Dietary Supplement Intake, Adverse Effects, and Reasons for Use by Military Service Members: A Narrative Review and Proposal for an Adverse Effects Surveillance System.

Extensive use of dietary supplements (DSs) by civilians and military service members (SMs) raises safety and efficacy issues. Adequate surveillance systems to detect dangerous DSs in the US marketplace do not exist. This paper reviews studies on SM DS use, safety, adverse effects (AEs), reasons for use, and knowledge as well as SM attitudes regarding DS safety, efficacy, and regulations. The findings are compared to US civilians and foreign SMs. Use of DSs by SMs has increased, from 53% (2006-2007) to 76% (2018-2019) in the Army. Compared to civilians, SMs use more DSs, and consume more potentially dangerous DSs, especially those purported to enhance physical performance and weight loss. The most commonly used DSs by SMs are multivitamins/multiminerals, proteins/amino acids, combination products, and individual vitamins/minerals. Self-reported prevalence of AEs by SMs is about 18%, and highest among those using combination products and prohormones which contain substances that could cause AEs themselves or interact with other DSs or medications. Most SMs using DSs believe they are safe (67%) and efficacious (71%); many (38%) believe government regulations ensure safety. Longitudinal studies indicate experiencing AEs does not deter SMs from DS use, since most AEs appear minor and may indicate the DS has the expected effects. Similar civilian data are not available regarding use of potentially dangerous DSs, attitudes, and AEs. Improved oversight, education, and prevention of AEs from DSs is necessary and could include a continuous surveillance program of SMs to detect potentially dangerous DSs.