CoQ10

Form

Ubiquinol (reduced form) preferred over ubiquinone for patients over 40 or with significant depletion. Ubiquinone acceptable for younger patients.

Dose

100–200 mg daily

Timing

Take with a meal containing fat — CoQ10 is fat-soluble.

Cautions

May modestly reduce warfarin (INR) effect — monitor if patient is anticoagulated.

Sources

Lipitor, Metformin, Type 2 Diabetes, Fatigue

Methylcobalamin

Form

Methylcobalamin or hydroxocobalamin preferred over cyanocobalamin — directly bioavailable, no methylation step required. Sublingual or lozenge form preferred for patients on metformin or PPIs (impaired GI absorption).

Dose

1000–5000 mcg daily

Timing

Take in the morning — may be activating. Sublingual form: dissolve under tongue for 60–90 seconds.

Cautions

Confirm with serum B12 and MMA testing before high-dose supplementation in older adults. Caution with Leber's hereditary optic neuropathy.

Sources

Metformin, Type 2 Diabetes, Fatigue

Magnesium Glycinate

Form

Glycinate or malate preferred — well absorbed, gentle on GI tract. Avoid magnesium oxide (poor absorption, causes diarrhea).

Dose

200–400 mg daily

Timing

Evening dosing supports sleep quality and muscle relaxation.

Cautions

Reduce dose if loose stools occur. Caution with severe renal impairment.

Sources

Metformin, Type 2 Diabetes, Fatigue

Vitamin D3 (Cholecalciferol)

Form

D3 (cholecalciferol) preferred over D2 (ergocalciferol). Combine with Vitamin K2 (MK-7, 90–180 mcg) to direct calcium to bone rather than vasculature.

Dose

2,000–5,000 IU daily

Timing

Take with largest meal of the day (fat-soluble). Evening dosing may affect sleep in sensitive individuals.

Cautions

Monitor 25(OH)D serum levels annually. Target: 40–60 ng/mL. Caution with granulomatous disease (sarcoidosis) or hypercalcemia.

Sources

Lipitor, Type 2 Diabetes, Fatigue

Alpha-Lipoic Acid

Form

R-ALA (R-alpha-lipoic acid) preferred over racemic ALA — more bioavailable and better tolerated.

Dose

300–600mg daily

Timing

Take on empty stomach for best absorption. Split dose if GI sensitive.

Cautions

May lower blood sugar — monitor closely in diabetics. Avoid high doses in thiamine deficiency.

Sources

Type 2 Diabetes, Fatigue

Iron Bisglycinate

Form

Bisglycinate chelate has high bioavailability and significantly less GI irritation than ferrous sulfate. Take with vitamin C for enhanced absorption.

Dose

25–50 mg elemental iron daily

Timing

Take on empty stomach if tolerated. If GI upset, take with small meal.

Cautions

Avoid taking with calcium, antacids, or dairy. Do not use without confirmed deficiency.

Sources

Type 2 Diabetes, Fatigue

L-Methylfolate (5-MTHF)

Form

L-Methylfolate (5-MTHF) preferred over folic acid — bypasses MTHFR conversion and is directly bioavailable. Avoid synthetic folic acid, especially in MTHFR variants and methotrexate users.

Dose

400–1000 mcg daily

Timing

Take with food. Can be taken as part of a B-complex.

Cautions

Do not use folic acid in patients with active untreated B12 deficiency — masks anemia while neurologic damage progresses. Confirm B12 status first. Caution with anti-seizure medications.

Sources

Metformin, Type 2 Diabetes, Fatigue

Selenium (Selenomethionine)

Form

Selenomethionine form preferred over selenite — superior bioavailability and tissue retention. Brazil nuts are a potent dietary source (1–2 nuts ≈ daily requirement).

Dose

100–200 mcg daily

Timing

Take with food.

Cautions

Do not exceed 400 mcg/day (UL) — chronic excess causes selenosis (hair loss, brittle nails, neuropathy). Caution with anticoagulants.

Sources

Lipitor, Type 2 Diabetes, Fatigue

High-quality multivitamin with minerals

Form

Whole-food based multivitamin preferred. Look for methylfolate (5-MTHF) instead of folic acid, and mineral chelates (glycinate, citrate) for better absorption.

Dose

1-2 capsules daily with food

Timing

Take with largest meal of the day to improve absorption of fat-soluble vitamins.

Cautions

Avoid high-dose isolated nutrients without clinical indication. Separate from thyroid medications by 4 hours.

Sources

Lipitor, Type 2 Diabetes, Fatigue

Calcium Citrate

Form

Calcium citrate required for patients on PPIs — does not require stomach acid for absorption, unlike calcium carbonate. Split doses for better absorption.

Dose

500 mg twice daily (1,000 mg total)

Timing

Take with meals. Split into 2 doses — absorption limited to ~500 mg per dose.

Cautions

Avoid excessive doses. Do not take with iron supplements simultaneously.

Sources

Type 2 Diabetes, Fatigue

Fish Oil

Form

Triglyceride form preferred over ethyl ester. Look for molecularly distilled, third-party tested for heavy metals.

