Vitamins and Birth Control Pills

Oct 30, 2019 | Featured, Nutrient Deficiency

Oral contraceptives, including birth control pills, interfere with vitamin absorption and activity. Vitamin, mineral, and other nutrient depletion is an effect of taking these drugs that has been documented since the 1960s, leading many researchers and pharmacists to recommend supplementing with vitamins and minerals while using these medications.

Most of these hormonal birth control pills contain a combination of estrogen and progestin, an extremely effective combination with a 99.9% success rate by preventing ovulation. How this effects nutrient levels is currently unknown, but for more than 50 years, scientists have documented lower levels of certain critical vitamins and minerals in women taking oral contraceptives.

Birth Control Depletes Folate

You need folate for cells to divide and reproduce, as well as to remove the chemical homocysteine that is dangerous to your cardiovascular system.

Since the 1960s1, 2, 3, 4, 5, 6, 7, 8, 9, researchers have documented oral contraceptive use with lower serum folate levels and restoration to normal levels after ceasing use. Researchers suggest that this could be due to the drugs causing malabsorption of folate, increasing excretion of folate in urine, and accelerating folate metabolism.

While researchers say these lower folate levels are not likely to cause anemia in women with good dietary folate intake who can absorb the vitamin properly, it may lead to problems for women with poor diet. They also recommend that women who are planning to become pregnant after ceasing birth control pills to supplement with folate due to its well-known association with mitigating risk of certain birth defects.

Types of birth control known to deplete folate10*

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone, Estrogen and Medroxyprogesterone

Example folate depletion symptoms10

  • Pale skin
  • Low energy
  • Weakness
  • Shortness of breath
  • Forgetfulness
  • Headache

Oral Contraceptives and Vitamin B2

B2, a.k.a. riboflavin, is essential for converting food to cellular energy that keeps your body running. This member of the Vitamin B family can act as an antioxidant that protects your cells from damaging free radicals. It’s necessary for proper growth of your body as a whole as well as your hair, skin, and nails.

It’s easy to become deficient in B2 when dietary intake is low. Your body constantly excretes riboflavin in urine. Since meat and dairy are major dietary riboflavin contributors, the National Institutes of Health lists vegans and vegetarians at risk for deficiency. It’s a common deficiency in women of child-bearing age of lower socio-economic status who may not have optimal diets. Researchers have found that birth control pills exacerbate the deficiency.1, 11, 12, 13

Types of birth control known to deplete B210*

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone, Estrogen and Medroxyprogesterone

Example B2 depletion symptoms10

  • Cracks around the mouth
  • Dry, scaly skin
  • Red, itchy eyes

Birth control and Vitamin B6 depletion

B6, also known as pyridoxine, is critical for your body to process and utilize dietary protein. It also makes neurotransmitters, the cells that control brain communication and mood.

Studies correlating birth control use with low B6 levels date back to the mid-1960s. Recent large-scale studies corroborate this relationship.1, 14, 15

Types of birth control known to deplete Vitamin B610*

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone, Estrogens (conjugated, synthetic, and esterified), Estrogen combinations, Estropipate

Example B6 depletion symptoms10

  • Poor sleep
  • Altered mobility
  • Low mood
  • Nausea

B12 deficiency and birth control pills

Vitamin B12 is critical for proper metabolism — converting food to energy. You also need it to make DNA. The only significant dietary sources of B12 are animal products, leaving vegans and vegetarians at major risk of deficiency. Because B12 requires stomach acid to extract it from food, people with lower stomach acid — due to age or medication use — are also at risk of low levels.

Though researchers don’t understand the mechanisms at play, several studies have found that serum B-12 levels are lower in women taking oral contraceptives.1, 15, 16, 17, 18, 19, 20, 21

Types of birth control known to deplete Vitamin B1210*

Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone

Example B12 depletion symptoms10

  • Fatigue
  • Loss of appetite
  • Confusion
  • Memory loss
  • Easy bruising

Oral contraceptives can deplete Vitamin C

You know Vitamin C for its support of the immune system. Your white blood cells and other entities in the immune system require it to function and protect you. Vitamin C is also essential to produce the collagen that keeps your skin firm and your joints, muscles, and tendons healthy. It’s also a powerful antioxidant that neutralizes the damaging free radicals that result from stress, environmental contaminants, and ingestion of harmful substances like alcohol and junk food.

