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HPRC Fitness Arena: Dietary Supplements
Bitter orange is an extract from the immature green fruit of the Citrus aurantium plant, also known as Seville orange. It is sometimes used in small amounts in food as a flavorant and often used in weight-loss supplements. The terms “bitter orange,” “bitter orange extract,” or “Citrus aurantium” are often used interchangeably with the ingredient name “synephrine,” but bitter orange (the extract from Citrus aurantium fruit) is actually a complex mixture of many compounds, including synephrine and octopamine. Although both synephrine and octopamine occur naturally in the Citrus aurantium plant, they also can be made in a laboratory.
Many safety concerns have been raised with regard to synephrine and octopamine, which are both stimulants. The National Collegiate Athletic Association (NCAA) bans both of them, but the World Anti-Doping Agency (WADA) bans only octopamine. Bitter orange is frequently used in "ephedra-free" products since 2004, when the Food and Drug Administration (FDA) banned ephedra for its association with serious adverse cardiovascular effects. Combinations of stimulants—such as bitter orange and caffeine, commonly found together in weight-loss and bodybuilding products—can cause hypertension and increase heart rate in otherwise healthy adults. A major concern with products that list bitter orange (or synephrine, or octopamine) on the label is that the amount of stimulants in the product is sometimes very difficult—if not impossible—to determine. Service members should exercise extreme caution when considering whether to use supplements containing bitter orange.
No conclusive, peer-reviewed, scientific evidence clearly establishes that bitter orange is any safer than ephedra. For more information on bitter orange and ephedra, read the monographs in HPRC’s Dietary Supplement Classification System series.
For more answers to common questions we’ve received about dietary supplements, please visit our Operation Supplement Safety (OPSS) FAQs.
What are omega-7 fatty acids? And do omega-7 supplements convey the health benefits advertised?
Omega-7 fatty acids are a type of unsaturated fat. Omega-7s are considered non-essential fatty acids, which means your body can make enough omega-7s to function properly. In other words, you don’t need to get them from foods or supplements.
One of the most common forms of omega-7s, which is also used in supplements, is palmitoleic acid (not to be confused with palmitic acid, which is a saturated fat). Omega-7 supplements are marketed for health benefits such as heart and liver health, improved cholesterol levels, weight loss, glucose (blood sugar) metabolism, and immune support. Limited research has shown some benefits from palmitoleic acid supplementation, but most of the research has been done on animals and only for short test periods (less than four weeks). As a result, no recommended dose or source of palmitoleic acid exists, and there is not enough evidence to suggest that omega-7 supplements can improve heart health or health in general.
At this time, the Food and Drug Administration (FDA) has not yet approved any vaccines or drugs for the prevention or treatment of Ebola. However, online advertising of some dietary supplement products makes claims that they can prevent or cure this deadly infectious disease.
By definition, a dietary supplement product cannot make a claim that it will prevent or cure a disease. FDA advises consumers to be aware that these products are fraudulent and should not be used. You can read more about these products and about Ebola in FDA’s Press Announcement. And be sure to visit the Operation Supplement Safety (OPSS) website to learn more about dietary supplements in general and how to choose supplements wisely.
Lately, HPRC has been receiving a lot of questions about the use of banned supplements in the military, but the fact is: There isn’t a list of banned dietary supplements currently available. It isn’t always easy to determine whether a dietary supplement product is safe or not, so the Department of Defense (DoD), together with HPRC, provides helpful resources on the Operation Supplement Safety (OPSS) website to help you choose supplements wisely. With regard to the military’s stance on supplements in general, please see the OPSS FAQ about a "banned list," which is pertinent to all service branches.
Some dietary supplements, including ones sold on military installations, contain potentially harmful and problematic ingredients. For some tips about how to avoid these, read the OPSS infosheet “Red Flags—What You Need to Know.” In addition, some other potentially dangerous ingredients include prescription drug ingredients and their analogs, drugs banned by FDA for safety reasons, controlled substances (such as anabolic steroids), and untested/unstudied new active drug ingredients, which may not be listed on the product label.
One way to ensure that a dietary supplement product is safe is to see if it is third-party verified. Third-party certification organizations have developed criteria for evaluating and authenticating the quality of a supplement—the ingredients, the dosage levels, the level of contaminants, the label claims, and whether the manufacturing facilities follow Good Manufacturing Practices (GMP).
The Natural Medicines Comprehensive Database (NMCD) is the gold standard for evidence-based information on dietary supplement products and ingredients and is an HPRC partner. (Subscription is free if you have a “.mil” email address; visit the OPSS FAQ for more information.) NMCD rates products on a scale of 1 to 10 based on safety and effectiveness. We encourage you to consider only using products rated 8 or above.
