Filed under: Risks
DMAA has been illegal for use as an ingredient in dietary supplements for more than 3 years. It still is, but just when you think it would be disappearing from the market, it seems to be on a slight rise again. Our online search of available dietary supplements with DMAA turned up 11 products we had never encountered before, in addition to 34 products still on the list since before DMAA became illegal. We also found 50 discontinued products with DMAA still being sold by third-party retail outlets.
Unfortunately, illegal substances of all kinds are readily available on the Internet. For example, ephedra has been illegal since 2004, when FDA acted on growing reports of severe adverse events, including deaths, associated with the popular weight-loss supplement ingredient. However, products containing ephedra are commonly marketed online. Even substances on the Drug Enforcement Agency’s list of controlled substances can be purchased online. Worse, laboratory testing of dietary supplement products sometimes reveals the presence of illegal ingredients even when they aren’t listed on the products’ labels.
Ingredients such as DMAA are not allowed in dietary supplements because, according to FDA, “they can be a health risk to consumers.” Stay informed, starting with the OPSS FAQ about DMAA and updated list of Dietary Supplements/Products Containing DMAA.
Since July 2016, the Food and Drug Administration (FDA) has released over 25 Public Notifications about individual supplement products marketed for sexual enhancement and weight loss that contain hidden active ingredients. Through laboratory testing, these products were found to contain drugs and controlled substances—ingredients that pose health and readiness risks. For a list of these Public Notifications, visit FDA’s Tainted Sexual Enhancement Products and Tainted Weight Loss Products.
The most common types of products found to contain “undeclared” ingredients (that is, substances not listed on the label) are those marketed for weight loss, sexual enhancement, and bodybuilding. Dietary supplements don’t require FDA approval before being put on the market, and there is no way to know the contents of a product without laboratory testing. So if you’re considering a dietary supplement, check the label to see if the product has been evaluated by an independent third-party organization.
Searching for reliable information about dietary supplements and don’t know where to go? Operation Supplement Safety (OPSS) has answers for you. OPSS has a comprehensive “Frequently Asked Questions (FAQs)” section with subcategories about general and miscellaneous topics, dietary supplement ingredients, performance, and weight loss. Or if you’re an educator and need some videos or short PSAs, click on “Tools for Warfighters,” and then search the “Video” tab. We also have materials that can be printed for distribution or ordered through the USAPHC Health Information Products e-catalog.
Didn’t find what you’re looking for while in OPSS? Use our Ask the Expert button located on the OPSS home page.
Sitting in front of a computer for hours can make your eyes tired, and your visual performance can suffer. To help with potential negative effects, create an environment that has equal brightness everywhere around your computer screen. Try these tips to help:
- Reduce intense fluorescent lights.
- Turn on some lights if you usually look at computer screens in the dark.
- Dim excess light coming through windows with blinds, tinting, or window covers.
- Avoid glare on your computer screen.
- Take microbreaks to look at distant objects.
If you’re in an office environment, if possible, turn off overhead lights and have a table lamp for softer light. If you can’t control the lighting in your environment, there are screens you can place on top of your computer screen to reduce glare. In a previous article, we highlighted how 30-second microbreaks every 20 minutes can ease physical discomfort and improve mental performance when working in front of a computer. Similar breaks also help reduce eye strain. Experts suggest looking at a distant object at least twice every hour to help prevent visual fatigue. So if you take a break every 20 minutes for brief stretching, make sure it also includes looking at a distant object to help both your eyes and body.
Stimulants can be dangerous to your health, especially in large quantities, but they’re what give energy drinks their “punch.” You may already know caffeine is a major stimulant found in energy drinks. But do you know that energy drinks often contain other stimulants? These can include “hidden sources” of caffeine (such as guarana, green coffee bean, green tea, and yerba mate), yohimbe, and synephrine (bitter orange).
Many energy drinks, however, aren’t labeled with the amounts of caffeine or other stimulants in them. Some or all of these ingredients are often part of “proprietary blends,” so it’s impossible to determine from the label the exact amount of each ingredient you would be taking. Furthermore, energy drinks might be mislabeled or marketed as sports drinks, causing even more confusion.
Remember, stimulants come in many different forms, so Operation Supplement Safety (OPSS) put together a list of stimulants found in dietary supplements to help you identify these potentially harmful ingredients. And to help you understand what’s in your energy drink, check out the OPSS infosheet on energy drink labels, which includes helpful notes about ingredients.
For older men, it’s especially important to lead a healthy and physically active lifestyle since the risk for certain chronic diseases increases with age. Multiple studies have found that as little as 30 minutes a day of moderate- to vigorous-intensity exercise can significantly lower a man’s risk for heart disease and related risk factors such as diabetes, high cholesterol, and high blood pressure. Age is also a significant risk factor for developing prostate and colorectal cancers, which makes prevention and risk-factor management even more important for older men.
Exercise has been linked to lower risk and rates of death for prostate, lung, and colorectal cancers, the three most common cancers experienced by men. So get out there! Take a brisk walk, go for a jog, swim, bike, play tennis, even certain heavy outdoor yard work is acceptable for this purpose. If you need more structure, try a gym—many fitness centers offer military discounts on memberships and personal training sessions. Some military facilities also offer group and family recreational activities. The important thing is to find an exercise routine that you enjoy. If it’s not fun or motivating then it’s not likely to become part of your lifestyle.
The benefits of an active lifestyle are numerous, but prevention is one goal to keep your regular exercise program on the right track. Be sure to consult with your physician before starting an exercise routine, especially if exercise is new for you. Living a healthy lifestyle and getting screened for health complications are important ways to maintain readiness, resilience and optimal performance.
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.
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.
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.
West Nile. Dengue. Malaria. Chikungunya. No, that’s not a typo. Chikungunya (pronounced “chik-en-gun-ye”), a mosquito-borne virus that primarily occurs in Africa, Asia, and the Indian subcontinent, and Warfighters deployed to these regions have been exposed to this risk for some time, now, however, it is reportedly spreading to Europe and the Americas. Most of the cases in the U.S. involve individuals who have recently traveled abroad, but the Centers for Disease Control and Prevention (CDC) just reported the first locally acquired case, in Florida.
The viral illness is characterized by fever and severe joint pain, but other symptoms include headache, muscle pain, joint swelling, and rash. There is currently no antiviral drug for Chikungunya, and treatment is aimed at relieving symptoms. Most patients will recover fully on their own, although sometimes symptoms persist for several months.
It’s important to know your environment. If you’re being deployed to these regions or even going there on vacation, there are things you can do to protect yourself from mosquito bites and mosquito-borne infections. Wearing long pants, shirts with long sleeves, and insect repellent while outdoors reduces the chance of an insect bite. Other precautions include removing standing water from containers such as flowerpots and buckets and placing screens over open windows and doors.
If you think you could have been infected, you should see your doctor, especially if you have recently traveled to high-risk regions. Visit the Center for Disease Control (CDC) for more information about Chikungunya.