Oral contraceptives lower Vitamin C levels in plasma leukocytes and platelets, elements of the immune system. The theory is that the estrogen in birth control pills increases the rate of Vitamin C metabolism. Researchers have stated that oral contraceptives alter tissue uptake patterns, thus the distribution of the vitamin.1, 22, 23, 24, 25 In a recent study, researchers suggested that taking oral birth control pills increased oxidative stress (free radicals) and that supplementing with antioxidants Vitamin C and Vitamin E increased the activity of naturally occurring antioxidant glutathione and reduced levels of free radicals.25

Types of birth control known to deplete Vitamin C10*

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone

Example vitamin C depletion symptoms10

  • Bleeding gums
  • Impaired wound healing
  • Loss of appetite
  • Muscular weakness

Vitamin E and birth control pills

Vitamin E is a powerful antioxidant required for proper immune system function.

Combined-type oral contraceptives decreased Vitamin E plasma content in healthy women. Other studies found changes in blood clotting activity in those taking birth control whose Vitamin E levels were depleted. This result prompted some researchers to hypothesize that lowered Vitamin E could be responsible for the adverse cardiovascular side effects of taking oral contraceptives.1, 26, 27

Birth control pills can deplete zinc

You need zinc for your immune system to work as it should. Even a mild deficiency can suppress the immune system https://blog.livonlabs.com/vitamins-and-nutrients/zinc-benefits/. This mineral also supports eye, hormone, and skin health. Because the zinc sources that contain the types of the mineral that are usable by the body are only found in animal-based sources, vegans and vegetarians are at risk for deficiency. Marginal zinc deficiency is rather common in the United States.

Several studies conducted in the past 50 years link lower serum zinc levels to oral contraceptive use, suggesting that women taking these medications may need more dietary zinc.1, 28, 29, 30

Types of birth control known to deplete zinc10*

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone, Estrogen combinations10

Example zinc depletion symptoms10

  • Impaired senses of smell and taste
  • Slow wound healing
  • Low mood
  • Joint pain

Selenium and oral contraceptive use

This trace mineral and potent antioxidant helps the thyroid function. It’s also critical to the immune system and balancing HDL and LDL cholesterol ratios. People with intestinal challenges — including celiac disease — tend to have difficulty absorbing this nutrient. Per several studies, oral contraceptives also interfere with selenium absorption.1, 30, 31

Types of birth control known to deplete selenium32

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Estrogens (conjugated), Estrogen combinations

Example selenium depletion symptoms10

  • Sore muscles
  • Fatigue
  • Low mood

Birth control and magnesium deficiency

Magnesium is part of more than 300 processes in the body from the bones to the brain. To be fair, oral contraceptive use isn’t the only reason for low magnesium levels since experts estimate that more than 50% of the US population is deficient.

Many studies have shown that oral contraceptives reduce serum magnesium levels.1, 34, 35, 36, 37 Other studies indicate that supplementing with estrogen and calcium in post-menopausal women has a similar effect.38

Types of birth control known to deplete magnesium10

Estradiol, Estradiol combinations, Ethinyl Estradiol, Ethinyl Estradiol combinations, Levonorgestrel, Norethindrone, Estrogens (conjugated, synthetic, and esterified), Estrogen combinations, Estropipate

Example magnesium depletion symptoms10

  • Irritability
  • Sleep problems
  • Fatigue
  • Poor memory
  • Neck pain
  • Muscle cramps and spasms
  • Constipation

Do you have hormonal birth control vitamin mineral depletion?

Deficiency tests

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.

Nutrient-dense foods

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. If this is not possible, supplements may be in order.

High-quality supplements

Addressing vitamin and mineral deficiency may require more nutrients than a daily maintenance multivitamin can provide. Supplementing the specific vitamins and minerals that birth control pills deplete offers more options in selecting a specific supplement.

