5 Nutrients You Need on Birth Control
Combined oral contraceptives create major changes in your body, and that is exactly what they are designed to do. With these changes, some nutrients can become depleted due to increased use or dysfunctional absorption. Read on to learn specific nutrients (that you can’t live without!) you may need to supplement when on birth control.
In case you don’t know, folate is foundational for healthy hormones (and just about everything else in your body!). Folate (also called B9) is named after foliage because it was first isolated from spinach! Folate is required for DNA synthesis, a methylation process that reduces homocysteine, and for the creation of SAMe. It also supports iron absorption and use.
Folate depletion is well-documented in women using oral contraceptives. Studies with older types of birth control showed that serum levels of folate continued to decrease with longer use, and levels returned to normal within three months of quitting. If your contraception fails or you stop using it, you are more likely than not to be depleted in folate at a critical time in embryonic development. This is why researchers recommend that women take folate (regardless of their family plans) when on birth control.
Spinach, lentils, chickpeas, and asparagus are high in folate. You can also take folate as a separate supplement, in a B complex, or in a multivitamin. Look for methylfolate on the ingredient list, not folic acid. On a side note, you may have heard of the MTHFR mutation, which increases the potential for folate insufficiency. Read more about MTHFR from my colleague Sunny Brigham’s blog.
Vitamin B6 affects energy production helps regulate homocysteine, is required for serotonin production, and increases the function of reproductive hormones by preventing them from binding and becoming inactive. Guess what tends to be the first to go when on birth control (or right after discontinuing it)? Your mood and your period schedule. B6 also contributes to iron production and oxygen transportation, which means deficiency can cause anemia and general fatigue. B6 deficiency increases risk of complications in pregnancy, as well as arterial and venous thrombosis when on birth control.
B6 can become depleted due to long-term birth control use, so it’s important to make sure you get enough. Food sources high in B6 include meat, fish, legumes (beans and peas), nuts, bananas, and potatoes. It’s also common to see P-5-P (the active form of B6) in a supplement with methylfolate and methylcobalamin (B12). If you’re not taking a multivitamin, ask your healthcare provider about a good supplement with P-5-P. For more information about the functions of B6, read this info page created by my colleague Aimee K. Hockett.
Most people think of B12 as a vitamin for energy. And it’s true, B12 is intricate involved in cellular energy production. Perhaps that is why deficiency is common in people with anemia, depression, Alzheimer’s, and dementia. B12 deficiency also contributes to cardiovascular disease, cancer development, and folate deficiency.
Several studies have showed lower serum B12 in women using oral contraceptives, possibly due to reduced binding capacity. Even though we don’t have all the answers, we can safely say that women should consume extra B12 when taking birth control.
Food sources of B12 are clams, liver, mackerel, beef, and eggs. Some plant foods have B12 look-alikes, but true B12 can only be found in animal foods. Fortified plant foods such as tofu, plant milk, and cereals contain added B12, but vegetarians and vegans should be extra careful and take a supplement. There are several types of B12 supplements, and the latest research shows that a person’s genes play a big part in their ability to process different types of B12. If you are concerned about this, work with your healthcare practitioner to identify which type of B12 is best for you.
One of the most under-appreciated minerals, magnesium’s contribution to your body’s function is simply amazing. It plays a major role in energy production, glutathione synthesis, bone structure, potassium and calcium transport, and cell communication and movement…so basically everything!
Magnesium needs may increase when taking birth control, as serum levels tend to be lower than normal. This also occur when estrogen is used to treat postmenopausal osteoporosis. The depletion of magnesium alters the ratio of calcium and magnesium in the body, which may explain the increased risk of thrombosis (along with B6 deficiency).
This is especially true if you’ve noticed symptoms such as anxiety, depression, poor sleep, muscle tightness or soreness, fatigue, or teeth grinding. Green plants are rich in magnesium, as well as almonds, cashews, peanuts, and black beans. Magnesium powder can be taken at night to support relaxation, or you can take a moderate dose tablet twice per day to improve absorption. Magnesium oxide is not recommended, as it is a poorly-absorbed form. However, there are many well-absorbed forms of magnesium that should be considered. This article gives a short summary of each form of magnesium, and offers high quality brand options in each category.
This micronutrient plays a major role in immune health, neurological function, and reproduction. It regulates gene expression and influences hormone release, and is essential for normal growth during gestation and infancy.
In a study that assessed zinc intake and status in women, users of oral contraceptives had decreased zinc status and decreased bone turnover, even though they ate plenty of zinc. Interestingly, their bodies attempted to combat this situation by increasing zinc retention. However, the potential for lower bone mass was still present. Women under age 25 and those who had not delivered children were affected the most.
Other risk factors of zinc insufficiency include chronic dieting, disordered eating, and digestive disorders like celiac. If you are strict vegetarian or vegan, you may need up to 50% more zinc than omnivores due to impaired absorption. Those who are on birth control and have one of these other risk factors should be especially careful. Symptoms such as acne, slow-healing wounds, hair thinning, and depression are associated with zinc deficiency. Fish, red meat, chicken, and eggs are the riches sources of zinc, while nuts and legumes offer a moderate amount. If you supplement, avoid doses over 50 mg (unless you are prescribed a high dose), as these can lead to zinc toxicity.
Not convinced that you need to add extra nutrient-rich foods to your life? That’s ok, it is totally your choice to make. Perhaps it would be helpful to know that symptoms such as mood change, breast tenderness, and weight gain are less common when women take a multivitamin during the placebo pill days of a combined oral contraceptive cycle. In my opinion, this shows that the missing nutrients make a difference! If all you can do is take a multivitamin, consider high quality options that have the types of vitamins and minerals that are most easily absorbed and used by your body. I like to recommend the following.
Keep in mind that multis have a huge variety of vitamin levels, so it’s a good idea to cross reference other supplements that you take in order to make sure that you don’t have too much of anything. For more info on multivitamins, read my blog about them.
If you learned something new, comment below and tell me! Questions are welcome, just remember that I can only offer general information because I don’t know your entire medical history.
Here’s to healthy hormones,
Shere, M., Balat, P., Nickel, C., Kapur, B., & Koren, G. (2015). Association Between Use of Oral Contraceptives and FolateStatus: A Systematic Review and Meta-Analysis. Journal of Obstetrics and Gynaecology Canada, 37 (5), 430-438..
Mohammad-Alizadeh-Charandabi et al (2015). The effect of multivitamin supplements on continuation rate and side effects of combined oral contraceptives: A randomised controlled trial. European Journal of Contraceptive and Reproductive Health Care, 20 (5), 361-371.
McArthur, J. O., Tang, H., Petocz, P., & Samman, S. (2013). Biological variability and impact of oral contraceptives on vitamins B(6), B(12) and folate status in women of reproductive age. Nutrients, 5 (9), 3634-3645.
Palmery, M., Saraceno, A., Valarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 17 (13), 1804-1813.
Simoes, T. M., Zpata, C. L., & Donangelo, C. M (2015). [Influence of hormonal contraceptives on indices of zinc homeostasis and bone remodeling in young adult women]. Rev Bras Ginecol Obstet, 37 (9), 402-410.