By Ross Pelton, RPh, PhD, CCN

I am the author of The Drug-Induced Nutrient Depletion Handbook.¹ During the process of writing that book, I was astounded to learn that oral contraceptives deplete more nutrients than any other class of drugs. This knowledge motivated me to write The Pill Problem, which teaches women how to protect themselves from the side effects of oral contraceptives.²

The purpose of this article is to summarize the nutrient depletions caused by oral contraceptives and the potential health risks associated with these nutrient depletions. I will not be making dosage recommendations. I believe practitioners should make these decisions on a case-by-case basis due to individual differences in genetics, diet, lifestyle and health history.

Although The Pill Problem was published in 2013, I was not successful in getting national publicity or wide spread distribution (I wasn’t born with a gene for marketing). However, I still strongly believe this information is critically important for women and I am grateful for the opportunity to summarize this information in an article for the Townsend Letter.

History of “The Pill”

On May 9, 1960, the Food and Drug Administration approved Enovid as the first oral contraceptive (OC) for use in the United States. This ushered in a new era of sexual freedom for women who could now enjoy spontaneous sex without the fear of becoming pregnant. It is estimated that over 100 million women utilize oral contraceptives worldwide.³

A survey conducted between 2015-2017 reported that 25.9% (9.7 million) women in the US between the ages of 15-44 were using oral contraceptives, which made “the pill” the most commonly used form of contraception during those years.⁴ However, various studies report that from 46 to 60% of women who begin using oral contraceptives discontinue using them within the first six months due to side effects.^5,6

Oral Contraceptive Nutrient Depletions

Oral contraceptives deplete vitamins B1, B2, B3, B6, B12, folic acid, vitamin C, vitamin E, magnesium (Mg), selenium, zinc, tyrosine, DHEA, and coenzyme Q10.⁷ Fourteen nutrients are being depleted in the bodies of approximately 10 million women in the US and over 100 million women worldwide.

There are other factors contributing to nutrient depletion(s). Factory farming practices such as lack of crop rotation, use of artificial fertilizers, use of pesticides and herbicides, and loss of topsoil each contribute to destruction of the microbiome in the soil and declining levels of nutrients in the crops being grown. In a manner similar to the way probiotic bacteria in the human gut microbiome regulate digestion of food and absorption of nutrients, bacteria break down organic matter in the soil and regulate the delivery of nutrients to growing plants. Multiple studies have reported alarming declines in the nutritional content of our agricultural food supply since the end of World War II. Many foods currently have 20 to 30% lower levels of many vitamins and minerals compared to 70 years ago.^8,9

I believe the massive widespread use of highly toxic pesticides and herbicides on agricultural food crops, residential lawns and gardens, golf courses and city parks (to name a few) is one of the greatest sins in the history of humanity. We are killing off the microbiome in the soil, lakes, streams and oceans on planet earth, which is creating nutrient depletion problems for all living things. A majority of people also consume diets that consist of highly processed fats and carbohydrates, large amounts of refined sugar, and are dangerously low in fiber content.

Polypharmacy: America’s Other Big Drug Problem

Americans take far more drugs than any other country.¹⁰ According to data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), 47% of non-pregnant women between ages 15-44 take prescription drugs, and about half take two or more prescription drugs daily.¹¹ Thus, in addition to oral contraceptive nutrient depletions, multiple other factors can cause nutrient depletions, which increases the risks for developing a wide range of health problems.

Difficult to Detect

When an individual has a side effect to a new drug their physician has prescribed, symptoms such as nausea, vomiting, diarrhea, or a skin rash usually happen within 24-48 hours. However, many of the health problems associated with drug-induced nutrient depletions develop gradually over time. Since they do not initially cause noticeable symptoms, women are often not aware of a developing health problem.

