Warfighter Nutrition Guide 051022 508

WARFIGHTER NUTRITION GUIDE
The Warfighter Nutrition Guide contains strategies and recommendations for all
aspects of performance nutrition for Service Members. It covers the spectrum
of nutritional needs to optimize the performance of Warfighters under the most
rigorous conditions. Despite differences across military commands, this Guide is
designed to provide Service Members with science-based, effective nutritional
strategies to optimize performance during operations and to preserve health.
CONTENTS
Chapter One: Nutrition for the Warfighter 3
Chapter Two: Balance Your Energy Tank 6
Chapter Three: Macronutrients for Everyday Fueling 13
Chapter Four: Micronutients for High Performance 21
Chapter Five: Hydrate with Fluid 29
Chapter Six: Build a Performance Plate in

the Dining Facility 37
Chapter Seven: Fueling at Home 44
Chapter Eight: Optimal Choices for Eating Out 52
Chapter Nine: Nutrient Timing and Training 59
Chapter Ten: Fuel for Your Optimal

Performance Weight 66
Chapter Eleven: Mission Nutrition for

Combat Effectiveness 72
Chapter Twelve: Dietary Supplements and

Performance-Enhancing Substances 87
Chapter Thirteen: Combat Rations 96
Chapter Fourteen: Eating Abroad 102
Chapter Fifteen: Returning to Home Base 111
Chapter Sixteen: Sustaining Health for

the Long-Term Warfighter 121
CHAPTER ONE:
NUTRITION FOR
THE WARFIGHTER
CHAPTER 1: NUTRITION FOR THE WARFIGHTER
IN THIS CHAPTER
Nutrition as a key to success
What to expect in WNG
NUTRITION AS A KEY TO SUCCESS

The demands of military service, training, and missions are unique, requiring
strength and endurance—physical and mental—to succeed. One factor that
can enhance your mental and physical performance and contribute to mis-
sion success is good nutrition. In addition, feeding your body nutrient-rich
foods can contribute to optimal lifelong health.
This Guide includes a variety of materials—from short summaries to de-

tailed information—with additional resources and important tips for nutrition
at home, in garrison, and during deployment. Each command has special-
ized missions, with the duration of deployments ranging from 30 days to 12
months. Long missions far from central support pose nutritional concerns,
and good solutions are not always possible. The Guide covers strategies for
optimizing nutrition for all phases of military life.
WHAT TO EXPECT IN WNG

The Warfighter Nutrition Guide (WNG) evolved into its first edition after many
conversations, discussions, and interactions with military, fitness, and nutri-
tion experts. Human Performance Resources by CHAMP (HPRC) updates it
periodically to keep pace with new developments in nutrition and wellness.
Chapters 2–5 provide general background information about energy

expenditure, sources of energy, essential nutrients, and hydration. These are
the backbone of WNG.
Chapters 6–8 explain how to select high-performance meals and snacks for
everyday life—whether you eat in military dining facilities, at home, or at
restaurants.
Chapters 9–12 review important information on using nutrition to excel. They

cover strategies to achieve your training and mission goals, nutritional strate-
gies for various missions, and dietary supplement safety and resources.
4
CHAPTER 1: NUTRITION FOR THE WARFIGHTER
Chapters 13 and 14 explore nutrition strategies while deployed, including

combat rations and ways to stay safe when eating abroad.
Chapter 15 discusses the importance of sleep, physical activity, and how you
can eat to regain pre-deployment health and fitness after returning home from
extended deployments.
Chapter 16 provides information on how to be a long-term warrior and what

the seasoned warrior can do to maintain operational readiness and good
health after years of intense physical training and activity.
Warfighters need effective

nutritional strategies to
optimize performance every
day—whether you're at home
or on a mission—and preserve
health into retirement.
5
CHAPTER TWO:
BALANCE
YOUR ENERGY TANK
CHAPTER 2: BALANCE YOUR ENERGY TANK
IN THIS CHAPTER
Calories: Units of energy
Energy balance: Energy intake versus energy expenditure
Fuel your tank
Assess your food intake
Body mass index
Personalized nutrition needs
KEY POINTS
It can be hard to balance energy intake and expenditure when activity levels
are very high (such as operating in extreme weather conditions) or very low
(such as working long hours at a desk).
Body weight typically remains constant when energy intake equals energy used.
Calculate your Estimated Energy Requirements (EER) to determine how much

energy you might use in one day.
Body mass index (BMI) is a clinical tool based on height and weight used to
classify individuals as underweight, normal, overweight, or obese.
Based on your activity, you can calculate how much fuel—or energy—your
“tank” requires for you to function optimally. Energy use must be balanced by
energy intake to maintain body weight or “energy balance.” To determine how
much fuel you need, learn more about your metabolic rate and activity level.
CALORIES: UNITS OF ENERGY

The calorie is the unit most commonly used to describe energy intake and
energy use. Think of a calorie as a measure of energy.
ENERGY BALANCE: ENERGY INTAKE VERSUS

ENERGY EXPENDITURE
Energy intake refers to the calories you eat and drink from foods and bever-
ages. Energy use, or “expenditure,” refers to the number of calories you use
or “burn” in a single day. The 3 major contributors to your EER are:
Basal metabolic rate
Physical activity
Energy used in digesting foods (“thermic effect of food” or TEF)
7
Energy intake and energy expenditure together make up energy balance.

When energy intake is greater than expenditure, there is a positive energy
balance, which leads to weight gain. However, when energy intake is less
than expenditure, there is a negative energy balance, or “energy deficit,”
which leads to weight loss. When energy intake equals energy expendi-
ture, body weight doesn’t change. Each body’s energy needs are unique,
and the amount of energy needed to lose or gain weight varies among
individuals and can be complicated. Overall, you can intentionally create an
energy deficit by exercising more, eating less, or both. You also can uninten-
tionally create an energy deficit by “under-fueling”—that is, by not eating
enough to balance the energy you expend through activity and exercise.
Continue reading to learn more about basal metabolic rate and physical ac-
tivity, the two factors that contribute the most to energy expenditure.
Basal Metabolic Rate

Basal metabolic rate (BMR) is the amount of energy—used for body func-
tions such as breathing, heartbeat, maintaining body temperature, and other
life processes—you need every day just to maintain life. You can use the ap-
propriate equation below to estimate your BMR. While it isn’t 100% accurate,
it can give you an idea of your energy (calorie) needs.
Physical Activity
BMR is the minimum number of calories your body needs to function. It
doesn’t include the calories you burn while you’re moving or exercising,
which vary from day to day. For example, some days you might be very
active, involved with strenuous running, swimming, calisthenics, cold-wa-
ter exposure, sleep deprivation, or carrying of heavy loads. Some days you
might be in a classroom or office, sitting a good portion of the day. Other
days you might be only moderately active, with some recreational activities.
To estimate your calorie needs for a day, multiply your BMR by the activity
factor appropriate for your lifestyle (Table 2–1 on the following page).
Calculate EER
Use the equation below to estimate your EER. While it isn’t 100% accurate, it
can give you an idea of your daily energy (calorie) needs based on your age,
physical activity (PA), weight, and height.
Institute of Medicine equation1:
EER for Men: 662 – (9.53 × age [y]) + PA × (15.91 × weight [kg] + 539.6 ×
height [m])
8
Example:
For a 25-year-old male
Warfighter who weighs
EER for Women: 354 – (6.91 × age [y]) + PA × (9.36 × weight [kg] + 726 ×
187 pounds, is 69 inches tall,
and is active, use the formula height [m])
(from above) to estimate daily Note: To convert pounds to kilograms (kg), divide pounds by 2.2. To convert
calorie needs:
inches to meters (m), multiply inches by 0.0254. You can use an online calcu-
10 × W (in kg) + 6.25 × H (in lator to convert the units.
cm) – 5 × A (in years) + 5 =
calories Next, select the appropriate PA category for your lifestyle (Table 2–1).
EER for Men: 662 – (9.53 × age

[y]) + PA × (15.91 × weight TABLE 2–1. INSTITUTE OF MEDICINE
[kg] + 539.6 × height [m]) PHYSICAL ACTIVITY CATEGORIES (PA)1
Step 1: Convert pounds to ki-
lograms and inches to meters. PA Category Mean PA Value Example
187 pounds ÷ 2.2 = 85 kg Sedentary Men: 1.00 A person with a sedentary

Women: 1.00 occupation who spends his or
69 inches × 0.0254 = 1.75
her entire day sitting
m
Step 2: Multiply age in years Low level of Men: 1.11 An office worker who sits most
times 9.53. physical activity Women: 1.12 of the day, other than the walk-
ing necessary to perform tasks
9.53 × 25 = 238
of daily living
Step 3: Subtract result in Step
Active Men: 1.25 An athlete who exercises
2 from 662.
Women: 1.27 approximately one hour a day,
662 – 238 = 424 or a person with an active
Step 4: Multiply weight in kg vocation equivalent to walking
times 15.91. 6–8 miles in a day
85 kg × 15.91 = 1352 Very active Men: 1.48 A competitive athlete engaging

Women: 1.45 in several hours of vigorous
Step 5: Multiply height in m
exercise per day
times 539.6.
1.75 m × 539.6 = 944
Step 6: Add results from Steps
FUEL YOUR TANK
4 and 5, multiply result by PA.
Warfighters should aim for a meal
1.25 (1352 + 944) = 2870
pattern that follows the MyPlate
Step 7: Add results from Steps eating guide. MyPlate tools can help
3 and 6. you build healthy meals with all the
424 + 2870 = 3294 calo- essential food groups. Table 2–2 in-
ries needed per day cludes recommended daily amounts
for each food group. MyPlate gen-
erally recommends filling ½ of your
plate with fruit and vegetables, ¼
9
of your plate with grains, ¼ of your plate with protein (plant- and/or ani-
mal-based), and one serving of dairy.
You also should include a serving of healthy fats with your meal or snack. For
example, add oil-based dressings to salads or an avocado-based topping to
fish. Foods in the MyPlate dairy or nuts (protein) categories also contain fats.
And it’s important to drink plenty of fluids with each meal or snack, so you’re
properly hydrated.
Following a meal plan such as MyPlate will ensure that you get enough
essential vitamins and minerals, fiber, protein, carbohydrates, and fats (dis-
cussed individually in Chapters 3 and 4).
TABLE 2–2. FOOD GROUPS AND RECOMMENDED DAILY AMOUNTS 2
Food Recom- What Examples of one serving

Group mended counts
Daily as one
Amount* serving?
Vegetables 2½ cups 1 cup 1 cup cooked leafy greens (for

example, spinach or lettuce)
2 cups raw leafy greens
12 baby carrots
Fruits 2 cups 1 cup 1 large banana (8” to 9” long)

1 small apple (2¼” diameter)
1 large peach (2¾” diameter)
½ cup dried fruit (for example,
raisins or cranberries)
Grains 6 ounce- 1 ounce- 1 slice whole-wheat bread

equivalents equivalent ½ cup cooked brown rice
½ cup cooked oatmeal
3 cups popcorn (popped)
Dairy 3 cups 1 cup 1 cup dairy or soy milk

8 oz container of yogurt
¹⁄ 3 cup shredded cheese
2 cups cottage cheese
Proteins 5½ ounce- 1 ounce- 1 oz meat, fish, or poultry

equivalents equivalent 1 egg
1 tablespoon nut butter
2 tablespoons hummus
¼ cup cooked beans or peas
* The amounts in this table are based on a 2,000-calorie/day eating plan. Active
Warfighters might have higher energy needs and require more servings of each
food group.
10
Remember that good nutrition is a lifestyle and all about consistency.

Warfighters should strive for the MyPlate pattern at all meals, not just before
a mission or training session. Keep in mind that your energy intake needs
might vary weekly or even daily, depending on your energy expenditure, job
duties, and tasks.
Warfighters also should be mindful of portion size—the amount of food you

actually eat—compared to serving size—a standard amount used primarily
for labeling and measuring foods. Overlooking the difference between por-
tion and serving sizes contributes to excess weight and obesity. Adjust your
portion sizes to match what your body actually needs for optimal perfor-
mance. On days when you’re more active, you likely need larger portions to
fuel your “tank” appropriately. In general, if your body weight is stable, you
feel energized, and you’re performing well, your “tank” is probably balanced.
ASSESS YOUR FOOD INTAKE

Understanding your energy expenditure and intake, as they relate to types
and amounts of food, can help you determine your nutritional “fitness.” Two
easy ways to assess your nutritional intake are (1) a 24-hour food recall and
(2) a food diary. Most people underestimate how much they eat, so track-
ing your intake can help you see where your calories are coming from. A
“24-hour food recall” is a snapshot of your diet that involves writing down
everything you ate in the last 24 hours—even that piece of candy or hand-
ful of pretzels on your way out the door. A food diary is more detailed: It
involves writing down what you eat and drink for at least 3 days (including
one weekend day). Many smartphone apps and online programs are available
to help you track your intake. To get the most out of your recall or diary, keep
these goals in mind:
Write down all foods and drinks you consumed.
Approximate how much you actually ate or drank. This can be challenging,
since most people have difficulty determining their portion sizes, but try your
best. If possible, measure or weigh out your portions for more exact amounts.
Identify where and when you ate—whether it was in your car, at home, at a
restaurant, or even at your desk. This will give some insight into your eating
habits and patterns.
After you complete your recall or diary, review your intake and ask yourself
some questions:
Where do you eat most of your meals? What impact might this location have
on your nutrition?
Are you getting the recommended amounts of fruits, vegetables, and whole grains?
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Do you ever eat when you aren’t hungry?
How many meals and snacks do you eat in a day?
How do you usually feel after you eat? Bloated, tired, satisfied, full, or “stuffed”?
Being aware of what, when, where, and how much you eat is the first step
toward positive lifestyle changes that will improve your health, maintain your
energy balance, and optimize your mental and physical performance.
Try a food-tracker app to start recording what you eat and drink.
BODY MASS INDEX

Body mass index (BMI) is a ratio of your weight to your height. It’s common-
ly used as a screening tool to classify individuals as underweight, normal
weight, overweight, or obese. BMI doesn’t measure the amount of fat or
muscle in your body. In fact, Warfighters who are very muscular might be
deemed “overweight” or “obese” according to their BMI. However, if your
body fat exceeds military standards, you probably need to lose weight. To
learn more and calculate your own BMI, visit the Centers for Disease Control
and Prevention web page “About Adult BMI.”
PERSONALIZED NUTRITION NEEDS

The nutrition each Warfighter needs to achieve or maintain optimal weight
for performance depends on his or her age, gender, job duties, activity level,
and environment. Under-fueling or over-fueling can be detrimental to your
mission readiness and success. Registered Dietitians (RD) and Registered
Dietitian Nutritionists (RDN) are food-and-nutrition experts who can help
take your performance to the next level. RDs and RDNs who are board-cer-
tified specialists in sports dietetics (CSSD) are especially useful for perfor-
mance-focused counseling and meal planning. Look for an RD or RDN at
your installation’s nutrition clinic, wellness or health-promotion department,
or general-medicine clinic.
CHAPTER 2 REFERENCES
1. Institute of Medicine, Food and Nutrition Board, Panel on Macronutrients, Subcom-
mittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation
and Uses of Dietary Reference Intakes, & Standing Committee on the Scientific
Evaluation of Dietary Reference Intakes. (2005). Dietary Reference Intakes for Energy,
Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washing-
ton, DC: The National Academies Press. doi:10.17226/10490
2. United States Department of Agriculture. What is MyPlate? Retrieved 30 July 2018

from https://www.choosemyplate.gov/MyPlate
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CHAPTER THREE:
MACRONUTRIENTS
FOR EVERYDAY FUELING
CHAPTER 3: MACRONUTRIENTS
IN THIS CHAPTER
Fuels for energy
Carbohydrates
Fats
Proteins
Water
Alcohol
KEY POINTS
Carbohydrates (carbs) are the body’s preferred fuel source for endurance and
resistance activities, competitive athletic events, and mental agility.
Fats, the primary form of stored energy, are essential. Most intake should be
healthy fats.
Proteins are essential for building and repairing body tissues, but excess pro-
tein is not beneficial to performance.
The foods you eat make a difference in your performance, longevity, and
quality of life. Your body needs and uses energy from carbohydrates, fats,
MACRO-
and proteins, but it will use whatever is available. Without energy, your body
would starve and begin to break down its own muscle and tissue for fuel,
which greatly reduces physical and mental performance. This chapter pro-
NUTRIENTS
vides basic information about macronutrients, water, and alcohol.
ARE: FUELS FOR ENERGY
CARBS
The 3 main sources of energy are carbohydrates, fats, and proteins. These
fuels are called “macronutrients” because you need to eat them in large
FATS
quantities compared to micronutrients, which you need in much smaller
quantities (as discussed in Chapter 4).
PROTEINS
Carbohydrates
Carbohydrates, commonly referred to as carbs, are your body’s preferred
source of energy. Carbs are found in many foods, including fruits, vegetables,
beans/legumes, dairy, and grains. They exist in many forms, but carbs are
classified basically as either simple or complex based on their structure. Carbs
also might be classified by how they react (digest)—fast or slow—in your body.
14
In general, simple carbs digest quickly while complex carbs digest more slowly.
Some foods, such as whole fruit, are simple in structure (fructose), but are con-
sidered slow carbs because their fiber content slows digestion.
Simple carbohydrates. “Fast” carbs—such as sucrose, fructose, lactose, and

several others—are digested quickly. Examples include white or brown sugar
(sucrose), fruit (fructose), milk sugar (lactose), honey, corn syrup, high-fructose
corn syrup, maple syrup, and molasses.
Complex carbohydrates. “Slow” carbs—such as starch and fiber—are made up

of chains of simple sugars and digest more slowly. Examples include grains,
fruits, seeds, potatoes, pasta, peas, beans, and all other vegetables. Complex
carbs come from plant materials and generally digest more slowly (or not at
all). Your body digests starches for energy. However, it doesn’t digest fiber, as
discussed in Chapter 16.
Function of carbohydrates in your body
Your body uses carbs mainly as fuel in the form of glucose for your muscles,
brain, heart, and other organs. It needs approximately 130 g of carbs daily to
supply your brain with glucose for proper brain function.1 Carbs also spare
the use of protein—needed for other functions—for energy.
Excess carbs not needed for immediate energy are stored in your skeletal
muscle and liver as glycogen. Your body uses glycogen as a fuel source
during exercise. However, your body can store only about 500 g of glycogen,
so it’s important to refuel with carbohydrate-rich foods after a training
session to replenish your glycogen stores. A 24-hour fast will use up the
glycogen stored in your liver as well, so it’s important to include carbs at each
meal. If you don’t eat enough carbs every day, you’ll likely experience fatigue
and an overall decrease in physical and mental performance—sometimes
referred to as “hitting the wall.”
Keep in mind that all carbs aren’t created equal. Carbs that are highly pro-
cessed and contain refined sugars (simple carbs) are less healthy than whole
foods such as baked potatoes, brown rice, whole-wheat pasta, whole-wheat
bread, and other whole grains (complex carbs).
How many carbs should you eat?
You can calculate how many grams of carbs you should eat based on your
body weight and activity level (Table 3–1). Chapter 9 discusses carb amounts
further with regard to nutrient timing and exercise.
15
TABLE 3–1. DAILY CARB NEEDS FOR FUEL AND RECOVERY 2-5
Activity Level Carb Needs (grams/

kg body weight)
Light (low-intensity or skilled-based activities) 3–5
Moderate (moderate exercise program; about 5–7

one hour per day)
High (endurance program; 1–2 hours per day 6–8

of moderate to high-intensity exercise)
Fats
Fats are vital to your eating plan because they add taste to foods, satisfy your
hunger, and play an essential role in normal body functioning. Dietary fats
are classified as either saturated or unsaturated (Table 3–2). Unsaturated fats
are better choices because they are beneficial to your health.
TABLE 3–2. TYPES AND SOURCES OF DIETARY FAT 6-8
Type Description Examples of Food

Sources
Monounsaturated Liquid at room Olive, canola, and

fats temperature but solid peanut oils; peanut but-
when refrigerated ter, cashews, almonds,
and avocados
Polyunsaturated Liquid at room Safflower, sesame, soy,

fats temperature corn, and sunflower oils;
nuts, seeds, and fish
Saturated fats Generally solid at room Whole milk, cream, ice

temperature; mainly cream, whole-milk chees-
in animal products but es, butter, lard, meat,
also in some tropical palm-kernel and coconut
oils oils, and cocoa butter
Trans fats or Solid at room tempera- Fatty parts of meat or

“partially- ture. Small amounts milk (small amounts);
hydrogenated” are naturally occurring packaged and processed
fats (meat and dairy). Most foods such as cookies,
of the trans fats you eat crackers, and baked
are created artificially goods; French fries,
from polyunsaturated donuts, and other
fats. commercial fried foods
16
FOR EVERYDAY FUELING TABLE 3–3. SUMMARY OF CALORIE
YIELDS FROM MACRONUTRIENTS,
ALCOHOL, AND WATER 8
Fats contain more than twice as many calories per gram as carbs and protein
1 gram of… = Calories
(Table 3–3), so be mindful of your portion sizes, especially if you’re trying
to maintain a healthy weight. (Visit Chapter 10 to learn more about weight Carbohydrate = 4
management.) Fat = 9
Protein = 4
Function of fat in your body
Alcohol = 7
Fat—dietary and body—serves a number of critical functions:
Water = 0
Provides energy during exercise, in cold environments, and during starvation
because it’s the major form of stored energy
Insulates the body
Helps transport other nutrients to various parts of the body
Protects organs
Serves a structural role in cells
Is needed for production of key hormones
How much fat should you eat?
Adjust your total fat intake (saturated, monounsaturated, and polyunsaturat-

ed) to fit your total caloric needs. No more than 30% of total calories should
come from fat.9 Saturated fat intake should not exceed 10%, and the balance
(20% or more) should come from mono- and polyunsaturated fats. Simple
changes to your eating plan can enable you to meet these recommendations.
Try the following strategies:
Use oils instead of butter when preparing and cooking food.
Avoid deep-fried foods. Try different methods of cooking such as baking,

broiling, stir-frying, grilling, roasting, and steaming.
Incorporate more whole grains, beans, legumes, fruits, and vegetables into
your meals.
Consume lean sources of protein such as fish and shellfish, skinless chicken
and turkey, and tofu.
Eat or drink reduced-fat or non-fat milk, yogurt, and other dairy, or eat smaller
portions of full-fat dairy products such as cheese.
Cut visible fat off meat and drain excess fat after cooking.
17
Proteins
Protein is made up of amino acids—small building blocks hooked together
in various ways. Although your body contains more than 20 different amino
acids, only the 9 “essential amino acids” (EAA) are of major dietary concern:
histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine,
tryptophan, and valine. EAA are called “essential” because your body can’t
make them, so you must obtain them from protein sources in your diet. An
unbalanced eating plan can result in not enough or the wrong balance of the
9 EAA and can cause the breakdown of bodily proteins such as those found
in muscles.
Function of proteins in your body
There are numerous types of proteins. They vary in size depending on how
many amino acids are linked together. Each one also performs different func-
tions in your body, including:
Contraction of muscles
Formation of muscle, hair, nails, skin, and other tissues
Production of energy (although not the primary source)
Repair of injuries
Protection from infections
Transportation of fats, vitamins, and minerals throughout the body
Structural roles for every part of the body
How much protein should you eat?
How much protein you need depends on your age, body weight, training in-
tensity, and activity level. In general, protein needs range from 0.8–1.6 g/kg/
day. Consume protein at the higher end of the range with intensified training,
more frequent training, new training stimulus, if you’re less trained, or when
energy intake (calories) is low.2
When you don’t take in enough calories to meet your body’s demands
(negative energy balance), you might need up to 2 grams of protein/kg body
weight to maintain muscle mass, strength, and performance. When you’re in
severe negative energy balance, such as during intense training, missions, or
extreme environmental conditions, even extra protein might not be enough
to preserve muscle mass. In these settings, it’s best to focus on getting
enough high-quality foods and drinks to help meet your energy needs. Eating
and drinking more calories helps your body avoid using protein for energy.
18
Protein needs can, and should, be met by whole foods instead of supple-
ments (Table 3–4). For optimal fueling, include protein at meals and snacks
throughout the day and after strenuous activities.2
Many Service Members believe if they eat more protein, their muscles will
increase in size. However, this isn’t necessarily true. There’s no “storage system”
for excess protein, so you must obtain protein from food daily. Once you’ve met
your daily protein and caloric needs, the rest is stored as fat. See HPRC’s
article on protein requirements to learn how to calculate your individual
protein needs based on your body weight and activity level, along with a
sample one-day meal plan.
TABLE 3–4. FOOD SOURCES OF PROTEIN 10
Food Protein (g)
Sirloin steak, 5 oz 42
Chicken breast, 5 oz 40
Pork chop, 5 oz 38
Atlantic cod, 5 oz 32
Non-fat Greek yogurt, strawberry, 5.3 oz 12
Low-fat milk, 8 fl oz 8
Black beans, ½ cup 7
One hardboiled egg 6
Almonds, 1 oz 6
Water
Water is the most abundant component of the body. It’s needed for digestion
and absorption of nutrients, excretion of waste products, blood circulation,
and regulation of body temperature. Approximately 50–70% of your total
body weight is water. Your body constantly loses water and other fluids
through urine, feces, sweat, and breathing, so you must consume fluids
regularly to ensure your body functions normally. When you don’t consume
enough fluids, dehydration occurs, impairing your health and your mental
and physical performance. Read Chapter 5 for in-depth information on hydra-
tion before, during, and after physical activity and Chapter 11 for information
on hydration during missions.
19
Alcohol
Alcohol itself is not a nutrient, but alcoholic beverages (beer, wine, or liquor)
contribute energy (calories) to your intake (see Table 15–1, Chapter 15). In
addition, it isn't a good source of energy for physical activity or exercise be-
cause alcohol can prevent your body from fully utilizing other nutrients. For
optimal performance, it’s a good idea to minimize the amount of alcohol you
consume. Refer to Chapter 15 for more information on alcohol.
ton, DC: The National Academies Press.
2. Academy of Nutrition and Dietetics, Dietitians of Canada, & American College of

Sports Medicine. (2016). Nutrition and athletic performance. Medicine & Science in
Sports & Exercise, 48(3), 543–568. doi:10.1249/MSS.0000000000000852
3. Burke, L. (2012). New guidelines for carbohydrate Intake in sport from the International
Olympic Committee. SCAN’s Pulse, 31(3), 7–11.
4. Maughan, R. J. (Ed.) (2014). The Encyclopaedia of Sports Medicine: Sports Nutrition

(Vol. 19). Chichester, UK: John Wiley & Sons Ltd.
5. Karpinski, C., & Rosenbloom, C. A. (2017). Sports Nutrition: A Handbook for

Professionals (6th ed.). Chicago: Academy of Nutrition and Dietetics.
6. MedlinePlus. (2016a). Facts about monounsaturated fats. Retrieved 2 May 2017

from https://medlineplus.gov/ency/patientinstructions/000785.htm
7. MedlinePlus. (2016b). Facts about polyunsaturated fats. Retrieved 2 May 2017 from
https://medlineplus.gov/ency/patientinstructions/000747.htm
8. 2015 Dietary Guidelines Advisory Committee. (2015). Dietary Guidelines for Amer-
icans, 2015–2020 (8th ed.). Washington, DC: Department of Health and Human
Services & U.S. Department of Agriculture.
9. Headquarters, Departments of the Army, the Navy, & the Air Force. (2017). Nutri-
tion and menu standards for human performance optimization (AR 40–25/OPNAVINST
10110.1/MCO 10110.49/AFI 44–141). Departments of the Army, the Navy, and
the Air Force, Washington, DC. Retrieved from: https://armypubs.army.mil/epubs/
DR_pubs/DR_a/pdf/web/AR40-25_WEB_Final.pdf
10. United States Department of Agriculture Agricultural Research Service. (2016).

USDA Food Composition Databases. Retrieved 26 April 2017 from National Agri-
cultural Library https://ndb.nal.usda.gov/ndb/
20
CHAPTER FOUR:
MICRONUTIENTS
FOR HIGH PERFORMANCE
CHAPTER 4: MICRONUTRIENTS
IN THIS CHAPTER
Role of micronutrients in performance
Dietary reference intakes and definitions
Nutrient density
Vitamins
Minerals
Special performance promoters: Antioxidants
Vitamin and mineral dietary supplements
KEY POINTS
Vitamin and mineral needs can be met by eating a variety of nutrient-dense

foods.
Vitamins and minerals don’t provide energy, but they’re needed for energy
production, among other functions.
Micronutrients support performance at a high level. They include vitamins

and minerals required by the body in very small amounts to perform vital
MICRO-
metabolic and physiologic functions. Taking in too little or too much of these
nutrients can interfere with normal body functions. Depending on gender,
age, activity, and environment, Warfighters need different amounts of vita-
NUTRIENTS
mins and minerals to perform well. The best way to obtain them is to include
nutrient-dense foods in your daily eating plan.
ARE:
ROLE OF MICRONUTRIENTS IN PERFORMANCE
VITAMINS In general, your body needs micronutrients in order to:
MINERALS
Help make energy
Make red blood cells
Optimize immune function
Maintain the health of muscles and joints
Recover from exercise
22
Visit the Office of Dietary
Supplements (ODS)
DIETARY REFERENCE INTAKES AND DEFINITIONS DRI web page for more
information on Dietary
The term Dietary Reference Intakes (DRI) refers to a set of well-established Reference Intakes.
values used to plan and assess a healthy person’s dietary nutrient intake. The
military has established Military Dietary Reference Intakes (MDRIs), based
on DRIs, to distinguish Service Members’ specific nutrient needs.1 MDRIs
are used to plan and assess diets and develop menus for military personnel
during garrison activities. They’re also used to set a minimum standard for
developing rations. While many MDRIs are similar to DRIs, one exception
is sodium. The DRI for sodium for the general population is considered too
low for the military, given the risk of sodium depletion during intense or
prolonged physical activity, especially in hot environments. Sodium’s DRI
for men and women is 1500 mg, but its MDRI is <2300 mg. Upper intake
levels (the maximum daily intake unlikely to cause adverse health effects) for
the military are the same as those for civilians.
NUTRIENT DENSITY
The term “nutrient density” refers to the amount of nutrients per calorie in a
given food—an index of nutritional quality. Essentially, a nutrient-dense food
provides a high amount of nutrients (such as vitamins and minerals) while
being relatively low in calories. Nutrient-dense foods include fruits and vege-
tables. Following a well-balanced eating plan with a variety of fruits, vegeta-
bles, grains, and protein-rich foods (plant- or animal-based) should help you
meet your micronutrient needs.
Table 4–1 compares the nutrient density of two different foods: an apple and
a serving of potato chips. As you can see, the potato chips provide more cal-
ories but fewer nutrients (vitamins, fiber, etc.). In general, try to choose foods
with more fiber, vitamins, and minerals and less saturated fats and added
sugars.
TABLE 4–1. NUTRIENT DENSITY COMPARISON 2
Nutrient Large apple Potato chips

(3¼” diameter) (1 oz; about 15 chips)
Calories 116 149
Fiber (grams) 5.4 0.9
Calcium (mg) 13 6
Vitamin C (mg) 10.3 6
Vitamin A (IU) 120 0
23
VITAMINS
Vitamins are nutrients that don’t actually provide calories, but you need them
for growth, development, and other body functions. They’re broadly classi-
fied as water- and fat-soluble.
Water-soluble vitamins. These dissolve in water, and your body can’t store
them. Any excess is eliminated through your urine once your body has used
the amount it needs. The water-soluble vitamins are vitamin C and the B vita-
mins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridox-
ine (B6), biotin (B7), folic acid (B9), and cyanocobalamin (B12).
Fat-soluble vitamins. These are stored in your body fat and your liver, so you
don’t necessarily need to eat them every day, even though your body uses them
daily. Since they’re eliminated from your body much more slowly than water-solu-
ble vitamins, they pose a greater risk for toxicity if you consume too much, such as
in dietary supplements. The fat-soluble vitamins are vitamins A, D, E, and K.
Functions of vitamins
Each vitamin has its own function, but your body generally needs them to:
Produce energy from macronutrients (carbs, fats, and proteins)
Repair and grow tissue
Maintain and support reproductive function
Develop immune response
Some functions are specific to only one vitamin, whereas other functions
require more than one vitamin. For example, several B vitamins and some
minerals are needed to produce energy from foods.
MINERALS
Similar to vitamins, minerals don’t provide energy or calories, but they’re es-
sential for health and optimal performance. Minerals typically are classified
as either major minerals (macrominerals) or trace minerals.
Major minerals. Your body requires these in relatively large amounts (> 200
mg/day). Macrominerals include calcium, phosphorous, magnesium, sodium,
potassium, chloride, and sulfur.
Trace minerals. Your body needs these in smaller amounts (< 200 mg/day).
Trace minerals include iron, manganese, copper, iodine, zinc, fluoride, and
selenium.
24
FUNCTIONS OF MINERALS
Your body requires appropriate dietary intakes of minerals to maintain physi-
cal health. For example, you need minerals for:
Brain and neural function
Bone structure and maintenance
Muscle function and growth
Production of energy
Reproductive functions For in-depth information about

specific vitamins and minerals,
Immune function
visit the website of the Office
of Dietary Supplements.
Good food sources of vitamins and minerals

