Treatments: 
Anemia High cholesterol Menkes’ disease (injectable copper histidine) Osteoporosis Wound healing Athletic performance Benign prostatic hyperplasia Cardiac arrhythmia Hypoglycemia Peripheral vascular disease Rheumatoid arthritis Sprains and strains

Common Symptoms:
Many people consume slightly less than the “safe and adequate range” of copper, 1.5–3.0 mg per day. Little is known about the clinical effects of these marginally adequate intakes, though frank copper deficiency is uncommon. Children with Menkes’ disease are unable to absorb copper normally and become severely deficient unless medically treated early in life. Deficiency can also occur in people who supplement with zinc without also increasing copper intake. Zinc interferes with copper absorption. Health consequences of zinc-induced copper deficiency can be quite serious. In the absence of copper supplementation, vitamin C supplementation has also been reported to mildly impair copper metabolism. Copper deficiency can result in anemia, lower levels of HDL (“good”) cholesterol, or cardiac arrhythmias.

Dosages:
Most people consume less than the recommended amount of this mineral. Some doctors recommend supplementing the average diet with 1–3 mg of copper per day. While the necessity of supplementing a normal diet with copper has not been proven, most people who take zinc supplements, including the zinc found in multivitamin-mineral supplements, should probably take additional copper. Cupric oxide (CuO) is a form of copper frequently used in vitamin-mineral supplements sold over-the-counter. However, animal studies have shown conclusively this form of copper is poorly absorbed from the gut; it should therefore not be used in supplements. Several other forms of copper (including copper sulfate, cupric acetate, and alkaline copper carbonate) are better absorbed, and are therefore preferable to cupric oxide.

Side Effects:
The level at which copper causes problems is unclear. But in combination with zinc, up to 3 mg per day is considered safe. People drinking tap water from new copper pipes should consult their doctor before supplementing, since they might be getting enough (or even too much) copper from their water. People with Wilson’s disease should never take copper. Zinc interferes with copper absorption. People taking zinc supplements for more than a few weeks should also take copper (unless they have Wilson’s disease). In the absence of copper supplementation, vitamin C may interfere with copper metabolism. Copper improves absorption and utilization of iron. Preliminary evidence shows that the levels of copper in the blood were higher among people who died from coronary heart disease than among those who did not. However, animals studies and some human studies suggest that, if anything, copper may prevent the development of heart disease. Although it is not clear why people who died of heart disease had elevated copper levels, this finding could be due to chronic inflammation, which is known to be associated with increased copper levels. Certain medicines may interact with copper. Refer to drug interactions for a list of those medicines.

Treatments: 
Anemia (for genetic thiamine-responsive anemia) Alzheimer’s disease Canker sores Childhood intelligence (for deficiency) Dialysis (for encephalopathy and neurologic damage; take only under medical supervision) Hepatitis Low back pain (in combination with vitamin B6 and vitamin B12) Type 1 diabetes Type 2 diabetes Cardiomyopathy (only for wet beri beri) Dysmenorrhea (painful menstruation) Fibromyalgia HIV support Multiple sclerosis Pre- and post-surgery health

Common Symptoms:
A decline in vitamin B1 levels occurs with age, irrespective of medical condition. Deficiency is most commonly found in alcoholics, people with malabsorption conditions, and those eating a very poor diet. It is also common in children with congenital heart disease. People with chronic fatigue syndrome may also be deficient in vitamin B1. Individuals undergoing regular kidney dialysis may develop severe vitamin B1 deficiency, which can result in potentially fatal complications. Persons receiving dialysis should discuss the need for vitamin B1 supplementation with their physician.

Dosages:
While the ideal intake is uncertain, one study reported the healthiest people consumed more than 9 mg per day. The amount found in many multivitamin supplements (20–25 mg) is more than adequate for most people. Vitamin B1 is nontoxic, even in very high amounts.

Side Effects:
Vitamin B1 works hand in hand with vitamin B2 and vitamin B3. Therefore, nutritionists usually suggest that vitamin B1 be taken as part of a B-complex vitamin or other multivitamin supplement. Certain medicines may interact with vitamin B1. Refer to drug interactions for a list of those medicines.

