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FIGURE 1 Images of the most common third-party certification 9. Dietary Supplement Health and Education Act of 1994, Public
seals or logos to show the products have undergone some level of Law 103-417. 103rd Congress; 1994.
quality assurance review, and in the cases of the first three, testing for 10. Cohen PA. Assessing supplement safety—the FDA’s controversial
substances on the World Anti-Doping List of substances prohibited proposal. N Engl J Med. 2012;366(5):389–391.
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14. Austin KG, Carvey CE, Farina EK, et al. Predictors of the re-
lationships between nutritional supplement use and weight-
modification goals of U.S. Army soldiers. Int J Sport Nutr Exerc
is not an official third-party certifier. It analyzes various cate- Metab. 2013;23(4):322–335.
gories of supplements for quality; membership is required to 15. US Food and Drug Administration. Current good manufac-
55
obtain their published information. In 2012, Cancio et al. turing practice in manufacturing, packaging, labeling, or hold-
ing operations for dietary supplements. Final rule. Fed Regist.
published a paper in which they reported that less than 12% 2007;72(121):34751–34958.
of all DSs sold on military installations were third-party certi- 16. Long J. Dietary supplement official: cGMP compliance still de-
fied. It would be interesting to repeat the process now, almost ficient in ‘fundamental’ areas. Natural Products Insider. 10 Jan-
7 years later. Clearly, this precaution of “only purchase those uary 2018. https://www.naturalproductsinsider.com/regulatory
that are certified” could be justified. /dietary-supplement-official-cgmp-compliance-still-deficient
-fundamental-areas. Accessed 23 August 2018.
17. NPA. NPA GMP Certification Program Overview. 2009; http://
Summary www.npainfo.org/index.php?src=gendocs&ref=NPAGMP
The recognition that some DSs pose a serious threat to mission CertificationProgramOverview&category=GMPcert. Accessed 28
readiness is important. 16,21,56–58 The current regulatory struc- March 2012.
ture for DSs, coupled with the vast array of products available 18. US Food and Drug Administration. New dietary ingredients in di-
and the ease with which DSs can be purchased, leave SOF Op- etary supplements—background for industry. 2018. https://www
erators insufficiently protected. Without medical communities .fda.gov/Food/DietarySupplements/NewDietaryIngredientsNoti
ficationProcess/ucm109764.htm. Accessed 23 August 2018.
being cognizant of possible risks, medical groups cannot pro- 19. US Government Accountability Office. Dietary supplements: FDA
tect SOF Operators. If performance optimization is the goal, should take further actions to improve oversight and consu mer
then we need to be sure SOF are only taking DSs that will understanding. 9 January 2009. https://www.gao.gov/products
serve their needs. /GAO-09-250. Accessed 14 October 2018.
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The opinions or assertions contained herein are not to be con- 21. Dwyer JT, Coates PM, Smith MJ. Dietary supplements: regulatory
strued as official or as reflecting the views of the Uniformed challenges and research resources. Nutrients. 2018;10(1):e41.
Services University, the US Special Operations Command, or 22. Anselmo CS, Mendes TC, Cabral LM, et al. Physicochemical
the Department of Defense. quality profiles of commercial oral tablets and capsules contain-
ing lutein—impact of insufficient specific sanitary regulations. An
Disclosure Acad Bras Cienc. 2018;90(3)3063–3073.
The author has indicated she has no financial relationships 23. Campbell N, Clark JP, Stecher VJ, et al. Adulteration of purported
herbal and natural sexual performance enhancement dietary sup-
relevant to this article to disclose. plements with synthetic phosphodiesterase type 5 inhibitors. J
Sex Med. 2013;10(7):1842–1849.
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