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Appendix C Findings from Recent Surveys on Dietary Supplement Use by Military Personnel and the General Population 383
384 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Findings from Recent Surveys on Dietary Supplement Use by Military Personnel and the General Populationa Reference Demographics Group Questions MILITARY PERSONNEL Corum, 2007 2003â2005 Soldiers Health Promotion and Mean age: 25.4 years (ranks: E1âE9) Prevention Initiative, dietary (n=5,206) supplements questionnaire Response rate not âEstimate how often you use known each of the following individual vitamin and mineral supplements (pills, tablets, gel caps, etc). For each supplement listed below: Step 1: Select ONE bubble in the yellow section that best describes how frequently you use a supplement. Step 2: Select ONE or MORE check boxes in the blue section to select the reasons you use that supplement.â
APPENDIX C 385 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Vitamins/minerals: Motivation Conclusions: Multivitamin: 33.8% Vitamins/minerals: â¢ 16% listed dehydration as Vitamin C: 24.4% Health an adverse effect (concern) Calcium: 19.3% Prevent illness â¢ Women and men tend to use Iron: 14.4% different dietary Potassium: 12.1% Ergogenic aids: supplements (DS) Vitamin A: 12.5% Performance enhancement â¢ 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 â¢ 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% â¢ 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: â¢ Response rate not known Echinacea: 3.6% <5% â¢ Results might be skewed because it was completed Supplement purchase: voluntarily (n=2,241) â¢ They do not have dietary Commissary/PX: 35.6% pattern surveys of Nutrition/health food store respondents on post: 25.3% â¢ Adverse effects are not Nutrition/health food store usually reported to health off post: 25.3% care providers Mail order/Internet: 13.2% Adverse effects: (n=951) Abdominal pain, breathing difficulty, chest pain, dehydration, diarrhea, dizziness, heart attack, heat stroke, loss of consciousness, muscle cramping, nausea/ vomiting, numbness in extremities, palpitations, tremors continued
386 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions French, 2007 2005 Nationally The Natural Marketing Men and women representative Institute ESP 18 y and older group of U.S. (E-screener panel) (n=376) adults âcurrently Questionnaire Index serving in the Response rate: 60% military, national Supplement use in past 3 mo guard, or reserveâ
APPENDIX C 387 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use: Supplement purchase (by Conclusions: Any: 69% age, military only): â¢ Supplement use increases Multivitamin only: 23% 18â29 years: with age (over age 45 y Two or more supplements: GNC: 28% more likely), higher income, 46% Internet: 19% and higher education in Nutrition/health food store: military Categories: 8% â¢ Military more likely to use Protein powders: 14% Natural food market: 6% multivitamins only, Weight loss: 9% Mail order/catalog: 4% significantly more sports- Herbal: 8% related supplement products Sports nutrition: 8% 30â44 years: â¢ Study also gives information Fiber: 4% GNC: 19% on overall use by gender Childrenâs: 3% Internet: 17% â¢ 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
388 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions French, 2007 2005 Nationally The Natural Marketing Men representative Institute ESP (E-screener and women 18 y and group of U.S. panel) Questionnaire Index older adults (nonmilitary) Supplement use in past 3 mo Response rate: 60%
APPENDIX C 389 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use: Conclusions: Any: 73% â¢ above for general See Multivitamin (only): 18% comments (French, 2007) 2 or more supplements: â¢ Supplement use increases 55% with age â¢ 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% Childrenâs: 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
390 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions GENERAL POPULATION Gardiner, 2002 National Health NHIS 2007 18â30 y Interview Survey (n=6,666) (NHIS) âHave you ever used a In-person multivitamin or vitamin?â Response rate: interviews 73.4% âDuring the past 12 months, did you use natural herbs for your own health or treatment?â
APPENDIX C 391 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use Conclusions: Vitamin (ever): 63% â¢ Nonvitamin and mineral Nonvitamin mineral: 17% supplement users were more likely to have high Of the 17%: education, high physical Echinacea: 47% activity, poor self-perceived Ginseng: 36% health status; and be Gingko: 23% prescription medication Garlic: 16% users St. Johnâs wort: 15% Peppermint: 15% Limitations: Ginger: 11% â¢ use is underrepresented DS Chamomile: 9% because only those that Kava: 9% responded positively to the Glucosamine: 4% question: âhave you ever Ephedra: 7% used a natural herb?â were further surveyed about use Prevalence of supplement of specific DS; ânatural use by physical activity level herbâ may be misleading (any/nonvitamin): â¢ Only 35 herbs listed in Sedentary: 34%/9% survey; thousands are sold Moderate: 22%/19% â¢ Herbs have unique common High: 43%/23% names based on region or cultural background Prescription medication users also taking nonvitamin/mineral supplement: 22% continued
392 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Gardiner, 1999â2002 National Health NHANES 2007 18â30 y and Nutrition (n=3,231) Examination âHave you used or taken any Survey (NHANES) vitamins, minerals, or other Response rates: In-person dietary supplement in the past 1999â2000: 82%, interviews month?â 2001â2002: 84% If Yes, asked to provide dose, frequency, and duration of use and to show supplement container. If container was not available, asked for exact name.