Treatments: 
Irritable bowel syndrome

Common Symptoms:
Grapefruit seed extract is not an essential nutrient and no deficiency states have been reported.

Dosages:
The typical recommendation for the liquid concentrate is 10–12 drops in 6–7 ounces of water one to three times daily. For capsules and tablets containing dried grapefruit seed extract, the usual recommendation is 100–200 mg one to three times daily.

Side Effects:
No side effects are known. The effects of grapefruit seed extract during pregnancy and breast-feeding have not been sufficiently evaluated. At the time of writing, there were no well-known drug interactions with grapefruit seed extract.

Treatments: 
Depression (DPA, LPA, DLPA) Low back pain (DPA) Pain (DPA) Parkinson’s disease (DPA) Vitiligo (LPA) Alcohol withdrawal support (DLPA) Osteoarthritis (DPA) Rheumatoid arthritis (DPA)

Common Symptoms:
People whose diets are very low in protein may develop a deficiency of LPA, although this is believed to be very uncommon. However, one does not necessarily have to be deficient in LPA in order to benefit from a DLPA supplement.

Dosages:
DLPA has been used in amounts ranging from 75–1,500 mg per day. This compound can have powerful effects on mood and on the nervous system, and therefore DLPA should be taken only under medical supervision. LPA has been used in amounts up to 3.5 grams per day. For best results, phenylalanine should be taken between meals, because the protein present in food can interfere with the uptake of phenylalanine into the brain, potentially reducing its effect.

Side Effects:
The maximum amount of DLPA that is safe is unknown. However, consistent toxicity in healthy people has not been reported with 1,500 mg per day or less of DLPA, except for occasional nausea, heartburn, or transient headaches. When 100 mg of LPA per 2.2 pounds body weight or more was given to animals, a variety of complex problems occurred, leading two researchers to have concerns about potential toxicity of high amounts in humans. While these concerns were directed at LPA specifically, they are likely to be equally applicable to DLPA. Although no serious adverse effects have been reported in humans taking phenylalanine, amounts greater than 1,500 mg per day should be supervised by a doctor. People with phenylketonuria must not supplement with phenylalanine. Some research suggests that people with tardive dyskinesia may process phenylalanine abnormally. Until more is known, it makes sense for people with this condition to avoid phenylalanine supplementation. LPA competes with several other amino acids for uptake into the body and the brain. Therefore, for best results, phenylalanine should be taken between meals, or away from protein-containing foods. People taking prescription or over-the-counter medications should consult a physician before taking DLPA. At the time of writing, there were no well-known drug interactions with phenylalanine.

Treatments: 
Anemia (if deficient) Athletic performance (if deficient, or to reduce pain and speed up muscle strength recovery after intense exercise) Bronchitis Bruising (for deficiency) Burns (in combination with vitamin E for prevention of sunburn only) Capillary fragility Common cold/sore throat Gingivitis (periodontal disease) (for deficiency only) Glaucoma Heart attack (for deficiency) High cholesterol (protection of LDL cholesterol) Infection Infertility (male) (for sperm agglutination) Reflex sympathetic dystrophy (prevention) Scurvy Stress Sunburn (oral, in combination with vitamin E) Wound healing Asthma Atherosclerosis Athletic performance (for exercise recovery) Autism Cataracts Childhood intelligence (for deficiency) Cold sores Dysmenorrhea (plus vitamin B3 [niacin] and rutin) Endometriosis (in combination with vitamin E) Gastritis Gingivitis (periodontal disease) (in combination with flavonoids) Gout Immune function Infertility (female) Influenza Iron-deficiency anemia (as an adjunct to supplemental iron) Lead toxicity Pancreatic insufficiency Parkinson’s disease (in combination with Vitamin E) Pre- and post-surgery health (if deficient) Preeclampsia (in combination with vitamin E; for high risk only) Pregnancy support (if the diet is low in vitamin C) Schizophrenia Skin ulcers Sprains and strains Sunburn (topical, in combination with vitamin E) Type 1 diabetes Type 2 diabetes Age-related cognitive decline Alcohol withdrawal support Amenorrhea Anemia (for thalassemia if deficient) Bipolar disorder/manic depression Boils (recurrent furunculosis) Childhood diseases Chronic obstructive pulmonary disease (COPD) Colon cancer (reduces risk) Ear infections (recurrent) Eczema Gallstones Halitosis (if gum disease and deficient) Hay fever Heart attack (for those not deficient) Hepatitis High blood pressure HIV support (oral and topical) Hives Hypoglycemia Leukoplakia Low back pain Macular degeneration Menopause Menorrhagia (heavy menstruation) Morning sickness Peptic ulcer Progressive pigmented purpura (in combination with rutoside) Prostatitis (acute bacterial prostatitis, chronic bacterial prostatitis) Retinopathy (in combination with selenium, vitamin A and vitamin E) Sickle cell anemia Sinusitis Tardive dyskinesia Urinary tract infection Vitiligo

