5 Common Prescriptions That Should Require Nutritional Counseling

woman takes a pillI’m not a drug denier. For the most part, at the base level, pharmaceuticals do what they’re supposed to do. Statins lower cholesterol. Beta-blockers lower blood pressure. Antibiotics kill bacteria. Whether those changes save lives or reverse disease is another question entirely. But we can all agree that pharmaceuticals deserve a place in modern medicine. And even if we don’t, they objectively have a place, and we must acknowledge reality.

We can also agree that many of the most common prescription drugs affect the way we absorb, metabolize, utilize, and excrete vitamins, minerals, and other important health co-factors. People taking them deserve nutritional counseling. This is my quick and dirty attempt to encourage that.

Please note that none of my advice is medical. I can’t speak to anyone’s personal circumstances and, therefore, can’t call this nutritional counseling or advice for your individual case. That said, research as always demonstrates patterns, and these aren’t always given their due in the course of prescription-writing or even follow-up exams. If you wish to discuss the following findings with the person prescribing you a drug, print out or email the references to which I link. Linking to the blog would be easier, but in my experience “this blog I read” is anathema to most MDs.

If you want to skim the nutrients affected, just look for the bolded lines.

Let’s go:


Statins don’t just reduce cholesterol production. Statins reduce cholesterol by inhibiting the HMG-CoA reductase enzyme pathway that lies upstream of cholesterol synthesis. But here’s the problem: lots of other biological compounds lie downstream of HMG-CoA, not just cholesterol.

When you block HMG-CoA reductase, you also block production or synthesis of several important nutrients:

CoQ10, which is important for cellular energy (ATP) production. Without CoQ10, our muscles and heart are really bad at contracting. CoQ10 deficiencies have been linked to heart failure and hypertension, and supplemental CoQ10 can counter statin-induced muscle wasting.

Vitamin K2, which is protective against cardiovascular disease, osteoporosis, and tooth decay. Totally expectedly, the sites where statin-related adverse effects occur (brain, kidney, pancreas, muscles) mostly happen to be storage sites for vitamin K2. 

Squalene, which the liver produces en route to producing cholesterol. However, it’s not just a precursor. Squalene also has antioxidant effects and forms part of the lipid barrier along the skin protecting us from the environment.

And since we use cholesterol in the skin to produce vitamin D upon exposure to UV light, blocking HMG-CoA in a roundabout way blocks vitamin D production.

Testosterone is another innocent bystander. We need cholesterol to make testosterone. I bet a few egg yolks a day might improve a statin-user’s health.

Hormonal Birth Control

I’ve written about hormonal birth control before, covering both the benefits and the health risks. One risk I didn’t mention last time was the threat of nutrient depletion. For decades, researchers have found correlations between BC usage and several key nutrient deficiencies. Whether each relationship is causative remains to be seen—BC usage may be higher in groups with lower nutrient intakes—but the consistency of the relationships and the fact that supplementing the nutrient often improves health suggests something is going on.

Which nutrients are we talking about?

Vitamin B6: Low-dose BC seems to negatively affect vitamin B6 status.

Vitamin B12: Two factors seem to decrease B12 absorption in BC users—greater degradation of B12 in the gut and lower B12 binding capacity.

Vitamin C: Giving vitamin C (and E) to women using BC reduces lipid oxidation and improves glutathione status.

Vitamin E: BC users have lower vitamin E levels; supplemental vitamin E normalizes platelet function in BC users.

Folate: BC use seems to increase folate excretion through the urine and impair folate metabolism in the body. Although eating enough folate should counter these issues, few people eat the requisite amount of greens and liver and other things to do it. Some contraceptives now come with folate included, and they seem to do the trick. Other researchers think low-dose BC doesn’t really affect folate status (or B12, for that matter).

Selenium and zinc: Giving healthy women oral BC significantly reduces zinc status and moderately reduces selenium.

Magnesium: BC directly lowers serum magnesium levels in humans. And in rats, supplemental magnesium ameliorates BC-induced glucose intolerance.

Proton Pump Inhbitors (PPIs)

Whether you’ve got peptic ulcers, acid reflux, or basic indigestion, your doc may prescribe a PPI. These do what they’re meant to—inhibit the function of the proton pumps that produce stomach acid. If you have “excess stomach acid,” shutting these pumps off can ease the burn. But we need adequate stomach acid to absorb the nutrients in our food.

PPI users are particularly at risk for impaired absorption of B12, iron, calcium, magnesium, and vitamin C. Long-term PPI usage is consistently associated with poorer bone health, thanks both to impaired bone-centric nutrient absorption and reduced proton pump activity in bone cells.