Nutrients come in various forms with varying degrees of usability in the body.

Take folate for example. When you eat foods containing folate (or folic acid), your body can’t immediately use the vitamin. You must convert it through a process called methylation into the active form of folate that can perform its duties in your cells. Many people have a genetic mutation that makes them unable to methylate folate, thus all the B9 they consume just goes to waste. Some folate or Vitamin B Complex supplements contain a pre-methylated form of folate that ensures everyone can benefit from the supplement.

Supplements also contain several forms of magnesium. The most common in multivitamins and bargain supplements is magnesium oxide, which your body has a lot of trouble using. This type of magnesium often has a laxative effect because your body excretes what it can’t use. Magnesium citrate and magnesium glycinate are more expensive, but are much easier for the body to use. Magnesium L-Threonate is a newly discovered form of the mineral that has the distinction of being the only compound proven to significantly raise magnesium levels in the brain.

Also, when supplementing to correct an oral contraceptive-induced vitamin depletion, you may be tempted to take large doses. When you’re supplementing water-soluble nutrients (which all the aforementioned are), remember that your body can’t store them. Since you can only absorb relatively small amounts at once, you may be losing much of the content on the label by taking large doses of traditional oral supplements. This is why people taking large oral doses of Vitamin C often report gastric distress. Liposome encapsulated Vitamin C, B Complexes, and Magnesium supplements enable you to absorb more nutrients from larger doses by bypassing your body’s restrictive absorption systems.

*Note: This is NOT a complete list and we have not used any branded names as new drugs are released so frequently that it is not possible to keep up. If you do not see your specific drug on this list, a Google search should show you nutrient depletions. From research published in books like Drug-Induced Nutrient Depletion Handbook, most drugs in certain classes cause the same nutrient depletions. This article only gives general information, so it is important to search for your specific medication by name to get the details.

1 Palmery, M., Saraceno, A., Vaiarelli, A., Carlomagno, G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 2013; 17; 1804-1813.

2 Trowbridge M, Jr., Wadsworth RC, Moffitt E. Malabsorption associated with gluten enteropathy, do oral contraceptives interfere with folate metabolism? J Maine Med Assoc 1968; 59: 240-242.

3 Paton A. Oral contraceptives and folate deficiency. Lancet 1969; 1: 418.

4 Ryser JE, Farquet JJ, Petite J. Megaloblastic anemia due to folic acid deficiency in a young woman on oral contraceptives. Acta Haematol 1971; 45: 319-324.

5 Whitehead N, Reyner F, Lindenbaum J. Megaloblastic changes in the cervical epithelium. Association with oral contraceptive therapy and reversal with folic acid. JAMA 1973; 226: 1421-1424.

6 Shojania AM. Oral contraceptives: effect of folate and vitamin B12 metabolism. Can Med Assoc J 1982; 126: 244-247.

7 Shojania AM, Hornady G, BARNES PH. Oral contraceptives and serum-folate level. Lancet 1968; 1:1376-1377.

8 Wertalik LF, Metz EN, Lobuglio AF, BALCERZAK SP. Decreased serum B 12 levels with oral contraceptive use. JAMA 1972; 221: 1371-1374.

9 PRASAD AS, LEI KY, MOGHISSI KS, STRYKER JC, OBERLEAS D. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12, and folic acid. Am J Obstet Gynecol 1976; 125: 1063-1069.

10 Pelton, Ross, RPh, PhD, CCN, LaValle, James, RPh, DHM, NMD, CCN, Hawkins, Ernest, RPh, MS, Krinsky, Daniel, RPh, MS. Drug-Induced Nutrient Depletion Handbook Volume 2. Lexi-Comp, 2001.

11 Sanpitak N, Chayutimonkul L. Oral contraceptives and riboflavine nutrition. Lancet 1974; 1: 836-837.

12 Newman LJ, Lopez R, Cole HS, Boria MC, Cooperman JM. Riboflavin deficiency in women taking oral contraceptive agents. Am J Clin Nutr 1978; 31: 247-249.

