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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.

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 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

• 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

• 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.