Another victim of PPIs are the gut bacteria. The stomach is acidic by design/selection; it’s a strong barrier to entry. By reducing stomach acidity, PPIs alter the pH of the gut and allow alkaline-preferring microbes to survive digestion and set up shop in the gut. PPI users are more likely to have bacterial overgrowth from these unwanted invaders in their guts.

To counter this, PPI users can consider taking probiotics and n-acetylcysteine. In one study, PPI users who took both n-acetylcysteine and a blend of 4 probiotic strains (L. rhamnosus, L. plantarum, L. plantosus, and L. delbrueckii) reduced bacterial overgrowth.

Perhaps a good addition would be a high-quality yogurt, which provides probiotics and calcium and has been shown to improve bone health in PPI-taking rats.

Beta Blockers

Beta blockers are the elders of the antihypertensives. They reduce blood pressure by reducing the strength of your heartbeat, which sounds incredibly archaic. If that isn’t the prime example of treating the symptom with brute force, nothing is.

One way to reduce the strength of the heartbeat is to impair production of the nutrient responsible for energy production in the heart: CoQ10. Just like statins, beta blockers block CoQ10, only this time it’s the desired effect. Take CoQ10 to counter this.

Beta blockers also block melatonin secretion at night. And sure enough, sleep disturbances are a common side effect of beta blockers. In a cruel twist of fate, poor sleep can increase the risk of the condition beta blockers are treating: hypertension. Take 0.25-0.5 mg melatonin a half hour before your bedtime.


The glucose-reducing drug metformin isn’t just for diabetics these days. A number of otherwise healthy people take it to inhibit mTOR and hopefully extend lifespanType 2 diabetics (a population with lower overall mortality) who take metformin live longer than age-matched controls who don’t have diabetes, for example.

Metformin also protects against the conditions that kill people, like cancer. It lowers hyperinsulinemia and may protect against insulin-related cancers (breast, colon, etc).

But if you’re going to take metformin, you should also consider supplementing with vitamin B12. B12 deficiency is incredibly common in people taking metformin, and researchers are even suggesting that B12 monitoring become standard care for metformin patients.

A good general rule for folks on the standard Western cocktail of statins, antihypertensives, PPIs, and metformin with the occasional round of antibiotics?

CoQ10, 200-300 mg (or eat lots of beef heart).

A good B-complex, particularly B12 and folate.

Melatonin at night, 0.25-0.5 mg.

Magnesium, 200-400 mg (or lots of leafy greens, some nuts and seeds, some blackstrap molasses, maybe even legumes).

A couple Brazil nuts for selenium.

Eat oysters and red meat for zinc.

A few egg yolks.

A good probiotic.

Fermented dairy (yogurt, kefir, cheese) for the calcium and probiotics. Fermented food in general (sauerkraut, kimchi, fermented condiments and sauces).

Hell, that’s not a bad lineup for anyone. But do take these to heart. Even if you’re not taking any drugs, someone you know and love probably takes one or more daily and could really use a nudge in the right direction.

Chances are, this will be the first they hear of it.

That’s it for today, everyone. Now I’d like to hear from you. What other drugs interact with vitamins and minerals in our diets? Are there any other nutritional considerations people taking prescription drugs should heed?

Thanks for reading!


TAGS:  Big Pharma

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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27 thoughts on “5 Common Prescriptions That Should Require Nutritional Counseling”

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  1. I don’t have a problem with relatively benign, short-term prescription drugs that actually serve a useful purpose. Unfortunately, many (if not most) are neither benign nor short-term, and they are often unnecessary. Again unfortunately, the primary goal of the pharmaceutical industry is PROFIT, not better health. Anyone who thinks otherwise is very naïve indeed.

    I think the era of reaching for a “magic bullet” in the form of a drug is waning. The good news is that more and more people are questioning the need to take something for every health issue which, if given some time and a better lifestyle, will often resolve itself. Also on the plus side, these are good tips for those who have no choice but to take drugs.

  2. Since there is an epidemic of painkiller use, I was wondering if that too should require nutritional counseling?

    1. Natural laxatives would be the call for opiate based pain killers

  3. Excellent information. I take Metformin and a baby dose of carvedilol (Coreg), and also CoQ10, magnesium, sublingual B12 and K2. I have consistently refused to take statins, which come up with every medical appointment. Only one of my docs, an osteopath, has ever mentioned these supplements.

  4. >Just like statins, beta blockers block CoQ10,
    >only this time it’s the desired effect.
    >Take CoQ10 to counter this.

    Isn’t this illogical? If you don’t want or need the desired effect of the BB, shouldn’t you just stop taking it instead of suppressing it with CoQ10?

