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Protein supplements (PSs) are, after multivitamins, the most frequently consumed dietary supplement by U.S. military personnel. Warfighters believe that PSs will improve health, promote muscle strength, and enhance physical performance. The estimated prevalence of regular PS use by military personnel is nearly 20% or more in active-duty personnel, which is comparable to collegiate athletes and recreationally active adults, but higher than that for average U.S. civilians. Although the acute metabolic effects of PS ingestion are well described, little is known regarding the benefits of PS use by warfighters in response to the metabolic demands of military operations. When dietary protein intake approaches 1.5 g ⋅ kg(-1) ⋅ d(-1), and energy intake matches energy expenditure, the use of PSs by most physically active military personnel may not be necessary. However, dismounted infantry often perform operations consisting of long periods of strenuous physical activity coupled with inadequate dietary energy and protein intake. In these situations, the use of PSs may have efficacy for preserving fat-free mass. This article reviews the available literature regarding the prevalence of PS use among military personnel. Furthermore, it highlights the unique metabolic stressors affecting U.S. military personnel and discusses potential conditions during which protein supplementation might be beneficial.
The Journal of Nutrition
Supplement: Efficacy and Safety of Protein Supplement Use
by Military and Other Physically Active Populations
Protein Supplementation in U.S. Military Personnel
Stefan M. Pasi akos,* Scott J. Montain, and Andrew J. Young
Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
Protein supplements (PSs) are, after multivitamins, the most frequently consumed dietary supplement by U.S. military
personnel. Warfighters believe that PSs will improve health, promote muscle strength, and enhance physical
performance. The estimated prevalence of regular PS use by military personnel is nearly 20% or more in active-duty
personnel, which is comparable to collegiate athletes and recreationally active adults, but higher than that for average U.S.
civilians. Although the acute metabolic effects of PS ingestion are well described, little is known regarding the benefits of
PS use by warfighters in response to the metabolic demands of military operations. When dietary protein intake approaches
1.5 g kg
, and energy intake m atches energy expenditure, the use of PSs by most physically active military personnel
may not be necessary. However, dismounted infantry often perform operations consisting of long periods of strenuous
physical activity coupled with inadequate dietary energy and protein intake. In these situations, the use of PSs may have
efficacy for preserving fat-free mass. This article reviews the available literature regarding the prevalence of PS use among
military personnel. Furthermore, it highlights the unique metabolic stressors affecting U.S. military personnel and discusses
potential conditions during which protein supplementation might be beneficial. J. Nutr. 143: 1815S–1819S, 2013.
The dietary supplement (DS)
industry continues to grow rapidly,
with sales in the United States now exceeding $30 billion annu-
ally (1). The U.S. military population regularly uses large
amounts of DSs (2–6). Recent evidence suggests that more than
half of the active-duty U.S. Army population regularly consumes
DSs (3). Protein supplements (PSs) are, after multivitamins, the
most popular DS consumed. Despite the high rate of PS use in
, data addressing the efficacy and safety of consum-
ing supplemental protein are sparse.
Physically active individuals, such as athletes, appear to benefit
from consuming dietary protein in excess of the RDA (7–9). In
certain military occupations, such as infantry, the strenuous nature
of the occupational duties may produce dietary energy and protein
requirements similar to resistance- and endurance-trained athletes.
Equally important, members of these occupations are often in
logistically and time-constrained situations that contribute to
undereating relative to energy expenditure and desired amounts of
dietary protein (10). However, the vast majority of military
occupations are less physically demanding than occupations such
as the infantry, and their protein needs are likely met by normal
dietary intake. This diversity of physiological demand within the
military requires consideration when assessing efficacy and safety
of PS use by warfighters. In addition, the potential for PSs to
impose unintentional metabolic harm must be considered, given
that concerns have been raised that too much dietary protein
might initiate or promote renal dysfunction (11,12), and because
DSs could be contaminated (13).
This concise review summarizes what is known regarding PS
use among military personnel. It also introduces the reader to the
The term ‘‘warfighter’ is used by the U.S. Department of Defense to refer to any
member of the U.S. Armed Forces. Warfighter is intended to be neutral regarding
military service or branch, sex, and service status and replaces previously used
terminology including ‘‘soldier,’ service member,‘ and ’’military personnel.’’
Presented at the Efficacy and Safety of Protein Supplements for U.S. Armed
Forces Personnel meeting, held at the U.S. Army Research Institute of
Environmental Medicine, Natick, MA, 7–8 November 2012. The summit was
sponsored by the Department of Defense, Center Alliance for Dietary
Supplements Research. The views expressed in these papers are not neces-
sarily those of the Supplement Coordinator or Guest Editors. The Supplement
Coordinator for this supplement was Krista G. Austin, U.S. Army Research
Institute of Environmenta l Medicine. Supplement Coordinator disclosures: Krista
G. Austin had no conflicts to disclose. This supplement is the responsibility of the
Guest Editor to whom the Editor of The Journal of Nutrition has delegated
supervision of both technical conformity to the published regulations of The
Journal of Nutrition and general oversight of the scientific merit of each article.
The Guest Editor for this supplement was Kevin Schalinske. Guest Editor
disclosure: Kevin Schalinske had no conflicts to disclose. Publication costs for
this supplement were defrayed in part by the payment of page charges. This
publication must therefore be hereby marked "advertisement" in accordance with
18 USC section 1734 solely to indicate this fact. The opinions expressed in this
publication are those of the authors and are not attributable to the sponsors or
the publisher, Editor, or Editorial Board of The Journal of Nutrition.
Supported by the U.S. Army Military Research and Material Command and the
Department of Defense Center Alliance for Dietary Supplement Research.
Authors disclosures: S. M. Pasiakos, S. J. Montain, and A. J. Young, no
conflicts of interest.
