Anxiety Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Choline

• Do not take choline if you have primary genetic trimethylaminuria.
• Choline can cause fishy body odor, excessive perspiration, hypotension (low blood pressure), depression, and gastrointestinal symptoms such as nausea and diarrhea.

D,L-Phenylalanine

• Do not take D,L-phenylalanine if you have phenylketonuria.
• Do not take D,L-phenylalanine if you are taking nonselective monoamine oxidase inhibitors (MAOIs).
• Do not take D,L-phenylalanine if you have schizophrenia. D,L-phenylalanine can exacerbate tardive dyskinesia (involuntary facial movements) in people who have schizophrenia.
• Consult your doctor before taking D,L-phenylalanine if you have high blood pressure. D,L-phenylalanine can exacerbate high blood pressure. D,L-phenylalanine can also cause high blood pressure.

DHEA

• Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
• DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss.

EPA/DHA

• Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.
• Discontinue using EPA/DHA 2 weeks before any surgical procedure.

Folic Acid

• Consult your doctor before taking folic acid if you have a vitamin B12 deficiency.
• Daily doses of more than 1 milligram of folic acid can precipitate or exacerbate the neurological damage caused by a vitamin B12 deficiency.

Ginkgo Biloba

• Individuals with a known risk factor for intracranial hemorrhage, systematic arterial hypertension, diabetes, or seizures should avoid ginkgo.
• Do not use prior to or after surgery.
• Avoid concomitant use of ginkgo with NSAIDS, blood thinners, diuretics, or SSRI’s.
• Gastrointestinal symptoms (nausea and diarrhea) may occur.
• Allergic skin reactions may occur.
• Elevations in blood pressure may occur.

Kava Kava

• Do not take kava if you are taking levodopa-based medication, alcohol, barbiturates, or other mood-altering drugs.
• Do not take kava if you have a depressive disorder. Kava may deepen a depressed mood.
• Do not take kava with the tranquilizer Xanax. Taking kava with Xanax can cause coma.
• Do not take kava for more than 3 months without consulting a physician.
• Do not take high doses of kava. High dose, long-term use of kava can cause a scaly rash, unwanted weight loss and hepatitis.
• Kava can cause an allergic reaction, a slight yellowing of the skin, gastrointestinal complaints, impaired or abnormal movement, loss of balance, pupil dilation, and difficulty focusing.

L-Tryptophan

• Do not take L-tryptophan if you have carcinoid tumors.
• Do not take L-tryptophan while taking monoamine oxidase inhibitors (MAOIs) (type A) or within 2 weeks of discontinuing MAOIs.
• Do not take L-tryptophan with any antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants or MAOIs.
• Do not take L-tryptophan with serotonin 5-HT receptor agonists, including naratriptan, sumatriptan and zolmitriptan.
• Do not take L-tryptophan if you have ischemic heart disease (e.g., a history of myocardial infarction, angina pectoris or documented silent ischemia), coronary artery spasm (e.g., Prinzmetal sangina), uncontrolled hypertension or any other significant cardiovascular disease.
• L-tryptophan can trigger excess serotonin formation in tissues other than the target organ and cause significant adverse reactions.?
• L-tryptophan can cause nausea, diarrhea, loss of appetite, vomiting, difficulty breathing, pupil dilation, abnormally sensitive reflexes, loss of muscle coordination, blurry vision and cardiac dysrhythmia.

L-Tyrosine

• Do not take L-tyrosine if you have inborn errors of metabolism alkaptonuria and tyrosinemia type I and type II.
• Do not take L-tyrosine if you are taking non-selective monoamine oxidase (MAO) inhibitors.
• Do not take L-tyrosine if you have hypertension.
• Do not take L-tyrosine if you have melanoma

Melatonin

• Do not take melatonin if you are depressed.
• Do not take high doses of melatonin if you are trying to conceive. High doses of melatonin have been shown to inhibit ovulation.
• Melatonin can cause morning grogginess, a feeling of having a hangover or a “heavy head,” or gastrointestinal symptoms such as nausea and diarrhea.

Niacin (Nicotinic Acid)

• Do not take high doses of nicotinic acid (1.5 to 5 grams daily or more) if you have liver dysfunction, an unexplained elevation in your serum aminotransferase (transaminase) level, active peptic ulcer disease, arterial bleeding, or if you consume large amounts of alcohol.
• Consult your doctor before taking high doses of nicotinic acid if you have a history of jaundice, peptic ulcer disease, gastritis, disease of the liver or bile ducts, gout, kidney dysfunction, or cardiovascular disease (especially acute myocardial infarction or unstable angina).
• Consult your doctor before taking high doses of nicotinic acid if you have diabetes. High doses of nicotinic acid can negatively affect glucose tolerance. Monitor your serum glucose level frequently if you take nicotinic acid and have diabetes.
• Have your doctor monitor your serum aminotransferase level if you take high-doses of nicotinic acid.
• Nicotinic acid may cause flushing, principally of the face, neck, and chest. This flushing is thought to be prostaglandin-prostacyclin mediated. Histamine may also play a role in the flushing.
• Nicotinic acid can cause dizziness, palpitations, rapid heartbeat, shortness of breath, sweating, chills, insomnia, nausea, vomiting, abdominal pain, and muscle pain.
• High doses of nicotinic acid can cause blurred vision, macular edema, toxic amblyopia, and cystic maculopathy.

PABA (Para-aminobenzoic Acid)

• Do not take PABA if you are taking sulfonamides or have a kidney disease.
• PABA can cause anorexia, nausea, vomiting, fever, and rash.

Saint John’s Wort

• St. John's wort can increase sensitivity to sunlight. To avoid sunburn while taking St. John’s wort, minimize your exposure to the sun.
• St. John's wort can cause bloating and constipation.

Trimethylglycine (Betaine)

• Do not take trimethylglycine (betaine) if you have gastritis, gastroesophageal reflux disease (GERD), or peptic ulcer disease.

Valerian

• Do not operate machinery or drive for several hours after taking valerian. Valerian can cause a sedative effect.
• Do not take valerian with other sedatives, including barbiturates such as Nembutal and benzodiazepine medications such as Ativan, Halcion, Librium, Valium, and Xanax.
• Do not take valerian with alcohol.
• Valerian can cause gastrointestinal symptoms, allergic reaction, headache, restlessness, sleeplessness, pupil dilation, and heart problems.

Vitamin B1 (Thiamin)

• Consult your doctor before taking vitamin B1 for a thiamin deficiency, lactic acidosis secondary to thiamin deficiency, Wernicke-Korsakoff syndrome, Wernicke's encephalopathy, or Korsakoff's psychosis.

Vitamin B2 (riboflavin)

• High doses of vitamin B2 (riboflavin) may interfere with the Abbott TDx drugs-of-abuse assay.
• Riboflavin absorption is increased in hypothyroidism and decreased in hyperthyroidism.
• If you are taking nucleoside reverse-transcriptase inhibitors, even a mild riboflavin deficiency can increase your risk of lactic acidosis.

Vitamin B6

• Individuals who are being treated with levodopa without taking carbidopa at the same time should avoid doses of 5 milligrams or greater daily of vitamin B6.

Vitamin B12 (cyanocobalamin)

• Do not take cyanocobalamin if you have Leber's optic atrophy.

For more information see the Safety Appendix