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FOOD COMPONENTS TO ENHANCE PERFORMANCE

An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations

Committee on Military Nutrition Research

Food and Nutrition Board

Institute of Medicine

Bernadette M.Marriott, Editor

National Academy Press
Washington, D.C. 1994



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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations FOOD COMPONENTS TO ENHANCE PERFORMANCE An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations Committee on Military Nutrition Research Food and Nutrition Board Institute of Medicine Bernadette M.Marriott, Editor National Academy Press Washington, D.C. 1994

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Part I of this report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was established in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine. This report was produced under grant DAMD17-92-J-2003 between the National Academy of Sciences and the U.S. Army Medical Research and Development Command. The views, opinions, and/or findings contained in chapters in Parts II through VI that are authored by U.S. Army personnel are those of the authors and should not be construed as official Department of the Army positions, policies, or decisions, unless so designated by other official documentation. Human subjects who participated in studies described in those chapters gave their free and informed voluntary consent. Investigators adhered to U.S. Army regulation 70–25 and United States Army Medical Research and Development Command regulation 70–25 on use of volunteers in research. Citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of these organizations. The chapters are approved for public release; distribution is unlimited. Library of Congress Catalog Card No. 94-66363 International Standard Book Number 0-309-05088-X Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, D.C. 20055 Call 800–624–6242 or 202–334–3313 (in the Washington Metropolitan Area). B454 Copyright 1994 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations COMMITTEE ON MILITARY NUTRITION RESEARCH ROBERT O.NESHEIM (Chair), Monterey, California RICHARD L.ATKINSON, Department of Internal Medicine, Veterans Affairs Medical Center, Hampton, Virginia WILLIAM R.BEISEL, Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland GAIL E.BUTTERFIELD, Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine; and Geriatric Research, Education, and Clinical Center, Veterans Administration Medical Center, Palo Alto, California JOHN D.FERNSTROM, Department of Psychiatry, Pharmacology, and Neuroscience, University of Pittsburgh School of Medicine, Pennsylvania JOEL A.GRINKER, Program in Human Nutrition, School of Public Health, University of Michigan, Ann Arbor G.RICHARD JANSEN, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins ORVILLE A.LEVANDER, Vitamin and Mineral Nutrition Laboratory, U.S. Department of Agriculture, Beltsville, Maryland GILBERT A.LEVEILLE, Nabisco Brands Incorporated, East Hanover, New Jersey JOHN E.VANDERVEEN, Office of Plant and Dairy Foods and Beverages, Food and Drug Administration, Washington, D.C. ALLISON A.YATES, College of Health and Human Sciences, University of Southern Mississippi, Hattiesburg Food and Nutrition Board Liaison JOHANNA T.DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts Committee on Military Nutrition Research U.S. Army Grant Officer Representative JAMES A.VOGEL, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts COL ELDON W.ASKEW, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts (through February 21, 1994) Staff BERNADETTE M.MARRIOTT, Program Director VALERIE McCADDON BREEN, Research Assistant DONNA F.ALLEN, Project Assistant

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations FOOD AND NUTRITION BOARD JANET C.KING (Chair), Department of Nutritional Sciences, University of California, Berkeley EDWIN L.BIERMAN (Vice-Chair), Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle JOHN W.ERDMAN, JR. (Vice-Chair), Division of Nutritional Sciences, University of Illinois, Urbana CUTBERTO GARZA (Vice-Chair), Division of Nutritional Sciences, Cornell University, Ithaca, New York PERRY L.ADKISSON, Department of Entomology, Texas A&M University, College Station LINDSAY H.ALLEN, Department of Nutrition, University of California, Davis DENNIS M.BIER, Children’s Nutrition Research Center, Houston, Texas FERGUS M.CLYDESDALE, Department of Food Science and Nutrition, University of Massachusetts, Amherst HECTOR F.DeLUCA, Department of Biochemistry, University of Wisconsin-Madison, Madison MICHAEL P.DOYLE, Department of Food Science and Technology, University of Georgia, Athens JOHANNA T.DWYER, Tufts University Schools of Medicine and Nutrition, Boston, Massachusetts SCOTT M.GRUNDY, Southwestern Medical Center, University of Texas, Dallas K.MICHAEL HAMBIDGE, Center for Human Nutrition, University of Colorado Health Sciences Center, Denver LAURENCE N.KOLONEL, Epidemiology Program, Cancer Center of Hawaii, University of Hawaii, Honolulu SANFORD A.MILLER, Graduate School of Biomedical Sciences, University of Texas, Health Science Center, San Antonio ALFRED SOMMER, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland VERNON R.YOUNG, School of Science, Massachusetts Institute of Technology, Cambridge STEVE L.TAYLOR (Ex-Officio), Department of Food Science and Technology, University of Nebraska, Lincoln ARTHUR H.RUBENSTEIN (IOM Council Liaison), Department of Medicine, the University of Chicago, Chicago, Illinois