The opinions or assertions contained herein are the private views of the authors
and are not to be construed as official or as reflecting the views of the Army or
the Department of Defense. Any citations of commercial organizations and trade
names in this report do not constitute an official Department of the Army
endorsement of approval of the products or services of these organizations.
* To whom correspondence should be addressed. E-mail: stefan.pasiakos@us.
Abbreviations used: AA, amino acid; DS, dietary supplement; FFM, fat-free
mass; PS, protein supplement; SF, special forces.
ã 2013 American Society for Nutrition.
Manuscript received February 19, 2013. Initial review completed April 25, 2013. Revision accepted May 3, 2013.
First published online September 11, 2013; doi:10.3945/jn.113.175968.
by guest on January 7, 2016jn.nutrition.orgDownloaded from
varied metabolic demands of military occupations and the
challenges (or lack thereof) of service members meeting their
nutritional needs by diet alone. The intent is to facilitate informed
discussion with regard to the merits and risks of PS use by military
Prevalence and Rationale of PS Use among
The U.S. Department of Defense, the Samueli Institute, and the
NIH, with additional support from the Food and Drug Adminis-
tration, requested that the Institute of Medicine convene an ad hoc
committee to assess DS use by military personnel and recom-
mended an approach to determine which DSs need to be actively
managed (14). An examination of the available scientific evidence
revealed widespread use of DSs, particularly PSs. For example, DS
use among 2215 U.S. Army Special Forces (SF) and U.S. Army
Ranger trainees between 1997 and 1998 was nearly 65%, with
most indicating using $1 DS daily (6). Nearly 30% of the special
operations candidates surveyed were consuming some form of
amino acid (AA) or protein-type mixture, and 14% were using
PSs daily. The prevalence of PS use was more common among
trainees performing resistance- and endurance-type exercise $ 3
times per week. Bovill et al. (2) confirmed these findings, because
the rate of PS use among SF soldiers (25%) was also predicted by
exercise frequency. Special operations soldiers believed that
consuming PSs would enhance physical performance by providing
energy. This decision was based on nutrition information obtain ed
mainly from magazines, friends, and teammates and not scientific
evidence. The pervasive use of PSs in this population of warfighters,
which has been reported to be as high as 63% (15), is not surprising
considering the occupational and physical demands of special
Surveys of PS use by U.S. military personnel have provided
varied outcomes. Brasfield (16) assess ed DS use among 874 active-
duty U.S. Army soldiers across 16 army installations located
within the continental US, and found that only 5% of the population
reported using AA supplements. However, t hose who reported using
AA supplements were doing so >5 times per week. In contrast, 43%
of U.S. Marine Corps recruits entering basic training in 2007
indicated using PSs regularly, and PSs were the most popular
DS surveyed in this population (5). Data from >105,000 U.S.
military personnel in the Millennium Cohort Study further
support a high rate of PS use: 23% of men and 5% of women
reported regular consumption of bodybuilding supplements. The
prevalence was highest in warfighters with $1 of the following
characteristics: U.S. Marines, healthy weight, active duty, married
(for men), deployed, or combat specialist and individuals that
participate in routine resistance- and endurance-type training (4).
The most comprehensive and detailed assessment of DS use
among active-duty military personnel to date was conducted by
Lieberman et al. (3), who randomly administered surveys to 990
soldiers across 11 global U.S. Army installations from 2006 to
2007. The use of DSs for the 6 mo before survey administration
was queried, and the data were weighted by age, sex, rank, and
SF status so as to represent the active-duty U.S. Army. More than
50% reported consuming DSs at least once per week. Multivi-
tamins and multiminerals were the most common (38%) DS
consumed. PSs were the second most popular DS, with nearly
19% of the population reporting regular use of PSs. The prevalence
of PS use was higher among men (20%) than women (9%), peaked
between the ages of 30–39 y (28%), and was not influenced by
educational status. Rank influenced PS use: a higher percentage of
ofcers (23%) and senior noncommissioned officers (23%)
reported using PSs compared with warrant o ffic ers (15%) an d
junior enlisted soldiers (14%). Nearly half of the SF soldiers
surveyed indicated regular use of PSs. Similarly, the use of PSs
was higher in s oldiers with military occupations classified as
combat arms (23%) and combat support (20%) than combat
service support (14%). Deployment status did not statistically
influence PS use, although ;26% of soldiers deployed to Iraq
during this time frame indicated using PSs compared with only
19% and 12% of soldiers stationed within and outside the
continental United States, respe ctively. The use of P Ss was
more prevalent in soldiers who frequently participated in resistance-
type training and those who performed nearly 8 h of endurance-
type exercise per week.
The reasons for taking PSs vary. More than half of those
surveyed by Lieberman et al. (3) reported using PSs because they
believe that PSs will create greater muscle strength. Nearly one-
third reported using PSs because they want to enhance physical
performance, whereas 21% consumed PSs to promote general
health. Approximately 10% of soldiers consumed PSs to provide
more energy and increase endurance and because they believe
that PSs will aid with weight loss. More than half were very
confident that the supplements they were consuming were safe
and worked as advertised (17). Similar reasons for using PSs
(combined with bodybuilding supplements) were recently reported
in a large cohort of U.S. military personnel using data derived from
the Department of Defense Survey of Health-Related Behaviors
Among Active-Duty Personnel (18). The most common reasons
for using PSs in this large group of service members (n = 16,146)
were to increase muscle mass (46%), enhance physical perfor-
mance (32%), and improve overall health (22%). Regardless of
the rationale, PS use among U.S. military personnel appears to be
common and may be differentially influenced by varying strenuous
occupational and physical demands of military service.
Comparison of PS Use between
Warfighters and U.S. Civilians
PS use among the general U.S. civilian population is relatively
low. Using random telephone surveys from 1994 to 1995, the
U.S. Food and Drug Administration reported that the use of
AA supplements was as low as 5–9% (19). Data from the third
NHANES (NHANES III, 1988–1994) suggest that PS use was
<2%, although PSs were classified as bodybuilding supplements
and not listed individually (20). Interestingly, using data from
NHANES III and NHANES 2001–2002, Block et al. (21)
reported that 47% of women and 56% of men who were classified
as multiple DS users (i.e., used an average of 17 different DSs per
day) consumed a daily PS. Block et al. (21) reported that multiple
DS users were at lower risk of chronic disease and less likely to
have elevated blood press ure and be diagnosed with diabetes
compared with non-DS users.
Patterns of PS use by service members appear to be similar to
those of athletes and avid exercisers (13,22). For example, in
a group of Division I athletes (115 men, 88 women) from the
University of Nebraska, Froiland et al. (23) reported that nearly
50% used PSs. The most frequently consumed PSs were protein
powders (22%), whey protein (13%), and free AAs (12%). Male
athletes were more likely to use PSs than females, and athletes
participating in metabolically demanding sports including football,
soccer, wrestling, and track and field used PSs more frequently than
athletes participating in less metabolically demanding sports such
as golf, baseball, and softball. The use of PSs is also common in
1816S Supplement
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men and women who exercise regularly at local fitness clubs (24).
The patterns o f PS use among athlet es and routine exercisers across
sexes and activities of varying metabolic demands, and the reasons
for consuming PSs including improved muscle strength and power
and health promotion, are similar to those recently reported for
active-duty military personnel (3).
U.S. Military Dietary Protein and Energy
Guidelines: A Brief Overview
The current military DRI (MDRI) for protein is based on the RDA
from the Institute of Medicine (25) but incorporates adjustments
to meet requirements for periods of increasing metabolic demand,
which ra nge from 0.8 to 1.5 g kg
(26). The military
recommendations for dietary protein and energy are also consis-
tent with current nutrition recommendations for physically active
adults from the American College of Sports Medicine (8).
Recent data from NHANES 2003–2004 suggest that the
daily protein intake for adults of military age (19–60 y) should
be ;1.1–1.4 g kg
(27). As such, dietary protein intake
during nonoperational, garrison conditions is likely consistent
with the current MDRI and should be adequate for most physically
active warfighters when total energy intake is equival ent to
energy expenditure. Whether regular PS use confers any
additional metabolic advantages or disadvantages for war-
fighters w hen nutrition requirements are met has not been
Combat rations are the primary source of food during military
field training and when conducting missions in remote areas. The
nutritional standards for operational rations specify nutrient content
requirements for different types of rations and serve as the basis for
feeding policies that establish the allowable duration that the ration
can be used as the sole source of nutrition (26). General-purpose
rations, of which the most commonly used and best known is the
Meal, Ready-to-Eat, may be consumed as the only source of food
for up to 21 d (28). The daily issue of Meals, Ready-to-Eat (3/d) is
designed to be nutritionally adequate and cu rrently provides ; 3975
kcal d
and 125 g of protein. In contrast, restricted rations are
nutritionally incomplete and designed for certain operational
scenarios, such as long-range patrol and reconnaissance, when
weight and volume restrictions prev ent pr ovi sion o f suffic ie nt
food to meet energy expenditures. Warfighters are allowed
to subsist solely on energy-restricted rations, such as the Food
Packet, Long-Range Patro l ration, which contains 1500 kcal d
and 50 g of protein or the First Strike Ration, which provides
2900 kcal d
and 94 g of protein for periods #10 d.
Operational Stress and Potential
Metabolic Benefits of PSs
The metabolic cost of military operations is largely dependent
on occupation and the type of training being performed. Many
military occupations are relatively sedentary. Moreover, during
nonoperational, garrison conditions, most soldiers likely con-
sume sufficient energy to match energy expenditure and main-
tain body weight (29). In fact, many soldiers now overconsume,
because overweight and obesity rates in military personnel have
been increasing (30). In contrast, soldiers in the SF, U.S. Army
Rangers, and infantry expend more energy than do combat
support and combat service support soldiers due to sustained
periods of physical activity. For example, soldiers engaged in
various dismounted combat missions may expend 3500–4600
kcal d
(10). At the extremes, total energy expenditures for
Marines engaged in mountain warfare training have exceeded
7000 kcal d
(31,32). Physical overload is a contributing
factor to the increased metabolic cost of military training. The
loads carried can be substantial. Whereas the typical assault load
is ;25 kg, approach loads can be as high as 55 kg. Load carriage
substantially increases the physiological strain of locomotion,
because oxygen consumption, heart rate, and ventilation are
increased, and endurance capacity is markedly less (33,34). The
metabolic cost of load carriage increases proportionally as the
load becomes heavier (35).
Service members in these physically demanding occupations
often have very limited opportunities to eat during their missions,
and their energy intake is usually insufficient to balance energy
expenditure, resulting in energy deficits (10). As a consequence,
these warfighters are very dependent on between-mission meals
and snacks for refueling and metabolic recovery. It is well
described that prolonged energy deficit coupled with military
operational and environmental stressors can diminish fat-free
mass (FFM) (36) and alter bone mineralization (37) and immune
responsiveness (38), which may compromise military performance
(39), and increase musculoskeletal injury risk (40–42).
Nutritional strategies that increase total dietary protein intake
may mitigate the detrimental effects of operational stress by
providing energy and AAs necessar y to sustain whole-body
and skeletal muscle protein balance. Evidence strongly sug-
gests that consuming dietary protein in excess of the current
RDA defends FFM in response to sustained periods of negative
energy balance (36,43). Pikosky et al. (44) demonstrated
negative nitrogen balance in healthy young soldiers in response
to a 7-d period of exercise-induced energy deficit (21000 kcal d
when protein was consumed at amounts similar to the current
RDA (0.9 g kg
). However, doubling dietary protein intake
(1.8 g kg
) attenuated nitrogen loss and the resultant
negative nitrogen balance while also maintaining hepatic glucose
production in response to the 7-d energy deficit (44,45). Recent
findings from Mettler et al. (43) and Pasiakos et al. (46,47) confirm
the muscle-sparing and glycemic regulatory advantages gained
from consuming protein at amounts above the RDA. These data
suggest that FFM and hepatic glucose production are preserved in
response to energy deficit when protein intake is provided at
amounts at least twice the RDA. A PS, provided as a component
of a recovery-based combat ration, might be an effective method
to achieve protein intakes approaching 1.6 g kg
periods of unavoidable energy deficit. However, further study is
required to evaluate the efficacy of PS use by U.S. military
personnel during (or in recovery from) sustained periods of
increased metabolic demand and energy deficit.
In conclusio n, the rate of PS use among U.S. military personnel
appears to be similar to that in athletes and physically active adults
and much higher than in the general U.S. civilian population. The
frequency of PS use differs between sexes, age, rank, and military
occupations; warfighters with more metabolically demanding
occupations consume nearly twice the amo unt of PSs than those
with more sedentary jo bs. Most military personnel believe that
regular use of PSs will enhance muscle strength, improve perfor-
mance, and promote health, whereas others believe that consum-
ing PSs will assist with weight loss and provide energy. These ideas
and the decision to purchase PSs are not based on credible sources
from family and friends. Scientific evidence does indicate that
supplemental protein may confer metabolic advantages for
warfighters in some conditions, especially during periods of
sustained energy deficit when PS consumption can provide energy
and AAs necessary to attenuate decrements in FFM. However,
Protein supplement use among warfighters 1817S
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most warfighters consuming a normal, ad libitum diet meet their
energy and the recommended dietary protein requirements with-
out the need for consumption of PSs.
The authors thank Harris R. Lieberman and Krista G. Austin
for their support in the development of t his meeting and
manuscript. All of the authors drafted, read, and approved the
final manuscript.
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protein diets on fat-free mass and muscle protein synthesis following
weight loss: a randomized controlled trial. FASEB J. 2013;27:3837– 47.
Protein supplement use among warfighters 1819S
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... In the long term, over-reliance of carbohydrate items in the meal pack may shift the ratio of macronutrients towards carbohydrate, and may induce a protein deficit, especially in longer-term operations. Pasiakos et al. [12,18], Ferrando, [19], Margolis et al. [13] have alluded to the possible requirement for protein supplementation due to increased catabolic processes and muscle damage when heavy exercise is superimposed upon long duration deployments in cold environments. It is also unknown how excessive carbohydrate intake (> 70% of total calories) affects immune function, cognitive processes, cold-induced injuries, and inducement of muscle damage. ...
... The reasons reported for consuming these supplements were either the need to increase muscle bulk, or to aid in recovery. In a U. S. study, Pasiakos et al. [18] have estimated that protein supplementation rate in U.S. military is almost at 20% of active duty personnel (higher than average U.S. citizens). However, data from their laboratory suggests that protein supplementation is only indicated when energy expenditure (i.e., metabolic requirements) exceeds total nutrient intake. ...
... 5. Data from the US Army [13,18] suggests that in prolonged cold operations, dismounted soldiers may be breaking down skeletal muscle at an increased rate, and protein supplementation to the diet might be indicated in specific Arctic operations. This should be investigated in the CAF context. ...
Technical Report
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The conduct of Canadian Armed Forces (CAF) operations and training in the harsh arctic environment will become increasingly frequent in coming years, as Arctic sovereignty patrols and the CAF’s presence accelerates. This Arctic presence will require a resilient and performance-ready soldier. Defence Research and Development Canada (DRDC) has been asked to support the CAF in evaluating incremental field feeding practices from a physiological and behavioural perspective, with a view to improving field nutritional provisions in harsh environments. Thirty-Eight Arctic Operational Course (AOC) participants volunteered to participate in a written survey and one semi-structured interview during the March 2012 AOC in Resolute NV. Over the course of a 4-day portion of the AOC which involved exposure to a variety of CF Arctic activities (snow cave survival, snow camping, over-land transit, and other operational-specific Arctic training activities). During training, students completed a written survey and were interviewed using a semi-structured format in Resolute. The results suggest that current field feeding provisions during field operations and exercises may be inadequate for provision of a necessary caloric density to physiologically support high-output and/or sedentary activities in extreme cold conditions.
... Los suplementos de proteína y/o aminoácidos de cadena ramificada (BCAAs, por sus siglas en inglés) son consumidos por atletas, militares y, en general, por población activa que practica actividad física, ejercicio físico y/o deporte de forma recreacional [1][2][3][4][5][6][7][8][9] . La toma de polvos de proteínas u otros suplementos sin una garantía de calidad del producto, a pesar de poder producir un aumento de la masa muscular, mejora de la fuerza y en consecuencia del rendimiento, pueden suponer un riesgo para la salud 3,7,9,10 . ...
... Los suplementos de proteína y/o aminoácidos de cadena ramificada (BCAAs, por sus siglas en inglés) son consumidos por atletas, militares y, en general, por población activa que practica actividad física, ejercicio físico y/o deporte de forma recreacional [1][2][3][4][5][6][7][8][9] . La toma de polvos de proteínas u otros suplementos sin una garantía de calidad del producto, a pesar de poder producir un aumento de la masa muscular, mejora de la fuerza y en consecuencia del rendimiento, pueden suponer un riesgo para la salud 3,7,9,10 . Algunos de los motivos por los cuales se toman los suplementos nutricionales son para ayudar a la recuperación del entrenamiento, el mantenimiento o mejora de la salud, la mejora del rendimiento, mejorar funciones inmunes, tratar y prevenir una enfermedad y/o para compensar una dieta pobre en ingesta de energía 1,2,[4][5][6]8,11 . ...
