Special Operations Nutrition Guide

The Special Operations Forces
Nutrition Guide
Patricia A. Deuster, PhD, MPH, CNS
Teresa Kemmer, PhD, RD
Lori Tubbs, MS, RD
Stacey Zeno, MS
Christiane Minnick, M.Ac
i
Acknowledgements
Many people have contributed to this revised guide, and it is dif-
ficult to list all those who have made small contributions. However, we
must acknowledge those who have made major contributions. First, we
thank LtCol Charity Thomasos, RD, USAF for her comments and sugges-
tions on multiple chapters and her efforts on chapters 11 and 12. We
thank our primary points for contact at the SOF Commands who arranged
and coordinated our site visits, to include LCDR David C. Krulak, MC
from MARSOC, MAJ(P) Anthony Littrell, MC, USA from USASOC, LTC
Robert Lutz, MC, USA from JSOC, MAJ Keith E. Schlechte, MC, USAF from
AFSOC, and CDR Lanny Boswell, MSC, USN from NAVSOC. We offer a very
special thanks to LCDR Jim Mucciarone, MC, UMO/DMO, Senior Medical
Officer for Naval Special Warfare, who provided invaluable feedback on the
chapters. We recognize MAJ Dirk Geers, Special Operations and Personnel
Recovery Office in Belgium, who used the previous Navy SEAL Guide and
posed many questions before the new guide was begun and provided excel-
lent comments based on his use of the information for deployments. We also
thank CAPT Roger Herbert, Commander of NSW Training who spent time
discussing the importance of nutrition to BUD/S training. Ms. Jennifer Davis
is recognized and thanked for her dedication to the Excel spreadsheets that
were developed specifically for this effort—she did a wonderful job. In addition,
we thank Mike Bottoms, Editor, Tip of the Spear.
We wish to thank USSOCOM for sorting through and sending us pic-
tures for use in the SOF Guide. Also CAPT Pete Van Hooser for his recom-
mendations and efforts in securing quotations from the SOF community.
Lastly, we recognize and thank all the persons at USSOCOM who were
instrumental in the administration of this effort for their patience over
the course of the project: COL Rocky Farr, Mr. Robert Clayton, Mr. David
Saren, and Mr. Thomas Hindes.
ii
Authors
Dr. Patricia Deuster, PhD, MPH, CNS, is a Professor and Scientific
Director for the Consortium for Health and Military Performance in the
Department of Military and Emergency Medicine at the Uniformed Ser-
vices University of the Health Sciences, in the F. Edward Hébert School
of Medicine in Bethesda MD. She was the author of the first US Navy
SEAL Nutrition Guide sponsored by US Special Operations Command,
and because of its success, was commissioned to update the nutrition
guide for the United States Special Operations Commands (USSOCOM).
Dr. Deuster, a Certified Nutrition Specialist, has conducted research in the
area of sports and warrior nutrition for over 25 years and has published
well over 100 peer-reviewed papers relating to stress, nutrition, physical
performance in the military. She has been a tennis professional, nationally
ranked marathoner, qualifier for the First Women’s Olympic Marathon Tri-
als, triathlete, sky diver with over 100 jumps, and world wide scuba diver.
In addition, she is an invited speaker throughout the country on sports nu-
trition and performance. Her dedication to sports, nutrition, and scientific
endeavors, and her long-term relationship with the USSOCOM make her
uniquely qualified to oversee this revision of the SOF Nutrition Guide.
Dr. Teresa Kemmer, PhD, RD, U.S. Army Retired, is currently an As-
sistant Professor, Department of Nutrition, Food Science and Hospitality,
South Dakota State University (SDSU), Brookings, SD. Dr. Kemmer has
provided consultative nutrition services to warrior athletes throughout her
career and brought recognition to the importance of the military’s role in
nutrition assessments and therapy in support of Stability, Security, Transi-
tion, and Reconstruction Operations. She designed and executed nutrition
assessment research/support programs in Honduras, the refugee camps
along the Thailand/Burma border, American Samoa, and rural villages in
Thailand. She assisted in the design and implementation of the ongoing
training program for the San Antonio Military Pediatric Center (SAMPC)
Residency Program in Honduras. She incorporated a research base into
the training program to ensure that data obtained was valid and could be
used by the Honduran Ministry of Health (MoH) and governmental and
nongovernmental organizations to establish policy and programs. Today,
this training program continues to be executed three times a year within
the remote areas of Honduras in collaboration with the Honduran MoH,
Joint Task Force Bravo Medical Element, SAMPC, military dietitians, and
SDSU. She has not only been instrumental in international nutrition re-
search initiatives but has designed and taught classes to ensure dietitians
and other medical professionals are prepared to recognize and manage
macro- and micronutrient deficiencies common in developing countries.
Lori Tubbs, MS, RD, CSSD, CSCS, has been working in the field of health
promotion and sports nutrition with the Naval Special Warfare community
for the past nine years. She is a registered dietitian (RD) and a certified spe-
iii
cialist in sports dietetics (CSSD) and strength and conditioning (CSCS). She
currently works with the SEAL community and has been tasked to initiate a
human performance program that includes full time nutrition support. She
has worked as the nutrition program manager for Navy-wide health promo-
tion and is a subject matter expert in sports nutrition for Navy Environmental
Health Center (NEHC). She has conducted training in nutrition and wellness
globally for Navy personnel, and has deployed on several aircraft carriers
and smaller ships to support the Navy fleet. An environmental nutrition ap-
praisal called Choosing Healthier Options for Wellness (CHOW) developed
in 2005 was used to assess healthy foods available on military bases for
service members, beneficiaries and contract workers. Her other initiatives
include the “Healthy Alternative” Navy vending program and the SEAL Re-
covery Meal Program. Lori is an avid year-round athlete who has competed
in several triathlons throughout the United States, to include Ironman Lake
Placid, along with numerous marathons and outrigger canoeing. She credits
most of her success to support and advocacy by many military leaders for
making the military a better environment nutritionally. Commodore/CAPT
Pete VanHooser, a Navy SEAL, has been influential in supporting the nutri-
tion component of human performance for the SEAL community.
Ms. Stacey Zeno, MS, is a graduate of American University in Wash-

ington, D.C. with a Masters of Science in Health Promotion Management.
She supervises the Human Performance Laboratory at Uniformed Servic-
es University of the Health Sciences in the Department of Military and
Emergency Medicine. In addition, she is a certified personal trainer who
works with recreational and club sport athletes. Ms. Zeno frequently deliv-
ers seminars on nutrition and works closely with female and male athletes
who have eating disorders. Sports have always been a passion and a key
component of her life. She has participated in track and field as well as
tennis, but is currently active with softball and weight lifting.
Christiane Minnick, BFA, MAc, spent over twelve years working as

a communications design professional in the fields of graphic design, ad-
vertising, and marketing. In 2003, she enrolled at Tai Sophia Institute for
the Healing Arts and graduated in 2007 as a Master of Acupuncture. Now
a licensed acupuncturist, she is building her private practice in downtown
Silver Spring, Maryland. Christiane believes there is a connection between
graphic design and acupuncture: in both fields, a holistic approach—one
which emphasizes not just numerous disparate pieces of information,
but how that information adds up to create and transcend the whole —is
crucial when developing a plan for a design project or an acupuncture
treatment. Just as a visual solution must emerge from this information to
form an identity or a message, so must those in health professions note
the themes and core beliefs that run through each person’s own human
experience (presented as information on a physical, emotional, social, or
spiritual level) to identify what may be contributing to their disharmony.
Christiane has a long-standing interest in the myriad ways, which includes
nutrition, a person can influence their own health and wellness, and wishes
to thank Patricia Deuster for the opportunity to work on this project.
iv
Executive Summary
1 The Warrior Athlete t Proteins are essential for building and repairing body
tissues; however, excess protein is converted to fat.
Special Operations Forces (SOF) are “Warrior Ath- t Restore fluid balance by taking in enough liquids to
letes,” the ultimate athlete. The physical and mental replenish weight (pounds) lost plus an additional 25%.
demands imposed by SOF training and missions require
t Performance decrements begin when only 2% of
appropriate nutritional habits and interventions so that,
body weight has been lost.
under the most rigorous conditions, performance is
optimized, and health is preserved.
This chapter serves as an introduction to the special- 4 High Performance Catalysts
ized needs of SOF and the information to be presented t Vitamin and mineral needs can be met by eating a
in The Special Operations Forces Nutrition Guide. variety of foods.
t Vitamin-mineral supplements do not provide energy.
2 Balancing the Energy Tank t Vitamin-mineral supplementation is warranted only
t Balancing energy intake and expenditure can be when energy balance is not met through the diet.
difficult when activity levels are very high and also t Mega-dosing on vitamins and minerals can be det-
when activity levels are very low, such as during rimental to health and performance.
isolation.
t Foods naturally high in antioxidants (fresh and
t Typically, body weight remains constant when colorful foods) should be eaten daily.
energy intake equals expenditure.
t To lose or gain one pound of weight, 3,500 calories
must be expended or consumed.
5 Nutrient Timing and Training
t The timing of nutrient delivery is critical to sustain-
t Calculating Resting Energy Expenditure (REE) and
ing performance.
the intensity of daily activities gives an accurate
estimate of how much energy an operator might t The Refueling Interval (RFI) is the 45 minutes after
expend in one day. finishing a workout.
t The Body Mass Index (BMI) is a clinical tool for t Eating during the RFI will accelerate recovery and
assessing body fat composition and classifies indi- restore energy for the next day’s workout.
viduals into underweight, normal, overweight, and
t A daily diet that is balanced and nutrient-dense will
obese categories.
ensure better performance and optimal recovery.
t CHO foods and beverages that have a moderate to
3 Fueling the Human Weapon high glycemic index, such as sport drinks, raisins,
honey, bananas or potatoes are ideal recovery foods.
t Carbohydrates (CHO) are the vital fuel for endur-
ance and resistance activities, competitive athletic t Adding protein to the recovery meal will help
events, mental agility, and healthy living. stimulate protein synthesis to assist in rebuilding
muscle (anabolism).
t Fats, the primary form of stored energy, are essen-
tial, but should be eaten in moderation. t For exercise longer than 90 minutes, consume 50
v
grams of CHO and 12 grams of protein as food or alertness without promoting weight gain.
drink immediately during the RFI and 50 grams of
t Keep nutrient dense snacks at home, work, or “on
CHO every 2 hours for 6 hours.
the go.”
t Adequate fluids must be ingested after a mission. t Snacks for night operations should include foods
t Fluid replacement beverages should contain so- low in carbohydrate and high in protein.
dium and potassium. t Snacks high in water, such as fruit, are great for warm
t Sports bars, gels and drinks are lightweight, por- weather operations.
table and easy to eat during SOF operations. t Snacks high in carbohydrate are good to consume
when exercising in the cold.
6 Optimal Choices for Home Chow t Avoid high-fat snacks during special operations.
t Foods eaten at home can impact mission performance.

t Smart shopping is the first step towards healthy 9 Secrets to Keeping Lean
meal preparation. as a Fighting Machine
t Most recipes can be modified to improve nutrient
t Consumption of carbohydrate (CHO) in defined
composition.
amounts is the most important fuel strategy for all
t Use nutrition labels as a guide for making smart forms of exercise.
food choices.
t Depletion of glycogen stores will result in poor
t Every meal is important for overall health and performance in the weight room and endurance
performance. training sessions, such as a pack run.
t Aim for as many servings of fruits and vegetables t Improper nutrient intake and low muscle glycogen
as possible. stores may increase the risk of musculoskeletal
injuries.
7 Optimal Choices for Eating Out t CHO ingestion improves the use of amino acids
when they are ingested together.
t Not all restaurants are equal. Choose wisely.
t Drinking too much plain water can pose perfor-
t Eating out can be healthy if careful meal selections mance pitfalls during prolonged missions/exercise
are made. sessions that involve constant movement.
t Selecting fruits and vegetables as a part of the t Individual food preferences should be determined
meal adds vitamins, minerals and fiber, and helps to avoid gastrointestinal distress during training
reduce fat and calories. and operations.
t Fast food restaurants have healthy alternatives to
the high-fat burger and fries. Make sensible food 10 Bulking Up
choices.
t Proper and consistent strength training, adequate
rest and a balanced diet will provide the lasting edge
8 Healthy Snacking when it comes to building strength and muscle mass.
t Snacking, or “eating between regular meals,” is t Eating a wide variety of foods and matching en-
important to help maximize performance and ergy intake with energy output will provide optimal
maintain mental and physical acumen. nutrition for building muscle.
t Healthy snacks can help increase energy and t All operators require no more than 1 gram of protein
vi
per pound of body weight per day. t Steroids and steroid alternatives are illegal and
unsafe; they can seriously harm the body and nega-
t Adequate amounts of fluids are vital to muscle
tively affect performance.
metabolism and contractility.
t Spend money on “real” foods, not supplements
and protein powders. 13 Combat Rations
t Combat rations are specially designed to supply
11 Looking for the Edge– adequate energy and nutrients for particular types
of missions.
Dietary Supplements t Environmental and operational dictate changes in
t SOCOM has a no dietary supplement (DS) policy— combat rations to meet nutritional needs.
check with medical. t Rations provide different amounts of energy to
t DS sold on military installations are not always meet the needs of various operational conditions.
safe, effective or legal. t Some rations have been designed to meet strict
t Manufacturers of DS are not required to conduct religious diets.
research on safety or effectiveness. The Food and t Commercial products are available to supplement
Drug Administration must prove a product is un- military rations and/or allow for greater diversity
safe before it can be taken off the market. and choice for eating when deployed.
t If you use DS, select high quality products with
USP (United States Pharmacopeia) certification la- 14 Eating Globally
bels. The label assures consumers that the product
has been tested and verified in terms of its ingredi- t Be aware of cultural differences including types of
ents and manufacturing process. food and proper eating utensils.
t Combining and stacking of DS increases the poten- t Avoid foodborne illnesses by taking extra precau-
tial for undesired and unsafe side effects. tions: stay away from typical foods associated with
foodborne illnesses.
t Energy drinks are not regulated and the long-term
effects of their combined ingredients are unknown. t Make wise food and beverage selections when eat-
ing on the economy.
12 Enemy Agents t Drinking contaminated water may severely affect

your health: purify your water!
t All tobacco products, including smokeless tobacco, t Carry Pepto-Bismol and seek medical treatment for
are addictive, and can cause cardiovascular dam- symptoms from contaminated foods or beverages.
age and various forms of cancer.
t Alcohol, in excess, can lead to dehydration and
compromise performance. Do not mix drugs and
15 Mission Nutrition for
alcohol: beware of alcohol-drug interactions. Combat Effectiveness
t Over-the-counter drugs, such as antihistamines, t Inadequate energy intake and/or dehydration can
non-steroidal anti-inflammatory drugs, and aspirin result in fatigue and impaired performance during
should be used in moderation and under a physi- combat.
cian’s care if being used for long-term therapy.
t Improper eating and sleeping due to all night and
t NSAIDs should not be used during deployments high op-tempo missions can be detrimental to
because they make bleeding difficult to control. overall health.
vii
t Eating before night operations should be planned

accordingly to prevent fatigue.
18 Sustaining Health for
t Various environmental exposures (i.e. heat, cold, and
the Long-Term Warrior
altitude) can alter combat effectiveness if nutritional t Eating a variety of foods is one key to healthy living.
needs and hydration are not met appropriately.
t A Mediterranean Diet has been shown to confer a
t Energy and fluid requirements are typically higher long, healthy life.
than normal during combat and combat-simulated
t Healthy bones require adequate calcium intake and
scenarios.
regular physical activity.
t Eating many different colorful real foods, which
16 Returning to Home Base contain important protective compounds—phyto-
nutrients, promote life-long health.
t Rest and rejuvenation should be emphasized upon
return from deployment to re-optimize mental and t At least 3–5 servings of colorful vegetables, 2 or
physical performance. more servings of fruit, and 6 or more servings of
whole grain products, should be consumed per day,
t A good night of sleep in a comfortable bed and dark
whenever possible.
room is essential for recovering from deployments.
t Products containing probiotics (yogurt, keifer, sau-
t A balanced diet high in complex carbohydrates, erkraut) may be helpful for maintaining a healthy
such as vegetables, fruit and whole grains, can digestive tract.
enhance stress resistance.
t Alkaline-forming, rather than acid-forming, foods
t Good nutrition and regular exercise are excellent are important during periods of high stress.
antidotes to stress.
t Avoid binge eating and drinking upon returning

from deployments. Excess food and alcohol intakes
can lead to unwanted weight gain and is detrimen-
tal to overall health.
17 The High Mileage SOF Warrior

t Try to maintain weight minimize weight cycling—
multiple episodes of weight loss.
t Pain from arthritis can be reduced by choosing

healthy foods and foods high in anti-inflammatory
compounds.
t NSAIDs should be used on a very limited basis.
t Foods, not supplements, should be the primary

source of nutrients. Food is the best and cheapest
way to take in essential nutrients.
t The risks of developing hypertension, coronary

heart disease, diabetes, and cancer increase with
age. Eating the right type of foods can limit risk
factors associated with these chronic diseases.
Table of Contents
1 The Warrior Athlete 1 4 High Performance Catalysts 20
Nutrition for the Warrior Key Points
Looking Forward Role of High Performance Catalysts in SOF
Future Success Dietary Reference Intakes and Definitions
Nutrient Density
2 Balancing the Energy Tank 3 Vitamins
Key Points Functions of Vitamins

Good Food Sources of Vitamins
Units of Energy
Preserving Vitamins in Foods
Sensitivity of Energy Balance
Minerals
Components of Energy Expenditure
Functions of Minerals
Resting Energy Expenditure
Good Food Sources of Minerals
Physical Activity Energy Expenditure
Mineral Requirements for Military Garrison
How to Calculate Energy Expenditure
Training
Body Size and Body Mass Index
Special Catalysts: Antioxidants
Substances That Interfere With High Performance
3 Fueling the Human Weapon 7 Catalysts
Key Points
Vitamin and Mineral Dietary Supplements
Fuels for Energy Vitamin and Mineral Supple-
Carbohydrates ment Use and Performance
Fat Risks of Vitamin and Mineral Supplements
Protein
Alcohol 5 Nutrient Timing and Training 31
Fueling the Tank Key Points
H2O Everyday Nutrition and the “ine” Diet
Distribution and Functions of Water Fatigue and Glycogen Depletion
Maintaining Water Balance “Staleness” and Overtraining
What Conditions Will Increase Water Losses? The Remedy
What Should You Drink? Nutrient Timing
Fluid Replacement Beverages All Carbohydrates are NOT Created Equally
Criteria for Commercial Off-The-Shelf Fluid Rehydration
Replacement Beverages Rehydration in the Field
When and How Much to Drink? Sodium/Electrolyte Replacement
ix
Sports Drinks Home

Recovery and Commercial-Off-The-Shelf-Products Work
(COTS) “On the Go”
Sports Bars What Foods/Snacks are Best for Different Occasions?
Sport Gels Operations at Night
Sleep-Enhancing Foods
6 Optimal Choices for Home Chow 45 Operations in the Heat
Key Points Operations in the Cold
Make the Most of Meals At Home Sustained Operations
Grocery Shopping
Recipe Modification 9 Secrets to Keeping Lean
Decoding Nutrition Labels
as a Fighting Machine 66
Ingredient List
Key Points
Serving Size
Fueling the Machine
% Daily Value (DV)
Carbohydrates and the Fighting Machine
Breakfast: Off to a Healthy Start!
CHO and Endurance
Lunch: How to Make the Grade
Protein Needs
Dinner: Fueling for the Night
Fruits and Vegetables—More Matters Vitamin and Mineral Needs
Fluid Requirements
7 Optimal Choices for Eating Out 52 Nutritional Interventions for Endurance
Key Points
Choose Restaurants Wisely
10 Bulking Up 74
Choosing a Nutritious Meal Key Points
Appetizers Benefits of Strength Training
Main Meal Factors Determining Muscle Mass
Other Main Courses Principles of Training
Other Helpful Tips: Lifting Pitfalls to Poor Performance
Fruit and Vegetables When Eating Out Range of Motion
Fast Foods Equipment Considerations
Suggestions for Choosing Fast Foods Victims of Bigorexia
Fast Foods and the Web Protein Requirements for Strength Training
Concerns with High Protein Intakes
8 Healthy Snacking 60 Other Nutritional Requirements
Key Points Carbohydrate Requirements
Healthy Snacking and Making the Most of Snacks Fat Requirements
Snacking Tips Vitamins and Minerals
The Snacking Environment Dietary Considerations for Bulking-Up
x
11 Looking for the Edge– 13 Combat Rations 136

Dietary Supplements 83 Key Points
Key Points The Meal, Ready-to-Eat Individual (MRE) Menus
Dietary Supplements and the Law MRE Improvements: 2002–Present
Combining and Stacking Supplements The Meal, Cold Weather/Food Packet, Long-Range
Be a Smart Shopper: Consumer Safety Tips Patrol (MCW/LRP)

Individual Products Discussed Light Weight Rations
Performance-Enhancing Agents Survival, General Purpose, Improved (GP-I)
Muscle Building Agents Survival, Abandon Ship
Athletic/Recovery Agents Survival, Aircraft, Life Raft
Dietary Supplements for Weight Loss Tailored Operational Training Meal (TOTM)
Appetite Suppressants Meal, Religious, Kosher/Halal
Other Supplements First Strike Rations
Thermogenic Agents Other Rations and Ration Components
Digestion Inhibitors Composition of Rations for Combat Operations
The Good, the Bad and the Ugly Facts Commercial Freeze-Dried Products
The Good Facts Future Rations
The Bad Facts
The Ugly Facts 14 Eating Globally 143
Energy Drinks Key Points
Cultural Awareness When Dining
12 Enemy Agents 124 Know the Local Customs
Key Points Think Before You Act….
Smokeless Tobacco (ST) Foodborne Illness
Nicotine Foods Associated with Foodborne Illness
Nicotine Withdrawal Making Wise Food Selections
Alcohol Water Purification
Antihistamines
Preventive and Treatment Measures for
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Foodborne Illness
Steroids (Anabolic-Androgenic)
When to Consult a Health Care Provider
Anabolic Steroids and Cycling
Adverse Effects of Steroids
Stacking
Agents Recently Banned Combat Effectiveness 151
Multi-Ingredient Steroid Alternatives— Key Points
The Bottom Line Nutritional Readiness Before Missions
Contamination and Adulteration Several Days Before a Mission
Ephedra Timing and Composition of Pre-Mission Meals
xi
Sustained Night Operations Sleep

CHO Intake Stress
Hydration Status Diet, Exercise, and Stress Connections
Caffeine Intake Anti-Stress Diet
Nutritional Readiness During Missions Exercise
Rations Meal Planning Strategies for Special Gatherings
Dehydration Alcohol
Gastrointestinal Complaints How Much Alcohol is Enough?
Missions in the Heat Binge Drinking
Fluids—Drink Early and Drink Often
Monitoring Hydration in the Field 17 The High Mileage SOF Warrior 187
Electrolyte Balance
Key Points
Missions in the Cold
Dietary Approaches for the High Mileage SOF
Energy Intake
Dependence on Vitamin M (Ibuprofen)
Glycogen Stores
Antioxidants
Fluid Status
Coenzyme Q10
Vitamin and Mineral Needs
A Well-Balanced Diet
Missions at Altitude
Arthritis and Musculoskeletal Injuries
Weight Loss
Treatment
CHO Intake
Weight Gain and Weight Maintenance
Dehydration
Food Quality
Oxidative Stress
Quality of Sleep
Missions in Water and at Depth
Preventive Measures
Energy Intake
Weight Loss
Fluid Intake
Yo-Yo Dieting
Mineral Balance
High Blood Pressure, or Hypertension
Antioxidant Balance
Coronary Heart Disease (CHD)
Mission Scenarios
Lowering Risks
Typical Training Day
Lipid Profiles
SDV Operation
Nutritional Choices to Protect Your Heart
Unconventional Warfare
Drug Treatments to Improve Lipid Profiles
Special Reconnaissance
Type II Diabetes
Nighttime Air Mission
Metabolic Syndrome
Summary
Cancer
16 Returning to Home Base 179

Key Points
18 Sustaining Health for the
The Reality Long-Term Warrior 199
Down Time = Rejuvenation = Reset Key Points
xii
Principles of Good Eating

Mediterranean Diet
Omega-3 Fatty Acids
How Much is Needed?
Fish Oil Supplements
Bone Health
Stress Fractures
Phytonutrients
Dietary Fiber
What is Dietary Fiber?
Eat More Fiber
When to Minimize Fiber Intake
Probiotics and Prebiotics
Probiotics
Prebiotics
An Alkaline Diet
1 The Warrior Athlete
Nutrition for the Warrior
T
he demands imposed by Special Operations Forces (SOF) training
and missions are unlike any athletic endeavor. Success requires the
mustering of all strength and endurance—both physical and mental.
In This Chapter SOF are “Warrior Athletes,” the ultimate athlete, at the top of the
Nutrition for the Warrior athletic pyramid. One factor that will contribute to mission success and life-
long health is good nutrition. It is well known that appropriate nutritional
Looking Forward habits and interventions can enhance performance, and these successful
Future Success approaches need to be known.
SOF Warrior Professional/Olympic Athlete
Year-round training cycle. Seasonal training.
Multiple skills. One sport.
Volunteer. Sponsored.
Well scheduled and orchestrated

24/7 potential for deployment.
events.
Self-trained/Help yourself. Full spectrum support.
Eat on the fly/Help yourself. Sports nutritionist/Psychologists.
Military issue tents. Pampered with 5-star hotels.
Coverts ops. Limelight and enthusiastic audience.
Life/Death. Win/Lose.
Global impact. Self-promotion/Local enthusiasm.
Unexpected is the norm. Structured and controlled.
Private reflection and Money, endorsements, Olympic gold,

satisfaction. public approval, and appreciation.
Unit at risk. Team effort.
Buddy-reliant. Coach-directed goals.

2
This manual is intended to be a resource for all SOF, ranging from short
summaries to detailed information, with worksheets, links, and important
tips for nutrition at home and when in theater.
Looking Forward
This SOF Nutrition Guide evolved into the final product after multiple con-
versations, discussions, and interactions with SOF individuals and teams, and
many other interested parties. The Guide is dense, but each chapter starts with
key information, and an executive summary provides a “shortened” version.
t Chapters 2 through 4 provide general background information about
energy expenditure, source of energy, essential nutrients and nutrition
concepts. These are the backbone of the guide.
t Chapters 5 through 8 will help you select a healthy diet: they contain
menus for eating at home, menus for eating in ethnic and fast food res-
taurants, choosing healthy snacks, selecting appropriate military rations,
“The sustenance and combining commercial-off-the-shelf products with military rations.
and nutritional t Chapters 9 through 13 review important information on being a warrior
well-being of our athlete. Detailed information and websites that discuss dietary supple-
ments, combat rations and products to be avoided are also provided.
warriors on the t Chapters 14 and 15 explore nutritional strategies for various missions,
battlefield is every how to optimize nutritional intake to combat challenging environmen-
tal and physiological conditions, and how to eat on the local economy
bit as important as when deployed.
their operational t Chapter 16 discusses nutritional strategies to regain pre-deployment
kit, weaponry, health and fitness after returning home from extended deployments.
and training. The t Chapters 17 and 18 provide information on how to be a SOF “war-
rior athlete” for 20+ years and what the “high mileage” SOF warrior
nutritional patterns athlete should consider in order to maintain operational readiness and
good health after years of physical abuse.
and eating habits
must be learned
Future Success
and practiced long
SOF are a select group of warrior athletes who can benefit from nutri-
before they deploy.” tional guidance. Each command has specialized missions, with the dura-
tion of deployments ranging from 30 days to 12 months. Long missions
Rear Admiral Kernan,
in locations far from the central support hub pose very difficult nutritional
CO NSW challenges to SOF, and unfortunately, good solutions are not always pos-
sible. Despite differences across SOF commands, this guide has been de-
signed to cover the spectrum of needs, so performance under the most
rigorous conditions is optimized. The success of SOF require effective
nutritional strategies to optimize performance during operations and pre-
serve health during the golden years of retirement.
2 Balancing the Energy Tank
In This Chapter
Units of Energy
Components of Energy Key Points

Expenditure
t Balancing energy intake and expenditure can be difficult when activity
Body Size and levels are very high and also when activity levels are very low, such as
Body Mass Index
during isolation.
t Typically, body weight remains constant when energy intake equals
expenditure.
t To lose or gain one pound of weight, 3,500 calories must be expended
or consumed.
t Calculating Resting Energy Expenditure (REE) and the intensity of
daily activities gives an accurate estimate of how much energy an
operator might expend in one day.
t The Body Mass Index (BMI) is a clinical tool for assessing body fat
composition and classifies individuals into underweight, normal, over-
weight, and obese categories.
E
nergy balance is one very important aspect of nutrition. Knowing
how much energy is going to be expended allows one to calculate
how much fuel the “tank” requires to function and how much fuel to
take on missions. Energy expenditure must be balanced by energy
intake to maintain body weight or “energy balance.” To determine how
much fuel your tank needs, basic information about metabolic rate and
activity level is needed. This chapter will address those issues.
Units of Energy
The unit most commonly used to describe energy intake and energy
expenditure is the calorie. The terms kilocalorie (kcal) and kilojoule are
also used when referring to energy intake and expenditure. For simplicity:
t 1 kcal = 1 calorie.
Throughout this book we will use the terms kcal and calorie inter-
changeably.
4

The energy balance equation can be “unbalanced” by changing energy
intake, energy expenditure, or both. To gain or lose 1 pound, approximate-
ly 3,500 extra kcal must be consumed or expended. Believe it or not, the
energy balance equation is very sensitive.
1 lb = 3,500 kcal.
Example 1:
t One 32 oz Gatorade® has 4 servings of 8 fl oz. If you consumed the
whole bottle, you would drink 200 kcal (8 oz = 50 kcal).
t If you drank one 32 oz Gatorade® per day every day of the year
without increasing your activity level, you would add 73,000 kcal (200
x 365 days/yr), which is 20.8 lbs in one year.
Example 2:
t Eating one PowerBar® Protein Plus per day would provide 258 kcal
of energy.
t Eating one PowerBar® Protein Plus per day for an entire year without
increasing your activity level, would add 94,170 kcal (258 x 365 days/
Resting Energy yr), which is 26.9 lbs per year.
Expenditure (REE):
Example 3:
The amount of energy
required to maintain life. t Drinking one extra beer per day would provide an additional 145 kcal
of energy.
t Drinking one beer per day for an entire year without increasing your
activity level, would add 52,925 kcal (145 x 365 days/year), which is
15.1 lbs per year.
Table 2–1. Determining Resting
Energy Expenditure (REE) of Men
From Body Weight (in pounds)
Components of Energy Expenditure
Age Equation to Derive
(yrs) REE (kcal/day) The three major contributors to energy expenditure are:
t Resting energy expenditure.

18–30 6.95 x Weight + 679
t Physical activity.
t Energy for digesting foods (TEF or thermic effect of food).

31–60 5.27 x Weight + 879
The first two are of interest here and will be discussed in detail.
5
Table 2–1. Physical Activity Fac-
Resting Energy Expenditure tor for Various Levels of Activity
Resting Energy Expenditure (REE) is the amount of energy required to Activity

maintain life—such as breathing, beating of the heart, maintaining body General Activity Factor
temperature, and other life processes. Measurements are made in the (x REE)
morning after waking with the body at complete rest. REE can be esti-
mated by a formula to predict your daily energy requirements. The only Very Light: Seated
information needed is your body weight in pounds. and standing activi-
1.3
ties, driving, playing
Physical Activity Energy Expenditure cards.
The amount of energy you expend during physical activity is different

each day, depending on your training. Some days are very strenuous and
Light: Walking,
involve running, swimming, calisthenics, cold water exposure, sleep de-
carpentry, sailing,
privation, and carrying heavy loads. Some days you are in the classroom 1.6
playing ping-pong
sitting a good portion of the day. Thus, determining your actual energy or pool, golf.
expended during activity is more difficult, but there are ways to estimate
it. You would usually take your REE and multiply it by a number (or factor)
based on your expected physical activity, as shown in Table 2–2. Multiply- Moderate: Carrying
ing your REE by this physical activity factor provides a rough estimate of a load, jogging, light
your total energy/calorie needs. swimming, biking, 1.7
calisthenics, scuba
diving.
Example: Heavy: Walking with

a load uphill, rowing,
You are 21, weigh 175 lbs, and activity is moderate.
digging, climbing, 2.1
REE = 6.95 x Weight + 679 = 6.95 x 175 + 679 = 1,895 kcal/day. soccer, basketball, run-
ning, obstacle course.
Total Energy Needs = 1,895 x 1.7 = 3,222 kcal/day.
Exceptional: Run-
ning/swimming
Note: Formula for REE came from Table 2–1; 1.7 is the Activity Factor for races, cycling uphill, 2.4
“Moderate Activity.” carrying very heavy
loads, hard rowing.
Click here to calculate your REE.
How to Calculate Energy Expenditure

You will need a calculator to complete this exercise.
Over a 24-hour period, different amounts of energy will be expended
in each activity you engage in, be it watching TV, eating, running in boots,
humping, or listening to teammates. The objective of this activity is to
increase awareness of the energy actually expended.
Click here to record your physical activity.
t Record your name and date on the Energy Expenditure Activity Form.
t List all the activities participated in over the last 12 hours and the
6
Name: Date:
approximate length of time (in minutes) spent on each
activity.
Energy t Go through the alphabetical list of activities, and find
Total
Time Value
Activity Calories the activity that most closely approximates the ones you
(minutes) (kcal/
(kcal) listed on the form.
minute)
t Write down on the form the kcal/minute (not per hour!)
Obstacle value in the appropriate column (Energy Value).
30 10 300
course
t Multiply the energy value by the total time in minutes.
4-mile run, For example, if you ran in boots for 25 minutes, then
8-min/mile 32 14 448 your energy expenditure for that activity would be 12
pace (energy value) x 25 (time) = 300 kcals.
Do this for five activities, or preferably all events in 12

Calisthenics 30 8 240 hours. Then add up the numbers to get an actual energy
expenditure estimate. How did you fare? Keep track of your
weight if you are in doubt—it is the most accurate way to
Weight
45 11 495 monitor energy balance.
lifting
14-mile run
in boots
140 12 1680 Body Size and Body Mass Index
Body Mass Index, or BMI, is a measure commonly used to
5-mile hike rapidly assess body composition and classify individuals as

100 14 1400 underweight, normal, overweight or obese. BMI is the ratio
w/80 lb load
of (weight in kg)/(height in m)2, or [(weight in lb) x 704.5]/
(height in inches)2. Reference standards have been devel-
oped for the United States population by race and gender,
so that individuals at risk for obesity can be easily identified.
However, the reference values for the U.S. population do not
always apply to special populations, such as SOF. As a re-
sult, unique populations often develop their own standards
and references based on individuals within that population.
A reference range based on a survey of over 800 SEALs was
developed. The average BMI was 25, and the average body
fat was 13%. For more information on BMI, click here.
BMI is a screening tool, and you can use it to keep track

of changes in your body composition. If your BMI is high,
4,563 have your body fat checked, and if your body fat is more
Grand Total
kcal than 20%, you should take action to lower your weight.
Click here to see reference BMI values for SOF.
3 Fueling the Human Weapon
In This Chapter
Fuels for Energy
Fueling the Tank
H20 Key Points

Fluid Replacement t Carbohydrates (CHO) are the vital fuel for endurance and resistance
Beverages activities, competitive athletic events, mental agility, and healthy living.
t Fats, the primary form of stored energy, are essential, but should be
eaten in moderation.
t Proteins are essential for building and repairing body tissues; however,
excess protein is converted to fat.
t Restore fluid balance by taking in enough liquids to replenish weight

(pounds) lost plus an additional 25%.
t Performance decrements begin when only 2% of body weight has

been lost.
“Y
ou Are What You Eat.” Although this statement has not been
proven, it is known that the foods eaten make a difference in
performance, longevity, and quality of life. A car engine typi-
cally uses only one source of fuel, but the body can use car-
bohydrate, fat, protein, and alcohol. To a certain extent, the source of fuel
is dictated by availability. In other words, the body tends to use whatever
it has. The macronutrients, or energy-providing nutrients, are important
in this respect. Without energy the body would starve, and performance
would be greatly reduced. The three main sources of energy are:
t Carbohydrate.
t Fat.
t Protein.
These fuels are called “macronutrients” because they are eaten in large
quantities unlike the micronutrients to be discussed later. This chapter will
provide basic information about macronutrients and alcohol, which may
be a dominant source of energy among SOF. In addition, information re-
lating to portion size and hydration will be provided.
8
Simple Carbohydrates: Fuels for Energy

Simple sugars that include
fructose, sucrose, lactose, Carbohydrates
and several other sugars.
Carbohydrates, or CHO, are the preferred foods for endurance and re-
sistance training, competitive athletic events, mental agility, and healthy
=More information on living. CHO foods are the preferred energy source for all athletes and for
simple carbohydrates. SOF: CHO should not be restricted. In the past, CHO have been consid-
ered “off-limits” and many SOF have blamed weight gain on CHO. In addi-
Complex Carbohydrates: tion, many fad diets promote protein and fat at the expense of CHO, but as
Complex sugars that are made a vital energy source, and restriction can degrade performance. Chapters
up of sugars with more complex 5, 9 and 10 discuss the amount of CHO to eat with respect to nutrient tim-
chains, such as fiber, vegetables,
ing and type of training.
beans, and whole grains.
Definition, Composition, and Classification
=More information on Carbohydrates exist in many forms, but the two major types of CHO are
complex carbohydrates. labelled simple and complex.
t Simple CHO include table sugar, honey, fruit sugars, milk sugar, brown
sugar, corn syrup, maple syrup, corn sweeteners, high-fructose corn
syrup, and molasses.
t Complex CHO include grains, fruits, seeds, potatoes, pasta, seaweed,

algae, peas and beans, and all other vegetables.
t Complex CHO, starches and fibers, come from plant materials. The
body digests starches, but it does not digest dietary fiber. Fiber is
discussed in Chapter 18.
Functions of Carbohydrate in the Body
CHO are used in the body mainly as:
t Fuel for muscles, brain, heart, and other organs in the form of glucose;
the brain requires 130 grams/day from glucose.
t Building blocks to make chemicals needed by the body.
t Chemical cement for joints and other structures in your body.
t Glycogen is the only CHO stored in humans.
Glycogen, stored in liver and skeletal muscle, is limited to about 500

grams and is depleted by three to four hours of heavy exercise; a 24-hour
fast will use up liver glycogen stores.
9
Carbohydrate in the Diet

Some people are phobic about eating CHO and believe that foods high
in CHO are unhealthy and lead to weight gain. Fear not. That notion
comes from muscle-building myths and low CHO diet fads that lack scien-
tific evidence. No one has ever been able to show that performance suffers
from consuming potatoes, rice and bread. To the contrary, performance is
enhanced by such foods. Rather, high-fat toppings (butter on bread, sour
cream on potatoes, cream cheese on bagels, cream sauces on macaroni)
may contribute to the notion that CHO are bad. Also, CHO that are highly
processed with high fructose corn syrup and other highly processed sug-
ars, are less healthy than whole food products, such as baked potatoes,
brown rice, whole wheat pasta, and wheat bread. CHO-rich foods from
around the world are shown below.
Table 3–1. Carbohydrate Sources in Selected Countries
Country Carbohydrates in food*
Mexico Corn tortillas, beans.
Brazil Black beans, rice.
India Chick peas (garbanzo beans), lentils, rice,

whole grain unleavened breads.
Japan Rice, tofu, vegetables.
Middle East Hummus (chick peas), tahini (sesame seeds).
United States Bread, potatoes, noodles, macaroni.
*When combined, these CHO are also a good source of protein.
Energy From Carbohydrate
One gram of Carbohydrate = 4 kcal.
= More information on fat.

Click here to calculate kcals from carbohydrates. = More information
on healthy diet.
Fat
Fat is a vital part of the diet as it adds taste to foods and satisfies hun-
ger. However, not all fats are created equal. By understanding the different
types of dietary fat, how it works in the body, and using guidelines for daily
10
fat consumption, excess fat can be eliminated from your diet and you can
eat for better health.
Definition, Composition, and Classification

Fat (technically fatty acids) is an essential nutrient and is usually classi-
fied according to its chemical form.
Type Description Examples
Saturated Fats Solid at room Whole milk, cream,

temperature. ice cream, whole-
milk cheeses, but-
ter, lard, meat, palm
kernel, coconut oils,
and cocoa butter.
Polyunsaturated Liquid at room Safflower, sesame,

Fats temperature. soy, corn and
sunflower-seed oils,
nuts, seeds, and
fish.
Monounsaturated Liquid at room Olive oil, canola

Fats temperature but and peanut oil,
may solidify in the peanut butter,
refrigerator. cashews, almonds,
and avocados.
Trans Fats or Man-made from Cookies, crackers,

“Partially saturated fats. and other commer-
Hydrogenated” cial baked goods,
Fats French fries, donuts,
fried onion rings
and other commer-
cial fried foods.
Functions of Fat in the Body

Fat serves a number of critical functions:
t Major form of stored energy: provides energy during exercise, in cold
environments, and during starvation.
t Insulates the body.
t Helps transport other nutrients to places in the body.
t Protects organs.
t Serves a structural role in cells.
11
How Much Fat Should We Eat?

All the different types of fats are desirable, but too much fat is the pri-
mary dietary problem in our country. A high intake of fat is associated
with many diseases, including:
t Heart disease.
t Obesity.
t Many forms of cancer.
t Diabetes.
The average American consumes 33% of daily calories as fat (52% car-
bohydrate and 15% protein). Total fat intake (saturated, trans, monoun-
saturated, polyunsaturated) should be adjusted to fit total caloric needs. It
is recommended that no more than 35% of total calories come from fat.
Saturated fat intake should not exceed 10% and the balance should come
from mono- and poly-unsaturated fats. Trans fat intake should be less than
1% of total calories each day.
Energy From Fat
One gram of FAT = 9 kcal.
Fat provides more than twice the

energy supplied by CHO and protein.
Determining Your Daily Fat Allowance

Everyone talks about grams of fat, but what does that mean on a practi-
cal level? How does one translate “grams” of fat to percent fat and how
many grams of fat should be consumed each day? Again, no more than
35% of calories should come from fat, so with that in mind, the example
below will show you how to determine your daily fat allowance.
Example: Determining Fat Allowance

If estimated energy need (EEN)= 3,222 calories
Step 1. Multiply EEN by 0.35 to get calories from fat
3,222 x 0.35 = 1,128 fat calories
Step 2. Divide fat calories by 9 to get grams of fat.
1,128/9 = 125 grams of Fat per day
12
Where Did The Numbers Come From?
= Protein in diet. Estimated Energy Need or EEN was given to you in the example. You
should know your EEN from the preceding chapter.
t 0.35 in Step 1 is for calculating 35% of calories from fat.
Amino Acids:
Small building blocks that t 9 in Step 2 represents the number of calories in one gram of fat.
are hooked together. t 125 is the maximum number of grams of fat that should be eaten to
ensure the diet provides no more than 35% of calories from fat.
An excel worksheet is provided to determine the amount of calories
from you should get from the fat in your food.
Table 3–2. How Many Grams of Click here to calculate kcals from fats.
Protein Do I Need?
Activity Protein Protein

Level Range Protein seems to be the preferred food among SOF to consume, based
(grams/lb) on the number of protein drinks and sports bars used in place of “real
food.” Also, people like to eat high protein foods because they think pro-
Low to 0.4–0.5
Moderate tein makes them grow “big and strong.” Are they correct? Let’s take a look
at protein and what it really does.
Endurance 0.6–0.8
Training Definition and Composition
Strength/Weight 0.6–0.8 CHO and fat consist of carbon, oxygen, and hydrogen; protein consists
Training of these atoms, plus nitrogen, which is essential for life. Proteins are made
up of amino acids—small building blocks hooked together in various or-
ders. Although over 20 different amino acids are part of our body, only 10
are “essential amino acids” (EAA) because our body cannot make them;
Over 1.6 grams of they must be obtained from protein in the diet. Failure to obtain enough
protein/pound body of the 10 EAA, in the right balance, may result in degradation of other
proteins, such as muscle, to obtain the one EAA that is needed. Unlike fats
weight may compromise and starch, the human body does not store excess amino acids for later
muscle growth. use—the amino acids must be obtained from the food every day.
The 10 EAA, in alphabetical order, are arginine (required for the young,
but not for adults), histidine, isoleucine, leucine, lysine, methionine, pheny-
lalanine, threonine, tryptophan, and valine.
Example: Suppose an SOF SEAL
weighs 175 pounds and is training
for a mission that requires both
Functions of Protein in the Body
endurance and strength. Proteins vary in size, depending on how many amino acids are linked
together, and each one performs different functions in the body. Although
Protein needs = 0.6 x 175 lb =
they can provide energy, protein is not a main source of energy, like car-
105 grams
bohydrates and fat. Some functions of protein are:
Protein needs = 0.9 x 175 lb =
t Muscle contraction.
140 grams
t Formation of muscle, hair, nails, skin, and other tissues.
Protein needs = 105–140 g/day.
t Direct energy production.
13
t Repair of injuries.
t Transport fats, vitamins and minerals around the body.
t Structural roles for every part of the body.
How Much Protein Should I Eat?

Protein needs are determined by age, body weight, and activity level. Many
athletes believe that if they eat more protein, their muscles will increase in
size, but this is not true. Excess calories from protein can be converted to and
stored as fat. Additionally, large quantities of protein strain the liver and the
kidneys. Table 3–3. Summary of
Macronutrients / Water
Click here to calculate protein needs.
1 gram of… = kcal/g
Energy from Protein Carbohydrate = 4
Fat = 9
One gram of protein supplies 4 kcal. Protein = 4
Alcohol = 7
Water = 0
Alcohol
Alcoholic beverages (beer, wine, or liquor) are a potent source of en-
ergy, but they are not good sources of energy for physical activity or exer-
cise. Obviously, alcohol is not essential, unlike CHO, protein and fat. Also,
most people tend to eat junk food when they are drinking. If trying to keep
in shape, it is a good idea to minimize the amount of alcohol consumed;
it contains little in the way of other nutrients, so replacing a meal with
alcohol is not a good idea.
One 12 oz beer is about 150 kcal and one 12 oz “lite” beer is approxi-
mately 110 kcal. Wine provides about 90 kcal for every 5 oz, and liquor
contains 90 kcal for every 1.5 oz If the liquor is prepared with a carbon-
ated drink, the energy intake will increase by at least 75 more kcal.
Click to see how many calories are in alcoholic drinks.
Energy from Alcohol
One gram of alcohol supplies 7 kcal.
Click to calculate the percent of daily calories from alcohol.

