Use of Dietary Supplements by Military Personnel (2008) / Chapter Skim
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Appendix C: Findings from Recent Surveys on Dietary Supplement Use by Military Personnel and the General Population
Appendix C: Findings from Recent Surveys on Dietary Supplement Use by Military Personnel and the General Population
Pages 383-419
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Appendix C Findings from Recent Surveys on Dietary Supplement Use by Military Personnel and the General Population 383
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supplements questionnaire Response rate not "Estimate how often you use known each of the following individual vitamin and mineral supplements (pills, tablets, gel caps, etc)
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Vitamin A: 12.5% Performance enhancement • Many of the DS used were Vitamin B6: 11.5% Strength associated with palpitations or anxiety, which could be Ergogenic aids: Herbal supplements: due to caffeine Sports drinks: 42.8% Prevent fatigue • Perception that if something Sports bars: 17.3% is sold in the base, it means Protein: 13.7% Sources of information: it is safe Ephedra-free: 10.1% (n=2,241) Friends: 36% Limitations: Herbal supplements: Magazines: 31.7% • Surveys not designed to Caffeine: 17.5% Internet: 22.1% relate adverse effects or Ginseng: 6.7% Sales associates: 10.4% benefits to any particular Garlic: 5% Doctors: <10% DS Ginkgo: 3.9% TV/radio/newspaper: • Response rate not known Echinacea: 3.6% <5% • Results might be skewed because it was completed Supplement purchase: voluntarily (n=2,241)
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(n=376) adults "currently Questionnaire Index serving in the Response rate: 60% military, national Supplement use in past 3 mo guard, or reserve"
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, higher income, 46% Internet: 19% and higher education in Nutrition/health food store: military Categories: 8% • Military more likely to use Protein powders: 14% Natural food market: 6% multivitamins only, Weight loss: 9% Mail order/catalog: 4% significantly more sportsHerbal: 8% related supplement products Sports nutrition: 8% 30–44 years: • Study also gives information Fiber: 4% GNC: 19% on overall use by gender Children's: 3% Internet: 17% • Study provides brand names Homeopathic: 2% Natural food market: 12% of sports nutrition and Condition specific: 2% Nutrition/health food store: muscle-building supplements 7% used Specific: Mail order/catalog: 5% Multivitamins: 57% Calcium: 13% 45 years and older: Vitamin E: 9% Internet: 23% Vitamin B: 8% GNC: 13% Glucosamine/Chondroitin: Nutrition/health food store: 7% 13% Creatine: 6% Mail order/catalog: 10% Fish oil: 5% Natural food market: 8% Omega-3: 4% Flaxseed oil: 4% Amino acids: 4% Vitamin D: 3% Conjugated linoleic acid (CLA) : 3% Lycopene: 2% Arginine: 1% continued
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Questionnaire Index older adults (nonmilitary) Supplement use in past 3 mo Response rate: 60%
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2 or more supplements: • Supplement use increases 55% with age • Nonmilitary significantly Categories: higher in DS use for specific Protein powders: 4% supplements except for Weight loss: 7% creatine, CLA, amino acids Herbal: 12% Sports nutrition: 2% Fiber: 8% Children's: 3% Homeopathic: 4% Condition specific: 3% Specific: Multivitamins: 58% Calcium: 26% Vitamin E: 20% Vitamin B: 14% Glucosamine/chondroitin: 11% Creatine: 1% Fish oil: 9% Omega-3: 7% Flaxseed oil: 6% Amino acids: 2% Vitamin D: 8% CLA: 1% Lycopene: 2% Arginine: 1% continued
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" Response rate: interviews 73.4% "During the past 12 months, did you use natural herbs for your own health or treatment?
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John's wort: 15% Peppermint: 15% Limitations: Ginger: 11% • use is underrepresented DS Chamomile: 9% because only those that Kava: 9% responded positively to the Glucosamine: 4% question: "have you ever Ephedra: 7% used a natural herb? " were further surveyed about use Prevalence of supplement of specific DS; "natural use by physical activity level herb" may be misleading (any/nonvitamin)
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vitamins, minerals, or other Response rates: In-person dietary supplement in the past 1999–2000: 82%, interviews month? " 2001–2002: 84% If Yes, asked to provide dose, frequency, and duration of use and to show supplement container.
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APPENDIX C 393 Authors' Conclusions and Findings: Usage Other Findings Study Limitations Supplement use: Conclusion: Any DS: 37% Supplement users more likely Nonvitamin/mineral: 7% to be ages 23–30 y female, non-Hispanic white, have high self-perceived health status, Of the 37%: and have high physical activity Multivitamin (any) : 23% level Vitamin C: 7% Vitamin E: 2% Limitations: Vitamin B: 1.4% • use likely DS Iron: 2.1% underrepresented because Calcium: 2.6% survey does not include teas, loose herbs, etc., or DS Of the 7%: without a bottle or label Sport: 2% • Did not record reason for Weight loss: 3% use or health condition Herbs: 4% associated with use • Did not ask about sports Prevalence of DS use by drinks, teas, or fortified physical activity level (any foods DS/nonvitamin)
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394 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1 Continued Reference Demographics Group Questions Jaghab, 2007 (n=1,200) Army physicians Electronic survey on Army (n=573)
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GNC: 22%/15% • Renal/kidney functions Given or sent: • Heat injury/heat stress 13.1%/14.2% • Supplements are not Unknown: 11.7%/4.9% regulated by the FDA Local markets: 2.8%/1.8% • Safety of taking supplements • Cardiac issues • Overuse of supplements • users don't understand DS the risks and complications of the supplements • Long-term effects continued
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These include prescriptions Children (<18 y) from your doctor or clinic, (n=581)
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APPENDIX C 397 Authors' Conclusions and Findings: Usage Other Findings Study Limitations Supplement use (most Slone data used as an example commonly used) : of survey design age group not Vitamins (any)
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Average age: 29 y Response rate: 80%
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APPENDIX C 399 Authors' Conclusions and Findings: Usage Other Findings Study Limitations Supplement use at least once Top 5 reasons for Conclusions: per week: supplement use: • Army populations All Males: 55% surveyed consume high Females: 70% Men: levels of DS Health • Different Army populations Top 10 supplements: Performance have different patterns of Men: Muscle strength use Multivitamins: 30% Other • Editorial comment: Sports drink: 20% Energy Scientific justification for Vitamin C: 13% this level of supplement use Protein powder: 13% Women: is lacking Vitamin E: 6% Health Calcium: 6% Other Study also provides Vitamin D: 5% Energy information on supplement Vitamin A: 5% Performance/weight loss/not use by age, education, Creatine: 5% sure occupation; supplement Sport bar: 5% Endurance/strength knowledge; and money spent on supplements per wk Women: Multivitamins: 28% Sports drink: 28% Calcium: 15% Folate: 13% Vitamin C: 13% Iron: 10% Vitamin B6: 10% Vitamin D: 8% Vitamin E: 8% Protein powder: 8% Number of different supplements used per week: Men: 1–2: 30% 3–4: 12% 5+: 14% Women: 1–2: 35% 3–4: 18% 5+: 18% continued
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Average age: 23.6 y Response rate not known Lieberman July 2000 Special Forces et al., 2007 Men (n=152) Average age: 31.3 y Response rate not known
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APPENDIX C 401 Authors' Conclusions and Findings: Usage Other Findings Study Limitations Supplement use at least once Top 5 reasons for General comments (see above) per week: supplement use: 81% Energy Health Top 10 supplements: Muscle strength Sports drink: 41% Other Multivitamins: 23% Physician Creatine: 19% Protein/amino acids: 18% Antioxidants: 14% Herbs (ginseng, garlic, etc.)