APPENDIX C 393 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use: Conclusion: Any DS: 37% Supplement users more likely Nonvitamin/mineral: 7% to be ages 23â30 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% â¢ 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% â¢ Did not record reason for Weight loss: 3% use or health condition Herbs: 4% associated with use â¢ Did not ask about sports Prevalence of DS use by drinks, teas, or fortified physical activity level (any foods DS/nonvitamin): Sedentary: 30%/5% Moderate: 38%/5% High: 41%/9% Prevalence of DS use among prescription medication users (any DS/nonvitamin): 45%/7% continued
394 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Jaghab, 2007 (n=1,200) Army physicians Electronic survey on Army (n=573) Medical Department Participation rate: Ancillary (AMEDD) Knowledge 15% (n=614) Management website Located in: Iraq >40% Afghanistan >20% Other >9%
APPENDIX C 395 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Top 10 supplements Top 5 reasons took Educational suggestions: reported to physicians/ supplements reported to â¢ Which supplements work ancillary: physicians/ancillary: and donât work Creatine: 32.5%/27% Performance enhancer: â¢ Better nutrition in general Protein: 16.2%/26.2% 52.5%/48.5% â¢ General risks of taking Multivitamin and minerals: Gain weight: 24.3%/22.1% supplements 13.4%/20.2% Lose weight: 23.9%/27% â¢ Weight-loss supplement None: 11.9%/10.4% Increase muscle mass/ education Weight loss: 10.5%/19.1% conditioning/strength: Metabolism boosters: 6.1%/6.5% Study also provides top 5 8.6%/8.8% Cognitive enhancer/stay brands of supplements used Ephedra: 7.7%/5.2% awake: 3.7% (to physicians Bodybuilders: 6.6%/7.7% only) Concerns about side effects Glucosamine and Supplement diet/health (from physicians and chondroitin: 3.5%/3.7% maintenance: 3.6% (to ancillary): Nitrous oxide: 2.8%/5.7% ancillary only) â¢ Interaction of supplements Caffeine: 2.8% (to with medications or other physicians) Supplement purchase: supplements Herbal preparations: 3.7% PX: 52%/59.3% â¢ Dehydration (to ancillary) Online: 35.4%/39.9% â¢ Side effects (general) GNC: 22%/15% â¢ Renal/kidney functions Given or sent: â¢ Heat injury/heat stress 13.1%/14.2% â¢ Supplements are not Unknown: 11.7%/4.9% regulated by the FDA Local markets: 2.8%/1.8% â¢ Safety of taking supplements â¢ Cardiac issues â¢ Overuse of supplements â¢ users donât understand DS the risks and complications of the supplements â¢ Long-term effects continued
396 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Kaufman, 2005 National survey Slone survey 2007 Men and women, all ages Telephone âWe are interested in all interviews, random medicines which you have Adults (n=2,684) digit dialing taken in the past 7 days. These include prescriptions Children (<18 y) from your doctor or clinic, (n=581) nonprescription medicines, (if under 14 y, vitamins, herbs, or alternative parents answer) medicines.â Asked to retrieve bottle and Participation rate: provide information on 57% container.
