Dairy products, eggs, and meat contain significant amounts of vitamin B2. Leafy green vegetables, whole grains, and enriched grains contain some vitamin B2.

Vitamin B2 deficiency can occur in alcoholics. Also, a deficiency may be more likely in people with cataracts or sickle cell anemia. In developing countries, vitamin B2 deficiency has been found to be a risk factor for the development of preeclampsia in pregnant women. People with chronic fatigue syndrome may be deficient in vitamin B2.

Anemia (if deficient) Migraine headaches Canker sores Cataracts High homocysteine (for people with a specific genetic makeup) Parkinson’s disease Preeclampsia Sickle cell anemia

At supplemental and dietary levels, vitamin B2 is nontoxic. Vitamin B2 works with vitamin B1, vitamin B3, and vitamin B6. For that reason, vitamin B2 is often taken as part of a B-complex supplement. Certain medicines may interact with vitamin B2. Refer to drug interactions for a list of those medicines.

The ideal level of intake is not known. The amounts found in many multivitamin supplements (20–25 mg) are more than adequate for most people.

LPA is found in most foods that contain protein. DPA does not normally occur in food. However, when phenylalanine is synthesized in the laboratory, half appears in the L-form and the other half in the D-form. These two compounds can also be synthesized individually, but it is more expensive to do so. The combination supplement (DLPA) is often used because of the lower cost and because both components exert different health-enhancing effects.

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.

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)

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.

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.

Most of the body’s lipase is manufactured in the pancreas, although some of it is secreted in the saliva, as well. Pancreatin contains lipase along with two other groups of enzymes: proteases and amylase.

People with pancreatic insufficiency and cystic fibrosis frequently require supplemental lipase and other enzymes. In addition, those with celiac disease or Crohn’s disease and perhaps some people suffering from indigestion may be deficient in pancreatic enzymes including lipase.

Cystic fibrosis Indigestion (for pancreatic insufficiency only) Celiac disease Crohn’s disease

Lipase does not generally cause any side effects at the amounts listed above. At the time of writing, there were no well-known drug interactions with lipase.

Products that contain lipase also usually contain other enzymes that help digest carbohydrates and protein. In the U.S., pancreatin, which contains lipase, amylase, and proteases, is rated against a government standard. For example, “9X pancreatin” is nine times stronger than the government standard. Each “X” contains 25 USP units of amylase, 2 USP units of lipase, and 25 USP units of proteolytic enzymes. Taking 1.5 grams of 9X pancreatin (or a higher amount at lower potencies) with each meal can help people with pancreatic insufficiency digest food.

Liver extracts are available as nutritional supplements in capsules and tablets.

As it is not an essential nutrient, no deficiency state exists.

Iron-deficiency anemia

No side effects or adverse reactions have been reported. Liver extracts should not be used by people suffering from iron-storage disorders, such as hemochromatosis. As the liver is a major filtering organ for many potentially toxic environmental chemicals, some doctors are concerned that consumption of liver extracts may result in increased intake of these chemicals. At the time of writing, there were no well-known drug interactions with liver extracts.

The recommended amount depends on the concentration, method of preparation, and quality of the liver extract.

Cartilage is derived from either sharks or cows. Collagen is derived from either cows or chickens.

Since they are not essential nutrients, neither cartilage nor collagen are associated with deficiencies.

Osteoarthritis Karposi’s sarcoma (skin cancer) Prostate cancer (shark cartilage)

Reports have suggested that some people should not use a cartilage supplement. This concern is based only on theory, not clinical evidence. This would include those people with cardiovascular disease, women who are planning to be or are pregnant, nursing mothers, anyone having or having had surgery within 30 days, and athletes training intensely. None of these concerns have been proven in clinical trials, however. Because shark cartilage contains calcium, people who ingest large amounts of shark cartilage (60 to 100 grams per day) may be consuming excessive amounts of this mineral. However, no cases of calcium toxicity resulting from the ingestion of shark cartilage have been reported. While use of gelatin, collagen hydrolysate, or type II collagen has not resulted in any reports of serious side effects, people with known sensitivities to chicken or beef should consult a doctor before using them. At the time of writing, there were no well-known drug interactions with cartilage.

