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HPRC Fitness Arena: Dietary Supplements
Following in the wake of the Food and Drug Administration’s warning letters to manufacturers and distributors of dietary supplements containing DMAA, the Army announced that its own study on the effects of DMAA on soldiers will continue. Read about the announcement and more in the recent Stars and Stripes article. For more information about the FDA’s action, you can read HPRC’s post, which also includes a link to the FDA news release.
The Food and Drug Administration (FDA) sent warning letters to manufacturers and distributors of dietary supplements containing 1,3-dimethylamylamine (DMAA) due to lack of safety evidence provided before marketing. The FDA states that information about the safety of DMAA as a dietary supplement ingredient has not been identified. For more information, see the FDA News Release and HPRC’s latest on Dietary Supplement Products Containing DMAA.
The latest news on DMAA includes the New Zealand government’s ban just placed on DMAA-containing products. DMAA has already been declared a drug in Canada and is banned by the World Anti-Doping Agency, the United States Anti-doping Agency (USADA), collegiate sports teams, and most professional sports teams.
HPRC has again updated its list of DMAA-containing dietary supplements, including a number of additions as well as some products that have been discontinued or reformulated. The additions mostly represent lesser-known products that have been around a while, but surprisingly there are a couple new products too. And we have added two new “aliases” to the list of other names for DMAA. To download the list, click on this link to “Dietary Supplement Products Containing DMAA.”
HPRC has written about energy drinks and their possible adverse health effects; these drinks continue to be in the news following the death of a teenage girl due to caffeine toxicity from drinking two Monster energy drinks. Senator Dick Durbin has now urged the Food and Drug Administration (FDA) to investigate energy drinks, specifically to regulate caffeine in these drinks (caffeine content in colas is already regulated) and determine whether other ingredients contained in them are safe. Read the press release and Senator Durbin’s letter to FDA.
Do you buy dietary supplements when you want to lose weight, improve your performance, or give yourself a boost to get through a long day or hard workout? Then watch for this soon-to-be-released service-wide educational campaign by the Department of Defense in collaboration with the Human Performance Resource Center. Operation Supplement Safety (OPSS) will help Warfighters and their families make informed decisions when choosing dietary supplements. See HPRC’s new OPSS link for an introductory article on supplement safety.
The goal of National Nutrition Month is to remind Americans to eat healthy and choose foods with good nutrition. The FDA’s theme for 2012 is “Remember to Use the Nutrition Facts Label.” One tool you can use to help make good food choices is the Nutrition Facts label that appears on all packaged foods and beverages. To learn how to read labels, visit the FDA’s web page “Nutrition Facts Label Programs and Materials.”
HPRC has received a number of questions about whether dietary supplements—especially those used for bodybuilding and weight loss—could result in a positive result on military drug tests.
Military drug testing begins with urine, which is first screened and then followed by additional tests depending on the outcome of the screen. You can get extensive information about DoD’s drug policy and drug testing from the Drug Demand Reduction Program (DDRP), including military testing. And for answers about the potential effects of specific dietary supplements on drug screening tests, you can contact your service’s military drug-testing laboratory by phone or email at:
- U.S. Army, Fort Meade, MD – (301)-677-7085 or USArmy.Meade.Medcomfirstname.lastname@example.org
- U.S. Army, Tripler AMC, HI – (808)-433-5176 or email@example.com
- U.S. Navy, Great Lakes, IL – 847-688-2045, press 2 or ext 113, or NDSLGLfirstname.lastname@example.org
- U.S. Navy, San Diego, CA – 619-532-5180 or NDSLSDemail@example.com
- U.S. Navy, Jacksonville, FL – 904-542-7755, press 2 or ext 104, or DLJAX@med.navy.mil
- U.S. Air Force, Lackland AFB, TX – (210) 292-3089 or firstname.lastname@example.org or 210-292-3101 or email@example.com
Positive urinalysis results due to dietary supplement use can occur because products on the market may contain undeclared drug ingredients—that is, controlled substances that are not stated/listed on the product label. More information can be found in the FDA Consumer Update There you will also find information about how to get updates about products FDA has identified as tainted. There is no way to know if a particular supplement contains an undeclared drug without laboratory testing, but FDA does keep track of such products once identified through its MedWatch program.