Here’s an example: Consider a woman who has been taking oral contraceptives for 10 years, without any noticeable problems. However, over the past six months, she has been increasingly noticing that she is tired all the time. She struggles to get up in the morning; or by mid-afternoon, she is feeling so exhausted that she can hardly function. Oral contraceptives deplete folic acid, vitamin B12, coenzyme Q10, and magnesium. Each of these nutrients is critically important for energy production. A depletion of any one of these nutrients can cause tiredness, weakness, lethargy and/or anemia over time. However, this woman probably doesn’t realize that the medication she has been taking for years has been causing nutrient depletions that are now causing health problems.

Overview of Health Risks

The nutrient depletions mentioned above can increase the risk of depression, sleep disorders, anemia, low energy, migraine headaches, heart attacks, strokes, blood clots, diabetes, a weakened immune system, giving birth to an infant with birth defects, and colon and breast cancer. I am not suggesting that women should stop taking birth control pills. My goal is to educate women and healthcare professionals about the fact that oral contraceptives commonly cause nutrient depletions and that the resulting health problems can frequently be prevented or corrected by taking the appropriate nutritional supplements. After each health problem, I will list the oral contraceptive nutrient depletions associated with the problem.

Fatigue (Mg, CoQ10, Folate, B12, and Selenium): Numerous studies report that twice as many women suffer from fatigue as men.¹² Studies also report that fatigue occurs most frequently in people between the ages of 15 to 34, which is the age range that women are more likely to be taking oral contraceptives.¹³  The OC-depleted nutrients associated with fatigue are below.

• Magnesium (Mg) and coenzyme Q10 (CoQ10) are both required for the production of cellular energy in the form of mitochondrial ATP.
• Folic acid and vitamin B12 are required for production of red blood cells. Depletion can cause anemia, tiredness, and fatigue
• Selenium (selenoproteins/deiodinases enzymes) is required for the production of thyroxine (T4) and conversion of T4 into its bioactive metabolite triiodothyronine. Fatigue is just one of many symptoms associated with low levels of thyroid hormones.

Blood clots (Mg, B6, B12, Folate): Magnesium, which functions as a mild anticoagulant, is depleted by oral contraceptives.¹⁴ Hence, magnesium deficiency increases thrombotic risks, which explains why women taking oral contraceptives have a greater risk of developing blood clots.¹⁵

Physicians frequently encourage women to take calcium supplements to help prevent osteoporosis. Calcium is involved in several steps in the blood coagulation process so excess calcium can promote clotting.  At the same time, birth control pills deplete magnesium, which increases risks for clot formation. Increased calcium, along with magnesium depletion, create a wider gap between the normal calcium/magnesium balance, which can create a “double-whammy” for increased risk of forming blood clots.¹⁶

Vitamins B6, B12, and folate are required to metabolize homocysteine; and decades ago, elevated homocysteine was found to be a major risk factor for the initiation of thrombosis/blood clots.¹⁷

Birth defects (Folate): Folate deficiency has been recognized as an “imminent health hazard” and is the primary cause of a worldwide epidemic of birth defects.¹⁸ Many studies document that folate is significantly depleted by oral contraceptives, and it is strongly recommended that women supplement with folate before and during early pregnancy.¹⁹

It is important to emphasize that folate and folic acid are not the same. Folate occurs naturally in foods. However, folic acid is a man-made supplement that is structurally different from folate. Whereas folate is totally safe to take, several studies have reported people taking high-dose folic acid supplementation have higher rates of cancer. For example, results from a six-year trial in Norway revealed that people taking high-dose folic acid had a higher incidence of cancer and were 43% more likely to die from cancer.²⁰   In a 10-year trial, women who took folic acid supplements had 20-30% increased risk of developing breast cancer.²¹ Encourage your patients to supplement with natural folate, not synthetic folic acid.

