Page 115 - JSOM Summer 2018

powerful—now!” are not consistent with the science and may for label claims for musculoskeletal pain. The most com-
be misleading. Although research suggests a large beneficial mon ingredient found in the DSLD is boswellia: 15 of the 41
effect of this ingredient, the quality of the evidence remains unique products contained this ingredient. Interestingly, bo-
low. Overall, the product label claims for the most part did not swellia studies tended to report large beneficial effects in re-
align with the quality of the evidence. For these ingredients, ducing pain intensity among patients with osteoarthritis, but
minimal adverse events to include minor gastrointestinal upset the quality of the evidence was questionable and the specific
have been reported. In all cases, obtaining the ingredient as formularies being studied were not well described. Hence, no
7
a food source when feasible was always recommended over evidence-based recommendations were made. Like curcuma,
8
any dietary supplement intake. However, the evidence sup- boswellia was identified as a high priority research area but
porting the use outweighed the evidence against the use, and not currently recommended for use. Claims like “Put an end
evidence-based recommendations in favor of these ingredients to creaks and pains” may be misleading to the consumer with
were ultimately made. no knowledge of the scientific evidence. For other ingredients,
evidence-based recommendations against the use were made
Some basic tips when considering the use of these ingredients when the evidence to judge was insufficient with any confi-
include: dence of added benefit to date. Healthcare providers and Op-
• Consult your healthcare provider before taking any di- erators may want to explore the ingredients where conditional
etary supplement. recommendations were made rather than focus on ingredients
• Read the entire label carefully to check all information. for which the evidence for benefit is very limited.
• Read the label claims with an objective eye.
• Do not assume that more is better: higher doses do not Summary
necessarily indicate better and quicker benefit and, in
some cases, cause problems. Dietary supplements are an attractive option to SOF Operators
• Check for verified/certified products at the NSF Cer- who seek alternative approaches to sustain their performance
tified for Sports or United States Pharmacopeia (USP) and combat pain from the physical demands of their job. As
Convention websites. the dietary supplement market continues to grow at a rapid
• Speak with a SOF performance dietician to explore us- pace, we as consumers and healthcare providers should be
ing these ingredients as a food source, if available and equipped with the tools to make objective, evidence-informed
feasible. decisions on what products to buy and what to look for on
• Go to USU CHAMP’s Operation Supplement Safety a label. What you can buy and the claims made on a label
(opss.org) and submit an Ask the Expert question. may not always align with the scientific evidence or “truth”
for benefit and/or potential risk. When selecting a product,
Buyers beware: select ingredients with label claims that are explore the ingredients where conditional recommendations
not supported by the current evidence to date were made, rely on the tips offered here, and always consult a
healthcare provider before using any product.
As noted in Table 1, a number of the ingredients evaluated
resulted in either no recommendation or a recommendation Disclosure
not to use. Table 3 displays these select ingredients based on The authors have indicated they have no financial relation-
the evidence and mapped to products in the DSLD search ships relevant to this article to disclose.

TABLE 3 Buyers Beware: Ingredients With Label Claims That Are Not Recommended for Current Use Based on the Available Evidence
No. of
Products With
Musculoskeletal
Pain Claims in Quality of the Does the Market
Ingredient DSLD (of 41) Examples of Claims Made on Product Label Evidence Match the Evidence?
Boswellia 15 • Highly effective, clinically studied ingredients to help Very low NO
you get back to your daily activities ⨁ High priority research
• Safe and effective professional pain formula area due to potentially
• May support the body's natural process for muscle large beneficial effects
pain and inflammation relief following exercise and but low certainty in
massage the evidence
• Recognized throughout the natural foods industry as
the standard for natural pain relief
• Natural herbal remedy shown to reduce swelling,
improve mobility and help prevent arthritis
• Put an end to “creaks” and pains.
Methylsulfonylmethane 10 • Reduces minor joint pain after strenuous exercise Very low NO
• “The Wave of the Future” ⨁ Insufficient evidence
• The answer to joint pain
• Formulated to work with your body in order to
safely and naturally promote joint health, strengthen
cartilage, and aid in joint pain relief!
Willow Bark 6 • Contains highly effective, clinically studied ingredients Very low NO
to help you get back to your daily activities ⨁ Insufficient evidence
Devil’s Claw 2 • Supports healthy joint pain management Very low NO
• Developed to help athletes perform at their best — ⨁ Insufficient evidence
before, during and after training and competition

Dietary Supplements for Musculoskeletal Pain | 113