Common Symptoms:
Although scurvy (severe vitamin C deficiency) is uncommon in Western societies, many doctors believe that most people consume less than optimal amounts. Fatigue, easy bruising, and bleeding gums are early signs of vitamin C deficiency that occur long before frank scurvy develops. Smokers have low levels of vitamin C and require a higher daily intake to maintain normal vitamin C levels. Women with preeclampsia have been found to have lower blood levels of vitamin C than women without the condition. Women who have lower blood levels of vitamin C have an increased risk of gallstones. People with kidney failure have an increased risk of vitamin C deficiency. However, people with kidney failure should take vitamin C only under the supervision of a doctor.

Dosages:
The recommended dietary allowance (RDA) for vitamin C in nonsmoking adults is 75 mg per day for women and 90 mg per day for men. For smokers, the RDAs are 110 mg per day for women and 125 mg per day for men. Most clinical vitamin C studies have investigated the effects of a broad range of higher vitamin C intakes (100–1,000 mg per day or more), often not looking for (or finding) the “optimal” intake within that range. In terms of heart disease prevention, as little as 100–200 mg of vitamin C appears to be adequate. Although some doctors recommend 500–1,000 mg per day or more, additional research is needed to determine whether these larger amounts are necessary. Some vitamin C experts propose that adequate intake be considered 200 mg per day because of evidence that the cells of the human body do not take up any more vitamin C when larger daily amounts are used. Some scientists have recommended that healthy people take multi-gram amounts of vitamin C for the prevention of illness. However, little or no research supports this point of view and it remains controversial. Supplementing more results in an excretion level virtually identical to intake, meaning that consuming more vitamin C does not increase the amount that remains in the body. On the basis of extensive analysis of published vitamin C studies, researchers at the Linus Pauling Institute at Oregon State University have called for the RDA to be increased, but only to 120 mg. This same report reveals that “. . . 90–100 mg vitamin C per day is required for optimum reduction of chronic disease risk in nonsmoking men and women.” Thus, the multiple gram amounts of vitamin C taken by many healthy people may be superfluous. The studies that ascertained approximately 120–200 mg daily of vitamin C is correct for prevention purposes in healthy people have typically not investigated whether people suffering from various diseases can benefit from larger amounts. In the case of the common cold, a review of published trials found that amounts of 2 grams per day in children appear to be more effective than 1 gram per day in adults, suggesting that large intakes of vitamin C may be more effective than smaller amounts, at least for this condition.

