“The survey data are currently being examined for relationships between dietary-supplement use and behavioral and demographic variables, including but not limited to, force status, levels of physical activity, self-reported health and dietary habits, caffeine intake,” military leadership said.

The IoM also recommended to DoD that its decision to initiate a review of a dietary supplement should be based on multiple criteria: severity and number of adverse events, as well as prevalence of use.

DoD and USUHS officials said no centralized or formal mechanism for identifying adverse events is in place, so reviews have focused on those supplements most likely to be associated with an adverse event, based on the literature and prevalence of use.

“A standardized process for reviewing the safety and efficacy of dietary supplements is in process, and supplements/ingredients with a high prevalence of use and highest number of suspected adverse events are being reviewed,” they said.

In response to  the IoM recommendations, DoD is in the process of developing a system that uses patient interviews during medical visits and electronic-health records to capture dietary supplement use and adverse event data.

 “We have proposed a Warfighter Kiosk, wherein all patients when they enter a Medical Treatment Facility (MTF) will record their supplement use via the kiosk. The kiosk would have a dropdown menu for available dietary supplements, and they would select all supplements they are taking. This information would then be transmitted to health care providers to include physicians, dieticians, pharmacists and the like. The information would be stored in their medical record for review and coordination with other drugs and OTC medications,” officials said.

The intention of the proposed kiosk data would be to, “maintain a denominator of those taking specific supplements, aggregate data for analysis and prepare automated alerts when a signal was detected that suggested signal or suspicion of risk for interaction with a particular supplement and/or medication or other treatment.”

Another recommendation was that the military designate a committee or military entity to be responsible for the oversight and coordination of dietary supplement-related activities. The DoD has a formal subcommittee, the DoD Dietary Supplement subcommittee, according to officials who said it, “has an advisory role and provides input to the DoD leadership on military policies in matters addressing the safety and efficacy of dietary supplements.”