No single food is a good source of all vitamins and minerals, which is why it’s
important to eat a variety of foods. Some processed foods provide many vi-
tamins and minerals because they’ve been fortified (added to) with nutrients,
whereas other processed foods might contain few, if any, micronutrients.
When eating at home or dining out, the key to eating a balanced meal is to
choose a variety of foods whenever possible. In general, foods rich in vita-
mins and minerals include fruits, vegetables, beans, legumes, whole grains,
dairy products, eggs, nuts, seeds, fish, poultry, and meat. See Table 2–2
(Chapter 2) for a list of food groups and recommended daily amounts.
If you’re eating field rations during training or deployment, eat all the entrées
and other foods and beverages provided in the pack, because different foods
and drinks are fortified with different micronutrients. Visit Chapter 13 for in-
depth information about combat rations.
SPECIAL PERFORMANCE PROMOTERS:

ANTIOXIDANTS
Antioxidants are substances that neutralize certain highly reactive, destruc-
tive compounds known as free radicals. Antioxidants can include vitamins
and minerals, as well as other compounds naturally found in food, so nutri-
ent-rich foods are the best sources of antioxidants (see Table 4–2). Chapter
16 includes more information about antioxidants and their importance for
long-term health and performance.
25
TABLE 4–2: WELL-KNOWN ANTIOXIDANTS
Name Classification Food Sources
Beta-caro- A pigment found in plants Carrots, squash, sweet

tene3 that gives them their yel- potatoes, tomatoes,
low and orange colors cantaloupe, peaches,
and apricots
Cysteine4 Nonessential amino acid High-protein foods,

including ricotta and
cottage cheeses, yogurt,
pork, chicken, turkey,
wheat germ, and granola
Flavonoids5 Natural compounds found Kale, beets, cranberries,

in plants berries, red and black
grapes, oranges, lemons,
grapefruits, and green tea
Selenium6 Mineral Fish, shellfish, red meat,

grains, eggs, chicken, and
garlic
Vitamin A7 Fat-soluble vitamin Salmon, eggs, milk, spin-

ach, carrots, sweet red
peppers, mangos, black-
eyed peas, and broccoli
Vitamin C8 Water-soluble vitamin, Citrus fruits, green

also called ascorbic acid pepper, broccoli, leafy
greens, strawberries, raw
cabbage, and potatoes
Vitamin E9 Fat-soluble vitamin Wheat germ, nuts, seeds,

whole grains, leafy greens,
and vegetable oil
VITAMIN AND MINERAL DIETARY SUPPLEMENTS

In general, a balanced eating plan with a variety of nutrient-dense foods that
matches your performance needs also should meet your daily vitamin and
mineral needs. However, vitamin and mineral supplements might be useful if...
You have a vitamin or mineral deficiency.
You have poor nutrient intakes and dietary habits. However, supplements are
not a substitute for a poor diet or under-fueling.
26
You can’t meet your energy requirements from food.
You’re exposed to extreme environments such as cold temperatures and high

altitude for prolonged periods.10
Taking a general multivitamin/mineral supplement appears to have no

measurable performance benefit when your vitamin and mineral needs are
met through food.11 If you want to take a vitamin and/or mineral supplement,
it should provide nutrients in amounts that meet the DRIs. No supplement
(or combination of supplements) should provide more than the upper intake
levels (UL) set by the National Academy of Sciences (NAS). And keep in mind
that supplements add to the amounts of nutrients you get from food.
If you’re considering taking a vitamin or mineral supplement, first talk with

your healthcare provider.
Risks of vitamin and mineral supplements

Excessive intake of some vitamin and mineral supplements can cause mul-
tiple side effects, and some vitamins and minerals can be toxic at intakes
above the UL established by NAS. Toxicity usually is caused by supplements
rather than foods. Excess amounts of single- or multiple-nutrient supple-
ments also can upset your overall nutrient balance and cause a deficiency
of other nutrients. Iron, zinc, and copper are good examples. Taking too
much iron from supplements might decrease zinc absorption, and taking too
much zinc can prevent proper absorption of copper.12 Vitamin E also is an
important antioxidant needed for healthy immune function. However, excess
vitamin E (in the form of alpha-tocopherol) from supplements might increase
your risk of bleeding after a cut or injury.9
As previously discussed, food is the best source of nutrients, including vita-

mins and minerals. Chapter 12 discusses dietary supplements in more detail.

27
3. Higdon, J., Drake, V. J., & Delage, B. (2016). β-Carotene, β-Carotene, β-Cryptoxan-
thin, Lycopene, Lutein, and Zeaxanthin. Retrieved 12 July 2018 from https://lpi.
oregonstate.edu/mic/dietary-factors/phytochemicals/carotenoids
4. Sarmadi, B. H., & Ismail, A. (2010). Antioxidative peptides from food proteins:
A review. Peptides, 31(10), 1949–1956. doi:10.1016/j.peptides.2010.06.020
5. University of Maryland Medical Center. (2013). In-Depth Patient Education

Reports: Articles: Vitamins. Retrieved 26 April 2017 from http://www.umm.edu/
health/medical/reports/articles/vitamins
6. National Institutes of Health, Office of Dietary Supplements (2018a). Selenium

– Fact Sheet for Health Professionals. Retrieved 12 July 2018 from https://ods.
od.nih.gov/factsheets/Selenium-HealthProfessional/
7. National Institutes of Health, Office of Dietary Supplements (2018b). Vitamin

A – Fact Sheet for Health Professionals. Retrieved 12 July 2018 from https://ods.
od.nih.gov/factsheets/VitaminA-HealthProfessional/
8. National Institutes of Health, Office of Dietary Supplements (2018c). Vitamin

C – Fact Sheet for Health Professionals. Retrieved 12 July 2018 from https://ods.
od.nih.gov/factsheets/VitaminC-HealthProfessional/
9. National Institutes of Health, Office of Dietary Supplements (2018d). Vitamin

E – Fact Sheet for Health Professionals. Retrieved 12 July 2018 from https://ods.
od.nih.gov/factsheets/VitaminE-HealthProfessional/
10. Institute of Medicine, Food and Nutrition Board, Committee on Military Nutrition
Research, Marriott, B. M., & Carlson, S. J. (Eds.). (1996). Nutritional Needs in Cold
and in High-Altitude Environments: Applications for Military Personnel in Field Opera-
tions. Washington, DC: National Academy Press.
11. Academy of Nutrition and Dietetics, Dieticians of Canada, & American College
of Sports Medicine. (2016). Nutrition and athletic performance. Medicine & Science in
Sports & Exercise, 48(3), 543-568. doi:10. 1249/MSS.0000000000000852
12. National Institutes of Health, Office of Dietary Supplements (2018d). Zinc – Fact
Sheet for Health Professionals. Retreived 5 November 2018 from https://ods.
od.nih.gov/factsheets/Zinc-HealthProfessional/#h8
28
CHAPTER FIVE:
HYDRATE WITH FLUID
CHAPTER 5: HYDRATE WITH FLUID
IN THIS CHAPTER
Fluid balance
Dehydration
Monitoring fluid losses
Electrolytes
Hydration and rehydration: Fluid ingestion and timing
KEY POINTS
Don’t rely on thirst as a good indicator of your fluid needs; consume fluids
throughout the day with meals and snacks to ensure adequate hydration.
Drink 14–22 fluid ounces of water at least 2–4 hours before and up to exercise
or training sessions; urine should be pale yellow in color.
Drink regularly or whenever possible during exercise, training, and operations.

Drink 16–32 fl oz of fluid every 60 minutes during activity to stay hydrated.
Performance will start to decline once you’ve lost as little as 2% of your

body weight.
To rehydrate (replace fluids) after exercise, drink liquids and eat foods that
contain fluids. Consume about 20–24 fl oz for every pound of weight you lost.
Drinking too much plain water or not consuming enough sodium can lead to
hyponatremia (low sodium levels in your blood), a potentially serious condition.
Water is the most abundant component of the human body—around 50–70%

of its weight—so your body requires fluids regularly to ensure its normal
function. This chapter covers how to maintain your body’s optimal amounts
of water and electrolytes at all times.
FLUID BALANCE
Fluid balance is the amount of fluids you take in versus the fluids you lose,
mostly through sweating, urinating, and breathing. It’s important to consume
fluids regularly throughout the day to maintain your fluid balance and ensure
your body functions normally. When you don’t drink enough water, your fluid
output will exceed your fluid input. This can cause dehydration, impairing
both mental and physical performance. Men and women have different hy-
dration needs. However, fluid requirements also can vary depending on your
30
workload, level of heat stress, and sweat rate. What and how much you drink
before, during, and after exercise can greatly affect your performance.
When and how much to drink?

Military guidelines recommend 3–4.5 quarts (96–144 fl oz) of fluid per day for
men and 2–3 quarts (64–96 fl oz) of fluid per day for women. Note: 1 quart is
equal to 32 fl oz.1 As a general rule of thumb, try to consume half your body
weight (in pounds) in fluid oz daily. Remember that all fluids from food and
beverages count towards this goal.
You can maintain hydration by drinking beverages and eating foods high in
water content throughout the day. However, each Warfighter’s fluid needs are
different, so it’s important to learn to look for signs that indicate your own
fluid needs. Be sure to adjust your intake when you’re working or exercising
outdoors, especially when it’s hot and humid. If it’s very hot, drink fluids with
sodium and potassium to replace electrolytes lost from sweating. The more
physically active you are, the more fluid you need!
DEHYDRATION
Fresh foods that contain high
It’s essential to stay well hydrated during operations. Dehydration can neg-
amounts of water include2:
atively affect your physical performance, decision-making abilities, concen-
tration, and mood. In addition, it can put you at risk of heat illness, including Broccoli Lettuce
heat exhaustion, heat injury, and heat stroke, and even can be life-threaten- Berries Peaches
ing. 3,5
Fluid losses are greater during exercise with a long duration and Cauliflower Peppers
when it’s hot or humid. However, it’s important to remember that you still
Celery Spinach
lose fluids even when you don’t seem to be sweating much, such as at higher
altitudes, when it’s cold, and during low-intensity physical activity. Citrus fruits Tomatoes
Cucumbers Watermelon
Symptoms of mild-to-moderate dehydration include:
Thirst
Headache, dizziness, or light-headedness
Dark yellow urine
Dry or sticky mouth
Decreased urine output
Sleepiness or fatigue
Constipation
Dry skin
31
TABLE 5–1. BODYWEIGHT LOSSES
AND DEHYDRATION
Starting Weight After 2%

Symptoms of severe dehydration include:
Weight (lb) Fluid Loss (rounded
to nearest lb)
Extreme thirst
150 147
Irritability or confusion
170 167 Unconsciousness or delirium
190 186 Very dark yellow or amber-colored urine
Rapid breathing
Rapid heartbeat
Lethargy
MONITORING FLUID LOSSES

You can monitor your hydration status by noting changes in your body
weight. To determine a body weight that reflects a well-hydrated state, weigh
yourself (nude for accuracy) first thing in the morning—over several days—
and calculate your average weight. To estimate fluid balance, weigh yourself
(nude for accuracy) before and after exercise and calculate the difference, as
shown in the following equation:
Total body weight (before) – total body weight (after) = fluid lost during exercise
Losing more than 2% of your body’s weight in water (Table 5–1) can result in
poor performance, especially in hot weather.3,4
You can assess your hydration status by the color of your urine too. Pale yel-
low, almost-clear urine indicates adequate hydration. In general, the darker
your urine, the more dehydrated you are. (Keep in mind that urine color can
change for reasons other than your hydration status. For example, your urine
can turn bright yellow if you’re taking B-vitamin supplements, especially
ones high in riboflavin.)
ELECTROLYTES
During activity, you mainly lose fluid through sweat. Sweat loss varies de-
pending on age, type of training, physical fitness, clothing, and environmen-
tal conditions, as well as how you adapt to those conditions. Individual sweat
rates for men and women can vary between 0.3 and 2.5 liters (about 0.3–2.6
quarts) per hour.3,5 In addition to fluids, you lose electrolytes (sodium, potas-
sium, chloride, calcium, and magnesium) and other minerals through sweat.
Amounts vary, but they can be significant depending on your training status,
dietary intake, genetics, sweat rate, and prior heat exposure. Electrolytes are
32
important for muscle function, and loss of electrolytes can make dehydra-
tion worse than just fluid loss alone.
It’s important to consume foods and fluid-replacement beverages that con-

tain electrolytes before, during, and after intense exercise or exercise of long
duration to help maintain hydration. In particular, sodium can help your body
retain fluids. Table 5–2 includes examples of foods that contain sodium. If
you’re eating at a dining facility that has the Go for Green® initiative, choose
foods labeled “High Sodium.” (Refer to Chapter 6 for more on Go for Green®.)
TABLE 5–2. APPROXIMATE SODIUM CONTENT OF FOODS 6
Food Serving Size Sodium (mg)*
Beef jerky 1 oz 590
Canned chicken 1 cup 700

noodle soup
Cheese, cheddar 1 oz 180
Cottage cheese ½ cup 400
Ham, honey-smoked 1 oz 250
Olives, black, canned 5 large 160
Peanut butter 2 Tbsp 150
Peanuts, dry-roasted, 1 oz 115

salted
Pickle, dill 1 large (4” long) 1,090
Pretzels, hard 1 oz 350
Soy sauce 1 tsp 300
Table salt 1 tsp 2,325
* Actual sodium content can vary by brand.
You can eat dried fruit and other foods to replace potassium (Table 5–3).
33
TABLE 5–3. APPROXIMATE POTASSIUM CONTENT OF FOODS 6
Food Serving Size Potassium (mg)*
Apricots, Mediterranean, ¼ cup 430