Atherosclerosis (Vit. B6, B12, Vit. C, Folate): The B-vitamins, vitamin B6, vitamin B12 and folate are required for the metabolism of homocysteine, and elevated homocysteine is a major risk factor for cardiovascular disease from plaque build-up and clogged arteries.²²

Low levels of vitamin C also increase the risk of atherosclerosis as evidenced by increased free radical damage, increased levels of oxidized LDL-cholesterol, and accelerated plaque build-up.²³

Hypertension (Mg, CoQ10): Magnesium, a natural muscle relaxant, helps relax blood vessels and lower blood pressure. Women taking oral contraceptives have substantially lower levels of serum magnesium compared to nonusers.²⁴

Coenzyme Q10 levels are lower in women using oral contraceptives, and blood pressure is higher in individuals with low levels of CoQ10.²⁵ Supplementation with CoQ10 is a very effective natural therapy to lower elevated blood pressure.²⁶

Oral contraceptives cause a slight elevation of blood pressure in most women. A condition referred to as Oral Contraceptive Hypertension occurs in about 5% of OC users. These blood pressure elevations are generally reversible within a few months after stopping.²⁷

Heart attacks (Mg): Magnesium regulates heart rhythm and it also functions as nature’s natural muscle relaxant. Every year, many people with relatively healthy hearts experience a serious heart attack; and in about 50% of these cases, the heart attack causes sudden death.²⁸ Many Americans are deficient in magnesium and taking adequate magnesium supplementation on a daily basis provides strong protection against heart attacks.

Cancer (Selenium, Folate): Selenium is a powerful antioxidant, and selenium and selenium-dependent enzymes play critical roles in detoxification. Women using oral contraceptives have been found to have lower levels of selenium compared to nonusers, and low selenium levels are associated with greater risks of breast cancer and colon cancer.[29]^,[30]

Low folate levels cause abnormalities during cellular division, which are associated with numerous types of cancer, such as cervix, colon, lung, and esophagus.³¹

Osteoporosis (Mg): Calcium and magnesium play critical roles in the regulation of bone metabolism, and the calcium/magnesium balance is critical for bone health. Many women take calcium supplements, which increase serum calcium levels while oral contraceptives lower magnesium levels. This is a double dilemma for bone health. The body attempts to normalize the calcium/magnesium ratio by leaching magnesium out of the bones, which actually weakens bone structure and can accelerate the development of osteoporosis.³²

Weak immune system (Vitamins C, E, Selenium, Zinc, Coenzyme Q10): Antioxidant nutrients play critical roles in the regulation of immune function, and each of the oral contraceptive-depleted nutrients listed above function as antioxidants. Additionally, vitamin C, selenium, and zinc provide anti-viral protection, which is critical for immune health.³³ A deficiency of any one of these nutrients will weaken the immune system.

Women taking OCs had vitamin C levels that were 30% to 42% lower than women not taking OCs.³⁴ Also, plasma levels of vitamin E,^35-37 are significantly lower in women taking oral contraceptives.

Depression (Vitamin B6, Folate, Vitamin B12, Tyrosine): In a meta-analysis, the incidence of depression in women taking oral contraceptives who reported depression ranged from 16% to 56%.³⁸ In a study comparing women taking oral contraceptives with non-users, women taking birth control pills had depression rating scores that were almost two times higher than women who were non-users.³⁹

Vitamin B6 is required for the synthesis of serotonin. Tyrosine is the precursor for the synthesis of the neurotransmitter norepinephrine. Disrupting these pathways increases the risk of depression.⁴⁰

Elevated homocysteine is associated with depression. Since B6, B12 and folate are required for homocysteine metabolism, a deficiency of any of these B-vitamins could contribute to elevated homocysteine and depression.⁴¹

Sleep disorders (Vitamin B6): Vitamin B6 is required for the conversion of tryptophan into serotonin, which then gets converted into melatonin. Melatonin is the chemical produced in our brains that triggers sleep. Sleep problems are one of the most common health issues for women. Approximately 25% of women in America suffer from insomnia.⁴² Hence, a deficiency of vitamin B6 inhibits the synthesis of serotonin, which can lead to depression; and it also inhibits the synthesis of melatonin, which can cause sleep disorders.