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations Staff BERNADETTE M.MARRIOTT, Acting Director, Food and Nutrition Board CATHERINE E.WOTEKI, Director, Food and Nutrition Board (through December 22, 1993) MARCIA S.LEWIS, Administrative Assistant SUSAN M.WYATT, Financial Associate

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations Preface This publication, Food Components to Enhance Performance, is another in a series of reports based on workshops sponsored by the Committee on Military Nutrition Research (CMNR) of the Food and Nutrition Board (FNB), Institute of Medicine, National Academy of Sciences. Other workshops or symposia have included such topics as nutritional needs in hot environments, body composition and physical performance, nutrition and physical performance, cognitive testing methodology, and fluid replacement and heat stress. These workshops form a part of the response that the CMNR provides to the Commander, U.S. Army Medical Research and Development Command, regarding issues brought to the committee through the Military Nutrition Division of the U.S. Army Research Institute of Environmental Medicine (USARIEM) at Natick, Massachusetts. FOCUS OF THE REPORT Optimal job performance without compromising the health and well-being of employees is the goal of employers no matter what the field of endeavor. Intermittent or prolonged physiological and psychological stressors that employees bring to the workplace have an impact not only on their own performance but on that of those with whom they work and interact. The very

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations significant effects of sleep deprivation on performance were clearly demonstrated in the recent report of performance decrements of medical interns and residents who needed to perform important medical tasks while on duty for extended periods of time, the Exxon Valdez accident, and similar military maritime accidents (National Commission on Sleep Disorders Research, 1993). The internal stressors an individual brings to his or her job are then compounded by the day-to-day physical and mental stresses of the job itself. Along with individuals engaged in the emergency and protective services in our communities—fire fighters, police, and emergency medical personnel—military personnel in combat settings endure highly unpredictable timing and types of stresses as well as situations that require continuing vigilance for hours or even days. The U.S. Army has been led by concerns about individuals’ abilities to avoid performance degradation and the need to enhance mental capabilities in highly stressful situations to an interest in devising military ration components that could enhance soldier performance. The Committee on Military Nutrition Research was asked to assist a collaborative developmental program between scientists at the U.S Army Research Institute of Environmental Medicine (USARIEM) and the U.S. Army Natick Research, Development and Engineering Center (NRDEC) by evaluating the performance-enhancing potential of specific food components. On the basis of recent research, the Army scientists specifically requested that the CMNR review and comment on the potential for tyrosine, other amino acids, complex carbohydrates, caffeine, carnitine, choline, and long-chain fatty acids to help sharpen an individual’s performance under the strain of military missions. The committee was requested to indicate which if any of these food ingredients would offer the most promise for future research that would lead to the development of prototype ration components. Production of sufficient quantities of prototype rations to allow human testing of the effectiveness of such ration components in enhancing individual and unit performance in laboratory and controlled field settings could then proceed. The CMNR was asked to consider the research possibilities of each of the above listed food components and to also address six general questions about using food components to enhance performance in military combat settings. The questions that were posed to the committee are included in Chapter 1 of this report. The views of military and nonmilitary scientists from the fields of neuroscience, nutrition, physiology, various medical specialties, and psychology on the most recent research concerning physical and mental performance enhancement in stressful conditions are included in this report. Although placed within the context of military tasks, the conclusions and recommendations presented in Chapters 1 and 2 of this report may have wide-reaching implications for individuals in any job setting.