To avoid potential problems, talk with your healthcare provider or dietitian before using dietary supplements. Also, see FDA’s list of tainted bodybuilding products, which includes important public notifications.
In a new Operation Supplement Safety (OPSS) PSA video, Gold Star mother Ms. Terri Bellamy-Coleman urges service members to seek out information and guidance on dietary supplements from the appropriate sources before taking them. Ms. Bellamy-Coleman’s son, who was attending the NCO (Noncommissioned Officer Academy, WLC (Warrior Leadership Course) in Fort Benning, GA at the time of his death, had been taking dietary supplements when he exerted himself during physical training, suffered a heart arrhythmia, and died. He had the sickle-cell trait, which may have aggravated the situation. She wants others to be aware of the possible risks associated with dietary supplements, especially when certain medical conditions are present, and urges service members to seek information to help prevent possible harmful health effects. Please watch the video, “A Mother’s Plea."
Weight-loss (diet) prescription medications are generally not permitted, but it’s important to check your service’s policy for specific conditions that may exist. Read this OPSS FAQ to find out more details, including links to specific policies. Also, be sure to check the OPSS site often, as we add answers to other questions about ingredients in performance-enhancing and bodybuilding supplements and how to choose supplements safely.
If you have a question about a particular dietary supplement ingredient or product, please use our “Ask the Expert” button located on the OPSS home page.
With their promises of fast results and huge gains or losses, dietary supplements can be tempting, whether you’re trying to maintain your fitness in combat or at home. The advertising claims can be difficult to navigate, and staying informed about potential side effects is a challenge.
Operation Supplement Safety presents an educational video with information you need to know before you consider taking any dietary supplement:
- Potential side effects
- What to do if you experience an unwanted effect
- Alternatives to taking supplements
- Where to get more information
If you have questions about dietary supplements or performance nutrition, and you can’t find answers on our website, submit your question to our experts.
Although the internet is a quick and easy way to find health information, the source may not always be reputable. The Office of Dietary Supplements at the National Institutes of Health has developed guidelines to help consumers evaluate internet-based health information. Click here to find out more.
Vitamin D is actually a hormone that your body produces when your skin is exposed to sunlight, earning it the nickname “sunshine vitamin.” It plays key roles in reducing your risk of many health conditions, including depression, cancer, heart disease, osteoporosis, and others. Spending 10 to 15 minutes outside on a sunny day with your arms and legs uncovered can provide nearly all the vitamin D most people need—challenging when you’re wearing a long-sleeved uniform or working inside all day—but you can also get some vitamin D in your diet from fatty fish (such as salmon), mushrooms, and many fortified foods.
The Recommended Dietary Allowance for most individuals is 600 IUs. People who have a vitamin D deficiency or certain medical conditions might require supplemental vitamin D but only under the supervision of their healthcare provider. That’s because excess vitamin D can be stored in your body, putting you at risk for toxicity. Over time, too much vitamin D can lead to irregular heart rhythms, kidney damage, and other serious health problems. If you take large doses of supplemental vitamin D and eat foods that are fortified with it, you could easily obtain more than recommended amounts.
Despite the risk for toxicity, nearly one-fourth of people living in the U.S. have low vitamin D levels, so all adults and children should have their vitamin D status checked by their healthcare provider. For more information about vitamin D, read this fact sheet from the Office of Dietary Supplements.
Operation Supplement Safety (OPSS) is a joint military initiative between the Human Performance Resource Center (HPRC) and the Department of Defense (DoD) to educate service members and retirees, their family members, leaders, healthcare providers, and DoD clinicians about dietary supplements and how to choose them wisely.
OPSS has partnered with Natural Medicines Comprehensive Database (NMCD) to provide all DoD personnel with access to evidence-based information on dietary supplements, including Natural Medicines Brand Evidence-based Ratings (NMBER)®.
Now there is an Operation Supplement Safety & Natural Data (OPSS & ND) app available that can help you make an informed decision by giving you:
- Dietary supplement safety and effectiveness (NMBER) ratings.
- Interaction ratings between drugs and natural medicines, known as “adverse reactions.”
- Effectiveness ratings for natural medicines by medical condition and more.
To access the app you must first visit HPRC’s link to NMCD and sign up for your free account. Click on the Warfighter version and use your valid .mil email address. Once you’ve created your free account you will have access to the full version of the app. Up-to-date reviews of commercially available products, Natural Medicines Brand Evidence-based Ratings (NMBER)® for commercially available products, an Effectiveness Checker, and more will be at your fingertips.
If you have questions, please use the “Ask the Expert” button on the OPSS home page.