Dose

1000–3000mg EPA/DHA daily

Timing

Take with meals containing fat — improves absorption and reduces fish burp.

Cautions

Use caution with blood thinners (warfarin, aspirin). Discontinue 2 weeks before surgery.

Sources

Type 2 Diabetes, Fatigue

Zinc Picolinate

Form

Picolinate or bisglycinate forms preferred for absorption. Take separately from ACE inhibitor dose to prevent chelation.

Dose

15–30 mg daily

Timing

Take with food to reduce nausea. Separate from calcium and iron by 2 hours.

Cautions

Do not exceed 40 mg/day (UL). Long-term high-dose zinc can cause copper deficiency — consider copper 1–2 mg if using >30 mg zinc.

Sources

Type 2 Diabetes, Fatigue

Vitamin K2 (MK-7)

Form

Menaquinone-7 (MK-7) — natto-fermented or synthesized; 72-hour half-life supports once-daily dosing. Activates osteocalcin (bone matrix protein) and matrix Gla-protein (vascular calcification inhibitor), routing dietary and supplemental calcium to bone rather than arterial walls. Synergistic with vitamin D3 — pair for bone density and cardiovascular calcification prevention.

Dose

90–180 mcg daily

Timing

With largest fat-containing meal (fat-soluble). Once-daily dosing sufficient given long half-life. Consistent daily timing if patient is on warfarin.

Cautions

WARFARIN — relative contraindication; requires INR monitoring and anticoagulation provider oversight before initiation, dose change, or discontinuation; DOACs (apixaban, rivaroxaban, dabigatran) — no significant interaction; pregnancy/lactation — limited data, use only under provider guidance; concurrent high-dose vitamin E (>400 IU daily) may blunt K-dependent carboxylation; severe hepatic disease may impair activation. Best paired with vitamin D3 (1000–5000 IU) for synergistic bone and cardiovascular benefit.

Sources

Lipitor

Iodine (Potassium Iodide)

Form

Potassium iodide or kelp-derived iodine. Lugol's solution available for higher therapeutic doses under provider supervision. Confirm thyroid status before high-dose use.

Dose

150–300 mcg daily

Timing

Take with food. Separate from thyroid medication by 4 hours.

Cautions

Contraindicated in autoimmune thyroiditis (Hashimoto's, Graves) without provider supervision — can trigger flares. Do not exceed 1100 mcg/day (UL) without monitoring.

Sources

Fatigue

NAC

Form

N-Acetyl Cysteine — standard pharmaceutical grade. Avoid effervescent forms with added sugar.

Dose

600–1800mg daily

Timing

Take on empty stomach or with light meal. Avoid taking with activated charcoal.

Cautions

Avoid with nitroglycerin or activated charcoal. May cause GI upset at higher doses.

Sources

Fatigue

Potassium (dietary + supplement)

Form

Dietary sources preferred (banana, avocado, leafy greens, legumes). Supplement with potassium gluconate or citrate if dietary intake insufficient. Monitor serum levels.

Dose

99 mg supplement; prioritize dietary sources

Timing

With food. Do not crush or chew slow-release formulations.

Cautions

Monitor serum potassium if on ACE inhibitor, ARB, or potassium-sparing diuretic. High-dose supplementation should be medically supervised.

Sources

Type 2 Diabetes, Fatigue

Myo-Inositol

Form

Myo-inositol preferred for insulin sensitivity, mood, and PCOS support. 40:1 ratio of myo- to D-chiro-inositol is well-studied for metabolic and ovarian function.

Dose

2000–4000 mg daily (split doses)

Timing

Take with food, split into 2 doses (morning and evening). Powder form mixes easily in water.

Cautions

Generally well-tolerated. May cause mild GI upset at higher doses — start low and titrate up.

Sources

Type 2 Diabetes

Riboflavin (B2)

Form

Riboflavin or riboflavin-5-phosphate (R5P — activated coenzyme form, preferred when MTHFR variants or FAD-dependent enzyme dysfunction suspected). High-dose (400 mg daily) evidence-based for migraine prophylaxis (Schoenen 1998).

Dose

25–50 mg daily

Timing

With food to minimize mild GI upset. Split doses above 100 mg. Bright yellow-green urine discoloration is harmless and indicates absorption.

Cautions

Generally very well-tolerated with no established upper intake level. Reduces tetracycline absorption and vice versa (separate dosing by 2 hours). Probenecid decreases riboflavin renal excretion (may increase levels). Anticholinergics may increase intestinal absorption. Theoretical photosensitization risk at very high doses with concurrent UV/phototherapy. No known major drug or condition contraindications.

Sources

Fatigue

L-Carnitine

Form

L-Carnitine tartrate preferred for athletic performance. Propionyl-L-Carnitine preferred for cardiovascular support.

Dose

1000–3000mg daily

Timing

Take 30–60 minutes before exercise or with meals.

Cautions

May increase TMAO levels with high red meat intake — discuss with patients on cardiovascular protocols.

Sources

Fatigue