dried
Avocado ¼ of an avocado 250
Banana 1 medium (7–8” 420

long)
Cantaloupe 1 cup 430

Example:
A 185-lb Warfighter wants Figs, dried 2 115
to hydrate properly before
Kiwi 1 kiwi (2” diameter) 215
his exercise session.
Lima beans, cooked ½ cup 480
Step 1: Multiply 2 ml times
Milk, reduced fat 1 cup 350
weight in pounds to get the
low end of fluid-intake range. Orange juice 1 cup 500
2 ml × 185 lbs = 370 ml Orange 1 small (2½” 180
diameter)
Step 2: Convert ml to fluid oz.
(There are 30 ml in 1 oz.) Peanuts, dry-roasted, 1 oz 180
370 ml ÷ 30 (ml per oz) salted
= 12 fl oz Potato, baked, with skin 1 small (1¾”–2½” 750
in diameter)
Step 3: Multiply 4 ml times
weight in pounds to get the Raisins 1 small box (1.5 oz) 320
high end of fluid-intake range. Spinach, cooked ½ cup 420
4 ml × 185 lbs = 740 ml
Tomatoes, cherry ½ cup 180
Step 4: Convert ml to fluid oz.
Yogurt, plain, nonfat 1 single-serve 400
740 ml ÷ 30 (ml per oz) container (5–6 oz)
= 25 fl oz
* Actual potassium content can vary by brand.
So, by this method,
a 185-lb Warfighter
should drink 12–25 fluid HYDRATION AND REHYDRATION:
ounces (370–740 ml)
starting 2–4 hours before
FLUID INGESTION AND TIMING
exercise for adequate
hydration. Before exercise
It’s important to be well-hydrated before exercise to reduce your risk of dehy-
dration during or after exercise. In general, consume approximately 14–22 fl
34
oz (about 414–650 ml) of fluid about 2–4 hours before and up to when you be-
gin exercise. You also can use your body weight to estimate your fluid needs.3
During exercise
Drink 16–32 fl oz of fluid every 60 minutes during exercise for good hydra-
tion.7 Adjust your fluid intake based on your environment and how much you
sweat because your fluid needs might be much higher in extreme environ-
ments such as heat and humidity, when it’s cold, or at altitude (as discussed
in Chapter 11). During exercise, limit fluid intake to 1.5 quarts (48 fl oz) per TABLE 5–4. ESTIMATED
hour.7 A “gulp” of fluid is about 1–2 oz. FLUID REPLACEMENT NEEDS
BASED ON WEIGHT LOSS 3
When exercising less than 60 minutes, focus on drinking water. If it’s hot
or humid, a sports drink might be better for hydration. For activity longer Weight Fluid to Replace Loss
than 60 minutes, you can drink water, sports drinks, or a mixture of both. Lost (lb)
Sports drinks help maintain hydration, replace electrolytes lost in sweat, and 1 16–24 oz (2–3 cups)
provide fuel (in the form of carbohydrates) for your muscles during exercise.
Look for a sports drink that contains 12–24 grams of carbohydrates, 82–163 2 32–48 oz (4–6 cups)
mg of sodium, and 18–46 mg of potassium per 8 oz serving.1 You also can 4 64–96 oz (8–12 cups)
make your own sports drink with a few simple ingredients, as described in
the article linked above.
While there are general recommendations, you still need to monitor your
own fluid loss to ensure you replace the amount you lost.
After exercise
After exercise, consume foods and beverages to replace the fluids and electro-
lytes (such as sodium and potassium) you lost. Over a period of several hours,
you actually should ingest more water and sodium than you lost. If you know
the change in your body weight after exercise, drink 20–24 oz of liquid per
pound of weight lost to fully restore your fluid balance (Table 5–4).3
It’s important to choose foods and beverages that contain sodium to promote
faster and more complete recovery. Drinking too much plain water or not
consuming enough sodium can result in hyponatremia (low sodium levels
in your blood), which requires immediate medical attention to reduce risk
of serious illness or death. Hyponatremia typically occurs during physical
activities of longer duration. Symptoms, which can be severe, include head-
ache, vomiting, swollen hands and feet, fatigue, confusion, disorientation,
and breathing problems. Keep in mind that some symptoms of hyponatremia
are similar to the symptoms of dehydration, so be mindful of how much and
how often you drink fluids.
On the flip side, if you consume too much sodium and not enough fluids,
you’re at risk of hypernatremia (high sodium levels in your blood), but this is
rare. Symptoms include thirst, headache, body cramps, and fatigue.
35
The guidelines discussed in this chapter will help ensure adequate fluid and
electrolyte replacement and balance and reduce the risk of developing hypo-
or hypernatremia.
1. Headquarters, Departments of the Army, the Navy, & Air Force. (2017). Nutrition
and menu standards for human performance optimization (AR 40–25/OPNAVINST
the Air Force, Washington, DC. Retreived 10 January 2020 from: https://armypubs.
army.mil/epubs/DR_pubs/DR_a/pdf/web/AR40-25_WEB_Final.pdf
2. Produce for Better Health Foundation. Insider’s Viewpoint: Stay Hydrated with
Fruits & Veggies. Insider’s Viewpoint. Retrieved 24 October 2019 from https://fruit-
sandveggies.org/stories/insiders-viewpoint-stay-hydrated-fruits-veggies/

4. Karpinski, C., & Rosenbloom, C. A. (2017). Sports Nutrition: A Handbook for Profes-
sionals (6th ed.). Chicago: Academy of Nutrition and Dietetics
5. Sawka, M. N., Burke, L. M., Eichner, E. R., Maughan, R. J., Montain, S. J., & Stachen-
feld, N. S. (2007). Exercise and fluid replacement (American College of Sports
Medicine position stand). Medicine & Science in Sports & Exercise, 39(2), 377–390.
doi:10.1249/mss.0b013e31802ca597

7. U.S. Army Public Health Command. (2011) Work/Rest and Water Consumption Table.
U.S. Army Medical Department. Retrieved 10 January 2020 from: https://www.
hprc-online.org/sites/default/files/document/APHC_Work_Rest%20and%20
Water%20Consumption%20Table508_0.pdf
36
CHAPTER SIX:
BUILD A PERFORMANCE
PLATE IN THE
DINING FACILITY
CHAPTER 6: BUILD A PERFORMANCE PLATE
IN THE DINING FACILITY
IN THIS CHAPTER
“Balance” your plate
Eat a variety of foods
Choose optimal portions
Recover with nutrient-dense foods
Fuel up with Go for Green®
KEY POINTS
A balanced plate creates the right mix of carbs, protein, and fat.
Fill your plate with a variety of foods to optimize nutrient intake.
Choose optimal portions for your activity and training needs.
Go for Green® is a quick and easy way to choose high-performance fuel in your
dining facility or galley.
Eating for performance requires choosing high-performance fuel for meals

and snacks. Military dining facilities provide opportunities to build a plate
to boost your performance morning, noon, and night. Consider the following
strategies for meals that fuel your job duties, training needs, and lifestyle.
“BALANCE” YOUR PLATE

For optimal nutrition, choose nutrient-dense foods from the 5 food groups:
grains, protein, dairy, fruits, and vegetables. At mealtimes, select items from
at least 3 of the food groups—a mixed meal that contains carbs, protein,
and healthy fats—to maintain energy for strong and effective training
sessions. The Main/Hotline, Deli/Sandwich Bar, Grill, and Salad Bar serve
components for delicious and nutritious meals.
Some combinations include:
Baked or grilled fish, brown rice, and vegetables
Whole-grain cereal, low-fat milk, and fruit
Turkey on whole-grain bread with tomato, lettuce, and onion
Low-fat Greek yogurt, whole-grain cereal, and fruit
Vegetable burrito (whole-grain tortilla, beans, vegetables, and cheese)
Baked potato with chili and broccoli
38
EAT A VARIETY OF FOODS

An assortment of nutritious foods can help maximize your intake of micronu-
trients such as vitamins, minerals, and antioxidants, which help boost mental
and physical performance. When eating in the dining facility, vary your
choices to get the most out of your meals. For example, B vitamins found in
a range of foods—including whole grains, lean proteins, dairy, nuts, beans,
and leafy greens—support your body’s processing of energy (see Chapter 2).1
In addition, vitamins A, C, and E act as antioxidants that reduce muscle dam-
age and enhance recovery from exercise (see Chapter 4).1 These essential
vitamins are found in many foods, including citrus (oranges and grapefruits),
kiwi, cantaloupe, sweet potatoes, carrots, nuts, and seeds.
If you usually choose eggs in the morning, also consider alternate sources of
protein: yogurt (Greek-style, if available), nuts, seeds, or peanut butter. If you
usually create a salad with iceberg lettuce, carrots, and tomatoes, try to mix
up your options—and add more color to your performance plate—by adding
Main/Hotline vegetables or vegetable sides from any specialty bar.
39
CHOOSE OPTIMAL PORTIONS

Select the optimal portions for your body, training schedule, health condi-
tions, and weight goals. Your portions might differ each day or even each
meal, depending on your planned activities or job duties. On days that
include intense training sessions, for example, eat extra portions of carbohy-
drate-rich foods to fuel your body properly. At breakfast, eat another scoop of
oatmeal, a second serving of fruit, or another bowl of whole-grain cereal. At
lunch or dinner, choose a second scoop of a starchy vegetable (potato, corn,
or peas), a starchy side (brown rice, pasta, or roll), or a second serving of
milk, yogurt, or 100% juice. Your plate should contain more starchy vegeta-
bles and grains on these days.
On days when you’re less active or involved in lighter training sessions,

choose smaller or fewer portions and fill your plate with more veggies and
less starchy vegetables and grains. Eat what you need to fuel your day and
feel satisfied, without being too full.
RECOVER WITH NUTRIENT-DENSE FOODS

After a tough workout or training session, the dining facility can provide
essential fuel for your recovery. Leave the bars and shakes and instead make
time for a well-balanced recovery meal or snack at your dining facility. Re-
fueling after a strenuous workout with a carb-rich meal that contains 20–25
grams of protein helps replenish muscle glycogen stores and repair and build
muscle.2-4 Ideally, consume a mix of carbs and protein (along with fluid for
hydration) within 2 hours of completing your workout or training. If your next
meal is more than 2 hours away, have a snack. For example, eat peanut butter
and jelly on whole-grain bread, or try granola with milk or yogurt. If you’re
really on the go, enjoy a glass of chocolate milk—which provides both carbs
and protein—for a quick recovery drink. You can learn more about nutrient
timing and recovery in Chapter 9.
FUEL UP WITH GO FOR GREEN ®

As discussed in Chapter 2, the MyPlate method helps Warfighters create a
balanced plate by dividing it proportionally by food group. Knowing the best
choice within each food group can optimize your mental and physical per-
formance. DoD’s Go for Green® (G4G) or Fueled to Fight® (Marine Corps) ini-
tiative helps you make performance-boosting choices in dining facilities and
galleys. G4G is an all-service performance-nutrition initiative that improves
the food environment where Service Members live and work. It prompts you
40
to make better food and beverage selections to optimize your performance,

readiness, and health.
G4G labels foods and beverages using a stoplight system—Green, Yellow,

and Red—based on nutritional quality to help identify your best choices for
peak performance. Nutritional quality also includes components such as
saturated fat, fiber, sugar, degree of processing, and total fat. For example,
Green-coded menu items are least processed, highest in nutrients, and lowest
in added sugar, and the fats they contain are healthy fats. Warfighters should
consume Green-coded foods and drinks most often.
Green = High-performance fuel for the Warfighter’s mind and body
Yellow = Moderate-performance fuel for the Warfighter’s mind and body
Red = Low-performance fuel for the Warfighter’s mind and body
G4G also labels foods with Low, Moderate, or High sodium symbols to point
out sodium content. Sodium codes are independent of their color code; for
example, not all Green-coded foods are low in sodium. Warfighters have
different sodium needs based on their medical conditions, activities, and
environments. If you’re training or working intensely or for extended periods
of time in a hot and humid environment, include some High-sodium items on
your plate to ensure you’re replenishing sodium lost through sweat.
The latest version of Go for Green® —G4G 2.0—is not yet available in all
military dining facilities and galleys. However, you still can use G4G resourc-
es to find high-performance fuel. G4G provides a quick and simple Guide
(see pages 42 and 43) to Green, Yellow, and Red foods and drinks, as well as
Low-, Moderate-, and High-sodium foods. Visit HPRC’s G4G website section
for more resources and tips about Go for Green®.
1. Lukaski, H. C. (2004). Vitamin and mineral status: Effects on physical performance.
Nutrition, 20(7–8), 632–644. doi:10.1016/j.nut.2004.04.001

3. Burke, L. (2010). Fasting and recovery from exercise. British Journal of Sports Medi-
cine, 44(7), 502–508. doi:10.1136/bjsm.2007.071472
4. Kerksick, C., Harvey, T., Stout, J., Campbell, B., Wilborn, C., Kreider, R., . . . Antonio,
J. (2008). International Society of Sports Nutrition position stand: Nutrient timing.
Journal of the International Society of Sports Nutrition, 5(17), 1_12. doi:10.1186/1550-
2783-5-17
41
THE G4G GUIDE: FOODS AND BEVERAGES
Eat Often Eat Occasionally Eat Rarely

Tips to build a
Whole foods, least processed More-processed foods Most processed, least nutrients
healthy plate
Naturally packed with nutrients Choose portions carefully Choose small portions
Vegetables Fresh or frozen vegeta- Vegetables with small — Deep-fried, tempura, Salads/vegetables
bles—grilled, steamed, amounts of added or breaded vegetables with large amounts of
Eat 3–4 cups non-
or raw Fats/Oils from the Fats/Oils or Protein
starchy vegetables Vegetables in cheese
Yellow or Red column from the Red column
a day. Leafy green salads or creamed vege-
with dark greens tables
See also Grains/
(spinach, spring mix)
Starches.
Fruits Fresh fruit Fruit canned in water Fresh or frozen fruit Dried fruit (sulfured) Fresh fruit with Dried fruit with
or own juice with added sugar/ cream coatings (yogurt,
Eat 2–2.5 cups Frozen fruit with Dried fruit with added
syrups Frozen fruit with chocolate, etc.)
of fruit a day. minimal added sugar, Dried fruit (unsul- sugar
added sugars, fats,
fat, and/or sauce fured, without added Canned fruit in light Canned fruit in heavy
Eat your fruit, don’t 100% fruit juice and/or sauce
sugar) syrup syrup
drink it.
Sweetened applesauce
Grains/ Brown rice, wild rice, Whole-grain, White rice, Sweetened oatmeal/ Biscuits, croissants, White/sweet potatoes
Starches bulgur low-sugar cereal/ couscous, pasta oatmeal packets full-fat muffins made or topped with
granola with less than moderate to large
Choose 100% Oats, quinoa, barley Grits, plain White-flour breads, Doughnuts, Danishes,
10g sugar and at least amounts of Fats/Oils
whole grain for bagels, English pastries, sweetened
Baked potato/sweet 3g fiber Baked French fries from the Red column
at least half of all muffins, rolls, waffles, breads
potato with skin with
grain servings. Whole-grain breads, White potatoes made pancakes Processed cereals
toppings from Green Grains or pasta with
bagels, rolls, waffles, or topped with ingre- with more than 18g
Starchy vegetables column Pretzels, baked chips cheese or cream
pancakes, muffins dients from the Yellow sugar per serving
such as potatoes sauce
Baked sweet-potato column Crackers, high-fiber,
and corn are English muffins with Deep-fried chips,
“fries” reduced-fat French fries (fried
included in this at least 3g fiber Whole-grain cereals/ most snack crackers
in oil)
group. Whole-grain pasta granola with 11–18
Popcorn with small Movie-style popcorn
and couscous grams sugar per serving
amounts of butter or oil
Protein Egg whites Ground beef (90/10), Whole eggs Hamburger Fried meat, poultry, Hot dogs, kielbasa,
ground poultry fish, seafood bratwurst
Vary your protein Omelets with vege- Chicken and turkey Ground beef (85%
choices. tables Pork tenderloin with skin lean) or ground Ground beef (stan- Salami, bologna
poultry dard or unspecified
Include seafood/ Fish and shellfish; Beans/lentils Chicken and turkey Refried beans made
fat), fatty (marbled)
fish twice a week. Tuna canned in water thighs and legs with- Chicken/turkey with lard or topped
Tofu, tempeh, cuts of red meat, beef
out skin sausage or bacon with cheese
Include beans for Chicken and turkey edamame ribs, corned beef
protein and fiber. breast without skin Ham, roast beef Soy patties, links, Fried tofu
Veggie burgers, vege- Cheeseburger
burgers
table- or bean-based Processed chicken/
Pork sausage and bacon
turkey deli meats Tuna canned in oil
Fats/Oils Oils—olive, canola, Nuts and seeds—raw, Oils—corn, peanut, Margarine/spreads Oils—coconut, palm, Creamy salad dress-
safflower, sunflower, dry, roasted vegetable (trans-fat free, limited palm kernel ings
Choose healthy fats
sesame, grapeseed additives)
and oils. Natural nut butters— Salad dressings made Shortening and lard Nut butters with add-
Salad dressings made peanut, almond, with these oils Peanut butter with ed sugar or chocolate
Most mayonnaises
with these oils hazelnut, soynut added oils/fats
Mayonnaise made Gravy (made with fat
Most margarines
Avocado with canola oil Gravy (made with drippings)
water or low-fat milk)
Beverages Water (plain or car- Decaf tea and decaf Sports drinks 100% fruit juice Energy drinks* Sweetened beverages
Choose water bonated) coffee of any kind (sodas,
Tea** and coffee**, Artificially sweetened Coffee and tea with
instead of sugary sweet teas, fruit
Naturally flavored Herbal tea plain or with small beverages (diet or light whole milk or cream
beverages. punches, juice drinks)
water (no artificial amounts of added sodas, teas, juices, and sugars or syrup
100% vegetable juice
For milk, see Dairy. sweeteners) sugar, cream, or milk many flavored waters)
Dairy Milk, unsweetened Yogurt, plain (non-fat Milk (2% fat) Frozen yogurt Milk (whole), plain or Cottage cheese
(skim, 1%) or low-fat) flavored (full-fat)
Compare sugar con- Flavored (vanilla, Yogurt, flavored,
tents of yogurts. Milk alternatives (soy, Cottage cheese (non- chocolate, etc.) and with added sugars or Hot chocolate made Cheese (full-fat)
almond, rice, fat or low-fat) artificial sweeteners with whole milk
Some low-fat dairy sweetened milk Cream cheese, sour
coconut), unsweet- (non-fat or low-fat)
products contain (skim, 1%, or 2%) and Cream, half-and-half cream (full-fat)
ened, with calcium
added flavors, stabiliz- milk alternatives Cheese and cottage
and vitamin D added Yogurt (full-fat) Ice cream, milk-
ers, sugar, or sodium; cheese (reduced-fat, 2%)
Hot chocolate made shakes, gelato
choose less-pro- with milk (skim, Cheeses naturally low-
cessed Green items Pudding
1%, 2%) er in fat (Feta, Swiss)
when possible.
* For more information on energy drinks, visit HPRC’s Dietary Supplements Classification System and read about Energy Drinks. **Contain caffeine.
42
THE G4G GUIDE: SODIUM
This guide is a starting point for understanding which foods of tablea salt. Sodium needs vary depending on medical con-
are high in sodium. Sodium is a mineral found naturally in dition, activity, and environment. The most active warriors
some foods and added to packaged items to preserve fresh- who operate in extreme conditions may require as much as
ness and enhance flavor. 3,500 mg (women) or 5,000 mg (men) of sodium per day.2
Restaurant food often contains more salt. At home and in
Too much sodium can be harmful to your health, especially if
military dining facilities, the amounts of sodium vary greatly.
you are salt sensitive. However, too little sodium can be harmful
Increased portion sizes also increase sodium intake. Use
to health and performance if you lose a lot of sodium through
the table below along with the Food and Beverages (Green,
multiple hours of activity, extreme environments, or sweat.
Yellow, Red) Guide to help choose appropriate foods and
Sodium is important to maintain fluid balance, control blood beverages for your sodium needs.
pressure, and for muscles and nerves to work properly.
For average Americans, 2,300 mg of sodium per day1 is

