Does the Birth Control Pill Cause Nutrient Deficiencies? Exploring Internet Battles, Research, and What Really Matters

I follow some popular myth busting (of misinformation—false information that is spread, regardless of intent to mislead, and disinformation—knowingly spreading misinformation) accounts on Instagram that I really enjoy. They are led by health professionals, mostly physicians, who call out people in the “wellness” space who make health claims that are unbacked by any evidence, usually in order to sell a cleanse, supplement, course or other product. Misinformation about health has blossomed on social media as the pandemic has left us feeling threatened and out of control, which are the perfect ingredients for increased medical mistrust, which feeds the cycle of misinformation.

Medical mistrust is a general distrust of the health care system including medical treatments and providers. In some cases, it is prompted by misinformation and conspiracy theories—something we’ve all witnessed exploding in popularity the last few years. In other cases, it is a rational response to both current and historic circumstances that inspire mistrust, like systemic racism and social and economic injustice experienced by marginalized groups. Mistrust of the medical system is a coping mechanism that fulfills the desire to understand, control, and maintain a positive view of self in the face of threats and uncertainty. In the case of Black Americans, who have experienced repeated discrimination and harm from healthcare, medical mistrust is often a protective coping strategy (1).

Women’s health has also experienced a patriarchal, discriminatory, and oppressive history that, for many people, specifically and especially Black birthing mothers, persists today. The result, again, is medical mistrust and a major problem with medical mistrust is that it contributes to increased health disparities as people delay seeking preventative healthcare and medical treatment for serious conditions like HIV, cancer, and diabetes (2).

Papers on medical mistrust recommend addressing this issue at multiple levels of society, as well as implementing anti-racist policies and bringing the power back into communities. A powerful quote from the authors of one paper stated, “We need to cultivate environments and relationships that do not require people to use medical mistrust as a coping mechanism against stigma and discrimination,” (3).

I believe both the myth busters and people in the alternative medicine space are attempting to cultivate trusting environments and relationships through the sharing of information online. This desire to share likely comes from two places. The first is caring and a sense of that they are providing people with accurate and safe information. The second, of course, is that this is business and there are products to be sold.

I see a very real battle playing out among these myth busting MDs and the wellness influencer/alternative medicine practitioners. On one side of that battle, people are screaming RESEARCH! SCIENCE! BEWARE OF CONSPIRACY THEORISTS! And on the other, MEDICINE IS BROKEN! BIG PHARMA! YOU’RE BEING LIED TO! Man, it’s a hard space for those of us who are contemplative, a little nerdy, and who rarely speak in all caps.

Calling out toxic wellness culture, which perpetuates the idea that our bodies need help detoxing and cleansing with special diets and protocols, is honorable because this culture preys on insecurity. However, as a person who practices Western medicine as an RN and soon to be nurse practitioner, who also believes in and enjoys alternative and complementary medicine, I am sometimes troubled by the “us vs. them” dichotomy and how each side is convinced of their rightness.

More often than not, I am nodding my head along with the people doing the call outs, but every now and then, I come across a call out that makes me pause and think, wait, there is more to this story. Here is one of those examples and it is about the infamous birth control pill.

Recently, one of these accounts I admire posted that the birth control pill absolutely does not cause nutritional deficiencies. Now, before I talk about this and the journey it led me on, I want to make it very clear that I believe contraception is a personal, individualized choice and options are crucial and empowering. I am not anti-hormonal contraception and I often see misinformation about the effects of hormonal contraceptives that leave out how beneficial this medication is for some people. Alas, social media has little room for nuance, and medication is all about nuance and weighing the risk versus benefit of that medication for the unique individual in their unique context.

OK. Back to this bit about the relationship between the birth control pill and nutrient deficiencies. I wrote about this relationship in the first chapter of How to Grow a Baby. And I wrote about it because when I conducted searches about this relationship in the current literature (i.e. peer reviewed studies published in trusted medical journals), I found a number of studies exploring oral contraceptives and how they may impact serum nutrient levels.

For example, a 2016 paper in PLoS One (4), cited other review studies that “have shown that blood folate, vitamin B2, vitamin B6, vitamin B12, vitamin C, vitamin E, zinc, selenium, and magnesium was lower in OC (oral contraceptive) users in comparison with non-users.” A 2014 systematic review (5) found decreased serum concentrations of zinc, selenium, phosphorus and magnesium in OC users. A 2020 study (6) found that serum zinc levels were lower in OC users. There are more studies with similar results and a few studies that find increased levels of certain nutrients (vitamin A and copper for example) in OC users.

So, there’s some compelling evidence that the use of OCs impact nutrient levels, but the takeaway from this evidence is not that OCs are evil and no one should take them. I’ll get to the takeaway soon, but after spending time re-reading these studies, a few things are clear:

1.    Several high quality studies have found lower serum concentrations of some nutrients among OC users. However, the evidence is inconclusive. The relationship between the use of OCs and nutrient deficiencies is complex and the way nutrient status is measured isn’t always accurate.

2.    OCs interact with individuals in unique ways. What is true for one person is not true for another. The individual person matters and so does their unique context.

3.    These studies are conducted not to warn people against using OCs, but to better inform safe use. Meaning, if OCs do cause nutritional deficiencies, users of this medication can focus on incorporating plenty of foods rich in these nutrients in their diets or supplementing with certain vitamins and minerals.

4.     The nutrient deficiencies found in some of the studies are likely a result of a combination of factors. For example, one paper found that OC users had a higher rate of alcohol and tobacco use, exercised less regularly, and these socioeconomic and lifestyle factors affect access to healthy food and nutrient metabolism.

The takeaway? Turns out it’s important for ALL PEOPLE to consume diverse, nutrient-dense foods. It’s important for all people to avoid smoking and excessive alcohol use. It’s important for all people to move their bodies frequently and in diverse ways.

We need more research on this topic. We will always need more research on everything related to health. On top of more research, we need individually tailored approaches to health and nutrition because everyone is different. We like drawing lines between right and wrong and correct and incorrect and we want this clarity because it helps us navigate not only overwhelming information, but also all the choices we must make about how we live, eat, and care for ourselves and others.

It would be much easier if the research found that OCs were just bad for us, or just great for us, but the reality is that the answer is much more complicated because it depends. It depends on the person, how the research is conducted, and what is being measured and how.

Context matters. This context is hard to find on social media because it takes much more space and attention than social media is designed for. The best myth busters and people sharing quality information in both conventional and alternative medicine take the time to write up full articles and examine the research with all of its findings and nuances. And we all read the same few words at the end of these papers, “we need more research.”

In the face of this complexity inherent to humanity, I come back the to the basics and essentials. Healthy food, movement, supportive communities, and caring for our shared ecosystem. These foundations, I think we can all agree, are important for everyone.

Below is a beautiful illustration with accompanying text from chapter 1 of How to Grow a Baby starring nutrient-dense food that is especially great to focus on when trying to conceive and during pregnancy, because, whether you’ve recently taken the birth control pill (or other hormonal contraceptives) or not, how you feed yourself is incredibly important for your health and the health of lil’ fetus.

illustrated by Michelle Lassaline for How to Grow a Baby

Yep, there’s more!

Wondering what the underlying themes are of How to Grow a Baby? You guessed it! Diverse, nutrient-dense food, movement, supportive communities and caring for our shared ecosystem.

These foundations guide the information and how it’s shared so that the book is accessible and applicable for all people.