A new dietary supplement ingredient, dendrobium, is appearing rapidly in dietary supplement products promoted to boost athletic performance. According to the Natural Medicines Comprehensive Database, manufacturers claim that dendrobium is a natural source of the stimulant phenylethylamine, but some researchers say that phenylethylamine doesn’t occur naturally in dendrobium. Phenylethylamine is a stimulant, with effects similar to those of amphetamines. At this time, the safety of dendrobium is unknown, so users should be aware that products containing this ingredient might be unsafe, particularly when used in combination with exercise.

Operation Supplement Safety (OPSS) is about to launch this summer and will answer many of your questions about Dietary Supplements. Watch for HPRC’s announcement coming soon.

Up-to-date information on tainted products marketed as dietary supplements are now provided on HPRC’s Dietary Supplement domain page via a “widget” from the Food and Drug Administration (FDA). Recent product alerts and health information on products marketed for weight loss, sexual enhancement, and bodybuilding are automatically displayed and updated as the FDA adds new notifications. Please see this new feature by visiting HPRC’s Dietary Supplements section.

The latest update of HPRC’s list of DMAA-containing dietary supplement products is now available online. Six more products have apparently been removed from the market; one has been added to the list because the fact that it contains DMAA is stated only on the product label, not on the manufacturer’s website.

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.

Inhalation of major air pollutants has been found to decrease lung function and exacerbate symptoms of exercise-induced bronchospasms, including coughing, wheezing, and shortness of breath.  In order to meet oxygen demands during light- to moderate-intensity exercise, you take in more air with each breath. And when you breathe through your mouth, you bypass the nose’s natural filtration of large particles and soluble vapors. As your exercise intensity increases, you breathe faster and deeper, which also increases the amount of pollution inhaled and the depth it travels into your respiratory system.

If you live in or near a busy city, you are exposed to even more combustion-related pollutants—such as nitrogen oxides (NO_x), carbon monoxide (CO), particulate matter (PM), and ozone—that can inflame your airways and worsen asthmatic responses. Exposure to freshly generated emissions is most common near areas of high vehicular traffic.

While indoor exercise is often a good alternative to limit exposure to outdoor pollutants, some indoor conditions may be just as toxic. Nitrogen dioxide (NO₂₎—the more toxic NO_x—is usually higher in gas-heated homes and indoor areas with poor ventilation. Carbon monoxide poisoning is also more likely to occur indoors. When carbon monoxide is in your system, the blood carries substantially less oxygen, reducing performance and eventually leading to carbon monoxide poisoning. Be sure to choose well-ventilated areas for indoor exercise.

Particulate matter and ozone are two significant pollutants you may be exposed to outdoors. Inhalation of high levels of particulates has been shown to reduce exercise performance as much as 24.4% during short-term, high-intensity cycling. Women may be more vulnerable than men to certain particulates, associated with greater decrements in performance. Ultrafine particle concentrations are highest in freshly generated automobile exhaust, and these small particles can be carried deep into the lungs. However, the further away you are from fresh exhaust, the less concentrated the particulates.

Bad ozone occurs lower in the atmosphere; it is not directly emitted into the air but is created from chemical reactions between NO_x, volatile organic compounds (VOCs), heat, and sunlight. Ozone levels also are higher in summer than in winter; and especially in larger, hotter cities, concentrations tend to peak around midday when solar radiation is highest. Exposure to ozone during exercise has been found to increase resting blood pressure, reduce lung function, and decrease exercise capacity.

The risks associated with not exercising at all are far greater than the risks of exercising outdoors; it just takes a little more planning on days and in conditions when pollution is bad.  When planning outdoor exercise activities, follow these tips to limit your exposure to pollutants:

• Avoid exercising in areas of heavy traffic, such as along highways and during rush hour.
• During summer, exercise earlier in the morning, when ozone levels and temperatures are not as high.
• Check the domestic or international air-quality ratings to determine if it’s safe to exercise outside. Limit your time outside on Code Red and Code Orange days. Environmental conditions on these days are not healthy, especially for children, the elderly, and people with existing respiratory conditions.
• Exercise indoors when the air quality indicates high ozone and particulate levels.
• Before any demanding physical activity, limit your carbon monoxide exposure by avoiding smoky areas and long car rides in congested traffic.

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.

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.