14
Clenched Fist Baseball Tennis Ball Checkbook Ping Pong Ball

= 8 fl oz = 1 cup = 1/2 cup = 3 ounces = 1 Tablespoon
Breakfast Cereals Beans Peanut Butter

Soup Tomato Sauce Cream Cheese
Mashed Potatoes
Meats
Beverages Green Salads Mayonnaise
Fruit Salad Canned Fish Sour Cream
Chinese Food Apple Sauce Salad Dressing
Fueling the Tank

The term “serving” describes the recommended amount of food that
should be eaten from each food group. Packaged foods list the number of
servings on the Nutrition Facts panel and a serving describes the amount
of food recommended in the Food Guide Pyramid and the Dietary Guide-
lines for Americans. A “portion” is the amount of a specific food chosen to
be eaten or served for breakfast, lunch, dinner, or snack. Portions can be
bigger or smaller than the recommended food servings. Over the past 20
years, portions have increased substantially, and this has resulted in many
people eating more than they should. Larger portions have also contrib-
uted to the high incidence of obesity. The next page provides a summary
Table 3–4. Body Weight Losses
of standard serving sizes, but a Serving Size Card can be downloaded, cut
and Dehydration
out, and laminated for long time use to help you recall what standard food
Starting 2.5% Weight servings look like. To test your knowledge of portion sizes click here.
Weight (lbs) Change (lbs)
150 146 H2O

170 166 Water is an essential nutrient and the most abundant component of the
human body. Approximately 50–70% of your total body weight is water.
190 185 Since lean body/muscle mass requires more water than fat, the leaner one
is, the more body water there is. Water must be consumed regularly to
ensure normal functioning of the body.
Distribution and Functions of Water

Water is found inside and outside cells, but most water is inside cells,
especially muscle cells. Water in the body serves many important roles,
= Click here for more
including:
information on hydration.
t Participates in digestion and absorption of nutrients.
t Participates in excretion of wastes.
t Maintains blood circulation in the body.
t Maintains body temperature.
15
A loss of 2.5% of your body weight will result in performance decre-

ments: decision-making and concentration will be impaired and 35% of
physical performance potential can be lost.
Being well hydrated during operations is absolutely critical, since
adequate fluids will help compensate for blood losses if wounded. For
these reasons, fluid balance is essential to SOF performance. Below are
signs and symptoms that might be experienced when weight is lost from
dehydration.
t Thirsty.
t Dry mouth. Table 3–5. Using Weight Loss to
Estimate Fluids Replacement
t Urine output reduced.
Weight Fluid to be
t Reduced physical performance.
Lost (lbs) Replaced (oz/cups)
t Headache and feeling ill.
20–24
t Difficulty concentrating. 1
(2.5–3 cups)
t Sleepiness.
40 to 48
2
(5–6 cups)
Maintaining Water Balance
Water balance is determined by water/fluid output and input. In order 80–96
4
to maintain performance, it is critical that a fluid deficit or dehydration (10–12 cups)
does not occur. With dehydration, water output exceeds input and balance
160–192
becomes negative. A sedentary man typically will expel body water at a 8
(20–24 cups)
rate of 1–3.2 quarts (1–3 liters or 32–102 oz) a day from the following:
16
t Urine and stools.

t Breathing.
The easiest way to restore
t Sweating.
fluid balance is by drinking
fluids that contain sodium. When activity levels are low, most fluids are lost through the urine.
This is very important However, when activity levels and/or the outdoor temperature are high,
most fluid is lost by sweating. Up to 2.1 quarts (2 liters or 66 oz) per hour
to remember. can be lost through sweating, depending on the outside temperatures and
intensity of the activity.
All fluids lost must be added back each day by drinking 125–150% of
the weight lost to restore fluid balance. This can be measured by weighing
yourself as often as possible. If no scale is available, monitor the color of
your urine. Sources of fluid for rehydrating include:
t Water in food.
= Calculate body weight t Sports drinks that contain sodium and potassium.
loss in pounds (lbs)
from dehydration. Sweat output increases markedly in both hot weather and during pro-
longed exercise—the amounts will be even greater if exercise is performed
in the heat.
Eating foods high in water and drinking fluids will help restore water
balance. The fresh foods listed in Table 3–6 are over 90% water. Beware
of drinking too much plain water (hyper hydrating). It is also important to
consume some sodium, which helps restore hydration status better than
water taken alone. Taking in salt will also help prevent levels of sodium in
the blood from getting too low (hyponatremia), which can be dangerous.
Hyponatremia is a huge operational problem. It is caused by excessive in-
take of plain water during prolonged exercise. Salty foods can be ingested
before or with other fluids (including sports drinks) to provide sodium,
promote fluid retention, and stimulate fluid intake.
Table 3–6. Fresh Foods Containing Mainly Water
Bean Sprouts Broccoli Cabbage Carrots
Cauliflower Celery Cucumbers Eggplant
Lettuce Peaches Spinach Squash
Strawberries Tomatoes Watercress Watermelon
What Conditions Will Increase Water Losses?

The primary ways in which you may become dehydrated,
or in need of additional body fluids, are by:
t Exercising for over 60 minutes.
17
t Working in a hot environment—wet or dry.

1
t Working in a cold environment—wet or dry.
t Going to high altitudes.
2
t Drinking too much alcohol or caffeine. Click for the 3
caffeine content of various products.
4
t Exercising in the heat, cold, or at altitude.
t Exercising with a hangover. 5
Several points about fluids should be considered:
6
t Do not rely on thirst as a good indicator of fluid needs;
body weight losses are better. 7
t Before any exercise or simulated-mission, fluids should 8
be ingested in anticipation of losing fluid (12–20 oz of
cool water before exercise). 9
t Before starting, urine should be clear or between 1–3
on the chart (unless taking B vitamin supplements)—this is a sign of
adequate hydration. The more dehydrated, the darker (and smellier)
urine will be (will look like cola).
t Drink regularly or whenever possible during workouts and operations.
Drink 16–20 oz of fluid every 20–30 minutes to maintain hydration;
t Weigh yourself before and after an event to determine how much fluid
is lost.
t Every one pound of weight lost requires 125–150% more fluid or 20–24
oz. It will take about 6 hours to recover from dehydration post exercise/
military operation.
t Performance decrements begin when only 2% of body weight has been lost.
What Should You Drink?

Although the type of activity will determine what to drink, the
beverage selected should:
t Empty from your stomach and intestines rapidly.
t Taste good.
t Provide CHO when exercise lasts > 1 hr.
t Contain a small amount of sodium (salt).
t Provide no more than 19 grams of CHO per 8 oz.
t Be cool (10 to 15°C).
t Be diluted to ≤ 9 grams CHO/8 oz or a 4–5% CHO solution if fluid
needs are > 4L.
18
Fluid Replacement Beverages

If the exercise is longer than one hour, a beverage that provides CHO
should be ingested. Beverages with “glucose polymers” (maltodextrin), or
a mixture of glucose and fructose are usually preferable to glucose or su-
crose alone. The important message is “drink.” A list of beverages, some
of which are used as “fluid replacement beverages” by athletes, and a set
of criteria for selecting commercial off-the-shelf fluids replacement bever-
ages are presented in Table 3–7.
Fluid replacement beverages that contain more than 19 grams of CHO

per 8 oz may cause stomach distress and not be absorbed well if con-
sumed before or during physical activity. For example, orange juice should
be mixed with an equal amount of water because it is so concentrated.
Criteria for Commercial Off-The-Shelf

Fluid Replacement Beverages
t < 95 kcal/8oz.
t CHO Content: 9–19 g/8oz.
t CHO to Protein Ratio: > 4:1 ratio, if any protein/amino acids.
t Sodium: 0.2–1.15 g/L (40-240 mg/8 oz).
t No carbonation.
t No substances other than CHO, electrolytes, and protein.
Table 3–7. Commercial Off-The-Shelf Fluid Replacement

Beverages Meeting Criteria
Energy CHO CHO:Pro Sodium

Products
kcal/8 oz g/8 oz ≥ 4:1 mg/8oz
CarboPack
94 19 - 55–160
Beverage
Cerasport 76 13 - 102
Gatorade
50 14 - 110
Original
Gookinade 86 10 - 64
GU2O 50 13 - 120
MetRx ORS 75 19 - 125

19
Table 3–7. Commercial Off-The-Shelf Fluid Replacement

Beverages Meeting Criteria
Energy CHO CHO:Pro Sodium

Products
kcal/8 oz g/8 oz ≥ 4:1 mg/8oz
Powerade 72 19 - 53
Power Bar
Endurance 70 17 - 160
Sports Drink
Gatorade High Activity Levels

50 14 - 200
Endurance Low Activity Levels
14
When and How Much to Drink?
Daily Water Requirements (L/Day)

Remember: although the following recommendations are generally 12
sound for most people, everyone is different. Each person must learn to
look for signs alerting to his fluid needs. Make adjustments to how warm/ 10
hot it is outside. If very hot, make sure to drink fluids with sodium to re-
place lost electrolytes from sweating. The more physical activity, the more 8
fluid needed! Be careful not to drink too much plain water, especially dur-
6
ing prolonged exercise in the heat. The figure to the right shows daily wa-
ter requirements as a function of activity and environmental temperature.
4
55 65 75 85 95 105
Average Daytime Temperature (ºF)
“A SOF warrior needs the right nutrition and quantity of

food in the same way a high performance car needs the
right mixture of high octane fuel and air to achieve peak
performance.”
CDR Todd L. Tinsley, NSWSBT22
4 High Performance Catalysts
In This Chapter
Role of High Performance
Catalysts in SOF
Dietary Reference Intakes Key Points

and Definitions
t Vitamin and mineral needs can be met by eating a variety of foods.
Nutrient Density
t Vitamin-mineral supplements do not provide energy.
Vitamins t Vitamin-mineral supplementation is warranted only when energy
balance is not met through the diet.
Minerals
t Mega-dosing on vitamins and minerals can be detrimental to health
Special Catalysts:
and performance.
Antioxidants
t Foods naturally high in antioxidants (fresh and colorful foods) should
Substances That be eaten daily.
H
Interfere with High
igh performance catalysts, or micronutrients, allow performance
Performance Catalysts
at a high level. Catalysts include vitamins, minerals, and other
Vitamin & Mineral Dietary essential nutrients required by the body in very small amounts to
Supplements perform vital metabolic and physiologic functions. Taking in too little
or too much of these nutrients can interfere with normal body functions.
Role of High Performance Catalysts in SOF

Some of functions of high performance catalysts are presented below.
Recovery from Production

Exercise of Energy
Role of High
Provision of
Oxygen to Performance Catalysts: Formation of
Red Blood Cells
Exercising Muscle
Micronutrients
Maintenance of Maximize
Healthy Muscles Immune
and Joints Function
21
Different amounts of catalysts are needed by individuals, depending on

gender, age, activity, and environment. The best way to obtain the required
If energy intake is amounts is to eat well-balanced meals with foods that are nutrient dense.
sufficient, the high catalyst A daily diet of diverse foods can provide the necessary amounts of high
requirements of performance catalysts for a well-tuned body.
SOF warriors should
be adequate.
Dietary Reference Intakes and Definitions
Various terms have been developed to explain how much of these “cat-
alysts” are needed. The term Dietary Reference Intakes (DRI’s) refers to
the amount of particular vitamins and minerals a typical person should
eat to prevent a deficiency. The DRIs also have a Tolerable Upper Intake
Dietary Reference Level (ULs) that tells us how much is too much. The term % Daily Value
Intake (DRI):
(DV) on a food label represents how much one serving contributes nutri-
The amount of particular
tionally to a 2,000-calorie-a-day diet. If the label says 15% DV for Vitamin
vitamins and minerals a typical
C, then one serving provides 15% of the DRI for Vitamin C. Other terms
person should consume to pre-
vent a deficiency or reduce the and definitions are noted on the side bar.
risk of chronic diseases. The U.S. Military also has Military Dietary Reference Intakes (MDRIs)
Tolerable Upper based on the U.S. DRIs. They are for planning, assessing diets, and devel-
Intake Level (UL): oping rations for the military population. Neither DRIs or MDRIs consider
The highest daily average of the nutrient needs of SOF warriors, who train and operate under diverse,
a particular vitamin or mineral often grueling, environmental conditions.
to consume safely.
Recommended Daily
Allowance (RDA): Nutrient Density
The average nutrient level
The term “nutrient density” is important to understand. It is the amount
sufficient for nearly all healthy
of a particular nutrient (vitamin, mineral, carbohydrate, protein, fat, etc.) per
individuals.
unit of energy in a given food, or per gram of food. It is also an index of nu-
Adequate Intake (AI): tritional quality. In the following table, Comparison 1 shows the nutrient den-
Provides a general sity of the food label for granola versus glazed donuts. Comparison 2 shows
nutritional goal. the information for orange juice versus coca cola. The granola and orange
Reference Intake: juice are clearly more “nutrient dense” than their comparative foods.
DRI’s applied to the healthy
military population. Table 4–1. Examples and Comparisons of Nutrient Density
Comparison 1 Comparison 2
=Click here for
more information on Kashi Go Lean Glazed Donut Orange Juice Coca Cola
Dietary Reference Intakes. Crunch (1 oz) (1 oz) (100 ml) (100 ml)
0% DV for 0% DV for 4% DV for 0% DV for

Vitamin A Vitamin A Vitamin A Vitamin A
22
Table 4–1. Examples and Comparisons of Nutrient Density
Comparison 1 Comparison 2
Kashi Go Lean Glazed Donut Orange Juice Coca Cola

Crunch (1 oz) (1 oz) (100 ml) (100 ml)

Calcium Calcium Calcium Calcium

Vitamin C Vitamin C Vitamin C Vitamin C

Iron Iron Iron Iron
20 g Fiber 0 g Fiber 0 g Fiber 0 g Fiber
10 g Protein 1 g Protein 1 g Protein 0 g Protein
Many other examples could be presented, but clearly foods with more
fiber, “high performance catalysts,” and less fat and simple sugars should
be selected. At least 90% of the diet should be comprised of nutrient
dense foods.
Vitamins
Vitamins are organic compounds that allow for energy to be produced,
among other functions. They are broadly classified as water- and fat-solu-
ble: water-soluble vitamins dissolve in water and are not stored, but rather
eliminated through urine; therefore, a continuous supply is needed in the
Fat Soluble Water Soluble

Vitamins Vitamins
Vitamins A, D, Vitamin C and

E and K Vitamin B Complex
Thiamin, Riboflavin, Niacin,

Vitamin B6, Folate, Vitamin B12,
Biotin, Pantothenic Acid,
and Choline
23
diet. However, fat-soluble vitamins are not required every day because
they are stored in fat tissue and the liver. Fat-soluble vitamins are best
absorbed with dietary fat. Choline is another essential nutrient and similar
to the B-vitamins, but not officially listed as a B-vitamin.
Functions of Vitamins
t Production of energy from macronutrients (CHO, fats, and proteins).
t Repair and growth of tissue.
Vitamins:
Organic compounds that t Maintenance and support of reproductive function.
do not provide calories, but
t Development of immune response.
are essential to life.
Some functions may be specific to only one vitamin, whereas other func-
tions may require more than one vitamin. For example, several B vitamins
and some minerals are required to produce energy from foods.
Click here for a list of vitamins and their functions.
Good Food Sources of Vitamins

No single food is a good source of all vitamins, which is why it is im-
portant to eat a variety of foods. Some processed foods provide many
vitamins because they have been fortified with nutrients, whereas other
foods may contain few, if any, vitamins. When eating at home or dining
away from home, the key to eating a balanced meal is choosing a variety
of foods, whenever possible. To obtain the necessary vitamins, a dinner
plate should include:
t A heaping pile of vegetables (excluding potatoes and corn).
t Black, pinto, or kidney beans and whole grains or corn.
t Fish, lean poultry, or lean cuts of red meat, tofu, dairy products.
t Nuts/seeds.
If eating field rations during training or deployment, eat the entrees as
well as the other food and beverage items provided in the pack since dif-
ferent food/beverage items are fortified with different micronutrients. For
example, cocoa in the Meal Ready to Eat ration is a source of vitamin B1,
calcium and magnesium.
Click here for a list of good food sources of vitamins.
Preserving Vitamins in Foods

Proper food storage and preparation can minimize vitamin losses. All
vitamins are destroyed by light and many are destroyed by excessive heat.
Water-soluble vitamins are easily washed out when foods are over-cooked.
Steps that should be taken to increase the retention of vitamins during
storage and preparation include:
24
t Keep foods out of direct light as much as possible, especially milk

and grains.
t Keep fresh produce refrigerated.
t Avoid soaking vegetables in water.
t Cook in just enough water to prevent burning.
t Use the shortest cooking time by cooking to a crisp and tender stage.
= More information
t Steaming and stir frying result in the best vitamin retention. on vitamin C.
t Cut and cook vegetables shortly before serving or refrigerate in an = More information
airtight storage container. on vitamin E.
= More information
on chromium.
Minerals = More information
on zinc.
= More information
on iron.
Major Minerals Trace Minerals Electrolytes
= More information
on vitamin A.
Calcium, Iron, Zinc, Copper, Sodium,

= More information
Phosphorus, Manganese, Potassium, on vitamin B6.
Sulfur, Magnesium Iodine, Selenium Chloride
= More information
on choline.
Minerals are inorganic substances that can be single elements, such as

magnesium (Mg) and calcium (Ca), simple salts (electrolytes), or metals,
such as iron (Fe). Numerous minerals are required by the body, and may
account for 4–5% of a person’s body weight. Typically, minerals are classi-
fied as major minerals, trace minerals, or electrolytes, depending on func-
tion and how much is in the body.
Major minerals are required in relatively large amounts (> 200 mg/
day), whereas trace minerals are required in smaller amounts (< 200 mg/
day). They can occur naturally in food or be added in elemental or min-
eral form. Appropriate dietary intakes of minerals must be sustained to
maintain physical health. Excessive intakes may lead to adverse conse-
quences because of the competitive nature between minerals in the body. Minerals:
For example, zinc and copper, and calcium and magnesium are needed in Inorganic compounds
particular ratios. Electrolytes include sodium, potassium, and chloride. found in all body tissues
and essential for life.
Functions of Minerals
t Brain and neural function.
t Bone structure and maintenance.
25
t Muscle function and growth.

t Production of energy.
t Reproductive functions.
t Immune function.
Click here for a list of minerals and their functions.
Good Food Sources of Minerals

As with vitamins, a variety of foods should be eaten in order to meet re-
quirements for these essential nutrients. Table 4–2 provides a list of foods
that are high in selected minerals.
Table 4–2. Primary Food Sources for Some Minerals
Food Products Major Mineral
Green leafy vegetables and Calcium

dairy products
Nuts, soy beans, and cocoa Magnesium
Milk and spinach Sodium
Legumes, whole grains, and Potassium

bananas
Table salt Chloride, iodine
Meat, eggs, and legumes Sulfur
Red meat, poultry and seafood Zinc
Red meat and leafy vegetables Iron
Click here for a list of good food sources of minerals.
Mineral Requirements for Military Garrison Training

The MDRIs reflect the Institute of Medicine (IOM) Dietary Reference
Intakes (DRIs). Modifications to these requirements should only be made
when sufficient scientific evidence exists to support different requirements
and intakes. The recommended values for some minerals should take into
account enhanced mineral losses caused by high-performance activities.
Evidence strongly indicates that sweat mineral losses of copper, iron and
zinc might be significant during garrison training. New recommendations re-
flect this evidence (See Table 4–3). However, insufficient data exists for sweat
losses of calcium, magnesium and selenium to recommend an increased in-
26
take. Also, requirements might be different for specific military situations and
more research is required prior to changing current recommendations.
Table 4–3. Mineral Intakes for Men: Institute of Medicine Dietary Refer-
ence Intakes, Current Military Dietary Reference Intakes, and Recom-
mended Levels for Military Garrison Training and Assault Rations
Nutrient IOM MDRI RDA of RDA for

RDA or AI for Assault
AI* MGT Rations*
Calcium 1,000 1,000 1,000 750–850

(mg)
Copper (µg) 900 ND 1,800 900–

1,600
Iron (mg) 8 10 14 8–18
Magnesium 420 420 420 400–550

(mg)
Selenium 55 55 55 55–230
(µg)
Zinc (mg) 11 15 15 11–25
Note: Institute of Medicine = IOM; RDA= Recommended

Dietary Allowance; AI=Adequate Intake; MDRI = Military
Dietary Reference Intakes; MGT= Military Garrison Training;
ND= Not Determined; *Institute of Medicine (2006).
Special Catalysts: Antioxidants

Antioxidants are substances in foods that neutralize highly reactive, de-
structive compounds called free radicals. Note the following key points
about free radicals and antioxidants:
t Free radical damage can lead to cancer and heart disease.
t Free radicals from harmful pollutants are neutralized by antioxidants.
t Foods rich in antioxidants are the best source of antioxidants.
information on antioxidants.
t Smokers should consume foods high in antioxidants.
Some well known antioxidants include:
t 7JUBNJO& t4FMFOJVN
t #FUB$BSPUFOF t(MVUBUIJPOF
27
t $ZTUFJOF t'MBWPOPJET
t 7JUBNJO$ t(MVUBUIJPOF
Some critical antioxidants are enzymes, such as superoxide dismutase,
and catalase. Additional antioxidant details are discussed in Chapter 18.
Click here for a list of foods high in antioxidants.
Antioxidants should come from food.
Substances That Interfere With High Performance Catalysts

Many substances affect both the absorption and loss of high perfor-
mance catalysts. For example, the amount absorbed from foods can be
influenced by dietary constituents (such as fiber), other factors (such as
medications), the body’s need for the nutrient, the chemical form of the
nutrient, and the integrity of the digestive tract. “ANTI-catalysts” that can
interfere with how well the body uses nutrients are shown below:
Caffeine
Aspirin Tobacco
ANTI
Antibiotics Fiber
Catalysts
Stress NSAIDS*
Alcohol
*Nonsteroidal Anti-Inflammatory Drugs
To minimize the potential effects of ANTI-catalysts, one should:

t Eat a variety of foods.
t Use good food preparation techniques.
28
Vitamin and Mineral Dietary Supplements

The DRI for high performance catalysts provide a wide safety margin,
but some adjustments may be required in individuals with very high en-
ergy expenditures. Nutrient requirements for antioxidant vitamins (C, E
and carotenoids), B vitamins, magnesium, zinc, copper, selenium and iron
needs may be slightly higher in SOF warriors because of activity levels.
But, a good, varied diet will allow the DRI to be met. Despite this, the
supplement industry encourages physically active people to purchase vi-
tamin and mineral supplements to enhance performance. About 40–80%
of military personnel use some form of vitamin and/or mineral supple-
ments. These include single vitamins (vitamin C), minerals (calcium) and/
or multivitamin-mineral combinations. In many cases the doses range
from amounts similar to or far in excess of the DRI. Vitamin and mineral
supplements are useful when:
t An existing vitamin or mineral deficiency is present.
t Individuals have poor nutrient intakes and dietary habits.
t Energy requirements cannot be met by food.
t Individuals are exposed to extreme environments, such as strenuous

exercise, cold exposure, and at high altitude.
Click here for approved vitamins by the United States

Pharmacopeia (USP).
Vitamin and Mineral Supplement

Use and Performance
Taking a general multivitamin/mineral supplement appears to be with-
out measurable performance benefit in healthy, well-nourished, physically
active men. Whether supplementation with such nutrients produces ben-
eficial effects on performance in SOF warriors is unknown. For example,
supplementation with selected vitamins/minerals may accelerate recov-
ery or reduce susceptibility to infections. Some information to confirm
these possibilities is available, but studies have not been conducted in mili-
tary populations. If a vitamin and/or mineral supplement is desired, the
supplement should provide nutrients in amounts that meet the DRI, and
no supplement should provide more than the Upper Limit as indicated by
the National Academy of Sciences.
29
The illustration below presents the relative amounts of “popular” vita-

min and minerals needed on a daily basis.
Relative Daily Intake of Vitamins and Minerals (mg/d)
Click here for the upper limit for vitamins.

Click here for the upper limit for minerals/elements.
Risks of Vitamin and Mineral Supplements

Excessive intakes of some vitamin and mineral supplements can cause
multiple side effects, and some vitamins and minerals can be toxic. Although
some people take excessive amounts of nutrients on a regular basis, it is
important to distinguish between excessive and toxic. Excessive amounts
of single or multiple nutrient supplements can upset overall nutrient bal-
ance and cause a deficiency of other nutrients. Iron, zinc and copper are
To avoid harmful good examples, since all three are absorbed via the same route. An exces-
effects from high sive intake of zinc can prevent the proper absorption of the others. Addi-
tionally, excess vitamin E (in the form of alpha tocopherol) has been shown
doses of supplemental to slow healing, inhibit the immune system, and increase the risk of bleed-
vitamins and minerals, ing. Symptoms may include fatigue, weakness, headache, blurred vision,
refer to the DRI and diarrhea. Other fat-soluble vitamins, such as vitamin A and D, can also
upper limits. be taken in excess. Vitamin C overdoses are unlikely, but taking a lot of vi-
tamin C followed by low levels can lead to “rebound scurvy.” Importantly,
intakes above DRI upper limits may have significant adverse effects. Table
Vitamin and mineral 4–4 provides a list of various nutrients and levels considered to be toxic.
supplements are
absorbed best when Table 4–4. Nutrients and Their Toxicity Values
taken with food.
Nutrient Toxicity Nutrient Toxicity
(units/day) (units/day)
Vitamin A >25,000 IU Magnesium >6,000 mg
Beta Carotene None Boron >100 mg

30
Table 4–4. Nutrients and Their Toxicity Values
Nutrient Toxicity Nutrient Toxicity

(units/day) (units/day)
Vitamin D >50,000 IU Chromium >10 mg
Vitamin E >1,200 IU Copper >35 mg
Vitamin B6 >2,000 mg Iron >100 mg
Vitamin C Rare Selenium >1 mg
Calcium >2,500 mg Zinc >150 mg
Click here for information on popular vitamins and minerals.

Do not take a vitamin/mineral supplement with a carbohydrate-protein
drink that already contains vitamins and minerals or the supplement and
money will be wasted: excess amounts are excreted in the urine.
5 Nutrient Timing and Training
In This Chapter
Key Points
Everyday Nutrition
and the “ine” Diet t The timing of nutrient delivery is critical to sustaining performance.
Fatigue and t The Refueling Interval (RFI) is the 45 minutes after finishing a workout.
Glycogen Depletion t Eating during the RFI will accelerate recovery and restore energy for
Nutrient Timing the next day’s workout.
t A daily diet that is balanced and nutrient-dense will ensure better per-
Rehydration
formance and optimal recovery.
Recovery and
t CHO foods and beverages that have a moderate to high glycemic in-
Commercial-Off-The-Shelf
Products or COTS dex, such as sport drinks, raisins, honey, bananas or potatoes are ideal
recovery foods.
t Adding protein to the recovery meal will help stimulate protein synthe-
sis to assist in rebuilding muscle (anabolism).
t For exercise longer than 90 minutes, consume 50 grams of CHO and

12 grams of protein as food or drink immediately during the RFI and
50 grams of CHO every 2 hours for 6 hours.
t Adequate fluids must be ingested after a mission.
t Fluid replacement beverages should contain sodium and potassium.
t Sports bars, gels and drinks are lightweight, portable and easy to eat
during SOF operations.
T
he goals of training are to promote changes in the body such that
muscular strength, aerobic capacity, and endurance are optimized.
Training goals cannot be achieved in the absence of appropriate nu-
tritional strategies. Before and after training or missions, strategies
to ensure adequate energy stores and rapid recovery for the next mission
are critical. Well conceived meal and snack plans will enhance prepared-
ness, boost morale, stimulate muscle protein synthesis, and help protect
against training injuries. Nutrient timing combined with rest are essential.
This chapter will provide information about nutritional strategies to opti-
mize training in preparation for missions.
32
Everyday Nutrition and the “ine” Diet

% of Energy
For performance and recovery to be optimal, the everyday diet of SOF

members must be as good as it possibly can be. Routine dietary habits
must be considered to determine what should be done to ensure opera-
tional performance and overall good health. The usual CPF (CHO: Protein:
Fat) pattern should approximate: CHO—55%; Protein—20%; and Fat—
25%. This is not the usual SOF pattern.
Navy SEAL Mike Fullerton stated that all military members are on the
so called “ine diet.” “We all wake up at 0-dark thirty, grab a big gulp of
java (caffeine), dip a pinch of Skoal (nicotine) and grab a few honey buns
from the “gee-dunk” (vending machine).” This pattern of eating over
many years comes back with revenge, and makes recovery from strenuous
missions more and more difficult. The following other dietary practices are
admitted by many SOF operators:
t Consuming the majority of calories at the end of the day.
t Underestimating calories consumed and portions eaten.
t Planning meals poorly.
t Eating too much fast food chow.
t Using multiple dietary supplements to enhance performance.
t Using caffeine and simple sugars to fill the void during the day.
The following operations require nutritional countermeasures to avoid
complete exhaustion and muscular fatigue:
Operator Activity:
Recall an operation that t Wearing boots and body armor and carrying heavy packs and ammu-
caused complete fatigue as nitions for over 60 minutes.
a result of sustained effort for t Fast roping or dragging a wounded comrade to safety.
mission success.
t Extended water operations.
t Altitude operations.
t Prolonged shivering in austere environments, such as operating in
mountainous regions or diving in cold water.
Fatigue and Glycogen Depletion

Fatigue is a complex phenomenon caused by failure at multiple sites
during exercise. The causes of fatigue can be central (mind/central ner-
vous system or neuromuscular) and/or local (peripheral—muscle). One
nutritional cause of fatigue is depletion of muscle glycogen. All strenuous
exercise, be it endurance, resistance training or missions, will deplete gly-
cogen. Muscle glycogen must be replenished through nutritional interven-
tions to override fatigue and accelerate recovery.
33
It takes at least 24 hours to replenish

muscle glycogen stores following exhaustive
exercise or operations.
Glycogen repletion occurs when enough

CHO is provided. If diet is neglected over
time, “staleness” can become a problem.
“Staleness” and Overtraining

The terms “staleness and “overtraining” are consistently noted for com-
petitive athletes and may apply to SOF as well. Staleness and/or over-
training are believed to result from too little recovery time in combina-
tion with too much training. Other factors or non-training stressors can
also contribute to staleness. A multitude of symptoms are associated with
overtraining, including:
t Unexplained, persistently poor performance.
t Moodiness, general fatigue, depression, and irritability.
t Painful muscles.
t Elevated morning resting pulse.
t Insomnia.
t Weight loss.
t Overuse injuries.
t Increased susceptibility to upper respiratory infections and gut problems.
34
Too rigorous a training program

can impair immune function.
How staleness or overtraining is expressed depends upon the physi-

cal and physiological makeup of the warrior, type of training regimens,
dietary practices, sleep patterns, and various other factors. No single test
can identify overtraining, but a number of key markers that change over
time have been proposed. Possible markers include stress hormones, im-
mune markers, indicators of muscle damage, compromised muscle glyco-
gen reserves, and decrements in aerobic and anaerobic capacity. Drs. Jack
Raglin and William Morgan from Indiana University developed a scale to
identify endurance athletes who exhibit signs of distress resulting from in-
tensive training. Called the Training Distress Scale, it consists of ten items
that are individually scored and then used to create a total score. If an
individual’s total score is high over several consecutive days, a couple of
days of rest are critical to preserve future performance.
Click here to complete the Training Distress Scale.
The Remedy
CHO intake over 24 t Make sure that training is accompanied by periods of rest.
hours will typically not
t Ingest a meal providing 1.5 gram of CHO per pound of body weight
exceed 650 grams.
approximately 4 hours prior to exercise.
t Ingest 0.4 grams of a low GI CHO drink or solid food per pound of
body weight 1 hour before exercise/operations.
t Consume an easily digested, high-CHO drink or food that provides

approximately 50 grams of CHO and 12 grams of protein within 45
minutes after exercise.
t Consume 0.5 grams of CHO per pound of body weight every 30 min-
utes until 4 hours after exercise.
t Consume a high CHO drink or solid food providing at least 250 kcal
(60 grams) of CHO with each meal.
t Be certain your body weight is stable during all phases of training by

matching energy intake to energy requirements.
35
Table 5–1. CHO Content (grams)
of Various Foods and Beverages
Example: CHO in grams for a 155 lb warrior:
Low-fat milk, 1 cup 12
Before Exercise:
233 g (155 x 1.5) of CHO 4 hrs before Bread, 1 slice 13
62 g (155 x 0.4) of a low GI CHO up to 1 hr before
Oatmeal cookie, 1 15
Immediately After Exercise:
Pound cake, 1 slice 15
50 g of CHO and 12 grams of protein
1–4 hours after exercise Apple, 1 19
78 g (155 x 0.5) of CHO every 30 minutes until 4 hrs
Blueberries, 1 cup 20
Click here to calculate CHO intake before and after exercise. Wheaties, 1 cup 25
Blueberry muffin, 1 25
Nutrient Timing Pear, 1 25
Baked potato, 1 25
Bean & meat burrito, 1 33

The timing of “when” nutrients are consumed may
be as important as “what” nutrients are consumed. Banana, 1 35
Sweet corn, 1 cup 40
The timing of nutrients should be viewed as three very distinct phases: Macaroni, 1 cup 40
t Recovery or maintenance.
Rice, 1 cup 40
t Exercise when energy stores are being depleted.
Cinnamon bagel, 4” 50
t The RFI, or critical period after exercise.
During exercise the environment is “catabolic” so that energy can be Bagged pretzels, 10 50
delivered to the working muscles. Insulin, an important hormone for pro-
Pancakes & syrup, 2 90
moting muscle protein synthesis, is not released during exercise because
it is not needed. After exercise the environments must become “anabolic,” Seedless raisins, 1 cup 130
so the process of recovery and building up what was lost begins: insulin
Re-Fueling Re-Fueling
Interval Interval
Recovery Recovery
Exercise Exercise
Phases of Timing Nutrient Intake

36
release must be stimulated. Ingestion of CHO stimulates “insulin.” Thus,

immediately after exercise, when glycogen stores and muscle protein
Nutritional intervention synthesis are low, is the critical time to provide what the body or muscle
within 45 minutes after needs: CHO with a small amount of protein.
exercise is the most critical Running on an empty tank for too long after strenuous operations or
time, or “RFI,” for recovery. PT will be detrimental to performance and duties the next day. To avoid
performance decrements, or fatigue, a CPF of 80%/20%/0%, or as little
fat as possible, is recommended. This means a small meal of CHO (50–60
grams) and protein (12–15 grams), taken as food or fluid within 45 minutes
after completing exercise, will help begin repletion of muscle glycogen
stores and synthesis of muscle protein. This RFI will set the stage for both
recovery, repair, and muscular growth.
% of Energy
RFI: Consume 50 g of CHO and 12 g of protein

within 45 minutes after training.
More protein may compromise recovery
and muscle protein synthesis.
Table 5–2. Possible RFI Foods
Food and/or Beverage Product(s) CHO (g) Protein (g)
Peanut butter, 2 Tbsp, and jelly, 2 tsp, 43 14

on wheat bread, 2 slices
Wendy’s Mandarin Chicken Salad and 88 27

Glycemic Index: Cran-apple juice, 8 oz
Describes how a particular food
Hard-boiled egg, 1, and bagel 56 12
raises blood glucose levels.
Hand-Tossed Style Chicken 57 13
Supreme Pizza (Pizza Hut), 1 slice, and
= List of Glycemic juice, 8 oz
Index Classification.
McDonald English Muffins with Jam, 2 36 5
Subway Oatmeal Raisin Cookie and 76 21

6” Deli Turkey Breast Sub
Subway Breakfast Western Egg with 43 0

Cheese on Deli Roll with orange juice, 4 oz
Taco Bell Bean Burrito, 1 54 13

37
Table 5–2. Possible RFI Foods

Good food choices should
Food and/or Beverage Product(s) CHO (g) Protein (g) be made throughout the
Low-fat yogurt with fruit, 8 oz 47 11
recovery/maintenance
phase when muscle
Soldier Fuel Bar, 1, or other high CHO 40 10 growth and tissue
Sports Bar
repair are needed.
String cheese, 2, and apple or pear, 1 large 23 14
Cereal with low-fat milk, 1 cup 53 13
Arby’s Jamocha Shake, regular size 81 11
After the first 45 minutes, nutrient intake will depend on the duration,
intensity, and type of activity. Low intensity exercise of short duration will
require regular meals at regular intervals, whereas high intensity exercise of
both short and long duration will require regular snacks of carbohydrate and
protein, with some fat. Obviously, the longer the duration of the activity, the
greater the energy drain, thus a greater need for refueling the tank.
A recovery meal to ensure nutrients, fluids, and calories are replenished
immediately after PT during the RFI and over the course of the day is im-
portant. Examples of nutrient-dense recovery foods include the following:
t Sports bar, 1, with 50 g CHO and 12 g protein.
t 100% fruit juice, 8 oz.
t Low-fat yogurt, 8 oz.
t Whole grain bagel, 1.
t Honey, 1 oz.
t Cottage cheese, 4 oz.
t Tuna fish, 3 oz.
t Tomato or V8 juice, 8 oz.
t Whole fruit, 1 piece.
t Homemade trail mix, 6 oz.
Click for nutrient content of recovery foods and a trail mix recipe.
These Recovery Meals ensure that nutrient-dense foods, to include
carbohydrate-rich, high quality protein, and healthy fats are eaten by SOF
personnel at the right time. Commercial Off the Shelf (COTS) products
are being used in some SOF commands currently to help provide carbo-
hydrate-rich foods such as sports drinks, bars, and gels during training so
38
they can train and deploy with the same products. These nutrition initia-
= Click here for more tives have allowed SOF to access nutritionally desirable foods within their
information on commands immediately after PT and in operational settings. Most impor-
electrolyte balance. tantly, COTS are considered “comfort foods” because they are familiar and
previously used during phases of training.
= Click here for more All Carbohydrates are NOT Created Equally
information on potassium.
Not all CHO foods are equally effective in restoring blood glucose. Cer-
tain foods raise blood glucose concentrations and promote glycogen syn-
thesis better than others. The term Glycemic Index is used to describe (and
rank) how high a particular food will raise blood glucose; foods with a high
glycemic index (GI) are the most effective for restoring glycogen. As shown
in the graph, a high GI food produces a “spike” in blood glucose, whereas a
Blood Glucose (mM)
low GI food takes a longer time to peak. Immediately after a mission, foods
and beverages that have a moderate to high GI should be consumed. During
recovery and maintenance, foods with a low GI are preferred.
Click here for a list of foods according to their GI.
Click here for more information on the Glycemic Index.
Rehydration
Fluid requirements can vary from 2–16 liters/day depending on:
t Workload.
t Level of heat stress.
t Sweat rates.
Sweat loss varies depending on age, training, and acclimation status,
exercise intensity and duration, air temperature, humidity, wind velocity,
cloud cover, clothing, and individual sweat rates.
The adequate fluid intake for men between 19–50 years of age is 13
cups/day. On average, 20–25% of the fluid comes from food and 75–80%
from beverages. Plain water, coffee, tea, soups, fruits, and vegetables also
provide fluids and support hydration. A small amount of caffeine in tea
or coffee (< 200 mg) should not negatively affect hydration status, but if
more caffeine is taken in, fluid balance may be negatively affected.
Click for the caffeine content of various products.
For each liter of sweat lost, a loss between 115–690 mg of sodium is
possible in a well-conditioned warrior. If unaccustomed to working in the
heat, heavy sweaters can lose as much as 2,500–5,000 mg of sodium per
liter of sweat! To individualize fluid and electrolyte recommendations:
t Record weight before and after exercise to determine how much fluid
should be replaced.
39
t Consume 2.5–3 cups of fluid for every pound lost.

Typically, voluntary consumption of fluids will restore only part of the
fluid lost. Whenever possible, weigh yourself before and after a training so
you can quantify your fluid loss. Your sweat rate during a mission will dif-
fer based on the environmental conditions, and this could intensify weight
loss. To determine how much fluid you may lose during a strenuous mis- After a training session
sion in 64˚F versus 82˚F or 18˚C versus 28˚C, click here. or mission, fluid
Over a period of several hours, you should ingest more water and so- ingestion is essential.
dium than initially lost. The total replacement volume should be between
125% and 150% of the decrease in body mass. So, if you lost 4 pounds,
you would want to take in 5–6 “pounds,” or 10–12 cups of water. The fluid Drink at least two
must be taken in over a period of time rather than at one time. Ingest-
8 oz cups of fluid every
ing 8–16 ounces every 20–30 minutes will allow for water absorption and
minimizes water lost by urination. Do not drink more than 48 oz or 1.5 L
20-30 minutes for two and
per hour. a half hours after exercise.
Fluid replacement beverages used during exercise are also appropriate
for rehydration. Rehydration beverages containing a higher percentage of
CHO than used during exercise are suitable, but it is better to obtain CHO
from real foods. Oral Rehydration Solutions (ORS) available through the
military medical supply channels can be used, but they are often higher in
sodium and lower in CHO than desired.
Rehydration in the Field

A drink that will rapidly promote rehydration, is almost palatable, and
contains an acceptable amount of electrolytes (although barely enough
potassium) can be made in the field. The fluid is prepared by mixing ¼
strength of a fluid replacement beverage (Gatorade, Powerade, Gookinade
or the like) with ¼ strength of a standard ORS. However, this drink will not
restore glycogen because it is too low in CHO.
Sodium/Electrolyte Replacement
Sodium and potassium losses in the sweat can be quite high during
prolonged physical activity, especially in warm weather. Replacing these
elements is an important part of the recovery process. Most commercially
available fluid replacement beverages contain electrolytes. Roughly, 1–2
grams of sodium/L of fluid (0.25 teaspoon/quart) will effectively replace
the sodium lost during exercise or a mission. Also, sodium is widely pres- Each one quart of fluid
ent in a variety of foods and fluids, such as bagels, pretzels, tomato juice, should contain about one
sport drinks, and pizza. quarter teaspoon of salt.
A bit of salt will speed up rehydration more effectively than plain water.
Typical commercial fluid replacement beverages contain both sodium and
potassium, but recovery foods should also include foods rich in potassium.
Some excellent food sources of potassium are listed to the left. You will
40
Table 5–3. Good Potassium Sources
notice that these foods are also good sources of CHO and most have a
Foods Beverages
moderate to high GI.
Banana Orange juice

Sports Drinks
Apricots, dried Tomato juice Fluids providing CHO and the electrolytes, sodium and potassium, have
been shown to sustain athletic performance. The genesis of sports nutri-
Orange Pineapple juice tion came about when beverages were created so that CHO, electrolytes,
and fluids could be consumed without having to mix, assemble or com-
Baked potato Grapefruit bine ingredients. The purposes of sports drinks are to:
juice
t Maintain hydration during exercise.
Melons Skim milk t Ensure rehydration after exercise.
t Replace electrolytes lost during sweating.

Yogurt Sports drink
t Supplement CHO stores and provide fuel for the working muscles
Note: 1 cup of orange juice or during exercise.
tomato juice will replace the po-
tassium, calcium and magnesium t Minimize muscle from strenuous workouts.
lost in 3 quarts of sweat.
t Protect the immune system.
Although sports drinks containing electrolytes will enhance endurance

performance, many people use these drinks as a recreational fluid. This
only adds calories, artificial coloring and flavors to their dietary intake.
Sports drinks are recommended when exercise is longer than 60 minutes
and then, only 8 oz should be ingested every 15 minutes. For activities
less than one hour, water is the best choice for hydration needs. Minimal
sodium and potassium are lost through sweat and glycogen stores will not
be depleted during short, low intensity workouts.
General rules for fluid replacement:
t If you are sweating profusely, try to consume fluids at the rate lost (not
to exceed 1.5 L/hour) or as much as tolerated if sweat rate is exceed-
Drinking sports drinks ing the rate of stomach emptying.
as recreational fluids
t Develop a plan for fluid consumption and practice it during training
only adds calories, and
and operations.
artificial coloring and
flavors to the diet. t Sip frequently rather than gulp on occasion; drinking small amounts of
fluids at a time are more effective than large amounts only occasionally.
t Start drinking before thirst kicks in.

41
The ideal CHO/electrolyte drink:

t Is not carbonated. To avoid gastrointestinal
t Empties rapidly from the digestive tract.
distress when fluid losses
are high (> 4L), beverages
t Tastes good.
should be diluted with
t Provides energy for exercise > 1 hr. water to half of their
t Delivers 9–19 grams of CHO per 8 oz. original strength.
t Contains sodium and potassium.
t Does not cause digestion problems.
t Is cool (10 to 15°C).
Sports drinks should be used during and after long bouts of exercise
in hot and humid conditions. However, if real food and 100% fruit juices
are available after exercise, these high CHO foods are the best electrolyte
choices. Sodium is still important to take after exercise as it helps increase
the desire to drink fluids and improves fluid retention.
Recovery and Commercial-Off-The-Shelf-Products (COTS)

Many Commercial-Off-The-Shelf (COTS) products are used for recov-
ery. In addition, sport drinks, sports bars, gels, and other similar products Table 5–4. Suggestions for
are used. Some have many nutrients added, which are usually not needed Selecting Sports Bars
or are provided in excessive amounts. The Nutrition Committee and the
Dietary Supplement Committee within the Department of Defense de- Bars should not provide more
veloped criteria for various COTS categories. The criteria were prepared than 100% of the DRI for vitamins
as guidelines on what products are safe and useful, according to scientific and minerals.
data, because such products are important when real food is not available.
Bars should be used with water,
The criteria for sports bars and gels are provided below.
not sports drinks, to prevent over-
loading on CHO.
Sports Bars
Sports bars originated in the early 1980s when it was shown that ul- Bars should be high in CHO, and
tramarathoners and other endurance athletes did better when provided low in fat and protein.
concentrated sources of easily absorbable CHO during long training runs.
Sports bars, in contrast to sport drinks, are solid, so the user must drink Protein should not exceed 1 gram
water to enhance digestion and absorption. to every 4 grams of CHO.
Fat take longer to digest than

Table 5–5. Criteria for COTS Recovery Sports Bars
CHO, so sport bars high in fat
CHO: ≥ 53% of Energy. should be avoided during exercise.
CHO/PRO: ≥ 4:1. High protein bars (40-30-30) should

only be consumed when real food
Fiber: ≥ 1 grams. sources of protein are limited.
42
Table 5–5. Criteria for COTS Recovery Sports Bars
Total Fat: ≤ 30% of Energy.
Saturated Fat: ≤ 20% of Energy.
No trans fats.
Sodium: 50–240 mg.
No substances other than vitamins, minerals, protein and fat.
Table 5–6. COTS Recovery Sports Bars Meeting Criteria
PRODUCTS kcal CHO Protein Fat (%

(g) (g) of kcal)
Bear Valley 420 62 16 25

Pemmican Mealbar
Gatorade Bar 260 46 8 17.0
Soldier Fuel 270 40 10 26.0

(Formerly Hooah)
Odwalla Bars 240 40 6 20.8

(not Super Protein)
PeakBars 244 57 4 <10
Smart Fuel MPN 180 31 8 16.7

Oatmeal WARPBar
PowerBar 230 45 10 10
Performance
The Hooah Bar, now known as “Soldier Fuel,” is an excellent recovery
bar available throughout the military. It must not be mistaken for the old
Hooah bar. In 2004 the manufacturer worked closely with Natick Soldier
Center researchers to refine, reformulate, and improve the original bar for
the military and commercial marketplace. The new bar has been rated
highly by all who have tasted it. The Washington Post rated the bar above
all other sports bars. The reformulated bar contains no trans fats and pro-
vides the requisite amount of CHO and protein for recovery.