... Son muchas las fuentes por las cuales la población obtiene información y adquiere los suplementos nutricionales: familiares, amigos, publicidad (como revistas o medios online), compañeros de equipo y entrenadores 1,3,7 . Además de las mencionadas con anterioridad, los atletas profesionales acostumbran a obtener esta información por otras fuentes como nutricionistas, médicos, farmacéuticos o fisioterapeutas 1,2,4,5,8 . ...
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Introducción: Los suplementos de proteína y aminoácidos de cadena ramificada (BCAAs) son consumidos por la población buscando una serie de efectos fisiológicos y metabólicos sobre el rendimiento y recuperación, entre otros. Objetivos: Revisión de las publicaciones más recientes que estudien los efectos del consumo de suplementos de proteína y BCAAs en entrenamiento de fuerza en diferentes parámetros fisiológicos y metabólicos. Material y métodos: Estudio descriptivo de revisión bibliográfica. Se realizó una búsqueda específica de palabras clave en la base de datos PubMed y estrategia de bola de nieve. Criterios de inclusión: estudios realizados en humanos de ≥ 18 años sin patología, metaanálisis, revisiones sistemáticas y ensayos clínicos controlados aleatorizados en inglés y español relacionados con el consumo de suplementos de proteína y/o BCAAs en entrenamiento de fuerza y sus efectos sobre el daño muscular, respuesta anabólica en la recuperación muscular, ganancia de masa muscular y fuerza, composición corporal y fatiga. Resultados: 64 estudios identificados mediante la ecuación de búsqueda, 20 cumplieron con los criterios de inclusión. La media aritmética de los sujetos participantes fue igual a (30,59 ± 24,47). Conclusiones: Los suplementos de proteína podrían tener un efecto positivo en el aumento del rendimiento y la masa muscular, pero hacen falta más estudios para esclarecer su posible beneficio sobre la composición corporal, la fatiga, la atenuación y reducción del dolor y daño muscular. La leucina tiene efecto en el aumento de la masa muscular y su función en población de edad avanzada. Los BCAAs podrían actuar sobre la atenuación de la fatiga central y en la mejora del rendimiento.
... Amongst nutritional strategies, protein supplements are widely used by athletes and physically active individuals to increase their muscle mass and enhance post-exercise recovery and performance, representing up to 70% of the sport supplement industry (5 billion dollars) (Petroczi and Naughton, 2008;Pasiakos et al., 2013;Draganidis et al., 2017). These consumers have been convinced that protein supplements will offset EIMD, facilitate skeletal muscle repair and contribute to an upregulated glycogen re-synthesis when co-administered with CHO during recovery (Pasiakos et al., 2014). ...
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Protein supplementation is a major nutritional practice among professional and amateur team-sport athletes representing a market of $5 billion in the USA alone. This practice, however, may not be supported by evidence-based science. Our objective as to present a thorough review of literature investigating the effects of protein supplementation on performance recovery and exercise-induced muscle damage following team-sport activity. PubMed-derived, full English language articles investigating the effects of protein-based supplementation/feeding on skeletal muscle performance, muscle damage and inflammatory status during recovery following team-sport activity were included. Studies investigated professional or amateur team-sport athletes participating in regular training and competition as well as examining the impact of protein supplementation on performance, muscle damage/soreness and inflammatory markers after team-sport activity. Finally, ten articles (150 participants) met the inclusion criteria. Experimental designs were evaluated for confounders. All protocols employing team-sport activity increased systemic muscle damage indicators and inflammatory markers and deteriorated performance during recovery. Protein-based supplementation attenuated the rise in muscle damage markers and enhanced performance recovery in six (60% of the studies included) and three (30% of the studies included) out of 10 studies, respectively. In contrast, immunity and muscle soreness remained unaffected by protein ingestion, independent of dosage and distribution pattern. In conclusion, there are limited and inconsistent data showing that protein supplementation may enhance performance recovery following team-sport activity despite an attenuation of indirect markers of muscle damage. Interpretation of results is limited by small sample sizes, high variability in tested supplements, participants' training level, length of recovery periods, absence of direct measurement of myofibrillar disruption, protein turnover and protein metabolism, and lack of dietary monitoring during experimentation.
... Certain nutritional recovery interventions suggest that increased protein and carbohydrate intake may mediate regeneration processes and promote muscle regeneration and, in so doing, accelerate recovery of performance [34]. Protein supplementation has been shown to expedite skeletal muscle protein turnover by interfering with its synthesis and degradation under conditions of increased physiological stress that favor a negative protein balance such as those applied during a congested football fixture [35][36][37][38][39]. ...
