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Banned Supplements in the Military


If you are serving in the military you may wish to take a supplement to help with your training and improve your overall performance.

After all, athletes take supplements to get that winning edge, and at the end of the day those athletes' lives won't necessarily depend on being stronger, fitter, and faster than their opponent, unlike the enemy you face on the battlefield.

Furthermore, it is hypothesized that soldiers are just like competitive athletes. [1]

They endure grueling fitness regimes, required to haul heavy loads and in all weathers, on little sleep, and have to be battle-ready all year round.

Whereas an athlete needs to just excel in one event, has on and off seasons while being supported by a team for optimum performance.

When you start to look at soldiers as elite athletes, it starts to make more sense that nutritional supplements can be of benefit.

soldier firing minigun

In this article we shall cover the following:

  • Supplement use in the military
  • Risks
  • Department of Defense prohibited list
  • Conclusion

Supplements for Military Training

Military training is designed to be arduous and difficult. It has been developed through hundreds of years of conflict then finely tuned for recent lessons from the battlefield.

Furthermore, military physical training focuses on full-body movements and all-over fitness which reflects lifting, moving, and carrying equipment.

Nutritional supplement use has been around since the early 20th Century.

Arguably taking 'supplements' or aids to increase performance have been around 500 B.C from what research tells us. [2]

When and what was the turning point?

While ancient warriors and athletes consumed different foods and potions, there wasn't any science or valid understanding of how the body works.

Even throughout the 1800s, there was a misunderstanding of what fuelled our bodies.

This changed around 1900 when vitamins and their role was discovered, this new appreciation and comprehension cemented the relationship between science and sports enhancement.

What's the Reason?

Research states that correct nutrition (including the use of supplements) can help an athlete cope with the high demands encountered with intensive training. [3]

Therefore, it may not come as a surprise to learn that it is reported that there is a high use of dietary supplements among elite athletes. [4] [5]

Furthermore, data collated from national surveys in the USA show that 71% of adults use dietary supplements. [6]

Yet it isn't just the US population that is hooked on supplement use...

A review and meta-analysis of 20 questionnaires and surveys published in the International Journal of Sports Nutrition and Exercise Metabolism illustrate that athletes around the world are using supplements for a variety of reasons, of which the most common are listed below. [7]

  • Performance enhancement
  • Improve general health
  • Increase energy
  • Better recovery and strength
  • Boost immunity
  • Avoidance of deficiencies
  • Endurance

If athletes are gaining an advantage, naturally soldiers want to as well. After all, having that edge over the enemy can be the difference between life and death.

Going on the data that a high percentage of athletes and even civilians are using nutritional supplements to gain that advantage, it would prudent to think that soldiers are using them too.

As a result, it may come as no surprise to learn that the majority of soldiers are using or have used supplements.

While there are different surveys showing slightly differing results across the various services and roles, the overall consensus is that supplement use is high and has risen over the years.

Data

The US Marines are a good example, as 50% of recruits were using supplements that were used upon basic training entrance. [8]

However, the highest usage is among those entering training for special forces roles which escalates to 85% of soldiers taking supplements. [9]

It is important to note that this data is representative of US military service personnel, and may not be reflective of the wider pool of other nations' military forces.

So, we wanted to see what the trends were elsewhere... 

A study published in 2017 by The Nutrition Society via the Cambridge University Press showed that 32.3% of Australian current serving and Middle East veterans used supplements.

17.5% of the survey participants used bodybuilding supplements, and they, on the whole, had healthy lifestyles and better health status than the other participants who were using fat loss and energy supplements. [10]

Moving on to the British Armed Forces, a survey saw that during 2010 and at the height of the War on Terror in Afghanistan, 56.3% of British soldiers were using or had used supplements ranging from protein shakes to testosterone boosters.

Interestingly there was a rising trend of use by approximately 8% compared to a similar survey taken during 2009 in Iraq. [11]

That's an 8% rise in just one year. 

Additional data also shows that 38% of soldiers entering training within the British Army reported the use of supplements. Some (a minority) even reported the use of anabolic steroids and growth hormones.

