This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
Over 60% of military personnel in the United States currently use dietary supplements. Two types of dietary supplements, weight loss and sports performance (WLSP) supplements, are commonly used by military personnel despite the associated serious adverse effects such as dehydration and stroke.
To understand peer-to-peer communication about WLSP supplements among military personnel, we conducted a pilot study using the social media website, Reddit.
A total of 64 relevant posts and 243 comments from 2009 to 2019 were collected from 6 military subreddits. The posts were coded for year of posting, subreddit, and content consistent with the following themes: resources about supplement safety and regulation, discernability of supplement use through drug testing, serious adverse effects, brand names or identifiers, and reasons for supplement use.
A primary concern posted by personnel who used supplements was uncertainty about the supplements that were not detectable on a drug test. Supplements to improve workout performance were the most frequently used.
Our pilot study suggests that military personnel may seek out peer advice about WLSP supplements on Reddit and spread misinformation about the safety and effectiveness of these products through this platform. Future directions for the monitoring of WLSP supplement use in military personnel are discussed.
The dietary supplement market in the United States is enormous and steadily growing, with a projected $56.7 billion in annual revenue by 2024 [
The Dietary Supplement Health and Education Act of 1994 allows the US Food and Drug Administration (FDA) to loosely regulate supplements, but the FDA cannot mandate rigorous testing and reporting of the efficacy, safety, or purity of dietary supplements before these are placed on the market [
Weight loss and sports performance (WLSP) supplements have been associated with a myriad of adverse health effects, including dehydration, electrolyte imbalance, digestive dysfunction, stroke, renal failure, and death [
Military personnel are particularly vulnerable to using these products and adopting other dangerous weight control behaviors because of their rigorous training regimens and long work hours and the need to reach a certain weight to be eligible for military service [
In 2012, the US Department of Defense (DoD) created the Operation Supplement Safety (OPSS) campaign to increase awareness of the dangers of dietary supplement use [
Social media platforms, such as Reddit, have been employed to understand the mental health needs and experiences of military personnel [
In several studies, Reddit has been used to assess peer-to-peer communication on topics such as mental health [
Our pilot study used data from Reddit to examine peer-to-peer communication about WLSP supplements among military personnel. The Boston Children’s Hospital institutional review board determined this study to be exempt from the need to obtain informed consent given the nonidentifying nature of the data.
Reddit hosts the following 6 publicly available military personnel subreddits for the air force, army, military, navy, and coast guard: r/AirForce, r/army, r/Military, r/navy, r/uscg, and r/USMC. To identify all potentially relevant posts between January 1, 2009, and December 31, 2019, we used the following search terms: “supplements,” “dietary supplements,” “ECA stack,” “EC stack,” and “drug test.” A total of 570 potentially relevant posts were extracted for review to identify those related to WLSP supplements. Posts related to vitamins and other types of dietary supplements were excluded. A total of 64 relevant posts, to which users posted 243 relevant comments in response, were included in the analytic database for this study.
Posts and comments were captured as PDF files and imported into QSR International’s qualitative software, NVivo 12, for coding [
One of the primary aims of our pilot study was to evaluate the intercoder agreement for the Reddit posts. We assumed that feasibility would be achieved if the lower bound of the two-sided 95% exact binomial CI for the proportion of successfully coded subreddits exceeded 80%; this is equivalent to observing successful coding of at least 58/64 (91%) posts. Cohen κ [
The word frequency analysis tool in NVivo 12 was used to identify words that were frequently used in the collected Reddit posts and comments. The tool identifies exact matches for strings of 3 or more characters. Frequent words were analyzed if they appeared in the Reddit posts 3 or more times. Common words including “the,” “like,” “and,” and “but” were excluded from the results.
Interrater agreement for coding of Reddit post themes appearing in military personnel subreddits from 2009 to 2019 (N=64 posts).
Themes | κ value (95% CI) | |
Operation Supplement Safety | 0.85 (0.56-1.0) | <.001 |
Other research citeda | 0.74 (0.39-1.0) | <.001 |
Drug testing/positive test result | 0.92 (0.75-1.0) | <.001 |
Products and ingredients | 0.97 (0.91-1.0) | <.001 |
Reasons for use | 0.97 (0.91-1.0) | <.001 |
Adverse effects | 1.0b (1.0-1.0) | N/Ac |
aResearch from sources other than Operation Supplement Safety (eg, the US Food and Drug Administration website).
bVariance was estimated to be zero as a result of perfect agreement between coders.
cN/A: not applicable.