    1. I believe the reason for taking the CoQ10 at that point is to support your other general muscle health. I’d guess that dietary coq10 is distributed differently and maybe not stored for the heart’s use as well?

  5. And what about the ACE inhibitors? Also very commonly prescribed.

  6. I try to avoid pharmaceuticals as much as possible, but I’ve done a fair bit of reading about metformin from a life extension standpoint and it MIGHT be something to consider using to biohack yourself even if your glucose is under control.

    1. If you can get your doctor to proscribe it. Good luck with that.

    2. There are other natural ways to inhibit mTOR ,and to lower blood glucose.Valter Longo spore about it.Big Pharma wants to focus on 2 parameters ,glucose and mTOR and à drug which Could put then under control.Good nutrition a lot of polyphenols for example can réduce mTOR , proteine in take control too.

  7. Thankfully I’m not taking anything. But I love the suggested list at the end…good for everyone. I just wish more doctors were on board with this.

  8. Hi Mark,

    Surely you mean 2.5mg to 5.0mg of Melatonin (as opposed to 0.25-0.5mg), as most tablets I have run across come in 2mg to 10mg doses.


    1. I’m guessing he really does mean a quarter or a half of a milligram. The argument I’ve read for the smaller dosages is that it’s closer to what your body makes on its own (accounting for whatever losses happen given that you’re ingesting it orally rather than making it on your own). If you really *need* the 2-10 mg range for it to be effective, I’d say that there’s some other stuff going on. There was for me in any case.

  9. Well shit. I’ve never had to regularly take any drugs (and it’s been YEARS since I’ve had to have any antibiotics) but I have had the Mirena IUD for eight years. The only noticeable effect other than lack of pregnancy is a lack of cycle (amazing!). Now I’m worried about my nutrient absorption. Not that I would ever get rid of it. But I guess this is yet one more reason I’ve discovered the wonders of primal.

  10. I was curious what other primal people’s experiences with birth control are. I’ve been on BC for the last 30 years and I estimate I have another 5-10 years until menopause. I’ve never had any issues with BC and have always felt happy and grateful that it’s the only prescription medication I take. However I’ve been reading more about the primal lifestyle and ‘free-range’ women who aren’t taking artificial hormones and it’s making me wonder what the long term effects might be? Or, since I’ve been doing it this long, why stop now? Also I wonder what will happen when I enter menopause and suddenly remove all these hormones from my system. Am I going to be like Godzilla for a while? 🙂

  11. I have been primal for about 7 years and have had great health all the while. Just recently, however, I was diagnosed with hypertension, which runs in my family but I thought I could avoid it with a healthy lifestyle. So now I’m on 3 meds for it, including a beta blocker. I also take some heart-healthy supplements, including CoQ10. My question is, if CoQ10 counteracts the beta-blocker, shouldn’t I NOT take CoQ10? The article states that I should take the CoQ10, which is confusing to me. Can you expand that discussion? Also, I know I’m treating the symptom with the meds, but until I figure out, and address the cause, I’m willing to take the meds because high blood pressure is scary and I feel the meds working. I’m hoping to get off them in the long run by addressing the cause. Thanks.

  12. As a pharmacist, I agree with this article 100%. There are drug-induced nutrient depletions associated with many common medications. Corticosteroids, diuretics & calcium channel blockers are a few other common classes of medications that deplete essential nutrients. I always try to counsel patients on these “Rx robbers”. Unfortunately, many patients fall victim to the endless cycle of medication > nutrient deficiency > side effect(s) > more medication(s). Medications prescribed for one illness can have have long-term effects if the drug-induced nutrient depletions are not addressed from the beginning. but patients can be spared lots of time and money with judicious use of supplementation. Pharmacists, especially those of us trained in functional medicine, are a great resource for patients with questions about how medications impact overall health status.

  13. I try to find advices for clients with blood thinner according to a primal diet … because they can’t eat anything healthy like green and fish oil. How could we help them ? Merci!

  14. I had a lot of bad side effects while taking metformin. Now i quit taking every medical substance and take omega 3, zink and selen in addition to my normal diet and my training. Too many doctors told me to take this and that. And nothing helped me to decrease my testosteron level. Without taking anything, my testosteron level got a small decrease.
    ..and I feel better now! 🙂

  15. Hi All,

    Please direct me to, if already covered.

    Will my dexamphetamine tablet kick me out of Ketosis?
    I am a beginner so please forgive me if this is general knowledge.

    Thank You


  16. Hi All,

    Can anyone tell me where I might find information on whether my Dexamphetamine tablet will kick me out of ketosis?