Osteoporosis (bone loss) is the primary disease associated with long-term
calcium deficiency; it may be associated with bone pain and spinal deformity.
Depleted levels can also cause muscle cramps, irregular heartbeat, and
Depleted levels of iron may lead to anemia and weakened immune function. In
the event of anemia, symptoms include dizziness, fatigue, shortness of breath,
pale skin color, and possibly irregular heartbeat.
Symptoms of vitamin B12 deficiency are rare because it takes years
to develop complications associated with long-term depletion of this nutrient.
Irritability, weakness, numbness, anemia, loss of appetite, headache,
personality changes, and confusion are some of the signs and symptoms associated
with vitamin B12 depletion. Low levels of this vitamin may also be
associated with an increased risk of colon cancer, heart disease, brain
disorders, and birth defects.
Vitamin D deficiency leads to abnormal bone formation (rickets) in children
and softening of the bones (osteomalacia) in adults. Vitamin D deficiency
interferes with calcium absorption, leading to deficiency of that nutrient with
all of the associated symptoms (such as increased risk of fractures,
osteoporosis (bone loss), and muscle weakness). Because this nutrient is
fat-soluble, prolonged periods of deficiency are required to produce these
Signs and symptoms of zinc deficiency include loss of appetite or sense of
taste, growth retardation, skin changes, and increased susceptibility to
The selected depletions information presented here identifies some of the
nutrients that may be depleted by certain medications. The signs and symptoms
associated with nutrient deficiency may also indicate conditions other than
nutrient deficiency. If you are experiencing any of the signs or symptoms
mentioned, it does not necessarily mean that you are nutrient deficient.
Nutrient depletion depends upon a number of factors, including your medical
history, diet, and lifestyle as well as the length of time you have been taking
the medication. Please consult your healthcare provider; he or she can best
assess and address your individual healthcare needs, and determine if you are at
risk for nutrient depletions from these medications as well as others not listed
Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY
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Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of
histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp.
Bengoa JM, Bolt MJ, Rosenberg IH. Hepatic vitamin D 25-hydroxylase inhibition
by cimetidine and isoniazid. JLab Clin Med.
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and biguanides. Horm Metab Res Suppl. 1985;15:111-115.
Bo-Linn GW, Davis GR, Buddrus DJ, et al. An evaluation of the importance of
gastric acid secretion in the absorption of dietary calcium. J Clin
Caron P, Gaillard J, Barousse C, et al. [Cimetidine treatment of primary
hyperparathyroidism]. BiomedPharmacother. 1987;41(3):143-146.
Carpentier JL, Bury J, Luyckx A, Lefebvre P. Vitamin B12 and folic acid serum
levels in diabetics under various therapeutic regimens. Diabetes Metab.
Cashman K, Flynn A. Optimal nutrition: calcium, magnesium and phosphorus.
Proc Nutr Soc. 1999;58:477-487.
Covington T, ed. Nonprescription Drug Therapy Guiding Patient
Self-Care. St Louis, MO: Facts and Comparisons; 1999:467-545.
Falchuk KH. Disturbances in Trace Elements. In: Fauci A, Braunwald E,
Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine.
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Festen HP. Intrinsic factor secretion and cobalamin absorption. Physiology
and pathophysiology in the gastrointestinal tract. Scand J Gastroenterol.
Force RW, Nahata MC. Effect of histamine H2-receptor antagonists on vitamin
B12 absorption. Ann Pharmacother. 1992;26(10):1283-1286.
Hambidge M. Human zinc deficiency. J Nutr. 2000;130(5S
Henderson LM, et al. Effect of intragastric pH on the absorption of oral zinc
acetate and zinc oxide in young healthy volunteers. J Parenter Enteral
Holick MF, Krane SM, Potts JT. Calcium, phosphorus, and bone metabolism:
calcium-regulating hormones. In: Fauci AS, Braunwald E, Isselbacher KJ, et al,
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10th ed. Washington, DC: National Academy Press; 1989.
Odes HS, Fraser GM, Krugliak P, et al. Effect of cimetidine on hepatic
vitamin D metabolism in humans. Digestion. 1990;46(2):61-64.
Pinelli P, Trivulzio S, Colombo R, et al. Antiprostatic effect of cimetidine
in rats. Agents Actions. 1987;22(3-4):197-201.
Potts JT. Diseases of the parathyroid gland and other hyper- and hypocalcemic
disorders. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed. New York: McGraw-Hill
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Rao DS. Perspective on assessment of vitamin D nutrition. J Clin
Russell RM, Golner BB, Kransinski SD, et al. Effect of antacid and H2
receptor antagonists on the intestinal absorption of folic acid. J Lab Clin
Skikne BS, Lynch SR, Cook JD. Role of gastric acid in food iron absorption.
Sturniolo GC, Montino MC, Rossetto L, et al. Inhibition of gastric acid
secretion reduces zinc absorption in man. J Am Coll Nutr.
Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and
safety. Am J Clin Nutr. 1999;69:842-856.
Review Date: October 2000
Reviewed By: All depletions monographs have been reviewed by a team of experts including
Derrick M. DeSilva, Jr., MD, Raritan Bay Medical Center, Perth Amboy, NJ;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor, A.D.A.M., Inc., Boston,
MA; John Hinze, PharmD, NMD, Woodbine, IA; Ruth Marlin, MD, Medical Director and
Director of Medical Education, Preventive Medicine Research Institute,
Sausalito, CA; Brian T Sanderoff, PD, BS in Pharmacy, Clinical Assistant
Professor, University of Maryland School of Pharmacy; President, Your
Prescription for Health, Owings Mills, MD; Leonard Wisneski, MD, FACP, George
Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, President and
Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu,
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed