Page 115 - JSOM Winter 2024

An Ongoing Series

Uncovering the World of Dietary Supplements
and Performance-Enhancing Substances in the Military

Patricia A. Deuster, PhD, MPH *; J. Russell Linderman, PhD ;
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Duy P. Hua, PhD ; Andrea T. Lindsey, MS 4
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ABSTRACT
This article highlights key topic areas related to dietary sup- “regular users.” One study found that 74% of Servicemem-
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plements (DSs) and performance-enhancing substances. It also bers use at least one DS more than once weekly, and 40% of
discusses evidence-based resources the medical community users consume ≥5 DSs per week. 3
can use when discussing high-quality DSs with Servicemem-
bers interested in taking DSs. We briefly overview how DSs are We believe that optimizing human performance requires the
regulated in the United States, discuss problematic categories right nutrients, cofactors, botanicals, or other dietary aids to
and issues related to quality, expand upon what are often con- optimize brain and immune health, support joint insults, expe-
sidered performance-enhancing substances yet sometimes sold dite recovery, and prevent deleterious health effects from envi-
as DSs, and then offer solutions to counter the consequences ronmental and operational exposures. Therefore, the medical
of the dark side of the DS industry. Solutions include third- community should be educated on how to ensure that Service-
party certification and intentional education and resources, as members only use high-quality DSs that work as intended.
military health care providers and medics need to know where
to go for evidence-based information, per the Department of To that end, we will present a brief overview of how DSs are
Defense Instruction 6130.06 – Use of Dietary Supplements regulated in the U.S., discuss problematic categories and issues
in the DoD (DoDI 6130.06), which set policy and guidelines related to quality, and expand upon what are often considered
for Servicemembers in 2022. Finally, Operation Supplement performance-enhancing substances yet are sometimes sold as
Safety (OPSS) resources and tools are discussed. DSs. Since the release of the DoD Instruction 6130.06 – Use of
Dietary Supplements in the DoD in March of 2022, guidance
Keywords: dietary supplements; education; operation has been established for all Servicemembers and those who
supplement safety; peptides; performance-enhancing provide health-related services within the DoD. Servicemem-
substances; public health; readiness; SARMs; third-party bers and their healthcare providers can rely on the available
certification; tianeptine educational resources and tools to make smart, informed deci-
sions about DS use. Thus, we conclude by offering solutions to
counter the consequences of the dark side of the DS industry,
including resources.
Introduction
Dietary supplement (DS) use is at an all-time high. Performance Dietary Supplement Regulations
dietitians recommend many DSs to optimize health, well- being,
and performance in Servicemembers; however, ineffective or The Food and Drug Administration (FDA) has oversight over
unsafe substances may be recommended by peers or predatory DSs based on the Dietary Supplement Health and Education
manufacturers hoping to make money off military members. Act of 1994 (DSHEA). This Act amended the Federal Food,
Because of their desire for performance optimization, Service- Drug, and Cosmetic Act to define dietary supplements as prod-
members are an excellent target for DS manufacturers. ucts intended for ingestion and to supplement the diet, includ-
ing vitamins, minerals, herbs and botanicals, amino acids, and
The global DS market size was estimated at USD 164.0 bil- substances such as enzymes, organ tissues, glandulars, and
lion in 2022 and is projected to grow at a compound annual metabolites. As the law implies, almost any dietary ingredient
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growth rate (CAGR) of 9.0% from 2023 to 2030. According that occurs “naturally” can technically be sold as a DS in the
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to the 2023 Council for Responsible Nutrition report, approx- U.S. Moreover, supplement ingredients in the food supply or
imately 74% of U.S. adults take DSs and 55% claim to be sold in the U.S. before 15 October 1994 are presumed to be
*Correspondence to patricia.deuster@usuhs.edu
1 Dr. Patricia A. Deuster, Dr. Duy P. Hua, and Andrea T. Lindsey are affiliated with the Consortium for Health and Military Performance
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(CHAMP), Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda,
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MD. CAPT J. Russell Linderman is Executive Officer of Naval Medical Research Unit Dayton, OH. Dr. Duy P. Hua is affiliated with the Henry
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M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.
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