APPENDIX C 397 Authorsâ 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): 40% the same as military Multivitamins: 26% Herbal/natural (any): 23% Lutein: 9.4% Lycopene: 7.8% Glucosamine: 4.0% Garlic: 2.6% Chondroitin: 2.5% Ginkgo biloba: 1.6% Co-enzyme Q: 1.5% Other: Prescription medication users who take one or more herbals: 30% continued
398 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Lieberman (ongoing) General Army et al., 2007 Men and women (n=484) Average age: 29 y Response rate: 80%
APPENDIX C 399 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use at least once Top 5 reasons for Conclusions: per week: supplement use: â¢ Army populations All Males: 55% surveyed consume high Females: 70% Men: levels of DS Health â¢ Different Army populations Top 10 supplements: Performance have different patterns of Men: Muscle strength use Multivitamins: 30% Other â¢ 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: 1â2: 30% 3â4: 12% 5+: 14% Women: 1â2: 35% 3â4: 18% 5+: 18% continued
400 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Lieberman April 1999 U.S. Army Rangers et al., 2007 men (n=768) 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
APPENDIX C 401 Authorsâ 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.): 9% Carbohydrate beverage: 7% Androstenedione: 7% Sports bar: 6% Sports gel: 3% Number of different supplements used per week: 1â2: 45% 3â4: 19% 5+: 15% Supplement use at least once Top 5 reasons for General comments (see above) per week: supplement use: 65% Health Performance Top 10 supplements: Energy Sports drink: 36% Other Multivitamins: 32% Physician Protein powder: 16% Creatine: 16% Sports bar: 15% Vitamin C: 11% Meal replacement beverage: 9% Vitamin E: 7% Antioxidants: 6% Androstenedione: 6% Number of different supplements used per week: 1â2: 41% 3â4: 14% 5+: 7% continued
402 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Lieberman 1999â2001 Army War College et al., 2007 Men and women (mid to upper (n=315) management) Average age: 44 y Response rate not known
APPENDIX C 403 Authorsâ 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: 1â2: 29% 3â4: 14% 5+: 12% Women: 1â2: 36% 3â4: 6% 5+: 23% continued
404 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Marriott, AprilâAugust 2005 Active duty military DoD Survey of Health Related 2007 (n=16,146) (worldwide) 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) Navy (n=4,626) Marine (n=3,356) Air Force (n=4,627)
APPENDIX C 405 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use Reasons for use: Conclusions: (last 12 months): Supplement diet â¢ Nutrient supplements Any: 60.3% Improve health provided through military Multivitamin: 45% Improve mental health health care Individual vitamin/mineral: Improve cognitive function Diet: <10% eat three or â¢ 26.9% Improve physical more servings of fruit and Antioxidants: 20.8% performance vegetables per day Bodybuilding: 20.5% Increase muscle mass â¢ Women in the Navy highest Herbal: 11.7% Lose weight reported fruit (10.7%) 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: â¢ 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
406 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-1â Continued Reference Demographics Group Questions Thomasos, 2006 Air Force Adapted from the U.S. Army 2007 (spring/summer) enlisted and officers Center for Health Promotion (n=10,985) and Preventive Medicine Dietary Supplement Questionnaire âHave you ever used any type of dietary supplement?â NOTE: BMI=body mass index; CAM=complementary and alternative medicine; DS=dietary supplement; PA=physical activity.
APPENDIX C 407 Authorsâ Conclusions and Findings: Usage Other Findings Study Limitations Supplement use: Primary reasons for use Conclusions: Currently using: 38% (from most to least â¢ Most U.S. Air Force Past use only: 31% commonly reported): members using DS Never used: 31% Promote health, weight loss, >60% DS bought on base â¢ strength, lean muscle mass, â¢ Most spend between Most common supplements stamina, fatigue reduction, $11â$50/mo used (5 or more times/wk): cognition/alertness, memory, â¢ Most members do not Multivitamin other report having adverse effects Multimineral on this survey Creatine Most common supplement â¢ Adverse effects are not Glutamine used: usually reported to health Vitamin C (1) Senior enlisted: for care providers Caffeine weight loss â¢ Education on DS is needed Calcium (2) Junior enlisted/officers: Protein powders for strength and lean body Additional information: Fish oils mass gains â¢ Supplements were Hydroxycut categorized into âlike typesâ Chondroitin Sources of information â¢ Study also provides NO2 (most to least commonly information on supplement reported): use by: Magazines, friends/family, Occupation books/journals, internet Grade (O1âO6 and E1âE9) sites, health care providers, tv/radio/newspaper, store salesperson Supplement purchase: Commissary/PX: >40% Other on-base stores: ~25% Off-base stores: ~24% Internet/mail order: <10% Adverse effects (most to least commonly reported): Palpitations, anxiety, dehydration, nausea/ vomiting, chest pain, dizziness/confusion, abdominal pain, tremors, diarrhea, muscle pain, numbness/tingling, breathing problems, heart attack, blood in urine, heat injury, visual disturbances, fainting
408 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-2â Surveys on Use of Dietary Supplements by Military Personnel Reference Demographics Group Questions Findings: Usage Arsenault n=2,215 males, Men entering Use of Supplement use: Past and Average age: 25 U.S. Army vitamins, and/or present: 85% Kennedy, (18â47 y) Special Forces minerals, pro- 1999 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%
