By Sandra Basu

WASHINGTON — Popularity of dietary supplements among servicemembers and the lack of formal policy on their sale or use has led to a potentially dangerous situation in the U.S. military, with two soldiers dying last year of heart attacks after ingesting a performance-enhancing product.

Empty display bottles of supplements were pulled off the shelves and put away at a store at Marine Corps Base Camp Lejeune recently. Numerous weight-loss and bodybuilding supplements have been put on medical hold to test the effects of the drugs. Photo by Pfc. Nikki Phongsisattanak.

The Army is conducting a safety review of the compound, 1,3-dimethylamylamine, more commonly known as DMAA, after the two soldiers had heart attacks last year during fitness training, and the substance was found in their toxicology reports. DMAA-containing dietary and performance supplements also were removed from military exchanges and installation concessions.

 The ongoing safety review will include a wider review of other deaths that may be associated with DMAA and also a study of servicemembers who have used DMAA-containing products and experienced adverse symptoms. It, will continue to evaluate potential links between the use of DMAA-containing products and adverse health effects. Results of the study, when complete, which will likely be in late summer 2012, will be released. “The Department of Defense is fully committed to servicemembers’ safety,” Army Medical Command officials told U.S. Medicine in a written statement.

Dietary Supplement Safety

The concern about DMAA in the military underscores a larger concern about the use and safety of dietary supplements by troops. Dietary-supplement manufacturers and distributors are not required to obtain approval from FDA before marketing dietary supplements, although FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market.

Dietary-supplement use by military members “is high,” and military personnel have virtually free access to these supplements, both at home and during deployments, DoD officials said.

“The 2005 Survey of Health Related Behaviors confirmed a high prevalence of use (>50%) and provided evidence that servicemembers using weight loss, performance-enhancing and bodybuilding supplements were significantly more likely to participate in high-risk activities, such as taking steroids, not wearing seatbelts, riding a bicycle/motorcycle without a helmet and heavy drinking,” according to a written statement from officials from DoD and the Uniformed Services University of the Health Sciences (USUHS).

Concern about supplements includes, “the prevalence of use, coupled with the high prevalence of tainted and contaminated products, current FDA regulations, the safety and efficacy of dietary supplements and the reality that dietary supplement use is unlikely to decline,” they said.

The statement confirmed that DoD does not have a formal policy with regard to dietary supplement and/or dietary-supplement education, “which means that free access remains for a population who may be naïve to the potential dangers.”

Report Calls for Guidelines

The challenge that dietary supplements pose to troops was highlighted four years ago in an IoM report commissioned by DoD, the Samueli Institute and the National Institutes of Health (NIH) to look at the issue.

That 2008 report recommended that guidelines to manage the use of dietary supplements need to be specific to  the military.

“Guidelines to manage the use of dietary supplements need to be tailored for the military, due to the different circumstances that can occur relative to the general civilian population. The methods used to evaluate these products in the general population might not be directly applicable to the military facing special conditions such as extreme heat and cold or risks such as injury or bleeding,” the report brief stated.

The report recommended that DoD develop  a system in place to monitor the use of dietary supplements by military personnel, adding that a framework is needed to determine the level of concern for dietary supplements in a military context. The IoM also recommended that a DoD system is needed to report adverse events associated with dietary supplements.

In their response to U.S. Medicine inquiries, DoD and USUHS officials pointed to steps taken since the IoM recommendations were made. One result of the report was the formation of the DoD Center Alliance for Dietary Supplement Research (CA) in 2010, created to identify dietary supplements that threaten force health protection, as well as those that provide health and performance benefits to DoD personnel, among other responsibilities.

The IoM also recommended that in-depth, anonymous surveys about dietary-supplement use be administered at select military installations. Since the IoM report, officials said that the CA has conducted several surveys about dietary supplement use among selected populations in the military.