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations HISTORY OF THE COMMITTEE The Committee on Military Nutrition Research (CMNR) was established in October 1982 following a request by the Assistant Surgeon General of the Army that the Food and Nutrition Board of the National Academy of Sciences set up a committee to advise the U.S. Department of Defense on the need for and conduct of nutrition research and related issues. The committee’s tasks are to identify nutritional factors that may critically influence the physical and mental performance of military personnel under all environmental extremes; to identify deficiencies in the existing data base; to recommend research that would remedy these deficiencies and approaches for studying the relationship of diet to physical and mental performance; and to review and advise on standards for military feeding systems. Within this context the CMNR was asked to focus on nutrient requirements for performance during combat missions rather than requirements for military personnel in garrison. (The latter were judged as not significantly different from those of the civilian population.) Although the membership of the committee has changed periodically, the disciplines represented have consistently included human nutrition, nutritional biochemistry, performance physiology, food science, and psychology. For issues that require broader expertise than exists within the committee, the CMNR has convened workshops. These workshops provide additional state-of-the-art scientific information and informed opinion for the consideration of the committee in their evaluation of the issues at hand. COMMITTEE TASK AND PROCEDURES In May 1992, personnel from the USARIEM requested that the CMNR examine the current state of knowledge concerning the potential of a number of food components to enhance performance in military combat settings. This request originated from a Science and Technology Objective (STO) to prevent performance degradation of the soldier under the stress of sustained field operations as part of the overall initiative—“The Soldier as a System.” This initiative recognizes the importance of all aspects of the soldier’s equipment and person as important in moving toward enhanced capabilities necessary for the future (see Chapter 3; Army Science Board, 1991). The committee was aware of the large volume and the diversity of quality of the scientific literature on the topic of performance enhancement. It decided that the best way to review the state of knowledge in this disparate area was through a workshop at which knowledgeable researchers could review published research with the committee. Such a workshop would enable the

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations CMNR to review the adequacy of the current research and to identify gaps in the knowledge base that might be filled by future research. A subgroup of the committee met in May 1992, determined the key topics for review, identified speakers with expertise in these topics, and planned the workshop for November 1992. Invited speakers were asked to prepare a review paper on their assigned topic for presentation and publication and to make specific recommendations in response to several questions posed to them prior to the workshop. The CMNR also believed that it would be beneficial to include a review of earlier and ongoing military research. Scientists at USARIEM and NRDEC participated in the workshop, resulting in a well-rounded agenda. At the workshop, each speaker gave a formal presentation, which was followed as time allowed by questions and a brief discussion period. The proceedings were tape-recorded and professionally transcribed. At the end of the presentations, a general discussion of the overall topic was held. Immediately after the workshop, the CMNR met in executive session to review the issues, draw some tentative conclusions, and assign the preparation of draft reviews and summaries of specific topics to individual committee members. Committee members subsequently met in a series of working sessions and worked separately and together using the authored papers and additional reference material to draft the summary and recommendations. The final report was reviewed and approved by the entire committee. The summary and recommendations of the Committee on Military Nutrition Research constitute Part I of this volume, and Parts II through VI include the papers presented at the workshop. Part I has been reviewed anonymously by an outside group with expertise in the topic area and experience in military issues. The authored papers in Parts II through VI are ordered in this volume as they were presented at the workshop. These chapters have undergone limited editorial change, have not been reviewed by the outside group, and represent the views of the individual authors. Selected questions directed toward the speakers and their responses are included when they occurred to provide a flavor of the workshop discussion. The invited speakers were also requested to submit a brief list of selected background papers prior to the workshop. These recommended readings, relevant citations collected by CMNR staff prior to the workshop, and selected citations from each chapter are included in the Selected Bibliography (Appendix C).

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations ACKNOWLEDGMENTS It is my pleasure as Chair of the CMNR to acknowledge the contributions of the FNB staff, particularly the excellent technical and organizational skills of Bernadette M.Marriott, Ph.D., the FNB program director for the CMNR. Her assistance in organizing the workshop and in bringing the proceedings to the point of publication is greatly appreciated. I wish to acknowledge as well the fine contributions by the workshop speakers and their commitment to participate and prepare detailed review papers on relatively short notice. The CMNR appreciates the assistance of COL Eldon W.Askew and others from the USARIEM, and Drs. C.Patrick Dunne and Irwin A.Taub of NRDEC for their assistance in identifying issues of concern to the military and obtaining the involvement of the military personnel who participated in the workshop. The assistance of Dr. Harris R.Lieberman in the planning and identification of participants is gratefully acknowledged. COL David Schnakenberg’s scientific expertise and his historical knowledge of relevant military studies contributed significantly, as in the past, to the success of the workshop. The critiques of the anonymous reviewers and Food and Nutrition Board liaison member, Johanna Dwyer, in addition to comments by FNB director Catherine Woteki, provided helpful insights in the development of this final document. The editorial efforts of Michael Hayes are gratefully acknowledged. The assistance of Valerie Breen, CMNR research assistant, and Donna Allen, CMNR project assistant, in word processing, editing, and proofreading this report is greatly appreciated. Finally, I am grateful to the members of the committee who participated significantly in the discussions at the workshop and in the preparation of the summaries of the proceedings. I also I want to thank committee members who participated in the initial planning of the workshop and those who drafted initial summaries of sections of this report. In particular, I want to thank former committee members Edward S.Horton, John A.Milner, and James G. Penland. The commitment of the members of this committee, who serve without compensation to provide sound, timely recommendations for consideration by the military, is commendable. It is a pleasure to work with this dedicated group. ROBERT O.NESHEIM, Chair Committee on Military Nutrition Research

