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Possible side effects

• Stomach upset, loose stools, nausea, and drowsiness are listed as common side effects, and ODS calls them mild.
• NCCIH says some people may get drowsiness, stomach upset, diarrhea, and vomiting.
• Increased heart rate variability has been reported.

Serious risks

• There are a few reports of more serious side effects, including effects on liver function.
• In reported liver injury cases, people's conditions improved over time after they stopped the supplement, and some also received medical treatment.
• NCCIH describes liver injury cases linked to ashwagandha supplements and calls them rare.
• Three case reports describe thyrotoxicosis in women taking ashwagandha extract.
• In all three thyrotoxicosis cases, stopping ashwagandha resolved the symptoms.

Avoid or ask a doctor first if

• Some experts advise pregnant women not to use ashwagandha, because some reports suggest it could cause spontaneous abortion.
• NCCIH says to avoid ashwagandha during pregnancy and not to use it while breastfeeding.
• NCCIH does not recommend it before surgery or for people with autoimmune or thyroid disorders.
• People with hormone-sensitive prostate cancer should avoid it because it may raise testosterone.

Medication interactions

• Ashwagandha might interact with thyroid hormone medications.
• It might also interact with antidiabetes drugs, antihypertensives, immunosuppressants, and sedatives.
• NCCIH lists diabetes, high blood pressure, immunosuppressant, sedative, anti-seizure, and thyroid hormone medications.

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.

Serious risks

• The Food and Nutrition Board reported no adverse effects from vitamin K in food or supplements in humans or animals.

Avoid or ask a doctor first if

• People taking medications regularly should talk with their health care providers about their vitamin K status.

Medication interactions

• Vitamin K can interact with warfarin and other anticoagulants.
• Antibiotics, bile acid sequestrants, and orlistat can have adverse effects on vitamin K levels.

Possible side effects

• Early signs of too much selenium are a garlic odor on the breath and a metallic taste in the mouth.
• Hair loss and nail brittleness or loss are the most common clinical signs of chronically high selenium intake.
• Other signs of chronically high intake include skin rash, nausea, diarrhea, fatigue, irritability, and nervous system abnormalities.

Serious risks

• Acute selenium toxicity can cause severe gastrointestinal and neurological symptoms, respiratory distress syndrome, heart attack, kidney failure, cardiac failure, and, in rare cases, death.
• Acute toxicity has resulted from misformulated over-the-counter products containing very large amounts of selenium. In 2008, 201 people had severe adverse reactions to a liquid supplement with 200 times the labeled amount.
• Brazil nuts contain very high amounts of selenium and could cause selenium toxicity if eaten regularly.

Avoid or ask a doctor first if

• The upper limits do not apply to people taking selenium under a physician's care.
• People who take medications regularly should discuss their selenium status with their health care providers.

Medication interactions

• Selenium supplements may interact with medications, and some medications, such as cisplatin, can affect selenium levels in the body.

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.

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.