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The effects of protein supplementation on performance recovery and inflammatory responses during a simulated one-week in-season microcycle with two games (G1, G2) performed three days apart were examined. Twenty football players participated in two trials, receiving either milk protein concentrate (1.15 and 0.26 g/kg on game and training days, respectively) (PRO) or an energy-matched placebo (1.37 and 0.31 g/kg of carbohydrate on game and training days, respectively) (PLA) according to a randomized, repeated-measures, crossover, double-blind design. Each trial included two games and four daily practices. Speed, jump height, isokinetic peak torque, and muscle soreness of knee flexors (KF) and extensors (KE) were measured before G1 and daily thereafter for six days. Blood was drawn before G1 and daily thereafter. Football-specific locomotor activity and heart rate were monitored using GPS technology during games and practices. The two games resulted in reduced speed (by 3-17%), strength of knee flexors (by 12-23%), and jumping performance (by 3-10%) throughout recovery, in both trials. Average heart rate and total distance covered during games remained unchanged in PRO but not in PLA. Moreover, PRO resulted in a change of smaller magnitude in high-intensity running at the end of G2 (75-90 min vs. 0-15 min) compared to PLA (P = 0.012). KE concentric strength demonstrated a more prolonged decline in PLA (days 1 and 2 after G1, P = 0.014-0.018; days 1, 2 and 3 after G2, P = 0.016-0.037) compared to PRO (days 1 after G1, P = 0.013; days 1 and 2 after G2, P = 0.014-0.033) following both games. KF eccentric strength decreased throughout recovery after G1 (PLA: P=0.001-0.047-PRO: P =0.004-0.22) in both trials, whereas after G2 it declined throughout recovery in PLA (P = 0.000-0.013) but only during the first two days (P = 0.000-0.014) in PRO. No treatment effect was observed for delayed onset of muscle soreness, leukocyte counts, and creatine kinase activity. PRO resulted in a faster recovery of protein and lipid peroxidation markers after both games. Reduced glutathione demonstrated a more short-lived reduction after G2 in PRO compared to PLA. In summary, these results provide evidence that protein feeding may more efficiently restore football-specific performance and strength and provide antioxidant protection during a congested game fixture.
... Negative energy balance is largely driven by sustained periods of low-to-moderate physical activity that result in daily energy expenditures that are difficult to match with energy intake, because food supply and time availability to eat or prepare a meal are often limited (16,19). As such, protein recommendations for these scenarios range from 1.5 to 2.0 gIkg j1 Id j1 (23). Whether current military operational protein recommendations are actually sufficient, particularly if degree of negative energy balance is severe (940% energy deficit), is not clear. ...
... Negative energy balance is largely driven by sustained periods of low-to-moderate physical activity that result in daily energy expenditures that are difficult to match with energy intake, because food supply and time availability to eat or prepare a meal are often limited (16,19). As such, protein recommendations for these scenarios range from 1.5 to 2.0 gIkg j1 Id j1 (23). Whether current military operational protein recommendations are actually sufficient, particularly if degree of negative energy balance is severe (940% energy deficit), is not clear. ...
Purpose: Determine if providing supplemental nutrition spares whole-body protein by attenuating the level of negative energy balance induced by military training, and to assess whether protein balance is differentially influenced by macronutrient source. Methods: Soldiers participating in 4-d arctic military training (AMT, 51 km ski march) randomized to receive 3 combat rations (CON; n = 18); 3 combat rations plus 4, 20g, 250 kcal protein-based bars (PRO; n = 28); or 3 combat rations plus 4, 48g, 250 kcal carbohydrate-based bars daily (CHO; n = 27). Energy expenditure (D2 O) and energy intake were measured daily. Nitrogen balance (NBAL) and protein turnover were determined at baseline (BL) and day 3 of AMT using 24 h urine and [N]-glycine. Results: Protein and carbohydrate intake were highest (P < 0.05) for PRO (mean ± SD, 2.0 ± 0.3 g[BULLET OPERATOR]kg[BULLET OPERATOR]d) and CHO (5.8 ± 1.3 g[BULLET OPERATOR]kg[BULLET OPERATOR]d), but only CHO increased (P < 0.05) energy intake above CON. Energy expenditure (6155 ± 515 kcal·d), energy balance (-3313 ± 776 kcal·d), net protein balance (NET; -0.24 ± 0.60 g·d), and NBAL (-68.5 ± 94.6 mg·kg·d) during AMT were similar between groups. In the combined cohort, energy intake was associated (P < 0.05) with NET (r = 0.56) and NBAL (r = 0.69) and Soldiers with the highest energy intake (3723 ± 359 kcal·d, 2.11 ± 0.45 g protein[BULLET OPERATOR]kg[BULLET OPERATOR]d, 6.654 ± 1.16 g carbohydrate[BULLET OPERATOR]kg[BULLET OPERATOR]d) achieved net protein balance and NBAL during AMT. Conclusion: These data reinforce the importance of consuming sufficient energy during periods of high energy expenditure to mitigate the consequences of negative energy balance and attenuate whole-body protein loss.
Introduction Diet has an impact on weight status, health, and physical performance. Assessing the usual at-home dietary intakes of military personnel can help ascertain their nutritional status before field training or operations. Preference for foods consumed on a routine basis can also impact the military’s preference for and consumption of field rations. Military personnel are limited by the inherent nature of the field rations and availability of calories and food types; and despite previous studies indicating a high acceptability of the field rations, it is unknown whether military personnel self-select the same number of calories when faced with a restricted list of field ration options as they would from their usual foods. Although field rations are intended to be nutritionally sufficient for standard military operations, there are limited data on the ad libitum intake of nutrients of Canadian Armed Forces (CAF) personnel from field rations in comparison to the military dietary reference intake (MDRI) recommendations, which establishes standards intended to meet the nutritional requirements of military personnel on duty. Thus, assessing the adequacy of their usual diets at home and longer-term sustenance on field rations in relation to MDRIs can provide insight on CAF personnel’s operational readiness. The objectives of this study were to describe and compare, in a convenience sample of CAF, their ad libitum nutrient intakes from the consumption of self-selected field rations at home with their usual home intakes and to compare both with MDRI recommendations. Materials and Methods Eighteen CAF participants weighed and recorded their dietary intake from the ad libitum consumption of field rations at home and their usual at-home diets. Both MDRIs and the Institute of Medicine’s dietary reference intake recommendations were used to assess the adequacy of intakes for each individual. Paired Student’s t-test or Wilcoxon-matched paired tests were used to compare nutrient intake levels between usual at-home diets and field rations consumed at home. Results Mean daily energy intakes were similar between ad libitum intakes from field rations (2,688 ± 619 kcal) and usual home diets (2,657 ± 580 kcal), although participants had significantly higher intakes of protein and fat from their home diets and higher intakes of carbohydrates from the field rations (P ≤ 0.05). Participants had less than the recommended intakes of some micronutrients (vitamins A and D, folate, calcium, magnesium, and potassium), from both their home diets and field rations, but adequate intakes of vitamin C and iron. Conclusions The results of this study showed no difference in energy intake between the consumption of field rations and home diets, with levels consistent with recommendations for individuals with average physical activity levels. The results also demonstrated less than the recommended intakes (in comparison with MDRIs) of some nutrients from both home diets and self-selected consumption of field rations, warranting further research into nutritional adequacy for operational readiness.