Bovine cartilage is typically recommended at 3 grams three times per day. Shark cartilage is sometimes taken in much higher amounts (e.g., 60 to 100 grams per day orally or by enema). These amounts are based on animal and anecdotal evidence and their safety and efficacy have not been confirmed by controlled clinical trials. Not only is toxicity information on this amount of shark cartilage lacking, but the amount of calcium in this amount of shark cartilage exceeds the 2 to 2.5 grams per day that is commonly considered to be the upper limit of safe intake. Type II collagen, when used for its effects on the immune system in rheumatoid arthritis, is used in very small amounts, from 0.02 mg to 10 mg per day. Gelatin and collagen hydrolysate is recommended at 7 to 10 grams per day.

7-KETO is available as a dietary supplement.

Since the level of 7-KETO is directly related to the level of DHEA in the body, people with lower DHEA levels likely have low 7-KETO levels as well. Low DHEA levels are primarily associated with aging.

Weight loss

A safety study in humans has shown that 7-KETO did not raise estrogen or testosterone levels or produce any other negative effects at levels up to 200 mg per day for eight weeks. Short-term animal studies also revealed no adverse effects with large amounts of 7-KETO. However, the long-term safety of 7-KETO for humans has not been demonstrated, and, because it is chemically related to steroid hormones, the potential for adverse effects must be considered. In addition, the increase in T3 levels resulting from taking 7-KETO could, in theory, produce adverse effects on the heart or promote bone loss. For these reasons, people wishing to take 7-KETO, particularly those who have a thyroid disorder or are taking thyroid hormone, should consult a physician. At the time of writing, there were no well-known drug interactions with 7-KETO.

The manufacturer of 7-KETO recommends 100 mg twice daily for weight loss.

EPO is found primarily in supplements. Its presumed active ingredient, GLA, can also be found in black currant seed oil and borage oil supplements. However, it is not known whether the effects of these three oils in the body are the same.

Those with premenstrual syndrome, diabetes, scleroderma, Sjogren’s syndrome, tardive dyskinesia, eczema, and other skin conditions can have a metabolic block that interferes with the body’s ability to make GLA. In preliminary research, supplementation with EPO has helped people with these conditions. There is evidence that alcoholics may be deficient in GLA, and a double-blind study suggested that alcohol withdrawal may be facilitated with EPO supplementation. Many people in Western societies may be at least partially GLA-deficient as a result of aging, glucose intolerance, high dietary fat intake, and other problems. People with deficiencies would presumably benefit from supplemental GLA intake from EPO, black currant seed oil, or borage oil.

Type 1 diabetes Type 2 diabetes Eczema Fibrocystic breast disease Osteoporosis (in combination with fish oil) Premenstrual syndrome (PMS) Rheumatoid arthritis Skin ulcers Alcohol withdrawal Atherosclerosis Attention deficit disorder Chronic obstructive pulmonary disease Intermittent claudication Irritable bowel syndrome (IBS) Multiple sclerosis Raynaud’s disease Scleroderma Sjogren’s syndrome Tardive dyskinesia

EPO has been reported to exacerbate symptoms of temporal lobe epilepsy, which can sometimes be mistaken for schizophrenia. Other nutrients are needed by the body, along with EPO, to make PGE1. Consequently, some experts suggest that magnesium, zinc, vitamin C, niacin, and vitamin B6 should be taken along with EPO. Certain medicines may interact with evening primrose oil. Refer to drug interactions for a list of those medicines.

Although many people may have inadequate levels of GLA, the optimal intake for this nutrient remains unknown. Researchers often use 3,000–6,000 mg of EPO per day, which provides approximately 270–540 mg of GLA.

NAG is available primarily in tablets and capsules.

As NAG is not an essential nutrient, no deficiency states have been reported.