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Average age: 44 y Response rate not known
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APPENDIX C 403 Authors' Conclusions and Findings: Usage Other Findings Study Limitations Supplement use at least once Top 5 reasons for General comments (see above) per week: supplement use Men: 71% Men: Women: 81% Health Other Top 10 supplements Performance/energy Men: Poor diet Multivitamins: 39% Physician Vitamin E: 22% Vitamin C: 17% Women: Sports drink: 10% Health Antioxidants: 7% Performance/energy B-complex: 6% Other Garlic: 6% Poor diet Beta-carotene: 5% Physician Ginkgo biloba: 5% Calcium: 5% Women: Multivitamins: 52% Calcium: 32% Vitamin E: 32% Vitamin C: 29% Antioxidants: 23% Beta-carotene: 16% Magnesium: 13% Folate: 13% B-complex: 13% Vitamin B6: 10% Number of different supplements used per week Men: 1–2: 29% 3–4: 14% 5+: 12% Women: 1–2: 36% 3–4: 6% 5+: 23% continued
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Behaviors Among Military Personnel plus added Response rate All four branches questions on diet, DS, CAM overall: 51.8% and pay grades Army (n=3,636)
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and Weight loss: 18% Specific health problems vegetable (12.9%) of three Joint health: 8.5% or more servings per day Performance: 8.4% Information sources: • Military dining services may Other types: 9.1% Personal contacts: 47.9% represent an opportunity for Print media: 29.1% increased communication Frequency of use: Friends/family: 24.8% about healthy diet and Once a month: 8.3% Multimedia nonprint: 23% dietary supplement use Once a week: 7.6% Health professionals: 17.3% Every other day: 7.7% Sales store associates: 5.7% Study also includes Once a day: 30.7% information on: 2 times or more a day: Bodybuilding supplements, 12.8% performance-enhancing supplements, and weight-loss Reporting use to military supplements by pay grade, personnel: gender, age, education, BMI, To doctor: 36.6% activity, smoking, drinking, To nurse/physician assistant: and supplement use overall by 21.7% gender, military branch Indicated on health record: 12.8% Author suggestions: analysis Women: 62.5% of specific information on Men: 45.2% exact supplements used with estimates of nutrient intake Reporting increases with from food and supplements age Reporting to doctor by military branch: Air Force: 49.5% Navy: 32.6% Army: 31.5% Marine: 25.3% continued
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enlisted and officers Center for Health Promotion (n=10,985) and Preventive Medicine Dietary Supplement Questionnaire "Have you ever used any type of dietary supplement?
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: members using DS Never used: 31% Promote health, weight loss, >60% DS bought on base • strength, lean muscle mass, • Most spend between Most common supplements stamina, fatigue reduction, $11–$50/mo used (5 or more times/wk) : cognition/alertness, memory, • Most members do not Multivitamin other report having adverse effects Multimineral on this survey Creatine Most common supplement • Adverse effects are not Glutamine used: usually reported to health Vitamin C (1)
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Special Forces minerals, pro1999 and Ranger performance or Current use: Response rate: training other Any kind: 64% 99% schools supplements Ergogenics: 29% Multivitamin: 37% Vitamin C: 20% Creatine: 18% Ginseng: 9% Daily use: Any kind: 35% Ergogenics: 14% Bovill n=152 male U.S. Army Surveys asked Supplement use: et al., Average age: Special Forces about 86% occasionally 2000a 31 y nutrition, supplement Frequency: Response rate use, Sports drinks: 66% not known demographics, Sports bars: 43% and health Multivitamins: 42% habits Vitamin C: 22% Protein powder: 22%
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APPENDIX C 409 Findings: Motivation Other Findings Authors Conclusions and Study Limitations Use for: • Use is higher than in Conclusions: General health, general population • Military population is at risk for performance of young men (39% potential adverse effects of inadequate enhancement, use them use of DS, including abrupt cessation interest in preventing occasionally) when deployed in operations or entering infectious diseases, • Supplement use training physical associated with • Presence of DS on military bases and performance, and higher scores for discontent with food might result in wound healing Army physical higher use of DS fitness tests, daily exercise, weight Recommendations: lifting, and • Further studies of benefits and risks are nonsmokers necessary • Not associated with • Routine one-size-fits-all advice should age, ethnicity, BMI, not be given chewing tobacco, or • OK to treat deficiencies but questions alcohol use about performance effects • Military health care professionals should be well informed about risks and benefits General health: 63% • Supplement use Performance: 20% associated with frequency of strength training • Not associated with age or habitual exercise • Information on nutrition from: Magazines/ newspapers/ books: 76% Friends: 54% Radio/TV: 34% Physicians/nurses: 33% Internet: 30% continued