Interestingly, data modeling suggests that the highest user of supplements for soldiers during training are female, a smoker, of a younger age, and entering officer cadet training. [12]

So what does this say to us?

Supplement use is widespread amongst athletes, soldiers, and the general public, and if past trends are to go by, it will increase over the years.

Supplements for Military Training

The British Army does not recommend the use of supplements as a way to fill a gap in a person's nutritional intake.

They are also concerned about the risk of contamination of supplements from unscrupulous manufacturers. [13]

On the other hand, the US military has taken a different, more educational approach to supplement use for personnel.

They set up a resource called 'Operation Supplement Safety'. This website offers information about which products are high risk and which ingredients are banned.

Thus providing a clear message to its personnel. Essentially, there are no excuses should you test positive for a drug test.

The Australian army notes that their policy for supplement use aligns with the World Anti-Doping Agency. That is, if it contains an ingredient on their list, it is banned for use by their soldiers. [14]

Funnily enough, an article posted on the Australian Army website blog debates the use of human enhancing drugs such as steroids and growth hormones to gain that competitive edge over the enemy.

It is worth noting that even though these military services do appear to clear themselves of any misgivings regarding supplement use among their personnel, all of these nations allow the sale of nutritional supplements on their bases.

The US military has over 100 supplement stores on its bases in the US alone. [15]

Conflicting Messages?

Maybe.

Whichever way you look at the policies in place, they tend to align with those stipulated for athletes.

So we are talking about those supplements and those included ingredients that are allowed or prohibited by WADA.

Are they all bad?

It seems that in some cases supplements may have been given a bad name, this is because there have been quality issues and are still quality issues amongst the manufacture and sale of supplements.

This has led to contaminations.

As a result, there does seem to be a reluctance of acceptance towards supplements within military policy.

No doubt due to the fast-evolving market and products being brought to the market.

That said, there is strong consumer confidence in the safety and quality of supplements, both in the civilian and military contexts. [16]

In addition, it is reported by findings published in the Journal of Clinical Psychopharmacology that supplement use is associated with positive health behaviors among US military personnel. [17]

What are the risks?

troops on troop carrier

There are two main risk points for supplement use for those in the military, these being:

1. Untested and therefore potentially unsafe ingredients
2. Possible contamination of banned substances

Let's look at the first point.

Regulation

The U.S Food & Drug Administration (FDA) can only direct the withdrawal of products from sale if there is proof of danger to consumers. [18]

Therefore, in effect, an event has to have happened for there to be an investigation into the sale of a product.

The FDA has to show proof of the danger rather than the manufacturer of a product having to prove the safety of what they sell.

This can open the door to many products being sold by companies who are merely chasing short term profits rather than long term sustainability.

This is why at Military Muscle we provide a supplement that is manufactured to the highest safety and quality standards using only approved ingredients that do not pose a health risk.

Case Study

The FDA was able to take the pre-workout supplement JACK3D off of the market when a number of soldiers died using it which contained DMAA (1.3-Dimethylamylamine). [19] [20]

Initially, DMAA wasn't banned. It was initially developed in the 1940s as a nasal decongestant.

It found its way into supplements around 2005 to help improve performance and lose weight.

Yet it wasn't until 5 years later that the World Anti-Doping Agency denied its use for athletes.

However, it took the deaths of soldiers [21] and the death of a marathon runner in London [22] to stimulate government agencies in the UK, Canada, and the US to re-classify DMAA from a dietary supplement to a drug, and as such ban its sale or inclusion in fitness supplements.

While the Department of Defense removed the sale of products containing DMAA after the death of the soldiers it was still a year after WADA had banned the substance yet two years prior to the FDA taking any action.

This example using DMAA shows that a product was available to buy, use, and contributed to deaths long before it was withdrawn from sale highlighting the limited restrictions on some products.

Contamination

A widespread issue is also the contamination of supplements with substances that are classed as drugs, and therefore must be regulated.

This may happen for a variety of reasons.

The supplement may be produced in a facility that also manufactures products classified as drugs and is accidental.

Or, they are produced with the intention of not declaring the included drugs to enhance the ability of the product to ensure repeat sales.

From a legal standpoint, it is the manufacturers' or the distributor's responsibility that their product is safe before marketed for sale.

Additionally, there are no provisions by the FDA to approve a product and they rely on feedback from consumers and industry professionals. [23]

As a result, this can lead to abuse of the system.

A regulatory system that had been criticized for not adequately using their powers to protect consumers [24] and recalling products that have been identified as including hidden ingredients that are unapproved drugs. [25]

Arguably, this lack of action by the relevant authorities can be associated with the tens of thousands of hospital admissions in the US linked to supplement use according to a study published in 2015. [26]

This criticism may have been the catalyst for a change reported by the FDA in February of 2019 to modernize their policies and regulations in order to protect the public and help ensure only the highest quality and safest products are available for sale. [27]

Case Study

During the 2008 Olympic Games, a swimmer was given a 1-year suspension and banned from the Olympic Games because a supplement that she had used was contaminated with Clenbuterol which is banned by WADA. [28]

The product that she was using was nothing more than a pre-workout supplement which was to contain arginine, branched-chain amino acids, B6, B12 folic acid, and biotin.

This ingredients list contains absolutely nothing that she should have been worried about. However, it was tainted.

This is why it is imperative that you check the source of your supplements. Where it is made, the regulations imposed and the extra procedures put in place.

Military Muscle is produced in an FDA accredited facility that adheres to Global Standards for Food Safety. Furthermore, it is produced in the UK.

Dietary supplements that are produced in the UK fall under the Food Safety Act 1990 legislation.

This means that dietary supplements must be fit for human consumption and not misleadingly mislabelled in order to increase consumer protections. [29]

In addition, any supplements produced or sold in the UK have to include only vitamins and minerals that feature on The Food Supplements Directive that have been assessed for safety and approved by the European Safety Authority.
[30]

Banned Military Supplements List

multiple pills and powder

We have skipped the banned ingredients, compounds, and metabolites that are listed by WADA as these do not correlate directly, although they do share similarities. 

Yet, as we have already seen, different agencies react independently of each other.

In the case of the DMAA issue, it was banned first by WADA, then DoD before the FDA took action.

Therefore, we shall look exclusively at the dietary supplement ingredients prohibited by the Department of Defense for the US Military. [31]

However, we shall go further than the information provided by the DoD, Uniformed Services University, and the Consortium for Health and Military Performance.

In this article, we shall take a further look at each banned substance and its dangers.

We shall cover these in alphabetical order, and any claims will be supported with cited references.

Supplements Not Allowed in the Military

This is the list:

Acacia Rigidula

This may seem like a harmless shrub. Funnily enough, it was synthesized in a laboratory long before it was discovered in a natural source.

The issue with Acacia is that in quite high doses it can have psychiatric effects and may cause users to test positive for amphetamine use which mirrors its amphetamine-like stimulatory effects.

There have been multiple cases of supplements containing Acacia yet lacks any rigorous safety testing.

Further to this, there has been precious little research on humans or even animals, period. [32]

A further concern is that there are many supplements claiming to contain analogs of synthetically made amphetamines, one of which is β‐methylphenylethylamine (BMPEA) which is marketed as Acacia. [33]

It is this which was related to the death of a Swedish woman who used a supplement called Jacked Power. [34]

As a result, it was advised by a published paper from 2015 that all products should be removed from sale to the public.

Aconite

Aconite is a plant with purple flowers that are favored in ornamental gardens. However, its gentle appearance belies a poisonous nature. 

It has been used in the past for medicinal purposes from as early as 1788 in Vienna and was introduced in the UK a little later in 1788 followed by the US in 1820.

However, being toxic, and there being a very fine line between benefit and danger, its use declined. [35]

It is worth noting that the roots of the plant are highly toxic, it can cause a host of health issues and even death. [36]

However, the supposed health benefits of improved strength, immunity and pain relief can prove too tempting for some. [37]

Aegeline

There appears to be some conflicting evidence regarding aegeline.