43
Sport Gels
Sport gels were developed in the 1990s in response to complaints by endur-
ance athletes that sports bars were too difficult to digest and absorb when used
during exercise. Gels have become increasingly popular for long workouts as
they help maintain blood glucose and fuel the tank. However, drinking fluids is
essential when using gels. Gels are popular with SOF because they are:
t An absorbable form of CHO, which makes eating on the go easy.
t Lightweight (1 oz) and easy to pack for many long and enduring opera-
tions lasting more than 90 minutes.
Gels may be useful after exercise for glycogen repletion when real foods are
not available, but are unnecessary for short workouts, regardless of intensity.
Potential Problems with Gels

Gels are virtually 100% CHO, so it is easy to take in too much, which will
lead to GI issues, such as diarrhea. Gels should be tested before combat
situations to see which one works best. After over an hour of exercise,
1–2 packets are recommended, but they should be used with water, rather
than sports drinks to prevent CHO overload. Listed below are the criteria
for gels and various products that meet the criteria.
Table 5–7. Criteria for Commercial Off-The-Shelf Sport Gels
CHO to Protein Ratio: ≥ 4:1 ratio if any protein.
Sodium: ≤ 3 mg/g weight.
Energy: ≤ 3 kcal/g weight.
No substances other than CHO, electrolytes, protein, and caffeine.
Table 5–8. COTS Sport Gels Meeting Criteria
Products kcal/100g CHOg/100g CHO:Pro Sodium
≥4 mg/g
Carb-BOOM! 268 66 - 1.2
Pro-Boom 170 30 - 2
Hammer Gel 253 64 - 0.6
Lava Gel 294 74 - 0.7
Clif Shot Gel 300 71 - 1.2

44
These CHO-rich supplements are used more often than needed because
they are convenient, easy to use, and provide readily absorbable energy.
It is both healthier Many athletes habitually eat sports foods instead of wholesome meals,
and cheaper to even though sports products cost more than other foods. Sports drinks
use real foods. cost more than water, sports bars cost more than Fig Newtons, and sports
gels cost more than honey.
The right combination of fluids, carbohydrates, proteins and fats in a

timely manner will provide the nutritional optimization required for strenu-
ous activities and high impact missions. The body is the vehicle that allows
operators to do what they have been trained to do and it must be fed the
same way as any vehicle requiring high-octane fuel. The strategies in this
chapter will, in the long run, greatly benefit the mission and the operator.
“Who would have thought just eating

breakfast would make the difference.”
Sean Morrison, SO1, USN
6 Optimal Choices
In This Chapter
Make the Most of
Meals at Home
for Home Chow
Grocery Shopping
Recipe Modification
Decoding Nutrition Labels Key Points

Breakfast t Foods eaten at home can impact mission performance.
Lunch t Smart shopping is the first step towards healthy meal preparation.
Dinner t Most recipes can be modified to improve nutrient composition.
Fruits and Vegetables t Use nutrition labels as a guide for making smart food choices.
t Every meal is important for overall health and performance.
t Aim for as many servings of fruits and vegetables as possible.
T
he foods and beverages consumed at home can impact mission per-
formance. Since missions and deployments may come up suddenly,
being ready to go at a moments notice is crucial. That translates into
being healthy at all times! Good nutritional habits will help achieve
health and better performance. This chapter provides basic information on
how to eat well at home and how to avoid some of the consequences of
frequently eating at fast food places.
Make the Most of Meals At Home

As families are occupied with their children’s activities, taking classes
in the evening, and other activities away from home, the family dinner has
become an endangered activity. Only about one third of families eat din-
ner together each evening. Yet, children who eat seven or more meals a
week with their families have fewer problems in school, are less depressed,
and less likely to smoke cigarettes, drink alcohol, or use marijuana. Parents
have a great opportunity and responsibility to be role models for good eat-
ing habits and provide children with nutritious meals.
Want to save money and keep off weight? Home-prepared meals are
healthier and less costly than restaurant meals. According to numerous
sources, home-prepared meals are higher in many nutrients (fiber, calcium,
folate, iron, vitamins B6, B12, C, and E), and generally lower in saturated
and trans fats. Also, less fried foods and fewer soft drinks are consumed
when meals are eaten at home. All meals should be planned around the
46
five food groups and provide foods from at least three food groups (a grain,
vegetable and/or fruit, and meat and/or dairy) to ensure nutrient require-
ments are being met.
A balanced meal
Click for more information on nutrition and eating at home.
includes foods from at
least 3 food groups. Click for 3 days of sample menus.
Grocery Shopping
Foods prepared at home can taste good and also be healthy and nu-
tritious. Healthy meals start with healthy ingredients. Commissaries and
grocery stores offer a wide variety of foods that can be the building blocks
for a healthy and nutritious meal. The key is to know which foods are the
most nutritious and can best fuel the body. The list below can help guide
selections while at the grocery store.
10 Tips for Grocery Shopping
1 Plan ahead by using a shopping list.
2 Shop the perimeter of the store to include all food groups.
3 Buy a colorful array of fresh fruits and vegetables.
4 Buy whole grains with good sources of dietary fiber.
5 Buy fat-free or low-fat dairy products.
6 Buy lean protein sources.
7 Consider meat alternatives, such as beans, nuts, grains and

soy products.
=Click here for more details
on the 10 Tips for 8 Buy heart healthy fats such as olive and canola oils.
Grocery Shopping.
9 Choose beverages that do not contain corn syrup and sugar.
10 Choose comfort foods with discretion by reviewing

Nutrition Labels.
Recipe Modification
A number of cookbooks and online recipe sites are devoted to healthy
cooking. In addition, most recipes can be modified to decrease calories,
fat, sugar, and sodium, and increase fiber.
47
Modifying a recipe to be healthier does not have to be complicated.

Some changes can be made by substituting ingredients or changing the
cooking technique. Table 6–1 provides some Sensible Substitutions on
how to reduce total fat, calories, sodium, and sugar, and increase fiber, in = Click here for more recipe
recipes. The links in the left margin lead to a more extensive list of recipe modification techniques.
modification techniques.
= Click here for helpful
Table 6–1. Sensible Substitutions a substitution list.
When a recipe calls for: Try this instead:

= Click here for a look at
Cream, 1 cup Evaporated skim milk, 1 cup easy to cook recipes from
Cooking Light Magazine.
White rice Brown rice, bulgur, kasha, quinoa, or
whole wheat couscous
= Click here for a look at easy
Butter/margarine, ½ cup Applesauce (or prune puree), ¼ cup + to cook recipes from the
canola oil, butter or margarine, ¼ cup American Diabetes
Association.
Egg, 1 Egg whites, 2, or liquid egg substitute,
¼ cup
All-purpose flour, 1 cup All-purpose flour, ½ cup + whole

wheat flour, ½ cup
Pasta Whole wheat pasta
Evaporated milk Evaporated skim (fat-free) milk
Chocolate chips, 1 cup Mini chocolate chips, ½ cup
Cheese, regular Low-fat or fat-free cheese
Bacon Lean Canadian bacon or ham
Broth Low-sodium broth
Sour cream Non-fat plain yogurt, 1 cup + 2 Tbsp

lemon juice + 1 Tbsp skim milk
Frying in fat Bake, broil, grill, poach, or stir fry
Decoding Nutrition Labels

Food labels are a valuable source of nutrition information at the gro-
cery store. However, they can be quite intimidating if you don’t know how
to read them. In a recent study, researchers discovered that though most
participants felt confident they understood nutritional labels and could use
48
Sample label for
Macaroni & Cheese.
them to make healthy choices, only 37% of participants could correctly
calculate the total grams of carbohydrate in a 20 oz soda.
The section below shows how to navigate around a food label to determine
whether the food is a healthy choice. When shopping for groceries, the labels
of food should be read and compared to determine which is healthiest.

Ingredient List

By federal regulation, any food made with more than one ingredient
must carry an ingredient list on the label. The ingredients are listed in
descending order according to weight, so the first ingredient is found in
the largest amount.
Serving Size
The place to start when looking at the Nutrition Facts label is the serv-
ing size. It indicates a normal portion and how many servings are in the
package. Always compare the label serving size with the amount that is
actually eaten.
% Daily Value (DV)

Start here. Briefly discussed in Chapter 4, Percent of Daily Values appears on the
label of most foods. It represents how much one serving contributes nu-
Check calories. tritionally to a 2,000-calorie-a-day diet. For example, a food is defined as
Limit these nutrients. “healthy” if it provides at least 10% of one or more of vitamins A or C,
iron, calcium, protein, or fiber. A DV of 20% or more is considered high;
Get enough of these try to aim high for vitamins, minerals and fiber.
nutrients.
Footnote. Points to Consider:

Quick guide to % DV: t Depending on age, gender, and activity level, more or less than 2,000
5% or less is low.
kcal a day may be needed; so more or less than 100% DV may be
20% or more is high.
required. Most SOF require at least 3,000 kcal/day, so 150% DV is
needed.
t When energy requirements are unknown, the % DV offers a good refer-
ence point. If a food item lists 50% DV for cholesterol, a serving of this
food provides 50% of the daily cholesterol needs for the 2,000 calorie diet.
t A DV of 5% or less is considered low; try to aim for low in total fat,
= Click here for more saturated fat, and cholesterol.
information on
nutrition labels. Daily Values Footnote
This reference chart applies to healthy people requiring 2,000–2,500
calories daily, and shows daily maximum amounts for total fat, saturated
fat, cholesterol, and sodium. Remember, these numbers may not be exact
for you as you may require more or less calories daily.
49
Descriptors—Nutrient Content
Terminology on products is important for consumers to know and un-
derstand. Click here to view terms that may appear on product packaging;
these terms are regulated by FDA labeling criteria.
Breakfast: Off to a Healthy Start!

Forty years of breakfast-related studies have shown that jump-starting
the day with breakfast is beneficial. Despite its benefits, breakfast may
be the meal most often neglected or skipped. If a car can’t run without
fuel, how can a body? Breakfast is the body’s early-morning refueling stop.
After 8–12 hours without food, the body needs glucose (also known as
blood sugar). A bowl of cereal with low-fat milk, toasted whole grain
breads, and a piece of fresh fruit are easy, quick, and nutrient-dense selec-
tions that can be eaten at home.
Breakfast eaters are likely to have more

strength and endurance, favorable body
weight, and better concentration and problem-
solving ability than non-breakfast eaters.
Lunch: How to Make the Grade

A sure way to eat a nutritious lunch is by bringing it from home. Week-
day brown bagging also saves you money. More importantly, you have
control over what and how much is eaten and, how the food is prepared.
Many non-traditional lunches can be made at home by selecting foods and
beverages from the shopping tips offered in the commissary. Some useful
ideas include:
t Vegetables: Pack them raw or lightly steamed (then chilled) with
a small container of dip or salad dressing.
t Hummus: Use as a dip or a sandwich spread.
t Stuffed Tomatoes or Bell Peppers: Add tuna, chicken, egg, pasta,
or rice.
t Salads: Don’t forget salads along with sandwiches.
t Sushi Rolls: A terrific lunchbox fare.
t Trail Mix: Make a trail mix with raisins or other dried fruit combined
with a whole-grain cereal or air-popped popcorn.
50
t Fruit: Grab several pieces of fruit to go and try some with low-fat yogurt.
Lunch is a great time to eat fruits and vegetables. Both fresh fruits and
vegetables are nutrient packed, satisfying foods that will replenish glyco-
gen, and help with hydration.
Click for Tips on Brown Bagging Ideas.
Dinner: Fueling for the Night

Dinner should not be the largest meal of the day. However, food records
provided by SOF indicate that most calories consumed, especially during
the workweek, occur in the evening hours. This is because other meals and
snacks have not been consistently eaten throughout the day. Lack of time
preparing for dinner and poor planning are also issues. Although planning
takes time, and shopping for foods is a must, many nutritious meals can
be prepared ahead of time or within 30 minutes after getting home. The
following are quick dinner strategies:
t Buy pre-cooked meats to heat in the microwave.
t Use meats and fish in vacuum bags with pasta or rice.
t Use bagged lettuce, baby carrots, and spinach.
t Mix canned chili beans with diced tomatoes and precooked chicken.
t Use canned fruit in natural juices with chocolate syrup as a dessert.
t Prepare a double batch and freeze half for another meal.
Other examples of easy, yet nutritious, dinner ideas include:
t Whole grain pasta or rice with lean meat/fish and vegetables.
t Whole grain rice and beans with salsa.
t Sirloin steak, baked potato, and salad.
t Salmon, sweet potato, and vegetables.
t Pizza with Canadian bacon and vegetables.
t Caesar salad with chicken and garlic toast.
t Sandwiches made with whole grain bread, lean meat, lettuce, and
tomato (grain, meat and vegetable groups).
Cooking foods, such as rice, pasta, and other grains, in large quantities
can provide the staples for quick meal planning throughout the week. Add-
ing lean meats and vegetables to the grill are other ways to end the day
with a nutritious meal before bedtime.
51
Table 6–2. Reasons to Eat A
Fruits and Vegetables—More Matters Variety of Fruits and Vegetables
Each Day
Current evidence shows that diets rich in fruits and vegetables are as-
sociated with improved health, reduced risk of chronic diseases, and some
types of cancer. Fruits and vegetables are high in fiber and water, and low Packed with vitamins
and minerals.
in calories. The term “nutrient density” has been used several times, and
another important term is “energy density.” The relationship between the
number of calories in a food and the weight or volume of the food is called
“energy density.” Although people have difficulty limiting the amount of
Reduces the risk of
calories they eat, most seem to be able to limit the volume, due to satiety, heart disease, stroke,
or the feeling of fullness. Fruits and vegetables provide good substitutes for and some cancers.
energy-dense foods, and provide satiety with fewer calories. Eating several
servings of fruits and vegetables will aid in weight management and pro-
vide the nutrients required for good health and disease prevention.
Calcium, potassium, fiber, magnesium, and vitamins A, C and E are the

An excellent source of
fiber and antioxidants.
nutrients most lacking in the diet. Fruits and vegetables are rich in these
nutrients, and half of your plate should consist of fruits and vegetables.
It is important to get as many servings of fruit and vegetables a day as

possible to maximize performance and health. According to the latest re-
Helps maintain a
search, men, on average, consume less fruit and vegetables than required healthy weight.
for good health and cancer prevention. For instance, most men consume
less than four servings of fruits and vegetables each day, despite needing
almost twice that amount. Every SOF should consume at least 2.5 cups of
fruit and 4 cups of vegetables. This is not always possible during deploy-
Taste delicious and a
ments, but it is when at home. Eat at least six servings of fruits and veg-
variety to choose from.
etables a day and choose a variety to benefit from the different vitamins,
minerals, and other nutrients each choice offers. Fruits and vegetables
are the super foods that will promote health and performance, maintain
weight, and provide fluid for hydration, as just a few of the benefits.
A 25-year old male exercising more than

1 hour per day needs 2.5 cups of fruit
and 4 cups of vegetables every day.
Click to determine how much fruit and vegetables you need each day.
7 Optimal Choices
for Eating Out
In This Chapter
Choosing a Nutritious Meal
Fruit and Vegetables Key Points

When Eating Out t Not all restaurants are equal. Choose the restaurant wisely.
Fast Food t Eating out can be healthy if careful meal selections are made.
t Selecting fruits and vegetables as a part of the meal adds vitamins,
minerals and fiber, and helps reduce fat and calories.
t Fast food restaurants have healthy alternatives to the high-fat burger
and fries. Make sensible food choices.
T
he trend toward eating more meals away from home reflects a grow-
ing demand for convenience, entertainment, and a variety of eth-
nically diverse foods. Active schedules, training requirements, and
deployments make eating a majority of meals away from home
appealing—it is simpler than cooking at home. Americans eat at least one-
third of their calories away from home. To maximize mental agility, stam-
ina, and health, healthy food and beverage selections are critical when
eating out at fast food places, dining facilities, restaurants, social events, or
when traveling. This chapter will present information on how to maintain
a high-performance diet when eating away from home.

On average, many foods prepared and eaten out tend to be less nutri-
ent dense and have more calories than foods prepared at home. However,
restaurant and fast food meals do not have to be unhealthy. By being in-
formed and by asking appropriate questions, the guidelines of a healthy
diet can be maintained and the benefits of eating out can be enjoyed. The
good news is that when you don’t want to cook, are too busy, or just want
to enjoy a dining out experience, it is possible to eat healthy. Some sugges-
tions on how to choose a restaurant include:
t Plan ahead: Select a restaurant where food is cooked to order rather
than where the food is made ahead of time.
t Avoid places with dessert carts and all-you-can-eat or buffet-only specials.
53
t Try Greek restaurants that serve Mediterranean-type meals.

t Choose healthy ethnic foods from Chinese, Japanese, Thai, Indian,
Italian, French, and Middle Eastern eateries.
t Skip the hot dogs and pizza and search for fast food places that offer
healthy options such as fruit, yogurt, soup, sushi, salads, sandwiches,
or wraps.
t Look for a place that offers menus with nutrition information.
t Find a place to eat before you’re starving or you will tend to choose
quickly. Plan ahead and give yourself time to choose. If you are very
hungry, buy an apple or other healthy snack to tide you over.
Choosing a Nutritious Meal

Once at your restaurant of choice, read the menu carefully to select a
high carbohydrate, nutrient dense meal. The following menu strategies are
usually available in most restaurants. Select a hearty meal that fits into your
nutrition plan. The following guidance will assist with meal selections.
Appetizers
Appetizers are tasty but they cause mindless nibbling, which adds fat
and calories. If you’re starving, have the bread but skip the butter. Have
the waiter remove the bowl of chips or peanuts, or the basket of bread,
after you’ve had a small portion. Select an appetizer that is neither fried
nor covered with cheese.
Soups can be a great appetizer or entrée.

Many soups are low in calories and will help fill you up and satisfy your
hunger. Select a broth or other light soup, such as a vegetable soup. Avoid
cream soups which are high in fat.
Salads are more than just rabbit food.

Fresh vegetable salads are great, but ask for a balsamic vinaigrette, a
fat-free, or a reduced-calorie salad dressing on the side to control how
much or how little you add.
If a salad bar is included in the meal, avoid cheese, croutons, fried or
crispy meat, bacon bits, potato and Caesar salads, creamed pastas, and
coleslaw. In other words, keep it simple. Fill the plate with lettuce, spinach,
other greens, and all the colorful vegetables. Add juicy red tomatoes, bright
orange shaved carrots, green peas, yellow and red bell peppers, dark green
broccoli, white cauliflower, crispy cucumbers, and other vegetables to turn
your greens into a fiesta of colors.
54
Main Meal
The main course, or main meal, can be a healthy affair.
t Choose entrees with fruits and vegetables as key ingredients. Enjoy
the flavors they offer. Fruits and vegetables are a good source of
dietary fiber, as well as a source of many vitamins and minerals. Or,
order a side of fresh, steamed veggies and make it a meal.
t If you want to eat less, order two appetizers, or an appetizer and a
salad, or soup and ½ sandwich as your meal. Ensure you are ordering
the low-fat options. Or, if portions at the restaurant are large, split one
meal with your dinner partner.
Meat/Fish
A reasonable portion of steak or other meat is 3–6 oz. Meat portions
should be about the size of a deck of cards, not the size of your plate. Pass
on gravies or heavy sauces, which add a significant amount of fat. Season
your meat with pepper, chunky salsa, or herbs.
t Chicken can be great if it is not fried or consumed with its skin.
t Pork, “the other white meat,” is good, but can be fatty. Skip the ribs
and go for a ham steak instead.
t Select healthy food preparations. Ask that the meat or fish be steamed,
poached, broiled, baked, grilled, or roasted instead of deep-fried or
prepared in butter or oil.
Starches/Carbohydrates
Several tips for ordering carbohydrates:
t Order a baked potato (without the sour cream and butter) or plain
rice—not fried rice. Avoid onion rings, other fried vegetables and au
gratin or Delmonico potatoes.
t Order pasta with marinara (tomato-based sauce), not cream sauce.
t Ask for salsa or chives with a baked potato instead of high-fat sour
cream, butter, cheese, or bacon. They are very low in calories and a
healthy alternative with a lot of flavor.
t Choose whole-grain bread and dishes made with brown rice.
t Beans, while usually a good choice, may have been prepared with
unhealthy lard. Ask your server how they are prepared.
Vegetables
Order two servings of steamed vegetables when possible. Stay away
from cheesy and battered, deep-fried vegetables or those prepared in oil
or butter. Grilled vegetables are a great option.
55
Other Main Courses
Casseroles
Casseroles are tasty but can be very high in fat and calories. Avoid cas-
seroles and foods with heavy cream or cheese sauces. Pot pies are primar-
ily high-fat gravy with little meat or vegetables.
Pastas
When ordering pasta dishes, look for tomato-based sauces (marinara)
rather than cream-based sauces. Tomato-based sauces are much lower in
fat and calories. In addition, the tomato sauce can count as a vegetable:
a win-win situation. To help fill you up, order an extra serving of steamed
vegetables to mix with your pasta. If you add meat, select grilled chicken
or salmon instead of the sausage. Add a small amount of grated Parmesan
cheese for additional flavor.
Sandwiches
Sometimes you aren’t hungry or don’t have time for a long sit-down
meal. In that case, a sandwich is a great alternative. Here are some helpful
tips about ordering a healthy sandwich:
t Select sandwiches on whole wheat, pita, multi-grain breads. Choose

low-fat deli meats and cheeses, mustard, relish, ketchup, or low-fat
mayonnaise. Add flavor and vitamins with roasted sweet peppers,
lettuce, tomato, jalapenos, and chopped olives (small amount).
t Order sandwiches with mustard rather than mayonnaise or “special

sauce.” Mustard adds zing with virtually no calories.
Beverages
It is important to stay adequately hydrated, but an easy way to gain
weight is by drinking sodas, alcohol, and milk, which only add unneces-
sary, empty calories. With or in between meals, select water, diluted fruit
juice, skim or low-fat milk, or unsweetened tea or coffee. Energy drinks,
CHO-electrolyte beverages, sweetened tea, and juice drinks can promote
weight gain.
If wine is desired, have one glass with the

main dish. Drink water with a wedge of
lemon while waiting for the main entree.
56
Drink only one glass of wine very slowly. Take time to enjoy the taste
by sipping it slowly rather than just consuming it.
Dessert
Try an herbal tea or decaffeinated coffee. If you can’t resist dessert, or-
der sorbet, fresh berries or fruit, sorbet, frozen yogurt, or ice milk. Angel
food cake with strawberries, plain Jell-O, or poached fruit is a refreshing
dessert. If you want something outrageous, split it with your dining partner
or eat half only.
Share a dessert with a friend.

Half the dessert equals half the calories.
Other Helpful Tips:

t Stop eating when you are full—your body gives you satiety clues.
t Eat slowly and take time to taste and savor the food. Enjoy your dinner
conversation.
t Remember not to deprive yourself of foods you love. All foods can fit
into a well-balanced diet. Small portions are the key.
t Ask how an appealing dish is prepared and request healthy substitu-
tions (baked instead of fried, olive oil instead of butter).
t Ask for a “doggie bag” up front and set aside half of your meal prior
to eating. This will help ensure that you will not overeat. You will have
another meal of your leftovers the next day.
t Try to avoid dishes described as au gratin, buttered, buttery, creamed,
crispy, escalloped, fried, hash, hollandaise, in cheese sauce, in cream
sauce, in gravy, pan-fried, pot pie, rich, sautéed, stewed, and with ba-
con or sausage.
Fruit and Vegetables When Eating Out

Remember, when it comes to fruit and vegetables, more matters.
Order these items when eating out:
t Select 100% fruit or vegetable juices for breakfast, lunch, dinner,
or a snack.
t Order a fruit cup for breakfast to get a good day’s start.
t Make a lunch meal out of vegetable soup and a side salad.
57
t Order sandwiches or wraps that include vegetables, such as lettuce,

tomato, sprouts, green pepper, cucumber, or other raw vegetables.
t Select an apple, orange, or banana—perfect fast food when on the run.
Table 7–1. Do’s and Don’ts of Ordering When Eating Out
Do’s Don’ts
100% fruit juice. Juice (many juices have

corn syrup).
Fresh fruit or fresh fruit cup. Fruit in syrup.
Steamed vegetables. Fried vegetables or cooked

in butter.
Wraps and burritos without Hoagie or sub roll with mayo.

mayo.
Extra vegetables or any French fries, fried vegetables,

vegetable combination. salads with lots of creamy
dressing.
Vegetable pizza “Meat lover’s” pizza.

(with > 3 veggies).
Baked potato or sweet potato. French fries or potato salad.
Salad bar. Skip the lettuce and go straight

for the mayonnaise pastas.
Fresh fruit with low-fat Tarts, cheese cake, Danishes,

whipped cream. and other pastries.
Fast Foods
Fast foods are a way of life!
Selecting fast food items that will meet your nutrient requirements and
match your activity patterns and performance demands is possible at fast
food restaurants. Fast foods can provide the protein, carbohydrate, and
58
adequate vitamins and minerals, but it takes careful planning. The carbo-
hydrate, protein, and fat (CPF) distribution of typical fast food meals is
illustrated. Often 40%–60% of the calories are from fat. Also, most menu
items are very high in sodium, which can contribute to high blood pres-
sure, and dietary fiber is usually lacking or quite low. Americans consume
about half the recommended daily amount of fiber.
Suggestions for Choosing Fast Foods

t Look for meals that provide 800–900 calories, have < 30 grams of fat
and < 1,000 milligrams of sodium.
t Select regular size portions and avoid jumbo-, giant-, deluxe-, and
super-sized options.
t Balance a fast food meal with the rest of the day’s dietary intake.
t Order a single burger without special toppings and sauces.
t Avoid chicken and fish that are breaded and fried.
t Select cheese or vegetarian pizzas. Avoid extra cheese, pepperoni and

sausage since they contribute additional fat.
Table 7–2. Substitutions at Fast Food Restaurants
Skip This Try Instead Calories Saved
Double cheeseburger Cheeseburger 280
Super fries Small fries 330
Burrito supreme Soft chicken taco 209
Stuffed potato Baked potato, plain 348
Pepperoni lovers pizza Cheese pizza, 174

2 slices
Large regular soda Spritzer water 310
Breaded chicken sandwich Grilled chicken 205
Click for sample breakfasts, lunches, and dinners that would be considered
nutritionally adequate, in terms of CHO, protein and fat (CPF) content;
however, they are all high in sodium.
Click to obtain the nutrient content of most fast foods.

59
Fast Foods and the Web

Many fast-food restaurants have their menus on the web—here are a
few to check out.
t Taco Bell:
http://www.yum.com/nutrition/menu.asp
t Kentucky Fried Chicken:
http://www.kfc.com/nutrition/zerotransfat.asp
t McDonalds:
http://www.mcdonalds.com/usa/eat/nutrition_info.html
t Pizza Hut:
http://www.pizzahut.com/Nutrition.aspx
t Subway:
http://www.subway.com/subwayroot/MenuNutrition/index.aspx
t Dunkin Donuts:
http://www.dunkindonuts.com/aboutus/nutrition/
t Starbucks:
http://www.starbucks.com/retail/nutrition_info.asp
t Arby’s:
http://www.arbys.com/nutrition/
t Chick-Fil-A:
http://www.chick-fil-a.com/Nutrition.asp
t Domino’s:
www.dominos.com/PublicEN/Site+Content/Primary/See+the+Menu
t Wendy’s:
http://www.wendys.com/food/NutritionLanding.jsp
t Burger King:
http://www.bk.com/#menu=3,-1,-1
t Five Guys:
http://www.fiveguys.com/menu.html
t Popeyes:
http://www.popeyes.com/nutrition/pop_nutrition.pdf
8 Healthy Snacking
In This Chapter
Healthy Snacking and
Making the Most of Snacks
The Snacking Environment Key Points

Snacks for Different Occasions
t Snacking, or “eating between regular meals,” is important to help
Occasional Snacking maximize performance and maintain mental and physical acumen.
t Healthy snacks can help increase energy and alertness without

promoting weight gain.
t Keep nutrient dense snacks at home, work, or “on the go.”
t Snacks for night operations should include foods low in carbohydrate

and high in protein.
t Snacks high in water, such as fruit, are great for warm weather operations.
t Snacks high in carbohydrate are good to consume when exercising

in the cold.
t Avoid high-fat snacks during special operations.
E
nergy expenditure can be extremely high on given days and during
various operations, and it is often difficult to eat enough at meals.
Snacking becomes very important during these times and may help
maintain performance and mental acuity. In addition, most of us snack
at various times during the day and evening anyway, so it becomes important
to look at what constitutes healthy snacks.
Healthy Snacking and Making the Most of Snacks

Most people think snacking is unhealthy and leads to weight gain. That
notion, however, has emerged because most people don’t eat healthy
snacks. If you don’t care about gaining weight, just about any snack will
do; but if you want to maintain weight and perform well, then your selec-
tion of snacks is critical.
Carefully chosen, snacks can fill nutritional gaps and boost energy with-
out causing weight gain. Think through a typical day. How often and where
do you usually snack? Are the snacks you choose high in nutrients or load-
61
ed with “empty” calories? If you aren’t sure, some tips to help promote
healthy snacking follow.
= More information Snacking Tips

on snack attacks. t Plan snacks ahead of time.
t To stave off hunger longer, pick snacks with protein and a
heart-healthy fat.
t Match snacks to activity level.
t Choose fresh fruit for a sweet snack rather than candy or cookies.
t Be conscious of portion sizes.
t If possible, do not snack in front of the TV or computer; it is too easy
to overeat.
t Avoid all-day nibbling.
t Choose a snack that provides dietary fiber as well as other nutrients
(unless the snack is for a mission).
Click here for a few ideas to start planning healthy and nutritious snacks.
The Snacking Environment

Satisfy the “snack tooth” urge with these convenient and healthy choices.
Home
Stock the fridge and freezer with:

t Low-fat varieties of yogurt, cottage cheese, cheese, milk
and frozen yogurt.
t Lean deli meats.
t Whole fruits and cut-up raw veggies.
t 100% fruit and vegetable juices, and frozen juice bars.
Stock up on microwave snacks:

t Single serving soups.
t Whole wheat pita bread or English muffins with tomato sauce,
Italian herbs and low-fat cheese for instant pizza.
t Fat-free refried beans and/or salsa with whole wheat tortillas or
baked chips.
t Low-fat cheddar cheese and a leftover baked potato or plain sweet potato.
62
Work
Stash snacks at work

Good snacks should be kept at work in case of late or long work days
or when are unable to pack a snack from home. Things to keep at work
may include:
t Vegetable or bean soups in heat-and-serve cans or instant dry soup cups.
t Snack-size cereal boxes; instant oatmeal packets; boxes of raisins or
other dried fruit, or whole-grain pretzels.
t Mini cans or pouches of water-packed tuna or chicken.
t A jar of natural peanut or almond butter with whole grain crackers or
rice cakes.
t Beef jerky.
t Single-serve fruit cups packed in light syrup or water.
t Dry roasted, unsalted nuts.
t Low-fat granola bars.
t Canned or boxed 100% fruit juice.
t Packages of low-fat microwave popping popcorn.
t Graham crackers.
t Raisin-nut mixes.
Find vending machines with food-group snacks:

t Peanuts, raisins, trail mix.
t Low-fat granola bars.
t Whole fruit.
t 100% fruit juice.
t Low-fat milk or yogurt.
t Pretzels.
When your duty section has the proverbial “snack station:”

If there is a snack station, talk with the POC to see if they can stock
some healthier items. Suggest the following items to include in the snack
station:
t Baked chips.
t Beef jerky.
t Dried fruit or fruit cups packed in water or light syrup.
63
t Mini cans or pouches of tuna packed in water.

t Frozen fruit bars.
t Low-fat yogurt.
t High-fiber cereal or low-fat granola bars.
t Individual snack packs of vegetables or fruit with dip.
t Instant oatmeal packets.
t Roasted, unsalted nuts.
“On the Go”

Choose wisely at convenience stores or malls where the temptation of
high-calorie, high-fat options abound. Choose:
t Bagged pretzels.
t Whole grain bagels with peanut butter or light cream cheese.
t Frozen yogurt or small fruit smoothies (made with real fruit).
t 100% fruit juice.
t Beef jerky.
t Baked chips.
Table 8–1. Possible Night Time t Snack size package of unsalted nuts.
Snacks for Ops
Power Bars/Peanut Toffee/Cool

Mint Chocolate Clif Bar What Foods/Snacks are Best for Different Occasions?
Bagel with Cream Cheese
Operations at Night
Crackers with Hardboiled Egg Foods low in CHO and high in protein are appropriate for night opera-
tions. Avoid foods high in the amino acid “tryptophan,” which is known to
Protein/CHO Beverage “promote” sleep. Choose:
t CHO made with whole grains such as sports bars, bagels, tortilla
Trail Mix
wraps, and pita bread.
Crackers with Peanut Butter t Add protein-rich foods to CHO, like peanut butter, low-fat cream
or Cheese cheese, or mashed canned beans like hummus, refried pinto or black
beans.
Dark Chocolate (semi-sweet)
t Protein/CHO beverages described in the fluids section of Chapter 3.
Hot Tea or Iced Tea t Caffeine-rich foods, yogurts with coffee flavor, caffeine chewing gum,
dark chocolate, and beverages such as coffee and tea.
Coffee
Caffeine always needs to be mentioned, even in the snack food section,
Coffee Flavored Yogurt while on the topic of “staying awake.” Products that contain caffeine, how-
ever, especially manufactured foods, are not required to have the caffeine
64
dosage reported on the food label. Therefore, it is possible to overdose on

caffeine while being unaware of how much has been consumed. For most,
between 200–400 mg of caffeine/day, or 2–3 cups of coffee, is adequate
as a stimulant and should not pose any serious side effects. = Click here for a chart
Click for the caffeine content of various products. on caffeine content
on popular products.
Caffeine is less effective for a person who routinely drinks (much) coffee or
caffeinated beverages, but it will work as a stimulant if consumed infrequently.
Sleep-Enhancing Foods
Foods appropriate for promoting sleep should be high in CHO and con-
tain a small amount of protein. As mentioned above, foods with trypto- Table 8–2. Foods Containing
phan are great “sedative/sleep-enhancing snooze foods.” Table 2 provides Tryptophan–Not Suitable for
a list of foods high in tryptophan: such foods should be eaten when you Night Operations*
are trying to go to sleep, and conversely, avoided on night operations. The
Oats Bananas
foods with the most tryptophan are listed first.
Operations in the Heat Fish (Tuna, Poultry

Halibut, Sar- (Chicken,
Conducting special operations in warm to hot environments require dines, Salmon) Turkey)
foods that provide fluid. Fluid replacement beverages are most useful, but
when fruit is available, the fluid and nutrients contained in these foods are
excellent. Foods that require fluids for digestion and those that naturally Dried Dates Sesame
promote thirst, such as foods high in fat or salt, should be minimized.
Milk, Yogurt Chickpeas
Table 8–3. Snacks to Eat
During Operations in the Heat
Tofu Sunflower
Watermelon Oranges Seeds
Strawberries Fruit Popsicles Cottage Cheese, Pumpkin

Mozzarella seeds
Grapes CHO Beverages with Electrolytes Cheese
Red Meat Peanuts

Operations in the Cold (Hamburger,
Steak)
Operations in cold weather require foods that produce heat. Foods high in
CHO produce more heat during digestion than either fat or protein. Drinking
hot beverages, such as cocoa, coffee, and teas, increases body temperature, Eggs Ham
enhances mental awareness, and provides comfort. Table 8–4 provides sug-
gestions for snacks to eat when the weather is cold.
*Remember: try to also avoid
combinations of these foods (such
Table 8–4. Snacks to Eat During Cold Weather Operations as pizza and ham)!
Granola/Power Bars Fig Newtons

65
Table 8–4. Snacks to Eat During Cold Weather Operations
Hot Chocolate Bagel with Jam
Pretzels Popcorn, Corn Chips or Tortilla Chips
Trail Mix Crackers (any kind)
= Healthful snacks for Sustained Operations

the chip-and-dip crowd.
By definition, sustained operations are those missions or training ses-
sions where work is continuous for over 24 hours with minimal sleep, and
few rest periods. During these times it is important to receive adequate
amounts of CHO as well as fluid. The specific types of snacks will depend
on the environment and how long the work must be sustained. In general,
high-fat foods should be avoided and CHO with some protein should be
eaten. A combination of the recommendations already made would be
best, depending on the environmental conditions.
Table 8–5. Snacks to Eat During Sustained Operations
Granola/Power Bars Oatmeal Cookies
Hot or Cold Protein/CHO Beverage Bagel with Jam
Pretzels Trail Mix
Dried or Fresh Fruit Crackers with Hard Cheese
Occasional Snacking and Discretionary Calories

There comes a time when being healthy is not a goal. Discretionary
calories in snacks are calories used to satisfy hunger and personal food
cravings. The amount of these snacks will depend upon whether weight
maintenance, gain, or loss, is desired. Regardless, it is still wise to be selec-
tive, so if a candy bar or other sweets is essential to well-being, choose one
as high in CHO and as low in fat as possible: peppermint patties, MARS
Chocolate Chip Whole Grain Bar, 3 Musketeers, or gum drops, for ex-
ample. Remember, these foods are not encouraged because they provide
only energy—no vitamins or minerals, which are essential to process the
energy. However, an occasional one will certainly not hurt.
9 Secrets to Keeping Lean
In This Chapter
Fueling the Machine
as a Fighting Machine
Carbohydrates and the
Fighting Machine
Protein Needs
Key Points
t Consumption of carbohydrate (CHO) in defined amounts is the most
Fluid Requirements important fuel strategy for all forms of exercise.
Nutritional Interventions t Depletion of glycogen stores will result in poor performance in the
for Endurance weight room and endurance training sessions, such as a pack run.
t Improper nutrient intake and low muscle glycogen stores may increase
the risk of musculoskeletal injuries.
t CHO ingestion improves the use of amino acids when they are ingest-
ed together.
t Drinking too much plain water can pose performance pitfalls during
prolonged missions/exercise sessions that involve constant movement.
t Individual food preferences should be determined to avoid gastrointes-
tinal distress during training and operations.
S
OF personnel must be in excellent physical condition to endure ar-
duous physical tasks for extended periods. Endurance capacity can
be greatly improved by regular physical conditioning, but it is main-
tained by sound nutritional practices. This chapter will discuss key
dietary nuances to delay fatigue and reduce the risk of injury during and
after training and/or missions. A well-fueled machine will work to its full
capability and capacity; one that is inadequately fueled will not.
Fueling the Machine

Prolonged running, swimming, load carrying and/or multiple short
bouts of high intensity activity, imposes significant demands on energy
stores. The primary source of energy for sustained (and resistance) exer-
cise is carbohydrate (CHO); without adequate CHO, performance goals
cannot be achieved. Failure to consume enough CHO may result in:
t Fatigue.
t Poor performance.
67
t Irritability.
t Poor sleep patterns.
t Musculoskeletal injuries.
Glycogen is composed of many glucose

molecules linked together.
Glycogen (our storage form of CHO) in liver and muscle is the primary
source of glucose/energy for muscles (and brain) during prolonged ac-
tivities. To optimize endurance performance, muscle and liver glycogen
stores must be maintained. The ability to sustain performance will de-
crease markedly when glycogen stores are depleted: Exhaustion is certain
when this happens.
Carbohydrates and the Fighting Machine

Optimizing glycogen stores is a special challenge for SOF personnel
under sustained operations, be it during training or a mission. The most
practical strategy, whenever possible, is to eat small high CHO meals fre-
quently; this also avoids the possible discomfort of large meals. A small
meal is particularly important in the morning, when liver stores may be
low from not having eaten for several hours. Breaking the fast (breakfast)
with a good source of CHO is critical to maintaining blood glucose and
liver and muscle glycogen stores.
CHO is the most important energy-

providing nutrient for endurance training.
The timing and frequency of CHO intake at various times of the day
and training are crucial determinants for optimizing glycogen stores. The
process is cyclical: CHO should be ingested immediately after exercise to
promote muscle and liver glycogen repletion, at various times before ex-
ercise (breakfast), and at multiple intervals throughout the day. Frequent
CHO ingestion will ensure a readily available source of fuel as glycogen
stores become depleted.
68
CHO and Endurance

The figure below illustrates patterns of muscle glycogen depletion over
three days, when exercising two hours per day. Subjects on a low CHO diet
gradually depleted their glycogen stores over the three-day period, where-
as glycogen stores were repleted between training sessions on a high CHO
diet. The need to consume foods high in CHO is clear.
Table 9–1. Ranges of CHO Intake

for Varying Duration of Endur-
ance Training Sessions
Exercise Time Carbohydrate

(hrs/day) (g/lb body weight)
1 2.5–4
2 3–4
3 4–5
4 4–6
Example:
Weight = 175 lbs and training is
one hour each day.
Eat 2.5–6 grams CHO per pound of
body weight daily, depending on the 2.5 x 175 kg = 437 grams of CHO
duration of the training session. 4 x 175 kg = 650 grams of CHO

CHO needs are between 437 and
650 grams per day.
Click here to calculate your CHO needs per day.
Another way to think about CHO needs is in terms of energy intake.

Typically, 50–70% of daily energy intake should come from CHO, and at
a minimum, 400 grams of CHO should be consumed each day to ensure CHO intake over 24
adequate glycogen stores. A diet providing 55% of the daily energy intake hours will typically not
needed will almost always provide 400 grams of CHO. When energy in- exceed 650 grams.
take is greater than 4,000 kcals, energy needs should be met by increasing
fat intake. Recommendations for approximate gram amounts of CHO, pro-
tein, and fat for various energy levels are presented in Table 9–2.
69
Example:
Table 9–2. Approximate Number of Grams of CHO, Protein and Fat for
Train 3 hrs each day and Various Energy Intake Levels During Sustained High-Tempo Operations
take in 3,500 kcal/day
Energy Level CHO (g) Protein (g) Fat (g)
60% of energy from CHO =
(kcal)
3,500 x 0.60 = 2,100
kcal from CHO 3,000 450 120 80
Amount of CHO =
3,500 525 135 100
2,100/4 kcal = 525 grams of CHO
4000 600 150 110
4500 625 165 150
5000 650 180 190
Because each gram of CHO provides 4 kcal, the number of grams of

CHO needed can be easily calculated from energy intake. A list of various
high CHO foods and the grams of CHO provided by each food is provided
in Chapter 5. Complex CHO foods are preferred since they also provide vi-
tamins and minerals in addition to CHO (see Chapter 4). Other important
recommendations include:
Eat high CHO snacks between training

sessions to replenish glycogen stores.
Consume at least 50 grams of CHO with

10–12 grams of protein immediately
after completing a training session.
Fluid replacement beverages and a sports bar are great during recov-
ery from long training sessions because they supply CHO, water, protein,
electrolytes, vitamins and minerals.
Click here for examples of meal replacement beverages and high CHO
sports bars.
Keep a log of all CHO foods eaten for several

days to determine if CHO intake is high enough.
70
Protein Needs
Although protein requirements are higher for endurance training than a
sedentary lifestyle, rarely is SOF personnel lacking in protein. Most diets
provide far more than what is needed.
Maintaining a positive energy balance is more

important than increasing protein intake for both
endurance and resistance exercise training.
Importantly, if protein intake is high, and eaten at the expense of CHO,

glycogen stores may be reduced and performance compromised. Protein
requirements were calculated in Chapter 3 so refer to that chapter for more
information. However, in general:
Protein intakes should range from

0.6–0.9 grams per lb body weight/day.
A number of factors will determine the response of the body to the

ingestion of protein. These include:
t Composition of the ingested protein.
t Metabolic state: exercise or rest.
t Presence of other nutrients.
t Timing of ingestion relative to exercise.
t Interactions among all the factors above.
It is well accepted that the composition of the ingested protein is more
important than the quantity. For example, amino acids (protein) from ani-
mal proteins (e.g., milk) may be superior to plant proteins. After resistance
exercise skeletal muscles take up amino acids from milk proteins (such
as whey and casein) faster than from soy protein. Also, during the resting
state, casein protein appears to produce a stronger “anabolic” environ-
ment than whey protein. This is because the amino acids from casein are
absorbed more slowly so that blood levels are elevated over a long pe-
riod of time. After resistance exercise, muscles take up similar amounts of
amino acids from casein and whey.
Ingesting other energy sources in combination with protein also affects
how rapidly the whole body and skeletal muscles take up amino acids. At
rest, the body seems to retain more amino acids when the protein is con-
71
sumed with CHO. Also, CHO ingestion improves the use of amino acids
when they are ingested together after resistance exercise. Importantly, a
small amount of the essential amino acids together is more effective than
large amounts of protein. The timing of protein ingestion is critical.
Finally, it is unreasonable to give broad recommendations for a par-
ticular amount of protein for SOF given all the important regulating and
interacting factors. However, more is not better.
Click to calculate grams needed of CHO, protein, and fat based on
energy needs.