The Department of Defense (DoD) currently has no formal policy on the use of dietary supplements and no list of either banned or safe supplements. For more on this topic, see Operation Supplement Safety’s (OPSS) FAQ “Is there an all-encompassing list of dietary supplements that are banned or illegal for use by military personnel?”
Lately, HPRC has been receiving a lot of questions about 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) is working on an educational campaign to inform Warfighters and their families about potential health risks involved with taking dietary supplements and steps to take before choosing/using a dietary supplement. And although DoD currently has no formal policy on the use of dietary supplements, a committee is working to establish such a policy.
Some dietary supplements, including ones sold on military installations, may contain potentially harmful and problematic ingredients. HPRC has put together the resource Red Flags: What You Need to Know to Stay Safe and Avoid Fraud. Of particular note are problematic, potentially dangerous ingredients that could be red flags, including approved prescription drug ingredients and their analogs, drugs banned by the FDA for safety reasons, controlled substances (such as anabolic steroids), and untested/unstudied new active drug ingredients.
You can also learn more on how to make informed decisions about dietary supplements and natural products from the Natural Medicines Comprehensive Database (NMCD). HPRC has made this available to all active-duty personnel; a “.mil” email address is required to create an account. We encourage consumers of dietary supplements to consider only using products rated eight or above on their rating scale. These are in the green area of the scale and have evidence of safety. Items in the yellow range mean data are lacking, and the red area indicates well-known safety concerns and/or proven ineffectiveness. HPRC makes this user-friendly database readily available through links on its website for both Warfighters and healthcare professionals. Choose the appropriate version and follow the instructions to create an account.
Generally, if a supplement is not banned or recalled by the FDA, FTC, or DEA, then it is not banned by DoD. 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). Currently, United States Pharmacopeia (USP) and NSF International conduct safety reviews, and NSF screens for substances banned by the World Anti-Doping Agency (WADA) or United States Anti-Doping Agency (USADA). Multiple professional sport/athletic organizations—including MLB, NHL, NBA, NFL, and NCAA—currently have policies requesting the use of NSF-certified products only. Shop for products with seals from USP and NSF International.
We encourage you to talk with your healthcare provider or dietitian before using dietary supplements to avoid potential problems. Also, see FDA’s list of tainted body building products, which includes important public notifications.
One Shot One Kill: Want to learn how the elite warrior accomplishes optimal performance time after time, under the most challenging conditions? The HPRC now has new program materials for the One Shot One Kill (OSOK) performance enhancement program online for you to use and download—by yourself or with your unit! One Shot One Kill (Integrative Platform version) is a “warrior-centric” performance enhancement program that warriors can set up and manage on their own. OSOK-IP is designed to enhance performance, hardiness, and resilience. By building on the skills that Warfighters already possess, OSOK aims to translate good Warfighter qualities to outstanding ones. OSOK-IP comes in two versions:
OSOK-IP Solo is a step-by-step integrative training plan, with supplemental materials, that enables the individual Warfighter to pursue this method of Total Fitness on his or her own and reach the optimal level of performance in almost all areas of life.
OSOK-IP Train the Trainer enables your unit to train as a group by selecting one member to learn and present OSOK-IP to the rest of the unit. This section of the website has the full curriculum available to download and even customize OSOK-IP content for your own military culture and unit.
We look forward to your feedback, too. Check out OSOK and let us know what you think!
A web-based dietary supplement education module is available for military healthcare providers to provide valuable information about identifying and reporting adverse events, how to take a comprehensive supplement history from patients, and where to get evidence-based resources on evaluating dietary supplement literature. This two-hour module is available from HPRC’s website, and continuing education credits are available for those who are eligible.