Aegeline supposedly has many health benefits, yet the clinical evidence is lacking. [38]

The catalyst for it to be banned appears to stem from reported liver injury associated with a supplement called OxyElite Pro which included aegeline.

One of the reported benefits is weight loss when consumed as a dietary supplement as animal studies have demonstrated some potential against obesity. [39]

However, the high number of reports of liver injury and even death by the users of the aforementioned supplement.

It was then concluded by members of the Queen's Liver Centre that aegeline was responsible. [40]

Yet, a paper published in 2018 disputes these claims and suggests that the historical evidence points towards aegeline being used as a treatment for jaundice and liver injury while the plant being part of many people's diets for thousands of years with no recorded health concerns. [41]

However, it must be noted that the author, Cyril Wilson, of the published report, has worked as a consultant to the manufacturing company of OxyElite Pro.

You could say that he is trying to balance the argument, or he may be considered as trying to dissolve any responsibility for USPlabs.

Aromatase Inhibitors

A natural compound called 3,3'-Diindolylmethane (DIIM) is found in vegetables such as kale, Brussels sprouts, and broccoli is considered an aromatase inhibitor with anti-estrogenic capabilities. [42]

However, DIIM doesn't pose a risk.

The banned supplements list concerns the following:

  • 1,4,6 etioallocholan-dione
  • 3,17-keto-etiocholetriene
  • Androsta-1,4,6-triene-3,17-dione (androstatrienedione)
  • Androsta-3,5-diene-7,17-dione (arimistane)

It appears that the main issue for the listed aromatase inhibitors is that they are not dietary supplements, but classified as steroidal drugs that can have irreversible effects.

They are also used alongside an anabolic cycle to help reduce issues such as water retention and Gynecomastia (enlargement of the nipples).

If used on their own, they can potentially increase testosterone levels by reducing estrogenic steroid hormones. [43]

In effect, this alters your steroidal hormone production. Furthermore, their use can trigger a positive test for the anabolic steroid, boldenone. [44]

Betaphrine

Studies remark how effective betaphrine is in regard to using stored fats as energy and could be used to mitigate obesity. [45]

So what are the issues? Why is it banned for military personnel?

Well, betaphrine is not a dietary ingredient and is chemically synthesized and classified as a drug because of the nature in which it can alter and affect the function of the body. [46]

BMPEA

There's a large list of varying names for this, but in the end, it all comes down to BMPEA.

This is another synthetic substance that doesn't fit in the role of a dietary ingredient, it also has a similar effect, although about two thirds less of amphetamine.

As such it has been included in sports supplements, and it has been associated with the death of an athlete. [47]

Cannabidiol (CBD)

If you are confused about the inclusion of CBD on the list, then you are not alone.

When it comes to the cannabis plant, there are two main compounds which are known as cannabinoids.

One is THC and the other CBD.

We'll try and keep it simple...

THC is what is associated with the 'high' of cannabis. The drug effect and the side effects such as hunger, paranoia, irreversible reduction of IQ over time amongst others. [48]

CBD is reported to have many beneficial health effects and doesn't cause the 'high' that is associated with cannabis nor are there any health-related problems associated with its use.

However, at present, there's a mixed legal status across the USA, and while absolutely minimal, there are still traces of THC. [49]

DMAA

As already discussed, DMAA has been linked to cardiac arrest and the death of soldiers plus a marathon runner. DMAA has been and is used for increasing physical performance and weight control.

Even as early as 2008, the government of New Zealand asked for retailers to voluntarily restrict the sale of products containing DMAA. [50]

DMBA

Back in October 2014, it was noted in issues 1 of volume 7 for the Drug Testing and Analysis Journal that DMBA was a synthetic stimulant that had never been tested in humans.

However, regardless of the lack of testing, it is appearing in supplements for human consumption. If you think the name looks familiar, it is because it's a dialogue of the banned substance, DMAA.

According to findings from some small scale animal studies from the 1940s, it would suggest that DMBA has similar, but not as strong effects as DMAA. [51]

Whilst not clinical, anecdotal side effects of DMBA have been described as leaving people jittery, dizzy, anxiety, and depression. [52]

As a result, it is another synthetically produced compound that is banned in sport by WADA.

DMHA

Also known as octodrine which is found in 'fat burner' products.

Its roots stem back to DMAA as a nasal decongestant.

There's not a great deal of reliable and credible research on DMHA, and lots of speculation along with anecdotal analysis.

DMHA does have physiological and psychoactive effects with high blood pressure and breathing difficulties being side effects. [53]

Ephedra

While ephedra is natural, it can have some negative reactions and creates a 'speed' like effect which increases alertness, energy, and help weight management. 

However, it has been associated with hundreds of dangerous reactions from users.

This has included heart attacks and even death.

Furthermore, over 30 US soldiers have died using ephedra with very few research papers available concluding athletic performance and weight loss enhancements over the long term. [54]

HGC

Human Chorionic Gonadotropin has demonstrated positive effects on increasing testosterone levels and stimulating penis growth for those with a micro-penis. [55]

There's also knowledge of people using HGC TO reduce bodyweight by accompanying it with an extreme calorie-restrictive diet. [56]

Clearly, men and athletes would like these advantages. So what are the risks?

According to a dietitian and health risk counselor, this hormone that is normally produced during pregnancy and used to enhance a weight loss program can cause fatigue, depression, fluid build-up, blood clots, and gynecomastia amongst other effects. [57]

Not only are there dangers, but there is also little conclusive evidence that an HCG supplemented diet is particularly effective and may cause more problems than any positive outcome. [58]

Hemp

Due to the fact that hemp marijuana products do contain a very low level of the compound THC which creates the feeling of being 'high', it is THC which remains illegal. [59]

With the gray areas of legality throughout the US and indeed some international markets, plus the difficulties of regulation and the effects this may cause for military drug testing, hemp and other related products are banned.

Much like CBD. [60]

HGH

Human growth hormone does exactly what it says.

It is required for the growth of every cell for human development.

It has anabolic effects on muscle growth, and as a result, has been banned from sport since the 1990s.

While studies relating to the effects of just HGH aren't widespread, the results of people using them are increases in muscle, power, and strength, however, the use of HGH is usually alongside other drugs.

There are some risks documented by excessive abusers which can include swelling, fluid retention, excessive sweating, increases in the size of feet and hands, cardiovascular diseases, and coarsened facial appearance amongst other side effects. [61]

IGF

Insulin-like growth factor 1 is important for growth in children, while in adults it has anabolic effects which help increase muscle development. [62]

However, there are some risks.

Some studies have connected high levels of IGF-1 with cancer. [63]

Yet the risks associated with bodybuilding and performance enhancement include headaches, seizures, jaw pain, altered liver function, low blood sugar to name a few. [64]

Kratom

While not illegal, and not difficult to source, kratom has psychotropic effects which change the way your mind operates.

There have been reported deaths of kratom misuse and it can cause sweating, hallucinations, constipation, seizures, loss of appetite and users may develop a dependency. [65]

It is used as a stimulant and also can have a relaxing effect, provide pain relief, and a 'legal' alternative to opioids. [66]

Methylsynephrine

Also known as oxilofrine, it is a pharmaceutical stimulant that has not been approved for use in the USA as either a prescription drug or a dietary supplement.

It stimulates the heart and increases blood pressure.

It has been the cause of some athletes' suspension from sport due to its inclusion in sports supplements. [67]

Phenibut

Discovered in the 1960s, phenibut has been used throughout Russia as a cognitive enhancer, while relieving tension, anxiety, improving sleep, alleviate depression, and improve sleep. [68]

However, phenibut is not approved for use in many Western countries and bodybuilders anecdotally claim that it can improve muscle building, although this has yet to be clinically proven. [69]

There are risks of becoming dependant on phenibut, particularly as sourcing from the internet can provided spurious amounts.

Picamilon

Another synthetic drug that was formulated in Russia during the 1960s.

It is still sold in Russia as a prescription drug, however, it is not classified as a dietary supplement in the US because it has not been tested for safety in humans. [70]

The state of Oregon sued a supplement manufacturer for including picamilon in their product which is potentially unsafe. [71]

Pseudoephedrine

This is a decongestant that helps relieves swollen blood vessels in the sinuses.

It can cause headaches, increase blood pressure, cause headaches and nausea. There's the possibility it can make you feel restless, nervous and shaky. [72]

The issue in the US is that any cold remedies that include pseudoephedrine is now controlled because it can be used to illegally produce methamphetamine which is a powerful and highly addictive stimulant. [73]

Racetams

Widely used as a nootropic, there are limited human studies and it is considered to be potentially harmful. [74]

As a result, racetams are not legal dietary supplements in the US, they aren't a controlled substance and do not occur naturally, nor are they derivatives of natural substances.

Redotex

Marketed as a weight-loss drug that is banned in the US but available in neighboring Mexico.

The use of redotex has resulted in a number of people being referred to poison centers and can be potentially toxic to the user. [75]

Salvia divinorum

The leaves of this plant can be chewed, brewed as a tea or smoked. The leaves contain compounds like opioids that can be hallucinogenic.

It has been used for hundreds of years, yet research is limited and the effects can vary between user and amounts used.

You may experience a pleasing psychedelic trip or it could be very disturbing.
There is a risk of it triggering psychotic episodes and injuring themselves whilst under the influence. [76]

SARMs

Selective Androgen Receptor Modulators are compounds that are similar to anabolics but without the unwanted side effects commonly associated with drugs such as steroids.

They have been developed over recent years to help people who are suffering from chronic diseases and aging. [77]

However, they are still being developed and more research is required. At present they have classified a new drug that is not approved for human use.

Tianeptine

Used to treat depression, its use can cause headaches, changes to dreams, constipation, dizziness, and abdominal pains although death has been reported from recreational misuse. [78]

Admissions to US poison control centers increased during 2014-2017 by users of Tianeptine which suggests a public health risk. [79]

However, at present, it is classed as an unsafe food additive and is not a dietary supplement ingredient. It is not approved by the FDA.

Vinpocetine

A synthetic version of a substance found in a plant, it is used as a nootropic to improve memory and cognitive function with some success. [80]

However, because it is not a constituent of a plant(s), it cannot be classified as a dietary ingredient.

Conclusion

BUY NOW MILITARY MUSCLE

There is no doubt that supplements play a large role in military personnel, and they can benefit physical and cognitive performance.

However, there are risks.

Risks that need to be eliminated for safety, and to maintain your role.

This list of ingredients banned by the Department of Defense is overwhelmingly full of substances that are potentially dangerous, proven by past events, or due to the unknown nature of the compound.

One of the problems that seem to be highlighted is the difference between what is considered a dietary supplement and a drug, particularly an unapproved drug.

Some substances that find their way into supplements are synthetic and do not meet the definition of a dietary ingredient, and as such, are classified as unsafe additives.

Whereas others are drugs that are newly developed but haven't yet been through sufficient testing to ensure their safety and effectiveness.

Others are drugs that require a prescription from a medical professional.

Let's take a look in more detail at these classifications.

Dietary Ingredient

According to the FDA a dietary ingredient that is to be used by a person in order to increase their nutritional dietary intake. [81]

They are not and cannot be sold or used to treat any ailments, nor diagnose or prevent diseases.

These can be vitamins, herbs, botanicals, or even amino acids.

The labeling for dietary ingredients or products including them cannot be misleading nor make claims such as reducing pain or treat cancer.

Drug

Unlike dietary ingredients, drugs are intended for the use of treatment of diseases; be this to cure, mitigate, prevent, and diagnose. [82]

They are designed to alter and affect the structure and the function of the body.

Drugs require extensive tests before FDA approval for use.

Standards: Hygiene, Safety, Quality

The lightly regulated nature of the supplement industry can expose supplement users to untested and unclassified substances whether listed on the ingredients panel or not.

It is as important as ever to check where, and to what standards your product is manufactured.

The internet and online market places like Amazon are awash with 'private label' products that are manufactured in facilities and regions whereby safety regulations are little to non-existent.

This can mean that your product is not produced in a clinically graded environment.

This increases the risk of cross-contamination, allergens, or that what is on the label isn't in the bottle particularly in supplements that contain a proprietary blend.

This is hugely important as we are currently in a period whereby we are faced with a global virus pandemic.

It is times like these whereby quality manufacturing standards are a priority, particularly for your safety.

At Military Muscle, we now ensure that there are no animal products in our supplement.

We have gone the extra mile to supply our product in vegan capsules.

Therefore there's no risk of disease or contamination from poorly regulated bovine or porcine sources originating from places like China.

In addition, our product is manufactured in highly regulated and FDA approved facilities to ensure optimum hygiene levels, quality of the ingredients, and that what is on the label, is in the bottle, as per the law states.

The products must not include anything that would be damaging to the health of the people who will consume it. [83]

Furthermore, all of the vitamins included meeting those that are permitted for use which has been assessed and approved by the European Food Safety Authority (EFSA).

This means you know that you are getting a premium, safe, and legal product.

A clean, safe, effective supplement that can be used by military personnel.

--------

This post was written by Ben - BA(Hons). 

military muscle founder nordic skiing

References

[1] https://academic.oup.com/milmed/article/183/7-8/e270/4840547

[2] https://academic.oup.com/jn/article/127/5/869S/4724164

[3] https://jissn.biomedcentral.com/articles/10.1186/s12970-019-0292-9

[4] https://link.springer.com/article/10.1007%2Fs40279-015-0387-7

[5] https://www.ncbi.nlm.nih.gov/pubmed/24149808?dopt=Abstract

[6] https://www.crnusa.org/resources/2016-crn-consumer-survey-dietary-supplements

[7] https://journals.humankinetics.com/view/journals/ijsnem/28/2/article-p126.xml#r9

[8] https://academic.oup.com/milmed/article/174/2/158/4333807

[9] https://www.ncbi.nlm.nih.gov/books/NBK3967/#a20015f31ddd00044

[10] https://www.cambridge.org/core/journals/public-health-nutrition/article/current-dietary-supplement-use-of-australian-military-veterans-of-middle-east-operations/BBE4C037450C163819E35F006CC88AE4

[11] https://militaryhealth.bmj.com/content/157/3/229

[12] https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/supplement-use-by-ukbased-british-army-soldiers-in-training/BA6E8B34B915448C1F7486DBB8075A98

[13] https://www.army.mod.uk/people/join-well/drugs-and-supplements/

[14] https://www.army.gov.au/our-future/blog/situational-awareness/anti-doping-in-sport-and-human-enhancing-technologies-in-army

[15] https://www.gnclivewell.com/military/

[16] https://www.ncbi.nlm.nih.gov/pubmed/23051046

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165472/#ref4

[18] https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements

[19] https://www.stripes.com/news/us/dmaa-role-in-military-deaths-still-in-question-1.235490

[20] https://www.tandfonline.com/doi/abs/10.1080/01947648.2014.913462?scroll=top&needAccess=true&journalCode=ulgm20

[21] https://www.ncbi.nlm.nih.gov/pubmed/23397688

[22] https://www.kcl.ac.uk/lsm/research/divisions/aes/newsevents/newsrecords/2013/Feb/Dr-Andrew-Kicman-(DCC)-quoted-in-article-about-London-marathon-runners-death

[23] https://www.fda.gov/food/dietary-supplements/how-report-problem-dietary-supplements

[24] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706489

[25] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496

[26] https://www.nejm.org/doi/full/10.1056/nejmsa1504267

[27] https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-agencys-new-efforts-strengthen-regulation-dietary

[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753965/

[29] https://www.hsis.org/food-supplements-regulations/

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[54] https://www.health.harvard.edu/staying-healthy/the-dangers-of-the-herb-ephedra

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[58] https://www.ncbi.nlm.nih.gov/pubmed/27010890

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[83] https://www.hsis.org/food-supplements-regulations/