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Supplements

Supplements are everywhere — and patients assume they are “safe” because they’re sold over-the-counter.

This section is built to answer the clinical questions that actually matter:

What does it do (mechanism)?
Does it work (evidence)?
What are the risks (toxicity + interactions)?
Who should avoid it (special populations)?
What labs/monitoring matter?

How to Use This Section

Start here when:

A patient asks “Can I take this with my meds?”
You see abnormal labs and suspect supplement toxicity (liver, kidney, thyroid, INR changes)
A patient is taking “stacked” supplements for weight loss, energy, sleep, pain, libido, or immunity

Quick Rule: If it has a physiologic effect, it can have side effects and drug interactions.

High-Risk Supplements (Clinical Watchlist)

These come up constantly and are associated with meaningful adverse effects or drug interactions:

St. John’s Wort (CYP induction; ↓ efficacy of many drugs)
Kava (hepatotoxicity)
Kratom (dependence, withdrawal, seizures; opioid-like effects)
Yohimbine (HTN, anxiety, tachyarrhythmias)
“Fat burners” / stimulant blends (tachycardia, HTN, anxiety)
Red yeast rice (statin-like; myopathy/hepatotoxicity)
High-dose biotin (false lab results: thyroid, troponin, etc.)

Supplement Categories

1) Metabolic / Weight Loss

Berberine
Cinnamon
Chromium
Green tea extract
Garcinia cambogia
Fiber (psyllium, glucomannan)

→ Weight Loss Supplements

2) Cardiovascular / Lipids / BP

Omega-3 fatty acids (EPA/DHA)
Red yeast rice
CoQ10
Garlic
Beetroot / nitrates
Magnesium

→ Cardiovascular Supplements

3) Sleep / Anxiety / Mood

Melatonin
Valerian
L-theanine
Magnesium
Ashwagandha
Kava (high risk)
5-HTP / tryptophan (serotonergic interactions)

→ Sleep & Mood Supplements

4) Pain / Inflammation

Turmeric / curcumin
Omega-3 fatty acids
Glucosamine / chondroitin
Capsaicin (topical)
Boswellia
Willow bark (salicylate-like)

→ Pain & Inflammation Supplements

5) Immune / “Cold & Flu”

Vitamin C
Zinc
Elderberry
Echinacea
Vitamin D

→ Immune Supplements

6) GI / Microbiome

Probiotics
Peppermint oil
Ginger
Fiber
Digestive enzymes

→ GI Supplements

7) Sexual Health / Testosterone / “Performance”

DHEA
Tribulus
Tongkat ali
L-arginine / citrulline
Yohimbine (high risk)

→ Sexual Health Supplements

8) Vitamins & Minerals (Deficiency-Driven Use)

Vitamin D
Iron
B12 / folate
Magnesium
Calcium
Zinc

→ Vitamins & Minerals

Drug–Supplement Interaction Quick Links

Evidence & Safety Legend

Label	Meaning
Effective	Good evidence for a clinically meaningful benefit
Maybe	Mixed evidence, small effect, or benefit only in specific populations
Not proven	No convincing benefit in high-quality studies
High risk	Significant adverse effects, contamination risk, or major drug interactions