text: Chapter 8
  8-50. The FDA also regulates whether new ingredients can enter the marketplace or existing ones should be
  removed for safety reasons. However, federal rules do not require dietary supplement makers to test
  supplement ingredients. The FDA also regulates what claims may (or may not) be made, but it does not
  monitor claims. The regulations within DSHEA contain many gaps. Some of the concerns include—
  * The responsibility of ensuring products are properly labeled lies with the manufacturer.
  * Supplement ingredients sold in the United States before October 15, 1994 are presumed safe and
  are therefore not subject to review by the FDA for safety.
  * The responsibility of providing evidence of safety lies with the manufacturer.
  * If a product is already on the market, the FDA must provide evidence that it is not safe.
  * Government resources to check dietary supplement quality are limited.
  8-51. In June 2007, FDA imposed new regulations that had been mandated by DSHEA. The FDA established
  regulations that dietary supplements must be produced in a quality manner, do not contain contaminants or
  impurities, and are accurately labeled. Supplement manufacturers are now required to test all the ingredients
  in their products to make sure they are not contaminated but that does not mean the ingredients are safe.
  Combining and Stacking Supplements
  8-52. Once dietitians know what a supplement contains, they consider what might happen when multiple
  supplements are combined, or “stacked.” The concept of “stacking” is a concern. 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 the FDA has banned ephedra, Soldiers use ephedra-free products (promoted as safe)
  despite the fact that they are as unsafe as ephedra-based supplements. Ephedra-free supplements are
  dangerous because—
  * The supplements contain high levels of stimulants often in combination with caffeine.
  * FDA does not require the makers of the supplements to list the quantity or amount of the stimulants
  in their products.
  Consumer Safety Tips
  8-53. Operation Supplement Safety (known as OPSS) is a joint initiative between the Human Performance
  Resources Center (known as HPRC) and the DOD to educate Service members, retirees, their family
  members, leaders, healthcare providers, and DOD civilians about dietary supplements and how to choose
  supplements wisely. The Operation Supplement Safety website at https://www.opss.org/ provides easy access
  to materials and databases for Soldiers to stay informed and make healthy dietary supplement choices. The
  Army Public Health Center site at https://phc.amedd.army.mil/topics/healthyliving/n/Pages/default.aspx also
  has information on nutrition and dietary supplements.
  8-54. FDA requires manufacturers to list all product ingredients on the “Supplement Facts” panel of a dietary
  supplement label as well as the amount of each by weight, except when the ingredients are part of a
  “proprietary blend.” A proprietary blend is a collection of ingredients often unique to a particular product
  and sometimes given a special name on a product’s Supplement Facts panel. A proprietary blend might be
  listed as a “blend,” “complex,” “matrix,” or “proprietary formulation.” Many proprietary blends contains
  stimulant (or stimulant-like) ingredients. Stimulants found in supplements can include caffeine, yohimbe,
  and phenethylamines, as well as illegal ingredients such as DMAA (1,3-dimethylamylamine), DMBA (1,3-
  dimethylbutylamine), BMPEA (beta-methyl-phenethylamine), and methylsynephrine. Laboratory testing is
  the only way to know contents in any particular dietary supplement product, which is why Soldiers need to
  look for third-party certification.
  8-55. Soldiers identify third-party certification by seals that appear on some supplement products. These
  seals confirm independent testing and evaluation of dietary supplements and their ingredients and ensure that
  manufacturing and storage facilities comply with good manufacturing practices requirements. The companies
  that conduct such reviews vary widely in how they certify and how they test products. Certification seals
  confirm that a product contains the ingredients listed on the label, but they do not ensure a product’s
  effectiveness or safety.