Side Effects:
Some people develop diarrhea after as little as a few grams of vitamin C per day, while others are not bothered by ten times this amount. Strong scientific evidence to define and defend an upper tolerable limit for vitamin C is not available. A review of the available research concluded that high intakes (2–4 grams per day) are well-tolerated by healthy people. However, intake of large amounts of vitamin C can deplete the body of copper an essential nutrient. People should be sure to maintain adequate copper intake at higher intakes of vitamin C. Copper is found in many multivitamin-mineral supplements. Vitamin C increases the absorption of iron and should be avoided by people with iron overload diseases (e.g., hemochromatosis, hemosiderosis). Vitamin C helps recycle the antioxidant, vitamin E. It is widely (and mistakenly) believed that mothers who consume large amounts of vitamin C during pregnancy are at risk of giving birth to an infant with a higher-than-normal requirement for the vitamin. The concern is that the infant could suffer “rebound scurvy,” a vitamin C deficiency caused by not having this increased need met. Even some medical textbooks have subscribed to this theory. In fact, however, the concept of “rebound scurvy” in infants is supported by extremely weak evidence. Since the publication in 1965 of the report upon which this mistaken notion is based, millions of women have consumed high amounts of vitamin C during pregnancy and not a single new case of rebound scurvy has been reported. A preliminary study found that people who took 500 mg per day of vitamin C supplements for one year had a greater increase in wall thickness of the carotid arteries (vessels in the neck that supply blood to the brain) than those who did not take vitamin C. Thickness of carotid artery walls is an indicator of progression of atherosclerosis. Currently, no evidence supports a cause-and-effect relationship for the outcome reported in this study. The vast preponderance of research suggests either a protective or therapeutic effect of vitamin C for heart disease, or no effect at all. People with the following conditions should consult their doctor before supplementing with vitamin C: glucose-6-phosphate dehydrogenase deficiency, iron overload (hemosiderosis or hemochromatosis), history of kidney stones, or kidney failure. It has been suggested that people who form calcium oxalate kidney stones should avoid vitamin C supplements, because vitamin C can be converted into oxalate and increase urinary oxalate. Initially, these concerns were questioned because of potential errors in
the laboratory measurement of oxalate. However, using newer methodology that rules out this problem, recent evidence shows that as little as 1 gram of vitamin C per day can increase the urinary oxalate levels in some people, even those without a history of kidney stones. In one case, 8 grams per day of vitamin C led to dramatic increases in urinary oxalate excretion and kidney stone crystal formation causing bloody urine. People with a history of kidney stones should consult a doctor before taking large amounts (1 gram or more per day) of supplemental vitamin C. Despite possible therapeutic effects of vitamin C in people with diabetes at lower intakes, one case of increased blood sugar levels was reported after taking 4.5 grams per day. Certain medicines may interact with vitamin C. Refer to drug interactions for a list of those medicines.

Treatments: 
Age-related cognitive decline (ARCD) Athletic performance (to enhance enurance in young active men) Alzheimer’s disease Depression Parkinson’s disease

Common Symptoms:
PS is not an essential nutrient, and therefore dietary deficiencies do not occur. Adults age 50 and older, especially those with age-related cognitive decline, may not synthesize enough PS, and appear most likely to benefit from supplemental PS.

Dosages:
Positive effects on mental function have been achieved using 200–500 mg per day of bovine PS; most studies used 300 mg per day. Preliminary animal research shows that the soy-derived PS does have effects on brain function similar to effects from the bovine source.

Side Effects:
No significant side effects associated with PS have been reported. At the time of writing, there were no well-known drug interactions with phosphatidylserine.

Treatments: 
High blood pressure High cholesterol Menopause Osteoporosis Premenstrual syndrome (PMS) Vaginitis

Common Symptoms:
Although deficiencies do not occur, people who do not consume soy foods will not gain the benefits of soy.

Dosages:
The ideal intake of soy is not known. Researchers suggest the equivalent of one serving of soy foods per day supports good health, and the benefits increase as soy intake increases. Societies in which large amounts of soy are consumed ingest between 50 and 100 mg per day of soy isoflavones. The cholesterol-lowering effects of soy have been observed at amounts as low as 20 grams of soy protein per day, if it replaces animal protein in the diet.

