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Wednesday, November 21, 2012

The Pill as an OTC product? The risk outweighs the benefits

Doctors in the States want to have "the Pill" available as an over the counter drug (OTC) to reduce unwanted pregnancies. Sounds to me like big pharma is thumping it's chest again.

Two fold problem as far as I can see. What it doesn't take into account are the reasons people aren't taking the Pill to begin with: money - it will still have a cost, religious reasons, health reasons - not everyone is keen on taking a pill.

If a patient wishes to be on the Pill, under a Dr's care many aspect of the patients life is taken into account before a prescription is filled out- or it should be. 

With it readily available OTC there isn't any consideration for the patients current health state or lifestyle (which needs to be taken into account) prior to considering taking the Pill. If a patient is a: heavy smoker, drinker or participates in recreational drugs, bad eating habits or is extremely inactive - are all reasons a Dr. should prevent a prescription. 

Not to mention there isn't any counseling on how to take it if it is an OTC product. When, how or best way to take it, side effects to watch out for, patients are left on their own. If we're speaking to people with little education or without English as a first language, these questions would not be addressed with a pamphlet within the OTC product. And no recourse for the patient if the side effects are harmful or fatal.

According to Elson Haas, MD, birth control pills (BCPs) are both the most effective and the most hazardous form of contraception. Though taking oral contraceptives regularly is 99 percent effective in birth control, there are many possible side effects. Weight gain, emotional swings, circulatory and vascular symptoms, and gastrointestinal upset are not uncommon. Blood clots, liver problems, and cancer are also possible, though relatively rare; these were more common in the 1960s with the higher-dose pills. Many women have difficulty with oral contraceptives, though many others seem to tolerate them well. The use of birth control pills is more common in young women and teenagers, which adds another dimension of uncertainty regarding the nutritional effects of these drugs.

There are also nutrient depletions that take place when a woman is taking the Pill

Aside from the long list of potential side effects birth control pills can deplete important nutrients. These nutrients include: Vitamin B2, Vitamin B6, Vitamin B12, Folic Acid, Vitamin C, Magnesium and Zinc.

Oral contraceptives may create certain nutrient deficiencies and excesses as well as increase the nutritional needs of the user. Most of the B vitamins, particularly pyridoxine (B6) and folic acid, are needed in higher amounts when birth control pills are taken. The copper level usually rises, and zinc levels often fall. Thus, more zinc is needed as well. An increased need for vitamins C, E, and K may also result from the use of birth control pills.

In Nutrition and Vitamin Therapy, Michael Lesser, M.D., points out that birth control pills cause an alkaline imbalance in the vagina that may lead to increased susceptibility to infection. Extra ascorbic acid, 1-2 grams per day, may help balance the acid environment and prevent this problem. He and other authors also suggest that the increased blood levels of copper generated by oral contraceptive use may contribute to depression and emotional symptoms; additional manganese and zinc may reverse these symptoms. Sharon DeBuren, nurse practitioner and nutritionist, adds that the depression from BCPs is also a neurochemical reaction to artificial steroids (female hormones), and from a lack of a women's own superior hormones, estradiol and natural progesterone secreted with ovulation. Iron levels may also rise, and less iron may be required because the pills often reduce the amount of menstrual blood loss, as well.

Because BCPs are metabolized by the liver before being eliminated, a diet low in other liver irritants is suggested. Alcohol, cocaine, and other drugs, pesticides and preservative chemicals in food, as well as fried foods should be avoided. Cutting down on refined foods and sugary treats is also suggested; these foods are "empty" calories and may cause further nutrient depletion. Avoiding nicotine and fried foods is also a good idea to prevent further vascular irritation. Teenage girls on "the pill" must also be particularly careful to avoid nutritional deficiencies, and all would be well advised to take a supportive nutritional supplement. Adequate intake of the antioxidant nutrients, such as vitamins C and E, selenium, and beta-carotene, can help reduce potential toxicity of oral contraceptives. The herb, milk thistle, contains silymarin and may be especially helpful.

A high-nutrient diet is the best prevention for problems. Low-fat protein levels and nutritious foods such as whole grains, vegetables, nuts, and seeds are also important. Eating lots of vegetables is the best way to prevent many mineral deficits and also maintain weight. And several teaspoons of cold-pressed vegetable oil, particularly olive oil, should also be used daily to ensure the intake of the essential fatty acids. All of the above-mentioned foods, along with protein intake from such foods as eggs, fish, poultry, dairy foods, and legumes, is a sensible approach. In addition to the usual female adult or teenage levels, if taking oral contraceptives it is recommended that intake of the following nutrients be increased to the levels listed:

Nutrient Daily Amounts (in 1 or 2 doses)
Vitamin B6 50-100 mg.
Vitamin B12 50-200 mcg.
Folic acid 600-800 mcg.
Vitamin E 400-600 IU
Vitamin C 1-3 g.
Zinc 20-40 mg.

Other B vitamins can also be increased to higher levels, such as an additional 25 mg. of each, to balance out the B complex. More antioxidants can also help reduce the deleterious effects of the drugs. These include beta-carotene, selenium, and possibly amino acid L-cysteine to complement the additional vitamins C and E.

Copper intake in supplements should be limited to 1 mg., though the increased zinc intake will help lower copper levels. Whole grains, nuts, seeds, and vegetables will ensure that copper requirements are met. Iron supplements may be decreased somewhat with use of birth control pills unless the menstrual periods are heavy or there is anemia. Iron needs are probably reduced from the usual 18 mg. to around 12-15 mg per day. All of these values can be checked occasionally by blood biochemistry profiles or evaluation of mineral levels to ensure proper individualized care.

Nutrient Program for Oral Contraceptives:

Water 1½-3 qt. 

Plus a high quality vitamin-mineral product with at least these nutrients: Vitamin A 5,000-10,000 IUs, Calcium* 600-1,000 mg., Beta-carotene 10,000-20,000 IUs, Chromium 200-400 mcg., Vitamin D 200-400 IUs, Copper 1-2 mg., Vitamin E 400-600 IUs, Iron 15-20 mg., Thiamine (B1) 25-50 mg., Magnesium* 400-600 mg., Riboflavin (B2) 25-50 mg.,
Manganese 5-10 mg., Niacin or niacinamide (B3) 25-50 mg., Molybdenum 150-300 mcg., Pantothenic acid (B5) 50-250 mg., Phosphorus 600-800 mg., Pyridoxine(B6) 25-200 mg.,
Potassium 1-2 g., Cobalamin (B12) 50-200 mcg. (at CHI we suggest 2800mcg daily), Selenium 150-300 mcg., Folic acid 600-800 mcg., Zinc 30-60 mg., Biotin 200-400 mcg., PABA 25-50 mg.,
Fatty acids, olive, or Flaxseed oils 1-2 teaspoons
Vitamin C 1-3 g. with Bioflavonoids 250-500 mg.