Birth Control and Nutrient Depletion - What Every Woman Should Know

Medications save lives and help many people live more full lives. But with all medications there comes risks, and side effects. This is the same with all forms of birth control. It would be naive to think that adding a synthetic hormone to your body would not cause a disruption. This is a non-natural addition to your biochemistry. As such it changes aspects of your biochemistry, some with positive and wanted effects, and others negative. These negative changes cause side effects. Some mild and some severe. Side effects are caused by a number of factors including the diminished ability to properly metabolize the additional hormones, allergic reactions to the medications, the act of disrupting your natural hormonal patterns, and nutrient depletion among others. In this article we will be addressing the nutrient depletion component. 

Birth Control & Nutrient Depletion

Written by Sarah Thompson CFMP, L.Ac., Doula

Throughout history women (and men) have tried to control and prevent unwanted pregnancies. The use of condoms dates back nearly 5,000 years! (1) Birth control as we know it in the form of hormonal pills was born (pun intended) in the 1950’s from the brilliant work of Margaret Sanger, the mother (yet another pun) of birth control. This miracle of medicine gave women the right to take control of their body’s reproductive capacity. It gave women empowerment. It gave us freedom.

The number of birth control options is as vast as the reason’s women choose to use them. They can be broadly categorized into non-hormonal barrier methods, hormonal birth control, and surgical sterilization. Non-hormonal barrier methods include condoms, spermicides, diaphragms, and the timing methods. The main goal of barrier method birth control is to prevent fertilization by preventing the egg and sperm from coming into contact, or by killing off the sperm to prevent contact. Other non-hormonal methods of birth control include surgical sterilization.

Today, there are many options in the category of hormone birth control. In the United States alone, millions of women use hormonal birth control each month for a variety of personal reasons that don’t always include preventing pregnancy. Combination forms are the most commonly prescribed and contain both progestin and estrogen components. There is also the “mini-pill,” which is a progestin only pill, and two types of IUD that are also commonly used; The progestin hormone IUD, and the Copper IUD. In addition to these more common forms there are the injectable progestin, the vaginal ring, the patch and the implant. All of which (other than the copper IUD) contain some form of synthetic hormone. 

Ethinyl Estradiol is a semisynthetic estrogen (2). It is highly estrogenic, and attaches to estrogen receptors to mediate estrogen dependent cellular responses.
​
Progestin is a synthetic hormone with actions similar to progesterone. There are multiple forms that can be found in different combination and single progestin applications. They synthetic hormones inhibit ovulation by inhibiting both luteinizing hormone (LH) and follicle stimulating hormone (FSH). They also stimulate changes in the thickness of cervical mucus and then endometrial lining. (2)

• Etonogestrel
• Desogestrel
• Levonorgestrel
• Medroxyprogesterone acetate
• Norelgestromin
• Norethindrone
• Norgestrel
• Norgestimate

 
Copper is the only non-hormonal birth control option (other than natural timing). 

Common Birth Control Side Effects

The list of side effects associated with all forms of hormonal and copper birth control methods can be several pages long (5).

The most common side effects that I see associated with the use of all forms of birth control include:

• Appetite Changes (decrease and increase)

• Depression
• Dizziness/Lightheadedness
• Headaches
• Insomnia
• Leg Cramps/Muscle Spasms
• Menstrual Flow Changes (spotting, too heavy or too light)
• Mood Swings
• Nausea & Vomiting

Although most women who use birth control will experience few if any side effects from the medication, certain lifestyle choices, health conditions, or dietary choices can increase the possibility of these side effects.
​
Taking combination birth control increases your risk of heart attack, stroke and blood clots 1.9x (this is rare, but can happen). The risk is even higher if you have preexisting hypertension, diabetes, elevated cholesterol, a history of migraines, are a smoker, or are over the age of 35 (6). 

What is Drug - Nutrient Depletion?

Drug-Nutrient depletion knowledge isn't new. Research has shown connections between OC (Oral Contraceptive) use and nutrient depletion since the 1970's.(7)(8) Most women will never know this though, as it is not discussed in doctor's offices when the medication is prescribed.

​When we are discussing drug-nutrient depletion we are talking about the negative effects certain medication have on nutrient levels or function in the body. When you are taking a medication, this drug uses different biochemical processes in order cause a reaction. Sometimes these processes are hyper functioning and in turn use up more nutrition that without the medication. In some cases, medications interfere with your body's ability to properly absorb nutrients from your food. In other cases, increased urination and detoxification of medications can cause nutrient loss. 

