Tracking adverse reactions to dietary supplements could help military readiness

Airman 1st Class Daniel Brosam

Could dietary supplement use by service members pose a threat to military readiness? Dietary supplements are readily available in retail stores on military bases, niche stores close to military bases, and over the internet. But few people realize that many of these supplements contain ingredients that could make them dangerous to the very service members we depend on to keep our nation safe.

Dietary supplement use is considerably higher in the United States Armed Forces compared with civilian populations, with more than two thirds of service members using them weekly or more often compared to 50 percent of the general population. Bodybuilding, energy or pre-workout, and weight-loss dietary supplements are commonly used by military personnel, likely due to their unique occupational demands and body composition requirements. However, predatory marketing strategies targeting service members likely also influence their high rates of use.

Dietary supplements can be dangerous when they contain adulterants or contaminants, such as steroids, stimulants, prescription drugs, or heavy metals, or when they contain multiple ingredients with unknown interactions. Likewise, due to potential interactions, it is risky to take dietary supplements with multiple stimulants or to use multiple dietary supplements while also taking prescriptions or over-the-counter medications. Which types of supplements have been found most often to carry these risks? Exactly the types that service members are especially likely to use: those sold for bodybuilding, energy or pre-workout, and weight loss.

Banned workout stimulant found in 14 dietary supplements

More than a decade ago, a series of devastating injuries to service members caused by dietary supplements — referred to as adverse events by the Food and Drug Administration ­­­— propelled the Department of Defense to establish Operation Supplement Safety as the “go to” resource for service members and their healthcare providers. The goal of OPSS is to provide the tools and resources to help users make informed decisions about dietary supplements to reduce the potential risks to their health and careers.

Now an established program, OPSS provides service members a reliable resource to ask questions by means of an Ask-the-Expert portal, be educated about dietary supplements, and utilize the OPSS Risk Assessment Scorecard when considering using dietary supplements. OPSS also maintains a continuously updated list of prohibited ingredients on its website that is publicly accessible for service members and civilians.

Despite the threat that dietary supplements pose to readiness of the nation’s service members, there is no system in place to track adverse events experienced by service members due to supplements. It is estimated that less than 2 percent of adverse events are reported to the FDA or to other appropriate systems, such as health departments. Without a centralized reporting system in the military for adverse events caused by dietary supplements, the Department of Defense has not had the vital data needed to quickly identify risky products and intervene to avert avoidable injury or illness in service members. But this may soon change. The National Defense Authorization Act of 2022, signed into law by President Joe Biden December 27, 2021, and for the first time includes reporting language from both the Senate and House committees urging the Department of Defense to address the gap in reporting of dietary supplement-related adverse events.

The reporting language from both committees is a huge step forward in the effort to have an internal Department of Defense reporting system that has not been realized to date, despite a recommendation by the Institute of Medicine in 2008. Adverse event reporting on dietary supplements in the Department of Defense would inform both the military health system and the FDA about potential health risks, which would have a beneficial impact on patient care, public safety, and mission readiness.

OPSS is a program under the Consortium for Health and Military Performance at the Uniformed Services University of the Health Sciences.

Melissa Givens, MD, MPH, is the Executive Director of the Consortium for Health and Military Performance, a DoD Center of Excellence at the Uniformed Services University.

Andrea T. Lindsey, MS is the Director of Operation Supplement Safety and Senior Nutrition Scientist for the Henry M. Jackson Foundation for the Advancement of Military Medicine, in support of the Consortium for Health and Military Performance.

Allison Ivie, MPP, MA, is the Vice President of Center Road Solutions, L.L.C.

S. Bryn Austin, ScD, is a professor at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital and founding Director of the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED.

Patricia A. Deuster, PhD, MPH, FACSM, is a professor at the Uniformed Services University and Chief Science Officer of the Consortium for Health and Military Performance.

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