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Possible side effects

• High-dose iron supplements can cause stomach upset, constipation, nausea, abdominal pain, vomiting, and diarrhea.
• Supplements with 25 mg iron or more can reduce zinc absorption and plasma zinc concentrations.

Serious risks

• Large acute intakes from supplements or medicines can lead to corrosive necrosis of the intestine, which might lead to fluid and blood loss, shock, tissue damage, and organ failure.
• In severe cases, iron overdoses can lead to multisystem organ failure, coma, convulsions, and even death.
• Case reports suggest some people develop more serious gastrointestinal effects, including gastritis and gastric lesions.
• At least 43 U.S. children died between 1983 and 2000 from ingesting high-dose iron supplements.
• Without treatment, people with hereditary hemochromatosis typically develop signs of iron toxicity by their 30s.
• Iron toxicity effects in hemochromatosis can include liver cirrhosis, hepatocellular carcinoma, heart disease, and impaired pancreatic function.

Avoid or ask a doctor first if

• People with hemochromatosis: treatment guidance includes avoiding iron and vitamin C supplements.
• The required FDA label on solid iron supplements says accidental overdose is a leading cause of fatal poisoning in children under 6, and to keep the product out of children's reach.

Medication interactions

• Iron supplements may interact with levodopa and levothyroxine.
• Proton pump inhibitors can potentially reduce iron absorption.

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.

Possible side effects

• Side effects are usually minor and consist of self-limited gastrointestinal symptoms such as gas.

Serious risks

• Probiotic use has been linked to bacteremia, fungemia, and infections that led to severe illness, mostly in severely ill or immunocompromised people.
• Severe or fatal infections have been reported in premature infants given probiotics, and the FDA has warned health care providers.
• In a Boston ICU analysis, 6 of 522 patients given LGG had the ingested LGG found in their blood, versus 2 of 21,652 who did not receive it.
• Possible harms include infections, harmful substances produced by the probiotic microorganisms, and transfer of antibiotic resistance genes.
• Some products have contained microorganisms not listed on the label, which in some instances may pose serious health risks.

Avoid or ask a doctor first if

• For high-risk people such as premature infants or seriously ill hospital patients, the risks of probiotics should be carefully weighed against their benefits.
• For people with compromised immune function or other serious underlying diseases, the WGO advises restricting probiotic use to strains and indications with proven efficacy.
• Consult a health care provider before taking a probiotic supplement, especially with health problems. Anyone with a serious underlying condition should be monitored closely.

Serious risks

• The Food and Nutrition Board set no upper limit for B12 because its potential for toxicity is low.

Avoid or ask a doctor first if

• People who regularly take certain medications are told to talk with their health care providers about their B12 status.

Medication interactions

• B12 supplements may interact with some medications. Gastric acid inhibitors and metformin may affect B12 levels.
• Several types of medications might adversely affect B12 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.

Avoid or ask a doctor first if

• The recommended intakes don't apply to people whose bodies clear potassium poorly, for example because of kidney disease or certain medications.
• People taking medications that affect potassium should talk with their health care providers about their potassium intake and status.

Medication interactions

• Several types of medications can affect potassium status in ways that could be dangerous.

Possible side effects

• High doses from supplements or medications can cause diarrhea, nausea, and abdominal cramping.
• Magnesium carbonate, chloride, gluconate, and oxide are the forms most commonly reported to cause diarrhea.

Serious risks

• Very high doses can lead to magnesium toxicity, with low blood pressure, vomiting, difficulty breathing, irregular heartbeat, cardiac arrest and other signs.
• A few cases of fatal hypermagnesemia have been reported.
• Very large doses of magnesium-containing laxatives and antacids have been associated with magnesium toxicity.
• The risk of toxicity increases with impaired kidney function or kidney failure.

Avoid or ask a doctor first if

• People with impaired kidney function or kidney failure face higher risk of magnesium toxicity.
• People taking medications regularly should discuss their magnesium intake with their health care providers.

Medication interactions

• Magnesium may interact with oral bisphosphonates, tetracyclines, and quinolone antibiotics.
• Some medications, including diuretics and proton pump inhibitors, can affect magnesium status.