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Possible side effects

• The most common complaints are diarrhea, nausea, abdominal cramps, and other digestive upset.

Serious risks

• High intakes may raise urinary oxalate and uric acid, which could contribute to kidney stones, especially in people with renal disorders.
• The best evidence that vitamin C contributes to kidney stones is in patients who already have hyperoxaluria.
• In people with hereditary hemochromatosis, long-term high doses could worsen iron overload and cause tissue damage.
• A few in vitro studies suggested that supplemental oral vitamin C, acting as a pro-oxidant, could cause chromosomal or DNA damage and possibly contribute to cancer.
• In postmenopausal women with diabetes in the Iowa Women's Health Study, supplemental vitamin C of at least 300 mg/day was significantly associated with a higher risk of dying from CVD.

Avoid or ask a doctor first if

• People with hereditary hemochromatosis face a concern about iron overload with chronic high doses.
• The upper limits do not apply to people receiving vitamin C as medical treatment, who should be under a physician's care.
• Infants should get vitamin C only from formula and food.

Medication interactions

• Vitamin C supplements may interact with radiation therapy and with medications, including chemotherapy drugs and statins.
• People taking these medications regularly should talk with their health care providers about vitamin C intake.

Possible side effects

• High blood calcium from vitamin D toxicity can lead to nausea, vomiting, muscle weakness, and other symptoms.

Serious risks

• Toxicity can cause high blood and urine calcium. In extreme cases it may lead to kidney failure, soft tissue calcification, heart rhythm problems, and death.
• Toxicity is almost always caused by taking too much vitamin D through supplements.

Avoid or ask a doctor first if

• The source says people on regular medications should talk with their health care providers about vitamin D intake and status.

Medication interactions

• Vitamin D supplements may interact with orlistat, statins, steroids, and thiazide diuretics.
• Taking calcium supplements with vitamin D supplements may raise the risk of certain adverse effects.

Serious risks

• No adverse effects have been reported from high thiamin intakes, but the FNB noted that excessive intakes could still have adverse effects.

Avoid or ask a doctor first if

• People who take certain medications regularly should talk with their health care providers about their thiamin status.

Medication interactions

• Thiamin isn't known to interact with any medications, but certain medications can have an adverse effect on thiamin levels.

Serious risks

• Food intakes many times the RDA show no observable toxicity; the source suggests limited solubility and absorption may explain this.
• Limited data on adverse effects don't mean high intakes are harmless, and the FNB urges caution with excessive amounts.

Medication interactions

• Riboflavin is not known to have clinically relevant interactions with medications.

Serious risks

• High biotin intakes, possibly even intakes above the AI, may pose a health risk tied to lab testing.
• Biotin beyond recommended intakes can cause clinically significant falsely high or falsely low lab results, depending on the test.
• In a small study of six healthy adults taking 10 mg/day for 1 week, biotin falsely lowered N-terminal pro-brain natriuretic peptide, which could result in a failure to identify congestive heart failure. Thyroid stimulating hormone was also falsely lowered.
• Case reports describe findings falsely indicating Graves' disease and severe hyperthyroidism in patients taking 10–300 mg biotin per day.
• A single 10 mg dose of biotin has interfered with thyroid function tests given within 24 hours.
• Per FDA, a patient with a high intake of supplemental biotin died after a troponin test gave a falsely low result because of biotin interference.

Medication interactions

• Biotin can interact with certain medications, and some medications can have an adverse effect on biotin levels.

Possible side effects

• High zinc intakes can cause nausea, dizziness, headaches, gastric distress, vomiting, and loss of appetite.

Serious risks

• Doses of 50 mg or more taken for weeks can interfere with copper absorption, reduce immune function, and lower HDL cholesterol.
• Very high supplemental doses (142 mg/day) might interfere with magnesium absorption and disrupt magnesium balance.
• According to a few reports, overuse of zinc-containing denture adhesive creams can lead to neurological symptoms and anemia.

Avoid or ask a doctor first if

• The upper limits don't apply to people receiving zinc for medical treatment, who should be under a physician's care.
• Zinc-free denture adhesive formulations are available to prevent the effects linked to zinc-containing creams.

Medication interactions

• Zinc may interact with quinolone antibiotics, tetracycline antibiotics, and penicillamine.
• Some diuretics can lower serum zinc by increasing zinc excretion in urine.
• People taking medications regularly should discuss their zinc status with their health care providers.

Possible side effects

• High copper exposure over time can cause gastrointestinal symptoms.

Serious risks

• Chronic exposure to high levels of copper can result in liver damage.
• Copper toxicity has been reported in people who drink water with high copper levels, for example from stagnant water in copper-containing pipes and fixtures.
• People with Wilson's disease can develop neurologic and liver damage that can result in cirrhosis.

Avoid or ask a doctor first if

• People with Wilson's disease have a high risk of copper toxicity.

Medication interactions

• Copper is not known to have any clinically relevant interactions with medications.

Serious risks

• Manganese toxicity mainly affects the central nervous system and can cause tremors, muscle spasms, tinnitus, hearing loss, and unsteadiness on one's feet.
• People who drink water with high manganese levels have also developed manganese toxicity.
• Workers such as welders and miners who chronically inhaled manganese dust have developed manganese toxicity.
• Toxicity signs and symptoms can progress to Parkinson's-like neuromotor impairments, including changes in gait and balance, tremor, and rigidity.

Avoid or ask a doctor first if

• People with chronic liver disease eliminate manganese less well in bile and are more susceptible to its neurotoxicity and other adverse effects of excess intake.
• Iron deficiency increases manganese absorption and can worsen symptoms of manganese toxicity.

Medication interactions

• Manganese is not known to have any clinically relevant interactions with medications.

Possible side effects

• Adverse effects are described as mild and infrequent, and may include digestive symptoms, dizziness, and headache.

Avoid or ask a doctor first if

• Saw palmetto may be unsafe during pregnancy or while breastfeeding.

Medication interactions

• The source advises talking with a health care provider before using any herbal product if you take medicine, because some herbs and medicines interact in harmful ways. No specific drug interactions are named for saw palmetto.

Avoid or ask a doctor first if

• Little is known about whether grape seed extract is safe during pregnancy or breastfeeding.

Medication interactions

• People who take any medicine should talk with a health care provider before using grape seed extract, because some herbs and medicines interact in harmful ways.