Page 136 - JSOM Winter 2018

a result of taking DSs, most of which were anabolic. Having to University’s CHAMP, all personnel with a “.mil” email ad-
be MEDEVAC’d from a deployment for hepatic injury is not dress can gain access to Natural Medicines, which is likely
trivial, and it has happened far too many times. Unfortunately, the most well-respected resource on DS, and information on
the Department of Defense (DoD) has no formal, centralized “natural” products or medicines, and complementary and
process or mechanism for reporting AEs from DSs, and thus integrative therapies. This resource allows medical personnel
no signals can be detected. Even if there were a centralized to examine how particular DSs might interact with concom-
system, it is unclear how many Servicemembers would report itant prescription medications, assess effectiveness based on
an AE. A series of studies reported that although 60% to 80% the available science, and be aware of potential adverse ef-
of physicians have witnessed an AE in association with a DS, fects. OPSS has an Ask The Expert button on every page, so
only between 1% and 4% were reported to the FDA. 48–50 How if the information being sought is not found, or if there is a
many SOF medical personnel have reported an AE suspected question about a product, questions can be submitted and ev-
of being triggered by a DS? idence-based responses will be provided.

Science or Fiction In addition to the website, OPSS hosts training, teaches classes,
Over the past two decades, the field of nutrition research has and offers telephone consultations. The overall mission of
been discussed with passion. One article claims it is “among OPSS is to provide the best information possible to ensure the
the most contentious fields of science” and another is en- safety, well-being, and performance of our military members.
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titled “Stopping the rot in nutrition science.” Why is this That may include taking a supplement for a particular reason
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important? Nutrition research is difficult to get real answers or warning against other products that could cause harm. No
from because of the many interacting and competing nutri- one who works on this program has any conflicts of interest;
ents, lifestyle behaviors, exposures, and differential responses we do not want unsafe or harmful products being promoted
to particular interventions—dietary and due to DSs. As such, to SOF personnel. Unfortunately, we have limited control over
the results may not be clear, yet there is much money being that. Countless websites could be presented that demonstrate
made from promoting foods and DSs. Researchers who con- how military members are targeted (e.g., discounts, percentage
duct nutrition- and supplement-related studies could have of purchase price donated to Wounded Warriors, free ship-
conflicts of interest: Their research may be sponsored by in- ping, and the concept of “military grade”). We would like all
dustry; they may indirectly or directly gain financially from DS ingredients, in fact, to be pharmaceutical grade, because
the outcome; they may have inherent biases or preferences that implies a certain standard and quality.
for particular nutrients, diets, and/or theories. All these can
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lead to products with very little science behind them, but One key message from OPSS is that when purchasing a DS,
lots of hype and promises. Although disclosures in published personnel should look for a product that has undergone
papers can help inform readers as to what biases exist, the “third-party certification or verification.” Although FDA did
consumer has relatively few avenues for getting at the “real implement regulations requiring cGMP and truth in label-
science.” ing, subgroups of manufacturers do not comply with cur-
15
rent requirements. Purchasing a product that has undergone
Because DS manufacturers can make much money by push- third-party certification ensures that all current FDA regula-
ing their products, SOF medical personnel need to have the tions are being followed and that what is on the label reflects
most up-to-date and accurate information possible. The SOF the exact content of the product. Third-party certification or
community is vulnerable, because every company would love verification consists of an independent third-party agency or
to make the statement “US Special Operations Forces are using organization conducting a quality review of a manufacturer’s
our product”: Their sales would increase markedly by making products and processes. This includes the manufacturing plant
that known. Again, SOF medical personnel need to be able to where the ingredients originate, the conditions under which
contact experts whose only interest is in SOF performance. and facilities where the ingredients are manufactured, where
the ingredients came from, and analysis of the final product
for multiple factors. Products that pass all verification re-
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Operation Supplement Safety
and Other Resources quirements may receive recognition and a seal of participation.
Although third-party certification does not ensure effective-
Operation Supplement Safety (opss.org) is the DoD’s program ness or even safety, such programs do allow consumers to
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dedicated to providing evidence-based information to SOF, feel confident that the product they purchased actually con-
warfighters, leaders, and all medical providers. The Consor- tains what it states on the label.
tium for Health and Military Performance (CHAMP) at the
Uniformed Services University runs OPSS and provides a Figure 1 presents, in alphabetical order, the “seals” or lo-
variety of resources, from posters, videos, and “apps” to ex- gos of the four most common third-party certifiers: Banned
pert answers and access to the Natural Medicines Database Substances Control Group (BSCG); Informed Choice/Sport;
through its website. Many of the OPSS educational resources National Sanitation Foundation (NSF) International; and US
are available to download for printing and as print materials, Pharmacopeia (USP). These third-party certification or verifi-
which are available through the Army Public Health Center’s cation organizations all have their own specific approaches,
e-Health catalogue. criteria, and processes for evaluating and authenticating prod-
ucts. USP typically only certifies vitamins, minerals, fish oils,
The website hosts the DoD List of Prohibited Substances, a list and selected other “nutritional” products, whereas the NSF,
of stimulants found in DSs, BLUFs (“bottom line up front”) BSCG, and Informed Choice test products of interest to ath-
on multiple topics, information specific for medical person- letes and high performers, and ensure no ingredients are on
nel, and information on SARMs and other ingredients found the WADA list. Another group, ConsumerLabs.com (www
in DSs. Through the OPSS website at Uniformed Services .consumerlab.com), is a “watch dog,” so to speak, because it

134 | JSOM Volume 18, Edition 4 / Winter 2018