Currently, the micronutrient requirements for endurance training are not
well defined. Because of the nature of your training, daily overall needs
may be 1.5–3 times greater than the average man. If a healthy diet com-
posed of a variety of different foods that meets your energy requirements
is consumed, daily vitamin and mineral needs should be met (see Chap-
ter 4 for information on food sources of various vitamins and minerals).
Because endurance exercise may increase the need for antioxidants due
to increases in free radical exposure and cellular breakdown, it is recom-
mended that several foods rich in natural antioxidants (vitamin C, vitamin
E and beta carotene) be consumed, as shown in the table below.
Table 9–3. Some Good Food Sources of Selected Antioxidant Nutrients
Vitamin C Vitamin E Carotenoids
Orange juice Sunflower seeds Carrots
Grapefruit juice Wheat germ Spinach
Broccoli Almonds Cantaloupe
Orange Peanuts Broccoli
Strawberries Spinach Winter squash
Cauliflower Olive oil Dried apricots
Red, yellow peppers Tomato Sweet potatoes
Papaya Kiwi Mango
Dried berries Mango Pumpkin
One important consideration is electrolyte (sodium and potassium) bal-

ance, particularly when training in hot weather. Adequate sodium is usu-
72
ally not a problem, unless you are on a sodium-restricted diet. However,

potassium requires careful selection of foods. See Chapter 4 for good food
sources of potassium or click here for food sources of minerals.
Fluid Requirements
Ingesting fluids at regular intervals and eating foods with high water
content are important for maintaining hydration and fluid status during
training. Chapter 3 provides a thorough overview of fluid requirements
and different types of beverages. In general:
t Drink one to two cups (8–16 oz) of water 60 minutes before a training
session.
t Drink one cup (8 oz) of a 5–8% CHO drink every 30 minutes dur-
ing exercise lasting more than 60 minutes. This translates into 50–80
grams of CHO/Liter or 9–19 grams/8 oz (Read the Nutrition Label to
determine the amount of CHO per serving).
t To avoid stomach cramps, beverages with a CHO content over 8%,
such as undiluted fruit juices, most energy drinks, and regular sodas,
should not be ingested during exercise.
t Commercial fluid replacement beverages or diluted juices are recom-
mended during training session lasting over 60 minutes.
t Beverages consumed after prolonged exercise should contain sodium,
potassium, and CHO.
It is possible to drink too much water.
Water intoxication is a concern among SOF and other athletes who

sustain long bouts of exercise without replenishing important electrolytes
contained in sports drinks, gels, and blocks. When drinking plain water
(without sodium), blood levels of sodium may become low and result in
“hyponatremia,” or low blood sodium. This condition is associated with
severe headaches, diarrhea and nausea and, potentially, convulsions and
death.
Nutritional Interventions for Endurance

Nutritional manipulations/interventions can delay fatigue and prevent
conditions detrimental to health and performance such as low blood sugar,
dehydration, and low blood sodium. The primary interventions include:
73
t Drinking 1–2 cups of a CHO beverage (5-8%) with electrolytes every

30 minutes during exercise to maintain performance.
t When an activity has been maintained for 2–3 hours without a CHO
source, blood glucose levels will fall and cause fatigue. Ingestion of
CHO beverages will prevent the fall in blood sugar (glucose) and delay
fatigue. Ingesting CHO after exhaustion will not allow immediate
resumption of activities.
t Solid CHO foods, such as fruits, and energy and sports bars, are ac-
ceptable during exercise, provided they are tolerated. Food selections
are personal choices, but some foods may cause stomach cramps and
diarrhea if eaten during exercise. Dietary fiber intake should be limited
during endurance exercise to avoid gastrointestinal discomfort and
possible pitstops in the woods for relief. All foods used for replenish-
ment during sustained operations and exercise sessions should be
“familiar” foods.
Dietary manipulations should be

tested during training to ensure they
are tolerated during operations.
“I’ve seen firsthand how the combination of core physical

training and proper nutrition enable our SWCCs to take an
unbelievable beating, stay mentally sharp, and accomplish
the mission over long ranges in incredible sea states; and
then do it again the next night.”
CAPT Kent Paro, USN, USSOCOM,
Former CO NSWSBT20
10 Bulking Up
In This Chapter
Benefits of Strength Training
Factors Determining
Muscle Mass
Victims of Bigorexia
Protein Requirements Key Points

for Strength Training t Proper and consistent strength training, adequate rest and a balanced
Other Nutritional Requirements diet will provide the lasting edge when it comes to building strength
and muscle mass.
Dietary Considerations
t Eating a wide variety of foods and matching energy intake with energy
for Bulking-Up
output will provide optimal nutrition for building muscle.
t All operators require no more than 1 gram of protein per pound of
body weight per day.
t Adequate amounts of fluids are vital to muscle metabolism and
contractility.
t Spend money on “real” foods, not supplements and protein powders.
S
OF missions and training require strength. A strength training pro-
gram enhances physical conditioning, builds functional strength and
allows you to perform and complete strenuous missions. In addi-
tion, the appropriate strength training program combined with a well
planned nutritional strategy can help optimize performance and prevent
musculoskeletal injuries. In this chapter, information on strength training
and the unique dietary requirements for this training will be provided.
Benefits of Strength Training

Strength training should complement endurance training workouts. The
specific benefits of strength training include:
t Increased muscle strength and endurance.
t Increased muscle fiber size.
t Increased ligament and tendon strength.
t Greater protection against “overuse” injury.
Because strength training makes you stronger, the risk of injuries that
may accompany endurance training is reduced. Finally, strength training
can make you faster at tasks requiring short bursts of activity.
75
Factors Determining Muscle Mass

Skeletal muscle accounts for over 50% of body weight and is very im-
portant in terms of regulating metabolism. The mechanical and metabolic
demands imposed on skeletal muscle require a constant “remodeling,”
or breaking down and rebuilding of various muscle proteins that support
muscle contraction (structural) and muscle metabolism (functional). This
remodeling is critical to maintain and ensure muscle quality—if proteins
were not constantly being broken down, damaged proteins would prevail.
Various factors regulate the balance between breaking down and build-
ing up, as well as the quantity and quality, of proteins. Some factors, like
genetics, are out of our control, but two major “controllable” factors that
participate in regulating muscle “remodeling” are:
t Exercise: Resistance training increases muscle mass by promoting
the turnover and re-build-up of structural proteins.
t Nutritional Status: Nutrients for muscle growth shift the balance
from “breaking down” to “building up.”
Principles of Training
For functional fitness, the importance of specificity, overload and pro-
gression must be considered.
Specificity
Principles of
Training
general information
on strength training Overload Progression
in PowerPoint.
t Specificity: Demands placed on the body will dictate the type of

adaptation that occurs.
t Overload: Increasing the intensity of training by increasing the num-
ber of sessions per week, performing more difficult exercises, adding
76
weight or sets of exercise, and/or decreasing rest periods between

exercise sets increases the load.
t Progression: Gradual increases in the load/intensity.
When these important principles are integrated into the physical train-
ing program, positive outcomes and fewer injuries can be expected. In ad-
dition, a 5–10 minute aerobic warm-up period is advised to increase blood
flow to the muscles and get the motor neurons firing.
Once muscular strength is achieved, optimal

muscular endurance should be pursued.
Lifting Pitfalls to Poor Performance

Although muscle strength and development are a part of SOF physical
training, moderation is the key, and recommended for balancing strength
and maintaining cardiovascular fitness. Heavy lifting is common for SOF
members because carrying and lifting heavy objects is important opera-
tionally; however, there are disadvantages to only lifting heavy weights.
77
The major pitfall is that heavy weight lifting can limit range of motion and
Example:
strengthens only the muscles within that specific range.
Train 3 hrs each day and
take in 3,500 kcal/day
60% of energy from CHO = Resistance and endurance exercise
3,500 x 0.60 = 2,100 kcal from CHO must be combined for injury prevention
Amount of CHO = and performance optimization.
2,100/4 kcal = 525 grams of CHO
Range of Motion
Taking a muscle through its full range of motion is critical. Full-range of
motion movements contract and strengthen the primary muscles you’re
working and stretch the opposing (antagonist) muscles. This contributes
to both muscle strength and joint flexibility.
Weight training strengthens the muscle when

it goes through the full range of motion.
It is important to remember that proper form and alignment are re-

Training Features of Free Weights quired when using any strength training equipment to maximize safety.
Certified Strength and Conditioning Specialists (CSCS) are very useful for
developing the appropriate functional lifting routines and tailoring a train-
Offers numerous movement
ing program consistent with individual operational tempos.
planes and hand positions.
Equipment Considerations
Safety and ease of use. Resistance training programs should be individualized to meet specific
training goals. To achieve training goals, the different types of strength
training equipment must be considered. Free weights (dumbbells, barbells
Use of stabilizing muscles. and kettle bells) and ground-based equipment, which are used in many
SOF training sites, require more coordination because of requirements for
muscular balance, control, and stabilization. Free weights mimic real life
Fixed range of motion. movements, in that there is no “fixed” range of motion. Multiple muscles
work together in order to achieve form and technique.
In contrast to free weights, various weight machines, such as Nautilus,

Mimics real life movement.
Cybex, LifeFitness and BodyMaster, can be used without a spotter, and
correct form is achieved easily, which increases the safety factor. However,
many machines do not take the muscles through the full range of motion.
Rotational resistance.
Machines for leg curls (hamstrings) and leg extensions (quadriceps) are
ones that do allow a full range of motion.
78
Victims of Bigorexia
Bigorexia, or muscle dysmorphia, is an obsession about being muscular;
it is the opposite of anorexia. Preoccupation with becoming more muscu-
lar may lead to exercising even when in pain or with an injury, being com-
pulsive about training every day and refusing to take a day off, skipping
social events for training, and/or refusing to go to restaurants, parties, or
social gatherings that offer food in order to remain on a strict nutritional
regimen. The bottom line is that victims of bigorexia are never accepting
of their bodies: it is never muscular enough. Excessive training is not the
only repercussion. Other symptoms of bigorexia are:
t Spending excessive amounts on supplements.
t Using steroids to increase muscle mass.

The need for spotters
t Being unhappy with one’s physique. when lifting very heavy
free weights is important.
Protein Requirements for Strength Training
The protein needs of strength and endurance athletes are quite similar:
0.6–0.9 grams of protein per pound body weight each day will meet all
SOF daily protein requirements. However, many SOF believe that more
protein is better. In fact, more may compromise the quality of the protein.
Protein intakes above 1.6 grams per pound per day may inhibit muscle
growth, increase loss of calcium, and compromise bone health. It is not
the amount, but rather the quality of the protein and effectiveness of the
strength training workout that determine muscle mass.
Click to see how much you know about protein.

79
Table 10–1 provides an overview of calculating protein requirements and

Protein intakes over 1.6 Table 10–2 presents the protein content of commonly eaten foods. Some
foods with high quality proteins are:
g/pound each day may
compromise appropriate t Chicken breast, 8 oz.
anabolic signals that t Sirloin Steak, 8 oz.

promote muscle growth. t Subway Turkey Sub.
t Subway Roast Beef Sub.
Table 10–1. How to Calculate Protein Requirements
How Much Protein Do I Need?
175 lbs x 0.9 grams = 158 grams
175 lbs x 0.6 grams = 105 grams
Body Weight x Requirement Grams/Day
My Protein Requirements Are:
_______________ x 0.8 grams = ____________
_______________ x 0.6 grams = ____________
Body Weight x Requirement Grams/Day
Table 10–2. Examples of Where You Get Protein
Food Item Protein (g) Food Item Protein (g)
Chicken 72 Sirloin Steak 62

Breast (8 oz) (8 oz)
Subway Roast 41 Subway 42

Beef Sub Turkey Sub
Vanilla 9 Chili 19
Milkshake (8 oz bowl)
Egg McMuffin, 1 18 Sports Bar, 1 12
TOTAL 138 TOTAL 135
Click here for a sample 1-Day menu with reasonable and excessive protein
intakes.
Most American diets provide more protein than shown in the example,
since protein is also in milk, cheese, fish, and non-animal sources of foods
80
(whole grains, beans, and pasta). Most athletes also consume additional
protein in commercially available sports bars, protein powders or carbo-
hydrate/protein supplements.
Muscle is only 20% protein and the rest is water and minerals, lactic
acid, urea and high-energy phosphates, so it is clear that eating a high
protein diet in order to bulk up just doesn’t add up!
Protein supplements, which provide excessive amounts of protein or
selected amino acids, are discouraged. Although heavily advertised, and in
some cases endorsed by celebrities, very high protein intakes from supple-
ments are not needed to build muscle. A properly balanced diet can meet
your protein needs very effectively.
Concerns with High Protein Intakes

The extra dietary protein must be broken down, which results in in-
creased formation and excretion of the waste product, “urea.” This ad-
ditional waste increases fluid requirements, and places a considerable
load on the liver and kidneys. In extreme cases, excessive protein intakes
can result in kidney failure. In some individuals, high protein intakes can
cause:
t Hypertension.
t Increased fluid needs.
If 100 extra grams of
t Diarrhea/abdominal cramps.
protein were eaten every
t Imbalance of the essential amino acids. day for one week, muscle
mass should increase
by 7 pounds! Clearly,
Other Nutritional Requirements this is not the case.
Carbohydrate Requirements
Strength training relies on glycogen stores for energy. Thus, carbohy-
drates (CHO) are very important.
50–70% of daily energy intake

should come from CHO.
The CHO recommendations for strength training are somewhat less

than for endurance athletes, since the overall energy requirements of
weight lifting are less. However, depending on the training schedule and
aerobic workout duration, 2.5–4 grams of CHO per pound body weight
per day may be needed. If only protein is eaten, the body must work hard
81
to convert protein into glucose, which is required by the brain and muscles
for fuel.
Carbohydrate is the primary fuel

source for strength training.
Fat Requirements
A thorough discussion of fat was provided in Chapter 3, but for fats in
general, the recommendation is:
Less than 35% of your energy should come from fat.
Remember, less than 10% of the fat should come from saturated fat and
the balance from mono- and poly-unsaturated fats.
Click to determine the number of grams of CHO, protein and fat to meet
your energy needs.
Vitamins and Minerals

If you meet your daily energy needs from a variety of different foods,
you should be able to meet your vitamin and mineral needs. See Chapter 4
for information on food sources of various vitamins and minerals.
Dietary Considerations for Bulking-Up

The major stimulus for muscle growth and strength are weight train-
ing and appropriately timed, good nutrition. After weight training, nutrient
dense energy sources are the single most important factor that affects
muscle gain—you must have the energy to train effectively on a daily basis.
All too often, SOF members are exhausted by the long Friday workouts,
Resistance training for due to not eating regularly and consistently over the week. Such dietary
muscle mass gains requires habits are not conducive to building muscle mass.
more focused attention on If nutrient intake is lacking as a result of poor meal planning and/or high
positive energy balance operational tempo, skeletal muscle may be in a negative protein balance
than protein intake. or a catabolic state. For optimal muscle remodeling and growth, the tim-
ing and type of nutrients are critical. Appropriate nutritional interventions
immediately after the exercise and over the next 24 hours are essential for
maintaining and promoting muscle mass.
82
Table 10–3. Nutritional Tips for Bulking-Up
Break for breakfast. Consume a hearty breakfast containing whole grains, fruit, and protein from lean meats
and eggs, as well as low-fat dairy products.
Graze frequently throughout the day. Keep a supply of healthy snacks to help replenish muscle glycogen.
Don’t go without food for more than 4 hours (if possible) to avoid glycogen depletion.
Remember “CPF” meal planning: Eat at least 3 Fish, rice, and vegetables
of the 5 food groups—a mixed meal containing CHO,
protein and fat—for an optimal fueling strategy to Cereal, milk, and fruit
maintain energy for strong and effective strength
trainings. Some combinations are: Turkey on whole grain bread with tomato, lettuce,
and onion
Low-fat yogurt, grape nuts and fruit
Vegetable burrito (tortilla, vegetables and cheese)
Avoid amino acid supplementation and minimize Lean beef, lamb, and pork
protein powders—real foods are more nutrient-
dense. Good food sources of proteins include: Low-fat dairy
Fish
Poultry
Venison
In This Chapter
11 Looking for the Edge–
Dietary Supplements
and the Law
Combining and Stacking

Dietary Supplements
Supplements
Shop Smart: Consumer

Safety Tips
Performance-Enhancing Agents Key Points

Dietary Supplements t SOCOM has a “no dietary supplement” policy—check with medical.
for Weight Loss
t Dietary supplements (DS) sold on military installations are not always
Other Supplements safe, effective or legal.
The Good, the Bad, t Manufacturers of DS are not required to conduct research on safety or
and the Ugly Facts effectiveness. The Food and Drug Administration must prove a prod-
uct is unsafe before it can be taken off the market.
Energy Drinks
t If you use DS, select high quality products with USP (United States
Pharmacopeia) certification labels. The label assures consumers that
the product has been tested and verified in terms of its ingredients and
manufacturing process.
t Combining and stacking of DS increases the potential for undesired
and unsafe side effects.
t Energy drinks are not regulated and the long-term effects of their
combined ingredients are unknown.
T
he most common reasons SOF personnel give for using DS include im-
proving performance, increasing muscle mass, enhancing energy level,
accelerating recovery, increasing alertness, boosting their immune sys-
tem, and improving joint function. The best sources of information on
DS are dietitians, sports nutritionists, physicians, or pharmacists. The purpose
of this chapter is to provide an overview of dietary supplements, describe is-
sues with dietary supplements, and provide basic information on a number
of commonly used supplements. This will not be inclusive as new products
appear on a regular basis, but the information is for educational purposes.
Currently, US SOCOM has a “no DS policy” (click to review). As such,
the use of DS supplements is forbidden. Individuals who spend their mon-
ey on supplements should be aware that these products target our human
desire for health and performance shortcuts. Many are detrimental and
some are dangerous. If it sounds too good to be true, it probably is. The
consequences of taking various supplements, either alone or in combi-
nation, should be carefully considered, and the information obtained for
making that decision should be from reputable sources.
84
Dietary Supplements and the Law

Well over 50% of the US population take some type of dietary supple-
ments. Sales of vitamins, minerals, herbs, meal supplements, sports-nutri-
tion supplements, and specialty supplements were in excess of $22 billion
in 2006. To understand why dietary supplement use is a concern, one
must appreciate the history. In 1994 the Dietary Supplement Health and
Education Act (DSHEA) was passed by Congress for several reasons:
t Limit impediments to marketing and promoting dietary supplements.
t Provide for wide availability of supplements to consumers.
t Enhance information available to consumers.
The passing of DSHEA gave the Food and Drug Administration (FDA)
regulatory control over dietary supplements, and the law required that the
label of a dietary supplement provide the name and quantity of each ingre-
dient. However, it is incumbent upon the manufacturer to provide the infor-
mation and the innocent consumer assumes that information on labels is
truthful and not misleading. This is, more than often, not the case. Consum-
erLab.com, a product-certification company, conducted a survey of nearly
1,000 supplements and found that one in four had quality problems.
The FDA also regulates whether new ingredients can enter the market-
place or existing ones should be removed for safety reasons. However, fed-
eral rules requiring makers of dietary supplements to test all their ingredi-
ents were not part of DSHEA. The FDA also regulates what claims may (or
may not) be made, but they do not monitor claims. The regulations within
DSHEA contain many gaps. Some of the concerns include:
t The responsibility of ensuring that products are properly labeled lies
with the manufacturer.
t Supplement ingredients sold in the United States before October 15,
1994 are presumed to be safe and are therefore not subject to review
by the FDA for safety.
t The responsibility of providing evidence of safety lies with the manu-
facturer.
t The FDA has to prove that a product is not safe if it is already on the market.
Purity is a concern: t Government resources to check dietary supplement quality are limited.
Supplements may be In June, 2007, FDA imposed new regulations, which had been man-
contaminated with dated by DSHEA. The FDA established regulations that dietary supple-
heavy metals and even ments must be produced in a quality manner, do not contain contaminants
or impurities, and are accurately labeled. Supplement manufacturers will
prescription medications.
now be required to test all of the ingredients in their products to make sure
they are neither adulterated nor contaminated.
Click for more information on this new ruling.
85
Combining and Stacking Supplements

Once it is known what a supplement contains, consideration should be
given to what might happen when multiple supplements are combined, or
“stacked.” The concept of “stacking” is a concern. Many variations of “stack-
ing” exist. Several examples of stacking and how they work are listed:
t “Additive,” or, 1+1=2. This suggests that when two supplements are
combined, the effect is equal to the sum of the individual effects. An
example of this concept might include calcium and vitamin D.
t “Antagonize,” or, 1+1=0. In this case, the effects of one supplement
may actually negate the effects of another. One example is the com-
bination of creatine and caffeine: Studies have shown that caffeine
antagonizes the effects of creatine.
t “Synergize,” or, 1+1=3. This is seen when two supplements are com-
bined and their effect is greater than the sum of their individual effects.
An example is Coenzyme Q10 and fat: When CoQ10 is taken with fat,
the action of CoQ10 exceeds what is would be if not taken with fat.
t “Potentiate,” or, 1+1=10 is similar to synergism, but to a much greater
degree. Two examples are vitamin C and iron, and ginseng and caf-
feine. Vitamin C enhances the absorption of iron, which is a good
thing, but if ginseng is taken with caffeine, it may be detrimental, as
ginseng has been shown to increase the effects of caffeine, to possibly
cause nervousness, sweating, insomnia, and/or an irregular heartbeat.
The number of potential stacking combinations is staggering and the
effects of combinations of ingredients are, for the most part, unknown.
One stacking approach that has proven deadly is the “EAC” stack, with
ephedra, aspirin and caffeine. Now that ephedra is banned, ephedra-free
products are being used, but the combination remains dangerous and
should be avoided.
A list of products commonly considered “stackers” used by SOF is
shown on the following page. Some are trade names and many are po-
tentially dangerous. Become familiar with ingredients and ask questions
about combining different compounds.
Table 11–1. Common “Stackers”
Muscle Milk A blend of casein and whey

proteins, combined with fats
and other substances.
NO2 or NO Products contain many ingre-

dients, but typically arginine
(described below).
86
Table 11–1. Common “Stackers”
Hydroxycut A classic EAC stacker that has

resulted in a number of deaths:
Avoid.
GAKIC A NO product with Glycine-l-

arginine-alpha-ketoisocaproic
acid.
Epovar A NO product with Magnesium

Orotate and Potassium Orotate.
Zantrex 3 A thermogenic product with

many forms of caffeine.
Xenadrine EFX A thermogenic product with

synephrine and many forms of
caffeine. Company was fined for
false advertising.
Triflex A combination of glucosamine,

chondroitin and methylsulfonyl-
methane.
Arginine Ethyl Ester A NO product.
Redline A line of products high in

caffeine and other substances.
ZMA A combination of vitamin B6.

Magnesium and Zinc, among
other ingredients.
Lipo-Products (Lipo-6, Lipo- Contains many combinations

AMP, Lipo-THIN Lipo-Com- of ingredients—thermogenic
plex) agent.
Animal Cuts May contain up to 20 ingre-

dients, including synephrine:
Avoid.
Metabolic XXX (Drive, Booster, Contains many combinations

Action, or Optimizer) of ingredients—thermogenic
agent: Avoid.
87
Be a Smart Shopper: Consumer Safety Tips

Supplements should be clearly labeled with “Seals of Approval.” The
seals include “CL” for a Consumer Lab seal of approval and “USP” for US
Pharmacopoeia. These for-profit and not-for-profit agencies inspect the
product and assign scores or ratings if they contain no contaminants, have
standardized doses, can be absorbed by the body, can be broken down by
the body, and the company that produces the products has quality control
standards in place during production and manufacturing to ensure safety
and purity.
If supplements do not have approval

seals, do not use them!
Click to choose verified dietary supplements.

Click for information about dietary supplements from the FDA.
Click for information about dietary supplements from the Office of
Dietary Supplements.
Individual Products Discussed

It would be impossible to discuss all of the dietary supplements and
herbals available. However, some are used more than others. Although not
inclusive, the following products will be discussed:
Bitter Orange Boron Branched Chain

Amino Acids
Caffeine Carnitine Choline
Chondroitin Sulfate Chromium Chrysin
CoEnzyme Q10 Conjugated Linoleic Cordyceps

Acid
Creatine DHEA Ephedra
Fish Oil Ginkgo Biloba Ginseng
Glucosamine Glutamine Guarana
HMB Hoodia Hydroxycitric Acid/

HCA
88
= Jump to:
Hydroxymethylbu- 5-Hydroxytrypto- Lysine
Bitter Orange tyrate phan
Boron
Melatonin Nitric Oxide Pycnogenol
Branched Chain Amino Acids
Caffeine Quercetin St. John’s Wort Synephrine
Carnitine
Tribulus Terrestris Tryptophan Turmeric
Choline
Chondroitin Sulfate Tyrosine Whey Protein Yohimbe
Chromium
Chrysin
Products in red should not be used.
CoEnzyme Q10
Conjugated Linoleic Acid
Cordyceps Performance-Enhancing Agents
Creatine
DHEA Performance enhancing agents are substances claiming to increase
Ephedra work output, performance or lean muscle mass. A discussion of each is
Fish Oil not possible, so some that are mass marketed are discussed.
Ginkgo Biloba
Ginseng Muscle Building Agents
Glucosamine
Glutamine These agents are listed in alphabetical order.
Guarana
HMB
Boron
Hoodia
Hydroxycitric Acid/HCA Claims Builds muscles and increases testosterone levels;
Hydroxymethylbutyrate may enhance cognitive function.
5-Hydroxytryptophan
Other Borate, Boric Acid, Boric Tartrate, and Sodium
Lysine
Names Borate.
Melatonin
Nitric Oxide How It No one is sure how (or if) boron is effective be-
Pycnogenol Works cause its biological role is unknown.
Quercetin
St. John’s Wort Dose No DRI has been established for boron, but a diet
high in boron would provide approximately 3.25
Synephrine
mg boron per 2,000 kcal/day, whereas a diet low
Tribulus Terrestris in boron would provide less than 0.25 mg boron
Tryptophan per 2,000 kcal/day. The maximum dose, at which
Turmeric no adverse effects would be expected, is 20 mg
Tyrosine per day for adults.
Whey Protein
Adverse None have been reported.
Yohimbe
Effects
89
= Jump to:
Boron
Bitter Orange
Comments More evidence is needed to determine the impor- Boron
tance of boron. Branched Chain Amino Acids
Caffeine
L-Carnitine Carnitine
Choline
Claims Enhance athletic performance, particularly endur- Chondroitin Sulfate
ance. Chromium
Chrysin
Other Carnitine, Carnitor, DL-Carnitine, L-Carnitine
CoEnzyme Q10
Names Fumarate, L-Carnitine L-Tartrate, L-Carnitine Tar-
trate, Levocarnitine, Levocarnitine Fumurate. Conjugated Linoleic Acid
Cordyceps
How It Carnitine enhances the transport of fats to the Creatine
Works energy powerhouse within the muscle and the DHEA
subsequent use of fats as fuel during exercise.
Ephedra
Fish Oil
Dose 2–4 grams/day have been taken without any clear
benefit. No dose has been established for improv- Ginkgo Biloba
ing athletic performance. Ginseng
Glucosamine
Adverse Nausea, vomiting, cramps, diarrhea, heartburn, Glutamine
Effects body odor, and seizures have been reported, when
Guarana
used inappropriately.
HMB
Comments Carnitine is found naturally in the body and can Hoodia
be obtained in the diet from red meats and dairy Hydroxycitric Acid/HCA
products. Taking L-Carnitine has not been shown Hydroxymethylbutyrate
to improve athletic performance or endurance.
5-Hydroxytryptophan
Lysine
Melatonin
Chromium
Nitric Oxide
Claims Increases lean muscle mass; is the natural alterna- Pycnogenol

tive to steroids. Quercetin
St. John’s Wort
Other Chromium Acetate, Chromium Chloride, Chro- Synephrine
Names mium Nicotinate, Chromium Picolinate, Chromium Tribulus Terrestris
Polynicotinate, Chromium Proteinate, Chromium
Tryptophan
Trichloride, Chromium Tripicolinate, Cr3+, Glucose
Tolerance Factor-Cr, GTF, GTF Chromium, GTF- Turmeric
Cr. Tyrosine
Whey Protein
Yohimbe
90
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Chromium
Bitter Orange
Boron How It Chromium is part of a number of substances that
Branched Chain Amino Acids Works regulate glucose metabolism.
Caffeine
Dose Doses ranging from 200–1000 mcg/day appear to
Carnitine
be safe.
Choline
Chondroitin Sulfate Adverse Chromium can cause headache, insomnia, and
Chromium Effects motor dysfunction in some people in doses as low
Chrysin as 200–400 mcg/day.
CoEnzyme Q10
Comments Some evidence suggests that chromium can in-
crease weight loss, body fat loss and increase lean
Cordyceps body mass in people taking chromium picolinate
Creatine (200–400 mcg/day) as part of a resistance training
DHEA program, but the results are questionable. Chro-
mium may be helpful in diabetes, hypertension,
Ephedra
and potentially weight loss.
Fish Oil
Ginkgo Biloba
Ginseng
Chrysin
Glucosamine
Glutamine Claims Enhances response to resistance training.
Guarana
HMB Other Flavone X, Flavonoid, Galangin Flavanone.
Hoodia Names
Hydroxycitric Acid/HCA
How It Claims are that it increases testosterone levels.
Hydroxymethylbutyrate Works
5-Hydroxytryptophan
Lysine Dose A dose of 300 mg daily has been used, but it
Melatonin is usually in combination with other potential
Nitric Oxide testosterone releasers, such as DHEA, Tribulus
terrestris, and saw palmetto.
Pycnogenol
Quercetin Adverse None have been reported.
St. John’s Wort Effects
Synephrine
Tribulus Terrestris Comments Chrysin is a naturally occurring isoflavone found
Tryptophan in various plants. Most chrysin products are ex-
tracted from the passion flower species. It does not
Turmeric
seem to be effective for enhancing the response to
Tyrosine resistance training in athletes, but minimal data are
Whey Protein available for this herbal because it is typically used
Yohimbe in combination with other substances.
91
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Creatine
Bitter Orange
Claims Gain muscle mass and improve anaerobic perfor- Boron
mance. Branched Chain Amino Acids
Caffeine
Other Creatine Monohydrate, Creatine Citrate, Creatine
Carnitine
Names Ethyl Ester, Creatine Ethyl Ester HCl, Serum Cre-
atine, Creatine Pyruvate, Phosphocreatine. Choline
Chondroitin Sulfate
How It Taking creatine allows the muscles to store great- Chromium
Works er amounts of creatine phosphate (or phosphocre- Chrysin
atine), which is used to regenerate ATP, the pri-
CoEnzyme Q10
mary energy for muscle contraction. Creatine can
cause visible bulking up of muscles by increasing Conjugated Linoleic Acid
the water content of muscle cells. Cordyceps
Creatine
Dose A dose of 3 grams/day is adequate and a loading DHEA
dose is unnecessary. The dose commonly recom-
Ephedra
mended for loading is 20 grams/day for 5 days
followed by a maintenance dose of less than 10 Fish Oil
grams/day. The higher doses are not any more Ginkgo Biloba
effective than the 3 grams/day. Ginseng
Glucosamine
Adverse Side effects, not demonstrated by research but Glutamine
Effects reported in association with creatine use include:
Guarana
muscle cramping, gastrointestinal disturbances,
kidney problems or dehydration. High doses of HMB
creatine may negatively affect kidney function. Hoodia
Individuals taking drugs that affect the kidneys (cy- Hydroxycitric Acid/HCA
closporine, gentamicin, tobramycin, and NSAIDS;
Hydroxymethylbutyrate
ibuprofen and naproxen) should avoid high doses of
creatine. Caffeine may negate the effects of cre- 5-Hydroxytryptophan
atine. Lysine
Melatonin
Comments The body makes creatine (1–2 gm/day) with 95% Nitric Oxide
being stored in skeletal muscle. Creatine supple- Pycnogenol
mentation may produce a small increase in explo-
Quercetin
sive strength or enhance performance for short
burst, high-intensity activities, like weight lifting St. John’s Wort
and sprinting. It does not improve endurance and Synephrine
if weight gain is high, endurance may be impaired. Tribulus Terrestris
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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HMB (Hydroxymethylbutyrate)
Bitter Orange
Boron Claims Increases muscle mass and enhances recovery.
Caffeine Other B-Hydroxy B-Methylbutyrate Monohydrate, Beta-
Names Hydroxy-Beta-Methylbutyric Acid, Hydroxym-
Carnitine
ethyl Butyrate.
Choline
Chondroitin Sulfate How It HMB might promote muscle growth by decreasing
Chromium Works or slowing down the catabolism or breakdown of
Chrysin muscle protein.
CoEnzyme Q10
Dose Doses of 1 gram three times daily or 1.5 grams
once or twice daily have been used for muscle
Cordyceps building and increasing strength during weight
Creatine training.
DHEA
Ephedra Adverse No known adverse effects have been linked to
Effects HMB.
Fish Oil
Ginkgo Biloba
Comments Evidence about the effectiveness of HMB for
Ginseng weight training is conflicting. Some research
Glucosamine shows no effect and other data suggest that HMB
Glutamine may be effective in people who have not previ-
ously trained. HMB is a by-product of the metabo-
Guarana
lism of the amino acid, leucine and a precursor to
HMB cholesterol.
Hoodia
Hydroxymethylbutyrate Nitric Oxide (NO)
5-Hydroxytryptophan
Lysine Claims Enhances delivery of nutrients to muscles so they
Melatonin can increase in mass with training. Increases
strength, improves in stamina, and accelerates
Nitric Oxide
recovery.
Pycnogenol
Quercetin Other NO-Xplode, Nitrix, NOX-CG3, NOx2, and NO.
St. John’s Wort Names
Synephrine
Tribulus Terrestris How It NO works in part by increasing bloods flow. How-
Works ever, supplements marketed as NO do not contain
Tryptophan
NO because it is a gas, which cannot be put into a
Turmeric pill. Rather the products contain the amino acid,
Tyrosine arginine.
Whey Protein
Yohimbe
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Nitric Oxide (NO)
Bitter Orange
Dose No dose has been established. Products marketed Boron
as NO will vary with the type and amount of Branched Chain Amino Acids
ingredients.
Caffeine
Carnitine
Adverse Because NO products are all different, it is very
Effects difficult to document adverse effects. Combina- Choline
tions of ingredients are a concern. Chondroitin Sulfate
Chromium
Comments Nitric Oxide is actually a gas produced in the body Chrysin
from the amino acid, arginine, to communicate
CoEnzyme Q10
with other cells. Most NO products are typically
amino acid mixtures containing arginine alpha-ke- Conjugated Linoleic Acid
toglutarate (A-AKG) and arginine-ketoisocaproate Cordyceps
(A-KIC). Creatine
DHEA
Ephedra
Fish Oil
Tribulus Terrestris Ginkgo Biloba

Ginseng
Claims Enhances muscle strength and athletic perfor- Glucosamine
mance; an antidote for male impotence. Glutamine
Guarana
Other Cat’s-Head, Devil’s-Thorn, Devil’s-Weed, Goat-
HMB
Names head, Nature’s Viagra, Puncture Weed, Tribule
Terrestre. Hoodia
How It Increases levels of testosterone, dehydroepi- Hydroxymethylbutyrate
Works androsterone (DHEA), and dihydrotestosterone. 5-Hydroxytryptophan
Lysine
Dose A dose of 250 mg per day has been used.
Melatonin
Nitric Oxide
Adverse None have been reported.
Effects Pycnogenol
Quercetin
Comments No study to date has demonstrated any benefit St. John’s Wort
to strength or athletic performance after taking Synephrine
Tribulus Terrestris. This herbal is derived from a
Tribulus Terrestris
Mediterranean plant that bears a spine-covered
fruit. Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Athletic/Recovery Agents
Bitter Orange The list of substances marketed to enhance or improve athletic perfor-
Boron mance is extensive and continually changing. Some commonly used products,
Branched Chain Amino Acids listed in alphabetical order (not order of effectiveness), are described below.
Caffeine
Carnitine Branched-Chain Amino Acids (BCAA)
Choline
Chondroitin Sulfate Claims Enhances exercise performance, prevents fatigue,
reduces protein and muscle breakdown during
Chromium
intense exercise.
Chrysin
CoEnzyme Q10 Other BCAA, Isoleucine, Leucine, L-Isoleucine, L-Leu-
Conjugated Linoleic Acid Names cine, L-Valine, N-Acetyl Leucine, Valine.
Cordyceps
Creatine How It BCAA act as signaling molecules to stimulate
Works protein synthesis or production; they are also used
DHEA
as an energy source during stress.
Ephedra
Fish Oil Dose No established dose.
Ginkgo Biloba
Ginseng Adverse BCAA in doses of 60 grams or higher daily can
Effects increase ammonia levels in the blood, which can
Glucosamine
lead to fatigue and loss of motor coordination.
Glutamine
Guarana Comments Research has not demonstrated that BCAA en-
HMB hance exercise or athletic performance. The
Hoodia Estimated Average Requirements for BCAA are
Hydroxycitric Acid/HCA 68–144 mg/kg/day (leucine 34 mg/day; isoleucine
15 mg/day; valine 19 mg/day). This would equate
to 4.7–10 grams per day for a 70 kg (154 lb) person.
5-Hydroxytryptophan BCAA are found in meat, dairy foods, and le-
Lysine gumes. About 15–25% of the total dietary protein
Melatonin intake is BCAA.
Nitric Oxide
Pycnogenol
Caffeine
Quercetin
St. John’s Wort Claims Improves mental alertness and enhances athletic
Synephrine performance; used for weight loss and diabetes.
Tribulus Terrestris
Tryptophan Other Methylxanthines and herbal products such as
Names Black Tea, Green Tea, Oolong Tea, Coffee, Cola
Turmeric
Nut, Guarana, and Maté.
Tyrosine
Whey Protein
Yohimbe
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Caffeine
Bitter Orange
How It Caffeine is a stimulant. It stimulates the central Boron
Works nervous system, heart, skeletal muscles, and res- Branched Chain Amino Acids
piration.
Caffeine
Carnitine
Dose 100-600 mg/day consumed over a period of
4–8 hours is the most common dose. For endur- Choline
ance doses may range from 2-10 mg per kg body Chondroitin Sulfate
weight. Higher doses may produce urine levels Chromium
greater than allowed by the International Olympic Chrysin
Committee.
CoEnzyme Q10
Adverse Adverse effects are in part determined by sensitiv- Conjugated Linoleic Acid
Effects ity to caffeine. Some people are rapid and oth- Cordyceps
ers slow caffeine metabolizers. Reported effects Creatine
of caffeine include headache, anxiety, agitation, DHEA
insomnia, nervousness, restlessness, gastrointesti-
Ephedra
nal distress, nausea, rapid heart rate, arrhythmias,
quickened respiration, tremors, convulsions, and Fish Oil
frequent urination. Chronic use, especially in large Ginkgo Biloba
amounts, can produce tolerance, habituation, and Ginseng
psychological dependence. Glucosamine
Caffeine produces physical dependence and with- Glutamine
drawal of caffeine elicits physical and behavioral
Guarana
symptoms, to include:
HMB
t Headache.
Hoodia
t Fatigue.
t Difficulty concentrating.
t Mood disturbances (depressed mood, irritability).
5-Hydroxytryptophan
t Flu-like symptoms (muscle aches, nausea, vomiting).
Lysine
The symptoms of withdrawal can occur taking only
Melatonin
100 mg of caffeine per day for 7 days or 300 mg per
day for 3 days. The onset of withdrawal symptoms Nitric Oxide
occurs within 12 to 48 hours after last dose and Pycnogenol
may last up to nine days. Withdrawal symptoms, Quercetin
which can vary from mild to incapacitating, can be St. John’s Wort
reversed 30 to 60 minutes after ingesting a product
Synephrine
containing as little as 30 mg of caffeine.
Tribulus Terrestris
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Caffeine
Bitter Orange
Boron Comments Caffeine is included on the FDA list as a substance
Branched Chain Amino Acids “generally recognized as safe.” However, the FDA
for cola beverages has established a maximum
Caffeine
concentration for caffeine: 32.4 mg per 6 oz or 65
Carnitine mg per 12 oz. Other than colas, the caffeine con-
Choline tent of food and beverages is not regulated.
Chondroitin Sulfate It is clear that caffeine is “performance enhanc-
Chromium ing,” and because of this, the International Olym-
Chrysin pic Committee (IOC) has banned its use above a
certain level (as detected in the athlete’s urine).
CoEnzyme Q10
Caffeine seems to increase physical endurance
Conjugated Linoleic Acid and may increase the time to exhaustion. It does
Cordyceps not seem to affect activities that require high exer-
Creatine tion over a short period of time, such as sprinting
DHEA or lifting, activity.
Ephedra
Comments Caffeine improves mental performance and alert-
Fish Oil ness after prolonged sleep deprivation. Some data
Ginkgo Biloba suggest that caffeine reduces pain. Although caf-
Ginseng feine is a diuretic, doses over 300 mg are usually
Glucosamine required to compromise fluid status.
Glutamine Some people are very sensitive to caffeine, and show
symptoms (tremors, sleep disturbances, gastrointes-
Guarana
tinal upsets) after small doses. Persons who experi-
HMB ence adverse reactions to caffeine-containing drinks
Hoodia or people with heart disease should avoid caffeine
Hydroxycitric Acid/HCA containing energy drinks (discussed below).
Hydroxymethylbutyrate Click for the caffeine content of various products.
5-Hydroxytryptophan
Lysine
Melatonin Choline
Nitric Oxide
Claims Enhance athletic performance by increasing en-
Pycnogenol
ergy and delaying fatigue in endurance activities
Quercetin and maintaining muscle strength for resistance
St. John’s Wort exercise.
Synephrine
Tribulus Terrestris Other Choline Bitartrate, Choline Chloride, Choline Cit-
Names rate, Lipotropic Factor, Phosphatidylethanolamine,
Tryptophan
Alpha-GPC, Lecithin, and Phosphatidylcholine.
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Choline
Bitter Orange
How It Choline is an essential part of the neurotransmit- Boron
Works ter responsible for muscle contraction—acetylcho- Branched Chain Amino Acids
line. Maintaining a supply of choline could possi-
Caffeine
bly prevent depletion of acetylcholine and sustain
muscle contraction. Carnitine
Choline
Dose The typical dose is 1–2 grams/day; unsafe in Chondroitin Sulfate
amounts above 3.5 gm/day for adults over 18 Chromium
years of age. Chrysin
CoEnzyme Q10
Adverse Choline can cause sweating, fishy body odor, vom-
Effects iting and diarrhea. Conjugated Linoleic Acid
Cordyceps
Comments Taking choline does not seem to enhance ath- Creatine
letic performance or endurance or delay fatigue. DHEA
However, the newer forms of choline have not
Ephedra
been tested. Choline is a component of phosphati-
dylcholine or lecithin. Choline is considered a B Fish Oil
vitamin, even though the body can make it. Liver, Ginkgo Biloba
meat, fish, nuts, beans, eggs, and peas are high in Ginseng
choline. The typical diet provides 200–600 mg/ Glucosamine
day. Choline is a component of Alpha-glycero-
Glutamine
phosphorylcholine (GPC), Lecithin, and phosphati-
dylcholine. Guarana
HMB
Hoodia
Co-Enzyme Q10 Hydroxycitric Acid/HCA
Claims Improves aerobic capacity. 5-Hydroxytryptophan
Lysine
Other CoQ10, Coenzyme Q10, CoQ10.
Melatonin
Names
Nitric Oxide
How It CoQ10 is important in the production of ATP and Pycnogenol
Works acts as an antioxidant. Quercetin
St. John’s Wort
Dose A common dose is 100 mg/day divided and taken Synephrine
at two different times during the day. Some re-
Tribulus Terrestris
search suggests it might slightly improve tolerance
to higher workloads, but more research is needed. Tryptophan
No established dose has been set for aerobic per- Turmeric
formance. Tyrosine
Whey Protein
Yohimbe
98
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Bitter Orange Adverse None identified.

