Page 60 - Journal of Special Operations Medicine - Winter 2015

training are forced to occur at a time not aligned with for task-specific requirements relative to Special Opera-
a Special Operator’s physiological circadian rhythm. tors’ individual factors; (3) optimizing mental perfor-
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Chronically, this misalignment is associated with in- mance through hydration, macronutrient distribution
creased disease risk, making the reduction of other, and timing, and appropriate dietary supplements; (4)
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more controllable, disease-risk factors elsewhere in a using fluids, macronutrients, micronutrients, and di-
Special Operator’s lifestyle even more critical. Acutely, etary supplements, as warranted, to lessen detrimental
caffeine can enhance adjustment to altered sleep/wake effects of arduous environments; and (5) making unbi-
patterns by decreasing sleepiness. There is some evi- ased dietary supplement recommendations by balancing
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dence for the use of melatonin supplements for promoting scientific evidence for health and performance benefits
sleep in specific populations 113,114 though military-unique with documented safety concerns.
applications of melatonin and its usefulness for sleep
initiation and benefit for circadian misalignment in a Reactive Component: Medical Treatment
healthy population require additional study. Chrono-
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nutrition, or the manipulation of circadian rhythm with Inherent risks associated with the SOF mission and envi-
the timing of nutrients, may provide a dynamic ad- ronment increase the potential for medical treatment over
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aptation technique for Special Operators with unpre- a Special Operator’s career. Medical nutrition therapy is
dictable shifts in work schedules. Researchers who have the use of specific nutritional interventions to treat an
studied shift workers have reported associations between illness, injury, or condition, and spans initial hospitaliza-
circadian rhythm adaptation and meal quantity, macro- tion through rehabilitation to return to duty. Manipula-
nutrient composition, and timing. These preliminary tion of calories and macro-, micro-, and phytonutrients,
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data supporting chrononutrition emphasize the need for based on pre-injury nutrition status and severity/type of
Special Operators to monitor meal timing in relation to trauma suffered, has been shown to be beneficial in
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wake time, as well as the quantity of meals and daily in- the treatment of common combat- and training-related
take, to identify both beneficial and negative individual injuries such as burns, wound healing and tissue re-
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associations with schedule adjustments. To facilitate cir- generation, and traumatic brain injuries. Continu-
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cadian misalignment adjustment, dining facilities should ous nutrition support from the time of injury through
provide a variety of food choices for Operators’ altered the rehabilitation process is essential for rapid return to
sleep/wake cycles (e.g., offer dinner options in addition duty. Though wound healing often increases calorie
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to breakfast foods at the early morning meal for Opera- and protein needs, these requirements must be balanced
tors returning from overnight missions). with decreased needs associated with long periods of in-
jury-induced reductions in physical activity. If body fat
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Additionally, sleep/wake cycles that minimize Special and muscle mass changes are not monitored throughout
Operators’ exposure to daylight may result in vitamin the rehabilitation process, the Special Operator’s return
D deficiency or insufficiency, 30,118 which has been asso- to full duty may be delayed. Beyond acute injuries and
ciated with decrements in physical and cognitive per- illnesses, medical nutrition therapy for the treatment
formance, 30,119 to include processes essential to combat of familial- and lifestyle- associated conditions such as
operations, such as immune function, response to stress, hypertension, insulin resistance, and dyslipidemia, also
and neuromuscular function. Vitamin D deficiency has contribute to Special Operator readiness and longevity.
also been associated with reduced testosterone levels, re- Medical providers should request clinical nutrition sup-
duced neuromuscular function, increased risk for muscle port and refer for nutrition counseling as early as pos-
or bone injury, prolonged recovery following mild trau- sible for all clinical conditions and rehabilitation with
matic brain injury, and potentially increased risk for post- nutrition and body composition implications. Special
traumatic stress disorder. Medical providers should Operators should seek nutrition counseling for wound
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screen for vitamin D deficiency or insufficiency by testing healing, delayed rehabilitation outcomes, and uninten-
25-hydroxyvitamin D levels. Based on test results, medi- tional body composition changes related to recovery.
cal providers should recommend schedule adjustments
to accommodate increased sun exposure, provide a refer- A comprehensive performance nutrition program ad-
ral for nutrition counseling, and/or prescribe supplemen- dresses medical treatment by facilitating nutrition sup-
tal vitamin D3 as indicated by test results. 120 port throughout inpatient and outpatient treatment to
the transition from rehabilitation to return to duty.
A comprehensive performance nutrition program ad-
dresses task-specific performance by: (1) basing event Organizational Culture and Resources
fueling and recovery plans on event- and condition- Eating programs as diverse as Paleo for Athletes and
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specific factors; (2) making body composition recom- The China Study diet put varying emphases on macro-
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mendations based on service-specific standards, chronic nutrient distribution and sources by discouraging or pro-
disease prevention, and optimal strength to weight ratio moting specific foods. The diversity of these programs,

48 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015