Cholesterol-lowering medications - bile acid sequestrants


  • Cholestyramine -- Questran, Questran Light
  • Colestipol -- Colestid



Your body converts beta-carotene to vitamin A, so the symptoms of beta-carotene deficiency are the same as those of vitamin A deficiency. One of the earliest symptoms is night blindness. Over time, low levels of beta-carotene cause more eye problems. Other signs of a mild-to-moderate deficiency include rough and dry skin, loss of appetite, hair that looks dull, brittle nails, joint pain, and increased susceptibility to infection.


Not getting enough healthy fat can lead to low levels of vitamins A, D, E, and K, which need fat for your body to absorb them. Other symptoms include eczema, dry and brittle nails and hair, fatigue, and difficulty concentrating. In children, not getting enough fat can slow growth and development. Long-term depletion of essential fatty acids is linked to a number of long-lasting (chronic) conditions.


Your body needs iron for red blood cells to carry oxygen to your organs and tissues. Low levels of iron can cause anemia and weakened immune function. Symptoms of anemia include fatigue, dizziness, shortness of breath, pale skin, and sometimes irregular heartbeat.

Vitamin A (Retinol)

One of the earliest symptoms of vitamin A deficiency is night blindness. Over time, low levels of beta-carotene cause more eye problems. Other signs of a mild-to-moderate deficiency include rough and dry skin, loss of appetite, hair that looks dull, brittle nails, joint pain, and increased susceptibility to infection.

Vitamin B9 (Folic Acid)

Low levels of folic acid have been linked to anemia, heart disease, birth defects, and colon cancer. Symptoms may include fatigue, mouth sores, swollen tongue, and poor growth.

Vitamin B12 (Cobalamin)

Noticeable symptoms of a vitamin B12 deficiency can take years to develop. Irritability, weakness, numbness, anemia, loss of appetite, headache, personality changes, and confusion are some of the signs and symptoms associated with very low levels of vitamin B12. Low levels of this vitamin may also be associated with an increased risk of colon cancer, heart disease, brain problems, and birth defects.

Vitamin D

Vitamin D deficiency leads to abnormal bone formation (rickets) in children and softening of bones (osteomalacia) in adults. Vitamin D deficiency interferes with calcium absorption, leading to increased risk of fractures, osteoporosis (bone loss), and muscle weakness. More recently, vitamin D deficiency has been linked to compromised immunity, cancer, and other chronic conditions. Since vitamin D is fat soluble, prolonged periods of deficiency are required to produce these symptoms.

Vitamin E

It's rare to be deficient in vitamin E. Symptoms include muscle weakness and vision problems. Long-term depletion of vitamin E may raise the risk of cancer and heart disease. Low levels may also weaken the immune system.

Vitamin K

The major symptom of vitamin K deficiency is impaired blood clotting. You might notice that you bruise easily or have nosebleeds or bleeding gums. Women may have heavy periods. Internal bleeding, which can be life threatening, may also result from insufficient vitamin K. Vitamin K is also important for bone health, which may be compromised in cases of deficiency.

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medications. If you have the signs and symptoms listed, it doesn't always mean you have low levels of these nutrients. Many things affect the level of nutrients, including your medical history, diet, and lifestyle, as well as how long you have been taking the medication. Please talk with your health care provider. He or she can best assess your health care needs and determine whether you are at risk for low levels of any nutrients.

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Cashman KD. Calcium and vitamin D. Novartis Found Symp. 2007;282:123-38; discussion 138-42, 212-8.

Fitzgerald MA. Drug-induced vitamin B12 deficiency. Nurse Pract. 2007;32:6-7.

Guardia G, Parikh N, Eskridge T, Phillips E, Divine G, Rao DS. Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five-year cross-sectional study with public health implications. Osteoporos Int. 2007; [Epub ahead of print].

Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency -- an update. Haematologica. 2006;91:1506-12.

Moretti R, Torre P, Antonello RM, Cazzato G, Cattaruzza T, Scapicchio PL. Vitamin B12 and folate depletion: clinical evidence in a neurological population. Neurologist. 2004;10:338-43.

Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5:949-60.

Schnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial. JAMA. 2002;288:973-9.

Stahl W, Heinrich U, Aust O, Tronnier H, Sies H. Lycopene-rich products and dietary photoprotection. Photochem Photobiol Sci. 2006;5:238-42.

Stocker R. Vitamin E. Novartis Found Symp. 2007;282:77-87; discussion 87-92, 212-8.

Svenson J. Neurologic disease and vitamin B12 deficiency. Am J Emerg Med. 2007;25:987.e3-4.

van Bennekum AM, Nguyen DV, Schulthess G, Hauser H, Phillips MC. Mechanisms of cholesterol-lowering effects of dietary insoluble fibres: relationships with intestinal and hepatic cholesterol parameters. Br J Nutr. 2005;94:331-7.

Voutilainen S, Nurmi T, Mursu J, Rissanen TH. Carotenoids and cardiovascular health. Am J Clin Nutr. 2006;83:1265-71.

Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med. 2003;61:19-21.

West KP Jr. Vitamin A deficiency disorders in children and women. Food Nutr Bull. 2003;24(4 Suppl):S78-90.

Version Info

  • Last reviewed on 9/21/2014
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed HealthCare Network. Also reviewed by the A.D.A.M. Editorial team.

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