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Use of Dietary Supplements by Military Personnel
pending on the specific subpopulation, the mission, and the environmental circumstances. Thus, the effects of dietary supplements, whether beneficial or detrimental, might be different for military service members, specifically for some subpopulations facing heightened risks (e.g., Special Forces, Rangers, aviators). Perhaps more importantly, even minor detriments to health that represent simply discomfort or inconvenience to a civilian (e.g., mild dehydration or mild diarrhea) might compromise a service member’s performance or health and, thus, the success of the military operation.
The regulatory responsibility of the U.S. Food and Drug Administration (FDA) for the safety of dietary supplements is designated by the 1994 Dietary Supplement Health and Education Act. Actions to restrict the availability of a dietary supplement must proceed from a demonstration by the FDA of a significant or unreasonable risk of illness or injury to consumers under conditions of recommended use. Manufacturers are responsible for ensuring the safety of the ingredient, but the FDA is not authorized by statute to require data supporting safety, as is the case for food additives or drugs. This approach may not be sufficient to ensure the safe use of dietary supplements in some military contexts, which inherently present considerable risk to individuals.
Based on the heightened risks, potential for benefits, frequency of use among military service members, the lack of consistent policies, and the absence of an internal process to report adverse events as they occur in military settings, the Department of Defense (DoD), Samueli Institute, and National Institutes of Health, with additional support from the FDA, requested that the IOM convene an ad hoc committee under the oversight of the CMNR. The Committee on Dietary Supplement Use by Military Personnel was asked to review the patterns of dietary supplement use among military personnel, to recommend a framework to identify the need for active management of dietary supplement use by military personnel, and to develop an approach system to monitor adverse health effects. The committee was further tasked with selecting a subset of dietary supplements and, by examining published reviews of the scientific evidence, identifying those that are beneficial and/or warrant concern (see full Statement of Task in Chapter 1).
The committee held a public workshop on February 12–13, 2007, in Washington, D.C., to gather results from military surveys on the use of dietary supplements, and current approaches and innovative ideas on monitoring adverse effects; this information was of primary consideration in the preparation of this report. The committee also reviewed the 2005 IOM report Dietary Supplements: A Framework for Evaluating Safety as a starting point for its deliberations. The 2005 IOM report framework was prepared to assist the FDA in evaluating scientific information to determine the level of concern prompted by use of a given dietary supplement.