Boron Effects
Caffeine Comments Dietary sources are meat and seafood; it can also
Carnitine be produced from fermenting beets and sugar
cane with special strains of yeast. CoQ10 is also
Choline
used for preventing “statin”-induced myopathy.
Chondroitin Sulfate
Chromium
Chrysin Cordyceps
CoEnzyme Q10
Conjugated Linoleic Acid Claims Improves athletic performance, increases energy
Cordyceps and stamina and reduces fatigue; strengthens the
immune system.
Creatine
DHEA
Other Caterpillar Fungus, Caterpillar Mushroom, Veg-
Ephedra Names etable Caterpillar.
Fish Oil
Ginkgo Biloba How It May work by stimulating various immune cells to
Ginseng Works accelerate recovery.
Glucosamine
Dose Typical dose is 3 gm/day.
Glutamine
Guarana Adverse None identified at this time.
HMB Effects
Hoodia
Hydroxycitric Acid/HCA Comments Cordyceps sinesis is a fungus parasite that lives on
Hydroxymethylbutyrate insects and arthropods. No research has demon-
strated an effect on athletic performance. Many
5-Hydroxytryptophan
commercial products grow the parasite in the labora-
Lysine tory.
Melatonin
Nitric Oxide
Pycnogenol Ginseng
Quercetin
Ginseng refers to a group of extracts derived from the plant family,
St. John’s Wort Araliacae. Three major types—Panax, American, and Siberian—
Synephrine are marketed; each are available in a variety of forms, ranging from
Tribulus Terrestris root powders to root extracts to leaf powders and extracts. The
Tryptophan forms also differ in terms of the active ingredients.
Turmeric
Claims All forms claim to enhance resistance to environ-
Tyrosine
mental stress or serve as an “adaptogen”, a term
Whey Protein used to indicate that a substance strengthens the
Yohimbe body and increases resistance to stress.
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Ginseng
Bitter Orange
Claims The name panax, or “all-healing,” ginseng has Boron
been touted for a broad range of ailments and is Branched Chain Amino Acids
used to restore life energy.
Caffeine
Carnitine
Other t Panax ginseng (or P. ginseng)
Names Choline
t Asian or Asiatic, Chinese, Korean, and Ori-
Chondroitin Sulfate
ental ginseng, radix ginseng rubra, ren shen,
Chromium
sang, seng, red or white ginseng. Red ginseng is
steamed and dried in heat or sunlight while white Chrysin
ginseng is simply the dried or powdered root. CoEnzyme Q10
Other t American Ginseng (Panax quinquefolius). Cordyceps
Names Creatine
t Anchi Ginseng, Canadian Ginseng, Ginseng, Gin-
seng Root, North American Ginseng, Occidental DHEA
Ginseng, Ontario Ginseng, Panax quinquefolium, Ephedra
Red Berry, Wisconsin Ginseng. Fish Oil
t Siberian Ginseng (Eleutherococcus senticosus). Ginkgo Biloba
t Acanthopanax Obovatus, Ciwujia, Ciwujia Ginseng
Root, Ciwujia Root Extract, Devil’s Bush, Devil’s Glucosamine
Shrub, Eleuthero Ginseng, Eleuthero Root, Rus- Glutamine
sian Root, Shigoka, Siberian Eleuthero, Siberian Guarana
Ginseng, Thorny Bearer of Free Berries. HMB
Hoodia
How It Appears to work by modulating the immune
Works system. Ginseng preparations have antioxidant
properties and may lower blood glucose. Panax Hydroxymethylbutyrate
ginseng may work against stress by affecting 5-Hydroxytryptophan
the responsiveness and regulation of the stress- Lysine
responsive hormone axis.
Melatonin
Nitric Oxide
Dose Dosing is generally around 0.6–3 grams of root
powder 1 to 3 times per day for Panax ginseng Pycnogenol
as a capsule or an extract standardized to 4–8% Quercetin
ginsenosides, 200–600 mg/day. St. John’s Wort
Dosing is slightly lower for American and Siberian Synephrine
ginsengs. Sometimes ginseng is taken continu- Tribulus Terrestris
ously, but cycling is usually recommended. Gin-
Tryptophan
seng is taken for 3 weeks to 3 months followed by
2 weeks to 2 months off. Turmeric
Tyrosine
Whey Protein
Yohimbe
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Ginseng
Bitter Orange
Boron Adverse Each form acts differently, but gastrointestinal,
Branched Chain Amino Acids Effects nervous, hypoglycemia, cardiovascular system
effects, insomnia, slight drowsiness, anxiety, irrita-
Caffeine
bility, and feeling of sadness may be reported.
Carnitine
Choline Comments The form of ginseng is very important. Please read
Chondroitin Sulfate product labels—thousands of commercial prod-
Chromium ucts contain the various forms of Ginseng but only
Chrysin three are USP certified. Siberian ginseng is often
misidentified or adulterated. American and Panax
CoEnzyme Q10
ginseng may be much more expensive. Be very
Conjugated Linoleic Acid careful when using ginseng products.
Cordyceps
Creatine Comments American Ginseng is indigenous to both the
DHEA Americas and the Far East; it has been used as a
medicinal plant for 5,000 years. Wild American
Ephedra
ginseng is highly sought after, for that reason,
Fish Oil it may become an endangered species in some
Ginkgo Biloba states.
Ginseng
Glucosamine
Glutamine Glutamine
Guarana
HMB Claims Enhances exercise performance and accelerates
recovery from strenuous exercise.
Hoodia
Other GLN, Glutamate, Glutamic Acid, Glutamic Acid
Hydroxymethylbutyrate Names HCl, L-Glutamic Acid, L-Glutamic Acid HCl,
5-Hydroxytryptophan L-Glutamic Acid Hydrochloride, L-Glutamine, N-
Lysine Acetyl-L-Glutamine.
Melatonin
How It Glutamine works by maintaining normal function
Nitric Oxide
Works of the intestine, immune system, and muscle ami-
Pycnogenol no acid homeostasis during stress; it also serves as
Quercetin a metabolic fuel for immune cells.
St. John’s Wort
Synephrine Dose Doses of 15–30 grams have been used after exer-
cise. It appears safe at up to 40 grams/day.
Tribulus Terrestris
Tryptophan
Adverse None identified at this time.
Turmeric Effects
Tyrosine
Whey Protein
Yohimbe
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Glutamine
Bitter Orange
Comments Glutamine does not appear to enhance exercise Boron
performance; but it has been shown to suppress Branched Chain Amino Acids
the rise in muscle breakdown during recovery.
Caffeine
Importantly, glutamine may prove to be a biologic
marker of overtraining. Carnitine
Choline
Chondroitin Sulfate
Guarana Chromium
Chrysin
Claims Enhance endurance performance, and improve CoEnzyme Q10
mental acuity, weight loss, and reduce mental and Conjugated Linoleic Acid
physical fatigue.
Cordyceps
Creatine
Other Brazilian Cocoa, Zoom.
Names DHEA
Ephedra
How It Guarana is a stimulant and contains caffeine, as Fish Oil
Works well as other potentially psychoactive substances. Ginkgo Biloba
Ginseng
Dose Doses vary, but 75 mg has been suggested. It is
Glucosamine
usually combined with other active ingredients.
Glutamine
Adverse Same as for caffeine. Guarana
Effects HMB
Hoodia
Comments Guarana is a plant species native to the central
Amazonian Basin, with a long history of use for
its stimulant effects. It is a common ingredient in Hydroxymethylbutyrate
Brazilian soft drinks. The guarana seed contains 5-Hydroxytryptophan
3.6%–5.8% caffeine. Guarana is often used in Lysine
combination with other ingredients for weight loss Melatonin
products and as a stimulant.
Nitric Oxide
Pycnogenol
L-Lysine Quercetin
St. John’s Wort
Claims Promote gains in muscle strength and mass. Synephrine
Tribulus Terrestris
Other Lysine, L-Lysine HCl, Lysine Hydrochloride,
Tryptophan
Names Lysine Monohydrochloride.
Turmeric
How It Lysine may stimulate the release of growth hor- Tyrosine
Works mone. Whey Protein
Yohimbe
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L-Lysine
Bitter Orange
Boron Dose No established dose for athletic performance, but
Branched Chain Amino Acids doses of 1–6 grams/day have been used, without
benefit.
Caffeine
Carnitine
Adverse Can cause diarrhea and abdominal pain.
Choline Effects
Chondroitin Sulfate
Chromium Comments Oral doses that might be high enough to induce
Chrysin growth hormone (GH) release are likely to cause
stomach discomfort and diarrhea. Exercise of
CoEnzyme Q10
moderate to high intensity is a far greater stimu-
Conjugated Linoleic Acid lus for GH release than lysine. No proven benefits
Cordyceps have been established for performance, but lysine
Creatine appears to be effective for reducing recurrence of
DHEA herpes simplex infections.
Ephedra
Fish Oil
Ginkgo Biloba
Pycnogenol
Ginseng
Claims Improves athletic endurance and decreases
Glucosamine muscle cramps and pain.
Glutamine
Guarana Other French Marine Pine Bark Extract, Maritime Bark
HMB Names Extract, OPCs, Pine Bark Extract, Pygenol.
Hoodia
How It Benefits may reflect antioxidant activity.
Works
5-Hydroxytryptophan Dose Typical dose is 200 mg daily.
Lysine
Melatonin Adverse None identified at this time.
Nitric Oxide Effects
Pycnogenol
Comments Pycnogenol is an extract from the bark of the
Quercetin French pine tree. Research has shown that it
St. John’s Wort improved endurance in recreational athletes aged
Synephrine 20–35 yrs and prevented muscle cramps and mus-
Tribulus Terrestris cular pain at rest, and pain after/during exercise.
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Pyruvate
Bitter Orange
Claims Improves athletic performance and promotes Boron
weight loss. Branched Chain Amino Acids
Caffeine
Other Alpha-Keto Acid, Alpha-Ketopropionic Acid, Cal-
Carnitine
Names cium Pyruvate, Calcium Pyruvate Monohydrate,
Creatine Pyruvate, Magnesium Pyruvate, Potas- Choline
sium Pyruvate, Proacemic Acid, Pyruvic Acid, Chondroitin Sulfate
Sodium Pyruvate. Chromium
Chrysin
How It Pyruvate serves as a metabolic regulator and may
CoEnzyme Q10
Works modify fat and CHO metabolism.
Dose Doses range from 6–44 grams/day. The most ef- Cordyceps
fective dose has not been determined. Creatine
DHEA
Adverse May cause gastric distress. Ephedra
Effects
Fish Oil
Ginkgo Biloba
Comments Research suggests that pyruvate, either alone or
in combination with creatine, does not improve Ginseng
athletic performance. Its effect on weight loss Glucosamine
remains to be determined. Glutamine
Guarana
HMB
Taurine Hoodia
Claims Improves mental performance and serves as an
antioxidant. Hydroxymethylbutyrate
5-Hydroxytryptophan
Other L-taurine. Lysine
Names Melatonin
Nitric Oxide
How It Believed to act as an antioxidant and free radical
Pycnogenol
Works scavenger. Its presence in brain suggests it may
also alter normal hormone function and neuro- Quercetin
transmission. St. John’s Wort
Synephrine
Dose A dose of 2–6 grams per day has been used. Tribulus Terrestris
Tryptophan
Adverse None reported.
Turmeric
Effects
Tyrosine
Whey Protein
Yohimbe
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Taurine
Bitter Orange
Boron Comments Taurine is a naturally occurring amino acid found
Branched Chain Amino Acids in meat, fish and shellfish and is formed in the body.
Dietary intakes of taurine range from 50–400 mg/
Caffeine
day. However, taurine is now often added to energy
Carnitine drinks and these drinks may contain 25, 300, 2,000
Choline mg, or 4,000 mg/L. As such, dietary intakes of
Chondroitin Sulfate taurine may be very high in individuals consuming
Chromium energy drinks with added taurine. An upper limit
of safety has not been determined. Taurine has not
Chrysin
been shown to enhance performance.
CoEnzyme Q10
Cordyceps Tyrosine
Creatine
DHEA Claims Improves alertness following sleep deprivation;
Ephedra maintains cognitive performance during stress.
Fish Oil
Other Acetyl-L-Tyrosine, L-tyrosine, N-Acetyl L-Ty-
Ginkgo Biloba
Names rosine, Tyr.
Ginseng
Glucosamine How It Providing additional tyrosine should maintain
Glutamine Works brain tyrosine and allow continued synthesis of
Guarana essential neurotransmitters and avoid negative
HMB effects of stress.
Hoodia
Dose Up to 150 mg/kg/day has been used to maintain
Hydroxycitric Acid/HCA alertness and cognitive performance.
5-Hydroxytryptophan Adverse May cause headache, fatigue, nausea, and heart-
Lysine Effects burn.
Melatonin
Comments Tyrosine is an amino acid made by the body from
Nitric Oxide
other amino acids. It is found in dairy products,
Pycnogenol meat, fish, eggs, nuts, beans, oats, and wheat.
Quercetin Tyrosine may improve alertness following sleep
St. John’s Wort deprivation.
Synephrine
Tribulus Terrestris
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Whey Protein
Bitter Orange
Claims Increase muscle mass and promote weight gain. Boron
Other Bovine Whey Protein Concentrate, Goat Milk Caffeine
Names Whey, Goat Whey, Milk Protein Isolate, Mineral
Carnitine
Whey Concentrate, Whey, Whey Peptides, Whey
Protein Concentrate, Whey Protein Hydrolysate, Choline
Whey Protein Isolate. Chondroitin Sulfate
Chromium
How It May enhance immune system and regulate muscle Chrysin
Works protein synthesis.
CoEnzyme Q10
Dose No established dose, but from 8–30 grams per day are
used. A high dose would be over 50 grams per day. Cordyceps
Creatine
Adverse May cause nausea, thirst, bloating, cramps, fa- DHEA
Effects tigue, poor appetite and headache. Ephedra
Fish Oil
Comments Whey protein is the name for a variety of proteins
Ginkgo Biloba
isolated from whey, which is the watery part of milk
after milk separates into a liquid and solid phase Ginseng
from heating. Casein, or curds, is the protein in the Glucosamine
solid phase. Whey protein contains carbohydrates Glutamine
(lactose), proteins (albumin and others), minerals,
Guarana
and amino acids. BCAA make up 24% of whey
protein. No research shows any benefit in healthy HMB
people. Some research suggests that whey protein Hoodia
is more effective than casein for promoting muscle Hydroxycitric Acid/HCA
mass during weight training. However, soy protein Hydroxymethylbutyrate
may be as effective as whey protein. Research as to
5-Hydroxytryptophan
whether whey protein can promote weight loss is
ongoing. The best protein source is still real foods Lysine
because they provide essential nutrients. Melatonin
Nitric Oxide
Pycnogenol
Yohimbe Quercetin
St. John’s Wort
Claims Enhances energy and stamina. Synephrine
Tribulus Terrestris
Other Johimbi, Yohimbine.
Names Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Yohimbe
Bitter Orange
Boron How It Yohimbe may work in several ways, but primarily
Branched Chain Amino Acids Works it works by blocking selected receptors that con-
trol the nervous system.
Caffeine
Carnitine
Dose A dose equivalent to 15–30 mg of Yohimbe daily
Choline is typical for impotence. No dose has been estab-
Chondroitin Sulfate lished for stamina.
Chromium
Chrysin Adverse Yohimbe may cause high blood pressure, head-
Effects aches, anxiety, dizziness, and sleeplessness and
CoEnzyme Q10
increase heart rate.
Cordyceps Comments Yohimbine is derived from the inner bark of an
Creatine evergreen tree native to Zaire, Cameroon, and
DHEA Gabon. Yohimbe has been used for centuries as an
aphrodisiac, and is used to treat erectile dysfunc-
Ephedra
tion. Yohimbe interacts with many other dietary
Fish Oil supplements, and should not be used. No data
Ginkgo Biloba indicate it improves stamina.
Ginseng
Glucosamine
Glutamine
Guarana Dietary Supplements for Weight Loss
HMB
Supplements that may aid in weight loss can be grouped according to
Hoodia
how they affect the body. They are typically classified as appetite suppres-
sants, thermogenic agents, or digestion inhibitors. The number of weight
loss supplements is staggering. In January 2007, the Federal Trade Com-
5-Hydroxytryptophan
mission fined four prominent weight loss supplement (Xenadrine EFX,
Lysine
CortiSlim, Trim Spa, and One-A-Day WeightSmart) manufacturers for de-
Melatonin
ceptive advertising. Many weight loss supplements make claims of effec-
Nitric Oxide
tiveness without reliable scientific evidence. Buyer beware!
Pycnogenol
Quercetin
St. John’s Wort
Appetite Suppressants
Synephrine Some dietary supplements marketed as natural appetite suppressants
Tribulus Terrestris are 5-HTP and Hoodia. Several prescription and over the counter (OTC)
Tryptophan medications, such as Wellbutrin, Redux, Meridia, and dexatrin, are also
Turmeric appetite suppressants. More recently, Alli (pronounced ally), whose active
Tyrosine ingredient is Orlistat, was approved as the first over-the-counter, FDA-
Whey Protein approved weight loss pill. In certain circumstances, Active Duty personnel
Yohimbe may be prescribed a weight loss medication for a limited time, under the
care of a physician.
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5-Hydroxytryptophan or 5-HTP
Bitter Orange
Claims Promotes weight and/or body fat loss. Boron
Other 5-hydroxy L-tryptophan, 5-Hydroxy Tryptophan, Caffeine
Names 5-L-Hydroxytryptophan and L-5 HTP.
Carnitine
Choline
How It 5- HTP crosses the blood brain barrier and in-
Works creases production of serotonin in the central ner- Chondroitin Sulfate
vous system. Serotonin can affect sleep, appetite, Chromium
temperature, and pain sensation. Chrysin
CoEnzyme Q10
Dose A typical dose is 150–300 mg/daily. No dose has
been established for weight loss.
Cordyceps
Adverse May cause gastrointestinal symptoms, such as Creatine
Effects heartburn, stomach pain, flatulence, nausea, vom- DHEA
iting, diarrhea, and loss of appetite. Safety con- Ephedra
cerns are comparable to tryptophan: 5-HTP has
Fish Oil
may cause eosinophilia myalgia syndrome (EMS)
because of certain contaminants. Ginkgo Biloba
Ginseng
Comments 5-HTP or 5-hydroxytryptophan is related to both Glucosamine
L-tryptophan and serotonin. In the body, L-tryp- Glutamine
tophan is converted to 5-HTP, which can then be
Guarana
converted to serotonin.
HMB
Hoodia
Hoodia
Claims Achieve weight or body fat loss. 5-Hydroxytryptophan
Lysine
Other Cactus, Hoodia Gordonii Cactus, Hoodia P57, Melatonin
Names Kalahari Cactus, Kalahari Diet, P57, Xhoba. Nitric Oxide
Pycnogenol
How It Contains a substance that is believed to be an ap-
Works petite suppressant. Quercetin
St. John’s Wort
Dose No established dose has proven effective for Synephrine
weight loss. Tribulus Terrestris
Tryptophan
Adverse None yet reported due to lack of published re-
Turmeric
Effects search.
Tyrosine
Whey Protein
Yohimbe
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Hoodia
Bitter Orange
Boron Comments Hoodia gordonii, Hoodia P57 or Kalahari Cactus,
Branched Chain Amino Acids is a succulent plant that grows in the Kalahari
Desert in southern Africa. It was used by bushman
Caffeine
to minimize sensations of hunger.
Carnitine
Choline
Chondroitin Sulfate
Chromium Other Supplements
Chrysin
CoEnzyme Q10 Chondroitin Sulfate
Claims Alleviates pain and improves function in persons
Cordyceps with osteoarthritis.
Creatine
DHEA Other Chondroitin Polysulfate, CPS, CS, CSA, CSC,
Ephedra Names GAG.
Fish Oil
How It Chondroitin is found in cartilaginous tissues where
Ginkgo Biloba
Works it functions to form the joint matrix structure; it
Ginseng may also protect cartilage against degradation by
Glucosamine inhibiting a particular enzyme.
Glutamine
Guarana Dose A typical dose is 200–400 mg two to three times
HMB daily or 1,000–1,200 mg as a single daily dose.
Hoodia
Adverse Chondroitin appears to be well-tolerated, although
Hydroxycitric Acid/HCA Effects some people experience can have stomach pain
Hydroxymethylbutyrate and/or nausea.
5-Hydroxytryptophan
Lysine Comments Products containing chondroitin or chondroitin
plus glucosamine vary greatly in quality and label
Melatonin
claims. Make sure the product is USP approved.
Nitric Oxide Chondroitin plus glucosamine combinations that
Pycnogenol also contain manganese may be the more effec-
Quercetin tive products.
St. John’s Wort
Synephrine Dehydroepiandrosterone
Tribulus Terrestris
Tryptophan Claims Dehydroepiandrosterone (DHEA) is used for a
Turmeric multitude of different reasons to include reversing
the effects of aging, weight loss, enhancing im-
Tyrosine
mune function, increasing strength, energy, and
Whey Protein muscle mass, depression, and diabetes.
Yohimbe
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Dehydroepiandrosterone
Bitter Orange
Other DHEA Boron
Names Branched Chain Amino Acids
Caffeine
How It DHEA is produced in the adrenal glands, liver,
Carnitine
Works brain and testes of men. DHEA and its sulfate
ester, dehydroepiandrosterone sulfate (DHEA-S), Choline
act on many tissues, but the actual way it might Chondroitin Sulfate
work is not certain. For sure it has potent actions Chromium
in the brain, and limited actions as a testosterone Chrysin
promoter.
CoEnzyme Q10
Dose The dose depends on the use. Typically 25–50 Conjugated Linoleic Acid
mg daily are used for the elderly whereas up to 90 Cordyceps
mg is used for depression. Up to 200 mg daily has Creatine
been used. DHEA
Ephedra
Adverse No real adverse effects have been noted at doses
Effects below 75 mg daily. Fish Oil
Ginkgo Biloba
Comments DHEA can be chemically made or derived from Ginseng
natural sources, such as soy and wild yam. How- Glucosamine
ever, these natural sources have no effect on blood Glutamine
levels of DHEA. Natural products (wild yam and
Guarana
soy) labeled, as “natural DHEA” should be avoided.
DHEA products have been shown to contain HMB
0%–150% of what is stated on the label. Lastly, Hoodia
DHEA is banned by the National Collegiate Athletic Hydroxycitric Acid/HCA
Association.
5-Hydroxytryptophan
Lysine
Fish Oils
Melatonin
Claims Used to decrease blood lipids, protect against Nitric Oxide

coronary heart disease and high blood pressure; Pycnogenol
used to decrease inflammation and symptoms of Quercetin
asthma. St. John’s Wort
Synephrine
Other Cod Liver Oil, Marine Lipid Oil, Marine Oils, Men-
Tribulus Terrestris
Names haden Oil, N-3 Fatty Acids, N3-polyunsaturated
Fatty Acids, Omega 3, Omega-3 Fatty Acids, Ome- Tryptophan
ga-3 Marine Triglycerides, Polyunsaturated Fatty Turmeric
Acids (PUFA), Salmon Oil, W-3 Fatty Acids. Tyrosine
Whey Protein
Yohimbe
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Fish Oils
Bitter Orange
Boron How It Fish oils are high in the omega-3 fatty acids ei-
Branched Chain Amino Acids Works cosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), which have anti-inflammatory and an-
Caffeine
tithrombotic (preventing aggregation and entrap-
Carnitine ment of cellular debris) effects.
Choline
Chondroitin Sulfate Dose Doses range from 1–3 grams/day in a single or two
Chromium divided doses. Doses over 3 grams are discouraged.
Chrysin
Adverse Can cause breath and burps to taste and smell like
CoEnzyme Q10
Effects fish. May experience heartburn and/or nausea.
Conjugated Linoleic Acid Doses greater than 3 grams per day might ad-
Cordyceps versely affect immune function.
Creatine
DHEA Comments Fish oils come from a variety of marine life in-
cluding mackerel, herring, sardines, tuna, halibut,
Ephedra
salmon, cod liver, and trout. Shellfish, such as
Fish Oil oyster, shrimp, and scallop contain less. Evidence
Ginkgo Biloba is rapidly accumulating that taking fish oil, as food
Ginseng or a supplement, has a very positive impact on
Glucosamine health.
Glutamine
Guarana
HMB Ginkgo Biloba
Hoodia
Claims Improve memory and concentration; prevent or
Hydroxycitric Acid/HCA minimize altitude sickness.
5-Hydroxytryptophan Other Fossil Tree, Ginkgo Folium, Japanese Silver Apri-
Lysine Names cot, Kew Tree, Maidenhair Tree.
Melatonin
How It Ginkgo contains many flavonoids or substances
Nitric Oxide
Works with antioxidant properties. It may work by pro-
Pycnogenol tecting against free radical damage.
Quercetin
St. John’s Wort Dose Doses of 120–600 mg per day have been used for
Synephrine improving memory and 120 mg twice a day for pre-
venting altitude sickness. Doses over 120 mg at any
Tribulus Terrestris
one time may cause mild gastrointestinal problems.
Tryptophan
Turmeric Adverse Well tolerated but may cause mild gastrointestinal
Tyrosine Effects problems, headache, dizziness, and constipation.
Whey Protein Increased risk of bleeding.
Yohimbe
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Ginkgo Biloba
Bitter Orange
Comments The Ginkgo tree, also known as the Maidenhair Tree, Boron
is unique, and may be the oldest tree in the world. The Branched Chain Amino Acids
female tree yields an apricot-like structure containing
Caffeine
nuts, fruit or seeds that are eaten for health benefits
and for special occasions. The substances from Carnitine
the ginkgo leaf are also extracted for medical uses. Choline
Studies regarding its efficacy for altitude sickness are Chondroitin Sulfate
varied—some report success and others no success. Chromium
Ginkgo may help some and not others, but who will
Chrysin
benefit is unknown.
CoEnzyme Q10
Glucosamine Cordyceps
Creatine
Claims Reduces symptoms associated with osteoarthritis, DHEA
joint pain, back pain, and possibly other musculo- Ephedra
skeletal problems. Fish Oil
Ginkgo Biloba
Other Glucosamine hydrochloride, glucosamine sulfate
Names and N-Acetyl glucosamine. Chitosamine, D-glu- Ginseng
cosamine HCl, Glucosamine, Glucosamine HCl, Glucosamine
Glucosamine KCl, Glucose-6-Phosphate. Glutamine
Guarana
How It Glucosamine hydrochloride is a constituent of car- HMB
Works tilage and is required for the formation and main-
Hoodia
tenance of tendons, ligaments, and cartilage.
Dose Typical doses are 500 mg three times daily alone Hydroxymethylbutyrate
or in combination with chondroitin sulfate. 5-Hydroxytryptophan
Lysine
Adverse Mild gastrointestinal symptoms such as gas, ab-
Melatonin
Effects dominal bloating, and cramps have been reported.
Nitric Oxide
Comments Glucosamine is usually derived from the outer Pycnogenol
structure of marine organisms or produced Quercetin
synthetically. Read glucosamine product labels St. John’s Wort
carefully for content. Avoid confusion with glu- Synephrine
cosamine sulfate and N-acetyl glucosamine be-
Tribulus Terrestris
cause these products may not be interchangeable.
Glucosamine sulfate has been studied the most Tryptophan
for osteoarthritis. Great variability exists among Turmeric
glucosamine and glucosamine plus chondroitin Tyrosine
products. Make sure the product is USP approved.
Whey Protein
Discuss these products with your physician.
Yohimbe
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Melatonin
Bitter Orange
Boron Claims Acts as a sleep agent; defends against jet lag and
Branched Chain Amino Acids oxidant stress.
Caffeine
Other MLT, Pineal Hormone.
Carnitine
Names
Choline
Chondroitin Sulfate How It The hormone, melatonin is produced in the pineal
Chromium Works gland and released into the circulation, where it
Chrysin binds to areas in the brain.
CoEnzyme Q10
Dose A typical dose for insomnia is 0.3–5.0 mg or 3–5
mg for promoting sleep during transcontinental
Cordyceps flights to alleviate jet lag.
Creatine
DHEA Adverse Minimal to no side effects are noted. Those noted
Ephedra Effects include drowsiness, headache, and dizziness.
Fish Oil
Comments Oral administration of melatonin has a rapid, tran-
Ginkgo Biloba
sient, and mild sleep-inducing effect. Melatonin is
Ginseng also used to advance the body clock before east-
Glucosamine ward flights by ingesting up to 5 mg in the evening
Glutamine of the days before departure. Melatonin is derived
from serotonin (via tryptophan and 5-HTP), which
Guarana
is converted to N-acetylserotonin, and then to
HMB melatonin.
Hoodia
Hydroxymethylbutyrate Quercetin
5-Hydroxytryptophan
Lysine Claims May be a substitute for ibuprofen/motrin/ and
Melatonin other anti-inflammatory agents.
Nitric Oxide
Other Bioflavonoid, Bioflavonoid Complex, Bioflavonoid
Pycnogenol
Names Concentrate, Bioflavonoid Extract, Citrus Biofla-
Quercetin vones, Citrus Bioflavonoid, Citrus Bioflavonoid
St. John’s Wort Extract, Citrus Flavones, Citrus Flavonoids.
Synephrine
Tribulus Terrestris How It Acts as an antioxidant and anti-inflammatory
Works agent.
Tryptophan
Turmeric
Dose A typical dose is 400–500 mg three times daily,
Tyrosine but 500 mg twice daily has been used. The ap-
Whey Protein propriate dose for anti-inflammatory actions is
Yohimbe unclear.
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Quercetin
Bitter Orange
Adverse May cause headache and tingling of the extremities. Boron
Effects Branched Chain Amino Acids
Caffeine
Comments Quercetin is a flavonoid found in red wine, tea,
Carnitine
onions, green tea, apples, berries, broccoli, spin-
ach, cabbage, cauliflower, Brussels sprouts, kale, Choline
collard greens, pak choi and kohlrabi. It is also a Chondroitin Sulfate
component of Ginkgo biloba and St. John’s Wort. Chromium
Many forms of quercetin are not well absorbed, Chrysin
which results in low bioavailability.
CoEnzyme Q10
Cordyceps
Tryptophan (L)
Creatine
Claims Induces sleep. DHEA
Ephedra
Other L-trypt, L-Tryptophan Fish Oil
Names Ginkgo Biloba
Ginseng
How It L- tryptophan acts on the brain to induce sleep.
Glucosamine
Works
Glutamine
Dose Doses of 0.3–6 grams per day have been used, Guarana
with 1–2.5 grams being most common for sleep. HMB
Hoodia
Adverse L-tryptophan has been linked to eosinophilia
Effects myalgia syndrome (EMS) and several deaths; 95%
of the cases were traced to a product produced in Hydroxymethylbutyrate
Japan. 5-Hydroxytryptophan
Lysine
Comments L-tryptophan may be beneficial as a sleep aid. Melatonin
Dietary tryptophan from protein sources is first Nitric Oxide
converted into 5-HTP (see below) and then to
Pycnogenol
serotonin, which has calming effects. Trypto-
phan should be obtained from food, such as milk, Quercetin
cheese, meats, poultry, and soy foods. Tryptophan St. John’s Wort
should not be taken in combination with sedat- Synephrine
ing products or herbals, such as 5-HTP, St. John’s
Tribulus Terrestris
wort, kava, skullcap, or valerian.
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
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Turmeric
Bitter Orange
Boron Claims May have pain-reducing and anti-inflammatory
Branched Chain Amino Acids properties. Also used to treat upset stomachs.
Caffeine
Other Curcumin, Indian Saffron, Radix Curcumae, Rhi-
Carnitine
Names zoma Cucurmae Longae.
Choline
Chondroitin Sulfate How It Appears to inhibit the inflammatory pathways,
Chromium Works similar to NSAIDs.
Chrysin
CoEnzyme Q10 Dose No dose established for anti-inflammatory actions;
500 mg four times daily has been used for stom-
ach upsets.
Cordyceps
Creatine Adverse Tolerated if dose is appropriate; may cause gastro-
DHEA Effects intestinal distress.
Ephedra
Fish Oil Comments Turmeric is a perennial plant of the ginger fam-
ily, and native to tropical South Asia. Plants are
Ginkgo Biloba
gathered to obtain the thickened stem (rhizomes)
Ginseng that grows below or on the soil surface. Turmeric
Glucosamine is frequently used to flavor or color curry powders,
Glutamine mustards, butters, and cheeses.
Guarana
HMB
Hoodia
Thermogenic Agents
5-Hydroxytryptophan None of these agents should be used.
Lysine
Melatonin
Nitric Oxide A multitude of thermogenic or “energy metabolism boosting” substanc-
Pycnogenol es are available on the market. The most common ingredients in dietary
Quercetin supplements marketed to promote weight loss are bitter orange (Citrus
St. John’s Wort aurantium), country mallow or heartleaf (Sida cordofilia), and ephedra.
Synephrine Others are marketed as “fat burners.” Each carries a significant degree of
Tribulus Terrestris risk, particularly when used during exercise training and extreme environ-
Tryptophan mental conditions, such as a warm environment, diving, and at altitude.
Turmeric
Tyrosine
Bitter Orange and Country Mallow
Whey Protein
Yohimbe
Claims Increase metabolic rate and induce weight loss.
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Bitter Orange and Country Mallow
Bitter Orange
Other Orange Peel Extract, Seville Orange, Shangzhou Boron
Names Zhiqiao, Sour Orange, Synephrine, Citrus auran- Branched Chain Amino Acids
tium, and/or Zhi Shi, Heartleaf, and White Mallow.
Caffeine
Carnitine
How It Synephrine, like ephedra, is a stimulant that in-
Works creases heart rate and blood pressure. Choline
Chondroitin Sulfate
Dose Since serious adverse effects have been linked to Chromium
low doses of these substances, there is no known Chrysin
safe or recommended dose for these products.
CoEnzyme Q10
The ephedra ban was upheld after a recent court
challenge in Feb 2007; the Food and Drug Admin- Conjugated Linoleic Acid
istration has submitted recommendations to have Cordyceps
both bitter orange and country mallow added to the Creatine
ephedra ban. DHEA
Ephedra
Adverse Bitter orange and country mallow all contain
Effects ephedrine or synephrine, which has been linked to Fish Oil
serious cardiovascular, or heart, events to include Ginkgo Biloba
ischemic stroke, rapid heart rate, heart attacks, Ginseng
and even death. Glucosamine
Glutamine
Comments Manufacturers have substituted synephrine in
Guarana
products that previously contained ephedra.
Marketed as ephedra-free, they typically contain HMB
synephrine from bitter orange and/or country Hoodia
mallow, plus caffeine and/or caffeine-containing Hydroxycitric Acid/HCA
supplements. These may pose the same or greater
risks than the original product that contained
ephedra. Bitter orange has Generally Recognized 5-Hydroxytryptophan
as Safe (GRAS) status in the US and is commonly Lysine
found in foods. Melatonin
Nitric Oxide
Conjugated Linolenic Acid (CLA) Pycnogenol
Quercetin
Claims Improves body composition/decrease fat mass in St. John’s Wort
overweight or obese persons; reduces hunger. Synephrine
Tribulus Terrestris
Other Conjugated LA, CLA-Triacylglycerol, LA, Linoleic
Names Acid. Tryptophan
Turmeric
How It CLA may help shrink fat tissue by inducing cell Tyrosine
Works death of fat cells. Whey Protein
Yohimbe
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Conjugated Linolenic Acid (CLA)
Bitter Orange
Boron Dose Doses ranging from 2–7 grams per day have been
Branched Chain Amino Acids used, but more than 3.4 grams per day does not
confer additional benefit.
Caffeine
Carnitine
Adverse CLA has been associated with gastrointestinal
Choline Effects distress to include nausea, loose stools, and heart
Chondroitin Sulfate burn. One form of CLA might predispose to type 2
Chromium diabetes and cardiovascular disease.
Chrysin
Comments Although CLA appears to reduce hunger, this is
CoEnzyme Q10
not associated with a reduction in energy intake.
Cordyceps
Creatine Ephedra
DHEA
Ephedra Ephedra has been banned and should not be used under any circum-
stances.
Fish Oil
Ginkgo Biloba
Ginseng Garcinia Cambogia or HCA
Glucosamine
Glutamine Claims Inhibits conversion of excess calories to body fat.
Guarana
Other Hydroxycitrate, Hydroxycitric Acid, Super Citri-
HMB
Names Max, Citrimax, Citrilean, Citrinate and Malabar
Hoodia Tamarinda.
Hydroxymethylbutyrate How It Garcinia may interfere with fat production by
5-Hydroxytryptophan Works inhibiting the formation of fatty acids. It may also
lower the formation of LDL and triglycerides. In
Lysine
addition, HCA may suppress appetite by promot-
Melatonin ing glycogen synthesis.
Nitric Oxide
Pycnogenol Dose Several different doses have been used: 300 mg
Quercetin three times daily; 500 mg four times daily; and
St. John’s Wort 1000 mg three times daily. Doses up to 2800 mg/
day appear to be safe for short periods of time (up
Synephrine
to 90 days).
Tribulus Terrestris
Tryptophan Adverse Can cause nausea, gastrointestinal distress and/or
Turmeric Effects headache.
Tyrosine
Whey Protein Comments No conclusive evidence is available that Garcinia
cambogia or HCA promotes any significant chang-
Yohimbe
es in weight.
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Digestion Inhibitors
Digestion inhibitors are typically high fiber products, such as psyllium, Bitter Orange
chitosan, glucomannan, guar gum, guggul and inulin. Boron
Caffeine
Claims Prevent weight gain by blocking the absorption or
digestion of food. Carnitine
Choline
How It They may slow digestion and interfere with or Chondroitin Sulfate
Works prevent the absorption of fat and carbohydrates. Chromium
Chrysin
Dose Each product promotes a certain dose. For exam-
ple, chitosan has been used in doses ranging from CoEnzyme Q10
1–5 grams and with other inhibitors. A specific Conjugated Linoleic Acid
combination of 1.2 grams of chitosan combined Cordyceps
with 1.2 grams of glucomannan daily has been Creatine
used. Also, 2.5 grams of chitosan with 1 gram of
DHEA
psyllium have been used.
Ephedra
Adverse Major potential problems include gastrointestinal Fish Oil
Effects upset, nausea, gas, bulky stools, and constipation. Ginkgo Biloba
Ginseng
Comments Chitosan appears to block the absorption of 5–9 Glucosamine
grams of fat daily; which is equivalent to only
Glutamine
45–81 kcal/day. Therefore, these products may
not be effective for weight loss. Guarana
HMB
Hoodia
The Good, the Bad and the Ugly Facts Hydroxymethylbutyrate
5-Hydroxytryptophan
The following supplements are categorized as “good” due to the avail-
Lysine
ability of data derived from scientific, controlled studies that have demon-
Melatonin
strated safety and effectiveness of these products for specific conditions.
Nitric Oxide
Pycnogenol
The Good Facts Quercetin
St. John’s Wort
Multivitamins for Protection from
Synephrine
“Vending Machine Malnutrition” Tribulus Terrestris
A daily multivitamin/mineral supplement providing less than 100% of Tryptophan
the RDI for any one nutrient is reasonable for individuals that consistently Turmeric
fail to consume a balanced diet. However, it is important to avoid “mega” Tyrosine
dose products that supply 1000% of the RDI for beta-carotene, vitamin A, Whey Protein
vitamin E and other fat-soluble vitamins. Long-term use of high doses of Yohimbe
fat-soluble vitamins can cause toxicity symptoms.
118
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Bitter Orange t May be beneficial in lowering blood glucose and blood lipid levels in
Boron patients with diabetes.
Caffeine
The Bad Facts
Carnitine
Choline
Chondroitin Sulfate None of the following products should be used.
Chromium
Chrysin
The following supplements are listed as “bad” due to serious health risks
CoEnzyme Q10
or adverse effects linked to use.
Cordyceps
Steroids and Steroid-Enhancers
Creatine
These agents have been linked to liver toxicity, testicular shrinkage,
DHEA
breast enlargement in males, adverse effects on lipid levels and increased
Ephedra
risk of heart attack and stroke.
Fish Oil
Ginkgo Biloba
Andro and Andro precursors
Ginseng
t Banned for use by military personnel!
Glucosamine
Glutamine t Listed as Schedule III controlled substances (cocaine and heroin are
Guarana also on this list).
HMB
Hoodia Hemp Oil
Hydroxycitric Acid/HCA From the seed of the hemp plant.
Hydroxymethylbutyrate t Widely used in body care products, lubricants, paints and industrial uses.
5-Hydroxytryptophan
t Hemp oil is deliberately manufactured to contain no significant
Lysine
amounts of THC and is therefore not a psychoactive drug.
Melatonin
t Banned for use by Air Force personnel.
Nitric Oxide
Pycnogenol t Pop positive for marijuana on drug urinalysis.
Quercetin
St. John’s Wort Ephedra (Ephedra sinica)
Synephrine t Ephedra is a naturally occurring substance derived from botanicals.
Tribulus Terrestris The principal active ingredient is ephedrine, an amphetamine-like
Tryptophan compound that stimulates the nervous system and heart.
Turmeric t Also known as ma huang, Chinese Ephedra, Ephedrine, Ephedrine Al-
Tyrosine kaloid, Herbal Ecstasy, Sea Grape, Teamster’s Tea, Yellow Astringent,
Whey Protein Yellow Horse.
Yohimbe t Ephedra is illegal: On August 17, 2006 the U.S. Court of Appeals for
the Tenth Circuit in Denver upheld the FDA final rule declaring all
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therefore illegal for marketing in the United States.
Bitter Orange
t Ephedra can cause life-threatening adverse effects in some people.
Boron
Multiple case reports have linked ephedra to hypertension, myocardial
infarction (MI), seizure, stroke, psychosis, and death.
Caffeine
t Ephedra is a stimulant that can cause heart arrhythmias and cardiac failure.
Carnitine
Choline
Synephrine Compounds: Bitter Orange (Citrus aurantium)
Chondroitin Sulfate
and Country Mallow, or Heartleaf (Sida cordofolia) Chromium
t Present in “ephedra free” compounds but the effects are comparable Chrysin
to ephedra. CoEnzyme Q10
t Effects on blood pressure and heart rate are enhanced when taken Conjugated Linoleic Acid
with caffeine-containing herbals such as guarana, kola nut, mate, green Cordyceps
tea and black tea. Creatine
DHEA
Ephedra
No approved thermogenic agents have been Fish Oil
shown to be safe and effective for weight loss! Ginkgo Biloba
Ginseng
Glucosamine
Glutamine
Valerian
Guarana
t Sold as a sleep aid and does have a sedative effect.
HMB
t Mixed with alcohol, it can be dangerous—increases sedative effect! Hoodia
Kava Kava Hydroxymethylbutyrate
t Linked to liver damage and liver failure! 5-Hydroxytryptophan
t Banned in European countries and Canada. Lysine
Melatonin
St. Johns Wort Nitric Oxide
Pycnogenol
t Effective in treatment of mild depression.
Quercetin
t Interferes with a huge number of medications, including birth control St. John’s Wort
pills, blood pressure medication, diabetes and cholesterol medications
Synephrine
and anti-depressants.
Tribulus Terrestris
t Safety warnings now posted in other countries. Tryptophan
Turmeric
5-HTP or 5-Hydroxytryptophan Tyrosine
t Preliminary results indicate that 900 mg/day decrease carbohydrate Whey Protein
consumption and causes early satiety and weight loss. Yohimbe
t Serious safety concerns due to cases of EMS (Eosinophilia myalgia syndrome).
120
= Jump to: Aristolochia
Bitter Orange t Used as an aphrodisiac and immune stimulant.

Boron
t Contains aristolochic acid, which is nephrotoxic and carcinogenic.
Caffeine t FDA considers all products containing aristolochic acid to be unsafe
Carnitine and adulterated.
Choline
Chondroitin Sulfate t Although illegal, is still available for sale over the internet.
Chromium
Chrysin Usnea or Usnic acid
CoEnzyme Q10
t Used for weight loss and pain relief.
Cordyceps t A lichen or type of fungus found in a weight loss product called Lipokinetix.
Creatine
t Linked to liver damage and liver failure.
DHEA
Ephedra t Warning issued by FDA on this product.
Fish Oil
Ginkgo Biloba Salvia
Ginseng
Glucosamine t A perennial herb from the mint family that is native to certain areas of
Glutamine Oaxaca, Mexico.
Guarana
t Used by the Mazatec Indians for ritual divination and healing.
HMB
Hoodia t Can induce hallucinations, changes in perception, and other psycho-
Hydroxycitric Acid/HCA logical effects.
5-Hydroxytryptophan t Can provoke introverted feelings, mild paranoia, excessive sweating
Lysine and confusion.
Melatonin
t Can induce unconsciousness and short-term memory loss.
Nitric Oxide
Pycnogenol t Could seriously undermine military missions.
Quercetin
St. John’s Wort
Synephrine Herbal formulas with multiple ingredients
Tribulus Terrestris
are risky because the quantities and
Tryptophan
Turmeric purity are unknown or measured!
Tyrosine
Whey Protein
Yohimbe Click for information about FDA warnings on herbals and dietary
supplements.
121
= Jump to:
The Ugly Facts
Popular products are considered “ugly” if no legitimate scientific research Bitter Orange
or supporting claim of safety and effectiveness are available or if adverse Boron
events are linked to the use of these products. A list of products with on Branched Chain Amino Acids
legitimate evidence to support their claims is provided. Buyer beware! Caffeine
Carnitine
Choline
Products with No Legitimate Evidence to Support Claims Chondroitin Sulfate
Boron Garcinia Cambogia Nitric Oxide Chromium

Chrysin
Branched Chain AA Ginkgo Biloba Pycnogenol CoEnzyme Q10
Carnitine Ginseng Pyruvate
Cordyceps
Chrysin Glutamine Taurine Creatine
DHEA
CoEnzyme Q10 Hoodia Tribulus Terrestris
Ephedra
Conjugated Linoleic Hydroxycitric Acid/ Turmeric Fish Oil
Acid HCA Ginkgo Biloba
Cordyceps 5-Hydroxytrypto- Whey Protein Ginseng
phan Glucosamine
Glutamine
DHEA Lysine Yohimbe
Guarana
HMB
Hoodia
Energy Drinks Hydroxycitric Acid/HCA

Energy drinks are beverages designed to give a burst of energy. Typical- 5-Hydroxytryptophan
ly they contain a combination of sugars, caffeine, B vitamins, amino acids, Lysine
and/or herbal ingredients. The amino acids may include taurine, carnitine,
Melatonin
creatine, leucine and the herbals may include guarana (extracts from the
Nitric Oxide
guarana plant), ginseng, maltodextrin, and/or ginkgo biloba. Some energy
Pycnogenol
drinks contain inositol and glucuronolactone. The FDA currently does not
regulate energy drinks and minimal research has been done on them. The Quercetin
long-term effects of the various energy drink ingredient contaminations St. John’s Wort
are unknown. Most claims are misleading and have not been proven. Po- Synephrine
tential side effects of energy drinks include an increase in heart rate and Tribulus Terrestris
blood pressure, anxiety, and nervousness. Energy drinks should not be Tryptophan
used while exercising, during training or missions or with alcohol because Turmeric
of the multiple combinations of ingredients, and the possibilities of gas- Tyrosine
trointestinal distress and disturbances in heart rhythms. Whey Protein
Caffeine is a common ingredient in energy drinks. The caffeine content Yohimbe
of energy drinks ranges from 33 mg to nearly 80 mg per serving, with most
122
= Jump to: drinks providing more than the FDA recommended limit for colas. SoBe No
Fear had 141 mg in a 16-oz. serving, in contrast to 55 mg, 46 mg, and 37 mg
Bitter Orange
in 12 oz of Mountain Dew, Diet Coke, and Pepsi Cola, respectively.
Boron
Branched Chain Amino Acids Taurine is also a common ingredient in energy drinks. The amount of
taurine obtained from these beverages is three or more times higher than
Caffeine
what is typically obtained through the diet. Limited information from ei-
Carnitine
ther animal or human studies is available to assess the risk of excessive
Choline
taurine intake. Also, potential interactions between taurine and caffeine
Chondroitin Sulfate
have not been adequately studied.
Chromium
Chrysin Glucuronolactone, an ingredient in many energy drinks, occurs
naturally in the body when glucose breaks down. The glucuronolactone
CoEnzyme Q10
content of the drinks varies between 2000 mg/L and 2400 mg/L. The
daily intake of glucuronolactone from a normal diet is only 1.2 to 2.3 mg
Cordyceps
and the intake of glucuronolactone from energy drinks is several hundred
Creatine
times higher. The potential effects of excessive glucuronolactone intake
DHEA
are unknown.
Ephedra
Table 2 on the following page presents the amounts of various ingredi-
Fish Oil
ents in some popular energy drinks.
Ginkgo Biloba
Ginseng Click for more information on energy drink ingredients.
Glucosamine
Glutamine
Guarana
HMB
“The resilience and determination of
Hoodia older operators beats the youthful use
Hydroxycitric Acid/HCA of untested supplements.”
5-Hydroxytryptophan Warner D. “Rocky” Farr, COLONEL, U.S. ARMY,
Lysine Command Surgeon, USSOCOM
Melatonin
Nitric Oxide
Pycnogenol
Quercetin
St. John’s Wort
Synephrine
Tribulus Terrestris
Tryptophan
Turmeric
Tyrosine
Whey Protein
Yohimbe
123
Table 11–2. Supplement Content of Energy Drinks
Beverage, Caffeine Taurine Ginseng Guarana L-Carnitine GRL (mg)*

Serving Size (mg) (mg) (mg) extract (mg) (mg)
Red Bull, 80 1000 – – – 600

8.3 oz
Monster 70 1000 200 * * Unknown

Energy, 8 oz amount
Arizona 7.5 1000 100 100 – 100

Green Tea,
8 oz
Rockstar 80 1000 25 25 25 –
Original,
8 oz
Rockstar 80 1000 25 25 25 –
Juiced, 8 oz
Full Throt- 144 605 90 .70 14 –

tle, 16 oz
SoBe No 83 1000 50 50 25 –
Fear, 8 oz
SoBe Adren- 78 1000 25 50 250 –

aline Rush,
8.3 oz
Amp, 8.4 oz 75 10 10 150 – –
Crunk 100 – – – – –
Juice, 8.3 oz
Spark, 8 oz 120 200 – – 10 –
Rush, 8.3 oz 50 1000 – – Unknown 1505

Amount
Redline, 250 – – – – 637

8 oz
Bookoo, 120 1000 – – – –

8 oz
Socko, 8 oz 80 1000 20 25 – 75
12 Enemy Agents
In This Chapter
Smokeless Tobacco (ST)
Alcohol
Antihistamines
Non-Steroidal
Anti-Inflammatory
Drugs (NSAIDs)
Key Points
t All tobacco products, including smokeless tobacco, are addictive,
Steroids
and can cause cardiovascular damage and various forms of cancer.
Multi-Ingredient t Alcohol, in excess, can lead to dehydration and compromise perfor-
Steroid Alternatives
mance. Do not mix drugs and alcohol: beware of alcohol-drug interac-
Ephedra tions.
t Over-the-counter drugs, such as antihistamines, non-steroidal anti-
inflammatory drugs, and aspirin should be used in moderation and
under a physician’s care if being used for long-term therapy.
t NSAIDs should not be used during deployments because they make
bleeding difficult to control.
t Steroids and steroid alternatives are illegal and unsafe; they can seri-
ously harm the body and negatively affect performance.
E
nemy agents are substances that may pose significant detrimental ef-
fects on health, even if some may enhance performance or make one
feel better, be it physical, mental, or psychological. If these agents
are used, it is important to be aware of their potential harmful ef-
fects, on either health or performance. The enemy agents of interest in this
chapter will be chewing tobacco, alcohol, antihistamines, steroids, non-
steroidal anti-inflammatory medications, other over-the-counter products,
and ephedra.
Enemy Agents: Smokeless Tobacco (ST)

Substances that impair physical,
mental, or psychological perfor- Like 7.3 million persons in the United States, many SOF personnel have
mance or compromise health. been or are frequent users of smokeless tobacco (ST). The majority of
people who use ST are young and middle age adult males. The primary
reason ST is considered an enemy agent is because of its adverse effects
= Smokeless Tobacco links. on health. Persons who use ST have:
t 50-fold higher risk of oral cancer than those who do not use ST.
t Increased risk for gum disease.
125
t Permanent tooth stains.

t Bad breath.
= National Institute t Sores on the lips and mouth.

on Alcohol Abuse t Tooth decay, because of the sugar added to ST.
and Alcoholism.
t Increased blood pressure and heart rate.
t Increased levels of LDL cholesterol, the “bad” cholesterol.
One reason the risk of cancer is so high is because ST products contain
at least 28 chemicals that may cause cancer. Despite these issues, many
athletes and SOF believe that ST improves performance or enhances reac-
tion time by providing a quick “rush” during the event, but this is usually
not the case.
Nicotine
Nicotine, the active ingredient in all tobacco products, is very addict-
ing (as addicting as cocaine or heroin), and nicotine addiction is one of
the most prevalent addictive behaviors worldwide. Nicotine is a naturally
occurring “alkaloid,” like caffeine, that exerts potent effects on the human
body. It is considered a psychoactive drug, which means it alters the nor-
mal functioning of the brain by stimulating the central nervous system.
This results in the nicotine “buzz,” or “high.” When ST is placed in the
mouth, the nicotine is readily taken up into the small blood vessels that
line the mouth and gums, after which it travels through the bloodstream to
the brain where it exerts multiple effects.
Nicotine initially causes a rapid release of adrenaline, the “fight-or-
flight” hormone, which increases heart rate, blood pressure, and blood
glucose. However, the results of nicotine’s effects are short-lived and may
last only 40 minutes to a couple of hours. After a period of time the effects
of nicotine are lessened, and more and more nicotine is needed to achieve
the same degree of stimulation or relaxation.
Although nicotine and tobacco have enough disadvantages to discour-
age their use, it is important to remember that, in certain situations, they
may provide desirable effects. This is why leaders, like George Washington
during the Revolutionary War, request “necessary” items like food, muni-
tions, and tobacco for their troops. The reported “benefits” of nicotine
include:
t Decreased appetite.
t Control of or reduction in body weight.
t Ability to focus attention.
t Increased energy.
t Decreased pain.
126
The ability to focus attention or “enhance mental state” is why users

claim their reaction time and performance are enhanced. However, no
studies have shown differences in reaction times between users and non-
users of smokeless tobacco. Remember: there are no reaction time im-
provements with chew.
Nicotine has some very detrimental effects. It:
t Increases blood pressure, heart rate, and rate of respiration.
t Constricts/tightens blood vessels, which is why increases in blood

pressure and heart rate are seen. One study of young athletes showed
that the amount of blood the heart pumped in one minute decreased
while using ST. This would be highly undesirable for SOF during
strenuous exercise, and could compromise performance particularly in
a warm environment.
t Stimulates the nervous system.
Nicotine Withdrawal
Repeated or chronic administration of nicotine usually results in drug
dependence. Therefore, cessation of nicotine after dependence develops
may result in withdrawal effects (see below). Most of these effects last
weeks, but some (body weight gain and nicotine craving) may persist a
year after cessation.
The adaptations of nicotine dependence may include increasing or

decreasing the number of receptors in the brain and/or increasing or de-
creasing the release of neurotransmitters that signal the brain. The end The risks of using ST
result is a disturbance in function. Some of the symptoms of trying to quit outweigh the benefits.
nicotine include:
t Irritability.
t Anxiety.
t Depression.
t Moodiness.
t Headaches.
t Trouble sleeping.
t Poor concentration.
t Craving for nicotine.
t Increased body weight.
The military has many programs for individuals trying to quit smoking
and chewing, but it is best to never start.
127
Alcohol
Heavy drinking is a major cause of preventable death. It can damage
the liver, heart, and skeletal muscles; increase the chance of developing
some cancers, contribute to violence, and interfere with relationships. In-
dividual reactions to alcohol differ, depending on many factors. Important
factors include:
t Age.
t Gender.
t Race or ethnicity.
t Genetics.
t Weight.
t Fitness level.
t Amount of food eaten before drinking.
t How quickly alcohol was consumed.
t Use of drugs/prescription medicines.
t Family history of alcohol problems.
Regardless of the factors, alcohol has only negative effects on perfor-
mance. In particular, drinking alcohol leads to a state of dehydration, in
the absence of adequate fluid replacement. People have died during road
races and regular training after a night of heavy drinking, due to inade-
quate rehydration prior to, and hydration during, exercise. Although a rare
occurrence, it can happen. More frequently, a dehydrated state places an
athlete at greater risk for musculoskeletal injuries (cramps, muscle pulls,
and muscle strains), which will clearly compromise mission objectives.
Excessive alcohol intake can lead

to severe dehydration.
Alcohol consumption also decreases the use of glucose and amino ac-
ids by skeletal muscles, which adversely affects energy supply and meta-
bolic processes during exercise. Chronic alcohol consumption may lead
to structural changes in skeletal muscle and a decrease in the size of all
muscle fiber types, both of which will adversely affect performance. Alco-
hol also hinders the muscle’s ability to replenish energy stores, which may
increase recovery time or compromise rehab after an injury. In addition,
athletes who use alcohol have twice the injury rate as non-alcohol users.
In addition to performance decrements, using specific drugs with alcohol
can have serious medical consequences. The National Institute on Alcohol
128
Abuse and Alcoholism (NIAAA) has a publication “Harmful Interactions:

Mixing Alcohol with Medicines” that details all of the known interactions.
Examples include the increased risk of bleeding in the stomach when
aspirin and non-steroidal anti-inflammatory medications are combined.
Also, taking medications that contain acetaminophen when drinking beer
can greatly increase the risk of liver toxicity. Combining beer with anti-
histamines, barbiturates (Nembutal, Luminal, Seconal), benzodiazepines
(Ativan, Valium, Restoril) and tricyclic antidepressants (Elavil, Pamelor),
and other agents used as sleeping aids may increase the sedative effect of
these drugs and cause other adverse effects.
Click for the NIAAA Publication on Alcohol-Drug Interactions.

information on
Mixing alcohol with drugs can be dangerous! antihistamines.
= Drugs, supplements,
and herbal information.
Antihistamines
Antihistamine use is prevalent among all groups of people because they
are common over-the-counter and prescription medications. Many types of
antihistamines are used, with the most common “sedating” ones being:
t Diphenhydramine (Benadryl).
t Chlorpheniramine (Chlor-Trimeton).
t Cyproheptadine (Periactin).
t Hydroxyzine (Atarax, Vistaril).
Some detrimental performance and side effects of sedating antihista-

mines include:
t Decreased ability to concentrate.
t Delayed reaction time.
t Sleepiness.
t More “misses” on target practice.
t Dry mouth.
t Increased heart rate.
t Blurred vision.
t Constipation.
129
Antihistamines may cause drowsiness and

compromise mental performance.
Because of the problem of drowsiness, other “non-sedating” or less se-

dating types of antihistamines have been developed. The “non” sedating
antihistamines include:
t Cetirizine (Zyrtec).
t Fexofenadine (Allegra).
t Loratadine (Claritin).
Allegra (Fexofenadine) is the least sedating, and although Claritin and
other Loratadine-containing products are minimally sedating, sedation
may occur at higher doses. The antihistamine, Zyrtec (Cetirizine) is con-
sidered less sedating than Benadryl, but it can be sedating at the usual
dose, so pay attention to individual reactions. No clearly defined effects on
physical performance have been reported, but caution should be exercised
when taking any type of medication.
The use of anti-histamines, specifically benadryl, has been associated
with heat casualties and heat stroke during training. Ranger school has
had at least one fatality due to heat stroke in a student who was taking
benadryl to treat poison ivy.
NSAID/Vitamin M delays
and hampers healing Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
in muscles, ligaments, A number of over-the-counter (OTC) medications, including aspirin and
tendons, and cartilage. ibuprofen (non-steroidal anti-inflammatory drugs, or NSAIDs), are readily
available and widely used by SOF, who call these medications “Vitamin
M.” Vitamin M refers to “Motrin.” These drugs are found in most medicine
cabinets and in a medic’s pack to treat pain, reduce fever, and/or inflam-
mation. However, several dangers are associated with using these medica-
tions on a regular basis. They include:
t Potential decrease in the effectiveness of daily aspirin use, if taken at
same time as the NSAID.
t Contribute to gastrointestinal problems, including bleeding and ulcers.
t Trigger an asthmatic attack in persons with exercise-induced asthma.
t Mask signs of a more serious medical problem that may require medi-
cal intervention.
t Contribute to development of hyponatremia in endurance athletes.
t Cause serious performance and health decrements of some endurance athletes.
130
t Slow down the healing of muscles, cartilage, ligaments and tendons.

