Soldiers, especially those in active fighting zones, face great physical and mental challenges. To achieve and maintain optimal fitness, as well as improve energy management, many soldiers turn to dietary supplements, especially those in the sports nutrition market.  Due to contamination, adulteration and other safety concerns, military officials have recently poured resources into figuring out how many soldiers take supplements, which products they take and how often they take them.  After finding widespread supplement use amongst their troops, officials are trying to figure out how to manage use, whether through guidance and/or prohibitions.

The U.S. Department of Defense (DOD) has learned most of its soldiers use supplements, about 64 percent of its men and 74 percent of its women (BMC Comp Alt Med). Elite military groups, including SEALs and Rangers, have the highest usage, at around 76 percent.  Use of herbal products is relatively low, while sports drinks and vitamins E and C were among the most used. In elite groups, creatine and sports bars are favorites.

DOD has become very concerned about the safety of such supplement use, especially with reported problems with contamination and adulteration in sports supplements. Dangerous ingestion of steroids and amphetamines is the primary concern.

The U.S. Military banned DMAA (1,3-dimethylamylamine)  in 2011, after it said its own research showed the substance can harm soldiers who take it while working out. Then officials warned troops in 2013 about possible hidden DMAA in a sports supplement, OxyElite Pro (from USPLabs). But military brass wanted to do more to limit use of what it considered dangerous supplements.

Just this past week, DOD’s Human Performance Resource Center released a High-Risk Supplement List as part of its Operation Supplement Safety (OPSS) initiative. The list includes more than 130 sports supplements including bodybuilding products and weight-loss aids that include compounds such as DMMA and its derivative DMBA, Citrus aurantium and andro. The list provides product brand names and potential contamination/adulteration compounds such as steroids and stimulants. The DOD list almost mirrors the list of high-risk supplements published by the U.S. Anti-Doping Association (USADA), which helped DOD and even hosted the DOD list at the USADA Supplement411 website.

U.S. soldiers are not prohibited from using non-banned supplements on the list but are strongly advised by DOD to make informed decisions, as soldiers are ultimately responsible for ingesting any banned or dangerous substances. This is no different than the situation for pro and Olympic athletes.

The U.S. Military isn’t the only one taking notice of supplement use by troops.

In 2014, British Army officials set out to determine the prevalence of dietary supplement use among its soldiers. The British Journal of Nutrition (2014 Oct;112(7):1175-84) published the findings from the cross-sectional, anonymous survey of 2,168 soldiers under training (SUTs) and associated military staff. Self-reported supplemented use was about 38 percent with the number of different supplements used per person between four and nine.

Further, it found the most used supplements in British Army were:

Only a small segment of those surveyed reported using controlled substances amphetamines and similar compounds (1.6 percent), cocaine (0.8 percent), anabolic androgenic steroids (1.1 percent), growth hormone (2.0 percent), and other anabolic agents, e.g. testosterone (4.2 percent).

The most common reason for British Army soldiers’ supplement use? To better prepare for training and activities, improve recovery from training and activities, enhance physical performance, and to supplement the diet.

However, the British Army has been inconsistent about governing supplement use amongst its troops, as some training sites banned supplement use and other sites allowed supplement use. Further, soldiers at those sites weren’t always aware of the supplement use policies, according to the researchers.

The Royal Air Force’s (RAF) position has been supplements should not be used to compensate for poor food choices, but energy supplements may be helpful for certain personnel in certain situations. Further, RAF officials agreed some supplements have proven benefits to physical and cognitive performance, but personnel should only take those products under the guidance of a well-informed professional and in accordance with UK Ministry of Defense supporting guidance written by subject area experts. In the end, however, it appears RAF personnel are free to use supplement at their discretion.

Canadian Military officials also have expressed concern about supplement use, which is similar in prevalence to that of U.S. and British military personnel. According to a Canadian Forces Personnel survey, 63.1 percent of its forces use supplements. Multivitamins (38 percent) and energy drinks (29 percent) were  the top products, with performance enhancers (14 percent) and weight-loss (12 percent) further down the list. However, Canadian soldiers considered performance enhancers and energy drinks the most effective.

A special publication from the Canadian Forces Health Services Group offered advice “from a military sports medicine perspective" to Canadian soldiers on how to make informed decisions on supplement relative to safety and efficacy. The guide highlighted several popular “performance enhancers," including creatine, ephedra, protein powders, anabolic prohormones, steroids, glucosamine, HMB, ginseng, Echinacea and caffeine.  Canadian soldiers are only prohibited from using products with substances that are on the national Controlled Drugs and Substances Act, which includes ephedrine and anabolic steroids and certain precursors. In 2011 Health Canada classified DMAA a drug.

Do you think all this advice or guidance from military officials will influence sports supplement use by soldiers? Will it influence other bodybuilders and athletes? Do you disagree with the inclusion of certain products/compounds on the new DOD high-risk list?