A Threat to Military Combat Power: Dietary Supplements

Whaley, David A.; Sylvester, Jillian E; Deuster, Patricia A.

doi:10.1016/j.amjmed.2021.07.026

Cited by 4 publications

(4 citation statements)

References 5 publications

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“… 15 , 16 , 17 , 18 , 19 , 20 These dietary supplement products have been associated with adverse events such as stroke, hepatoxicity, and even death. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 The most recent statistics from 2004 to 2013 showed that dietary supplements were associated with an estimated 23 000 emergency department visits each year and many were due to products marketed as weight loss. 28 It is unknown what these statistics are today.…”

Section: Introductionmentioning

confidence: 99%

“…Service members may face serious consequences beyond exposure to a potential serious adverse health effect or a resulting performance decrement, such as the risk of positive drug tests, which could jeopardize their military careers if they mistakenly take a product that contains a drug (prescription or unapproved) or other substance prohibited for use. 26 , 30 Yet, fraudulent marketing of weight loss products—some with exaggerated claims, some that are potentially dangerous, and some containing illegal ingredients—continues, especially through online sources. Some sources even target service members through offering military discounts.…”

Section: Introductionmentioning

confidence: 99%

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Label Accuracy of Weight Loss Dietary Supplements Marketed Online With Military Discounts

Crawford,

Avula,

Lindsey

et al. 2024

JAMA Netw Open

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ImportanceDietary supplements for weight loss, among the most popular supplement products on the market, are promoted not only for losing weight and shedding fat, but also for added benefits of energy and performance, all packed into 1 capsule with multiple combinations of ingredients. Fraudulent marketing of weight loss supplements, some with exaggerated claims, some that are potentially dangerous, and some that contain illegal ingredients, is ever present, especially through online sources, where multiple manufacturers target service members by offering military discounts.ObjectivesTo examine whether select dietary supplements marketed online for weight loss from companies advertising military discounts are accurately labeled according to the Supplement Facts listed ingredients, whether they contain any ingredients prohibited for use in the military, and to qualitatively describe the products’ label claims.Design, Setting, and ParticipantsIn this case series, 30 dietary supplement products marketed for weight loss were selected and purchased in June 2023 from 12 online companies advertising military discounts. Data were analyzed from July to August 2023.Main Outcomes and MeasuresLiquid chromatography-mass spectrometry was used to verify whether products were accurately labeled according to the Supplement Facts listed ingredients and whether they contained any substances on the DoD Prohibited Dietary Supplement Ingredients List. A separate analysis was conducted to describe product label claims by using the Operation Supplement Safety (OPSS) Risk Assessment Scorecard.ResultsOf the 30 products tested, analysis showed that 25 had inaccurate labels. Of these, 24 had ingredients listed on the label that were not detected (misbranded); 7 had hidden components not present on the label, some of which would be considered adulterated; and 10 had substances on the DoD Prohibited Dietary Supplement Ingredients List either on or hidden from the label. All products were rated as risky when applying the OPSS Scorecard.Conclusions and RelevanceIn this case series study, the majority of products had inaccurate labels. Some were misbranded, others would be considered adulterated with ingredients not allowed in dietary supplements, and some contained ingredients prohibited for use in the military.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Label Accuracy of Weight Loss Dietary Supplements Marketed Online With Military Discounts

Crawford,

Avula,

Lindsey

et al. 2024

JAMA Netw Open

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“…13 Of great concern, however, are the deaths of several service members potentially associated with DS use and others who were hospitalized with hepatic injury or suffered other AEs from taking DSs containing harmful ingredients. [14][15][16][17][18] Although the evidence is limited, even excessive use of some vitamin and mineral supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]). 18 Therefore, identifying supplements that are safe to consume and have scientifically validated efficacy is critical for sustaining military health and performance.…”

mentioning

confidence: 99%

“…Users of purported steroid analogs were more than 2.5 times more likely than nonusers to report experiencing dizziness 13 . Of great concern, however, are the deaths of several service members potentially associated with DS use and others who were hospitalized with hepatic injury or suffered other AEs from taking DSs containing harmful ingredients 14–18 . Although the evidence is limited, even excessive use of some vitamin and mineral supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]) 18 .…”

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confidence: 99%

Challenges in Reporting Adverse Events From Dietary Supplements

2023

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In 2008, the Institute of Medicine Committee on Dietary Supplement Use by Military Personnel recommended the development of service-wide military policies (eg, education or regulations) to guide commanders in management practices for safe use of dietary supplements (DSs). This review summarizes the activities the military has undertaken to advance the safe use of DSs by service members and develop best practices on reporting adverse events across the Department of Defense (DoD). In March 2022, the Department of Defense issued a DoD Instruction (DoDI) regarding the use of DSs by members of the US military. This DoDI provides guidelines to establish an official list of prohibited substances. The DoDI also identifies Operation Supplement Safety at CHAMP as DoD's “go-to” program for DS use and information about DSs and ingredients. Noted are a number of gaps in the reporting of adverse events from DSs that need to be addressed by multiple constituencies.

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