Vaginal yeast infections (Probiotics): Oral contraceptives alter the acid/base balance in the intestinal tract, which favors the growth of candida. In addition to a number of OTC treatments, there is emerging evidence that some strains of probiotic bacteria specifically promote a healthy vaginal microbiome.⁴³

Migraine headaches (Riboflavin, Magnesium, CoQ10): Studies show that high-dose riboflavin can help prevent or treat migraine headaches although the mechanism is not clear.⁴⁴

Brain imaging studies reveal that brain magnesium levels are low during migraine attacks.⁴⁵ Other theories include magnesium’s role as a muscle relaxent and its role in ATP production.⁴⁶

Coenzyme Q10’s role in migraines appears to also be related to mitochondrial energy metabolism.⁴⁷

Fluid retention/weight gain (Not due to nutrient depletions): Most women will retain some excess fluid, which results in weight gain when they begin taking OCs because synthetic estrogens alter several hormonal systems that regulate fluid in the body. Hormones altered are arginine vasopressin (AVP), atrial natriuretic peptide (ANP), renin and aldosterone. This causes slight retention of sodium and fluid, resulting in a new “set point.”⁴⁸

Sexual side effects (Not due to nutrient depletions): Oral contraceptives lower a woman’s sex drive, which is one of the most common reasons that women discontinue taking the “pill.”   Common sexual side effects associated with oral contraceptives include the following:

1. Decreased desire for sex,
2. Greater difficulty becoming aroused,
3. Vaginal dryness resulting in painful sex,
4. Difficulty or inability to achieve orgasm.

These sexual side effects are caused by hormone imbalances that result from ingesting the synthetic, chemically altered hormones in oral contraceptives. The unnatural hormones react differently with cell receptors. This alters signals that are sent to genes, which causes negative effects on a woman’s sexual hormones and on other physiological processes.

Oral contraceptive-induced sex hormonal imbalances include the following: 1) Testosterone levels are lower in women taking OCs.⁴⁹ 2) Dehydroepiandrosterone (DHEA) is the precursor for testosterone production. Women taking oral contraceptives have lower circulating levels of DHEA.⁵⁰ 3) Sex hormone binding globulin (SHBG) is a protein that binds to sex hormones so they can be transported throughout the body. When testosterone is bound to SHBG, the testosterone is not free to function at the cellular level. Women taking oral contraceptives have been found to have levels of sex hormone-binding globulin four times higher than the level of SHBG in women who had never taken oral contraceptives.⁵¹ This dramatically lowers the amount of free testosterone available to act at the cellular level, which decreases sex drive and the ability to achieve an orgasm.

A disturbing long-term problem: Blood samples from women who had discontinued taking oral contraceptives for six months revealed levels of SHBG that were still two times higher than the levels in women who had never used oral contraceptives. This means that even after women stop taking oral contraceptives, they may experience long-term sexual dysfunction.⁵¹

Increased free radical damage/accelerated aging (Vitamin C, E, Selenium, Zinc, Coenzyme Q10): Depleting levels of antioxidants in the body can result in increased levels of free radical damage throughout the body, which accelerates biological aging.

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References

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Ross Pelton, RPh, PhD, CCN is currently the scientific director for Essential Formulas, Inc, based in Dallas, Texas. As a pharmacist, he is an expert on pharmaceutical drugs and their life-altering side effects. As a certified clinical nutritionist (CCN), he counsels clients on diet, nutrition, and natural therapies for a wide range of health issues. As a health care professional, Ross helps clients and other healthcare professionals utilize and integrate natural therapies and life extension technologies into their lives and/or practices to achieve a healthier, longer life.

Ross is the author of ten books on a variety of health topics: The Drug-Induced Nutrient Depletion Handbook, (Lexi-Comp, 2001) The Nutritional Cost of Drugs, 2nd Edition (Morton Publishing Co., 2004) The Natural Therapeutics Pocket Guide (Lexi-Comp., 2000) How To Prevent Breast Cancer (Simon & Schuster, 1995) Alternatives In Cancer Therapy (Simon & Schuster, 1994) Mind Food and Smart Pills (Doubleday, 1989)

Website, Blog, and full bio at https://www.naturalpharmacist.net/