Air Force Capt. Denise Campbell has seen the symptoms before. While deployed, she talked to an individual who was rushed to the clinic for shortness of breath and an irregular heartbeat. 

“This guy had mixed a pre-workout product with an energy drink because he didn’t have any water on hand. No surprise, that’s a large dose of caffeine in a very short time, and he reacted badly,” said the health promotion dietitian from Spangdahlem Air Base, Germany. “Fortunately, there were other people in the gym to call emergency services, and the gym was near the clinic.” 

Campbell said the service member was a victim of “stacking,” a term used when taking different products or supplements together. The effects might be much stronger than when taken separately. As she described it, “1+1 can equal 10!” In addition, dietary supplements can interact with prescription or over-the-counter medications. It all underscores the danger some supplements pose instead of enhancing the abilities of their takers. 

“Vitamins and mineral supplements can be OK, but some other dietary supplements might have contaminants and can be dangerous if used,” said Patricia Deuster, director of the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences and one of the Military Health System’s experts on supplements. “The biggest problem is there’s no pre-market approval for safety or effectiveness of supplements. And a large number of dietary supplements don’t contain what’s on the label.” 

Military members naturally want to be faster, leaner, stronger and perform better, especially when they are deployed and lives are on the line. Deuster encouraged those considering supplements to find ones that have third-party verification. Look for a seal on the product, such as the United States Pharmacopeia, better known as the USP, seal, which Deuster said is particularly trustworthy. One of CHAMP’s educational arms, Operation Supplement Safety, educates service members, retirees and family members about dietary supplements and how to choose wisely.

Deuster pointed to some items that should raise red flags. Supplements that have more than five ingredients can be dicier, because more just increases the possibility of interactions with other supplements or with prescription and over-the-counter medications. This rule of thumb applies mainly to weight loss, pre-workout and body building supplements. That’s just one more way a service member can end up a victim of stacking. She also said to look for terms such as “proprietary or custom blend.” The manufacturer can say a product contains a certain amount of that proprietary blend. “But you don’t know how much of each ingredient there is, and the makers don’t have to tell anyone how much. When listed as single ingredients, the label must state how much of each is in the product,” said Deuster. 

Supplements claiming to cure diseases and enhance cognition are also particularly hot right now. Deuster warned many of the claims are inappropriate and some of the ingredients might not be approved for dietary supplements. 

Campbell said people need to ask themselves some critical questions when considering taking a supplement: Is it safe and effective? Is there a chance something’s in the product that’s not on the label? And, will it help you meet your performance goals? It’s important to do your homework. “Most people will do hours of research when purchasing a new car, new computer or new cellphone, and we need to put that same level of time and care into learning about products and their ingredients,” she said. 

As a dietitian, Campbell stressed the importance of the right food and the right amount of exercise to help people truly perform at their best.

“Dietary supplements are not shortcuts to long-term health and wellness,” said Campbell. “Keys to good health include healthy eating practices, regular physical activity, good sleep hygiene and appropriate stress management; no supplement will substitute!”