KELLY KAIM, MS, RD, CSSD, TSAC-F
DIETARY SUPPLEMENTS —
WHAT IS BEHIND THE LABEL?
The views expressed in this article are those of the author, and
do not necessarily reflect the official position or policy of the U.S.
Army, the Department of Defense, or the U.S. Government.
American’s spend over 1.4 billion dollars on dietary supplements
annually and more than 50% of military service members
use dietary supplements one or more times per week (1,6). A
supplement contains one or more vitamins, minerals, herbs,
amino acids, or botanicals and includes everything from energy
drinks to muscle building supplements. While some supplements
may help to improve stamina, body strength, or overall health,
others are flat out dangerous or do not contain what is listed on
the label. The regulation of supplements is not well understood
by all military populations and other consumers. According to
a 2002 Harris Poll, “the majority of consumers believed that
dietary supplements are approved by a government agency, and
two-thirds thought that the government requires the labels of
supplements to include warnings of their potential side effects and
dangers,” (4). Unfortunately, neither of these sentiments is correct
and in fact, as a result of the 1994 Dietary Supplement Health and
Education Act (DSHEA), dietary supplements are now placed in
a separate “foods” category and therefore are exempt from the
Food and Drug Administration (FDA) standards and approval
(6). There has been a wide range of supplements identified to be
contaminated with toxic plant materials, metals, and even bacteria
(4). It is suggested that as much as 25% of dietary supplements
marketed to enhance physical performance contain ingredients
not included on the label (6). Many of these ingredients not only
present a safety concern for military populations and compromise
readiness, but also could potentially cause a positive urine test for
banned substances.
With the current lack of regulation for dietary supplements, it
can take months or even years for a product causing harm to be
pulled from the market. “For example, the FDA took approximately
10 years after issuing its first advisory about ephedra—a popular
weight loss supplement in the 1990s reported to have caused
heart attacks, seizures, and deaths—to gather sufficient data to
meet the statutory burden of proof before banning it from the
market in April 2004,” (6). Ephedra, a stimulant, can increase
metabolic rate and when taken along with caffeine or exercise can
be fatal. According to investigations, at least 15 service members
that consumed ephedra died during exercise (6). Another
ingredient often found in dietary supplements of concern is DMAA
(methylhexanamine or geranium oil), which acts much like an
amphetamine or ephedrine in the body and was originally sold as
a drug before being discontinued due to potential side effects (5).
12
Beverages marketed as energy drinks also fall under the category
of unregulated dietary supplements and can have adverse
side effects. Research from Operation Enduring Freedom in
Afghanistan found that almost 45% of deployed soldiers consume
energy drinks on a daily basis (2). The most common energy
drinks were evaluated for label accuracy and it was found that
25% contained 27 – 113% of the amount of caffeine that was listed
on the label (3). Caffeine in excess amounts is linked similarly
to serious adverse events occurring with ephedra and DMAA
containing products (5).
While dietary supplements are not a replacement for a poor diet,
the right ones can help supplement the diet to lead to desired
effects. But how do you know what you are getting if they are not
regulated and the labels are not accurate? Which supplements
are proven to enhance performance and which ones do little
more than burn a hole in your pocket? The first thing to do when
evaluating a supplement is to see if the product is third-party
certified. Third-party certifiers are outside entities that are hired
by the supplement company to help the consumer identify quality
products that meet FDA, manufacturing, and quality review
standards. The five primary third-party certifiers are National
Sanitation Foundation (NSF), United States Pharmacopeia
(USP), Informed Choice, Banned Substance Control Group, and
Consumer Lab (6). Lists of supplements that are third-party
tested and certified are a great starting point for finding a quality
supplement. However, keep in mind that most supplements are
third-party tested on an annual or semi-annual basis, so unless you
purchase the exact batch that has been tested, there are
no guarantees.
If the particular dietary supplement in question is not third-party
certified, it is important to identify if there are any red flags,
such as: does it contain over 100% of the daily value, are there
ingredients listed that have potential for positive drug tests,
is it a high risk supplement (e.g., bodybuilding, weight loss,
male enhancement, etc.), or does it contain a proprietary blend
where the actual amounts of each ingredient are not listed? The
Operation Supplement Safety (OPSS) website is a great resource
for additional information on identifying high risk supplements.
Lastly, when contemplating the use of a dietary supplement, it
is important to understand what research has been done on the
supplement in an environment similar to the one in which its use is
intended. For example, you would not want to look at research on
creatine’s effect on strength training if the intended use is distance
events. Another thing to keep in mind is that the supplement
company’s research on their own product is often biased in favor
NSCA’S TSAC REPORT | ISSUE 33