The FDA has requested that package inserts for all NSAIDs include a
warning about the potential increased risk of cardiovascular events and,
serious, and potentially life-threatening, gastrointestinal bleeding. The
clear message is that NSAIDS or Vitamin M should be used on a limited
basis. Products with fewer side effects should be used, whenever possible
(See Quercitin in Chapter 11). When pain is prolonged or seems to be
worsening, medical attention must be sought for a proper evaluation.
With respect to hyponatremia and long distance events, NSAIDs should
not be used until after exercise and even then, taken in moderation. A
proper warm-up and sound nutritional practices will do more to prevent
muscle soreness and inflammation than popping Vitamin M.
Importantly, the mission must be considered before taking NSAIDs as
they interfere with clotting. If injured, the use of NSAIDs makes bleed-
ing difficult to control. For general aches and pains, acetaminophen is
an alternative. If an NSAID is essential, meloxicam (Mobic) or celecoxib
(Celebrex) are alternatives.
Consult with a physician or pharmacist Generic Name Brand Names

prior to using NSAIDS. Aspirin Made by
several
companies
Ibuprofen Motrin®,
Steroids (Anabolic-Androgenic) Advil®,
Motrin IB®
Anabolic steroids are compounds “designed” to behave like testos-
terone, the primary androgenic or “masculinizing” hormone that builds Naproxen Naprosyn®,
Aleve®
muscle and enhances male attributes. These steroids are classified as
“Controlled Substances” and regulated by the Drug Enforcement Admin- Meloxicam Mobic®
istration (DEA). They are banned by most athletic associations.
Congress passed the Anabolic Steroid Control Act of 2004 in response
to a rise in steroid abuse by athletes, teenagers, and, especially, young-
sters. This Act redefined the term “anabolic steroid” to mean “any drug or
hormonal substance, chemically and pharmacologically related to testos-
terone (other than estrogens, progestins, corticosteroids, and dehydroepi-
androsterone).” Androstenedione, androstenediol, androstanediol, andros-
tanedione and similar substances (total of 26 androgenic and pre-cursor
substances) were banned by the FDA in January 2005. Many of these
substances, once sold as dietary supplements, became controlled, which
means they are in the same category as cocaine and heroin: they are il-
legal to purchase or use.
131
It is important to understand that testosterone itself is not effective

when taken orally or by injection because of its rapid degradation by the
liver. This is why so many modifications are made to the chemical struc-
ture of testosterone with the expectation of finding a substance with ac-
tions similar to testosterone. This is the reason why transdermal patches,
buccal tablets and nasal sprays are being used as delivery modalities.
Anabolic Steroids and Cycling

Steroids are used illegally by athletes and others to enhance perfor-
mance and/or improve physical appearance. The use of anabolic-andro-
genic steroids has been shown to increase body mass, lean body mass,
strength, and power, and decrease body fat, which may directly or indi-
rectly enhance performance. Because of these effects, SOF may be using
them intentionally or unintentionally.
Doses taken by users/abusers may be 10–100 times higher than doses typi-
cally used for medical conditions. Anabolic steroids are taken orally or injected,
typically in cycles of weeks or months. “Cycling” is when multiple dosages are
taken over a period of time and then stopped for a specific period of time be-
fore beginning the cycle over again. The primary reason for cycling is to reduce
the risk of side effects, which increases with length of time on the drugs.
= More information on
anabolic steroids.
“Stacking” is a method commonly used by steroid (ab)users. Two or

more types of steroids may be taken at the same time, sometimes mixing
Steroid use will harm the oral and injection drugs. Some drugs may be obtained “off the economy”
body, both short term of a foreign country, or they may be meant for veterinary use. This is a
and in the long run. serious concern, because such drugs may be adulterated with other dan-
gerous substances.
“Pyramiding” is another dangerous method of steroid use/abuse. There
are many paradigms, but in one case, the person increases the frequency,
dosage, and/or adds various types of steroids, followed by decreasing
132
dose and frequency until no drugs are taken. The cycle during “pyramid-
ing” is usually 6–12 weeks, with return to a low/no dose at the end of
the cycle. The expected or intended benefits of “cycling,” “stacking,” and
“pyramiding” have not been substantiated scientifically. An example of a
“Ski Slope Pyramid” is shown below.
Adverse Effects of Steroids

The well-documented short- and long-term negative side effects of
anabolic steroids must be understood. It is very clear that the benefits
of performance enhancements and increasing physical attributes do not
outweigh the risks involved.
The physical side effects of using steroids are shown in Table 1. Howev-
er, many behavioral changes occur and may include aggression, violence,
irritability, anxiety, distractibility, and abrupt shifts in mood: anabolic ste- Anabolic steroids
roid users are often vulnerable to depression or rage. Of note is the fact
should be avoided.
that using anabolic steroids disturbs the regular production of testoster-
one, which may persist for months after discontinuing the drug. An un-
known portion of those who use steroids become addicted to them.
Table 12–1. Possible Health Risks/Consequences of Anabolic Steroid Use
Hormonal System Cardiovascular Liver

System
Shrinking testicles Increase in LDL Cancer

(bad cholesterol)/ (Breast, prostrate,
Decrease in HDL pancreatic)
(good cholesterol)
Develop Breasts High blood pressure Tumor(s)
Infertility Heart attack
Male-pattern bald- Enlargement of

ness heart’s left ventricle
Skin Infection Psychiatric
Severe acne HIV/AIDS Mania
Fluid retention Hepatitis Delusions
Oily scalp Rage
Jaundice Aggressive
Behavior
133
Stacking
Of great concern is the use of multiple compounds in combination with
steroids to counteract the common adverse effects. Other drugs often
used with anabolic steroids include diuretics, anti-estrogens, human cho-
rionic gonadotrophin, human growth hormone, thyroid hormone, insulin,
gonadotrophin-releasing hormone, clenbuterol, and clomid. This “poly-
pharmacy” practice is a deadly combination, and has resulted in the death
of military members.
Click for additional reliable information about steroids.
Agents Recently Banned
Androstenediol
Claims Enhances recovery and promotes muscle growth

from exercise.
Other 4-AD, 4-Androstenediol, 5-AD, 5-Androstenediol,

Names Androdiol.
How It A weak steroid hormone and is a direct precursor

Works of testosterone.
Dose A dose of 100 mg twice daily has been used.
Adverse At low doses nothing of note. May increase endog-

Effects enous testosterone production and increase levels
of estrone and estradiol.
Comments Androstenediol does not appear to increase mus-

cle strength or mass when used during 12 weeks
of high-intensity resistance training. The Anabolic
Steroid Control Act of 2004 reclassified andros-
tenediol from a dietary supplement to an anabolic
steroid, a controlled substance.
Androstenedione
Claims Enhances recovery and promotes muscle growth

from exercise.
Other Andro, Androstene.

Names
134
Androstenedione
How It A direct precursor of testosterone.

Works
Dose Doses of 100–300 mg daily have been used with-

out success.
Adverse May decrease endogenous testosterone produc-

Effects tion and increase estrogen. Stimulate growth of
prostate cancer cells. May increase risk of heart
disease in men.
Comments Taking androstenedione orally in doses of 100-

300 mg per day did not result in increased muscle
strength or size, or lean body mass when used for
2-3 months during weight training. The Anabolic
Steroid Control Act of 2004 reclassified andros-
tenedione from a dietary supplement to an ana-
bolic steroid, a controlled substance.
Multi-Ingredient Steroid Alternatives—The Bottom Line

The increased search for the creation, manufacture, and promotion of
new “designer steroids,” “pro-steroids,” “pro-hormones,” and/or “precur-
sor steroids” as over-the-counter anabolic compounds is staggering. Mul-
tiple steroid alternative products have surfaced on the market in alarm-
ing numbers, but the questions are, do they work, and how well do they
work?
Some supplements containing herbs, glandulars, minerals such as chro-

mium and boron, and a number of other compounds (ZMA) are being
marketed to build big muscles. They claim to be “alternatives to steroids.”
The major concerns associated with using such products are:
t Not properly tested and absolutely no basis to substantiate claims.
t Potential for harmful side effects, allergic reactions and toxicities.
t Metabolic pathways and waste products from some compounds are

unknown.
t Potential for testing positive for banned substances.
t Expensive and unlikely to replace the benefits of a good diet and

sound training program.
135
Contamination and Adulteration

A large number of “non-hormonal” dietary supplements, like vitamins,
minerals, and amino acids, commonly used by athletes and others, are
contaminated with and contain prohormones and/or precursor steroids.
In 2003 the International Olympic Committee issued a warning of wide-
spread contamination in numerous dietary supplements sold to athletes.
These contaminated products included:
t Protein powders and amino acids supplements.
t Creatine.
t Hydroxy-Methyl-Butyrate (HMB).
t Carnitine, ribose, pyruvate.
Approximately one in
t Guarana.
five dietary supplements
(20%) sold for building t Tribulus Terrestris.
muscle and improving t Vitamins supplements and some mineral supplements containing zinc.
athletic performance t Numerous herbal extracts.
were contaminated with t Supplements marketed as “pro-hormones” of testosterone.
“steroid-like” chemicals.
Ephedra
Ephedra (ma huang), which was discussed in Chapter 11, is an herb
containing several substances called ephedra alkaloids (ephedrine and
pseudoephedrine). Ephedra was an ingredient in dietary supplements for
a number of years until multiple adverse events (heart attack, stroke, and
death) were reported. Based on these multiple adverse events, in 2004 the
FDA concluded that dietary supplements containing ephedrine alkaloids
pose a risk of serious adverse events (heart attack, stroke, and death), and
that these risks are unreasonable in light of any benefits that may result
from the use of these products. Thus, ephedra became illegal.
FDA has the authority to take action against a dietary supplement when
the product (1) presents a significant risk, an unreasonable risk, or an im-
minent hazard; (2) does not comply with good manufacturing practices,
or (3) makes an unsubstantiated structure-function claim. The FDA rul-
ing that banned dietary supplements containing ephedrine alkaloids will
remain in effect until further notice. Although it is still available over the
internet and some companies are still selling it, this should not be happen-
ing. No product containing ephedra should be purchased or used.
If a product sounds too good to be

true, it is usually not worth trying.
In This Chapter
The Meal, Ready-to-Eat
13 Combat Rations
Individual (MRE) Menus
The Meal, Cold Weather/

Food Packet, Long-Range
Patrol (MCW/LRP)
Light Weight Rations
Tailored Operational
Training Meal (TOTM)
Key Points
First Strike Rations
t Combat rations are specially designed to supply adequate energy
Other Rations and and nutrients for particular types of missions.
Ration Components
t Environmental and operational dictate changes in combat rations
Composition of Components to meet nutritional needs.
for Combat Operations t Rations provide different amounts of energy to meet the needs
Commercial Freeze-Dried Products of various operational conditions.
t Some rations have been designed to meet strict religious diets.
Future Rations
t Commercial products are available to supplement military rations
and/or allow for greater diversity and choice for eating when de-
ployed.
M
ilitary rations are the cornerstone of combat and field feeding.
Currently, four types of rations are available: Group Feeding, In-
dividually Packaged, Restricted, and Specialty Rations. The type
of ration a warfighter needs depends on the unit’s mission, loca-
tion, and availability of personnel and equipment for preparing meals. All
military rations, except the Restricted Rations, are nutritionally adequate,
which means they meet the regulations for what a ration must contain. In
this chapter an overview and descriptions of selected rations are provided.
The Meal, Ready-to-Eat Individual (MRE) Menus

The Meal, Ready-to-Eat (MRE) is designed to sustain an individual
engaged in heavy activity when normal food service facilities are not avail-
able. The MRE may be consumed as the sole ration for up to 21 days. After
21 days, other appropriate rations should be included. When the MRE is
the sole ration, supplements and enhancements (for example, bread, milk,
and fresh fruit) should be provided, whenever feasible.
The MRE is a self-contained combat ration. Except for the beverages,
the entire meal is ready to eat: rehydration of MREs is not necessary. One
MRE packet provides an average of 1,250 kcal with approximately 13% of
137
energy from protein, 36% from fat, and 51% from CHO: one MRE provides
Each MRE menu provides ¹/3 of the Military Recommended Daily Allowance for vitamins and miner-
als, as deemed essential by the U.S. Surgeon General. Although nutrition-
an average of 1,250 kcal ally balanced (if all components are eaten), the percentage of energy from
(13% of energy from fat is higher than current recommendations in the U.S.
protein, 36% from fat, Because the different meal components of the MRE are fortified with
and 51% from CHO). selected vitamins and minerals, at least some of the contents from each
food item must be eaten.
Click here to see nutrients provided by components of the MRE.
The shelf stable, split-top bread, used to supplement the meal, provides
200 kcals (55% CHO, 12% protein, 33% fat) per pouch.
MRE Improvements: 2002–Present

Feedback from Operation Desert Shield/Storm suggested that War-
fighters would consume more of the MRE if their preferences were consid-
ered. Based on that feedback, the Fielded Individual Ration Improvement
Program was initiated to boost up variety, acceptability, palatability, and
nutrient distribution of individual combat rations to enhance consump-
tion, and hence, performance, on the battlefield.
Click here for sample MRE menus.
The Meal, Cold Weather/Food Packet, Long-Range Patrol

(MCW/LRP)
Based on activity level,
2–4 MREs would be The MCW/LRP serves as an operational ration for two separate scenar-
ios. The Meal, Cold Weather (MCW) is intended for cold weather feeding:
needed each day. it will not freeze and extra drink mixes for countering dehydration during
cold weather activities are included. Three per day should be issued for a
complete cold weather ration. The MCW is packaged in a white camou-
flage pouch similar to the former Ration, Cold Weather (RCW).
The Food Packet, Long Range Patrol (LRP) is a restricted calorie ration
meant for special operations where resupply is not available and weight
and volume are critical factors. One per day is issued to a warfighter for up
to ten days. The LRP is packaged in a tan camouflage menu pouch similar
to the current MRE. The menus contain dehydrated entree items, as well
as other accessory items.
One menu bag per day is used for the LRP, whereas three menu bags
are used per day for MCW. Thus, the MCW provides 4,500 kcal, which is
needed to replenish glycogen from exertion in extreme cold. The individ-
ual prepares the menu bags, which require 34 ounces of water to hydrate
all components in the individual menu bag.
Click here for sample menus for MCW and LRP.
138
Light Weight Rations

Each menu provides
Survival, General Purpose, Improved (GP-I) about 1,540 kcals (15%
The Food Packet, Survival, General Purpose, Improved is a restricted protein, 35% fat, and
ration used to sustain an individual in survival situations (including escape 50% carbohydrate).
and evasion, under all environmental conditions, and when potable water is
limited, for periods of less than 5 consecutive days). The ration contains six
compressed bars: 2 cereal bars, 3 cookie bars, and 1 sucrose bar. Lemon tea,
sugar, soup, and gravy base are also included. Each packet provides 1,447
kcal (5% protein, 39% fat, and 56% carbohydrate). This ration is designed to
provide a maximum of 8% of the energy from protein to minimize metabol-
ic water requirements. The percentage of kcal from fat is higher than typi-
cally recommended in order to increase the energy content and minimize information on operational
total weight: one packet weighs 11.4 ounces. Fourteen ounces of water are rations. This site offers
required to reconstitute the lemon tea, soup, and gravy base. menus, prices, weight, etc.
Survival, Abandon Ship

The Food Packet, Survival, Abandon Ship is used by the Navy to sus-
tain one person for three days (using two bars/day) who must abandon
ship; it is designed to fit in the storage areas of lifesaving craft. The packet
contains a minimum of six individually wrapped cereal bars. The ration
is strictly a short-term survival food to minimize the negative effects of
acute starvation. Each packet provides approximately 2,400 kilocalories
(54% carbohydrate). The components are compatible with potable water
restrictions. No preparation is necessary, except opening packages. The
ration weighs 5.2 ounces.
Survival, Aircraft, Life Raft

The Food Packet, Survival, Aircraft, Life Raft is used by the Navy to
sustain personnel who survive aircraft disasters. The packet, along with
other essential equipment, is supplied in emergency kits on naval aircraft.
The ration weighs 3.5 ounces and contains hard candy, candy-coated chew-
ing gum, and twine. An instruction sheet explains the use of the twine for
storing components after the packet is opened. Each packet provides ap-
proximately 300 kcal (100% carbohydrate). It is strictly short-term survival
food to minimize the negative effects of acute starvation. The components
are compatible with potable water restrictions. No preparation is neces-
sary, except opening packages.
139
Tailored Operational Training Meal (TOTM)

The Tailored Operational Training Meal ration provides an alternative
operational training meal in lieu of “sack lunches” and catered commercial
meals to organizations that engage in “inactive duty training” (IDT) where
traditional operational rations are not mandated. The “train as you fight”
philosophy is being promoted. Using this meal during training will allow
units to become familiar with pre-packed meals, similar to MRE. The TOTM
is similar to the standard MRE in packaging and contains many of the same
components. However, it employs commercial packaging to reduce costs.
The TOTM is not an MRE, nor is it designed to take the place of the
MRE. It is a lightweight, totally self-contained packet consisting of a meal
in a flexible meal bag that fits easily into military field clothing pockets. A
TOTM typically contain an entrée, wet-pack fruit, a beverage base, flame-
less heater, dining kit, and other assorted components.
The content of one TOTM meal bag

provides an average of 997 kcals.
Except for the beverages, the entire meal is ready to eat. The entree
may be eaten cold when operationally necessary, but it can also be heated
in a variety of ways, including immersion in hot water. A flameless heating
device is included in each meal bag to heat the entree.
Click here for sample TOTM menus.
Meal, Religious, Kosher/Halal

The Meal, Religious, Kosher or Halal is used to feed individuals who
maintain a strict religious diet. Each meal consists of one Kosher or Halal
certified entree and religiously certified/acceptable complementary items
to meet the MDRA. Like the MRE, it is a totally self-contained meal with
one entree, plus a bag containing other components.
Click here for information on the Religious Meal Choices.
Each Religious Meal provides approximately

1,200 kcals (11-13% protein, 37-40%
fat, and 48% carbohydrate).
140
First Strike Rations

Negative energy balance (weight loss) is expected during strenuous
sustained operations (SUSOPS). However, the potential accompanying fa-
tigue and mental impairments (confusion, depression, and loss of aware-
ness) can be overcome by appropriate nutrition. The First Strike Ration,
or FSR, is designed to help sustain physical performance, postpone fatigue
and minimize other adverse health consequences experienced during
SUSOPS.
The FSR is a compact, eat-on-the-move assault ration designed to be
consumed during the first 72 hours of intense conflict by forward deployed
warfighters. The FSR is lightweight and designed to sustain needs during
highly mobile, intense operations. All components of this lightweight ra-
tion are familiar, eat-out-of-hand foods that require little or no prepara-
tion. The beverages must be reconstituted and consumed directly from
the drink pouch.
The FSR provides about 2,900 calories, whereas one MRE provides ap-
proximately 1,250 calories; it also weighs much less than one MRE. The
FSR is not intended for non-combat operations or field training exercises
and is not nutritionally complete. The FSR was first delivered to the warf-
ighters in 2007, and is under revision, as the product provides too much fat
and not enough CHO and protein for sustained SOF missions.
Other Rations and Ration Components

Unitized Group Rations—A (UGR-A) Menu Improvements
The most efficient way to get breakfast, lunch and dinner to large
groups of warfighters around the world is the Unitized Group Ration.
The 50 complete meals are packed together in the UGR. They have been
improved over the past few years.
Unitized Group Ration—Express (UGR-E)

The UGR-E is a compact, self-contained module that provides a com-
plete, hot meal for 18 Warfighters. By simply pulling a tab, the food is
heated in just 30-45 minutes, and served in trays to warfighters like a cook
prepared meal.
Shelf Stable Pocket Sandwich

Shelf stable pocket sandwiches will enhance the variety of individual ration
components while providing a much needed eat-on-the-move capability. Cur-
rent varieties include Barbecue Beef, Pepperoni, Italian, and Barbecue Chick-
en—all of which were given high marks during field tests. A Bacon Cheddar
141
pocket was recently developed to provide a breakfast option and further in-
crease variety. Additional breakfast sandwiches are under development.
Performance Enhancing Ration Components

Carbohydrates, caffeine, vitamins, and antioxidants are some of the
food enhancers used to make Performance Enhancing Ration Compo-
nents (PERC). PERCs are formulated to improve the physical and mental
performance of warfighters during sustained operations and under all cli-
matic conditions.
t Food Packet, Carbohydrate Supplement (CarboPack)
The CarboPack is a ration supplement that provides additional energy
to the warfighter during intense, prolonged physical activity and highly
stressful conditions. It consists of two 12 oz carbohydrate electrolyte bev-
erages and one carbohydrate rich bar. It provides a minimum of 75 grams
of carbohydrate, four grams of protein, and 380 kilocalories.
t ERGO Drink
ERGO stands for Energy Rich, Glucose Optimized. This drink is a
primary source of carbohydrates (12%) to restore glycogen and speed re-
covery.
t HooAH!® Bar
The bar is formulated for glucose release, but its solid structure means
digestion occurs over a longer period of time. The HooAH!® bar helps
delay fatigue and extend endurance.
t Soldier Fuel
This energy booster gel provides warfighters an alternative to solid bars
for performance enhancement. Laboratory data have shown these prod-
ucts to be effective in maintaining blood glucose, which should provide
sustained energy.
t Next Generation HooAH!® Bar
These multi-component bars will incorporate selected proteins to con-
serve lean body mass, probiotics/prebiotics to maintain gastrointestinal
integrity, and functionally stable micro/macronutrients to mitigate perfor-
mance degradation and increase ration consumption.
t Caffeine Gum
In 2006 the Army introduced “Stay Alert,” a caffeinated chewing gum,
as a countermeasure for fatigue. Each piece of Stay Alert contains 100
mg of caffeine, which is comparable to a 6 oz cup of coffee. Caffeine is
delivered approximately four to five times faster than a liquid, because it
is absorbed in the mouth. Stay Alert, also a component of First Strike Ra-
tions, is available through military supply channels.
142
Composition of Rations for Combat Operations

In 2006 a panel of experts (Institute of Medicine) met to examine the
energy, carbohydrate, protein, vitamin, and mineral requirements for ra-
tions designed to support personnel during short term, high-intensity
combat operations. In the end, the requirements were primarily based on
DRIs (See Chapter 4), but modifications were made based on sweat loss-
es and nutrient utilization under conditions of high energy expenditure
and stress. These requirements were established to help develop the First
Strike Ration, and are being used for further ration development.
Click here for information on these nutrient recommendations.
Commercial Freeze-Dried Products

Light weight, freeze-dried foods are commercially available from a num-
ber of manufacturers. Two of the most popular manufacturers are Moun-
tain House and AlpineAire. As with any food manufacturer, their products
differ in terms of taste, energy distribution, protein, and sodium content.
Many of the items from both companies have been tested under field con-
ditions for up to 30 days, and the acceptability varies from person to per-
son. What is important is that a ration that will providing adequate energy
and CHO is chosen.
Click here for sample foods and menus from Mountain House.
Click here for sample foods and menus from AlpineAire.
Click here for sample menus for high activity days.
Future Rations
Current and future initiatives will continue to explore technologies for
continual improvement of all military rations. The end result will be a
highly acceptable product that provides the warfighter with sustained en-
ergy, mental alertness, and eat-on-the-move capability. The Department
of Defense Combat Feeding Program strives to uncover new solutions and
capabilities that support U.S. military objectives.
14 Eating Globally
In This Chapter
Cultural Awareness
When Dining Key Points
Foodborne Illness
t Be aware of cultural differences including types of food and proper
eating utensils.
t Avoid foodborne illnesses by taking extra precautions: stay away from
typical foods associated with foodborne illnesses.
t Make wise food and beverage selections when eating on the economy.
t Drinking contaminated water may severely affect your health: purify
your water!
t Carry Pepto-Bismol and seek medical treatment for symptoms from
contaminated foods or beverages.
M
ost operations take place on the soil of other countries and each
country, region and even town may have their own culture. Foods
are a large part of any culture and sharing meals can be a great
way to interact and form relationships with the locals. Enjoying
the local chef ’s food is important, but some cultural foods or approaches
to preparing meals can lead to illness for those unaccustomed to local
practices. This chapter will discuss cultural differences, foods that are and
are not eaten based on religious beliefs, and how to avoid foodborne ill-
nesses.
Cultural Awareness When Dining

Cultural awareness means recognizing, understanding, appreciating
and respecting the different perspectives and customs of one’s own cul-
ture and the culture of others. Culture involves language, beliefs, religion,
values, behaviors, food preferences, and eating habits, and more.
Click for religious food requirements and/or practices.
Always be aware of the host country’s surroundings and become famil-
iar with the local customs and cultures to avoid stereotypes, prejudice, and
insulting the host, particularly when it comes to dining.
144
As you deploy to different regions of

the world, learn the eating customs
and enjoy the dining experiences.
Cultural differences in eating habits may be as simple as using a fork

and knife in Europe and the U.S. versus chopsticks in Asia or fingers in
other countries. In some parts of the world a common plate is shared ver-
sus individual plates in other countries. In some countries, the right hand
is considered the clean hand and is used for eating.
Some cultures eat primarily vegetarian meals and in other countries
almost anything that moves is considered edible. Don’t be surprised if
you are fed lamb, goat, horse, dog, camel, or monkey. In many cultures all
parts of the animal are consumed or used in cooking (brains, organs, feet,
intestines, etc).
Different foods are used throughout the world in holiday and ceremo-
nial meals. A few additional customs related to eating are listed; however,
prior to deployment and throughout deployments, the local eating cus-
toms should be learned and respected.
Know the Local Customs

Don’t be surprised when visiting another country to find many customs
that we as Americans have never heard of. Do your homework before be-
ing deployed.
Click here for a list of countries and their staple foods, meats, popular
dishes, typical fruits and vegetables, and beverages.
Think Before You Act….
The Basics
t Know whether punctuality is or is not emphasized.
t Use the appropriate customary greeting (hand shake, bow, etc).
t Learn if it is customary to bring a hostess gift, food, or beverages to
the social gathering. In some cultures it is very impolite and implies
that you are paying for the meal.
t Don’t criticize.
t Know whether it is customary to clean your plate or leave a little food.
In some cultures, cleaning your plate indicates hunger and poverty.
t Eating may be as much for social interactions as it is for nourishment.
Do not rush through your meals.
145
t Do not be wasteful or gorge yourself. Your host may have gone to

great expense to prepare an extravagant meal. Remember that it prob-
ably has been quite costly, and what you consume may cost a week’s
salary or feed his/her family for an extended period of time.
Who Eats First?

t Be aware of who should begin the meal—is it the host, the guest or the
person of highest status?
Appetizers
t Some countries serve a salad with a meal, while others serve it as an
appetizer or following the main meal.
Soup
t Hot soups may be eaten after every dinner meal.
t Some foods are very spicy. The small green bean in the soup may
actually be a hot pepper.
t Is slurping soup considered rude or acceptable and a sign of enjoyment?
Meats/Fish
t Pork is not eaten by Muslims for religious reasons.
t Christians keep dogs, cats, and horses for pets, while others may eat
them for dinner.
t Fish is typically a neutral food.
Not Just Any Rice

t In Thailand, it is believed that rice has a sacred essence, and it is im-
portant to avoid inappropriate usage or disposal of rice.
Dessert
t Desserts may or may not be a typical part of the meal.
Beverages
t Coffee and tea may be served with sugar and cream already added; it
may be very sweet.
Food Offerings
t Foods are typically offered when visiting and it may be rude to turn
down a beverage.
t If you are the host in a developing country, serve something when oth-
146
ers visit your office or, as you would be treated when visiting their office.
t Try not to refuse beverages and food when offered.
What Time is Dinner Being Served?

t Meals are eaten at different hours of the day.
Eating Instruments
t Some countries use the fork as the primary eating utensil and others
use the spoon, hand or chopsticks.
t Be familiar with the use of chopsticks and whether they are used for
the entire meal or only with the appetizers.
t Follow the host’s lead. Is rice pushed from the rice bowl directly into
the mouth or eaten with a utensil?
t Is soup consumed with a spoon or drunk directly from the bowl?
t Bosnian Muslims, unlike Arab Muslims, use their left hand when eating or
passing objects. In Saudi, the left hand is considered the dirty, toilet hand.
Proper Dress Attire

t Dress appropriately and not too informally.
t In certain cultures, it is important to remove shoes at the door.
Paying the bill

t Paying for a meal is generally done by the one inviting.
t Paying is considered an honor.
Good Ideas
t Become aware of local food taboos.
t Avoid yawning at the table.
t Excessive or loud talking and joking during a meal may be

considered rude.
t Don’t criticize.
t It may be impolite to stare at someone while they are eating.
t Become familiar with local foods that have traditional medicinal

qualities or are used as folk medicine.
147
Foodborne Illness
Situations may arise where food choices are extremely limited, like
when deploying to austere environments in developing countries. In addi-
tion, when an international host presents foods and beverages, it may be
difficult to refuse what is offered.
It is very important to be courteous of

local customs and culture surrounding
food preparation and consumption.
When placed in situations where food and beverage choices are limited,
a few basic principles should be followed to avoid foodborne illness. To
maintain operational readiness and prevent the common gastrointestinal
distress or “traveler’s diarrhea,” paying close attention to what you eat and
drink is essential.
Foodborne illnesses are “infections” caused by consuming food or water
that contains selected bacteria, viruses, parasites, and/or various harmful
toxins, such as pesticides, poisonous mushrooms, and arsenic. The risk of
infection varies depending on where the food is eaten—from fairly low in
private homes to high in food purchased from street vendors.
The more than 250 different foodborne diseases have many different
symptoms, so there is no one “syndrome” that describes foodborne ill-
ness. However, the “culprit” enters the body through the gastrointestinal
tract, where the first symptoms—nausea, vomiting, abdominal cramps,
and diarrhea—appear.
Foods Associated with Foodborne Illness

Certain foods are typically associated with foodborne illnesses. Raw
foods, particularly of animal origin, are a major concern if served. Stay
clear of:
t Raw meat and poultry.
t Ground beef and raw eggs.
t Unpasteurized milk or fresh squeezed fruit juice.
t Raw shellfish, including oysters.
t Raw fruits and vegetables.
t Salads.
t Alfalfa and bean sprouts.
148
Fruits and vegetables can be just as poisonous as raw meat and fish. Wash-
ing can decrease, but not eliminate, contamination, in part because the water
may be contaminated, so consumers can do little to protect themselves.
Making Wise Food Selections

It is possible to make wise food selections; eating with caution may save
a few days of discomfort. Remember these basic tips:
t Food that has been cooked and is still hot is usually safe.
t Some fish is not guaranteed to be safe, even when cooked, because of
the presence of toxins.
t When eating at street vendors ensure foods are cooked in front of you.
Do not select those that may have been cooked hours ago.
t Avoid raw ingredients, such as fresh vegetables. Fresh salads, even in
many restaurants, can be contaminated due to the use of human waste
for fertilizer.
t If offered a beverage, choose a safe one, such as boiled water, hot
beverages (such as coffee or tea) made with boiled water, canned or
bottled carbonated beverages, beer, and wine.
t Avoid ice in beverages. Ice may be made from contaminated water.
t Use purified or bottled water to brush your teeth. Do not even use
small amounts of untreated water for rinsing your mouth.
t Fresh fruit and vegetables with skins are usually fine if cleaned thor-
oughly. Scrub the skin with purified water or soap and water and then
peel. If not cleaned, the contamination may be transferred to the fruit
or vegetable during the peeling process.
t Avoid fruits and vegetables that have already been peeled.
t Most bakery products are safe, but avoid those with a cream or meat
filling.
t Order hamburgers cooked well-done and without lettuce and tomato.
t Avoid milk and juice that has not been pasteurized.
t Foods that have been deep fried or cooked thoroughly are acceptable
to eat.
t Staple items such as pasta, rice, potatoes or other root vegetables that
Drink only bottled water have been boiled or cooked over high heat, are safe items.
from approved sources. t Do not consume foods left at room temperature for over 4 hours.
t When eating eggs, ensure that the yolk is cooked until firm.
t High salt, high sugar, and high acid levels keep bacteria from growing,
which is why salted meats, jam, and pickled vegetables are traditional
preserved foods.
149
Water Purification
“Montezuma’s Revenge” from contaminated drinking water can occur
anywhere. Chemical disinfection can be achieved with either iodine or chlo-
rine. These chemicals may not make water taste like bottled water from
home, but it will decrease the risks of drinking untreated water.
The disinfection capabilities of iodine have been recognized for many
years and iodine tablets are widely used as an emergency drinking water
disinfectant.
t Add two iodine tablets to a 1.1 quart (1 liter) of water, wait 5 minutes,
shake, loosen the cap, and then wait 30 more minutes before drinking.
Chlorine is also a reliable water disinfectant. Water purification tablets
issued by the military that contain chlorine kill giardia lamblia cysts, bacte-
ria, viruses, and other harmful micro-organisms, and remove sediment.
t Add 1 water disinfectant tablet (600 mg/1.4% available chlorine) to
1.10 qt (1 L) of water at temperatures of 77°F (25°C). Add two tablets
(2.8% available chlorine) at 41°F (5°C) for the same purpose.
Lastly, boiling is a most reliable method to make water safe to drink.
t Bring water to a vigorous boil, and then allow it to cool.
Water purification tablets are intended for

clarifying and disinfecting polluted/suspended
water to make it safe for drinking.
Preventive and Treatment Measures for

Foodborne Illness
Many different foodborne diseases may be prevented or treated. One
preventive approach is Pepto-Bismol. Pepto-Bismol can be taken before
and during international travel to help prevent diarrhea. The usual ap-
proach is to take two ounces of the pink medication four times daily, or
two tablets, four times daily, for no longer than three weeks.
Side effects of Pepto-Bismol may include temporary blackening of
tongue and stools, occasional nausea and constipation, and rarely, ringing
in the ears. Do not take Pepto-Bismol if you have an aspirin allergy, re-
nal insufficiency, gout, or are taking anticoagulants, probenecid (Benemid,
Probalan), or methotrexate (Rheumatrex).
The treatment of foodborne illnesses depends on the symptoms. Illness-
es that cause primarily diarrhea or vomiting can lead to dehydration more
body fluids and salts (electrolytes) are lost than taken in.
150
The treatment of traveler’s diarrhea requires the replacement of lost fluids

and salts. This is best achieved by use of an oral rehydration solution, such
Whenever possible, you as the World Health Organization’s oral rehydration salts (ORS) solution. An-
should consult a health other solution to electrolyte losses may be the new SportStrips, which deliver
care professional for electrolytes directly through cells in the mouth. These SportStrips, by Health
Sports, have not been tested, but do provide essential electrolytes indepen-
foodborne illness. dent of the gastrointestinal tract and may be helpful for GI distress.
ORS packets, available at stores or pharmacies in almost all developing
countries, are similar to Pedialyte. ORS is prepared by adding one packet
to boiled or treated water. Packet instructions should be followed carefully
to ensure that the salts are added to the correct volume of water. Sports
drinks, such as Gatorade, do not replace the losses correctly and should
not be used for the treatment of diarrheal illness. Electrolyte sport strips
(http://www.enlytenstrips.com) should allow for rapid absorption of elec-
trolytes and would be tastier than ORS.
For those who don’t listen to warnings, Pepto-Bismol and other prepa-
rations of bismuth subsalicylate can reduce the duration and severity of
simple diarrhea. Pepto-Bismol decreases diarrhea frequency and shortens
the duration of the illness. An over-the-counter antidiarrheal medication,
such as Lomotil or Imodium, can decrease the number of diarrheal stools,
but can cause complications in people with serious infections. An antidiar-
rheal medication may provide symptomatic relief, but these medications
should not be used with a high fever or bloody stools because they may
make the illness worse.
Antibiotics (which require a prescription) may shorten the length of ill-
Careful hand washing can ness. The CDC does not recommend the use of antibiotics to prevent trav-
curtail and potentially eler’s diarrhea because they can sometimes cause additional problems.
prevent the spread of Consult a doctor before taking these medications.
infection to other people.
When to Consult a Health Care Provider
Foodborne illnesses can be dangerous and must be treated seriously.
Consult a health care provider when diarrheal illness is accompanied by:
t High fever (temperature over 101.5°F, measured orally).
t Blood in the stools.
t Prolonged vomiting that prevents keeping liquids down.
t Signs of dehydration, including a decrease in urination, dry mouth and
throat, and feeling dizzy upon standing.
t Diarrhea that lasts more than 3 days.
Do not be surprised if antibiotics are not prescribed for diarrheal illness.
Diarrheal illness caused by viruses will improve in two or three days with-
out antibiotic therapy. Other treatments can alleviate the symptoms, and
hand washing can prevent others from becoming sick.
In This Chapter
Nutritional Readiness
Before Missions
Combat Effectiveness
Sustained Night Operations
Nutritional Readiness
During Missions
Missions in the Heat
Missions in the Cold Key Points

Missions at Altitude t Inadequate energy intake and/or dehydration can result in fatigue and
Missions in Water and at Depth impaired performance during combat.
t Improper eating and sleeping due to all night and high op-tempo mis-
Mission Scenarios
sions can be detrimental to overall health.
t Eating before night operations should be planned accordingly to pre-
vent fatigue.
t Various environmental exposures (i.e. heat, cold, and altitude) can
alter combat effectiveness if nutritional needs and hydration are not
met appropriately.
t Energy and fluid requirements are typically higher than normal during
combat and combat-simulated scenarios.
T
he synergistic relationship between adequate fueling and operation-
al performance on the battlefield cannot be underestimated when it
comes to mission success. SOF operators, like humvees, black hawks
and submarines require high performance fuels to operate effectively.
In some instances fueling options are limited, but meeting energy and fluid
requirements whenever possible is critical. This chapter describes various
fueling options when exposed to various environmental and logistical ex-
tremes. As Napoleon Bonaparte stated, “An army marches on its stomach.”
Nutritional Readiness Before Missions

SOF must be prepared for deployments at any time. Immediately before
such events, SOF may find themselves in the field or under locked down
on base. Regardless, the two main nutritional considerations for readiness
before missions are:
t Maximizing glycogen stores.
t Being well-hydrated.
152
Several Days Before a Mission

The average, lean, 175-pound man has approximately 1,800 calories
of CHO stored as glycogen in liver and muscle, and 75,000 to 150,000
calories stored as fat or adipose tissue. Despite these large energy stores
of fat, CHO is still the preferred fuels, and glycogen depletion will com-
promise physical and mental performance. Low glycogen stores = fatigue.
A diet rich in CHO for several days before a mission will increase liver and
muscle glycogen stores, and thereby ensure adequate fuels stores.
Timing and Composition of Pre-Mission Meals

The purpose of the pre-mission meal is to ensure adequate glycogen
stores and maintain blood sugar. Every SOF should know his own tolerance
for timing of meals and what patterns are needed to sustain performance. In
general, intense physical activities demand a longer time period after meal
ingestion to allow for digestion and minimize gastrointestinal distress.
Eat 2–4 grams of CHO per pound body

weight, but no more than 400 grams, 3–4
hours before a sustained operation.
A pre-mission meal should provide a minimum of fat, since it takes

longer to digest than CHO. CHO beverages and CHO/protein drinks are
excellent choices if taken four hours before the start of a mission. Liquids
are digested and absorbed more rapidly than solids, but personal choice
is important. Avoid a high protein meal because it is harder to digest than
CHO, and is not a readily available source of energy.
Sustained Night Operations

Night exercises require acute cognitive awareness and the ability to
react quickly to sudden and potential compromised situations. Sustained
Operations (SUSOPS) are work periods of 12 hours or more that usually
result in physical and mental fatigue as well as sleep loss. In contrast, Con-
tinuous Operations (CONOPS) are periods of uninterrupted activity of
“normal shift length” followed by sufficient sleep. Missions include both
SUSOPS and CONOPS, which can frequently result in fatigue and sleep
deprivation. Nutritional interventions can partially offset the detrimental
effects of fatigue and sleep deprivation on physical and mental perfor-
mance. The nutritional interventions most effective include:
153
t Carbohydrate intake
t Hydration status
t Caffeine intake
CHO Intake
As noted earlier, a high CHO diet is needed to maintain muscle glyco-
gen stores and blood glucose. A diet that provides 50 to 70% of energy
from CHO, 10 to 20% from protein and 20 to 35% of calories from fat is
important for SUSOPS. High CHO snacks and/or CHO-containing fluid
replacement beverages providing 15–30 g of CHO/hour will also help
to maintain blood glucose and delay fatigue during strenuous prolonged
missions. When blood glucose levels fall, hypoglycemia results causing
performance to drop rapidly, and you will be incapable to continue the
workload you initially started at.
Table 15–1. Symptoms of Hypoglycemia
Headache Weakness
Dizziness Fatigue
Blurred vision Sweating
Confusion Unconsciousness
Portable foods that are easily accessible should always be included in a

SOF “kit.” Quick eating foods that can fit conveniently in uniform pockets
were presented in Chapter 8, Healthy Snacking. Additional foods include
vacuum packed tuna or chicken with crackers and pocket sandwiches.
Avoid foods that are high in the amino acid, tryptophan, since tryptophan
promotes sleep.
Table 15–2. Foods High in Tryptophan
Dairy products and Eggs Soy products
Seafood Whole grains
Poultry Rice
Meats Hazelnuts, Peanuts
Beans and Lentils Sesame seeds, sunflower seeds

154
Hydration Status
Since water is critical for maintaining optimal operational performance as
well as maintaining good general health, proper daily water intake is one of
the most important factors for operators. In 2004, the Institute of Medicine
updated the adequate intake (AI) for water to 3.7 liters, or nearly one gallon
of water, per day for men over the age of 19. Individuals typically need 1
milliliter of water for every kcal consumed. SOF operators usually have fluid
needs greater than the recommended because of intense training, working
in high humidity, extreme temperatures and austere environments.
When possible, select fluids that contribute not

only fluids, but also vitamins and minerals.
Fluid balance can be maintained with beverages containing water, such

as juice, milk, coffee, tea, soda, and foods. Fruits and vegetables contain
an upwards of 70%–90% water, whereas meats, dairy products and grain
products consist of 30%–50%.
Beverages consumed in the heat should be no

more than 8% CHO—or less than 19 grams/8 oz.
The need for electrolyte replacement in the field may be very great
under warm and hot weather conditions, and during military exercises in-
volving high mobility and strenuous physical work lasting 60 minutes or
longer. When water is the only fluid available, the electrolyte SportStrips,
a new product on the market, may be very useful. The SportStrips, which
provide sodium and potassium, are inserted into the mouth between the
gums and cheek and should be absorbed very quickly. The gastrointesti-
nal tract is not required for absorption and as such, may be important for
other conditions, such as dehydration from diarrhea. The effectiveness of
this product is under review, but appears promising for military applica-
tions because of its simplicity and ease of transporting.
Dehydration can result in a loss of appetite.
Fluid replacement beverages with CHO are suggested during extended

missions; however, the amount of CHO should be lower than usual so that
the fluid/water is rapidly absorbed.
155
Caffeine Intake
It is well-recognized that caffeine increases alertness and may delay
fatigue during extended operations. However, the effective dose may vary,
depending on habitual caffeine intake and sensitivity to caffeine. Caffeine
is less effective for those who routinely consume large amounts. For caf-
feine to be effective, it should be consumed on an irregular basis.
A common dose shown to be effective for maintaining performance and
vigilance is 200 mg. Although less may also be effective, the military has
prepared “Stay Alert” gum, which contains 100 mg per chicklet. The cur-
rent recommendation is to take 200 mg every two hours, for up to eight
hours straight to help with alertness during operations. A regular dosing is
needed because the effects of caffeine typically wear off within six hours.
Caffeine-rich beverages and foods are among the most popular forms Weight loss in the field
of nutrition to help operator’s maintain alertness at night. However, most is common, but may
products containing caffeine do not list amounts of caffeine on Nutrition impair mental and
Facts Labels. Manufacturers are not required to list caffeine amounts on
physical performance.
labels, so the consumer can only determine the caffeine content by recog-
nizing caffeine effects.
Click here for caffeine content of various foods, beverages, and other
products.
Nutritional Readiness During Missions

Four major nutrition-related issues encountered in the field are:
t Inadequate ration consumption.
t Inadequate energy intake.
t Dehydration.
t Gastrointestinal complaints.
Rations
One of the biggest problems with eating rations is that it gets boring!
Monotony and lack of time to eat contribute to decreased ration intake
and weight loss. Therefore, it is important to consume as much of the field
ration as possible to maintain performance and health.
Eat part of each ration item to obtain

all the essential nutrients.
156
Limit use of non-issue food items as meal/ration substitutes since they

may be lacking in several important nutrients. Use these items as snacks to
supplement daily rations. Also pack high CHO items, such as crackers, dried
fruits, trail mixes, sports bars, and like (see Chapter 8 for snack ideas). Ex-
periment beforehand to see what suits you best. When planning to use high
CHO bars, check the fat content, because if the fat content is greater than 3
g/100 calories it may slow down absorption and can cause cramps.
The new First Strike Ration, which provides an average of 2,900 kcal per
day, is great for missions, except that additional CHO must be provided to meet
CHO needs. Table 3 provides the content of the three menus. This new ration
takes up less space and weighs approximately 50% less than three MREs.
Table 15–3. Menus for First Strike Ration
Menu 1 Menu 2 Menu 3
Filled French Brown sugar cinna- Lemon poppyseed

toast pocket mon toaster pastry pound cake
Bacon cheddar Italian pocket Honey BBQ beef

pocket sandwich sandwich pocket sandwich
Pepperoni pocket Chunk chicken Albacore tuna

sandwich
Jalapeno cheese Tortillas Tortillas

spread
Wheat snack bread Peanut butter Cheese spread,

plain
ERGO drink Cracker, plain Cracker, plain
ERGO drink ERGO drink ERGO drink
First Strike!™ ERGO drink ERGO drink

mocha
First Strike!™ First Strike!™ apple First Strike!™

chocolate cinnamon mocha
Peanut butter First Strike!™ First Strike!™

dessert bar cranraspberry cranraspberry
Beef snack, Dessert bar, mocha Dessert bar, choco-

sweet BBQ late banana nut
Beef snack, teriyaki Beef snack, Beef snack,

sweet BBQ sweet BBQ
157
Table 15–3. Menus for First Strike Ration
Menu 1 Menu 2 Menu 3
CHO enhanced Beef snack, teriyaki Beef snack, teriyaki

applesauce
Nut fruit mix CHO enhanced CHO enhanced

applesauce applesauce
Caffeinated gum Nut fruit mix Nut fruit mix
Caffeinated gum Caffeinated gum
Mayonnaise, fat-free Mayonnaise, fat-free
Hot sauce Hot sauce
Access C Access B Access A
Apple cider Lemon tea Coffee
Towelette Towelette Cream substitute
Salt Salt Sugar
Matches Matches Towelette
Tissue Tissue Salt
Each menu comes with a zip-lock pouch, 2 towelettes, and a spoon.
If possible, drink 25 to 60 grams of CHO/hour to maintain blood

glucose.
Dehydration
Dehydration occurs when sweat and urine losses are not replaced by
drinking water and other fluid replacement products. It can occur at alti-
tude, in the cold, in the heat, during diving, and even under conditions of
low physical activity. Mild dehydration can decrease appetite and cause
lethargy. It should be avoided at all costs.
Water and other fluids should be consumed when thirsty. At least 4 L
should be consumed each day—more when the environment is hot.
Gastrointestinal Complaints
Changes in diet, dehydration, too much fiber, poor sanitary conditions,
contaminated food, unfamiliar bacteria, and/or stress may result in diar-
rhea or constipation in the field. Ensure adequate hydration at all times,
158
and avoid new non-issue foods whenever possible. Chapter 14, Eating Lo-
cally discusses approaches to mitigating GI distress.
Missions in the Heat

Repetitive movement along difficult terrain with heavy gear, such as
during land warfare operations, is strenuous under any environmental
condition, but particularly arduous with extreme heat and humidity. Land
warfare scenarios where operators carry heavy loads or injured comrades
increase overall effort and energy expenditure, as well as fluid and electro-
lyte needs. The major concerns during operations in a warm/ hot environ-
ment are fluid and electrolyte balance. Working or exercising in the heat
exacerbates water and electrolyte loss through sweating. The amount of
sweat and fluid lost depends on:
t Environmental temperature and humidity.
t Work rate.
t Fitness level and acclimatization.
t Volume and rate of fluid replacement.
When the same task carried out in thermoneutral environment is per-
formed in a hot environment, energy requirements are slightly increased
due to the increased work of maintaining thermal balance. When living/
working in temperatures ranging from 86 to 104° F (30 to 40° C), energy in-
takes typically increase by 10%, unless activity level decreases accordingly.
If 4,000 kcal/day are required, a 10% increase in

energy would = 4,000 x 0.10 or +400 kcal/day.
Goal: Consume 4,400 kcal/day.
= More information
on fluid needs during
Tip: If activity levels decrease, no extra energy is needed!
heat stress.
High work rates in hot, humid surroundings can significantly increase
fluid and electrolyte losses. Losses of one to two quarts per hour or even
more are likely when special clothing, such as chemical protective gear,
and/or body armor is worn. The highest sweat rates reported are over five
quarts per hour. That is a lot of fluid.
Fluids—Drink Early and Drink Often

Starting any operation without being adequately hydrated may increase
the risk of performance mishaps. Some believe that relying on thirst is ad-
equate for sustaining hydration, whereas others believe that thirst itself is
159
an indicator of dehydration. For certain, failure to replace lost fluids from

sweating will result in dehydration and possibly heat injury. Always drink
when thirsty.
Although forced drinking is recommended throughout training in a warm

environment to ensure adequate fluid replacement and performance, this
is not always wise. Too much water can result in hyponatremia. A pre-
determined drinking schedule is recommended to ensure enough fluids
are being consumed: some type of beverage should be consumed with all
meals and snacks.
Drink 1–2 cups of fluid every 30 minutes.

Drinking more than 4 cups per 60
minutes may be too much to absorb!
In the field when it is difficult, if not impossible, to obtain a body weight,

urine color should be used to gauge hydration status.
One pound of weight lost requires 2.25 cups or

Example:
0.5 quarts of fluid to restore fluid balance.
A SOF weighs 175 pounds.
A 4% weight loss would be
A fluid loss of 2% body weight can impair physical performance and 175 x 0.04 = 7.0 lbs.
mood, decrease appetite, and increase the risk of heat injuries. A 5% loss Goal: Stay above 168 lbs.
of body weight can decrease work performance by 30%. This amount of Click here to calculate your lower
water loss is a serious threat to overall health. weight for fluid loss.
Monitoring Hydration in the Field
Monitor hydration status by inspecting urine color.
Dark yellow or smelly urine suggests some degree of dehydration; fluid

consumption should be increased until urine becomes pale yellow. If tak-
ing B vitamins, urine may be bright yellow, not pale, regardless of hydra-
tion status.
Click here to view a urine color chart.

160
Electrolyte Balance
Excessive loss of electrolytes (i.e., sodium, potassium) from sweating
can lead to muscle cramping or severe medical problems. Being in excel-
lent physical condition will help minimize electrolyte losses, but athletes
given free access to water when exercising in the heat replace only one
half to two thirds of their fluid losses. Also, camelbacks are routinely used
to stay hydrated, but since they provide water alone, electrolyte balance
may be compromised. To maintain electrolyte snacks that contain sodium
and potassium, fluids with electrolytes, electrolyte SportStrips or electro-
lytes in the form of gels and blocks may be needed during and after mis-
sions. Electrolytes should offset hyponatremia.
Fluids alone may not be adequate for restoring or maintaining elec-

trolyte balance, because there is an upper limit to how much sodium and
potassium should be provided in a beverage.
Table 15-4. Upper Limits for Sodium and Potassium in

Fluid Replacement Beverages During Heat Stress
Units Sodium Potassium
mg/8 oz 165 46
mg/L 690 195
mEq/8 oz 7.2 1.2
Check labels to ensure that beverages provide no more than indicated in

the chart above. The National Academy of Sciences recommends that
chloride be the only “anion” (negatively charged electrolyte) accompany-
ing sodium and potassium, and no other electrolytes are recommended.
Typically, magnesium and calcium are included, but the amounts are well
below recommended upper limits.
In addition, foods that naturally provide sodium and potassium should

be selected. Dried fruits are optimal food choices for potassium. For ex-
ample, a small box of raisins provides 322 mg of potassium. Even if heat
acclimatization has occurred, it is important to understand the importance
of salt: 200–400 milligrams of sodium can be lost per pound of sweat,
along with sodium excreted in urine. Adding salt to foods (1/2 teaspoon
provides 1,200 milligrams) or including sodium-rich foods in the diet will
help retain water and avoid a sodium deficit. Sodium is the most critical
electrolyte for maintaining fluid balance.
161
Table 15-5. Sodium Content of Foods
Food Serving Size Sodium (mg)
Bacon 3 oz 621
Canned chicken soup 1 cup 850
Cheese, American 1 oz 304
Cornflakes 1 cup 298
Cottage cheese ½ cup 459
Deli ham 1 oz 341
Deli turkey breast 1 oz 335
Olives, black 5 large 192
Peanut butter smooth, salted 2 Tbsp 147
Peanuts, dry roasted, salted 3 oz 691
Pickles, dill 1 large 1,731
Potato chips 1 oz 183
Pretzels 1 oz 486
Sardines 3 oz 429
Sauerkraut ½ cup 780
Soy sauce 1 tsp 304
Table salt 1 tsp 2,358
Tortilla chips 3 oz 669
Table 15-6. Potassium Content of Foods
Food Serving Size Potassium

(mg)
Apricots, dried 10 halves 407
Avocados, raw 1 oz 180
Bananas, raw 1 cup 594

162
Table 15-6. Potassium Content of Foods
Food Serving Size Potassium

(mg)
Cantaloupe 1 cup 494
Dates, dry 5 dates 271
Figs, dry 2 figs 271
Kiwi fruit, raw 1 medium 252
Lima beans 1 cup 955
Melons, honeydew 1 cup 461
Milk, fat-free or skim 1 cup 407
Nectarines 1 medium 288
Orange juice 1 cup 496
Oranges 1 orange 237
Pears, fresh 1 pear 208
Peanuts, dry roasted, 1 ounce 187

without salt
Potato, baked, with skin 1 potato 1,081
Prune juice 1 cup 707
Prunes, dried 1 cup 828
Raisins 1 cup 1,089
Spinach, cooked 1 cup 839
Tomato sauce 1 cup 909
Winter squash 1 cup 896

= Nutrition advice for Yogurt, plain, skim milk 8 oz 579
operations in a cold
weather environment.
= More information on
cold weather training.
Missions in the Cold
Exposure to a cold environment seriously challenges the human body.
Blood vessels tighten to conserve heat and shivering is initiated to gener-
163
ate heat and guard against hypothermia (a dangerously low core body
temperature). Side effects of these responses are: an increase in urine out-
put and an increase in energy metabolism. Therefore, the most important
nutritional considerations for a cold environment are:
t Energy intake.
t Glycogen stores.
t Fluid status.
t Vitamin and mineral needs.
Energy Intake
Energy requirements can increase

25–50% during cold weather operations
as compared to warm weather operations.
Cold weather increases energy requirements significantly. Factors that

increase caloric intake include:
t Added exertion due to wearing heavy gear.
t Shivering, which can increase resting metabolic rate by two to four
times the normal level.
t Increased activity associated with traveling over snow and icy terrain.
t Increased activity to keep warm.
Many studies have shown that warfighters tend to progressively lose
weight when conducting two to three week field exercises in the cold. Be-
cause significant weight loss can result in fatigue and performance decre-
ments, energy intake should meet the increased energy demands.
Energy expenditure for soldiers during periods of physical exertion in
the cold may range between 4,200 and 5,000 kcal/day. Although CHO is
critical, a diet that provides 35% of the energy as fat may be necessary to
match energy needs. It is important to remember that both fat and CHO
are important energy sources in a cold environment.
Ideally, during cold weather operations, 50–60% of energy should come
from CHO, 30–35% from fat, and 10–20% from protein: high CHO snacks
should be eaten between meals. A high protein diet is not advised as it may
increase fluid requirements.
Missions in cold weather require foods that produce heat. Foods high in
CHO produce more heat through digestion than either fat or protein. Hot
beverages, such as cocoa, provide CHO and other warm beverages, to in-
164
clude coffee, teas and broth, increase body temperature, enhance mental
Example: awareness and provide comfort.
SOF require ~4,000 kcal/day

A 25% increase in energy would
Eat high CHO snacks frequently.
= 4,000 x 0.25 or +1,000 kcal
Goal: Consume 5,000 kcal/day
Glycogen Stores
Prior to deploying to a cold environment, the pre-mission diet should
ensure that glycogen stores are optimized. Likewise, a high CHO diet is
preferred during cold exposure, as CHO are needed to replenish glycogen
being used to maintain core temperature. Thus, regular meals and snacks
providing CHO should be eaten to maintain CHO intake. Including a liquid
or solid CHO supplement may be critical for maintaining energy balance
and performance.
A minimum of 400 grams of CHO

is necessary in the cold.
Fluid Status
Becoming dehydrated in cold environments is easy because of the cold-
induced increase in urine output, increased fluid losses through breathing,
involuntary reduction in fluid intake, and sweating. Because dehydration
decreases performance and potentially may lead to various medical prob-
lems, maintaining fluid status by drinking plenty of fluids and monitoring
hydration is absolutely critical.
Table 15-7. Tips for Maintaining Fluid Status
Force yourself to drink 2–4 cups of warm fluid at hourly intervals.
Avoid alcoholic beverages: alcohol tends to increase heat and

urine losses.
Drink beverages with CHO to increase energy intake.
Don’t eat snow without first melting and purifying it.
Moderate caffeine consumption.

165
Beverages containing 5–8% CHO

and some electrolytes are best.
Drinking 1 to 2 cups per 30
minutes is recommended.

The requirements for some vitamins and minerals increase when work-
ing in the cold due to increases in energy metabolism (example: thiamin)
or urinary losses (example: magnesium, zinc). The amount by which daily
vitamin and mineral needs may increase above the DRI during cold weath-
er operations are shown in Table 8. These amounts are based on intake
data from field studies, urinary excretion of nutrients and other measures
of “nutrient status.” In most cases, energy requirements and vitamin and
mineral needs can be met by eating all ration components.
Table 15–8. Vitamins and Mineral Supplements

for Cold Weather and Altitude Operations
Nutrient Suggested % DRI

Amount
Vitamin B1, Thiamin 3 mg 200
Vitamin B2, Riboflavin 2 mg 118
Vitamin C 250 mg 417
Vitamin E 400 mg Ȭ-TE 1,990
Zinc 15–20 mg 133
Missions at Altitude
Ascent to altitude and flying can cause a variety of disturbances, and
adequate nutrition is crucial for maintaining performance. The major nu-
tritional concerns at altitude are:
t Weight loss.
t CHO intake.
t Dehydration.
t Oxidative stress.
166
Weight Loss
Virtually all people who go to high altitudes experience weight loss and
loss of lean body mass. At altitudes below 5,000 m weight loss can be pre-
vented by being vigilant about eating on a regular basis. Above 5,000 m, a
5–10% weight loss is inevitable. Energy intakes should range from 3,500–
6,000 kcal per day, which is equivalent to eating at least four MREs or two
= Nutrition advice for
First Strike Rations daily. Some reasons for weight loss at altitude include:
military operations in
high-altitude environments. t Increased energy requirements to 115–150% of sea level requirements.
t Decreased sense of taste, which causes a reduction in food intake.

= A Soldier’s Guide to
Staying Healthy at t Changes in the metabolism of fat and CHO.
High Elevations. t Loss of body water from increased breathing rate and dry air.
t Impaired absorption of nutrients.
t Acute Mountain Sickness (AMS), which can cause nausea, vomiting,

headache and decreased appetite.
The only way to minimize weight loss is by being vigilant about main-
taining energy intake.
Energy requirements may increase

Example: 15–50% above requirements at sea level.
A SOF requires 4,000 kcal/day.
A 50% increase in
energy would be
= 4,000 x 0.50 or +2,000 kcal
CHO Intake
Goal: Eat 5,000 kcal/day High CHO foods are the preferred energy source at altitude and in flight
because they:
t Replete glycogen stores.
t Require less oxygen to produce energy than fat.
t Are the most efficient energy source.
t Can blunt and delay the progression or severity of AMS symptoms

Dehydration in a (nausea, vomiting, and headache).
plane is different from t Maintain blood glucose.
on a mountain.
Diets should provide at least 400 grams of CHO and CHO should con-
tribute 50–70% of the total energy. This can be accomplished by eating
high CHO snacks between meals and drinking CHO-containing beverages
during strenuous activity, long flights, and recovery.
167
Dehydration
Dehydration in a plane is different

from on a mountain.
Exposure to high altitude is associated with significant levels of dehydra-

tion because water losses are increased. If these losses are not replaced,
dehydration will result. Some studies suggest that vigorous hydration may
decrease the incidence and severity of AMS. Dehydration will increase the
risk of cold injury. The reasons dehydration occurs at altitude include:
t Increased respiratory losses due to increased ventilation.
Taking regular sips of
t Increased urine output due to altitude and cold temperatures. cool, 40°F water before
t Possible diarrheal fluid losses. feeling thirsty may help
t Failure to drink water. prevent dehydration.
t Poor access to water.
Pilots need to have regular access to a bottle of water or an electrolyte
beverage, but on a limited basis. Drinking beverages with sugar is not rec-
ommended. Also, coffee, sodas, and teas should be avoided.
Importantly, do not over-exercise before a flight, since strenuous exer-
cise can deplete body water, which may be difficult to replace quickly. Re-
cent illness, fever, diarrhea, or vomiting will also greatly affect the degree
of dehydration.
Fluid requirements may be > 4 quarts

per day at high altitude.
Maintain a drinking schedule and monitor
hydration status daily to avoid AMS.
Oxidative Stress
One consequence of altitude exposure is the production of an exces-
sive load of reactive oxygen species. In particular, increased metabolic
rate and hypoxic conditions at altitude can increase the production of
harmful free radicals. Collective free radicals cause oxidative stress, which
may slow blood circulation and impair physical performance. Polyunsatu-
rated fatty acids (PUFAs) are the nutrients most susceptible to oxidative
stress. Studies have shown that symptoms of altitude sickness correlate
168
with markers of oxidative stress. Thus, antioxidants have been used to

minimize oxidative stress.
Several studies indicate that taking Vitamin E (400 IU/day) may reduce
free radical production at altitude, and help maintain blood flow and aerobic
energy metabolism in men. Also, a combination of antioxidants (1,000 mg
of Vitamin C, 400 IU of d,l-tocopherol acetate and 600 mg of alpha-lipoic
acid) taken in divided doses in the morning and evening was shown to mini-
mize symptoms of altitude sickness and improve energy intake in men.
Although studies are showing benefits of antioxidants, too much may
be harmful. Exposure to altitude produces natural adaptations and it is
possible that too much of any antioxidant could compromise nature’s
response to lower oxygen levels.
Missions in Water and at Depth

Like exposure to altitude and cold environments, water operations, es-
pecially cold water operations, are associated with increased energy ex-
penditure and marked fluid losses. Thus nutritional concerns for diving are
maintaining:
t Energy intake.
t Fluid intake.
t Mineral balance.
t Antioxidant balance.
Energy Intake
When working at the same rate in water as on land, the energy expen-
diture to accomplish the same task is greater in water. The reasons for this
increased energy expenditure during water operations include:
t Greater resistance offered by water.
t Decreased efficiency of movement when thermal protective clothing
are worn.
Glycogen stores are rapidly used when performing hard work in cold
water. These stores must be replaced between operations to prevent per-
formance decrements. Increasing CHO intake before an anticipated dive
has been shown to improve and extend exercise performance during pro-
longed dives.
Fluid Intake
Immersion in water increases urinary excretion by 2–10 times above
normal. Without adequate hydration a diver can quickly become dehydrat-
ed and suffer performance decrements. For example, immersion during a
169
single dive for 3 to 6 hours can result in a 2–8 pound loss in body weight by
urination; this is equivalent to losing 1–3 quarts of fluid. Importantly, drink
fluids with CHO whenever possible to maintain blood glucose. A decline
in blood glucose is known to adversely affect performance.
Mineral Balance
Immersion in water, especially cold water, increases urinary losses of
magnesium, calcium, zinc, and chromium. It is important to consume foods
high in these important minerals to restore immersion-induced losses. See
Chapter 4 for foods high in these minerals.
Antioxidant Balance
Like altitude, diving results in greater oxidative stress than working at sea
level. This makes sense because with increased depth comes increases in oxy-
gen tension. Oxidative stress is even greater when oxygen is the air breathed
at depth. As noted with altitude, some adaptation takes place and natural an-
tioxidant defense systems are “up-regulated” to minimize cell damage from
oxidative stress. Despite this, antioxidants have been used to combat potential
deleterious effects of oxidative stress. Although no definitive recommenda-
tions can be made, some benefits have been noted by taking 1 gram of vita-
min C and 400 IU of vitamin E two hours before extended dives. However, a
diet high in natural antioxidants should confer protection as well.
Diving at depth, especially when breathing

oxygen-rich gas, facilitates the formation
of “reactive” oxygen species.
Mission Scenarios
Nutrition challenges are expected during deployments where harsh en-
vironmental conditions, austere living quarters, and lack of food services
are the rule. Although nutritional inadequacies can compromise perfor-
mance, if energy intake can be maintained above 2,000 kcal/day with
at least 300 gram of CHO and 60 gram of protein, and fluid status main-
tained, performance should be sustained over a period of weeks. How-
ever, developing sound nutritional plans for training and mission scenarios
should help sustain performance. Sample nutrition plans are provided for
the following training scenarios:
t Typical Training Day.
t SDV Operation.
170
t Unconventional Warfare.
t Special Reconnaissance.
t Nighttime Air Mission.
For most scenarios, the macronutrient recommendations assume
an energy requirement of 4,000 kcal/day. If energy requirements are
lower or higher, the amounts of CHO, protein, and fat should be al-
tered accordingly. The timing and/or amount of any particular
nutrient can be modified to suit individual needs based on the
scenario and personal experiences. Snacks refer to food and bev-
erages that can be carried and consumed while on the mission/op-
eration. Specific foods are not identified, but a list of good field foods,
both from rations and commercial off-the-shelf products is included.
Each person has individual tastes and it is most important that all
food components taken for deployment be tested. The caveat is for
extended missions when eating on the economy is the rule, rather
than the exception.
Click for the nutrient content of First Strike Ration Menu Items.
Click for the nutrient content of various COTS useful for deployments.
Typical Training Day
OPORDER: Get in shape.
Duration: 12 hours.
Chow Availability: COTS.
Terrain: Command Dependent.
Nutrition Recommendations:
t Plan a healthy recovery meal after morning PT.
t Maintain a high intake if CHO.
t Drink fluids and eat CHO during long training events.
t Choose plenty of fresh fruits and vegetables, and a variety of
whole grains while still on home territory.
Table 15–9. Typical Training Day
Time Activity CHO Protein Fat

(g) (g) (g)
0530 Wake-Up —Juice 50 0 0

171
Table 15–9. Typical Training Day

(g) (g) (g)
0630–0830 PT
0830 Breakfast 100 20 15
0830–1000 Classroom/briefing
1000–1200 Work on gear/other
1100 Snack 40 10 6
1300–1330 Break for lunch 120 30 30
1400–1630 10 mile march 60 0 0

2 mile swim
3 hr dive
1630–1730 Clean Gear—snack 40 0 0
1730 End of work day—

go home
1730–1900 Dinner 120 60 40
1900–0530 Personal time

and sleep
2200 Snack 40 10 6
Total g 570 130 97
Total kcal 2,280 520 873
Total Daily kcal 3,673
Food Suggestions:
t Yogurt and bagel.
t Whole-wheat crackers.
t Fruit and vegetables.
t Chicken and fish.
t Fruit juices.
t Rice and baked potatoes.

172
SDV Operation
OPORDER: Long range insertion.
Duration: 12–14 hours at night.
Chow Availability: COTS/Rations.
Terrain: Nautical Environment—Surface water

temperature 55–60°.
Nutrition Recommendations:
t Eat a high CHO meal or snack two hours before mission.
t Increase fluids to offset urinary losses.
t Consume CHO rich beverages to maintain blood glucose.
t Consume foods high in magnesium, calcium, zinc and chromium (trail
mix, beef jerky).
t Consume a hot CHO beverage upon mission completion, if possible.
t Eat CHO rich foods between sorties.
Table 15–10. SDV Operation

(g) (g) (g)
1700 Pre-Mission Meal 100 25 25

Water 16 oz
1800 Descent 1
2400 Snack 60 10 5
CHO drink, 16 oz
0100 CHO Drink, 50 0 0

32 oz
0200 Descent 2
0800 CHO Snack 60 10 5

Water, 16 oz
0900 CHO drink, 32 oz 40 0 0
1200 Meal 100 20 25

Water, 16 oz
1400 Snack 60 10 0
Water, 16 oz
173
Table 15–10. SDV Operation

(g) (g) (g)
1600–1730 Dinner 100 25 25
Total g 570 100 85
Total kcal 2,280 400 765
Food Suggestions (CHO, protein, fat in grams):

t Chunked Chicken and tortilla, 1 serving each—(32, 35, 9).
t Whole-wheat crackers, 10 each—(27, 4, 6).
t Turkey Jerky, 2 oz—(12, 24, 1).
t Soldier Fuel Bar, 1—(40, 10, 9).
t Poppyseed pound cake, 1 piece—(37, 4, 13).
t Fruit nut mix, 0.3 cup—(18, 12, 26).
t Coconut-Almond bar, 1—(56, 16, 12).
t Strawberry-Honey granola, 1 serving—(43, 18, 12).
t Dried cranberries, 0.5 cup—(45, 0, 1).
t Gels, 1 pack—(27, 0, 0).
t CHO Beverage, 8 oz—(15, 0, 0).
Unconventional Warfare
OPORDER: Train indigenous guerilla force.
Duration: Multi-year until completion of mission.
Chow Availability: Limited resupply; be prepared to exist

on indigenous, local food sources.
Resupplies should include sport bars,
CHO-electrolyte packets, and other snacks.
Terrain: Tropical to sub-artic, with some heavy

forested areas.
174
Nutrition Suggestions:
t Purify water.
t Refer to Chapter 14 on Combat Rations and Chapter 13 on Eating Globally.
t Try to maintain 2,000 kcal per day with as much CHO as possible.
t Eat a sport bar every two hours to maintain blood sugar.
t Protein and CHO may come from local sources (animal, legumes,
grains, dairy).
t Majority of energy may come from rations (MRE /First Strike Ration)
and COTS.
t See section above on hot/cold weather.
Table 15–11. Unconventional Warfare

(g) (g) (g)

CHO/PRO beverage
0730 Snack 40 10 5
Water, 8–16 oz
0930 Snack 40 0 0
Water, 8–16 oz
1130 Lunch 120 20 20

Water, 8–16 oz
1430 Snack 40 10 10
Water, 8–16 oz
1630 Snack 120 30 30

Water, 8–16 oz
1830 Snack 75 10 15
CHO/PRO
beverage, 8–16 oz
2130 Snack 40 0 0
Water, 8–16 oz
Total g 595 90 100
Total kcal 2,380 360 900

175

t Mountain House Beef Stroganoff, 1 serving—(62, 21, 21).
t Alpine Aire Freeze-Dried Pineapple Chunks, 1 serving—(20, 10, 0).
t Powerbar Endurance sport powder drink, 16 oz—(40, 0, 0).
t Gookinaid ERG drink powder, 8 oz—(40, 0, 0).
t Odwalla Super Protein bars, 1 bar—(31, 16, 5).
t Zapplesauce, 2 serving—(64, 0, 0).
t Carb-BOOM! Gel, 1 pack—(27, 0, 0).
t FSR tortillas, 1 serving—(32, 4, 5).
Special Reconnaissance
OPORDER: Conduct recon and gain awareness of
enemy ground activity.
Duration: Four cycles of night.
Chow Availability: Rations/Rations.
Terrain: Altitude—be prepared to work between

7,000–9,800 feet.
t Pre-mission meal should be high in CHO, protein, and fluids.
t Purify water—hydration critical to minimizing AMS.
t Meals must be easy to prepare, and high in CHO.
t Vitamin E (400 IU) and C (1 gram) may be helpful.
t Moderate caffeine intake may be needed for alertness and cognitive
function.
t Easily portable and accessible foods are requisite.
t Minimize fiber intake.
Table 15–12. Special Reconnaissance (SR)

(g) (g) (g)

Water, 16 oz
1900
176
Table 15–12. Special Reconnaissance (SR)

(g) (g) (g)
2100 Snack 50 0 0
Fluid, 16 oz
2300 Snack 40 10 6
Fluid, 16 oz
0100 Snack 75 10 15
Fluid, 16 oz
0300 Snack 40 10 6
Fluid, 16 oz
0500 Snack 40 5 30
Fluid, 16 oz
0700
0900 Meal 100 30 25

Fluid, 16 oz
1100
1300 Snack 40 0 0
Fluid, 16 oz
1500 Repeat 24 hours 40 0 0

Cycle
Total g 545 105 112
Total kcal 2,180 420 1,008

t Beef BBQ pocket sandwich, 1 serving—(40, 9, 9).
t MRE cracker, plain, in FSR—(26, 4, 5).
t HooAH! Cran-Raspberry, 1 serving—(25, 2, 3).
t ERGO drink, 16 oz—(86, 0, 0).
t Zapplesauce, 1 serving—(32, 0, 0).
t French toast pocket, 1 serving—(60, 5, 10).
t Desert Bar, mocha, 1 serving—(21, 2, 15).
177
t Alpine Aire Freeze-Dried Strawberries, 1 serving—(24, 2, 0).
Nighttime Air Mission
OPORDER: Infiltrate ground troops/bundle drops.
Duration: 10-14 hrs in length.
Chow Availability: COTS/Rations.
Environment: Too hot or too cold during flight, circadian

rhythms are periodically switched.
t Plan for a CHO rich pre-mission meal.
t Decrease fluid intake during the mission.
t Consume small, CHO rich snacks on a regular basis to maintain

blood glucose.
t Eat a meal after the mission.
t Increase fluid intake after landing to restore fluid balance.
Table 15–13. Nighttime Air Missions

(g) (g) (g)
1600 Pre-Mission 100 20 20

Meal, 8 oz
1900 Snack 40 10 5
2100 Snack 40 10 5
0100 Snack 40 0 0
Water, 8 oz
0300 Snack 40 10 10
0500 Snack 40 10 10
0700 Meal 100 20 20

Water, 16 oz
0900 Rest
1100 60 5 10
178
Table 15–13. Nighttime Air Missions

(g) (g) (g)
1300 Snack 40 10 5
Water, 8 oz
1500 Repeat Cycle
Total g 500 95 85
Total kcal 8,000 1,520 6,885

t Mountain House Beef Stew, 1 serving—(54, 36, 16).
t Whole-wheat crackers, 6—(11, 1, 3).
t Beef jerky, teriyaki, 2 oz—(9,11, 4).
t Soldier Fuel bar, 1—(40, 10, 9).
t Zapplesauce, 2—(64, 0, 0).
t Ergo drink, 1—(43, 0, 0).
t Trail mix, 5 oz—(18, 12, 26).
t Box raisins, 1.5 oz—(32, 1, 0).
Summary
The three primary ways to be nutritionally prepared during missions are:
t Eating a high CHO diet to maintain and sustain glycogen stores.
t Being well hydrated—follow a forced fluid replacement schedule since
thirst is not a always a good indicator of fluid needs under extreme
environmental conditions.
t Eating snacks every 2 hours to maintain blood glucose.
16 Returning to Home Base
In This Chapter
The Reality
Down Time = Rejuvenation

= Reset
Diet, Exercise, and

Stress Connections
Key Points
t Rest and rejuvenation should be emphasized upon return from deploy-
Special Gathering
ment to re-optimize mental and physical performance.
Meal Planning Strategies
t A good night of sleep in a comfortable bed and dark room is essential
Alcohol for recovering from deployments.
t A balanced diet high in complex carbohydrates, such as vegetables,
fruit and whole grains, can enhance stress resistance.
t Good nutrition and regular exercise are excellent antidotes to stress.
t Avoid binge eating and drinking upon returning from deployments.
Excess food and alcohol intakes can lead to unwanted weight gain
and is detrimental to overall health.
P
rofessional athletes have the luxury of going home soon after com-
petition, so life can return to normal. In contrast, SOF may be away
about operational for extended periods of time and, during those times, can be depleted
rations. This site offers of essential nutrients needed for health. Choices in food and bever-
information such as ages may be limited in areas without military food service support and lo-
menus, prices, and weight. cal foods may be unsuitable due to sanitation issues. Limited choices can
result in significant weight loss. Upon returning home, many will “pig-out”
and “drink-like-a-fish,” which transforms the warrior athlete into a less than
optimal machine. This chapter will provide information about how to regain
health and become nutritionally replete upon returning to home base.
The Reality
Many SOF personnel have expressed concerns about their eating and
drinking behaviors upon returning home after a deployment. Stress incurred
over the preceding months can sometimes lead to unhealthy decisions that
may add greater stress to an already stressful life. Weeks or months away
from home can result in feelings of having been deprived of comforts, such
as alcohol and favorite foods. This can promote binging on previously un-
available food and beverages. Significant problems, such as weight gain, al-
cohol dependency, driving under the influence, domestic problems, and even
180
work related conflicts may occur. Choosing good food and making positive
lifestyle choices are essential for a smooth transition. Healthy food choices
and limiting alcohol consumption will minimize weight increases and help
avoid weight fluctuations (gains and losses). Repeated weight loss and/or
gain can affect overall military performance and render a finely tuned hu-
man vehicle antiquated or useless before its time.
Down Time = Rejuvenation = Reset

Rest is one of the most important aspects of recovery. Mental and phys-
ical stressors are common during deployment and resetting the stress-re-
sponse system is important. Lack of sleep, stress, and inadequate nutrition
disrupt the body’s finely regulated internal rhythms. Time off upon return
from deployment is essential for reconnecting with family, normalizing
routines within the household, and resetting internal rhythms.
Sleep
Sleep is vital for re-establishing normal daily rhythms, which are neces-
sary for optimal mental and physical performance. Most hormones, such
as the stress hormone, cortisol, and human growth hormone, have day
and night cycles: they are greatly affected by loss of sleep. One third of a
person’s life should be spent sleeping. Most operations away from home
allow for minimal sleep, so time at home should ensure high quality, restor-
ative sleep. Sleep is important for:
t Growth and development.
t Restoration of the nervous system.
t Immune function.
t Memory and learning.
t Mood improvement and human behavior.
=More information on sleep.

Sleep is critical—for the brain and the body.
In contrast, chronic lack of sleep increases the risk of developing:

t Obesity.
t Diabetes.
t Cardiovascular disease.
t Opportunistic infections.
t Mood disturbances.
181
Lack of sleep affects two major body systems: the "master" hormone
regulating gland and the autonomic (automatic or involuntary) nervous
system. Many factors that control the release of important hormones are Each menu provides
regulated during sleep. Also, the signals that usually allow us to be alert about 1,540 kcals (15%
and vigilant when awake are maintained in an active state in the absence protein, 35% fat, and
of sleep. Sleep allows this “sympathetic” nervous system to be reset and
50% carbohydrate).
restored for the upcoming day. Returning home from deployment is an im-
portant time to make sleep a priority. This allows the body to reset biologic
rhythms and prepare for a repeated SOF training phase.
Sleeping and feeding are closely related because the hormones regulating
appetite (leptin, ghrelin, and insulin) are strongly influenced by the amount
of sleep. Sleep deprivation creates an imbalance in the signals for energy
balance, and may lead to obesity. According to the Department of Health
and Human Services, people who sleep on average, five hours a night are
more likely to become obese over time compared to people who sleep sev-
en to eight hours a night. One other potential effect of a continually active
nervous system and lack of sleep is the development of glucose intolerance
or predisposition to Type II diabetes. This is of utmost concern.
Sleep Disturbers
Factors that may prevent a good night’s sleep include:
t Caffeine: Receptors that trigger sleep are blocked by caffeine.
t Nicotine: May act as a stimulant and decrease ones ability to fall
asleep; nicotine withdrawal may cause early awakening.
t Alcohol: A sedative that prevents deep, restorative sleep (REM).
t Pain Relievers: Most contain caffeine.
t Exercise: Daytime exercise may improve sleep, but exercising 1–4
hours before bedtime may cause insomnia.
t Medications: Decongestants, steroids and beta-blockers can decrease
restorative sleep.
How Much Sleep is Enough?

Every person requires a certain amount of sleep: anywhere from 5–10
hours nightly. Whether a person is getting enough sleep can be determined
subjectively from various signs and symptoms. Selected signs of sleep de-
privation include:
t Difficulty waking up in the morning.
t Difficulty concentrating.
t Falling asleep during work or class.
t Feelings of irritability, depression, anxiety, and/or moodiness.
182
Researchers in Australia developed a “sleepiness” scale (Epworth

Sleepiness Scale), which is used around the world to measure sleep depri-
vation. Questions about the likelihood of dozing off in selected situations
are asked and the most appropriate answer for each situation is chosen; a
score is tallied based on the responses. Total scores are assigned a sleep
category ranging from “Enough” to “Severe Sleep Debt.”
Click to complete the Epworth Sleepiness Scale and see if your sleep is
adequate.
What is Good Sleep?

Individuals who are tired fall asleep within five minutes or less. Good
sleep usually means sleeping in one’s own bed, which should be comfort-
able and quiet. If your partner typically disturbs your sleep, switch to a
queen- or king-size bed. Also, try different mattresses and pillows. Other
considerations for good sleep include:
t Finding a therapeutic pillow that cradles the neck and allows for sleep-
ing on one’s side.
t Making the bedroom a place for sleeping so the body knows the bed-
room is a place for rest.
t Making certain the room has adequate airflow and is neither too hot
nor too cold.
t Using a fan to block out various noises.
t Hiding the clock so the time and the light can not be seen.
t Making sure the room does not “rise with the sun:” the room needs to
be dark in the morning.
Stress
Stress in life is inevitable, and life is all about confronting challenges.
The body’s two main stress-response systems are the autonomic nervous
system (discussed above) and the hypothalamic-pituitary adrenal (HPA)
axis. Chronic stress can disrupt the regulation of these two systems. For
example, lack of sleep can affect hormones like cortisol and growth hor-
mone, among others.
Dealing with stress when returning home is not easy. Loved ones at
home have not had the same experiences. Loved ones may feel stressed
as well, and overly stressed people are not always attentive. Everyone per-
ceives their particular stressors as very important, and there is no way to
change this perception. What is clear is that the stress of war, which is
considered an extreme stress, can lead to violent, abusive or threatening
behaviors. Upon return from war, alcohol and other drugs are often used
to reduce stress, but, in reality, they create more stress. It is also important
183
to realize that overly stressed people are more likely to smoke, have poor
dietary habits, and be physically inactive.
SOF are mentally and physically resilient individuals, and most are like-
ly to experience Post-Traumatic Stress Growth (PTSG), rather than PTSD.
Good nutrition and regular
PTSG implies inner growth and increased determination—unlike PTSD. exercise are excellent
Nevertheless, conversations with team members and other SOF about de- antidotes to stress.
ployment experiences are healthy and can be cathartic. SOF commands
have embedded operational, combat-focused psychologists who are famil-
iar with SOF missions, demands, and lifestyles; these persons are available
to speak with SOF personnel at any time. They can inspire and promote
PTSG. In addition, Family Services are available on Navy, Marine Corps,
Army, and Air Force bases. These services provide resources for stress
management, improving relationships, money management, and referrals
to help resolve family and personal issues. Such resources are invaluable
upon re-entry after deployment.
Diet, Exercise, and Stress Connections

Research continues to show a strong relationship between nutrition and
stress, and exercise and stress. A high-fat, high-sugar diet in combination
with chronic stress are major factors in the development of obesity. In
contrast, selecting a diet rich in complex carbohydrates, such as colorful
vegetables, fruits, and whole grains, can help enhance stress resistance.
Upon returning home, if body weight is 10–15 pounds lower than pre-
deployment, it is easy to feel comfortable selecting “comfort” foods (high-
fat/high-sugar), but before long, weight creeps back up and exceeds what = Click here for
is optimal for SOF missions. Making wise diet and exercise choices will more information on
promote a more rapid readjustment. shopping, cooking, and
meal planning.
Anti-Stress Diet
An anti-stress diet will do wonders upon returning home. It is becom-
ing clear that stress can lead to obesity because of the stress hormone
cortisol. Eating an anti-stress diet means resisting an increase in body fat,
which typically accumulates in a man’s belly. Products and foods to avoid
for minimizing stress on the body include:
t Caffeine.
t Hard liquor.
t Tobacco.
t Trans-fats from fried foods, red meats, and highly processed foods.
Essential nutrients are important in combating stress. These include the
minerals, zinc and magnesium, and vitamins C, B, and E. The B vitamins
and magnesium are involved in the production of serotonin, which helps
184
regulate mood and relieve stress. Foods high in these nutrients are the
foods of choice. If one had to develop a list of foods important for coun-
tering stress, many whole foods would be on the list. Table 16–1 provides
a list of foods that will help alleviate or prevent some of the consequences
of chronic stress. In addition, these foods will help minimize weight gain
due to overeating and excess intake of high-fat, high-sugar foods. If 90%
of the foods selected can be from the list of nutrient dense foods, the other
10% can be from “comfort foods.”
Sudden weight gain due to overeating

and excessive alcohol consumption will
compromise performance and health.
Table 16–1. Top Foods for Combating Stress
Almonds Green tea, herb teas,

lemon water
Sweet potatoes, beets Broccoli, zucchini, green beans
Whole-grain rice or pasta Sushi
Goat Cheese, whey Carrots, tomatoes, peas
Cantaloupe, other melons Salmon, other cold water fish
Blueberries, kiwi, grapes Garlic
Exercise
Physical exercise is one of the most effective ways of relieving stress.
The act of physical exertion causes the body to release chemical sub-
Exercise will also stances (endorphins) similar in nature to opiates. These natural substances
prevent belly bulge make us feel good and have no adverse effects, unlike many other drugs.
and deconditioning. Regular exercise should be a scheduled part of any returning home plan—
it may be in the form of enjoyable recreational activities, such as camping,
hiking, basketball, surfing, cycling, or running and weight lifting. Making
room for exercise will help keep life issues under control and promote
relaxation.
185
Meal Planning Strategies for Special Gatherings

The key to avoid gaining excess pounds is to make smart selections at
parties. The rule “it is not a good idea to shop at the commissary while
hungry” applies to parties; do not attend a party on an empty stomach.
The following strategies can help maintain nutritional balance, while still
having a good time:
t Eat a regular meal before the event to avoid overeating.
t Eat breakfast to control hunger and avoid the tendency to overeat. = More information
on energy balance
t Drink water to avoid dehydration, and minimize hangover symptoms,
and binge eating.
from alcoholic beverages: one glass of water should be drunk for ev-
ery glass of alcohol consumed.
t Focus on appetizers: variety in selection and appropriate portion size
are key.
t Resist deep-fried appetizers: stock the plate with shrimp and vegeta-
bles.
t Resist cream based soup, cheese-filled dishes, pies, pastries, and many
baked goods.
t Choose fruits and vegetables, as well as whole grain breads and crack-
ers, that are high in dietary fiber. They will curb appetite, taste great
and add vitamins and minerals.
t Choose sweets made with dark chocolate. A small amount of dark
chocolate can be healthy and satisfying.
t Drink sparkling apple juice or cider, seltzer mixed with fruit juices, fla-
vored calorie-free water and/or low-sodium vegetable juice to main-
tain hydration and avoid a hangover.
Alcohol
At least 23% of service members admit to drinking heavily—a statistic
that hasn’t been lowered in over 25 years. This is also true in SOF—al-
cohol-related incidents (DUI, drunk and disorderly, alcohol related reck-
less driving, sexual assaults, suicidal attempts) continue to rise at alarming
rates, and teams have been formed to assess what is being done and what
should be done to address the problem. A 2007 report from the Depart-
ment of Defense Task Force on Mental Health noted a three-fold increase
in alcohol-related incidents from the third quarter of FY 2005 to the third
quarter of FY2006. Unfortunately, no noticeable increases in persons en-
tering the alcohol program accompanied the rise in incidents. In fact, only
41% of warfighters involved in alcohol-related incidents were referred to
the alcohol program.
186
In addition to alcohol-related incidents, alcohol contributes to obesity

and belly fat. Alcohol provides 7 kcal per gram of empty calories—its nu-
trient density is low. The liver processes alcohol, which is why many alco-
holics and heavy drinkers experience liver damage.
Alcohol abuse is a problem and returning home from deployment is a

critical time for abuse to surface.
How Much Alcohol is Enough?