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations REFERENCES Army Science Board 1991 Soldier as a System. 1991 Summer Study Final Report. Assistant Secretary of the Army Research, Development and Acquisition. Washington, D.C.: U.S. Department of the Army. National Commission on Sleep Disorders Research 1993 Wake up America: A National Sleep Alert, Volume 1: Executive Summary and Executive Report, submitted to the U.S. Congress and to the Secretary, U.S. Department of Health and Human Services, January 1993. Washington, D.C.

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations Contents PREFACE   vii I COMMITTEE SUMMARY AND RECOMMENDATIONS   1 1   Introduction and Background   3 2   Conclusions and Recommendations   47 II BACKGROUND AND INTRODUCTION TO THE TOPIC   63 3   Nutritional Enhancement of Soldier Performance at the U.S. Army Research Institute of Environmental Medicine, 1985–1992 Eldon W.Askew   65 4   Optimizing the Design of Combat Rations Irwin A.Taub   77 5   Biochemical Strategies for Ration Design: Concerns of Bioavailability C.Patrick Dunne   93 III MILITARY ISSUES   111 6   Evaluation of Physical Performance James A.Vogel   113 7   The Effects of Sleep Deprivation on Performance During Continuous Combat Operations Gregory Belenky, David M.Penetar, David Thorne, Kathryn Popp, John Leu, Maria Thomas, Helen Sing, Thomas Balkin, Nancy Wesenten, and Daniel Redmond   127 8   The Role of Context in Behavioral Effects of Foods Herbert L.Meiselman and F.Matthew Kramer   137

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations IV STRESS AND NUTRIENT INTERACTIONS: METABOLIC CONSEQUENCES   159 9   Stress and Monoamine Neurons in the Brain John D.Fernstrom   161 10   Endocrine and Immune System Responses to Stress William R.Beisel   177 11   The Metabolic Responses to Stress and Physical Activity Edward S.Horton and William R.Beisel   209 V POTENTIAL PERFORMANCE-ENHANCING FOOD COMPONENTS   221 12   Food Components That May Optimize Physical Performance: An Overview John L.Ivy   223 13   Effects of Nutrients on Neurotransmitter Release Richard J.Wurtman   239 14   Performance-Enhancing Effects of Protein and Amino Acids Carol E.Greenwood   263 15   Tyrosine and Stress: Human and Animal Studies Harris R.Lieberman   277 16   Tyrosine and Glucose Modulation of Cognitive Deficits Resulting from Cold Stress Stephen T.Ahlers, John R.Thomas, John Schrot, and David Shurtleff   301 17   Carbohydrates, Protein, and Performance Bonnie J.Spring, Regina Pingitore, and Jen Schoenfeld   321 18   Structured Lipids: An Overview and Comments on Performance Enhancement Potential Ronald J.Jandacek   351 19   Choline: Human Requirements and Effects on Human Performance Steven H.Zeisel   381 20   Effects of Caffeine on Cognitive Performance, Mood, and Alertness in Sleep-Deprived Humans David M.Penetar, Una McCann, David Thorne, Aline Schelling, Cynthia Galinski, Helen Sing, Maria Thomas, and Gregory Belenky   407 21   The Role of Carnitine in Enhancing Physical Performance Peggy R.Borum   433

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Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations VI SAFETY AND REGULATORY ASPECTS OF POTENTIAL RATION ENHANCEMENT   453 22   Safety Concerns Regarding Supplemental Amino Acids: Results of a Study Timothy J.Maher   455 23   Regulation of Amino Acids and Other Dietary Components Associated with Enhanced Physical Performance John E.Vanderveen   461 APPENDIXES   475 A   Scenarios that Illustrate Potential Usefulness of Food Components to Enhance Performance Harris R.Lieberman and Mary Z.Mays   477 B   Military Recommended Dietary Allowances, AR 40–25 (1985)   481 C   A Selected Bibliography on an Evaluation of Potential Performance-Enhancing Food Components for Operational Rations   501 D   Biographical Sketches   515 INDEX   529

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