appropriate; this is about the amount found in one teaspoon
Low Sodium Moderate Sodium High Sodium
Fruit—fresh or frozen Some breads, rolls, biscuits, pancakes, waffles, Canned vegetables and beans
Vegetables—fresh or frozen English muffins Canned tomato products
No-added-salt/salt-free canned vegetable and Low-sodium canned vegetables Instant noodles with flavor packet
tomato products Most snack foods (pretzels, crackers, chips, Deli meats/cold cuts—turkey, ham, bologna,
Grains—plain, unseasoned popcorn) salami, etc.
Grain products—plain, unseasoned pasta, rice, Most sauces/glazes on chicken, turkey, beef, Processed meats—sausage, bacon, pepperoni,
quinoa, couscous or pork hot dogs
Foods and Unsalted nuts, seeds Most homemade soups made with low- Cheese
Beverages sodium broth
Unsalted nut butters (peanut, almond, soynut) Condiments and toppings—soy sauce, ketchup,
Most frozen meal “starters” marinades, cocktail sauce, gravy, nacho cheese
Fresh chicken, turkey, beef, pork
Packaged rice/grain dishes, if you use only half dip, pickles
Milk the seasoning packet Seasoned salts, table salt
Most yogurts
Canned soups
Olive oil, canola oil
Almost all “fast foods”
Dry beans, peas, lentils
Frozen entrees/“microwave dinners”
Eat low-sodium foods most often, especially if you Eat moderate-sodium foods sometimes. Eat high-sodium foods rarely or in small
have been told to follow a “low-sodium diet.” amounts.
Moderate-sodium foods areappropriate for most
When
Not all low-sodium foods are also labeled warriors who are moderately active For warriors who are active multiple hours per
to Eat
Green; limit Yellow- and Red-labeled foods and day and/or in extreme environments, some
beverages for overall good health. high-sodium foods should be included daily.
Choose mostly whole, fresh foods. Although snack foods and breads have Table salt is mostly sodium; use sparingly.
Cooking at home can help reduce sodium moderate sodium, large portions can increase Processed, packaged, and convenience foods
content. your sodium intake to high. contribute about 80% of sodium to our diets; read
General Purchase unflavored foods, and add your own Drain and rinse canned foods (beans, tuna) to food labels and pay attention to serving sizes.
Tips fresh seasonings: herbs, spices, vinegars, citrus. reduce their sodium content. Many condiments and toppings are high in
When cooking with whole, fresh foods that are Even low- and reduced-sodium versions of sodium.
naturally very low in sodium, it’s okay to add a your favorite chips or crackers may fall into the Restaurant foods are generally higher in sodi-
pinch of salt. moderate sodium category. um than homemade foods.
1
Dietary Guidelines for Americans 2010
2
Military Dietary Reference Intake
43
CHAPTER SEVEN:
FUELING AT HOME
CHAPTER 7: FUELING AT HOME
IN THIS CHAPTER
Boost nutrition with homemade meals
Grocery shopping
Decoding Nutrition Facts labels
Breakfast: Off to a healthy start
Lunch: Midday fuel
Dinner: Finish strong
Healthy snacking
KEY POINTS
Nutritious homemade meals can boost mission performance.
Smart grocery shopping is the first step toward healthy meal preparation.
Use the Nutrition Facts labels on packaged-food labels to help guide your choices.
Every meal is important for overall health and performance.
Use snacks as opportunities to pack more high-performance fuel into your day.
Homemade meals can have a positive impact on your performance, your

health, and your family. When you cook, you can choose your ingredients
and how your food is prepared. This chapter provides basic information on
how to prepare and eat balanced meals and snacks at home.
BOOST NUTRITION WITH HOMEMADE MEALS

Making your own meals is a better choice than dining out because you can
control the ingredients and preparation, which means they are generally
higher in nutrients (such as fiber, calcium, iron, and vitamins such as folate,
B6, B12, C, and E) and lower in saturated and trans fats. Homemade meals
don’t need to be fancy, and they often can be planned in minutes. They’re
usually cheaper than restaurant meals too.1, 2 When cooking at home, use the
MyPlate food guide (see Chapter 2) to plan your balanced meals with a vari-
ety of nutrient-rich foods, including fruits, vegetables, whole grains, and lean
proteins. The Go for Green® (G4G) Guide (see pages 42 and 43 of Chapter 6)
also can help you choose the best fuel for your plate.
45
GROCERY SHOPPING
High-performance meals start with high-quality, nutrient-dense ingredients.
Commissaries and grocery stores offer a wide variety of foods that can be the
building blocks for any performance-boosting meal. The key is to know which
foods are more wholesome and can best fuel your body. Build your meals
and snacks around high-performance fuels such as fruits, vegetables, whole
grains, and lean protein.
The tips below can help guide your selections and stretch your food dollars
while shopping at the grocery store.
Tips for grocery shopping
Use a shopping list or smartphone app to help with your meal planning and
shopping.
Shop the perimeter of the store for fresh offerings from all food groups.
Select a colorful array of tasty fruits and vegetables.
Buy whole grains and whole-grain products.
Choose low-fat dairy products or plan smaller portions of full-fat dairy products.
Purchase lean protein sources.
Consider meat alternatives such as beans, nuts, seeds, and soy products
Buy heart-healthy fats such as olive and canola oils, nuts, seeds, olives, and
avocados.
Limit drinks and foods that contain added sugars.
Read Nutrition Facts labels on packaged foods and carefully choose indul-
gent foods.
For more ideas, visit the MedlinePlus page about healthy grocery shopping.
DECODING NUTRITION FACTS

Packaged foods display Nutrition Facts labels that can help you get a sense
Source: https://www.fda.gov/down-
of the nutritional content of what you’re eating. When shopping for groceries, loads/Food/GuidanceRegulation/Guid-
anceDocumentsRegulatoryInformation/
read Nutrition Facts labels to compare foods and determine which ones suit LabelingNutrition/UCM501646.pdf
your nutritional goals.
46
Serving sizes and calories

Always look at serving sizes first, so you can see how the rest of the informa-
tion on the label relates to how much you’re actually going to eat. The new
Nutrition Facts label shows serving size in larger print for visibility. Many
serving sizes also have been revised to more closely match what people typi-
cally eat or drink.
Take a look at the number of servings per container too. You might be sur-
prised to see how many servings are in that package of cookies or bottle of
juice. It’s often more than one. If you eat more than one serving, multiply
each component (calories, fat, carbs, etc.) by the number of servings you eat
to get the actual amount you consume.
The upper part of the Nutrition Facts panel lists calories, total fat (saturated
fat and trans fat), cholesterol, sodium, total carbohydrates (including fiber,
total sugar, and added sugar), and protein. The amount of each nutrient is
displayed in grams and as % Daily Value.
Percent Daily Value

The % Daily Value (DV) tells you how much of a nutrient a food provides
compared to how much you need every day. Keep in mind that DV is based
on a 2,000-calorie diet, which might not be enough for a Service Member due
to a Warfighter’s training needs or job duties.
In general, more than 20% of any nutrient is high—whether the food is “high”
in a nutrient you should eat more of (such as fiber) or “high” in something you
should limit (such as cholesterol). In addition, anything less than 5% is low—
whether the food is “low” in added sugar or “low” in fiber.
Micronutrients
The lower part of the Nutrition Facts label lists micronutrients. The new
panel displays amounts of vitamin D, calcium, iron, and potassium. Vitamin
D and potassium were added to the new format because many Americans
don’t get enough of these essential minerals. Vitamins A and C are no longer
included since deficiencies of these are rare. Other nutrients might be includ-
ed on the Nutrition Facts label as well.
Ingredients and allergens

According to federal regulations, any packaged food with more than one
ingredient also must carry an ingredient list on the label. The ingredients are
listed in descending order according to weight (not volume). For example, if
your granola bar lists sugar as its first ingredient, this means that there is more
sugar (by weight) than any other ingredient listed. If you have any food allergies
47
or intolerances, double-check the ingredient list for any ingredients you need
to avoid or limit. The 8 most common allergens are milk, soy, wheat, tree nuts,
seafood, shellfish, eggs, and peanuts. Allergen information is listed below the
ingredients in bold, making it easy to find.
BREAKFAST: OFF TO A HEALTHY START

After a night of rest and 8–12 hours without food, your body needs fuel in
the form of glucose (also known as sugar), especially if you exercise in the
morning. Breakfast is your body’s early-morning refueling stop to keep you
energized until lunchtime. It’s also an opportunity to eat important nutrients
your body needs to power your day. Nutrient-dense choices such as a bowl
of cereal with low-fat milk, toasted whole-grain bread with natural peanut
or almond butter, and a piece of fresh fruit are easy, quick choices you can
prepare and eat at home.
LUNCH: MIDDAY FUEL

Pack a nutritious lunch at home and take it to work. Weekday brown bagging
saves money. More important, you can control what and how much you’re
eating and how it’s prepared. Try to fill half your “plate” with fruits and
vegetables. Think about where you’ll eat, and plan ahead, because some
foods are better suited for eating at a table while others are better for eating
on the go. Some tasty ideas include:
Vegetables: Pack raw or lightly steamed (then chilled) choices with a small
container of dip or olive oil-based salad dressing.
Hummus: Use as a dip or sandwich spread.
Stuffed tomatoes or bell peppers: Add tuna, chicken, egg, pasta, or rice.
Salads: Include a colorful, vegetable-based salad with your sandwich.
Sushi rolls: While these are terrific lunchbox fare, try to avoid deep-fried rolls
or ones with cream cheese.
Trail mix: Make your own with raisins or other dried fruit, whole-grain cereal
or air-popped popcorn, and nuts or seeds.
Fruit: Grab several pieces of fruit to go and try some with Greek yogurt.
DINNER: FINISH STRONG

Sometimes it can be hard to figure out what you should eat for dinner, espe-
cially after a long day at work. But with good planning and shopping skills,
48
you can put together a balanced plate quickly. Although planning takes some
time, and shopping for foods is a must, you can prepare many nutritious
meals ahead of time or within 30 minutes. Try these quick dinner strategies:
Use canned, frozen, or pre-washed vegetables such as lettuce, baby carrots,

and spinach. (Be sure to rinse canned varieties if you’re trying to limit your
sodium intake.)
Use weekends to plan and prepare meals that can be popped in the oven or
microwave when you’re ready to eat.
Invest in a crockpot: Toss ingredients into the crockpot in the morning, and
you’ll have a delicious, balanced meal waiting for you at dinnertime.
Other easy, nutritious dinner ideas include:
Whole-grain pasta or rice with lean protein (tofu, meat, or fish) and vegetables.
Brown rice and beans with salsa.
Sirloin steak, baked potato, and leafy green salad.
Grilled salmon, baked sweet potato, and vegetables.
Colorful salad with beans or lentils, topped with an olive oil-based dressing or
nuts/seeds, and whole-wheat toast.
Sandwiches made with whole-grain bread, lean meats, and plenty of veggies
(cucumber, lettuce, and tomato).
Cook whole grains such as brown or wild rice, barley, whole-wheat pasta, or
quinoa in large quantities for use throughout the week. Just reheat and add
grilled, baked, or roasted lean meats and vegetables to help round out meals
that support performance and recovery.
HEALTHY SNACKING
Snacks help maintain physical and mental performance. Carefully chosen
snacks can fill nutritional gaps and boost energy without causing weight gain.
Think through a typical day. How often and where do you usually snack? Are
your snacks high in nutrients or loaded with “empty” calories?
Snacking tips
Plan and prepare snacks ahead of time.
To stave off hunger longer, pick snacks with protein, fiber, and heart-healthy fats.
Match snacks to your activity level. If you’re more sedentary, choose ones that
49
are lower in calories or smaller in size. However, if you’re active and exercise
daily, you might need larger portions or more frequent snacks.
Be conscious of portion sizes (as discussed in Chapter 2).
If possible, avoid snacking in front of the TV or computer because it’s too easy
to overeat.
Avoid all-day nibbling or eating directly out of the bag or box, which makes it
difficult to keep track of how much you’re eating.
Read HPRC’s article about smart snacking for more ideas.
Snacking environment
Satisfy your snacking urge with convenient and healthy choices—whether
you’re at home, at work, or on the go.
Stock your fridge and freezer at home (and at work) with:
Greek yogurt, cottage cheese, cheese sticks or slices, and milk
Lean deli meats
Whole fruits and cut-up raw veggies
100% fruit and vegetable juices
Frozen juice bars
Plain baked potato or sweet potato with a sprinkle of cheddar cheese
Whole-wheat pita bread or English muffins with tomato sauce, Italian herbs, a
sprinkle of mozzarella cheese, and diced peppers for instant pizza
Whole-grain bagel with peanut butter and banana slices
Single-serve packs of vegetables or fruit with dip
Natural peanut, cashew, or almond butter with whole-grain crackers or bread
No-bake energy bites
Shelf-stable options:
Vegetable or bean soups in heat-and-serve cans or instant soup cups
Refried beans or salsa with whole-wheat tortillas or baked chips
Snack-size boxes or packets of cereal, instant oatmeal, raisins or other dried

fruit, or whole-grain pretzels
Trail mix
Mini cans or single-serve pouches of water-packed tuna or chicken
50
Beef jerky
Single-serve fruit cups packed in 100% juice or water
Dry-roasted, unsalted nuts or seeds
Whole-grain granola bars low in sugar
Canned or boxed 100% fruit juice (no added sugar)
Single-serve packages of microwave popcorn
For more videos, tips, and hints on cooking equipment, grocery shopping,
and cooking, visit HPRC’s Eating Environments section.
1. French, S. A., Story, M., Neumark-Sztainer, D., Fulkerson, J. A., & Hannan, P. (2001).
Fast food restaurant use among adolescents: Associations with nutrient intake, food
choices and behavioral and psychosocial variables. International Journal of Obesity,
25(12), 1823–1833. doi:10.1038/sj.ijo.0801820
2. Lin, B.-H., & Guthrie, J. (2012). Nutritional quality of food prepared at home and
away from home, 1977–2008. United States Department of Agriculture Agricultural,
Washington, DC. Retrieved from: https://www.ers.usda.gov/publications/pub-de-
tails/?pubid=43699
51
CHAPTER EIGHT:
OPTIMAL CHOICES
FOR EATING OUT
CHAPTER 8: OPTIMAL CHOICES FOR EATING OUT
IN THIS CHAPTER
Dining out
Choose high-performance meals
Fast food
KEY POINTS
Choose restaurants that offer lean proteins, vegetables, and meals

cooked to order.
Add more vegetables to your meal to boost your intake of vitamins, minerals,
and fiber.
Eat smaller portions of heavy, creamy, cheesy, or fried dishes and desserts.
Make sensible food choices at fast-food restaurants.
Active schedules, training requirements, and deployments boost the appeal

of dining out, especially because it can be simpler than cooking at home.
When eating out at fast-food places, restaurants, social events, or when
traveling, it’s important to choose foods and drinks that improve your per-
formance and maximize mental agility, stamina, and health. This chapter
provides information on how to maintain a high-performance eating plan
when eating away from home.
DINING OUT
As discussed in Chapter 7, with meals prepared at home you can control the
ingredients and how they’re prepared. Still, restaurant and fast-food meals
don’t have to be poor performance fuel. If you know what to look for, you can
maintain a high-performance eating plan while enjoying the experience of
dining out. Try these tips on how to choose a restaurant:
Select a restaurant where food is cooked to order rather than one where
items are prepared in advance.
Avoid places with all-you-can-eat or buffet-only specials.
Skip the hot dogs, burgers, and pizza. Instead, search for restaurants and
fast-food places that offer nutritious options such as fruit, sushi, salads,
sandwiches, or wraps.
Plan ahead: Look for a place that offers menus with nutrition information or
53
check the restaurant’s website for nutrition details before you head out.
Avoid eating out when you’re very hungry. Eat a healthy snack to tide you
over, if necessary.
CHOOSE HIGH-PERFORMANCE MEALS