Peer-to-peer communication about WLSP supplements was seen in all 6 military personnel subreddits beginning in the year 2012, but no relevant posts were identified from 2009 to 2011 (
Terms related to drug testing, such as “drug test,” “illegal,” “banned,” and “pop,” appeared frequently in posts and comments, suggesting that users were concerned with which WLSP supplements were legal and which might lead to a positive result on a drug test (
As shown in
Keywords in military personnel subreddit posts and comments by year (2009-2019) and subreddit.
Reddit post information |
Frequency of words, n | |
|
||
|
Supplements/dietary supplements | 232 |
|
Drug test | 84 |
|
ECa/ECAb stack | 27 |
|
||
|
r/AirForce | 23 |
|
r/army | 13 |
|
r/Military | 11 |
|
r/navy | 8 |
|
r/uscg | 2 |
|
r/USMC | 7 |
|
||
|
2009 | 0 |
|
2010 | 0 |
|
2011 | 0 |
|
2012 | 7 |
|
2013 | 5 |
|
2014 | 5 |
|
2015 | 4 |
|
2016 | 9 |
|
2017 | 8 |
|
2018 | 10 |
|
2019 | 16 |
aEC: ephedrine and caffeine.
bECA: ephedrine, caffeine, and aspirin supplement mix.
Frequently used words representing key themes in military personnel subreddit posts (N=64) and comments (N=243) from 2009 to 2019.
Key theme | Frequency of words, n | ||
|
|||
|
Link to Operation Supplement Safety website | 23 | |
|
|||
|
Food and Drug Administration | 30 | |
|
Department of Defense | 25 | |
|
|||
|
Banned | 93 | |
|
Illegal | 30 | |
|
Pop/popped/popping | 53 | |
|
|||
|
Animal Pak | 20 | |
|
Bronkaid | 8 | |
|
Caffeine | 12 | |
|
DMAAb | 46 | |
|
Ephedrine | 32 | |
|
Ephedra | 7 | |
|
Jack3d | 17 | |
|
Pseudoephedrine | 4 | |
|
Stack | 16 | |
|
Tea | 3 | |
|
|||
|
Bodybuilding | 12 | |
|
Detox | 3 | |
|
Preworkout | 60 | |
|
|||
|
Base (ie, military base) | 22 | |
|
GNCc | 31 | |
|
Online | 14 | |
|
Over the counter | 12 |
aResearch from sources other than Operation Supplement Safety (eg, the US Food and Drug Administration website).
bDMAA: 1,3-dimethylamylamine.
cGNC: General Nutrition Center.
Reddit users asked their subreddit peers about ECA stacks, where to purchase the ingredients, and if the use of these supplements would lead to a positive result on a drug test. Several users shared similar reasons for using ECA stacks, as expressed by one user who wanted to “cut some fat and [get] below [my] max weight.” The OPSS website and other research sites, such as the FDA website, were mentioned as resources by some Reddit users.
Exemplar quotes related to weight loss and sports performance dietary supplements for each key theme appearing in military personnel subreddits from 2009 to 2019.