No significant side effects or interactions have yet been reported in studies on NAG. At the time of writing, there were no well-known drug interactions with N-acetyl-glucosamine.

Most manufacturers recommend supplementation with 1,500 mg daily.

Glucosamine is not present in significant amounts in most diets. Supplemental sources are derived from the shells of shrimp, lobster, and crab, or may be synthesized.

A glucosamine deficiency in humans has not been reported.

Osteoarthritis (glucosamine sulfate) Autism Knee pain (glucosamine HCI) Minor injuries Osteoarthritis (glucosamine HCl) Sprains and strains Wound healing (oral)

At the amount most frequently taken by adults 500 mg three times per day of GS adverse effects have been limited to mild reversible gastrointestinal side effects. In one trial, people with peptic ulcers and those taking diuretic drugs were more likely to experience side effects. Animal research has raised the possibility that glucosamine could contribute to insulin resistance. This effect might theoretically result from the ability of glucosamine to interfere with an enzyme needed to regulate blood sugar levels. However, available evidence does not suggest that taking glucosamine supplements will trigger or aggravate insulin resistance or high blood sugar. Two large, 3-year controlled trials found that people taking GS had either slightly lower blood glucose levels or no change in blood sugar levels, compared with people taking placebo. Until more is known, people taking glucosamine supplements for long periods may wish to have their blood sugar levels checked; people with diabetes should consult with a doctor before taking glucosamine and should have blood sugar levels monitored if they are taking glucosamine. In 1999 the first case of an allergic reaction to oral GS was reported. Allergic reactions to this supplement appear to be rare. Some GS is processed with sodium chloride (table salt), which is restricted in some diets (particularly for people with high blood pressure). The theory that GS and chondroitin sulfate work synergistically in the treatment of osteoarthritis remains unproven. At the time of writing, there were no well-known drug interactions with glucosamine.

Healthy people do not need to routinely supplement with glucosamine. Most research with people who have osteoarthritis, uses 500 mg three times per day of GS. Appropriate amounts for other conditions are not known.

Brewer’s yeast, which has a very bitter taste, is recovered after being used in the beer-brewing process. Brewer’s yeast can also be grown specifically for harvest as a nutritional supplement. “De-bittered” yeast is also available, though most yeast sold in health food stores that does not taste bitter is not real brewer’s yeast.

Brewer’s yeast is not an essential nutrient, but it can be used as a source of B-complex vitamins and protein. It is by far the best source of chromium, both in terms of quantity and bio-availability.

High cholesterol Type 2 diabetes Diarrhea (infectious)

Side effects have not been reported from the use of brewer’s yeast, although allergies to it exist in some people. It is not related to Candida albicans fungus, which causes yeast infection. Because it contains a highly biologically active form of chromium, supplementation with brewer’s yeast could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium or brewer’s yeast only under the supervision of a doctor. Saccharomyces boulardii is registered in Europe under the name Saccharomyces cerevisiae, though the manufacturer states that S. boulardii is not the same as brewer’s yeast (S. cerevisiae). There is a case report of a person with severely impaired immune function who, after receiving treatment with S. boulardii, developed an invasive fungal infection identified as S. cerevisiae. People with severe impairment of the immune system should therefore not take brewer’s yeast or S. boulardii unless supervised by a doctor. Certain medicines may interact with brewer’s yeast. Refer to drug interactions for a list of those medicines.

Brewer’s yeast is often taken as a powder, or as tablets or capsules. High-quality brewer’s yeast powder or flakes contain as much as 60 mcg of chromium per tablespoon (15 grams). When doctors recommend brewer’s yeast, they will often suggest 1–2 tablespoons (15–30 grams) of this high-potency bulk product per day. Remember, if it is not bitter, it is not likely to be real brewer’s yeast and therefore will not contain biologically active chromium. In addition, “primary grown” yeast (i.e., that grown specifically for harvest, as opposed to that recovered in the brewing process) may not contain GTF.