Read restaurant menus carefully and try to order nutrient-dense meals. The
following strategies can help you select meals that fit into your nutrition plan.
Appetizers
Appetizers are tasty, but they can lead to mindless nibbling and overeating,
leaving little room for a nutritious meal. Ask your server to remove chips,
peanuts, or your basket of bread after you’ve sampled a small portion. Try
to limit appetizers that are fried or covered with cheese. Or choose healthier
options. For example, many broth-based soups, such as vegetable soup, will
help fill you up and satisfy your hunger. Cream-based soups tend to be high in
saturated fat and calories.
Enjoy fresh vegetable salads as appetizers too. If you’re at the salad bar, remem-
ber your salad should be mostly vegetables: Start with dark leafy greens such
as romaine lettuce, kale, or spinach, plus colorful vegetables. Add tomatoes,
shredded carrots, green peas, yellow and red bell peppers, broccoli, cauliflower,
crispy cucumber, and other vegetables to turn your greens into a fiesta of colors.
Don’t forget the healthy fats—sliced avocado and a sprinkle of nuts, seeds, or
olives—that add richness to salads and help you feel fuller longer. Top it off with
an oil-based salad dressing (such as olive-oil vinaigrette) or spread (hummus).
Avoid high-calorie, nutrient-poor additions such as bacon bits, croutons, and
fried tortilla strips.
Main meal
To maximize nutrients, ensure your main course is full of vegetables, lean
protein, and whole grains. Just like you do at home, try to “balance” your
plate and choose high-performance fuel when dining out (Table 8–1).
54
TABLE 8–1. RESTAURANT “FUELING” OPTIONS
High-performance Fuel Low- or Moderate-performance Fuel
Fresh fruit or fruit cup in 100% Fruit in syrup

fruit juice
Wraps and burritos with veg- Hoagie or sub roll with extra deli meat,
gies and lean protein cheese, and creamy sauces or dress-
ings
Extra vegetables or any French fries or fried vegetables

vegetable combination
Vegetable pizza (with 4 or more “Meat lovers” pizza

veggie toppings)
Baked potato or sweet potato French fries or potato salad
Salad bar Pasta salads with mayonnaise
Fresh fruit with a dollop of Tarts, cheesecake, Danishes, and other

whipped cream pastries
Try the following tips to create a more balanced plate when eating away
from home.
Meat and fish
A reasonable portion of steak, chicken, or fish is 3–6 oz. If you have higher-
calorie needs (perhaps because you’re more active), you’ll want to eat a por-
tion that’s on the higher end. Portion sizes should be about the size of a deck
of cards or the palm of your hand, not the size of your plate.
Pass on gravies or heavy sauces, which add significant amounts of calories,

sodium, and less-healthy fats. Season your meat or fish with pepper, chunky
salsa, or herbs.
Opt for skinless chicken that’s not fried.
Choose pork cuts such as tenderloin and chops, which tend to be leaner than
other cuts. Limit fatty choices such as sausage, bacon, and ribs.
Select healthy food preparations. Ask if your meat or fish can be steamed,
poached, broiled, baked, grilled, or roasted rather than fried.
Add a protein powerhouse such as grilled chicken, salmon, or tuna to a salad

for a satisfying meal.
55
Starches and other carbohydrates
Order a baked potato or plain rice (brown or wild, if available), not fried rice.
Avoid au gratin. Top your baked potato with small portions of sour cream,
butter, cheese, or bacon. Or skip those toppings altogether and add salsa or
chives for a healthier alternative with a lot of flavor.
Choose dishes made with whole grains—such as brown rice, quinoa, whole-
grain couscous, and barley—and whole-wheat bread.
Beans and lentils are great sources of carbohydrates, fiber, and lean protein.
Vegetables
Protein is often the “star” of your restaurant meal, so order an extra side (or
two) of fresh, steamed veggies or a side salad to balance out your plate. Most
restaurants will substitute an extra side of vegetables for potato options.
Make a meal out of vegetable soup and a side salad. Be sure your meal in-
cludes a serving of protein to keep you full and satisfied.
Instead of battered, deep-fried, or cheesy vegetables, choose steamed, grilled,

sautéed, or roasted ones.
Pastas
When ordering pasta dishes, choose tomato-based sauces (marinara) over

cream-based sauces. Tomato sauce can count as a vegetable, so it’s a win-win
situation.
Look for whole-wheat pasta, which provides an extra boost from fiber, vita-
mins, and minerals.
If you add meat to your pasta entrée, select grilled chicken or salmon instead
of sausage or meatballs.
Sandwiches
Order sandwiches with whole-wheat or whole-grain pita or breads.
Choose lean deli meats and cheeses, and top with condiments such as mus-
tard, relish, or ketchup. Spreads such as hummus and avocado are nutrient-rich
alternatives to mayonnaise or “special sauce.”
Add as many vegetables as available, including roasted sweet peppers, lettuce,

tomato, cucumber, sprouts, shredded carrots, chopped olives, and jalapeños to
add flavor and texture.
56
Beverages
Drink water (plain or sparkling), small (4 oz) portions of 100% fruit juice, skim
or low-fat milk (or soy milk), or unsweetened tea or coffee with your meal. Al-
cohol and sugar-sweetened beverages such as sodas, sweet tea, and lemonade
add unnecessary “empty” calories.
If you want wine or beer, drink one glass with your main dish. Take time to
enjoy the taste by sipping it slowly rather than mindlessly consuming it.
Desserts
Desserts are often high in unhealthy fats and sugar and low in performance-en-
hancing nutrients. If you can’t resist dessert, order sorbet, fresh or poached
fruit, or frozen yogurt. Fresh berries with a dollop of whipped cream or an-
gel-food cake with strawberries are refreshing desserts too.
If you want an “over-the-top,” big, rich dessert, split it with your dining part-
ners to enjoy a smaller portion.
Mindful eating
Be mindful, eat slowly, and take time to taste and savor your food.
It takes about 20 minutes for your brain to receive the signal that you’re full, so
eat just until you feel satisfied, not full or uncomfortable.
Remember not to deprive yourself of foods you love. All foods can fit into a
well-balanced eating plan. How much and how often you eat various foods is
the key.
Other helpful tips
Ask how a dish is prepared and request healthy substitutions (for example,
baked instead of fried and olive oil instead of butter).
If portions at the restaurant are large, split one meal with your dinner partner.
Or ask for a “doggie bag” up front and set aside half of your meal before you
start eating. This will help ensure that you don’t overeat, and you’ll have anoth-
er meal from your leftovers.
Try to avoid dishes described as au gratin, buttered, buttery, creamed, crispy,

escalloped, fried, hash, hollandaise, in cheese sauce, in cream sauce, in gravy,
rich, stewed, or with bacon or sausage.
57
FAST FOOD
Fast food is typically high in calories, saturated fat, and sodium, so it’s best to
eat it occasionally and choose carefully when you do (Table 8–2). However, if
you plan ahead, it can fit into your healthy eating plan.
TABLE 8–2. FAST FOOD SWAPS
Skip This Calories1 Try This Calories1 Calories

(approx.) (approx.) Saved
Double 460 Cheeseburger 280 180

cheeseburger
Large fries 480 Small fries 220 260
Burrito with 435 Soft chicken 185 250

beans, cheese, taco
and beef
Breakfast 530 Breakfast 290 240

croissant English muffin
sandwich with with egg,
egg, cheese, cheese, and
and sausage Canadian
bacon
Pepperoni 315 Cheese pizza 230 85

pizza (regular (thin crust),
crust), one one slice
slice
Large cola 415 Plain or seltzer 0 415

(32 oz) water with
lemon wedge
Crispy chicken 365 Grilled 275 90

tortilla wrap chicken
tortilla wrap
58
CHAPTER NINE:
NUTRIENT TIMING
AND TRAINING
CHAPTER 9: NUTRIENT TIMING AND TRAINING
IN THIS CHAPTER
Everyday nutrition and training
Fatigue and glycogen depletion
“Burnout” and overtraining
Nutrient timing
KEY POINTS
A balanced, nutrient-dense daily eating plan will ensure better performance

and optimal recovery.
The timing of nutrient and fluid delivery is critical to sustain your performance.
Add protein to your recovery meal to help rebuild and repair muscle
(anabolism).
For prolonged, strenuous exercise that’s longer than 60 minutes, consume

foods or drinks that are rich in carbohydrate and contain protein within 2 hours
after exercise.
Sports bars, gels, and drinks are lightweight, portable, and easy to eat
during military operations.
Training promotes changes in your body to optimize muscular strength, aero-

bic capacity, and endurance. You can meet your training goals with appropri-
ate nutritional strategies. Before and after training or missions, it’s important
to ensure adequate energy stores and rapid recovery so you’re ready for the
next mission. This chapter will provide information about nutritional strate-
gies to optimize your training in preparation for missions.
EVERYDAY NUTRITION AND TRAINING

Nutrition is a key enabler for successful military operations. Properly planned
and executed, good eating practices in the field maintain and enhance oper-
ational performance and contribute significantly to mission accomplishment.
In addition, well-balanced meals and snacks can support recovery by helping
rebuild muscle and reduce your risk of injury. You can meet your training
goals through appropriate nutritional strategies implemented before,
during, and after training. But before you implement nutrient-timing practic-
es, it’s important to focus on your everyday diet. For example, if you eat lots
of highly processed foods or regularly skip meals, eating a recovery snack
60
won’t optimize your performance. Refer to Chapter 2 for information about

“fueling your tank” daily.
FATIGUE AND GLYCOGEN DEPLETION

When you feel tired or lack energy, you’re experiencing fatigue. Its causes can
be central (brain and central nervous system) or local (muscle). One cause of
fatigue is depletion of glycogen (the stored form of carbohydrate in the body).
All strenuous exercise, including endurance and resistance training—whether
you’re at home or on a mission—will deplete glycogen, but fatigue is more
likely to happen if you’re under-fueling your body. Under-fueling by not get-
ting enough carbohydrates can be intentional, especially when you’re limiting
calories, avoiding gluten, or losing weight. Or you might be limiting carbs un-
intentionally if you’re unsure how much you need to eat or if you’re skipping
meals or snacks due to limited time or money. Female Warfighters are more
susceptible to under-fueling than male Warfighters.
It’s important to eat enough carbs every day because they feed your work-
ing muscles and help maintain blood sugar. Try to fill ²⁄3 to ¾ of your plate
with carb-rich foods such as fruit, vegetables, whole grains, beans, and dairy
to fuel your body properly. Choose a variety of fruits and vegetables to opti-
mize your intake of vitamins, minerals, and fiber. Whole-grain breads, grains,
and pastas provide more performance-boosting nutrients than white-flour
and refined versions. Dairy products contribute carbs along with protein and
calcium. If you don’t fuel properly, your post-exercise recovery could suffer
and result in “burnout.”
“BURNOUT” AND OVERTRAINING

The terms “burnout” and “overtraining” are concerns for competitive ath-
letes that can apply to Warfighters as well. Burnout and overtraining might
result from too little recovery time in combination with too much training. A
multitude of symptoms are associated with overtraining:
Unexplained, persistently poor performance
Moodiness, general fatigue, depression, and irritability
Painful muscles
Insomnia
Weight loss
Overuse injuries
Increased susceptibility to upper respiratory infections and gut problems
61
The symptoms of burnout or overtraining depend on your physical and

physiological makeup, types of training regimens, dietary practices, sleep
patterns, and various other factors. No single test can identify overtraining,
but sports-medicine specialists and researchers have identified a number of
key markers that change over time. These include stress hormones, im-
mune markers, indicators of muscle damage, compromised muscle glycogen
reserves, and decreases in aerobic and anaerobic capacity. For more informa-
tion, read HPRC’s article about overtraining.
NUTRIENT TIMING
To optimize your performance, get enough rest between workouts, and time
your nutrition properly. You can view nutrient timing as 3 distinct phases:
Pre-exercise fueling
During exercise, when energy stores are being depleted
Post-exercise refueling (recovery)
Before exercise
A pre-exercise meal or snack can provide the fuel your body needs to opti-
Example: A Warfighter mize your workout. The amount and timing of your meal or snack depend
weighs 187 pounds and prefers on the type, intensity, and duration of your exercise, as well as your personal
to eat 2 hours before his
preferences for food choices and pre-exercise fueling.
long-distance run.
In general, if you have 30–60 minutes before your workout, eat a carbohy-
Step 1: Convert pounds to
kilograms. drate-rich snack. Aim for around 200–300 calories. For example, eat half a
peanut-butter-and-jelly sandwich.
187 lb ÷ 2.2 = 85 kg
For exercise you expect to last more than 60 minutes, use these pre-exercise
Step 2: Multiply weight in kg
fueling guidelines if you want to be more specific: Eat 1–4 grams of carbs
times 2.
per kilogram (about 0.5–1.8 grams of carbs per pound) of body weight 1–4
85 kg × 2 g/kg = 170 g of hours before exercise.1 Adjust the timing and amount of carbs to match your
carbs
schedule, activity, and preference. If you want to eat more, allow more time
His meal might include stir-fry for digestion.
with 2 cups rice, 1 cup mixed
vegetables, 3 oz chicken, a See Table 9–1 for examples of the carbs in various foods. Also, consuming up
banana, and one cup of 100% to 30 grams of protein before exercise might benefit those primarily involved
fruit juice. in strength or power training to maximize their muscle building.2
During training is the time to find out if you need to avoid foods high in fat or
fiber to reduce your risk of gastrointestinal issues.3 Experiment ahead to see
what works for you; don’t wait until an event day or a mission to try new foods.
62
TABLE 9–1. APPROXIMATE CARBOHYDRATE CONTENT OF

