YOUR BODY ON BIRTH CONTROL: Nutrient Depletions

Statistics reveal that a whopping 11 million women around the globe have used oral contraceptives at some point in their life. Although its intended use is pregnancy prevention, many physicians prescribe birth control for a number of other reasons, including acne, endometriosis, and others. While it's true, oral contraceptives have shown great promise with few drastic side effects in the current research as we know it, when you analyze these studies deeper, you will find that most are limited to its impact within a span a year. What's the problem here? Very few women are prescribed birth control for a year or less - in fact, many women, myself included, are on it, or have once used it for 5, 10, or even 15 years. Don't get me wrong, in saying this, I by no means think birth control should no longer exist or not be widely available. Instead, I stand behind the belief that we women should be given informed consent prior to making the decision to be prescribed oral contraceptives or not, especially if we have the long-term in mind. Unfortunately, while we may be given this right for other pharmaceutical medications (very rare) or surgical procedures, that is not the case for birth control as most clinicians fail to inform their patients of the potentially harmful effects of its usage. Ultimately, this echoes the statement made by Dr. Elizabeth Kissling in Scientific American, which states that the prolonged use of hormonal birth control is one of the longest and largest uncontrolled trials we have ever had.

That in mind, I'd like to take a moment to give you the education the majority of us have not yet been given. To start, let's dive into the nutrient depletions that result from birth control use, and how they impact our general state of health...

Magnesium

The use of oral contraceptives lowers blood magnesium levels and can cause hypomagnesemia, or magnesium deficiency, especially in people with low dietary magnesium intake. How? The estrogens present in birth control, even those classified as "low-dose estrogens" causes the body to store more magnesium in the soft tissues and bones, thus lowering the amount of this crucial mineral in the blood. Seeing as though magnesium is involved in over 300 biochemical reactions - including those that regulate mood, muscle function, sleep, and brain health - this enhanced storage poses an issue, as there is less available magnesium to travel around to these different organs. That, paired with the knowledge that most Americans do not consume enough magnesium through diet alone, greatly increases a woman's chance of experiencing symptoms of magnesium depletion with prolonged use of oral contraceptives.

Even more alarming, when magnesium depletion occurs as a result of prolonged oral contraceptive use, it skews the calcium:magnesium ratio that governs blood coagulation. Calcium's role is to induce the clotting reaction, whereas magnesium is in charge of keeping the blood flowing freely, preventing unnecessary thickening of the blood. In this way, maintaining a proper ratio of calcium to magnesium ensures that our blood continues to circulate, only clotting when absolutely necessary - like in response to physical trauma for example. That in mind, when magnesium is depleted, our blood can become thick and clot more readily - and it just so happens that blood clots and strokes are two major, well-known risk factors of long-term birth control use.

Magnesium is involved in: Sleep, muscle contraction, cognition, bowel health, and more.

B Vitamins

Folate (Folic acid)

Folate, often referred to as folic acid or vitamin B9, is a major coenzyme, meaning it helps to catalyze or kickstart various biochemical reactions in the human body. Of these processes, it's highly involved in the formation of DNA and RNA, which is why this micronutrient is of laser focus when it comes to pregnancy, as well as protein metabolism, and the formation of red blood cells. Unfortunately, long-term hormonal birth control use is known to reduce the body's absorption of folate, while at the same time, increasing it's excretion. To exacerbate this depletion even further, birth control also increases protein binding of folate in the blood, effectively rendering it useless as it is not able to function as a coenzyme in this form.

In this way, research has shown that folate levels fall progressively throughout the duration of oral contraceptive use, increasing the severity of depletion as time goes on. While some may think that the remedy may be as simple as quitting birth control, studies have shown that folate levels do not return to normal until about three months after usage has stopped - a time during which many women become pregnant (Mountifield, 1985). As mentioned above, adequate folate levels are vital during pregnancy, as depletions and deficiencies can result in birth defects like spina bifida and anencephaly. The risks of birth control induced folate depletion don't just effect those women who get pregnant during this time, it predisposes all birth control users to anemia, cervical dysplasia, dry skin, dry hair, and other manifestations B9 deficiency.

Folate is involved in: DNA and RNA synthesis and repair, fetal development, red blood cell formation, and more.

Vitamin B12

While less is known regarding the impact of birth control-induced vitamin B12 depletion on health as a whole, studies have found that blood levels of this essential vitamin are, on average, 40% lower than compared to individuals who are not taking oral contraceptives (Mountifield, 1985). Even further, researchers have found that a sharp decrease in blood vitamin B12 levels occur during the first 6 months of birth control use, illustrating that it has immediate impacts on our bodies outside of the reproductive system.

Vitamin B12 is involved in: DNA synthesis, neurological function, red blood cell formation, energy production, and more.

Vitamin C

All forms of hormonal birth control increase copper levels in the blood. In doing so, oxidative stress increases, resulting in an imbalance between the production of free radicals and the body's ability to detoxify their harmful effects. What is responsible for neutralizing the harmful effects of oxidative stress? Antioxidants like vitamin C. By increasing the body's oxidative stress load, it uses up vitamin C more readily in order to prevent the deleterious effects that result from free radical formation. Basically, you use up vitamin C more quickly on birth control, thus depleting its levels to a greater degree. In the end, more vitamin C is being used to mitigate the harmful side effects of birth control use than what is made available for other, equally as vital bodily processes like immunity.

Vitamin C is involved in: immune health, hormone production, support and structure of the nerve cells, collagen synthesis, and more.

Zinc

Zinc, another imporant antioxidant, is also notoriously depleted thanks to long-term birth control use. It is said that the synthetic estrogens present in oral contraceptives increase the uptake of zinc into tissues, while at the same time reducing tissue zinc release (Kamp et al., 2011). Like magnesium, this means that there is less zinc available in the blood to be used in other processes for which it plays a vital role - like skin and immune health, for example. Even more interesting, this depletion of zinc caused by birth control has been linked to an increased incidence of dental cavities (Mountifield, 1985).

Zinc is involved in: wound healing, the digestion of carbohydrates, the senses of taste and smell, insulin sensitivity, and more.

Now, just a disclaimer - the above nutrient depletions are merely those that are most widely studied. More recent research has begun to reveal that long-term oral contraceptive use also impacts levels of selenium and riboflavin (vitamin B2), two other essential nutrients. If this resonated with you, stay tuned, because my birth control series will also unveil the ways in which birth control impacts our stress response and mood states (hint: we're not crazy!) as well as its influence on the mates we choose...yes, you read that right - birth control impacts who we are attracted to.

Resources:

Kamp, F., Rodrigues, T. S. L., & Donangelo, C. M. (2011). Effect of oral contraceptive use and zinc supplementation on zinc, iron and copper biochemical indices in young women. E-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 6(6), e253–e258. https://doi.org/10.1016/j.eclnm.2011.09.004

Mountifield, J. A. (1985). Effects of Oral Contraceptive Usage on B12 and Folate Levels. Canadian Family Physician, 31, 1523–1526.