Questioning the sense of any supplement Published June 20, 2016 By Cliff McArthur 28th Medical Operations Squadron ELLSWORTH AIR FORCE BASE, S.D. -- Military members often turn to dietary supplements to enhance their performance in order to meet the demands placed before them, but sometimes they do little to no research beforehand. With such focus on professional, personal and societal demands, few questions on supplements are asked of sport and wellness nutritionists; not even important, basic questions such as what do you think of supplements, are they worth it, or are they good for you? It is not surprising why anyone would seek the potential boost of one or more dietary supplements and decide to take something like vitamin D or a protein powder. Once their decision is made, the typical question that most seem to ask of the store employee is if it works. If Airmen are interested in learning the answer to these questions, they can look for several key words to help determine the safety and value of a supplement: "laboratory testing," "clinical trials" and "third-party testing." At any point in time, hundreds of naturally occurring compounds, many of which are potential medicines or supplements, are being screened for possible benefit to humans in scientific laboratories around the world. Few people volunteer as "guinea pigs" to ingest substances that, although natural, could prove deadly so substances are screened using animals such as rats to determine not just whether some positive effect occurs but whether the compounds are safe. Often when there is a slight improvement within these animals, the rest of the study may be terminated and the supplement put on the market. Clinical trials are known as testing performed on humans in a way designed to tell whether a supplement and one or all of its ingredients truly works on humans. These trials are very costly in part because people have to be recruited, often compensated for their time, and the trial is painstakingly designed in such a way that neither participants nor scientists initially know who is taking what. In rare cases where clinical trials were performed, the true extent of the effects of a supplement remain unknown even after it has entered the marketplace. For example, a clinical trial of Garcinia Cambogia as a potential weight loss aid was published in the Journal of the American Medical Association in 1998. It found those who took the herbal agent actually lost slightly less weight than those who took a placebo, meaning those who took a sugar pill lost more weight than those who took the actual agent. Despite reports of Garcinia Cambogia not working and being linked to liver damage and liver failure, it is still on the market. Concerns about supplements persist not just because studies on them were limited and most never proven safe or effective before hitting the market, but because many are composed of multiple ingredients. Such "stacking" makes it very difficult to attribute harm or benefit to any one ingredient or to the combined effect of two or more. This raises another possibility that should deeply concern athletes and military members: a banned substance may be added to a supplement yet not included in a long list of ingredients. In fact, hundreds of supplements have been found to be contaminated with anything from novel anabolic steroids and stimulants to banned weight loss medications, including more than two-thirds of supplements that were still available for purchase despite having been previously recalled by the FDA. Those who study this very issue have noted that "dietary supplements for weight management are being sold although the possible toxicity associated with the regular use of these supplements has raised concerns [and] in most cases, complaints have been related to multicomponent formulations." Dr. Pieter A. Cohen, Harvard University, wrote in the April 2014 issue of The New England Journal of Medicine, "Americans spend more than $32 billion a year on more than 85,000 different combinations of vitamins, minerals, botanicals, amino acids, probiotics and other supplement ingredients." No evaluation of a supplement is more effective than objective, third-party testing by independent organizations composed of knowledgeable people who have no vested interest in a product's efficacy or lack thereof. When it comes to research on the Internet, searches are available to see whether a supplement that interests you has been vetted by one of the following independent organizations: Human Performance Research Center, a Department of Defense initiative under the Force Health Protection and Readiness program, is hosted by the Uniformed Services University in partnership with CHAMP, the Natural Medicines Comprehensive Database, and the Real Warriors Campaign. HPRC Online (www.HPRC-onlineorg) contains information on countless supplements that have been checked out to see if they are safe for members of the military. Consumer Lab (www.consumerlab.com) can be counted on for reliable information as it conducts independent tests and reviews of vitamin, mineral, protein and other types of supplements. The Natural Medicines Comprehensive Database (www.naturaldatabase.com) is built on solid, evidence-based scientific data. Entering any product or supplement name or component returns an objective review. It is unquestionably critical that any supplement, however innocent and harmless it may appear, be checked out or "cleared" via one of the above sites, for as Cohen argues, "consumers and physicians cannot be assured that the pills, powders, and potions labeled as dietary supplements are safe for human consumption." Labels can be inaccurate and highly misleading not just by what is claimed on them but by what is not included or not disclosed as well and the product still sold to consumers. Three years after the DOD removed supplements known to contain the stimulant 1,3-dimethlyamylamine (DMAA), three competitors at the 2014 Winter Olympics were banned after testing positive for DMAA. In each case, the athlete reported inadvertently consuming it in supplements. For more information, call Cliff McArthur, 28th Medical Operations Squadron registered dietitian nutritionist, at (605) 385-3789. 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