Patterns and Perceptions of Supplement Use by U.S. Marines Deployed to Afghanistan

Abstract

Dietary supplements are implicated in an increasing number of minor and serious adverse events, including death. A series of adverse events in deployed Marines using multiple supplements prompted medical officers to investigate the prevalence of supplement use among Marines stationed on Camp Leatherneck, Afghanistan. The investigators developed a survey to identify the types of supplements used, patterns of supplement use, reasons for taking supplements, perceived benefits from using supplements, and self-reported adverse effects. Marines were invited to complete an anonymous 17-question survey while visiting recreational and athletic facilities. A total of 329 active duty Marines completed the survey. The prevalence of supplement use was 72% for males and 42% for females (p = 0.009). Of the 12% of Marines reporting side effects, 79% were taking multiple supplements and 89% were using stimulants. Deployment was significantly associated with new supplement use (p < 0.001). Of users, 81% noted an improvement in physical performance. The majority of deployed Marines use multiple dietary supplements and perceive a high benefit. Given the high prevalence of supplement use and recent deaths associated with supplement use, recommendations are needed to guide the use of certain supplements by U.S. Marines in the deployed environment.

Soldier use of dietary supplements, including protein and body building supplements, in a combat zone is different than use in garrison

“…Interestingly, our findings of DS use among deployed personnel are remarkably similar to DS use by United States Marines deployed to the same region of conflict (Cassler et al 2013). Previous reports of DS use for deployed soldiers (Boos et al 2010(Boos et al , 2011Cassler et al 2013;Jacobson et al 2012) did not directly compare deployed and garrison personnel using the same survey instrument as was done in the current investigation. Therefore, this report is the first we are aware of that definitively demonstrates that patterns of DS use change during deployment.…”

“…Also, a large cohort study reported greater use of body-building and weight-loss supplements in both males and females with a history of deployment to a combat theater (Jacobson et al 2012). Another study found greater DS use by United States Marines who were deployed to Afghanistan (Cassler et al 2013). The prevalence of overall DS use we observed among deployed personnel was much higher than the 35%-40% levels reported in the recent studies of British soldiers deployed in Afghanistan or Iraq, but this may reflect differences in the questionnaires used in each study (Boos et al 2010(Boos et al , 2011 or general differences between British and American DS use.…”

“…Separately, a larger cohort of deployed United States military personnel had higher prevalence of bodybuilding, energy, and weight-loss supplement use compared with soldiers who had never deployed (Jacobson et al 2012). A more recent survey of deployed United States Marines in Afghanistan reported that 70% of respondents used DSs and that almost 30% of supplement users began consuming supplements during deployment (Cassler et al 2013). Protein supplements were the most common supplement used.…”

A systematic review and meta-analysis on the prevalence of dietary supplement use by military personnel

“…Thirty-three unique investigations in 38 publications met the review criteria. Seven reports were in government technical reports [14-20], two were only in abstract form [21,22], 9 were in an Institute of Medicine report on the use of DSs in military personnel [23-31], and 20 reports were in peer-reviewed journal articles [5-9,12,32-45]. Three individual studies had two reports each [15,19,25,30,32,38] and one produced three relevant publications [8,41,42].…”

“…Like athletes, military personnel often have occupational tasks that require intense and prolonged periods of physical activity. Like athletes, service members may use DSs that have purported ergogenic effects to enhance their occupational performance [5-9]. Unlike athletes, service members may be working in austere and hostile surroundings under extreme environmental conditions with high risk of injury.…”