FOODS AND BEVERAGES 4
Food Serving Size Carbohydrate

(g)*
Pancakes with syrup 2 (6” diameter) with 78

2 Tbsp syrup
Cinnamon-raisin bagel 1 (4½” diameter) 72
Pretzels 10 twists 50
Rice 1 cup 45
Bean-and-meat burrito 1 medium 42
Pasta, no sauce 1 cup 40
Blueberry muffin 1 small (2–3” diameter) 35
Cereal, wheat flakes 1 cup 32
Seedless raisins ¼ cup 31
Sweet corn 1 cup 30
Potato, baked, with 1 small (1¾”–2½” diame- 29

skin ter)
Banana 1 medium (7–8” long) 27
Apple 1 medium (3” diameter) 25
Blueberries 1 cup 20
Oatmeal cookie 1 medium 17
Wheat bread 1 slice 14
Milk, reduced fat 1 cup 12
* Actual carbohydrate content can vary depending on brand or preparation.
In general, consuming up to 200 mg of caffeine (amount in 16-oz coffee)

approximately 30–60 minutes before an endurance event can improve per-
formance. Caffeine intake should not exceed 600 mg in 24 hours (or 800 mg
for sustained operations). For more information, read “Caffeine and Perfor-
mance” from Operation Supplement Safety (OPSS).
During exercise
During exercise, energy stores help provide energy to your working mus-
cles, as muscle protein is being broken down.5 Consuming small amounts of
63
carbs at regular intervals can enhance your athletic performance, especially

when the exercise lasts longer than one hour. Water is generally sufficient for
exercise less than approximately one hour. During exercise lasting longer
than one hour, a fluid such as a sports drink that contains carbs as well as
electrolytes can help keep you hydrated. Small to moderate amounts of carbs
(30–60 g per hour) from foods or fluids can extend your endurance perfor-
mance. When your exercise duration is greater than 2.5–3 hours, you might
need to consume up to 90 grams of carbs per hour, depending on the inten-
Trail mix is a great sity of the exercise.6 For exercise longer than 3 hours, Warfighters typically
portable, quick, nutrient-
need to consume solid foods (such as sports gels or chews, fresh or dried
dense snack for recovery.
fruits, and pretzels) as well as liquids to meet carb needs.
Enjoy it with 8 fl oz chocolate
milk for the right balance of Try to eat various foods during your training to determine which ones are
carbs and protein. most suitable for you. Exercise intensity, duration, environmental conditions,
Try this homemade version: and mode of exercise—whether you’re running, marching, or performing
manual labor—help determine the amounts of carbs and fluid your body
2 cups dried fruit (raisins,
cranberries, blueberries, needs. Service Members should simulate mission events to determine their
pineapple chunks, or mango) optimal fuel sources. Never test new foods during a mission or compe-
tition; experiment during training to find what works best for you. Keep in
2 cups nuts and/or seeds
(peanuts, almonds, cashews, mind that while protein is essential to build and repair muscle, consuming
pistachios, walnuts, sunflower protein during events doesn’t appear to improve performance.
seeds, or pumpkin seeds)
After exercise (recovery)
Mix well and store in an air-
tight container. The serving After exercise, your body needs to transition from a catabolic (breakdown)
size is ¼ cup or about one state to an anabolic (build-up) one to promote recovery and restore what was
handful (20 g carb, 4 g protein). depleted during exercise. Within 2 hours after strenuous exercise lasting over
For more meal and snack 60 minutes consume a balanced meal.3 Aim for carb-rich foods and fluids along
ideas, read HPRC's guide to with 15–30 grams of protein to help restock your fuel stores and rebuild your
nutrient timing. muscles.6-9 (If you know you can’t eat a meal within that 2-hour time frame, try
to eat a snack.) Foods with essential amino acids, especially leucine6, will pro-
mote post-exercise muscle protein synthesis to rebuild and repair your muscle
tissue. Foods with leucine include eggs, dairy, and chicken.
Without appropriate refueling after a hard training session or mission, your

performance might be compromised, especially if a second workout or mis-
sion is going to occur within less than 24 hours.
Keep in mind that fueling and recovery occur throughout the day, not just
before or after exercise. All meals, snacks, and beverages consumed during
the day are part of the maintenance/recovery phase. Choose well-balanced
meals and snacks with a good variety of food sources to optimize your per-
formance. Refer to Chapter 3 for specifics on daily nutrition.
64
sionals (6th ed.). Chicago: Academy of Nutrition and Dietetics.
2. Jäger, R., Kerksick, C. M., Campbell, B. I., Cribb, P. J., Wells, S. D., Skwiat, T. M.,...
Antonio, J. (2017). International Society of Sports Nutrition Position Stand: Protein
and exercise. Journal of the International Society of Sports Nutrition, 14(20), 1-25.
doi:10.1186/s12970-017-0177-8
3. Burke, L. (2012). New guidelines for carbohydrate intake in sport from the Interna-
tional Olympic Committee. SCAN’s Pulse, 31(3), 7–11.

5. Stellingwerff, T., & Cox, G. R. (2014). Systematic review: Carbohydrate supplemen-

tation on exercise performance or capacity of varying durations. Applied Physiology,
Nutrition, and Metabolism, 39(9), 998–1011. doi:10.1139/apnm-2014-0027

7. Dunford, M., & Doyle, J. A. (2008). Nutrition for Sport and Exercise (1st ed.). Belmont,
CA: Thomson/Wadsworth.

9. Williams, M. (2009). Nutrition for Health, Fitness & Sport (9th ed.). New York: Mc-
Graw-Hill Science/Engineering/Math.
10. Director, Operations Directorate, Joint Culinary Center of Excellence. (2012). Mem-
orandum: Commercial Off-the-Shelf (COTS) Nutrition Supplements for Special Forces
(SOF). U.S. Army Quartermaster Corps and Quartermaster School, Fort Lee, VA
28301.
65
CHAPTER TEN:
FUEL FOR YOUR OPTIMAL
PERFORMANCE WEIGHT
CHAPTER 10: FUEL FOR YOUR
OPTIMAL PERFORMANCE WEIGHT
IN THIS CHAPTER
Getting lean
Bulking up (muscular fitness)
Anabolic steroids
KEY POINTS
Look at your current eating habits to help maintain your optimal perfor-
mance weight.
Visit a Registered Dietitian for personalized help with your performance

nutrition plan.
Getting enough protein, calories, and strength training is essential for building
muscle and strength.
Anabolic steroids are illegal and not permitted for use by Warfighters.
Warfighters must be in excellent physical condition to endure arduous phys-

ical tasks for extended periods. Military missions and training also require
strength. This chapter covers sound nutritional practices to enhance regular
physical training and enable Warfighters to reach and maintain optimal per-
formance weight and muscular fitness.
GETTING LEAN
For some Warfighters, injury, stress, lack of time, frequent travel, or other
reasons might contribute to a higher-than-optimal weight. If you’re one of
them, it’s important to find what’s contributing to your weight gain or your
inability to lose weight. It’s most likely a matter of how you eat. However, it’s
also important to be realistic, because meaningful weight loss doesn’t happen
overnight. It takes dedication to adjust your eating habits, portion sizes, food
choices, physical activity, and stress management. In addition, you’re more
likely to maintain lean muscle mass and performance if you lose no more
than 1% of body weight per week.1 Overall, taking in fewer calories plus
burning more calories adds up to weight loss.
If you’re working to achieve your optimal weight, assess your current habits
and make sure portion sizes and food choices are right for your activities and
weight goals. Track your food intake, as discussed in Chapter 2. This can help
especially if you’ve hit a plateau in your weight loss. It’s easy for old habits and
67
poor food choices to creep back into your lifestyle, so just remember to go back
to the basics: Focus on an eating plan that consists of nutrient-rich, lean sourc-
es of protein—including fish, poultry, beans, nuts, and dairy products—and in-
corporate whole grains, fruits, and vegetables. Keep in mind that beverages can
add calories too. Stick to water, low-fat milk (or soy milk), and unsweetened
beverages with and between meals to stay hydrated. Sugar-sweetened bever-
ages such as soda, sweet tea, and juice can add too many calories and interfere
with your healthy eating goals. Finally, look at your portion sizes: Even small
increases in portion sizes can add up and result in weight gain.
Since each body’s nutrition needs are unique, consider making an appoint-
ment with a Registered Dietitian (RD) or Registered Dietitian Nutritionist
(RDN) for personalized recommendations and assistance with meal plans.
Visit HPRC’s Fighting Weight Strategies section for more resources to help
you achieve your optimal weight for performance.
BULKING UP (MUSCULAR FITNESS)

Military missions and training require muscular strength and endurance.
In order to increase your strength and build your muscles, it’s important to
do well-rounded resistance training, which includes both endurance and
strength training. Improving muscular fitness enhances physical condition,
builds functional strength, and allows you to perform and complete strenu-
ous missions. And if gaining weight is your goal, then it’s best to do so with
muscle, not fat. The appropriate strength-training program combined with
a well-planned nutritional strategy can help optimize your performance and
prevent musculoskeletal injuries too. Strength training also reduces your risk
of injury from aerobic endurance training, and it can boost your speed with
tasks requiring short bursts of activity.
Machines and bodyweight exercises are great for beginners because they’re
easier to learn and require less technique. For more experienced lifters, a
combination of free weights and machines is ideal for building muscle mass.
Another thing to consider is the number of muscles involved in the motion of
each exercise. The more joints and the larger the muscle group involved,
the better. For example, an exercise that involves the ankles, knees, and hips
is better than one just involving the ankles.
In general, aim for 2 or 3 days each week of resistance training for each large
muscle group. Make sure you’re progressing your workouts at appropriate
intervals as well. If you continue to do the same thing without pushing your
body beyond what it’s used to, you won’t see any progress. Add more weight
or intensity to your workout. Or create a periodization program. Remem-
ber to include rest days (48 hours) between bouts of resistance training for
each major muscle group to allow for recovery and avoid putting yourself
68
at risk of burnout or injury. Resistance training can be performed on a daily

basis so long as you don’t work the same major muscle group on consecutive
days. Rest days and sleep are also critical for muscle growth. Rest actively by
choosing lighter-intensity exercise or a different modality, such as walking,
biking, or yoga.
Nutrition requirements
The most effective method to increase your muscle mass is to accompany
strength training with a positive nutritional energy balance.2 If your nutrient
intake is lacking as a result of poor meal planning and/or high operational
tempo, skeletal muscle might be in a negative protein balance or a catabolic
(breakdown) state. The timing and types of nutrients are critical for optimal
muscle remodeling and growth. Appropriate nutritional interventions imme-
diately after exercise and over the next 24 hours are essential to maintain
and promote muscle mass. For more information about nutrient timing, read
Chapter 9.
Protein requirements for building muscle

The protein needs of Service Members range from 0.8–1.6 g/kg (about 0.4–0.7
g/lb) body weight each day.1 You might need higher intake for a short time
during intensified training or when reducing your energy (calorie) intake.1 (See
Chapter 3 to learn more about protein.) Many Warfighters believe that more
protein is better. However, eating more protein than the established rec-
ommendation doesn’t provide any additional benefit.3 In addition, if you
consume excess protein, you are likely eating less of another essential macro-
nutrient (carbohydrate or fat) to make room in your eating plan for the protein.4
Because carbs are your body’s preferred fuel source for performance, under-fu-
eling with carbs can be detrimental to your performance.
You can meet your protein needs through intake of whole foods such as lean
meats, poultry, fish, beans, nuts, eggs, and low-fat dairy. Whole foods provide
other essential nutrients that protein powders and supplements lack. How-
ever, protein powders are sometimes acceptable when high-quality protein
foods aren’t available or practical. In general, a properly balanced eating plan
can meet your protein needs effectively.
For some Warfighters, it can be challenging to eat enough to gain weight and
build muscle. Use these tips to help add more calories and protein to your
eating plan.
Eat more often. Plan to eat or drink something every few hours, especially
after your workout. Be sure to keep snacks on hand—at work, in your bag,
and at home—for convenient bites between meals. You can make your own
trail mix to have on hand wherever you go.
69
Consume protein-rich foods. Protein is essential to build and repair your

muscles. The best sources of protein are simply whole foods such as lean
meats, poultry, fish, beans, nuts, eggs, and low-fat dairy. Try to add a source
of protein to every meal and snack. You can use HPRC’s article about protein
requirements to calculate your individual protein needs based on body weight
and activity level.
Try smoothies, shakes, or soups. Liquids can be an easy way to load up on

calories in a small volume. Add Greek yogurt, milk or soy milk, powdered milk,
flaxseeds, or chia seeds to your smoothies, shakes, and soups for calories
and protein.
Add healthy fats. These are good for your heart and pack a lot of calories in
a small amount of food. They’re also versatile and can be added to almost
any meal, snack, or drink. Use avocado or nut butter in sandwiches or
smoothies, and add a little extra olive oil, canola oil, or oil-based spreads
in your meal preparation.
ANABOLIC STEROIDS
Some Warfighters looking to build muscle and strength turn to anabolic
steroids or dietary supplements. Anabolic steroids include testosterone and
artificial compounds designed to behave like testosterone, the primary an-
drogenic (“masculinizing”) hormone that enhances male attributes, including
muscle mass. They’re used to enhance performance and improve physical
appearance. However, anabolic steroids are classified as “controlled sub-
stances” and are regulated by the U.S. Drug Enforcement Administration
(DEA). They’re illegal to purchase, use, or possess without a prescription;
they’re banned by most athletic associations; and they’re prohibited for use
by Service Members. However, they sometimes are found in products mar-
keted as dietary supplements, so it’s important to read labels carefully and
use only products that have been tested by a reputable third-party organi-
zation to ensure there are no “hidden” ingredients. Warfighters who use such
substances (intentionally or unintentionally) might test positive for anabolic
steroids on a DoD drug test.
Adverse effects of steroids

Anabolic steroids, whether taken alone or in combination with other perfor-
mance-enhancing substances (“stacking”), can have short- and long-term
effects.5, 6 These include physical, psychological, and behavioral adverse side
effects. Using anabolic steroids disturbs your regular production of testos-
terone, which might persist for months after discontinuing use. Some steroid
users become addicted to them and experience withdrawal effects such as fa-
70
tigue, mood swings, sleep problems, and decreased sex drive when they stop.
For more information about anabolic steroids, visit the National Institute on
Drug Abuse web page.
For information about dietary supplements and other “performance-enhanc-

ing” substances, including ones not permitted for use and ones that might be
health risks, read Chapter 12.
2. Garthe, I., Raastad, T., Refsnes, P. E., & Sundgot-Borgen, J. (2012). Effect of nutri-
tional intervention on body composition and performance in elite athletes. Europe-
an Journal of Sport Science, 13(3), 295–303. doi:10.1080/17461391.2011.643923
sionals (6th ed.). Chicago: Academy of Nutrition and Dietetics.

5. Piacentino, D., Kotzalidis, G. D., Casale, A. d., Aromatario, M. R., Pomara, C., Paolo
Girardi, & Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in
athletes. a systematic review. Current Neuropharmacology, 13(1), 101–121. doi:10.21
74/1570159X13666141210222725
6. Trenton, A. J., & Currier, G. W. (2005). Behavioural manifestations of anabolic ste-

roid use. CNS Drugs, 19(7), 593–595. doi:10.2165/00023210-200519070-00002
71
CHAPTER ELEVEN:
MISSION NUTRITION
FOR COMBAT EFFECTIVENESS
CHAPTER 11: MISSION NUTRITION
IN THIS CHAPTER
Nutritional readiness before missions
Maintaining nutrition during missions
Caffeine
Sustained night operations
Missions in the heat
Missions in the cold
Missions at altitude
Missions in water and at depth
KEY POINTS
Inadequate energy intake and/or dehydration can result in fatigue and impair
your performance during combat.
Disruptions in eating and sleeping due to all-night and high op-tempo missions
can affect your overall health.
Plan to eat before night operations to prevent fatigue.
Environmental exposures such as heat, cold, and altitude can reduce combat
effectiveness if your nutritional and hydration needs aren’t met appropriately.
Energy and fluid requirements are typically higher than normal during combat
and combat-simulated scenarios.
Adequate fueling is essential for operational performance and mission

success. Operators of equipment such as Humvees, helicopters, and subma-
rines especially need high-performance fuels to operate effectively. In some
instances, fueling options are limited, but it’s critical to meet your energy and
fluid requirements whenever possible. This chapter describes fueling options
when you’re exposed to various environmental and logistical extremes.
NUTRITIONAL READINESS BEFORE MISSIONS

Warfighters must be prepared to deploy at any time. Immediately before,
they might find themselves in the field or under lockdown on base. The two
73
main nutritional considerations for readiness before missions are optimum

glycogen stores and proper hydration.
Timing and composition of pre-mission meals

A pre-mission meal can help ensure adequate glycogen stores and maintain
your blood sugar. A carb-rich eating plan (for several days before a mission,
if possible) will increase glycogen stored in the liver and muscles and ensure
adequate fuel stores.1 Every Warfighter should know his or her own tol-
erance for timing of meals, types of snacks, and amounts of food needed to
sustain performance. In general, intense physical activities demand a longer
waiting period after you eat to allow for digestion and minimize gastrointesti-
nal (GI) distress, as discussed in Chapter 9.
A pre-mission meal should be high in carbohydrates with some fat and

protein. Avoid high-fat and high-protein meals because protein and fat digest
more slowly than carbohydrates. Carbohydrate beverages and carb/protein
drinks are excellent choices if consumed 1–4 hours before the start of a
mission. The body digests and absorbs liquids more rapidly than solids, but
personal taste and suitability are important in choosing what to consume.
Be sure to try any new foods and beverages before deploying to ensure
tolerance during missions.
MAINTAINING NUTRITION DURING MISSIONS