13 Briggs M. Letter: Oral contraceptives and vitamin nutrition. Lancet 1974; 1: 1234-1235.

14 Rose DP. The influence of oestrogens on tryptophan metabolism in man. Clin Sci 1966; 31: 265-272.

15 Lussana F, Zighetti ML, Bucciarelli P, Cugno M, Cattaneo M. Blood levels of homocysteine, folate, vitamin B6 and B12 in women using oral contraceptives compared to non-users. Thromb Res 2003; 112: 37-41.

16 Wertalik LF, Metz EN, Lobuglio AF, Balcerzak SP. Decreased serum B 12 levels with oral contraceptive use. JAMA 1972; 221: 1371-1374.

17 Wilson SM, Bivins BN, Russell KA, Bailey LB.Oral contraceptive use: impact on folate, vitamin B(6), and vitamin B(1)(2) status. Nutr Rev 2011; 69: 572-583.

18 Sutterlin MW, Bussen SS, Rieger L, Dietl J, Steck T. Serum folate and Vitamin B12 levels in women using modern oral contraceptives (OC) containing 20 microg ethinyl estradiol. Eur J Obstet Gynecol Reprod Biol 2003; 107: 57-61.

19 Riedel B, Bjorke Monsen AL, Ueland PM, Schneede J. Effects of oral contraceptives and hormone replacement therapy on markers of cobalamin status. Clin Chem 2005; 51: 778-781.

20 Shojania AM, Wylie B. The effect of oral contraceptives on vitamin B12 metabolism. Am J Obstet Gynecol 1979; 135: 129-134.

21 Veninga KS. Effects of oral contraceptives on vitamins B6, B12, C, and folacin. J Nurse Midwifery 1984; 29: 386-390.

22 Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982; 4: 423-440.

23 Webb JL. Nutritional effects of oral contraceptive use: a review. J Reprod Med 1980; 25:150-156.

24 WHO. Advances in Methods on Fertility Regulation. World Health Organization, 1975.

25 Zal F, Mostafavi-Pour Z, Amini F, Heidari A. Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives. Contraception 2012; 86: 62-66.

26 Briggs M. Letter: vitamin E status and oral contraceptives. Am J Clin Nutr 1975; 28: 436.

27 Renaud S, Ciavatti M, PERROT L, Berthezene F, Dargent D, Condamin P. Influence of vitamin E administration on platelet functions in hormonal contraceptive users. Contraception 1987; 36: 347-358.

28 Wapnir RA. Protein Nutrition and Mineral Absorption. Boca Raton, Florida. CRC Press; 1990.

29 Halsted JA, Hackley BM, Smith JC, JR. Plasma-zinc and copper in pregnancy and after oral contraceptives. Lancet 1968; 2: 278-279.

30 Fallah S, Sani FV, Firoozrai M. Effect of contraceptive pill on the selenium and zinc status of healthy subjects. Contraception 2009; 80: 40-43.

31 Heese HD, Lawrence MA, Dempster WS, Pocock F. Reference concentrations of serum selenium and manganese in healthy nulliparas. S Afr Med J 1988; 73: 163-165.

32 Cohen, Suzy, RPh. Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients—and Natural Ways to Restore Them. Rodale, 2011.

33 Akinloye O, Adebayo TO, Oguuntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J 2011; 60: 308-315.

34 Hameed A, Majeed T, Rauf S, Ashraf M, Jalil MA, Nasrullah M, Hussan A, Noreen R. Effect of oral and injectable contraceptives on serum calcium, magnesium and phosphorus in women. J Ayub Med Coll Abbottabad 2001; 13: 24-25.

35 Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987; 6: 313-319.

36 Olatunbosun DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on Serum magnesium levels. Int J Fertil 1974; 19: 224-226.

37 Blum M, Kitai E, Ariel Y, Schnierer M, Bograd H. Oral contraceptive lowers serum magnesium. Harefuah 1991; 121: 363-364.

38 Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990; 3: 197-215.

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