Data collected between 2017 and March 2020 from the National Health and Nutrition Examination Survey (NHANES) reported that approximately half of the United States population has taken at least one prescription drug in the past 30 days. A look into the most prescribed medications in the United States reveals the underlying health challenges its citizens face: cardiovascular disease, high cholesterol, diabetes, and high blood pressure. Among the top five most prescribed medications are atorvastatin, simvastatin, and metformin.
Atorvastatin and simvastatin are commonly called statins, which are medications used to treat high cholesterol and triglycerides and help prevent heart disease, strokes, and heart attacks. It works by reducing the amount of low-density lipoprotein cholesterol (LDL-C) and increasing the amount of high-density lipoprotein cholesterol (HDL-C) the body produces.
Metformin is an FDA-approved medication to support those with dysregulated blood sugar, especially those with diabetes or prediabetes. Metformin reduces glucose absorption, decreases glucose production, and helps improve insulin sensitivity in patients with type 2 diabetes (T2DM).
To that end, some medications are known to deplete nutrient stores — aptly named drug-nutrient interactions. One well-recognized drug-nutrient interaction is the reduction in coenzyme Q10 (CoQ10) synthesis due to statin drugs. Statins affect the mevalonate pathway by inhibiting the hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase enzyme. Cholesterol and CoQ10, also known as ubiquinone, are produced at the end of this pathway, but HMG-CoA reductase is a relatively early step; thus, inhibiting this enzyme reduces the biosynthesis of everything that follows, not just cholesterol. A common side effect of statin use is myopathy.
A systematic review was performed to investigate the effects of CoQ10 supplementation on mitigating statin-induced myopathy. The authors discuss that the patients who were given CoQ10 intervention exhibited reduced myopathy-related symptoms, including muscular complaints such as myalgia, myopathy, and myositis. Additionally, serum CoQ10 levels increased compared to the placebo group. The CoQ10 intervention and duration varied across the included studies, but included either liquid or capsules at 100 mg/dL or up to 200 mg daily for one to six months. However, further research is needed to understand this interaction fully. As the name implies, ubiquinone (or CoQ10) is found ubiquitously in the food supply. It’s estimated that the average daily intake is between 3 and 6 mg based on food frequency questionnaires.
Sources of CoQ10 include:
Metformin is another widely prescribed drug that may result in reduced B12 absorption in some individuals, with deficiency being associated with permanent neuropathy. It is estimated that up to 30% of patients who are prescribed metformin have evidence of reduced B12 absorption. Compared to baseline B12 levels, patients given daily metformin for three months experienced significantly reduced serum total vitamin B12 levels from approximately 400 pg/ml to 282 pg/ml. Furthermore, levels of holotranscobalamin (holoTCII), an early marker of subnormal vitamin B12 absorption, decreased from a baseline level 175 pg/ml to 111 pg/ml. These patients were then given one month of 1.2 grams of calcium carbonate (as TUMS®) and experienced partially recovered holoTCII levels, increasing from 111 pg/ml to 152 pg/ml. The authors discuss that the mechanism associated with this altered B12 absorption is likely due to metformin interfering with the calcium-dependent binding of the intrinsic factor (IF)-vitamin B12 complex, which was corroborated by the partial recovery of serum holoTCII levels seen in the group given calcium.
Food sources of vitamin B12 include:
Food sources of calcium include:
The widespread use of prescription medications such as statins and metformin reflects the significant burden of chronic diseases like cardiovascular disease, hyperlipidemia, and type 2 diabetes in the United States. While these medications may be essential for managing disease, their impact on nutrient status warrants careful consideration by qualified health-care practitioners. By inhibiting the mevalonate pathway, statins can inadvertently reduce CoQ10 synthesis, potentially contributing to myopathy. Similarly, metformin’s interference with the calcium-dependent absorption of B12 can result in clinically significant deficiencies. Evidence that calcium supplementation may partially restore B12 absorption highlights the importance of recognizing and managing drug-nutrient interactions in clinical practice. Ultimately, understanding common drug-nutrient interactions, proactive monitoring, and individualized strategies are crucial for optimizing the nutritional well-being of patients without compromising the efficacy of commonly prescribed drugs.
To read more about drug-nutrient interactions:
How Do Medications Affect B12 Status?
CoQ10 and the Mevalonate Pathway: Mitochondria and Myopathy
By Bri Mesenbring, MS, CNS, LDN
Designs for Health has been dedicated to being the most trusted source for superior quality, science-based nutritional products for nearly three decades. We’re committed to maximizing successful health outcomes by providing healthcare practitioners with comprehensive support through our extensive product line, ongoing clinical education, and practice development programs. The blogs we publish here cover a range of topics, including new and original approaches to diet and healthcare, analyses of the latest cutting-edge research, deep-dives into specific nutrients, botanicals, nutraceuticals and more, all fully referenced for those who want to dig deeper into the primary literature.
