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39 CHAPTER FIVE SUPPLEMENTS: NUTRITIONAL, HERBAL, ENERGY BOOSTERS, DIETARY, AND HEALTH FOODS INTRODUCTION TO SUPPLEMENTS the safety of the ingredient(s), but by statute the FDA is not authorized to require data supporting safety from the manu- Every year the dietary and nutritional supplement industries facturer, as it does for food additives or drugs (see the FDA introduce another proliferation of chemical compounds in website on Center for Food Safety and Nutrition at: http:// enticing new formats (i.e., energy-boost drinks, bottled flavored www.cfsan.fda.gov and Kurtzweil 1999; GAO-09-250 2009). water augmented with vitamin mixes, nutritional supplement candy chews, caffeine-infused chewing gum, high-energy food Dietary supplements are widely available through a rapidly bars, lose-weight crash-diet measures, and so on). Marketers expanding market of products commonly advertised as bene- engage popular professional athletes and other celebrities in ficial for better health, performance enhancement, and dis- splashy advertising designed to encourage consumers to use ease prevention (IOM report: Greenwood and Oria 2008). The such products to achieve a better, more healthful or exciting "dietary ingredients" in these products may include vitamins, lifestyle. However, manufacturers offer little published medical minerals, herbs, other botanicals, amino acids, and substances and human performance research data to support or back up such as enzymes, organ tissues, and gland tissue or secretions. advertising claims about many such supplements. Dietary supplements can be extracts or concentrates, and may be found in many forms including tablets, capsules, gel caps, This chapter covers a variety of chemical substances and/or liquids, and powders, and in food bars, flavored candy-like psychoactive compounds that commercial drivers might chews, and chewing gum. Information on their label must not ingest on occasion, but which do not fit neatly into the two represent the product as a medication, as a conventional food, categories of hypnotics and stimulants described in chapters or as a sole item of a meal or diet. An ergogenic aid is defined three and four. This encompassing chapter includes coverage as anything that helps enhance energy utilization and usually of traditional nutritional, herbal, and health food supplements; promotes physical performance in the body. Nutritional sup- relaxants; insomnia treatments; dietary compounds used plements such as sports drinks (e.g., GatoradeTM) or those to control a person's weight; and energy boosters such as meant for inclusion in meals might be classified as ergogenic drinks, candies, and gums. Many of these products are aug- aids. An ergolytic agent is anything that possesses the ability mented with active chemical ingredients, some of which are to decrease work output such as exhibiting a negative effect on psychoactive. Certainly these have effects on performance; the muscle activity (U.S. Army CHPPM 2004). principal concern here being their effects on vehicle operator performance. These consumer products are available across Dietary supplements available to commercial drivers range the counter in grocery, convenience, and drug stores; in health from those that might impart beneficial effects, to better food shops; and at shopping center kiosks. Importantly, many health and performance with negligible side effects, to others of them are readily available in convenience shops not far from that have uncertain benefits and that potentially might be the fuel pumps at highway rest stops. This chapter attempts to harmful to health and performance. The challenge is to outline what is known about these chemical substances, and determine which supplements fall into each of these two to identify the supplements that appear to warrant additional categories. In the United States there are no commercial research to determine their efficacy and their safety issues transportation-wide policies regarding dietary supplements. relating to truck and bus/motorcoach drivers. Some safety concerns over supplements, especially the lack of appropriate guidance for their use, were described when DEFINITIONS OF SUPPLEMENTS IOM assessed supplements for the military (Greenwood and Oria 2008). The paucity of medical guidance for use of sup- A dietary supplement is normally thought of as a product taken plements prompts similar concerns that commercial drivers by mouth that contains an "ingredient" intended to beneficially who take supplements might inadvertently compromise their supplement what one normally eats. The Dietary Supplement own performance or health. Without usable information and Health and Education Act (DSHEA) of 1994 places dietary guidance, drivers also might forgo taking dietary supplements supplements in a special category under the general umbrella that potentially could improve their performance or health. of "foods," not drugs, and requires that every such ingredient or combination of ingredients be labeled as dietary supplements. Nutritionists portray how what we eat or consume can Manufacturers of supplements are responsible for ensuring help us achieve adequate or even optimal performance levels