The importance of diet and nutrition to military readiness and performance has been recognized for centuries as dietary nutrients sustain health, protect against illness, and promote resilience, performance and recovery. Contemporary military nutrition research is increasingly inter-disciplinary with emphasis often placed on the broad topics of: 1) determining operational nutrition requirements in all environments, 2) characterizing nutritional practices of military personnel relative to the required (role/environment) standards, and 3) developing strategies for improving nutrient delivery and individual choices. This review discusses contemporary issues shared internationally by military nutrition research programs, and highlights emerging topics likely to influence future military nutrition research and policy. Contemporary issues include improving the diet quality of military personnel, optimizing operational rations, and increasing understanding of biological factors influencing nutrient requirements. Emerging areas include the burgeoning field of precision nutrition and its technological enablers.
Background: The objective of this study was to assess military rations. Military rations must provide military personnel with suitable nutrition, as high-quality nutrition is crucial for promoting health. Aim: This systematic review provides information regarding the nutritional design of military rations according to energy and protein intake and supplements. Methods: A systematic search was conducted for articles published to date regarding the nutritional needs involved in a military diet for an active population of either gender, ranging from 18 to 60 years old, without excluding material by year, type of document, location, or author. The pertinent articles found were published from 1994 to 2017. Results: Physical activity and environmental factors directly affect calculating energy needs and carbohydrate intake when designing military rations. However, the results showed no influence on protein, fat and/or sodium intake. Furthermore, the search revealed that military populations have a high intake of dietary supplements; it is thus worth considering their incorporation into campaign rations. Conclusion: Military personnel macro- and micro-nutrient needs depend on physical activity and nutrient intake measurement methodologies. The data regarding military personnel dietary supplement consumption indicated that this is a niche worth considering when designing military rations. Research on nutritional needs for military rations could concentrate on optimizing the amount of macro- and micro-nutrients and their biological value, according to physical activity, as well as maintaining their sensory quality, safety and shelf life using different processing technologies.
Introduction Military personnel are reported to use more dietary supplements (DS) than the general population. However, a comprehensive investigation of DS use in Australian Army personnel has not been conducted. This study investigated the prevalence and types of DS used by Australian Army personnel and examined the underpinning reasons and demographic factors influencing this use. Materials and Methods A Convenience sample of Australian Army personnel from both Headquarter (desk-based) and Brigade (field-based) environments completed a researcher-designed DS questionnaire. The questionnaire examined 19 types of DS (including sports foods) and reasons for use. Logistic regression, adjusting for age, sex, education, physical activity, BMI, and occupational group were performed. Results A total of 667 personnel completed the questionnaire. Overall, 74.5% of personnel reported using ≥1 DS/day, with ~26% reporting use of ≥5 types of DS at least once/week. The most common DS used daily were caffeine (48.4%), vitamin and mineral supplements (34.8%), protein powders (27.9%), creatine (13.3%), and amino acids (13.2%). Reasons for use in descending order were “to provide energy,” “performance,” “general health,” “I like it,” “muscle gain,” “hydration,” “endurance,” “convenience,” and “weight loss.” Using ≥5 DS/week was associated with a higher level of education (p = 0.034), physical activity >10 h/week (p < 0.0005) and having an occupation as a physical training instructor (p = 0.040). Conclusion If military personnel choose to utilize DS, it is important they are used in a safe, legal and effective manner. Education and up to date guidance on the rapidly evolving range of DS available are therefore necessary.
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The purpose of this work was to determine the effects of varying levels of dietary protein on body composition and muscle protein synthesis during energy deficit (ED). A randomized controlled trial of 39 adults assigned the subjects diets providing protein at 0.8 (recommended dietary allowance; RDA), 1.6 (2×-RDA), and 2.4 (3×-RDA) g kg(-1) d(-1) for 31 d. A 10-d weight-maintenance (WM) period was followed by a 21 d, 40% ED. Body composition and postabsorptive and postprandial muscle protein synthesis were assessed during WM (d 9-10) and ED (d 30-31). Volunteers lost (P<0.05) 3.2 ± 0.2 kg body weight during ED regardless of dietary protein. The proportion of weight loss due to reductions in fat-free mass was lower (P<0.05) and the loss of fat mass was higher (P<0.05) in those receiving 2×-RDA and 3×-RDA compared to RDA. The anabolic muscle response to a protein-rich meal during ED was not different (P>0.05) from WM for 2×-RDA and 3×-RDA, but was lower during ED than WM for those consuming RDA levels of protein (energy × protein interaction, P<0.05). To assess muscle protein metabolic responses to varied protein intakes during ED, RDA served as the study control. In summary, we determined that consuming dietary protein at levels exceeding the RDA may protect fat-free mass during short-term weight loss.-Pasiakos, S. M., Cao, J. J., Margolis, L. M., Sauter, E. R., Whigham, L. D., McClung, J. P., Rood, J. C., Carbone, J. W., Combs, G. F., Jr., Young, A. J. Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: a randomized controlled trial.