Two servings are considered moderate. One serving consists of:
t A 12-oz bottle or can of beer.
t A 5-oz glass of wine.
t A shot of liquor or spirits (either straight or in a mixed drink).
Click for a list of calories in various alcohol beverages.
Calories from alcohol tend to be stored

in the abdomen as belly fat.
“For many people, moderate drinking is probably safe. It may even have
health benefits, including reducing your risk of certain heart problems. Any-
thing more than moderate drinking can be risky. Binge drinking—drinking
more than five drinks at a time—can damage your health and increase your
risk for accidents, injuries, or assault.”
—National Institute on Alcohol Abuse and Alcoholism
It is recognized that alcohol (wine) in moderation (two drinks a day for

men) increases good cholesterol (HDL). However, beyond these amounts,
alcohol has many harmful effects, and moderation requires forethought
and discipline.
Binge Drinking
Binge drinking is drinking until intoxicated over a period of at least
two days. Being repeatedly intoxicated overrides participation in usual ac-
Binge drinking is a sign tivities and fulfillment of other obligations. According to results from the
of being overstressed. Army’s “Self Reported Health Risk Appraisal” of 404,966 soldiers, “those
consuming more than 21 drinks per week were at six times the risk for
subsequent alcohol-related hospitalizations.”
Relationships and internal rhythms will be seriously compromised if

alcohol is substituted for good food, performance, and health.
In This Chapter
Dietary Approaches for
17 The High Mileage
SOF Warrior
the High Mileage SOF
Vitamin M
Antioxidants
Arthritis and
Musculoskeletal Injuries
Weight Gain and

Weight Management Key Points
High Blood Pressure
t Try to maintain weight minimize weight cycling—multiple episodes of
or Hypertension
weight loss.
Coronary Heart Disease t Pain from arthritis can be reduced by choosing healthy foods and
(CHD) foods high in anti-inflammatory compounds.
Type II Diabetes t NSAIDs should be used on a very limited basis.
Metabolic Syndrome t Foods, not supplements, should be the primary source of nutrients.
Food is the best and cheapest way to take in essential nutrients.
Cancer
t The risks of developing hypertension, coronary heart disease, diabe-
tes, and cancer increase with age. Eating the right type of foods can
limit risk factors associated with these chronic diseases.
T
he aging SOF warrior is concerned about general health. Punish-
ment from years of heavy physical activity can take a toll on SOF
warriors. This chapter will look at various diseases associated with
aging and what can be done to promote good health into retire-
ment. Major health problems can include arthritis, musculoskeletal inju-
ries, weight gain, hypertension, coronary heart disease, Type II diabetes,
metabolic syndromes, and cancer. Each will be briefly discussed.
Dietary Approaches for the High Mileage SOF

Many foods, or dietary components, contain biologically active sub-
stances that may confer health benefits or desirable physiological effects
beyond basic nutrition. Such foods are now called “functional foods.”
Knowing which foods contain these important components allows greater
control of personal health through food choices. Foods that impart spe-
cific health benefits include fruits and vegetables, whole grains, fortified or
enhanced foods and beverages. The health-promoting attributes of many
traditional foods are being discovered, and new food products with benefi-
cial components are being developed. Selected functions served by food
components would include:
188
Table 17–1. Examples of
Functional Food Classes t Restoring fluid balance.
Carbohydrates t Improving endurance.

t Enhancing muscle strength.
Carotenoids
t Preventing muscle/joint injuries or fatigue.
Fiber
t Enhancing immune function.
Flavonoids t Preventing heart disease and diabetes.
Isocyothionates t Preventing high blood pressure.

t Reducing pain and inflammation.
Minerals
Click to look up information on various health topics, prescription and
Phenolic Acids non-prescription drugs, and functional food classes.
Phytoestrogens
Plant Sterols Dependence on Vitamin M (Ibuprofen)

Prebiotics Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to relieve
pain, fever, and inflammation. It is commonly known as Vitamin M among the
Probiotics SOF community because of its frequent use. Some SOF warriors are known
to take up to 2 grams/day. The use of ibuprofen is not without risks. Common
Vitamins
side effects include gastrointestinal distress, raised liver enzymes, salt and flu-
id retention, and hypertension. The risk of myocardial infarction appears to be
higher among chronic users of ibuprofen than non-users.
Some foods or food components can serve as alternatives to NSAIDs (see
Chapter 12 for a list of these products). The alternatives are both dietary and
exercise oriented. Table 17–2 presents a list of products that are recognized for
providing pain relief. Some can be taken as foods rather than supplements.
=Click here for Table 17–2. Anti-Inflammatory Foods and Dietary Supplements
more information on
inflammatory arthritis. Substances Significant Sources
=Click here for Glucosamine No food sources. Dietary supplements are
more information derived from hard outer shells of shrimp,
on osteoarthritis. lobsters, and crabs.
Chondroitin No food sources. Dietary supplements

sources are derived from shark and beef
cartilage or cow trachea.
Vitamin E Poultry, seafood, vegetable oils, wheat

germ, fish oils, whole-grain breads, forti-
fied cereals, nuts and seeds, dried beans,
green leafy vegetables, fruits, and eggs.
189
Table 17–2. Anti-Inflammatory Foods and Dietary Supplements
Substances Significant Sources
Selenium Tuna, wheat germ, garlic, whole grains,

sunflower seeds, eggs, and Brazil nuts.
Omega-3 Fatty Acids Cold water fish (salmon, mackerel, sar-

dines, and herring), flaxseed, soybeans,
soybean oil, pumpkin seeds, and walnuts.
Capsaicin Cream Pharmacies and health food stores.

(from chili peppers)
Bioquercitin Apples, yellow and red onions, cherries,

certain citrus fruits, leafy vegetables,
broccoli, raspberries, black tea, green tea, Dietary sources of
red wine, and red grapes. antioxidants are superior
to single or combined
Methylsufonyl- Onions, garlic, and cruciferous vegeta-
methane or MSM bles, such as cabbage and broccoli. antioxidant supplements.
Antioxidants
Oxidation, or the production of free radicals, is a normal consequence
of strenuous exercise, exposure to UV-radiation, pollutants, chemicals, and
extreme environments, and just living. Usually the body's natural defense
systems, or “antioxidants” can neutralize free radicals and render them
harmless. However, the body can be overwhelmed by free radicals, which
may result in structural and functional damage. Inflammation, infection
and muscle injury from exercise may reflect an inability to defend against
oxidant stress. In addition, free radical damage contributes to aging and a
host of illnesses, including cancer and heart disease.
= Click here for

more information
People who chew tobacco should make
on antioxidants.
sure their diets are high in antioxidants.
A well-balanced diet providing many antioxidant-rich foods supports

the body’s natural defense against free radical threats and protects against
tissue damage. Importantly, more than 4,000 compounds in foods act as
antioxidants. These could also be considered functional foods. The most
well known antioxidants are vitamins C and E, beta carotene and the min-
eral, selenium. However, those are only a few of the many substances.
Click here to see a list of foods high in antioxidants.

190
Coenzyme Q10
Coenzyme Q10 is sold
as a dietary supplement, Coenzyme Q10 (also known as ubiquinone or CoQ10) is a vitamin-like
but the FDA does substance made by the body. It is essential for producing the energy (ATP)
not “approve” dietary that makes cell function. Tissue levels of CoQ10 decrease with age and
supplements for are low in some chronic diseases (heart, cancer, diabetes, hypertension).
effectiveness. Physician sometimes prescribe CoQ10 to increase tissue levels, but the
effectiveness of CoQ10 is not definitive. However, it appears to help with
mild hypertension.
It is also important to note that statins inhibit the body’s ability to make
CoQ10. Some health care providers request that SOF warriors taking sta-
tins should also take CoQ10. This should be done under the guidance of a
physician and at the appropriate dose.
Click here for more information from Medline Plus on Coenzyme Q10.
Click here for more information from the Mayo Clinic on Coenzyme Q10.
A Well-Balanced Diet
A well-balanced diet of fruits, grains, and vegetables will provide the
requisite antioxidants and other nutrients. Many studies have shown that
people who eat a well-balanced diet are less at risk for developing many
chronic diseases.
Eat at least 4 servings of fruit and 5

servings of vegetables daily.
Arthritis and Musculoskeletal Injuries

About one-third of U.S. veterans suffer from some form of arthritis, which
may be due to orthopedic injuries sustained on active duty. Also, musculo-
skeletal injuries are the leading cause of medical profiles for active duty per-
sonnel. This rate is double that seen in non-veterans. Because SOF training
imposes a significant risk for musculoskeletal injuries, it may be inevitable
that SOF warriors are likely to develop some form of arthritis. However, the
pain can be minimized by choosing foods high in various nutrients.
191
Osteoarthritis
Rates of osteoarthritis are on the rise within the military. Osteoarthritis,
which occurs when cartilage in the joint deteriorates, can be extremely
painful. Being overweight is a major risk factor for osteoarthritis, so weight
loss may relieve some of the joint pain. Another approach to pain reduc-
tion is low-impact exercise. Moderate cardiovascular exercise and strength
training will improve physical performance and reduce pain.
Treatment
Traditional methods, such as prescription drugs and surgery, are avail-
able to relieve discomfort and improve mobility but these approaches will
not lead to a cure. Alternative therapies include dietary manipulations.
Consuming foods high in anti-inflammatory substances (green vegetables,
carrots, avocados, pecans, soy products, brown rice, millet, oats, wheat,
and barley, sesame, flax, and pumpkin seeds) and cold-water fish (salmon,
sardines, herring, and tuna), and minimizing dietary intake of alcohol, cof-
fee, sugar, and hydrogenated fats (margarine).
Two popular supplements for arthritis and musculoskeletal injuries are

glucosamine and chondroitin sulfate. They are widely used and prescribed,
but more information is needed to determine the best dose and form.
Weight Gain and Weight Maintenance

As the warrior ages, it is easy to increase body weight and difficult to
take it off. Food quality, sleep hygiene, and portion control are very impor-
tant issues for maintaining the desired body weight.
Food Quality
The quality of food is especially important for high mileage SOF war-
= Portion control is
riors. Decreasing the amount of “junk food” in the diet is essential as you critical to losing weight.
age. “Junk” foods not only add chemicals and processed food fillers to the
body, but also empty calories. Eating sweets and highly processed foods,
like potato chips, store purchased baked goods, and alcohol, deplete the
body of high performance catalysts needed for other functions. They also
add toxins to a healthy, fine-tuned body.
Quality of Sleep
There is more to weight gain than food and exercise. Sleep habits can
negatively affect body weight. Adequate rest is essential when possible.
The fewer hours slept, the higher the chance of being overweight.
192
Preventive Measures
t Increase sleep, when possible.
t Count and contain the number of “Happy Hour” drinks consumed.
t Keep up the cardio workouts—focus on long, slow, distance training
for better fat utilization.
t Combine cardio and strength training at least three times a week.
Weight Loss
As discussed in Chapter 2, energy intake and energy expenditure must
be balanced to maintain weight. Weight loss can be made easy following
this principle: less “junk” foods and more exercise equal weight loss, right?
Yes and no. In the ideal world this would work, but numerous life variables,
like parties, social drinking, and binge eating, get in the way. See Chapter 2
for tips on how to make weight loss a part of every day life are provided
Yo-Yo Dieting
Yo-yo dieting, or weight cycling, is defined as repeated weight loss by
repeated dieting and, when more food is introduced, subsequent regaining
of weight. Repeated weight gains and losses can cause health problems.
As an SOF warrior, dieting may not be a major issue, except when return-
ing home from 720 pounds lighter. Once home, binge eating and drinking
often occur, which can result in a rapid weight gain (see Chapter 16).
High Blood Pressure, or Hypertension

High blood pressure, or hypertension, is the most common “heart” condi-
tion among active duty personnel. Although the prevalence among SOF has
not been reported, it is reasonable to suspect the rates are comparable to
other male service members. The major behaviors to consider when trying to
lower or prevent high blood pressure include:
t Keeping a healthy weight: as little as a 5-10% weight loss can drop
blood pressure significantly.
t Being moderately physically active every day of the week, if possible.
t Eating a healthy diet.
t Avoiding foods high in sodium.
t Drinking alcoholic beverages in moderation.
Blood pressure is measured as two numbers—systolic (heart contracts)
over diastolic (heart relaxes) pressure. Normal blood pressure values are
less than 120 (systolic) and 80 (diastolic) mm Hg. Values higher than 120
and 80 may be a problem and should be discussed with a physician. If you
193
are at risk for hypertension, the Dietary Approaches to Stop Hypertension

(DASH) eating plan is the diet most often recommended. In brief, the plan
suggests the following: A healthy, well-balanced
t Eating more fruits, vegetables, and low-fat dairy foods. diet is more than
fueling muscles; it also
t Cutting back on foods high in saturated fat, cholesterol, and total fat.
protects the heart.
t Eating more whole grain products, fish, poultry, and nuts.
t Eating less red meat and sweets.
t Eating foods rich in magnesium, potassium, and calcium.
t Reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon).
Click here for more information on the DASH diet.
Coronary Heart Disease (CHD)

The “High Mileage” SOF warrior is not invincible from coronary heart
disease (CHD). Age naturally increases the risk, if diet is neglected. Main-
taining good eating patterns and cardiovascular fitness can decrease the
“High Mileage” warrior’s chance of developing CHD.
Eating fruit, vegetables and whole grains is a good place to start. Dietary
guidelines from the American Heart Association are provided below.
Building Blocks for Life
Healthy Eating Patterns Healthy Body Weight
t Eat a variety of fresh fruits t Balance energy needs. Table 17–3. Risk Factors for CHD
and vegetables.
t Physical activity. Diabetes
t Eat whole grain pastas
t Avoid the “Apple Shape” body.
and rice. Cholesterol
t Waist girth needs to be (HDL/LDL)
t Select low-fat products.
below 40”.
High Blood Pressure
Desirable Blood Lipid Profiles Desirable Blood Pressure
Smoking/
t Limit use of saturated fats. t Limit use of salt. Tobacco Use
t Avoid trans fats. t Limit alcoholic consumption Alcohol

(2 for a day). Consumption
t Replace saturated fats with
fats from vegetables, fish, t Maintain body weight.
Family History
and nuts. of Heart Disease
t Follow DASH Diet.
194
Lowering Risks
The risk of CHD can be lowered, but some factors cannot be controlled:
t Age.
t Gender: Men have an increased risk of developing heart disease.
t Family history of cardiovascular disease or diabetes.
Luckily, there are some factors for which you do have control. They
include the following:
t Diet.
t Exercise patterns.
t Annual checkups.
Eating a variety of fish
t Frequent blood pressure screenings.
can improve lipid levels!
t Smoking history.
t Lipid profile.
Lipid Profiles
A lipid profile is a panel of tests used to determine the risk of CHD. The
test measures levels of Total Cholesterol, High-Density Lipoprotein Cho-
lesterol (HDL or good cholesterol), Low-Density Lipoprotein (LDL or bad
cholesterol) and triglycerides in blood. Physicians use the results (in com-
bination with other known risk factors) to develop a treatment plan, which
should be treated seriously, and to assess the effectiveness of the plan.
Treatments for High Risk Lipid Profiles
Three easy treatments for reducing high risk lipid profiles include:
t Change your diet.
t Exercise regularly (aerobic exercise).
t Quit smoking.
Nutritional Choices to Protect Your Heart

The easiest way to protect the heart is by choosing foods known to be
effective in reducing the risk of CHD. Some foods known to decrease the
risk of developing CHD are presented in Tables 17–4 and 17–5..
195
Table 17–4. Heart Healthy Foods
Soy Isoflavones compounds in soy products

may reduce LDL (“bad”) cholesterol. En-
joy foods such as tofu, soy nuts, soy flour,
and enriched soymilk.
Beans Eating a cup of beans daily, no matter

which kind, can lower cholesterol by 10%
in six weeks.
Salmon Omega-3 fatty acids—found in salmon

and other cold-water fish—help lower
LDL (“bad”), raise “good” HDL choles-
terol, and lower triglycerides.
Avocado A great source of heart-healthy mono-

unsaturated fat that may help raise HDL
(“good”) and lower LDL (“bad”) choles-
terol levels.
Garlic Garlic helps stop artery-clogging plaque

from forming at its earliest stage by keep-
ing individual cholesterol particles from
sticking to artery walls.
Spinach A daily ½ cup of spinach, which is rich

in lutein, guards against heart attacks by
helping artery walls “sluff off” cholesterol
that causes clogging.
Walnuts, Cashews These nuts have all been linked to healthy

and Almonds hearts and contain vitamin E, monoun-
saturated fats, and magnesium.
Tea Antioxidants in green tea lower total

cholesterol levels and improve the ratio of
HDL (“good”) to LDL (“bad”) cholesterol.
Dark or Bittersweet The flavonoids in dark chocolate help

Chocolate keep blood platelets from sticking to-
gether and may even help keep arteries
unclogged.
196
Table 17–5. Nutrients that Protect the Heart
Nutrient Foods Risks Reduced
Soluble fiber Oats, oat bran, barley, Helps lower blood

rye, flax seed, legumes, cholesterol.
psyllium husk, dried
fruits, apples, pears,
citrus fruit, carrots, nuts,
dried beans, and peas.
Omega-3 fatty Cold water fish, such as Lowers blood

acids salmon, halibut, scal- pressure and
lops, tuna, mackerel, triglycerides;
cod, shrimp, snapper, helps prevent
and sardines, and vege- clot formation
tables such as flaxseeds, and irregular
pumpkin seeds, sesame heart beats;
seeds, walnuts, soy- defends against
beans, dried cloves, cau- inflammation.
liflower, mustard seeds,
boiled cabbage, broccoli,
romaine lettuce, spin-
ach, dried oregano, tofu,
brussels sprouts, green
beans, strawberries, and
turnip greens.
Vitamin B6 Beans, nuts, legumes,

eggs, meats, fish, whole
grains, and fortified A deficiency of
breads, and cereals. any will increase
homocysteine
Vitamin B12 Eggs, meat, poultry,
levels, which is
shellfish and milk
associated with
products.
risk of coronary
Folate Fortified grains, leafy heart disease.
green vegetables, le-
gumes, seeds, and liver.
Vitamin E Wheat germ, corn, nuts, Limits LDL oxida-

seeds, olives, vegetable tion and slows down
oils (corn, sunflower, plaque formation.
soybean, cottonseed),
spinach and other green
leafy vegetables, and
asparagus.
197
Drug Treatments to Improve Lipid Profiles

Many physicians prescribe pharmaceutical agents to improve lipid pro-
files, because they are highly effective. Table 17–6 provides a snapshot of
drugs prescribed to SOF warriors, with an emphasis on statins. Some peo-
ple who take statins develop exercise-related rhabdomyolysis, or muscle
breakdown, which can be dangerous. Physicians may recommend taking
Coenzyme Q10 in combination with statins, but evidence to support this
is lacking. However, taking 50 mg daily of a USP approved Coenzyme Q10
supplement cannot hurt and may be helpful, particularly if there is a family
history of high cholesterol levels.
Table 17–6. Classes and Types of Drugs to Improve Lipid Profiles
Class Type Expected Result
Resin Cholestyramine t Lowers cholesterol

(Questran) and by binding bile
Coestipol (Colestid). acids in GI tract.
Triglyceride- Fibrates (Lopid or t Reduces triglycer-

lowering Drugs Tricor, nicotinic acid). ide production and
removes it from
circulation.
t Increases HDL
levels.
Statins Fluvastatin (Lescol), t Reduce production

Lovastatin (Mevacor), of cholesterol in
Simvastatin (Zocor), liver.
Pravastatin (Pravachol), t Reduces LDL by
Atorvastatin (Lipitor). up to 40%.
t Helps reduce size
of plaques on
artery walls.
Some research shows that persons taking statins and consuming foods
high in omega-3 fatty acids have a better chance of avoiding heart prob-
lems than those who took only statins. Again, eating foods high in omega-3
Type II diabetes, which is
fatty acids may help protect against heart disease.
closely related to obesity
and physical inactivity,
The primary food sources of omega-3 fatty acids are the oils from some
fish and plants. Cold-water fish, such as salmon, mackerel, halibut, sar-
can be controlled by diet
dines, and herring, are rich sources. Plants that contain oils with omega-3 and regular exercise.
fatty acids include flaxseeds, soybeans, pumpkin seeds, and walnuts. New
Zealand green lipped mussels are also an excellent source of omega-3
fatty acids.
198
Type II Diabetes
The incidence of Type II diabetes among adults in the military has risen
markedly in the last decade, and is expected to double in the next 50 years.
Those with diabetes are twice as likely to develop cardiovascular prob-
lems than those who are not diabetic. The prevalence of Type II diabetes
among SOF is unknown, but certainly of concern because if undiagnosed
and untreated, the risk of developing other chronic diseases increases.
Metabolic Syndrome
Metabolic Syndrome, a disorder of the 21st century, is brought on by
a sedentary lifestyle, stress, poor dietary choices (fast foods and highly
processed foods), and other unhealthy lifestyle choices. About 10 years
ago, before we understood the various contributing factors, this constel-
lation of factors (which occur together) was called “Syndrome X.” Now
it is clearly recognized as Metabolic Syndrome. In particular, belly fat or
central adiposity is present. “Central obesity” is determined by measuring
waist circumference: a man with a waist circumference ≥ 37 inches (94
cm) is considered at risk. However, for Metabolic Syndrome to be diag-
nosed, at least two of the following other factors must also be present:
t Serum triglyceride levels are ≥150 mg/dl or being treated for this lipid
problem.
t Serum HDL cholesterol levels are < 40 mg/dl.
t Systolic blood pressure is ≥130 or diastolic blood pressure is ≥85
mmHg or being treated for high blood pressure.
t Fasting plasma glucose concentration is ≥100 mg/dl or a diagnosis of
Type II diabetes has been made.
If you think you have one or more of these “factors” you should
consulted your doctor about having metabolic syndrome.
Cancer
Various factors contribute to the development of cancer: genetics, im-
mune function, environment, and diet. A Mediterranean diet, fiber rich
Some foods may inhibit diets, and other diets high in colorful fruits and vegetables, protect against
cancer development. cancer. In contrast, a high alcohol intake, with the exception of moderate
consumption of wine, has been associated with promoting some cancers.
Wine appears to lower the risk of several chronic diseases, perhaps be-
cause of the high phytonutrient and antioxidant levels.
Click here for a list of foods high in antioxidants.
18 Sustaining Health for
In This Chapter
the Long-Term Warrior
Mediterranean Diet
Omega-3 Fatty Acids
Bone Health
Key Points
Phytochemicals
t Eating a variety of foods is one key to healthy living.
Dietary Fiber
t A Mediterranean Diet has been shown to confer a long, healthy life.
Pro-/Pre-biotics
t Healthy bones require adequate calcium intake and regular physical
Alkaline Diet activity.
t Eating many different colorful real foods, which contain important
protective compounds—phytonutrients, promote life-long health.
t At least 3–5 servings of colorful vegetables, 2 or more servings of
fruit, and 6 or more servings of whole grain products, should be con-
sumed per day, whenever possible.
t Products containing probiotics (yogurt, kefir, sauerkraut) may be help-
ful for maintaining a healthy digestive tract.
t Alkaline-forming, rather than acid-forming, foods are important during
periods of high stress.
I
t is possible to be a Long-Term Warrior if good habits are developed at
a young age and sustained throughout life. These “good” habits include
a nutritious diet and a balanced exercise program. If good habits are
developed, the risks of developing musculoskeletal injuries and many
other chronic diseases associated with SOF experiences will be minimized.
This chapter discusses the proper dietary plan to maintain a healthy life.

t Variety.
t Balance.
t Moderation.
A variety of foods must be consumed to obtain all the requisite nutrients
for a strong, healthy body. Eating the same foods is not only boring, but
decreases the opportunity to include diverse nutrients in your diet; it can
also mean taking in the many environmental pesticides and chemicals on
200
those particular foods. For example, some fish are tainted with mercury,
so eating the same kind of fish daily could result in accumulation of mer-
A healthy diet is achieved cury. Likewise, if strawberries were the only fruit eaten, the body would
by balancing a variety accumulate the pesticides from the strawberries. In addition, the nutrients
of foods from the potentially derived from eating a variety of foods would be limited. Fresh
major foods groups. and dried fruits, fresh vegetables, whole grains, nuts, eggs, dairy products,
meats, poultry, and fish are all nutritious: they provide a ready supply of
energy and nutrients to keep the body healthy.
Moderation is perhaps the most difficult goal to achieve without plan-

ning meals and snacks in advance. If one meal contains high-fat foods,
another meal needs to be low in fat. Advance planning allows all foods to
be eaten without incurring an energy deficit or surplus.
90% of your foods should be healthy.

Limit junk food to only 10% of your diet.
Mediterranean Diet
One diet singled out as healthy for all ages is the Mediterranean Diet.
Research has shown that this type of diet, which is higher in monounsatu-
rated fats than other diets, results in lower blood sugar and cholesterol
levels and lower blood pressure than a typical American diet. This is at-
tributed to using olive oil (a monounsaturated fat), consuming lots of fruits
and vegetables, and also drinking some red wine. Grapes used to make the
wine contain powerful antioxidants.
=Click for the There is not an official “Mediterranean” diet because at least 16 coun-
Traditional Healthy tries border the Mediterranean Sea and not all of the same foods are eaten.
Mediterranean Diet Pyramid. However, there are similarities to the dietary patterns. They include:
t High intake of fresh fruits, vegetables, bread, wheat and cereals, pota-
toes, beans, nuts and seeds.
t Weekly intake of up to 4 eggs.
t Minimal intake of red meat.
t Low to moderate intake of dairy products, fish, and poultry.
t Frequent and regular use of olive oil.
t Low to moderate intake of red wine.

201
Omega-3 Fatty Acids

Omega-3 fatty acids were discussed in Chapter 3, but more informa-
tion on these “polyunsaturated” fatty acids (PUFA) is important because
of their health benefits. The important omega-3 fatty acids are alpha li-
nolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic
acid (DHA). The body cannot make these “fats,” but interconversions with
omega-6 fatty acids can occur. For example, vegetarians rely on the con-
version of ALA into EPA and DHA.
Fish and seafood, particularly oily fish (sardines, salmon, trout, mackerel,
herring, and anchovies) are excellent sources of omega-3s. Green vegeta-
bles and some nuts and seeds (tofu and other forms of soybeans, canola
and soybean oils, walnuts, brazil nuts, and flaxseed) are sources of ALA.
Flaxseed (linseed) oil is the best concentrated source of ALA.
A low dietary intake of omega-3 fatty acids has been associated with
heart disease, stroke, cancer, inflammatory conditions and auto-immune
diseases, and possibly negative mood, depression and other mental health
conditions. Thus, a diet that provides adequate amounts of omega-3 fatty
acids is important.
How Much is Needed?

Although the exact amount of omega-3s needed for optimal health is
unknown, intakes ≥ 650 mg/day, or 0.3% of total calories, for EPA and
DHA have been recommended. The recommended intake of ALA is 1.6
grams/day for men. An omega-3 deficiency is nonexistent in healthy indi-
viduals. Table 18–1 below provides the EPA and DHA content of various
foods sources. Clearly, eating 3 ounces of tuna (or the like) each day pro-
vides the recommended amounts of omega-3s. Table 18–2 provides the
ALA content of various plant products. Eating less than 1 oz of walnuts
provides more than the amount recommended.
Diets of today are often high in saturated and trans fatty acids (discussed in
Chapter 3), and low in omega-3 fatty acids. The ratio of omega-6 to omega-3
fatty acids in the diet today ranges from 14:1 to about 20:1. A healthier ratio
would be 5:1. It should be noted that food sources of omega-6 fatty acids in
the diet are ample: omega-6 are found in margarines and vegetable oils.
Table 18–1. Content of EPA and DHA in Various Fish Products
Fish (3 oz) EPA DHA Total Total

(mg) (mg) EPA+ Fat (g)
DHA (g)
Bass, Striped 184 637 0.8 2.5

202

DHA (g)
Catfish, farmed 42 109 0.2 6.8
Clams (9 small) 117 124 0.2 1.1
Fish sticks (~3 sticks) 126 212 0.3 11.1
Flounder & sole 207 219 0.4 1.3
Haddock 65 138 0.2 0.8
Halibut 77 318 0.4 2.5
Herring, Kippered 825 1,003 1.8 10.5
Mackerel, Pacific 555 1,016 1.6 8.6
Mackerel, Atlantic 428 594 1.0 15.1
Oysters, Eastern, 228 248 0.5 2.1

wild, raw (~6)
Perch, Atlantic 88 230 0.3 1.8
Rockfish 154 223 0.4 1.1
Salmon, Atlantic, 587 1,238 1.8 10.5

farmed
Salmon, Atlantic, wild 349 1,215 1.5 6.9
Salmon, Coho, farmed 347 740 1.1 7.0
Salmon, Sockeye, 418 564 1.0 6.2

canned, drained
Salmon, Coho, wild 341 559 0.9 3.1
Sardines, Pacific, 520 845 1.4 1.2

packed in tomato sauce
Sardines, Atlantic, 402 432 0.8 9.1

oil-packed
Swordfish 111 579 0.1 4.4
Trout, Rainbow, farmed 284 697 1.0 6.1

203

DHA (g)
Trout, Rainbow, wild 398 442 0.8 4.9
Tuna, Bluefin 309 910 1.3 5.3
Tuna, White, water- 198 535 0.1 2.5

packed, drained
Tuna, Light, water- 40 190 0.2 0.7

packed, drained
Tuna, Light, oil-packed, 23 86 0.1 7.0 Eat a variety of fish at least

drained
twice a week and include
other foods rich in ALA.
Table 18–2. ALA Content of Various Vegetable Products
Vegetable/Nuts/ ALA (mg) Total Fat (g)

Seeds (3 oz)
Brazil Nuts 30 56.5
Flaxseeds 19,400 35.8
Soybeans, 301 5.4

green, boiled
Spinach, raw 56 0.13
Sunflower seeds, 59 42.3

dry roasted
Tofu 495 7.4
Walnuts, English 7,700 55.5
Winter Squash 31 0.12

Increasing omega-3
Source: United States Department of Agriculture: National Nutrient
Database for Standard Reference, Release 19 (http://www.nal.
intake through foods
usda.gov/fnic/foodcomp/search/). EPA and DHA values not is preferable to
available for all foods. supplements.
Despite being a rich source of omega-3 fatty acids, fish and seafood are
potentially major sources of environmental contaminants. Thus, fish con-
204
sumption is an example where the potential benefits and risks may be in

competition. However, it is still acknowledged that the health benefits of
eating fish outweigh the risks.
Fish Oil Supplements

Because many people do not like or do not have access to foods high
in omega-3s, fish oil supplements are commonly taken. However, fish oil
supplements should only be taken under the care of a physician. The most
common side effect of fish oil supplements, which was discussed in Chap-
ter 11, is gastrointestinal complaints. It is also possible high intakes of ome-
ga-3 fatty acids (> 3 grams/day) may result in prolonged bleeding time.
See www.usp.org for USP-approved fish oils.
Bone Health
The health status of bones is determined by various lifestyle behaviors
between birth and age 30. Bone health is of great concern in SOF train-
ing because stress fractures can eliminate potential “wannabe’s” from the
playing field. The major determinants of achieving “peak bone mass” dur-
ing adolescence and early adult life are diet and physical activity.
The primary nutrients for achieving healthy bones are calcium, vita-
min D, protein, and other essential minerals. Calcium is one of the most
abundant minerals in the body, yet one frequently lacking in the diet of all
individuals. On average, daily intake of calcium ranges from 500–700 mg,
which is much lower than the suggested level of 1000 mg.
Milk, milk products, and calcium-fortified products are important to
bone health. An inadequate intake of calcium can lead to borrowing calci-
um “reserves” from the bones to meet the body’s needs; with a prolonged
deficit, osteopenia or low bone mass may develop. A list of foods with
high calcium and vitamin D content is presented below. Note that non-
fat milk products have a higher calcium content than their low- or full-fat
counterparts.
Table 18–3. Foods with High Calcium and Vitamin D Content
Food Amount Calcium Content

(mg)
Yogurt, plain, 8 oz 450

non-fat
Yogurt, plain, 8 oz 350–415

low-fat
205
Table 18–3. Foods with High Calcium and Vitamin D Content
Food Amount Calcium Content

(mg)
Yogurt, low-fat, 8 oz 250–350

with fruit
Milk, skim 1 cup 302–316
Milk, 2% 1 cup 313
Cheddar cheese 1 oz 204
Provolone cheese 1 oz 214
Mozzarella cheese, 1 oz 207

part skim
Ricotta cheese, 1 cup 337

part skim
Swiss cheese 1 oz 272
Almonds ½ cup 173
Figs, dried 10 figs 269
Orange juice, 1 cup 250

calcium fortified
Orange 1 medium 56
Rhubarb, cooked ½ cup 174

with sugar
Collards, turnip 1 cup 200–270

greens, spinach,
cooked
Broccoli, cooked 1 cup 178
Oatmeal, with milk 1 cup 313
Salmon, canned, 3 ½ oz 230

with bones
Sardines, canned, 3 ½ oz 350

with bones
Halibut Half fillet 95

206
One of the primary reasons for a low dietary intake of calcium is that sodas
and colas have replaced milk as the beverage of choice: on average, 23 gal-
lons of milk are consumed per person per year as compared to 49 gallons of
soft drinks. Not only have soft drinks replaced milk as the beverage of choice
with meals, but they also contain phosphoric acid, which may disturb the
natural balance of bone growth. Cola soft drinks are especially harmful due to
the caffeine content. Caffeine may interfere with the absorption of calcium
from foods and/or supplements, and compromise bone mineral density.
Other reasons why bone health is not what it should be relates to physi-
cal activity patterns. Many young men of today are sedentary—playing
video games may maintain healthy bones in the fingers and hands, but
regular, weight-bearing aerobic exercise and an active lifestyle are essen-
tial for promoting good bone health. Other dietary and lifestyle patterns
that may compromise bone health include:
t > 3 alcoholic beverages/day.
t An acidic diet.
t Smoking/smokeless tobacco.
t Excessive intakes of Vitamin A (i.e., retinol).
t Excessive intakes of protein.
Stress Fractures
It is not uncommon for SOF and other military personnel to develop
stress fractures, which is a consequence of poor bone health and physical
fitness. Risk factors for stress fractures include:
t Short height.
t Low bone density or poor bone structure.
t Smoking.
t Alcohol consumption.
t Low calcium intake.
t Low fitness and/or activity levels before enlistment.
t Previous injury.
t Poor muscle strength.
However, in addition to the risk factors noted above, several aspects of
military training may contribute as well. These include:
t Training schedules with too much, too soon.
t High running mileage.
t Excessive loss of calcium in sweat.
t Boot/shoe fitting and design.
207
Phytonutrients
One reason the Mediterranean diet is so healthy is because most of the
foods provide phytonutrients (phytochemicals). Phytonutrients are sub-
stances found in plants that protect against bacteria, viruses, and fungi.
Eating a variety of many colorful foods that contain phytochemicals (fruits
and vegetables, whole grains, cereals, and beans) appears to decrease the
risk of developing certain cancers, diabetes, hypertension, and heart dis-
ease. The actions of phytonutrients vary by color and type of food: they
may act as antioxidants, anti-inflammatory agents, and/or other nutrient
protectors. Table 18–4 below provides a partial list of phytonutrients and
food sources of these important nutrients. Phytonutrients may also be
considered functional foods, as discussed in Chapter 17.
Table 18–4. Types of Phytonutrients and Good Food Sources
Phytonutrients Sources
Allicin Onion, garlic.
Anthocyanins Red and blue fruits (raspberries,

cranberries, cherries, and blue-
berries) and vegetables.
Bioflavonoids Citrus fruits.
Carotenoids Dark yellow, orange, and deep

green fruits and vegetables (to-
matoes, parsley, oranges, pink
grapefruit, and spinach).
Flavonoids Fruits, vegetables, wine, green

tea, onions, apples, kale, and
beans.
Indoles Bok choy, cabbage, kale, brussels

sprouts, and turnips (cruciferous
vegetables).
Isoflavones Soybeans and soybean

products.
Lignins Flaxseed and whole grain

products.
Lutein Leafy green vegetables.
Lycopene Tomato products.

208
Table 18–4. Types of Phytonutrients and Good Food Sources
Phytonutrients Sources
Phytonutrients should be
derived from real foods, Phenolics Citrus fruits, fruit juices,
not dietary supplements. cereals, legumes, and oilseeds.
At present, a recommended daily allowance for phytonutrients does not

exist. However, eating a variety of foods, including plenty of fruits and
vegetables, will ensure an adequate intake. Phytonutrients are now being
added to supplements, but it is most likely that their healthful effects are
due to their natural packaging. Other foods high in phytonutrients include
the following:
= Click here for

more information
Broccoli Berries Soynuts Pears Turnips
on dietary fiber.
Celery Carrots Spinach Olives Tomatoes
Dietary Fiber: Lentils Cantaloupe Garlic Apricots Onions
A form of carbohydrate that Seeds Soybeans Green Tea Apples Cabbage

is not classified as a nutrient
Brussels Bok Choy Kale Red Wine Grapes
and it cannot be digested.
Sprouts
Insoluble Fiber:
Dietary Fiber
Absorbs water in the gastro-
intestinal tract and promote Dietary fiber is a critical component of the diet for health. However,
regular elimination of stools. during missions and operational scenarios when performance is critical to
the end result, dietary fiber may need to assume a back-seat role.
What is Dietary Fiber?

Dietary fibers, non-starch forms of carbohydrate obtained from plants,
are structural components that cannot be digested by the body. Some types
of dietary fiber are cellulose, dextrins, inulin, lignin, chitins, and pectins.
Because dietary fiber is neither digested nor absorbed, it is not a nutrient
like vitamins, minerals, protein, fats, and carbohydrates, but it is still an es-
sential part of a healthy diet.
Insoluble Fiber versus Soluble Fiber

Dietary fibers are classified as soluble or insoluble, and most fiber-rich
foods contain some of both types. These two types function differently in
the body. Insoluble fibers, the predominant fiber in most foods, absorb wa-
ter in the gastrointestinal tract and promote regular elimination of stools.
209
Five Most Fiber-Rich Foods
An increase in stool weight and a faster time for meals to be digested and
eliminated are common for diets high in insoluble fiber are ingested. In
contrast, soluble fibers undergo processing to yield compounds that con-
fer health benefits. For example, soluble fibers such as oat bran appear to
lower serum cholesterol and help regulate blood sugar levels.
These special effects of dietary fiber have prompted many health agen-
cies to make specific recommendations regarding how much dietary fiber Legumes: 15–19 g/cup
a diet should provide.
Eat More Fiber

The National Cancer Institute, the American Heart Association, the Na-
tional Academy of Sciences, and the United States Department of Agri-
culture all have dietary recommendations for fiber because of its role in Wheat bran: 17 g/cup
reducing the risk factor for various chronic diseases:
t Gastrointestinal diseases.
t Hypertension.
t Diabetes.
t Heart disease.
Prunes: 12 g/each
t Several types of cancer, including colon cancer.
In contrast, a high-fiber intake is associated with a decreased risk. For
these reasons, increasing your intake of dietary fiber may be very impor-
tant with respect to your future health. Recommendations for intake of
dietary fiber include:
t Consuming at least 3–5 servings of various vegetables, 2 or more
Asian pears: 10 g/pear
servings of fruit, and 6 or more servings of grain products
t Taking in between 20–35 grams of dietary fiber per day.
The first recommendation is easy to follow because their typical serving
is likely a quarter of a SOF serving. As a rule of thumb: one serving of fruit
would be one apple, one banana, one orange, or one pear. One serving of
grain products would be one slice of whole wheat bread or one bagel. In
addition, one serving of vegetables would be ½ cup of peas, one small Quinoa: 9 g/cup
potato, or ½ cup of carrots. It is likely that SOF warriors are eating more
than one serving at each meal.
The second recommendation is more difficult, since it is difficult to Eating more fruits and
know how much fiber is in each food, unless the amount is on a label, vegetables, whole wheat
which does list the total amount of fiber. breads, whole grain
cereals, beans, rice, nuts,
When to Minimize Fiber Intake and seeds is the best way
Dietary fiber increases transit time, stool bulk and weight, and promotes to add fiber to your diet.
regularity. During extended operations, “regular eliminations” may want to be
avoided for as long as possible. A low-fiber diet may be preferred for these oc-
210
casions. Also, many high-fiber foods can cause bloating and gas if they are not
regularly consumed, or if not enough water is consumed as well. High-fiber
foods should be tested during training to find out how your system reacts. No
dietary modifications should be tried before a mission or operational scenario.
Probiotics and Prebiotics

Probiotics and prebiotics are both of interest because they can help main-
tain a healthy gastrointestinal tract. Probiotics are live microorganisms (in
most cases, bacteria) that help maintain the natural balance in the intestines
and promote a healthy digestive system. Over 400 types of “good bacteria,”
“friendly bacteria,” or intestinal flora reside in the human tract (lactic acid
bacteria), where they reduce the effects of harmful bacteria.
Probiotics
Sources of Probiotics
Probiotics are found in real food, such as yogurt, kefir, and other cultured
milk products, as well as added to capsules, tablets, beverages, and powders.
Yogurt: dairy product produced Fermented milk, such as

by bacterial fermentation of milk. buttermilk.
Unfermented milk. Tempeh: fermented food made

by the controlled fermenta-
tion of cooked soybeans with a
Rhizopus mold.
Soy beverages. Kefir: fermented milk drink.
Sauerkraut: finely sliced cab- Kimchi: fermented dish made

bage fermented by various of seasoned vegetables, often
lactic acid bacteria. cabbage.
Kombucha: sweetened tea or Miso: Japanese food produced

tisane that has been fermented by fermenting rice, barley and/
by a macroscopic solid mass of or soybeans, with salt and the
microorganisms. mold.
Uses of Probiotics
Because “good bacteria” can be destroyed by antibiotics, illnesses, and
other insults to the body, probiotics are sometimes used. For example,
people use probiotics to prevent diarrhea caused by antibiotics. Although
antibiotics eliminate harmful bacteria that may cause an illness, they also
destroy the “good bacteria.” A decrease in the number of beneficial bacte-
211
ria may lead to other complications, such as intestinal illnesses and flare-
ups of inflammatory bowel disease. Taking probiotics may help replace
the “good bacteria” that have been destroyed and restore the balance of
“good” to “bad” bacteria. Some of the health claims of ingesting probiot-
ics have been substantiated by research.
Purported health benefits of probiotics, when the probiotics are derived

from food sources, include:
t Prevent colon cancer.
t Lower LDL “bad” cholesterol.
t Lower blood pressure.
t Improve immune function and prevent infections.
t Improve mineral absorption.
t Prevent harmful bacterial growth under stress.
Prebiotics
In contrast to probiotics, prebiotics are the fuels used by the bacteria
present in the gastrointestinal tract. Prebiotics are non-digestible carbo-
hydrates that selectively stimulate the growth and/or activity of beneficial
bacteria (probiotics) in the colon. Unlike probiotics, prebiotics naturally
occur in plants, such as garlic, asparagus, and onion. Other foods contain-
ing prebiotics include oatmeal, barley, beans, whole grains, leafy green
vegetables, berries, yogurt, and milk. Two prebiotics added to many foods
are inulin and fructo-oligosaccharides (FOS). Because prebiotics may
boost the effects of probiotics, food manufactures have created synthetic
prebiotics and added them to foods.
212
An Alkaline Diet
The energy-providing nutrients of all foods are carbohydrates, proteins,
fats (and alcohol). They combine the four basic elements: carbon, nitrogen,
hydrogen, and oxygen. When these nutrients are used for energy, they result
in “acids,” which need to be disposed of through urine, sweat, and the like. If
too many acid-products are formed due to lifestyle behaviors and exposures
(ingesting too much alcohol, overwork, over-indulgence, insufficient rest,
inadequate water intake, tobacco use, pollution, etc.), the body has a dif-
ficult time removing all of them. Eating foods that are alkaline (such as fruits
and vegetables that contain calcium, magnesium, sodium, potassium, etc.)
can help remove excess acid. Overall, it is healthier to strive for a balanced
middle ground—acid and alkaline foods. However, when under significant
physical and mental stress, a diet high in alkaline foods is recommended.
The acidity of the body is usually determined by testing the first urine
of the morning, before any food has been eaten. Urine tends to have wide
variations (pH of 4.5–8) based on the acid or alkaline potential of foods
eaten the day before. Blood is basically neutral or slightly alkaline (pH =
7.41). Urine strips can be purchased to test urine, but overall, it is best to
select foods that are both acid and alkaline.
Click here for an acid-alkaline food chart.
“The SOF operator is the primary weapons platform. There

is an imperative to extend the operational life and maximize
the battlefield performance of the operator. Nutrition is a
critical component in human performance strategies.”
CAPT “Pete” Van Hooser, Former Commodore,
CNSWG-Two

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What are probiotics and what are some of their purported health benefits?

What are probiotics and what are some of their purported health benefits?

The Special Operations Forces

Ms. Stacey Zeno, MS, is a graduate of American University in Wash-

Christiane Minnick, BFA, MAc, spent over twelve years working as

t Foods eaten at home can impact mission performance.

12 Enemy Agents t Drinking contaminated water may severely affect

t Eating before night operations should be planned

t Avoid binge eating and drinking upon returning

17 The High Mileage SOF Warrior

t Pain from arthritis can be reduced by choosing

t NSAIDs should be used on a very limited basis.

t Foods, not supplements, should be the primary

t The risks of developing hypertension, coronary

Key Points Functions of Vitamins

Sports Drinks Home

7 Optimal Choices for Eating Out 52 Nutritional Interventions for Endurance

11 Looking for the Edge– 13 Combat Rations 136

Key Points The Meal, Ready-to-Eat Individual (MRE) Menus

Dietary Supplements and the Law MRE Improvements: 2002–Present

Be a Smart Shopper: Consumer Safety Tips Patrol (MCW/LRP)

Sustained Night Operations Sleep

16 Returning to Home Base 179

Principles of Good Eating

Nutrition for the Warrior

SOF Warrior Professional/Olympic Athlete

Year-round training cycle. Seasonal training.

Multiple skills. One sport.

Well scheduled and orchestrated

Self-trained/Help yourself. Full spectrum support.

Eat on the fly/Help yourself. Sports nutritionist/Psychologists.

Military issue tents. Pampered with 5-star hotels.

Coverts ops. Limelight and enthusiastic audience.

Global impact. Self-promotion/Local enthusiasm.

Unexpected is the norm. Structured and controlled.

Private reflection and Money, endorsements, Olympic gold,

Unit at risk. Team effort.

Buddy-reliant. Coach-directed goals.

Sensitivity of Energy Balance

Components of Energy Key Points

Sensitivity of Energy Balance

t Resting energy expenditure.

t Energy for digesting foods (TEF or thermic effect of food).

Resting Energy Expenditure (REE) is the amount of energy required to Activity

The amount of energy you expend during physical activity is different

Example: Heavy: Walking with

How to Calculate Energy Expenditure

Do this for five activities, or preferably all events in 12

5-mile hike rapidly assess body composition and classify individuals as

BMI is a screening tool, and you can use it to keep track

Fueling the Tank

H20 Key Points

t Restore fluid balance by taking in enough liquids to replenish weight

t Performance decrements begin when only 2% of body weight has

Simple Carbohydrates: Fuels for Energy

Definition, Composition, and Classification

t Complex CHO include grains, fruits, seeds, potatoes, pasta, seaweed,