Side Effects:
Soy products and cooked soybeans are safe at a wide range of intakes. However, a small percentage of people have allergies to soybeans and thus should avoid soy products. Soy isoflavones have been reported to reduce thyroid function in some people. A preliminary trial of soy supplementation among healthy Japanese, found that 30 grams (about one ounce) per day of soybeans for three months, led to a slight reduction in the hormone that stimulates the thyroid gland. Some participants complained of malaise, constipation, sleepiness, and even goiter. These symptoms resolved within a month of discontinuing soy supplements. However, a variety of soy products have been shown to either cause an increase in thyroid function or produce no change in thyroid function. The clinical importance of interactions between soy and thyroid function remains unclear. However, in infants with congenital hypothyroidism, soy formula must not be added, nor removed from the diet, without consultation with a physician, because ingestion of soy may interfere with the absorption of thyroid medication. Most research, including animal studies, report anticancer effects of soy extracts, though occasional animal studies have reported cancer-enhancing effects. The findings of several recent studies suggest that consuming soy might, under some circumstances, increase the risk of breast cancer. When ovaries have been removed from animals a situation related to the condition of women who have had a total hysterectomy dietary genistein has been reported to increase the proliferation of breast cancer cells. When pregnant rats were given genistein injections, their female offspring were reported to be at greater risk of breast cancer. Although premenopausal women have shown decreases in estrogen levels in response to soy, pro-estrogenic effects have also been reported. When pre-menopausal women were given soy isoflavones, an increase in breast secretions resulted an effect thought to elevate the risk of breast cancer. In yet another trial, healthy breast cells from women previously given soy supplements containing isoflavones showed an increase in proliferation rates an effect that might also increase the risk of breast cancer. Of 154 healthy postmenopausal women who received 150 mg of soy isoflavones per day for five years, 3.9% developed an abnormal proliferation of the tissue that lines the uterus (endometrial hyperplasia). In contrast, none of 144 women who received a placebo developed uterine hyperplasia. Although no case of uterine cancer was diagnosed during the study, endometrial hyperplasia is a potential forerunner of uterine cancer. The amount of isoflavones used in this study is two to three times as much as that used in many other studies. Nevertheless, the possibility exists that long-term use of isoflavones could cause uterine hyperplasia, and women taking isoflavones should be monitored appropriately by their doctor. Soy contains a compound called phytic acid, which can interfere with mineral absorption. Certain medicines may interact with soy. Refer to drug interactions for a list of those medicines.

Treatments: 

Common Symptoms:
According to several studies, blood levels of cysteine and glutathione are low in people infected with HIV. Cysteine has a role in the proper function of the immune system, so a deficiency of this amino acid may either contribute to, or result from, immune suppression associated with HIV.

Dosages:
Most people do not need to supplement with cysteine. Almost nothing is known about appropriate supplemental levels, in part because almost all clinical research has been done with N-acetyl cysteine and not cysteine itself.

Side Effects:
No consistent adverse effects of NAC have been reported in humans. One small study found that daily amounts of 1.2 grams or more could lead to oxidative damage. Extremely large amounts of cysteine, the amino acid NAC is derived from, may be toxic to nerve cells in rats. Adequate amounts of methionine are needed in the diet, as the precursor to cysteine, to prevent cysteine deficiency. At the time of writing, there were no well-known drug interactions with cysteine.

Treatments: 
High homocysteine Liver cirrhosis Neural tube defects (prevention) Tardive dyskinesia Alzheimer’s disease Bipolar disorder Gallbladder attacks Hepatitis High cholesterol

Common Symptoms:
Although choline deficiencies have been artificially induced in people, little is known about human deficiency in the real world.

Dosages:
Small amounts of choline are present in many B-complex and multivitamin supplements.

Side Effects:
With several grams of choline per day, some people will experience abdominal discomfort, diarrhea, or nausea. Supplementing choline in large amounts (over 1,000 mg per day) can lead to a fishy body odor. PC does not have this effect. Depression has been reported as a side effect in people taking large amounts of choline, such as 9 grams per day. The body uses both PC and pantothenic acid to form acetylcholine. At the time of writing, there were no well-known drug interactions with Lecithin/Phosphatidylcholine/Choline.

Treatments: 
Crohn’s disease (enteric-coated, free-fatty-acid form of fish oil) High blood pressure High triglycerides Rheumatoid arthritis Asthma Atherosclerosis Bipolar disorder Breast-feeding support Cardiac arrhythmia (do not take, or take only with a doctor’s supervision, if there is a history of sustained ventricular tachycardia or ventricular fibrillation) Cystic fibrosis (EPA) Depression Eczema Heart attack Immune function (omega-3 fatty acids for critically ill and post surgery patients only) Intermittent claudication (in combination with vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid) Kidney disease Lupus Macular degeneration (in combination with acetyl-L-carnitine and coenzyme Q10) Multiple sclerosis Osteoporosis (in combination with evening primrose oil) Phenylketonuria (if deficient in polyunsaturated fatty acids) Pre- and post-surgery health Pregnancy and postpartum support (to prevent premature delivery) Psoriasis Raynaud’s disease Schizophrenia Sickle cell anemia Ulcerative colitis Angina Chronic fatigue syndrome Chronic obstructive pulmonary disease (COPD) Colon cancer (reduces risk) Dysmenorrhea (painful menstruation) Endometriosis Glaucoma Migraine headaches Osteoarthritis Osteoporosis Photosensitivity Preeclampsia Type 1 diabetes Type 2 diabetes

Common Symptoms:
So-called “primitive” diets have much higher levels of EPA and DHA than modern diets. As a result, some researchers and doctors believe that most people who eat a typical western diet are likely to be consuming less-than-optimal amounts of EPA and DHA. To a very limited extent, omega-3 fatty acids from vegetable sources, such as flaxseed oil, can convert to EPA. At least four studies have reported a reduced blood level of omega-3 fatty acids in people with depression. People with rheumatoid arthritis have been found to have decreased levels of omega-3 fatty acids, such as are found in fish oil, in their joint fluid and blood.

Dosages:
Presumably, healthy people who frequently eat fatty fish (several times per week) have no need to supplement with fish oil. How much EPA and DHA, if any, should be supplemented by healthy people who do not eat much fatty fish, remains unclear. Most researchers studying the effects of EPA and DHA in humans who have a variety of health conditions have given those people at least 3 grams of the total of EPA plus DHA—an amount that may require 10 grams of fish oil, because most fish oil contains only 18% EPA and 12% DHA. The health benefits for people with Crohn’s disease have been reported with a special, enteric-coated preparation of purified EPA/DHA manufactured from fish oil. This preparation of purified fatty acids has also been reported to not cause the gastrointestinal symptoms that often result from taking regular fish oil supplements, again suggesting unique benefit. In one trial, the maximum amount of fish oil tolerated by people being treated for cancer-related weight loss was reported to be approximately 21 grams per day. However, in people who do not have cancer, the maximum tolerated amount may be different.

Side Effects:
While those with heart disease and diabetes have often been reported to benefit from supplementation with fish oil, both groups should check with their doctor before taking more than 3 grams of fish oil per day for several months. Elevations in blood sugar and cholesterol levels may occur in some people who take fish oil. The increase in blood sugar appears to be related in part to the amount of fish oil used. Some evidence suggests that adding vitamin E to fish oil may prevent the fish oil-induced increase in blood sugar levels. In other research, the impairment of sugar metabolism sometimes caused by supplementation with fish oil has been prevented by the addition of half an hour of moderate exercise three times a week. While supplementation with fish oil consistently lowers triglycerides, the effect of fish oil on LDL (“bad”) cholesterol varies, and in some people, fish oil supplementation has been reported to increase LDL levels. People who took fish oil and who also took 15 grams of pectin per day were reported to have reductions in LDL cholesterol. This suggests that pectin may overcome the occasional problem of increased LDL cholesterol reported in people who supplement with fish oil. The LDL-cholesterol raising effect of EPA and DHA has also been reported to be prevented by taking garlic supplements (or presumably including garlic in the diet) along with EPA and DHA. Certain medicines may interact with Fish Oil and Cod Liver Oil. Refer to drug interactions for a list of those medicines.