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HPRC Fitness Arena: Dietary Supplements
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.
What do you put in your body to boost your performance, increase your energy, shed pounds, build muscle, or otherwise supplement your diet? What’s in that drink, pill, or powder? What will it do for you? What will it do to you? Is it worth the risk?
More and more Warfighters are taking dietary supplements, most without being fully informed that some of the ingredients could have harmful side effects. HPRC has just unveiled its Dietary Supplement Classification System to provide this kind of information and help you make informed decisions about a particular supplement. To start exploring this new resource, visit HPRC’s new web pages. If you have a question, contact us via “Ask the Expert.”
The Food and Drug Administration (FDA) is advising consumers to stop using multiple weight-loss products that contain the undeclared drug ingredient sibutramine, which was removed from the market in 2010 for safety reasons and may present significant risks for those with coronary artery disease and other heart issues. The following 18 products have received FDA Public Notifications advising consumers not to purchase or use any of them:
- Lose Weight Coffee
- Dream Body Slimming Capsule
- Pai You Guo Slim Tea
- Botanical Slimming
- Fruit Plant Lossing Fat Capsule
- Sheng Yuan Fang
- Acai Berry Soft Gel ABC
- PhentraBurn Slimming Capsules
- Magic Slim Tea
- Magic Slim Weight Reduction Capsule
- P57 Hoodia
- Leisure 18 Slimming Coffee
- A-Slim 100% Natural Slimming Capsule
- Advanced Slim 5
- Ja Dera 100% Natural Weight Loss Supplement
- Slender Slim 11
For more information, see the FDA Tainted Weight Loss Products page, and click on a product name under “Public Notifications.”
Dietary supplement products containing DMAA have been temporarily removed from military stores by the AAFES, but they are still available on the public retail market. HPRC has prepared a list of many of these products to help you watch for them if you are considering the purchase of dietary supplements. DMAA is found most commonly in products sold for bodybuilding or weight loss, but it can also be found in other performance-enhancing products, as well as in recreational party pills. The list also includes other names for DMAA that may be found on product labels. To download the list, go to the Dietary Supplements Resources page under the “Resources” tab, or just
Do you really know what’s in that energy drink? There are different forms of stimulants in energy drinks, many of which are prohibited. The United States Anti-Doping Agency (USADA) has put together an information sheet on these “stimulant drinks,” including a helpful example of an ingredient label.
The Office of Dietary Supplements has released new fact sheets on multivitamin/mineral supplements. The QuickFacts version was designed for consumers; health professionals and those who want to know more can get additional detailed information from the Fact Sheet.
The Paleo Diet, also known as the Paleolithic or Caveman Diet, is based on the notion that by consuming what humans ate during the Paleolithic Era—wild animals, plants, eggs, tree nuts, vegetables, roots, fruits, and berries—we will be healthier, have lower disease risk, and live longer. Hunters/gatherers during that time had to rely on what was available and had no agriculture. But what are the implications of this type of diet for the athlete, let alone the average individual?
Foods that were grown and introduced after the Agricultural Revolution (roughly 10,000 years ago) are not allowed in the Paleo Diet. That means dairy and dairy products, grains, and legumes (beans, peas, and lentils) are excluded. Proponents of the Paleo Diet believe that we are “genetically programmed” to follow the diet of the hunters/gatherers. A specific book has been written for athletes who want to follow this diet, which accommodate athletes by allowing some carbohydrates: The authors present five stages of eating for the athlete to follow, based on the glycemic index (GI; how quickly food raises blood glucose levels). The stages are: (1) eating before exercise, (2) during exercise, (3) and 30 minutes after exercise, and (4) during post-exercise extended recovery and (5) long-term recovery. Low- to moderate-GI carbohydrates are recommended at least two hours prior to exercise. Sports drinks or high-GI carbohydrates are recommended for exercise lasting longer than 60 minutes. Immediately after exercise a recovery drink with carbohydrate and protein in a 4:1 to 5:1 ratio is recommended. Stage IV recovery foods (extended recovery) should be a 4:1 to 5:1 carbohydrate-to-protein ratio, with carbohydrates such as raisins, potatoes, sweet potatoes, and yams. Stage V recommends focusing on eating from the main Paleo Diet, with carbohydrates coming from fruits and vegetables. So one could argue that the Paleo Diet for Athletes is like most diets for athletes in that it requires carbohydrates. However, the Paleo Diet for Athletes is higher in protein and fat and lower in carbohydrates than what is recommended for athletes by most health professionals.
What we do know from scientific research is that carbohydrates provide the energy needed for endurance and resistance training, competitive athletic events, mental agility, and healthy living. Complex carbohydrates such as fruits, vegetables, whole-grain pasta, rice and grains, beans, and other legumes contribute to an overall healthy eating plan. By limiting consumption of some of these to only a brief time after exercise, the athlete runs the risk of not having enough fuel for the body, so the body will use protein for energy. Low-fat dairy products also contribute to a healthy lifestyle, providing much-needed calcium and vitamin D as well as probiotics. The Paleo Diet eliminates dairy entirely, even for athletes.
We also know from the scientific literature that during the post-exercise period, within roughly 30-45 minutes of exercise, eating a carbohydrate/protein snack, generally with a 3:1 carbohydrate-to-protein ratio, is essential to stimulate re-synthesis of muscle proteins and replenish glycogen (the storage form of carbohydrate). It doesn’t stop there: It is important to maintain glycogen levels in the muscle and liver to sustain all activities, especially over the course of several days. Eating high-carbohydrate snacks between training sessions is important to replenish glycogen stores. Carbohydrate intake recommendations for athletes are 6 to 10 g/kg body weight per day, or roughly 55% of daily calories from carbohydrates.
What’s the bottom line? Grains and dairy products are staples of modern-day society and provide essential nutrients to an overall healthy diet. By eliminating one or more food groups, you run the risk of missing important nutrients. And can we really eat as humans did during the Paleolithic era? Their life expectancy was about one quarter to one half of what ours is, and we benefit from research showing that eating a variety of foods over the course of time provides us with energy and the important vitamins and minerals needed to sustain us in daily activities and exercise.
A myriad of dietary supplements make their way to the market labeled as “healthy” for the public. However, many contain dangerous substances, including steroids, and consumers have no idea they are taking harmful substances. Supplement Safety Now, a public protection initiative, was founded by the U.S. Anti-Doping Agency to make sure over-the-counter supplements are safe for consumers. For more information, read more about this initiative.
Salmon is commonly touted for its omega-3 fatty acids. HPRC recently received a question about what foods other than salmon are the best sources of omega-3 fatty acids. For a complete answer, including the recommended intakes from the American Heart Association, please see HPRC’s answer.
Many adverse events associated with dietary supplement use go unreported. HPRC has developed one page information resources on how to report adverse events. Warfighters and their families can follow the directions for reporting adverse events to MedWatch (FDA) and Natural Medicines Watch. In addition to these sites, Health care providers can follow step by step directions for reporting via AHLTA.