APPENDIX C 409 Findings: Motivation Other Findings Authors Conclusions and Study Limitations Use for: â¢ Use is higher than in Conclusions: General health, general population â¢ 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, â¢ Supplement use training physical associated with â¢ 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 â¢ Further studies of benefits and risks are nonsmokers necessary â¢ Not associated with â¢ Routine one-size-fits-all advice should age, ethnicity, BMI, not be given chewing tobacco, or â¢ OK to treat deficiencies but questions alcohol use about performance effects â¢ Military health care professionals should be well informed about risks and benefits General health: 63% â¢ Supplement use Performance: 20% associated with frequency of strength training â¢ Not associated with age or habitual exercise â¢ Information on nutrition from: Magazines/ newspapers/ books: 76% Friends: 54% Radio/TV: 34% Physicians/nurses: 33% Internet: 30% continued
410 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-2â Continued Reference Demographics Group Questions Findings: Usage Bovill n=157 male U.S. Army Supplement use: et al., (119 Special Special Forces Current: 87% 2003 Forces, and support 38 non-Special soldiers (non- Specific use: Forces) Special Similar to above (Bovill Forces) et al., 2000) Response rate: 89%
APPENDIX C 411 Findings: Motivation Other Findings Authors Conclusions and Study Limitations A majority (64%) of â¢ Supplements used by Conclusions: soldiers incorrectly more Special Forces Possible trend in increased use of believed that protein (90%) than non- supplements in military is used for energy Special Forces for short-term (76%) athletic events, 58% â¢ Supplement use believed that associated with vitamins provide more frequent energy exercise and greater nutrition knowledge â¢ Not associated with age, weight, ethnicity â¢ Information on nutrition similar to above (Bovill et al., 2000) continued
412 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-2â Continued Reference Demographics Group Questions Findings: Usage Brasfield, n=874 Enlisted U.S. Use of Supplement use: 60.9% 2004 750 men Army, active supplements Frequency: 124 women duty and motivation Multivitamin: 56% Average age: Vitamin C: 28% 24.9 y Representative Creatine: 23% (17â49 y) sample of Ephedra: 21% soldiers Ginseng: 21% Response rate: Calcium: 20% 64% Vitamin E: 15% Vitamin A: 13% Iron: 13% Garlic: 12% DS users consumed: Three or more DS: 53% Two DS: 22% One DS: 25% Deuster n=38 U.S. Army Nutrient, Daily supplement use: et al., Average age: Rangers alcohol, DS 81.5% 2003 25 y (18â40 y) 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
APPENDIX C 413 Findings: Motivation Other Findings Authors Conclusions and Study Limitations General health, Source of information Conclusions: performance (in order of High number of adverse effects that might enhancement, frequency): be attributed to DS use prevent illness Other (friends, family, etc.) Recommendations: Magazines â¢ Use of some DS should be discontinued Store salesperson prior to undergoing surgery Internet â¢ Health care screening Doctors â¢ Routine assessment Books â¢ Education TV â¢ Further surveys recommended More females than Limitations: males consumed a DS; â¢ Self-reporting might result in however, more men misunderstanding and misreporting consumed creatine, â¢ Generalizations to general population are ginseng, and garlic not possible â¢ 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
414 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-2â Continued Reference Demographics Group Questions Findings: Usage Johnson n=294 U.S. Army Use of Supplement use: 56% et al., In Average age: Rangers supplements; press 23 y potential Frequency: (survey was factors Whole protein: 62% conducted in associated: age, Creatine: 46% 1999) 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. soldiers, Use of Massage and supplements and Average age: retirees, complementary were most commonly Schwenka, 39 y (18â83 y) spouses in and alternative used 2004 military medicine Response rate: hospital (CAM) CAM use: 73% Active duty: 72% Retiree: 85% Family: 89% Supplement use: Herbal supplements: 36% Nutritional food supplements: 36%
APPENDIX C 415 Findings: Motivation Other Findings Authors Conclusions and Study Limitations â¢ difference in age No Conclusions: of user compared to â¢ Soldiers consume ergogenics at the same nonuser rate as other athletic populations â¢ Supplement use â¢ Supplement use is inversely correlated to associated with nutritional knowledge recreational activities, weight Recommendation: training Further education of unit surgeons â¢ Source of information: Limitation: Other soldiers: 59% Self-exclusion of soldiers with higher usage Fitness magazines: might result in low response and 46% apparently lower supplement use level Internet: 18% Nutritionist: 8% Unit surgeon: 6% â¢ Supplement use lower than general male population (42%), elite athletes (59%), or U.S. Army Special Operations candidates (64%) â¢ Supplement use associated with frequency of strength training â¢ Not associated with smoking or aerobic training. Pain, 81â98% thought the Conclusions: stress, treatment was effective â¢ Health providers need to become anxiety, educated in CAM therapies depression, â¢ Further studies needed weight loss Limitation: Geographical area might have biased the results, Western region (increased CAM, more providers) continued
416 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL TABLE C-2â Continued Reference Demographics Group Questions Findings: Usage Schneider n=91 Naval Sea, Supplement use: 78% et al., Air, Land 1998 Response rate (SEAL) Using more than one not known personnel supplement concurrently: 4â9 DS: 32% 3 DS: 34% 2 DS: 18% 1 DS: 16% Sheppard n=229 U.S. 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-Î²-methyl- butyrate (HMB): 10% Anabolic/androgenic steroids: 3% aâ ome of the findings from Bovill et al. (2000) and Bovill et al. (2003) are virtually the same S and might come from the same study.