Symptoms of nutrient depletion are often subtle. (9)

• Fatigue, Migraine, Loss of Appetite, Mood Changes, Brain Fog = Low Thiamine (B1)
• Angular Cheilitis, Tongue sores, Dry Skin, Tinnitis = Low Riboflavin (B2) 
• Mouth Sores, Vomiting & Diarrhea, Fatigue, Depression, Brain Fog = Low Niacin (B3)
• Weakness, Headaches, Numbness & Tingling in the Hands & Feet, Depression = Low Pyridoxine (B6)
• Anemia & Lightheadedness, Headaches, Numbness & Tingling in the Hands & Feet, Brain Fog = Low Cobalamin (B12)
• Muscle Cramps, Irregular Heartbeat, Mood Changes, Loss of Appetite, Headaches = Low Magnesium
• Infertility, Glucose Dysregulation, Unexplained Weight Gain, Joint Pain = Low Manganese
• Loss of Appetite, Taste & Smell, Hair Loss, Diarrhea, Infertility = Low Zinc
• Anemia, Fatigue, Depression, Dry Skin & Hair, Easy Bruising & Bleeding = Low Vitamin C

Those look very similar to the symptoms associated with birth control use, don't they. So, let's dig a little bit more. HOW does hormonal birth control cause these nutritional deficiencies?

Birth Control and B Vitamins

The B vitamins are group of water soluble vitamins. Each of the B vitamins has a unique set of functions in the body. Some of these functions require a complex of B vitamins, and some of these function require only one of the B Vitamins. Because of these they are often grouped together into a complex to better they utilization in supplemental form. 

B1,(8) B2,(9) and B3(11) are used in cellular energy metabolism, and the least researched vitamins in conjunction with OC-nutrient depletion. Research shows that OC use causes depletion of these B vitamins, but the mechanism behind how is still not fully understood. 

The stars of the OC-Nutrient depletion show are B6, Folate, and B12.

B6, in the form of pyridoxal 5' phosphate (PLP or P5P), is a coenzyme for over 100 different enzymes in the body. These enzymes are responsible for the formation and function of neurotransmitters (such as serotonin and dopamine), regulation of homocysteine, cellular metabolism, and blood cell formation.

B9 (folate) is also a conezyme. It helps to form DNA & RNA (why it is essential for pregnancy) and is involved in protein metabolism. It also plays an important role in the regulation of homocysteine and the formation of red blood cells.

B12 is essential for brain and neurological function. It is also a part of homocysteine regulation and the formation of red blood cells.

When you are taking OC, you are changing your metabolism (14). In pregnancy, your metabolism of nutrients (macro and micro) changes. You are unable to absorb certain dietary forms, as well as the functional form of the vitamins changes to facilitate pregnancy. Cool fact: The form of B6 in your blood changes form...to the form found primarily in pregnancy! (12)

Birth Control and Vitamin C

Research shows a decrease in serum Vitamin C in women using OC. All forms of hormonal and copper birth control cause an increase in copper levels. These raises in serum copper which causes a depletion in Vitamin C by increasing oxidation (12). Oxidation is the increase is oxygen reactive species in the body. It is the job of antioxidants, such as Vitamin C, to neutralize these chemicals to prevent cellular damage. If damage does occur, it can affect cellular energy metabolism (remember the role of B Vitamins in cellular metabolism). 

Birth Control and Zinc

This one, to me, is very important. In my practice I see women for a variety of conditions...one of these is fertility. Zinc is essential for proper egg health, and if there is a zinc deficiency it can cause infertility. I am blown away by the number of women that come into my office, in their 20's, with fertility issues. The majority of these young woman have been on birth control since their teens. When I ask if they were taking a multivitamin, or supplements to address possible drug-nutrient depletion, they give me a big, blank stare. This was never discussed by their primary doctor. We all know what good eaters teen girls and young women are right...always eating a balanced diet with lots of fruits and vegetables and quality meat....no? Excatly! In these young women, the rate of nutritional deficiency associated with OC use is greater due to their poor diets. Which is why we see the reproductive system not quite coming back on when they stop their OC method. 

I've already mentioned the elevation in Copper that occurs with OC use. This plays a role in Zinc Depletion (13). Unlike most other OC-nutrient depletion that take long term use to occur, zinc deficiency occurs in the first cycle of use. As I mentioned before, the metabolism of the body changes to that of a pregnant women when on OC. Because of this, Zinc is also redistributed to the red blood cells. If, though, there is anemia (which is an OC side effect, and more common in young women), there can be a functional deficiency in zinc levels that could cause long term side effects associated with fertility. 

