Nutritional supplements: Buyer beware

  • Published
  • By Capt. Michael Bolduc
  • 8th Medical Operations Squadron aerospace and operational physiologist
In January 2011 a dietary supplement company based out of Southern Florida announced a recall of one of their weight loss supplements.

The reason for the recall was the supplement contained a Food and Drug Administration regulated drug, commonly used as an appetite suppressant for weight loss, but was not advertised on the product's label. How is this possible? The answer lies in the current state of overall regulation governing the supplement industry in the U.S.

First of all, the 1994 Dietary Supplement Health and Education Act states manufacturers need not register or seek approval from the FDA to produce or sell dietary supplements. To make matters more interesting, the FDA will only take action against an unsafe dietary supplement after it reaches the market. Simply put: supplements are not regulated.

Thankfully, the Air Force has a more conservative approach to supplementation for aircrew members. According to the Official Air Force Approved Aircrew Medications list, published June 2012, dietary, herbal and nutritional supplements can only be used with the approval of a flight surgeon. A major reason nutritional supplements are a part of this list is to ensure that negative interactions do not occur between the desired supplements and prescribed medications.

Currently, Air Force Instructions 44-120, "Military Drug Demand Reduction Program," and 44-121, "Alcohol and Drug Abuse Prevention and Treatment Program," are the only policy references for Air Force members describing drug testing ramifications. According to AFI 44-120, "The ingestion of products containing or products derived from hemp seed or hemp seed oil is prohibited." Hemp can be found in many "health food" products so be sure to read labels carefully prior to purchase.

Not all products necessarily have to be illegal for consumption in order to have detrimental effects on performance. In the February 2011 Journal of Aviation, Space and Environmental Medicine titled Reduced G-Tolerance Associated with Supplement Use, a seasoned fighter pilot experienced two episodes of visual degradation under moderate gravitational force (4-5 Gs).

After the event, the flight doctor's medical evaluation revealed none of the usual factors associated with diminished G-tolerance (dehydration, fatigue, poor diet, lack of exercise or illness) but did identify the individual started a regimen of Vitamin B, niacin and Coenzyme Q10 two weeks prior to experiencing the event.

The combination of niacin and Coenzyme Q10 supplements caused an overall reduction in his blood pressure and vascular resistance and effectively reduced the pilot's G-tolerance. Niacin is purported to reduce blood pressure while Coenzyme Q10 can lead to vasodilation effects. A fighter pilot under G's needs both adequate blood pressure and peripheral vascular resistance to maximize protection from the effects of positive G's.

The nature of the supplement industry simply does not merit the amount of trust consumers place on it. In addition, laws regulating the supplement industry in South Korea may be even more liberal, so be judicious if you choose to shop for supplements off base. Bottom line, when it comes to supplementation, ask a medical professional first.