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Background United States Army Soldiers regularly use dietary supplements (DS) to promote general health, enhance muscle strength, and increase energy, but limited scientific evidence supports the use of many DS for these benefits. This study investigated factors associated with Soldiers’ confidence in the efficacy and safety of DS, and assessed Soldiers’ knowledge of federal DS regulatory requirements. Methods Between 2006 and 2007, 990 Soldiers were surveyed at 11 Army bases world-wide to assess their confidence in the effectiveness and safety of DS, knowledge of federal DS regulations, demographic characteristics, lifestyle-behaviors and DS use. Results A majority of Soldiers were at least somewhat confident that DS work as advertised (67%) and thought they are safe to consume (71%). Confidence in both attributes was higher among regular DS users than non-users. Among users, confidence in both attributes was positively associated with rank, self-rated diet quality and fitness level, education, and having never experienced an apparent DS-related adverse event. Fewer than half of Soldiers knew the government does not require manufacturers to demonstrate efficacy, and almost a third incorrectly believed there are effective pre-market federal safety requirements for DS. Conclusions Despite limited scientific evidence supporting the purported benefits and safety of many popular DS, most Soldiers were confident that DS are effective and safe. The positive associations between confidence and DS use should be considered when developing DS-related interventions or policies. Additionally, education to clarify Soldiers’ misperceptions about federal DS safety and efficacy regulations is warranted.
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Sustained periods of negative energy balance decrease body mass due to losses of both fat and skeletal muscle mass. Decreases in skeletal muscle mass are associated with a myriad of negative consequences, including suppressed basal metabolic rate, decreased protein turnover, decreased physical performance, and increased risk of injury. Decreases in skeletal muscle mass in response to negative energy balance are due to imbalanced rates of muscle protein synthesis and degradation. However, the underlying physiological mechanisms contributing to the loss of skeletal muscle during energy deprivation are not well described. Recent studies have demonstrated that consuming dietary protein at levels above the current recommended dietary allowance (0.8 g · kg(-1) · d(-1)) may attenuate the loss of skeletal muscle mass by affecting the intracellular regulation of muscle anabolism and proteolysis. However, the specific mechanism by which increased dietary protein spares skeletal muscle through enhanced molecular control of muscle protein metabolism has not been elucidated. This article reviews the available literature related to the effects of negative energy balance on skeletal muscle mass, highlighting investigations that assessed the influence of varying levels of dietary protein on skeletal muscle protein metabolism. Further, the molecular mechanisms that may contribute to the regulation of skeletal muscle mass in response to negative energy balance and alterations in dietary protein level are described.
Dietary supplements are widely available through a rapidly expanding market of products commonly advertised as beneficial for health, performance enhancement, and disease prevention. Given the importance and frequent evaluation of physical performance and health as a criteria to join and remain in the military, the use of these products by military personnel has raised concern regarding over-all and long-term efficacy and safety. This evaluation is especially difficult, as many of these supplements contain multiple ingredients, have a changing composition over time, or are used intermittently at doses difficult to measure. This book analyzes the patterns of dietary supplement use among military personnel, examines published reviews of the scientific evidence, and identifies those dietary supplements that are beneficial and/or warrant concern due to risks to health or performance. The book also recommends a system to monitor adverse health effects and a framework to identify the need for active management of dietary supplements by military personnel. Military policy makers, personnel, and recruits will find this book useful, as will nutritionists, athletes, and others working in strenuous environments. © 2008 by the National Academy of Sciences. All rights reserved.
A U.S. Army Special Forces (SF) unit was studied to determine characteristics of supplement users, assess nutrition knowledge, and identify nutrition information sources. SF-qualified (n = 119) and non-SF, support soldiers (n = 38) participated. Most soldiers (87%) reported current supplement use with more SF (90%) than non-SF, support soldiers (76%) using supplements (p <= 0.05). Supplements SF reported using most were multivitamins, sports bars/drinks, and vitamin C. The mean nutrition knowledge score for all soldiers was 48.5 +/- 15.2% correct responses. Most soldiers incorrectly believe protein is used for energy for short-term athletic events (64%) and that vitamins provide energy (58%). The most common information sources reportedly used were popular magazines/ books (75%), friends/teammates (55%), physicians/nurses, radio/television (34%), and the Internet (31%).
A 2000 kcal lightweight ration (RLW-30) was tested as the sole source of food for 30 continuous days during a Special Forces field training exercise (FTX) in September and October, 1986 at Camp Ethan Allen, VT. Eighteen Special Forces soldiers were assigned to the RLW-30 group and another 18 were assigned to a calorie adequate control ration (MRE VI). Both groups of soldiers performed similar missions at the same location but were physically separated from each other. A battery of physical and psychological tests was conducted before, during and after the 30 day FTX. The RLW-30 is a compact ration that is palatable and easy to use by the soldier in the field, provided an adequate supply of water is available. It supported physical and mental performance reasonably well in a low stress temperate environment. The results of this study indicate that the RLW-30 ration, if used as a sole source of food for 30 days, can be expected to cause some uncomfortable physical symptoms and a small to moderate decrement in physical performance capacity that should be considered in mission planning.
U.S. Army soldiers spend months at a time working in austere environments during deployments. The numerous physical demands placed on them during deployment can lead to musculoskeletal injuries. These injuries account for the majority of medical evacuations and lost duty days, seriously affecting mission readiness. Because of limited electronic injury data, little research has been done on physical demands associated with injury in deployed environments. To this end, this study conducted a survey on 263 soldiers in a Stryker Brigade Combat Team during their third month of deployment to Afghanistan. In the third month, 23% sustained an injury and 43% of injuries affected the low-back, shoulder, or knee. Dismounted patrolling and lifting were reported to account for 36% of injuries. Wearing heavy loads and lifting tasks were identified as injury risk factors. Wearing heavier equipment and lifting objects higher may increase physical demands and may result in injury.
The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel. Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007-2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities. Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements. The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring.