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Anticonvulsant Medications
Barbiturates

Depletions
Calcium

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 depression.

Vitamin B12 (Cobalamin)

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 B9 (Folic Acid)

Low levels of folic acid have been linked to anemia, heart disease, and birth defects.

Vitamin D

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 symptoms.

Editorial Note

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Berger W. Incidence of severe side effects during therapy with sulfonylureas and biguanides. Horm Metab Res Suppl. 1985;15:111-115.

Carpentier JL, Bury J, Luyckx A, Lefebvre P. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabetes Metab. 1976;2(4):187-190.

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.

Holick MF, Krane SM, Potts JT. Calcium, phosphorus, and bone metabolism: calcium-regulating hormones. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill Companies Health Professional Division; 1998:2221-2222.

National Research Council. Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press; 1989.

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 Companies Health Professional Division; 1998:2241.

Rao DS. Perspective on assessment of vitamin D nutrition. J Clin Densitom. 1999:2(4):457-464.

Reynolds, EH. et al. Anti-convulsant therapy, megaloblastic hematopoiesis, and folic acid metabolism. Q JMed.1966;35:521-537.

Roe, DA. Drug-Induced Nutritional Deficiencies. Second Edition. Westport, CT, Avi Publishing, p. 37, 57, 1985.

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, HI.