Theme and subreddit | Year of posting | Quote | Coded themes | ||||
|
|||||||
|
r/army | 2012 | “Just curious if supplements such as preworkouts or proteins are allowed in basic?” |
Regulation of supplements Preworkout |
|||
|
r/army | 2012 | “…the Army (and pro-sports) has banned any preworkout with 1,3 Dimethylamylamine [DMAA] in them (such as Jack3d and Oxyelite Pro).” |
Regulation of supplements DMAAa Jack3d OxyElite Pro |
|||
|
|||||||
|
r/navy | 2019 | “https://www.opss.org/dietary-supplement-ingredients-prohibited-department-defense |
Operation Supplement Safety Regulation of supplements |
|||
|
|||||||
|
r/army | 2019 | “If you are ordering stuff from sketchy suppliers on the internet, who knows what’s in it. |
Other research Regulation of supplements |
|||
|
|||||||
|
r/AirForce | 2015 | “Are we allowed to take EC stack? I’ve heard anecdotes of people saying you can take it and there’s no problem, but just to be clear, ephedrine can cause false positives for methamphetamine. You have to buy Bronkaid or Primatene at a pharmacy in order to use the EC stack because ephedrine isn’t sold as a standalone product.” |
Positive test result ECc stack Ephedrine Bronkaid |
|||
|
r/army | 2018 | “I am thinking of starting an E/C stack taking Bronkaid (OTC) and Caffeine pills in order to cut some fat and get below my max weight. I wanted to just ensure that this is ok for me to do, and that it wouldn't get me in any sort of trouble. I appreciate any and all advice, thanks!” |
Regulation of supplements Weight loss Bronkaid EC stack |
|||
|
r/navy | 2019 | “E/C stack is about the only stack that's not a waste of money” |
EC stack |
|||
|
|||||||
|
r/USMC | 2018 | “Want to take a preworkout with DMHA in it. DMAA is on the banned substance list, but DMHA is not. If I pop a false positive on a drug test, will I get charged? Or will they do further tests and determine it was a legal stimulant in a pre-workout?” |
Regulation of supplements Preworkout DMAA DMHAd |
|||
|
|||||||
|
r/AirForce | 2019 | “PSA for all you PT/Mock test takers. Do not, under any circumstances, take multiple energy pills you bought at the gas station before you test. Never thought it would be a problem, but I was testing one of our officers this morning. He completed 1 lap and proceeded to vomit. His heart rate was over 210 and I was starting to worry that we would have to call an ambulance.” |
Vomiting Elevated heart rate Energy supplements |
|||
|
r/army | 2019 | “jack3d apparently did [make you test positive on a drug test] back in like 2009-2010. I used to use it lmao but never popped hot or anything. The military banned it and the product changed to remove some sort of amphetamine it had. It also killed a [couple] dudes in the Army and at USMA though from heart attacks so it could also have been that.” |
Regulation of supplements Drug testing Jack3d Heart attack |
aDMAA: 1,3-dimethylamylamine.
bResearch from sources other than OPSS (eg, the US Food and Drug Administration website).
cEC: ephedrine and caffeine.
dDMHA: 1,5-dimethylhexylamine.
To our knowledge, our pilot study is the first to examine peer-to-peer communication about WLSP supplements on a social media platform and document messaging around these products within all 6 publicly available military personnel subreddits from 2009 to 2019. Our results suggest that military personnel are interested in using these supplements regardless of existing DoD regulations and the potentially serious adverse effects.
The DoD has prohibited the use of some of these types of supplements because of the associated serious adverse effects [
The results of this study suggest that there is interest in using muscle-building and preworkout supplements among military personnel despite DoD prohibitions and the risk associated with the use of some types of supplements. ECA stacks were frequently mentioned in these subreddits and seemed to be favored by Reddit users over preformulated performance and preworkout supplements because of the perceived effects of the ECA ingredients on the body. Reddit users posted simple instructions for their peers explaining how users can make their own ECA stack from easily obtained ingredients. Many users suggested that the supplements had the effect of “cutting” fat, which would help them reach the weight required for service. Our results showed that the r/AirForce subreddit had the highest number of posts, but it is unclear if WLSP supplement use is higher in this branch than in the other branches of the military.
A limitation of this pilot study is that Reddit does not provide any demographic information on their users. Therefore, we could not determine the location, age, or gender of these users. There may be important differences in these demographic characteristics among military personnel who use these products. In addition, the subreddits included in our study were publicly accessible; although these communities are described as affinity groups for military personnel in different branches, it is possible that nonmilitary Reddit users join and post on these subreddits. Another limitation is that our research team could not access certain subreddits. For example, r/Marines is a private subreddit and a user has to be invited and approved by a moderator to access the subreddit. We do not know if WLSP supplements are discussed in these subreddits and—if they are—whether these conversations are similar to those in the publicly available subreddits.
Our investigation was restricted to Reddit to evaluate the feasibility of studying peer-to-peer communication about WLSP supplements among military personnel on a social media platform. Our findings suggest that such a study is not only feasible but can also provide novel insight into peer-to-peer communication about beliefs, misconceptions, concerns, and behaviors vis-à-vis WLSP supplements. Future research should focus on other social media platforms to examine similar communication among military personnel and other populations.
With the current use of dietary supplements at over 60% for military personnel [
Department of Defense
ephedrine, caffeine, and aspirin
ephedrine and aspirin
Food and Drug Administration
General Nutrition Center
Operation Supplement Safety
weight loss and sports performance
Support for this work has been provided by the Ellen Feldberg Gordon Fund for Eating Disorders Prevention Research and the Strategic Training Initiative for the Prevention of Eating Disorders. SBA is supported by training grant number T76-MC00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.
None declared.