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et al., 2000) Response rate: 89%
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than non- supplements in military is used for energy Special Forces for short-term (76%) athletic events, 58% • Supplement use believed that associated with vitamins provide more frequent energy exercise and greater nutrition knowledge • Not associated with age, weight, ethnicity • Information on nutrition similar to above (Bovill et al., 2000)
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intake, and Most common: physical CHO/electrolyte fluids Response rate: activity level Protein powder: 24% 100% Creatine: 13% Ephedrine: 13% Also reported use of ginseng, glutamine, vitamins/minerals
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Recommendations: Magazines • Use of some DS should be discontinued Store salesperson prior to undergoing surgery Internet • Health care screening Doctors • Routine assessment Books • Education TV • Further surveys recommended More females than Limitations: males consumed a DS; • Self-reporting might result in however, more men misunderstanding and misreporting consumed creatine, • Generalizations to general population are ginseng, and garlic not possible • Categorization of DS No association with aerobic exercise Stores on military bases specifically to sell frequency DS, in 2004, 92 stores worldwide on military installations Adverse events: 18% Palpitations: 46% Dizziness/confusion: 30% Tremors: 26% Abdominal pain: 24% Numbness/tingling extremities: 16% Loss of consciousness: 4% Conclusions: Use of supplements is not necessary based on the dietary intakes of protein by the Rangers continued
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participation in Thermogenics: 44% competitive or Anabolic steroids: <2% Response rate: recreational 40% athletics, weight training; sources of nutritional information McGraw n=367 U.S. Army Use of Supplement use: et al., Average age: Rangers supplements 36% 2000 22 y and associated factors Frequency: Response rate Creatine: 19% not known Multivitamin/ multimineral: 16% Protein/Amino acids: 14% Vitamin C: 7% Sport bars: 6% McPherson n=291 U.S.
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• Supplement use associated with frequency of strength training • Not associated with smoking or aerobic training. Pain, 81–98% thought the Conclusions: stress, treatment was effective • Health providers need to become anxiety, educated in CAM therapies depression, • Further studies needed weight loss Limitation: Geographical area might have biased the results, Western region (increased CAM, more providers)
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civilian Use of creatine Creatine use: et al., (133 military) and military and other 12.2 g/d for 40 wk 2000 health clubs supplements Response rate: Military supplement use: 40% Vitamin: 65% Mineral: 47% Protein: 45% Creatine: 29% Herbal: 21% Androstenedione: 13% Hydroxy-β-methyl butyrate (HMB)
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APPENDIX C 417 Findings: Motivation Other Findings Authors Conclusions and Study Limitations Increase muscle Notes: Navy, concurrent supplements mass, strength, and power; provide energy; improve general health • Supplement use Conclusions: associated with • Concerns: creatine use with other resistance training anabolic supplements goal of strength • Popular magazines as main source of • Creatine use information associated with male • Education and access to information of gender, goal of users is critical strength training, • 45% of current creatine users reported lower frequency and adverse effects: gastrointestinal, muscle duration of aerobic cramping/spasms, dehydration training, use of protein, andro/ DHEA, and HMB • Information on creatine from: Popular media: 69% Physicians: 14% Dieticians: 10%
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2007. Survey of Army health care providers concerning dietary supplements.
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Paper presented at the Institute of Medicine Workshop on Dietary Supplement Use by Military Personnel, Washington, DC, February 13. Institute of Medicine Committee on Dietary Supplement Use by Military Personnel.
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