NSAIDs (Anti-Inflammatories)
Common brand names: Ibuprofen, Naproxen, Celecoxib
Three nutrients listed against this medication. The most severe is marked moderate.
At a glance
One of the three is marked well documented. The other two carry their own evidence levels.
At a glance
- Folic Acid / FolateModerate · Traditionally cited, limited evidence
- Vitamin CModerate · Moderate evidence
- IronModerate · Well documented
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, High-dose aspirin and some NSAIDs compete with folate for binding sites on folate-binding proteins, reducing effective folate availability.
Common signs, Elevated homocysteine An amino acid in the blood that rises when vitamin B12, folate or B6 are low., megaloblastic changes with chronic high-dose use
Alter et al. (1971; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 5571429): aspirin folate competition documented
L-methylfolate 400–800 mcg daily is a range in common use with chronic NSAID therapy, not from a trial cited on this row. The cited paper concerns rheumatoid arthritis, folic acid and aspirin.
Mechanism, Aspirin increases urinary excretion of Vitamin C and reduces platelet Vitamin C concentration.
Common signs, Immune impairment, oxidative stress, bruising
Basu (Int J Vitam Nutr Res Suppl, 1982; PMID 6811490): in human subjects, co-administered aspirin blocked the normal rise in plasma and leukocyte vitamin C, suggesting impaired absorption.
Vitamin C 500–1,000 mg daily is a range in common use, not from a trial cited on this row. The cited paper studied vitamin C and aspirin and compared no forms; buffered sodium ascorbate is chosen in practice for stomach tolerance rather than on evidence cited here.
Mechanism, NSAIDs cause subclinical gastric bleeding that can deplete iron stores over time.
Common signs, Iron deficiency anemia, fatigue, cold intolerance
McQuilten et al. (Ann Intern Med, 2023; PMID 37335992): in the ASPREE RCT Randomized controlled trial: people are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect., low-dose aspirin increased incident anemia and ferritin decline in healthy older adults, independent of major bleeding.
Ferritin is commonly monitored with chronic NSAID use, alongside gut-protective strategies such as zinc carnosine and glutamine.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →