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Jennifer Grebow is editor-in-chief of Nutritional Outlook.
Why the supplements industry should start with the military to convince policymakers to adopt broad-scale recommendations.
It takes a lot to get U.S. scientific bodies and policymakers to officially recommend the use of a dietary supplement. The road to recommendation is long and arduous and one that’s been especially challenging to the dietary supplements industry. One example of this is the multivitamin. Despite the fact that more than half of Americans already take multivitamins, the U.S. Preventive Services Task Force and the current Dietary Guidelines for Americans stop short of recommending multivitamins, citing insufficient evidence of benefit.
But there may be a stepping stone in the process, according to the keynote speaker at this year’s Council for Responsible Nutrition (CRN; Washington, DC) annual conference and workshop, held in November. Retired army colonel Wayne Jonas, MD, proposed that if dietary supplement makers can demonstrate the benefits of supplement usage in the military, it could sway U.S. policymakers to recommend supplements for the civilian population.
Military: First Out on Healthcare Policies
Military healthcare policies have historically paved the way for broader nationwide policies, said Jonas, who is the former director of the Office of Alternative Medicine at the National Institutes of Health, the former director of medical research fellowship at the Walter Reed Army Institute of Research, and current president and CEO of the Samueli Institute, a Virginia-based research group doing a great deal of healthcare research in the military.
Take the National School Lunch Program, Jonas said. This federal program got its start during World War II, when military leaders realized that many newly enlisted soldiers were undernourished. “Those are the kinds of things that happen and are driven by the needs of the military,” he said.
Calling the military a “potential market” and a “tremendous opportunity” for the supplements industry, Jonas encouraged industry members to help facilitate more supplements research in the military. If the industry can get the military to speak up for supplements, he argued, the rest of the country may follow. And one critical fact makes this possible: “The military loves supplements,” Jonas said.
“The military uses supplements at a higher rate than the civilian population,” he said. A survey on marines deployed to Afghanistan found that up to 72% of male service members and 42% of female service members in the field used dietary supplements. A majority of service members also say they are confident supplements work as advertised, he added.
With so much supplements usage going on, “the military is looking for not just preventing the use of [harmful] supplements or regulating it but actually recommending [supplements]…to enhance performance of the military and enhance the health of the military,” Jonas said.
A Quicker Road to Recommendations
The military also tends to make healthcare policy decisions independently and more quickly, he pointed out. Whereas U.S. policymakers and scientific bodies require decades of research steeped in RCTs and meta-analyses to confirm a supplement’s safety and efficacy, the military looks to “adopt things sooner” because the need for good health and optimal performance for servicemen in combat is immediate and critical.
“It’s very likely that they will make recommendations for actual use of supplementation [even] when the national policy and FDA policy are not making those recommendations,” Jonas said.
The military can make policy decisions more quickly because it looks for evidence in the form of “effectiveness” instead of “efficacy,” he said. Efficacy is a word used to describe the type of controlled-environment, clinical-setting evidence-RCTs, meta-analyses, etc.-that policymakers demand before considering nationwide recommendations. By contrast, “effectiveness” research is much more “pragmatic,” Jonas said. “Effectiveness is the effect of a supplement under real-life conditions.”
“Unlike the NIH, which is particularly interested in mechanisms [of action] and efficacy, and unlike the FDA, which is focused primarily on efficacy for regulatory purposes, the military is very interested-probably more interested-in effectiveness,” he added. “They want to know, 'Does it work out there compared to something else?'”
“It’s not that the military isn’t interested or [doesn’t] think it [is] important to look at placebo or mechanisms,” he said, but exploring mechanisms of action may not be as immediately important to the military than finding out quickly whether a supplement may benefit servicemen now.
Jonas pointed to the example of an acupuncture study that the Samueli Institute conducted in military members. “There was a big debate as to what should be the next study. Should we do placebo acupunctures? Should we try to identify what the specific biological mechanisms were in the brain, etc.? The military didn’t want any of that. They wanted another pragmatic study to demonstrate, ‘Could we utilize it actually in practice?’ In other words, could you train medics to use it on the battlefield, and what impact would that have on drug utilization, pain, and performance? They wanted a pragmatic study.”
This willingness to consider different levels of clinical evidence is part of a general “paradigm” shift that needs to happen overall, he said. “We have to use good science and good science methodologies, but we need to use a diversity of methodologies to get information about utilization for different decision makers and contexts in these areas. I think research in the military provides a great opportunity to do that.”
As for the supplements industry, he said, a good way to “get the ball rolling” is to start by conducting pilot studies in military populations. If study results are positive, it may lead to larger military-funded studies. The payoff may be well worth the investment, he said, because the military is “more than willing to create their own regulations for their own population.” And the rest of the country may follow in time.
Sidebar: What Kinds of Supplements Does the Military Take?
There are a number of studies underway-many by the Samueli Institute-on supplements in the military. One of them is an omega-3 supplement trial examining benefits on physical and cognitive function. Based on the military’s high use of certain types of supplements, there is room for more research still.
Military personnel are especially keen on sleep aids as well as stimulants (caffeine, energy drinks), Jonas said, because “the need to sleep and hurry up and wake is a huge issue” in combat situations.
Multivitamins are popular overall, as are sports nutrition beverages, especially among elite forces. Weight-loss supplements (to meet weight targets) are also big among women, and performance enhancers and protein supplements are popular among men.
And, he said, military leaders are now more interested in supplements that enhance not only physical performance but cognitive performance as well. “Some of the soldiers [are currently dealing with] embedded microphones and automatic communication, multiple cell phones, visual-enhancement devices, monitoring devices, etc. Managing all of it is a challenge for anybody but especially in the field,” he said.
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