Birth Control and Minerals

Magnesium is one of the most common nutritional deficiencies in America. 90% or more of American women of reproductive age do not consume enough Magnesium in their diets. Magnesium is a catalyst for 100's of chemical reactions in the body. Magnesium is also the regulator of other electrolytes in the body. Without enough Magnesium, the muscles and blood vessel can contract, but they cannot relax. 

Manganese is a rarely talked about mineral. It is a strong antioxidant that plays a role in reducing joint inflammation. The changes in metabolism that occur with OC causes a decrease in manganese as it is needed for glucose regulation. OC causes glucose dysregulation and increase production of insulin, draining manganese. Manganese is also needed for the absorption of other vitamins, which are also commonly depleted with OC use (Vitamin C, Vitamin E, Thiamine, and Choline). Manganese also affects Luteinizing Hormone. LH stimulates ovulation, and a deficiency can be associated with anovulation. Another reason that long term OC use could be associated with fertility issues. Last but not least, Manganese activates superoxide dismutase, a powerful antioxidant enzyme that helps "clean" out cellular oxidation. Depletion of Manganese can cause a depletion in B vitamins, and Vitamin C due to increased oxidative stress.

Prevention & Treatment

Recommendations for supplementation when taking oral contraceptives has been neglected. I believe in prevention. When a patient comes to see me, I will ask what medications and supplements they are taking. If they are not taking a supplement to support the nutrient depletion associated with that medication, I recommend one. Why? Prevention is always easier than treatment.  Maintaining a healthy diet is also key. 

Want to know more? Want help with your diet? Set up an appointment and I would be more than happy to assess your specific situation.

Each different form of birth control has its own nutrient depletion associated with is. Click the link below to be directed to your specific form of birth control and its associated drug-nutrient depletion. Don't see your's listed, call me.

Apri
Desogen
​Heather
Kariva

Low Ogestrel
Lybrel
​Mircette
​Ortho Cept

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RESOURCES

1. Dhont M. History of oral contraception. Eur J Contracept Reprod Health Care. 2010 Dec;15 Suppl 2:S12-8. doi: 10.3109/13625187.2010.513071.
2. National Center for Biotechnology Information. PubChem Compound Database; CID=5991, https://pubchem.ncbi.nlm.nih.gov/compound/5991 (accessed Mar. 8, 2019).
3. ASHA (2013). Birth Control Method Comparison Chart. Accessed 3/12/2019 http://www.ashasexualhealth.org/pdfs/ContraceptiveOptions.pdf
4. Cleveland Clinic. Mini Pill. Accessed 3/12/2019 https://my.clevelandclinic.org/health/drugs/17707-minipill
5. U.S. National Library of Medicine. Ethinyl Estradiol and Etonogestrel Vaginal Ring. Accessed 3/12/2019
6. Loyola University Health System. (2015, September 18). Birth control pills pose small but significant stroke risk. ScienceDaily. Retrieved March 12, 2019 from www.sciencedaily.com/releases/2015/09/150918132654.htm
7. Massey LK., Davison MA., Effects of Oral Contraceptives on Nutritional Status. Am Fam Physician. 1979 Jan;19: 119-23  https://www.ncbi.nlm.nih.gov/pubmed/760421 
8. Briggs M., Thiamine Status and Oral Contraceptives.  Contraception. 1975 Feb; 11(2):151- 154.  ​https://www.popline.org/node/504265
9. Newman Lj. et al., Riboflavin deficiency in women taking oral contraceptive agents. Am J Clin Nutr. 1978 Feb;31(2):247-9. https://www.ncbi.nlm.nih.gov/pubmed/623047
10. Harvard Health Publishing. (2016, August). Are your Medications Causing Nutrient Deficiency? Accessed 6/10/2019 https://www.health.harvard.edu/staying-healthy/are-your-medications-causing-nutrient-deficiency
11. ​Thorp VJ., Effect of oral contraceptive agents on vitamin and mineral requirements. J Am Diet Assoc. 1980 Jun;76(6):581-4. https://www.ncbi.nlm.nih.gov/pubmed/7400487
12. Anderson JE., Nutrition and Oral Contraceptives. Colorado State University Fact Sheet #9.323. Accessed 6/10/2019.  https://tra.extension.colostate.edu/wp-content/uploads/sites/9/2016/02/09323.pdf
13. Schenker JG., Et. Al. Serum Copper and Zinc Levels in Patients Taking Oral Contraceptives. Fertility & Sterility. Vol. 22. No.4. April 1971. https://www.fertstert.org/article/S0015-0282(16)38162-6/pdf
14. Sondheimer S., Metabolic Effects of the Birth Control Pill. Clin Obstet Gynecol. 1981 Sep;24(3):927-41. ​https://www.ncbi.nlm.nih.gov/pubmed/7026112