine
CoQ10, B6
Hydralazine-induced nutrient depletion
The same 1975 study that found clonidine depleted CoQ10 indicated that hydralazine had a similar effect3. B6 depletion has more scientific corroboration4, 5, 6, 7. According to the PeaceHealth healthcare network in the Pacific Northwest, “Vitamin B6 can bind to hydralazine to form a complex that is excreted in the urine, increasing vitamin B6 loss.”
Loop diuretics
Example loop diuretics that deplete nutrients1
Bumetanide, ethacrynic acid, furosemide, torsemide
Nutrients depleted by loop diuretics
Calcium, magnesium, potassium, B1, B6, Vitamin C, zinc
Loop diuretic-induced nutrient depletion
Diuretics increase urine production, which causes increased excretion of water-soluble nutrients that your body cannot store. The authors of Drug-Induced Nutrient Depletion8 cite ten studies that confirm that loop diuretics deplete magnesium9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. This depletion can be particularly problematic as high blood pressure is a symptom of magnesium deficiency. Potassium depletion by loop diuretics is also well researched18, 20, 21, 22, 23, 24. Thiamine depletion has been the subject of numerous studies in humans and rats, and particularly affects medication users with heart failure25, 26, 27, 28. A limited number of studies show that loop diuretics deplete vitamins B629, 30 and C29 while a single study of 26 subjects indicates a relationship between this drug class and zinc depletion24.
Potassium-Sparing Diuretics
Example potassium-sparing diuretics that deplete nutrients1
Triamterene
Nutrients depleted by potassium-sparing diuretics
Calcium, folate
Potassium-sparing diuretic-induced nutrient depletion
Two studies suggest a relationship between potassium-sparing diuretics and increased calcium excretion causing depletion of the mineral31, 32. Two studies dating back to the 1970s indicate that the potassium-sparing diuretic triamterene interferes with folate absorption in humans. In a fourth study about a single elderly woman who presented with folate deficiency, researchers theorized that this was caused by triamterene34.
Thiazide Diuretics
Example thiazide diuretics that deplete nutrients1
HCTZ, hydrochlorothiazide, chlorothiazide, chlorthalidone, methylclothiazide, metolazone
Nutrients depleted by thiazide diuretics
Magnesium, potassium, sodium, zinc, CoQ10
Thiazide diuretic-induced nutrient depletion
In the aforementioned 1975 study examining various hypertension drugs on CoQ10 levels, researchers found that the thiazide diuretic hydrochlorothiazide had a similar inhibiting effect as clonidine and hydralazine3. The effects of these drugs on magnesium13, 36, 37, 38, 39, 40, 41 and potassium39, 41, 42, 43 levels have far more validation. While researchers have found in numerous studies correlations between thiazide diuretic use and low levels of both nutrients, they are not sure of the exact reasons why. One theory is that the lack of magnesium, which regulates other electrolytes, leads to potassium depletion.
High blood pressure is also a symptom of magnesium deficiency, which may confound the relationship. Thiazide diuretics may also deplete sodium levels44, 45, 46, 47, 48. While we’ve been told for decades to monitor sodium intake, that sweeping statement refers to table salt, not the critical electrolyte needed to maintain ideal fluid levels in your cells. You may follow a low-sodium diet, but you don’t want depleted sodium in your cells. In multiple studies conducted on elderly subjects, researchers found relationships between thiazide diuretic use and low sodium. The mechanism behind zinc depletion are more clear: numerous studies have confirm that thiazide diuretics increase zinc excretion49, 50, 51, 52.
Do you have blood pressure drug vitamin or mineral depletion?
Simple blood tests, ordered by a doctor and administered by a professional phlebotomist or phlebotomy technician, are often enough to measure deficiency of some nutrients. Others, like magnesium, are more difficult to assess. Doctors should be able to tell you if you have a deficiency.
Why replenish vitamins and minerals depleted by blood pressure drugs?
Zinc is a critical nutrient for your immune system, and even mild deficiency depresses immune response. CoQ10 is beneficial for optimal heart health and acts as a powerful antioxidant. Magnesium, potassium, calcium, and sodium are electrolytes, which regulate fluid levels in your cells. They also have other important roles, with magnesium performing 300+ essential functions in your body. And, without the B vitamins, your cells can’t produce the energy they need to survive.
How to replenish nutrients depleted by blood pressure drugs
While some foods are high in specific nutrients, the most effective way to ensure you are getting all the nutrients you need is to eat a varied whole food diet that does not exclude major food groups. Zinc, for example, is at its most bioavailable in animal foods. Phytates in plant sources of zinc, like seeds and legumes, interfere with zinc absorption, leading the National Institutes of Health to recommend vegetarians and vegans consume up to 50% more zinc than the recommended daily allowance.
Many experts recommend supplementing with magnesium as the recommended daily allowance is difficult to consume in food alone due to lower levels of magnesium in traditional plant sources. Just look for an absorbable magnesium supplement. B vitamins are easy to find in supplements. A B Complex is your best bet because it will include optimal ratios of all the vitamins in the B family. Look for one, like our Lypo-Spheric® B Complex Plus, that includes absorbable forms of the vitamins (like methylated folate and benfotiamine).
Resources
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2 Mohn, Emily S et al. “Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update.” Pharmaceutics vol. 10,1 36. 20 Mar. 2018, doi:10.3390/pharmaceutics10010036
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4 Vidrio H. “Interaction of Pryidoxal as a Possible Mechanism of Hydralazine Hypotension.” J Cardiocas Pharmacol, 1990, 15(1):150-6.
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6 Rosen F, et al. “Selective Metabolic and Chemotherapeutic Effects of Vitamin B6 Antimetabolites.” Vitamins and Hormones, Harris RS, Wool IG, and Loraine JA, eds, New York, NY: Academic Press, 1964, 609-41.
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