Page 89 - Journal of Special Operations Medicine - Fall 2014

put forward and approved in 2012. Approved products on the market. Importantly, DSs are defined as con-
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are typically safer, healthier, and more likely to sustain taining one or more of the following dietary ingredients:
performance with no untoward effects than those prod- vitamins, minerals, herbs, or other botanicals, amino
ucts that do not meeting the criteria. acids, and other substances (e.g., enzymes, organ tis-
sues, glandulars, and metabolites); they are intended to
supplement the diet by increasing the total dietary in-
2. Read the “nutrition facts” label for all packaged foods take of that ingredient. Today, many products do not
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to determine energy, nutrient, and vitamin content.
“supplement the diet” but rather claim to build muscle,
The second commandment is straightforward and simply enhance weight loss, increase energy, enhance sexual
states that one should read the Nutrition Facts label/panel prowess, optimize performance, mitigate pain, ensure a
on all packaged foods prior to purchasing them. The good night of sleep, and so on. The original intent of
Nutrition Facts label was introduced in 1993 by the US DSHEA has been lost, and consumers have no way of
Food and Drug Administration (FDA) to provide a va- knowing what is and what is not safe to use; a public
riety of nutritional information on food packages to all health problem has emerged because of inadequate fed-
consumers. On 27 February 2014, the FDA proposed eral oversight of the DS industry, 17−22 which is a very real
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changes to ensure the Nutrition Facts label provides the concern for the US military, as many military members
latest scientific information linking diet and chronic take a variety of different supplements while engaged
diseases. The proposed label changes would (1) replace in diverse occupations under hazardous environments.
out-of-date serving sizes to clearly indicate how much The DSs consumed by military personnel have typically
a person could actually eat; (2) include a line for added not been tested under military operational conditions.
sugars; (3) omit calories from fat but keep saturated and Most have not been tested at all.
trans fat on the label; (4) add vitamin D and potassium;
and (5) highlight key parts to maximize understanding The most significant concerns relate to multi-ingredient,
of serving size. For a comparison of the current and the unapproved ingredient, adulterated, and contaminated
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proposed Nutrition Facts labels, please check out http:// DS that could pose a significant risk to SOF and com-
hprc-online.org/ and search for Nutrition Facts. promise readiness. 7,18,23−35 Thus, SOF should be aware
that some products might well be harmful. One very
Currently, each nutrient is given as a percent of Daily important check for a supplement is to see whether it
Values (DVs), which are the recommended levels of in- has been “third party” certified or verified. Independent
take based on a 2,000-calorie diet. Daily values also oversight is important for ensuring quality in any busi-
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will be updated on the new label for various nutrients: ness or industry, and third party certification/verifica-
sodium, dietary fiber, and vitamin D. If a food product is tion refers to a product that has been reviewed by an
a good source of a particular nutrient associated with a independent organization. Typically, the product is then
health benefit, it may be noted as such. Claims that may given a seal of certification/verification (e.g., NSF Certi-
be made on food products as defined by statute and/ fied for Sport, USP): one showing that it has been ana-
or FDA regulation include health claims, nutrient con- lyzed (e.g., ConsumerLab.com) or one showing that it
tent claims, and structure/function claims. To date, no does not contain any substances banned by the World
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“performance” claims are allowed. Information about Anti-Doping Agency (Figure 1).
these categories may be obtained from Label Claims for
Conventional Foods and Dietary Supplements. The buyer, resourceful and skeptical of exaggerated
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claims made regarding expensive DS products, must
be informed. Table 1 presents selected questions that
3. Most Americans do not need dietary supplements.
should be asked prior to purchasing any DS. Of con-
The third commandment deals with the topic of “dietary cern is that each year many adverse events, including
supplements.” The 1994 Dietary Supplements Health headaches, central nervous damage, liver failure, kidney
and Education Act (DSHEA) defined dietary supple- stones, rhabdomyolysis, seizures, peptic ulcers, and even
ments and placed them in a special category under the
general umbrella of “foods,” not drugs. As a result Figure 1 Examples of certification, verification, or evaluation
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of DSHEA, the FDA does not evaluate the safety, ef- seals found on supplements that have been reviewed by an
ficacy, or quality of DS ingredients or products. In other independent third party.
words, supplements are not subject to premarket safety
evaluations and manufacturers are not required to dem-
onstrate product safety or effectiveness prior to market-
ing. Although this exemption may have been suitable
in 1994 when only 4,000 DSs were available, it is not
adequate in 2014 when more than 55,000 products are

The 10 Commandments of Nutrition 81