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 â¢ Supplement use Conclusions: associated with â¢ Concerns: creatine use with other resistance training anabolic supplements goal of strength â¢ Popular magazines as main source of â¢ Creatine use information associated with male â¢ Education and access to information of gender, goal of users is critical strength training, â¢ 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 â¢ Information on creatine from: Popular media: 69% Physicians: 14% Dieticians: 10%
418 USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL REFERENCES Arsenault, J., and J. Kennedy. 1999. Dietary supplement use in U.S. Army Special Operations candidates. Mil Med 164(7):495-501. Bovill, M. E., S. M. McGraw, W. J. Tharion, and H. R. Lieberman. 2000. Supplement use and nutrition knowledge in a Special Forces unit. FASEB Journal 15(5):A999. Bovill, M. E., W. J. Tharion, and H. R. Lieberman. 2003. Nutrition knowledge and supple- ment use among elite U.S. army soldiers. Mil Med 168(12):997-1000. Brasfield, K. 2004. Dietary supplement intake in the active duty enlisted population. US Army Med Dept J (Oct-Dec):44-56. Corum, S. J. C. 2007. Dietary supplements questionnaire. 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. Deuster, P. A., A. Sridhar, W. J. Becker, R. Coll, K. K. OâBrien, and G. Bathalon. 2003. Health assessment of U.S. Army Rangers. Mil Med 168(1):57-62. French, S. 2007. Insights into dietary supplement usage by U.S. active military personnel. 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. Gardiner, P. 2007. Prevalence of dietary supplements in the U.S. young adult population. 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. Jaghab, D. 2007. Survey of Army health care providers concerning dietary supplements. 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. Johnson, A. E., C. A. Haley, and J. A. Ward. In Press. Hazards of dietary supplement use. Kaufman, D. W. 2007. Design and conduct of surveys on dietary supplement use. Paper presented at the Institute of Medicine Workshop on Dietary Supplement Use by Military Personnel, Washington, DC, February 12. Institute of Medicine Committee on Dietary Supplement Use by Military Personnel. Lieberman, H. R., T. Stavinoha, S. McGraw, and L. Sigrist. 2007. Use of dietary supplements in U.S. Army populations. 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. Marriott, B. M. 2007. Dietary supplement use by active duty military personnel: A world wide sample. Paper presented at the Institute of Medicine Workshop on Dietary Supplement Use by Military Personnel, Washington, DC, February 13. Institute of Medicine Com- mittee on Dietary Supplement Use by Military Personnel. McGraw, S. M., W. J. Tharion, and H. R. Lieberman. 2000. Use of nutritional supplements by U.S. Army Rangers. FASEB J 14(4):A742. McPherson, F., and M. A. Schwenka. 2004. Use of complementary and alternative therapies among active duty soldiers, military retirees, and family members at a military hospital. Mil Med 169(5):354-357. Schneider, K., L. Hervig, W. Y. Ensign, Jr., W. K. Prusaczyk, and H. W. Goforth, Jr. 1998. Use of supplements by U.S. Navy SEALS. Med Sci Sports Exerc 30:S60. Sheppard, H. L., S. M. Raichada, K. M. Kouri, L. Stenson Bar Maor, and J. D. Branch. 2000. Use of creatine and other supplements by members of civilian and military health clubs: A cross-sectional survey. Int J Sport Nutr Exerc Metab 10(3):245-259.
APPENDIX C 419 Thomasos, C. 2007. Assessment of Air Force dietary supplement usage by major commands. 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.