Rations
Boredom with rations and lack of time to eat contribute to decreased ration
intake and weight loss. So, it’s important to consume as much of your field ra-
tion as possible to maintain optimal performance and health. Combat rations
often are fortified with vitamins and minerals to optimize nutrition, so try to
eat at least part of each ration item whenever possible to obtain all the es-
sential nutrients. See Chapter 13 for more information about combat rations.
Limit substitution of non-issue food items for rations or meals since they
might lack important nutrients. Save them for snacks to supplement your
daily rations. When authorized by your Command, pack high-carbohydrate
items such as crackers, dried fruit, trail mixes, and sports bars too. Experi-
ment with new foods and timing beforehand—during training—to see what
eating patterns and foods suit you best.
Hydration status
Adequate daily fluid intake is critical to maintain optimal operational perfor-
mance and health. Warfighters’ fluid needs usually are greater than the
recommended general guidelines (see Chapter 5) due to their intense training
74
or work in extreme environments. Dehydration can affect your mental and

physical performance, so stay hydrated with water, including beverages (such
as juice, milk, coffee, and tea) and foods (mostly fruits and vegetables; see list
in Chapter 5) that contain water.
You’ll also need electrolyte replacement if you’re (1) physically active longer
than 3 hours; (2) not getting adequate nutrition; or (3) working in conditions
where you sweat a lot, such as humid and hot weather conditions in the field
and military exercises involving high mobility and strenuous physical work.2
In such situations, consume fluid-replacement beverages with carbs and
electrolytes (sodium and potassium) during extended missions, as discussed
in Chapter 5. A carbohydrate–electrolyte beverage powder is available in
rations, but if you use a commercial sports drink instead, choose one with
no more than 24g of carbs per 8 oz during missions.
GI complaints
Changes in diet, dehydration, too much fiber, poor sanitary conditions,
contaminated food, unfamiliar bacteria, and stress might result in diarrhea
or constipation in the field. Try to ensure adequate hydration at all times and
avoid new, non-issue foods whenever possible. See Chapter 14 to learn more
about relieving GI distress.
Dietary fiber
Dietary fiber makes food pass through the GI system faster, improves stool
bulk and weight, and promotes regularity. Consider a low-fiber diet during
extended operations. Many high-fiber foods can cause bloating and gas, espe-
cially if you don’t consume them regularly or if you don’t drink enough water.
It’s important to gradually add fiber to your diet to prevent GI distress. Test
high-fiber foods during training to find out how your system reacts. Avoid all
dietary modifications right before a mission or operational scenario.
Caffeine
Caffeine is a stimulant found in energy drinks, coffee, tea, many sodas, some
dietary supplements, and a few components of military rations. Research on
caffeine shows it positively affects military-relevant tasks such as marksman-
ship, reaction time, vigilance, and logical reasoning.3-7 In athletics, caffeine
can help reduce perception of fatigue and allow you to sustain your targeted
(or intended) intensity for a longer period of time.
Caffeine can increase your alertness and possibly even delay fatigue during
extended operations. Caffeine (in moderate doses up to 200 mg) can improve
cognitive performance in rested, sleep-deprived, and fatigued individuals.8,10
However, the effective dose can vary, depending on your habitual caffeine
75
intake and sensitivity to caffeine, and higher doses can cause unwanted side
effects such as nausea, anxiousness, insomnia, and restlessness, which can
have a negative effect on performance.8,11
Caffeine-rich drinks and foods are among the most popular forms of nu-
trition to help Warfighters maintain alertness at night. Sources of caffeine in
First Strike Rations and Modular Operational Ration Enhancement include
caffeinated chocolate pudding (200 mg), Mocha First Strike Bar (mini; 110
mg) and caffeinated mints and gum (100 mg per piece, 5 pieces per package).
In addition, coffee is available in the Meal, Ready-to-Eat (MRE), FSR, and
Meal, Cold Weather (MCW) rations (80–100 mg per package).
For more about caffeine and performance, see the Operation Supplement
Safety (OPSS) Caffeine & Performance infographic and Tables 11–1 and 11–2
below. Despite its effects on alertness and performance, caffeine shouldn’t be
used as a substitute for healthy habits (adequate sleep, regular meals, etc.).
TABLE 11–1. CAFFEINE CONTENT OF SELECTED BEVERAGES*
Item Serving Size Amount of

Caffeine (mg/
serving)
Coffee
Coffee, brewed 8 oz 95
Coffee, brewed, decaffeinated 8 oz 2
Coffee, instant 1 tsp 31
Coffee, instant, decaffeinated 1 tsp 2
Starbucks Doubleshot Espresso 1 can (6.5 oz) 110

(Espresso & Cream)**
Dunkin Donuts hot coffee 1 small (10 oz) 150
Starbucks Pike Place Roast** 1 “tall” (12 oz) 235
Teas
Black tea, brewed, decaffeinated 8 oz 2
Green tea, brewed 8 oz 28
Black tea, brewed 8 oz 47
Brisk Iced Tea (Lemon)** 1 bottle (20 oz) 14
Fuze Iced Tea (Lemon)** 1 bottle (20 oz) 20
Honest Tea (“Just” Green Tea)** 1 bottle (16 oz) 55
76

Caffeine (mg/
serving)
Pure Leaf (Black Tea)** 1 bottle (18.5 oz) 70
Sodas*
Coca-Cola 1 can (12 oz) 34
Pepsi 1 can (12 oz) 38
Mello Yello 1 can (12 oz) 51
Mountain Dew 1 can (12 oz) 54
Energy Drinks**
Red Bull 1 can (8.4 oz) 80
Mountain Dew Kickstart (Fruit 1 can (16 oz) 92

Punch, Black Cherry, and Orange
Citrus)
Arizona Natural Energy 1 can (15.5 oz) 120
Amp Energy (Cherry Blast and Tropical 1 can (16 oz) 160
Punch)
Full Throttle 1 can (16 oz) 160
Monster Energy Extra Strength 1 can (12 oz) 160
NOS High Performance Energy 1 can (16 oz) 160

Drink
Rip It Energy Fuel (G-Force) 1 can (16 oz) 160
Venom Energy 1 can (16 oz) 160
Xyience 1 can (16 oz) 176
Rockstar Punched 1 can (16 oz) 240
Energy Shots**
5-Hour Energy Decaf 1 bottle (1.93 oz) ≤6
Guayaki Yerba Mate Shot (Wild Berry 1 bottle (1.99 70

Reishi) oz)
Clif Shot Energy Gel (Double Ex- 1 pack (1.2 oz) 100
presso)
77

Caffeine (mg/
serving)
Rip It Energy Shot 1 bottle (2 oz) 100
Rip It Energy Shot Extra Strength 1 bottle (2 oz) 120–135
Guayaki Yerba Mate Shot (Lime 1 bottle (1.99 140

Tangerine and Lemon) oz)
5-Hour Energy 1 bottle (1.93 oz) 200
Eternal Energy 1 bottle (2 oz) 222
5-Hour Energy Extra Strength 1 bottle (1.93 oz) 230
* Except where noted otherwise, caffeine content was obtained from the USDA Food
Composition Databases.12 Actual caffeine content can vary depending on brand and
preparation.
** Caffeine content obtained from product’s marketing website or third-party retail

website.
TABLE 11–2. CAFFEINE CONTENT OF SELECTED FOODS AND

OVER-THE-COUNTER DRUGS*

Caffeine
(mg/serving)
Combat Rations
Coffee (freeze-dried) 1 package 80–100
Caffeinated gum 1 piece 100
Caffeinated mints 1 piece 100
Mocha First Strike Bar (mini) 1 bar 110
Caffeinated chocolate pudding 1 container 200
Chocolates
Milk chocolate 1 block (7 g) 1
Dark chocolate-coated coffee beans 10 pieces 121
Chewing Gum**
Neuro Gum 1 piece 40
Run Gum 1 piece 50
78

Caffeine
(mg/serving)
Java Gum 1 piece 65
Blast Power Gum 1 piece 80
Over-the-counter Stimulants**
Jet-Alert 1 tablet 100
NoDoz 1 caplet 200
Vivarin 1 tablet 200
Over-the-counter Pain Relievers**
Anacin 1 tablet 32
Excedrin Extra Strength 1 caplet 65
* Except where noted otherwise, caffeine content was obtained from the USDA Food
Composition Databases.12 Actual caffeine content can vary depending on brand and
preparation.
** Caffeine content obtained from product’s marketing website or third-party retail
website.
SUSTAINED NIGHT OPERATIONS

Night exercises require acute cognitive awareness and the ability to react
quickly to sudden and potential compromised situations. Missions include
both Sustained Operations (SUSOPS) and Continuous Operations (CONOPS),
which frequently can result in fatigue and sleep deprivation. SUSOPS—work
periods of 24 hours or more—usually result in physical and mental fatigue
as well as sleep loss. In contrast, CONOPS involve periods of uninterrupted
activity of “normal shift length” followed by “normal” sleep, but not always
sufficient to recover or prepare for SUSOPS.13, 14
Under-fueling while exposed to these strenuous circumstances can lead to

weight loss, fatigue, and mental impairments, including confusion, depres-
sion, and loss of vigilance.13 Nutritional interventions can partially offset
the detrimental effects of fatigue and sleep deprivation on physical and
mental performance. You need high-carb meals and snacks to maintain
muscle glycogen stores and blood glucose. If you fail to fuel properly during
sustained missions, your blood glucose levels will fall, resulting in hypoglyce-
mia (low blood sugar) and a decline in performance. Symptoms of hypoglyce-
mia include headache, dizziness, blurred vision, weakness, fatigue, sweating,
confusion, and unconsciousness.
79
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
it’s particularly grueling with extreme heat and humidity. Land-warfare sce-
narios in which Warfighters carry heavy loads or injured comrades increase
overall effort, energy expenditure, and fluid and electrolyte needs. The major
concerns during operations in a warm or hot environment are fluid and elec-
trolyte balance. Working or exercising in the heat worsens water and electro-
lyte loss through sweating. The amounts of sweat and fluid lost depend on:
Environmental temperature and humidity
Work rate
Fitness level and acclimatization
Volume and rate of fluid replacement
Genetics
When the same task carried out in a more neutral-temperature environment

is performed in a hot environment, energy requirements increase slightly due
to the increased work of maintaining thermal balance.1 If you’re acclimated
to heat, you likely won’t need to increase your calories. However, working in
the heat might decrease your appetite or alter your food preferences, so it’s
important to monitor your food intake and any changes in body weight.15
Fluids—Drink early and often

High work rates in hot, humid surroundings can significantly increase fluid
and electrolyte losses. Losses of 1–2 quarts (32–64 fl oz) per hour or even
more are likely when Warfighters wear special clothing such as chemical
protective gear or body armor.15 Your risk of performance mishaps is greater
when you start any operation without being adequately hydrated. In addi-
tion, failure to replace fluids lost from sweating will result in dehydration
and possible heat injury. When engaging in light to moderate activity in a
temperate climate (under 86°F), you should aim to drink 2–5 quarts of fluids
per day, but when working in the heat, your daily fluid needs can double.2
Fluid-replacement beverages are most useful for rehydration. If it's available,
fruit juice also provides some carbs, electrolytes, and fluid to help hydration.
Don’t rely on thirst as a guideline to drink. By relying solely on thirst, your

hydration can lag several hours behind fluid needs.16 Try to set a pre-deter-
mined drinking schedule to ensure you’re consuming enough fluids. Make
80
sure to drink some type of beverage (water, juice, milk, iced tea, or sports
drink) with all meals and snacks too.
Although such “forced drinking” is recommended during training and

missions in a warm environment to ensure adequate fluid replacement for
performance, drinking too much water can result in hyponatremia (as dis-
cussed in Chapter 5). Symptoms of hyponatremia include headache, vomit-
ing, fatigue, confusion, and disorientation. Do not drink more than 1.5 quarts
(48 fl oz) of water per hour or 12 quarts (384 fl oz) per day.16
Electrolyte balance
Excessive loss of electrolytes (sodium and potassium) from sweating can
lead to severe medical problems. You can help minimize electrolyte losses if
you stay in excellent physical condition. To maintain electrolyte balance, you
might need to consume snacks that contain sodium and potassium, fluids
with electrolytes, or electrolytes in the form of gels or chews during and after
missions. Dried fruits are optimal food choices for potassium. For example,
a small box of raisins (1.5 oz) provides 320 mg of potassium. Adding salt to
foods (½ teaspoon provides 1,200 mg) or including sodium-rich foods in your
diet will help retain water and avoid a sodium deficit. MREs provide sodium
within the food components and in the salt packet.16 Sodium is the most
critical electrolyte for maintaining fluid balance. The Military Dietary
Reference Intake for sodium is < 2,300 mg for men and women.2 Adequate
sodium intake should offset hyponatremia.
MISSIONS IN THE COLD

Exposure to a cold environment seriously challenges the human body. Blood
vessels tighten to conserve heat, and shivering generates heat and guards
against hypothermia (a dangerously low core body temperature). Side effects
of these responses are increases in urine output and energy metabolism.
Energy intake
Energy requirements can increase 10–40% during cold-weather operations
as compared to warm-weather operations.17 Factors that can increase your
calorie needs include:
Added exertion due to wearing heavy gear
Shivering to maintain body temperature
Greater exertion traveling over snow and icy terrain
Increased activity to keep warm
81
Energy expenditure for Warfighters during periods of physical exertion in the

cold might range 4,200–4,600 calories per day, with some situations requiring
as much as 6,000 calories per day.17 A high-carb eating plan can provide the
carbohydrates you need to replenish the glycogen your body uses to maintain
core temperature. The high-calorie needs of cold weather operations can be
difficult to meet. Both fat and carbs are significant energy sources, so you
might need an eating plan that provides 35% of the energy as fat. Consume 3–4
standard MREs or 3 MCW/LRP rations per day to meet your energy needs.
Supplementing regular meals with frequent snacks between meals and before
bed also can help you meet your calorie needs. High-carb snacks, many of
which can be stored in your pockets for portable access, include:
Granola or power bars
Oatmeal cookies
Hot or cold protein or carb beverage
Bagel with jam
Pretzels
Trail mix
Dried or fresh fruit
Crackers with hard cheese
Popcorn, corn chips, or tortilla chips
Keep in mind that the increase in energy requirements doesn’t apply to War-
fighters located in cold-climate regions unless they are actually exposed to
outdoor temperatures.17
Fluid status
Becoming dehydrated in cold environments is easy because of cold-induced
increase in urine output, increased fluid losses through breathing, involuntary
reduction in fluid intake, and sweating. Since dehydration decreases your
performance and might lead to various medical problems, it’s crucial to drink
plenty of fluids and monitor your hydration, as discussed in Chapter 5. Fluid
needs depend on physical activity level, but most Warfighters require 3–6
quarts (96–192 fl oz) per day for adequate hydration.17 Try these tips to help
maintain your fluid status.
Drink fluids (water, juice, tea, sports drinks, and coffee) with meals.
Force yourself to drink 16–32 fl oz of warm fluid at hourly intervals.
82
Avoid alcoholic beverages because alcohol tends to increase heat and

urine losses.
Drink beverages with carbs to increase your energy intake.
Don’t eat snow without first melting and purifying it.
Vitamin and mineral needs
Your requirements for some vitamins (for example, thiamin) and minerals
(such as magnesium or zinc) are greater when you’re working in the cold due
to increases in energy metabolism or urinary losses.18 People who are defi-
cient in iron, copper, or zinc sometimes have difficulty regulating their body
temperature. In most cases, you can meet your energy (calorie), vitamin, and
mineral requirements by eating all ration components.
MISSIONS AT ALTITUDE
Ascent to altitude and flying can cause a variety of disturbances and in-
creased oxidative stress, so adequate nutrition is crucial to maintain perfor-
mance. The major nutritional concerns at altitude are:
Weight loss
Carb intake
Dehydration
Weight loss
At altitudes greater than 10,000 feet, energy needs greatly increase (by as
much as 25%), especially for Warfighters performing extremely strenuous
activities.19 Virtually all people who go to high altitudes experience loss
of weight and lean body mass due to greater energy needs, reduced food
intake, loss of body fluids from increased breathing, decreased fluid intake,
decreased absorption of nutrients, and GI symptoms (nausea, vomiting, and
decreased appetite) related to Acute Mountain Sickness (AMS).1 Over a
period of several weeks or longer, bodyweight loss of approximately 5%
or less is typical and usually won’t affect the performance of most tasks.20
The only way to minimize weight loss is to be vigilant about your

energy intake.
83
Carbohydrate intake
High-carb foods are the preferred energy source at altitude and in flight
because they:
Replete glycogen stores
Provide the most efficient energy source
Can delay the progression or severity of AMS and reduce its symptoms (nau-
sea, vomiting, and headache)
Maintain blood glucose
During strenuous activity, long flights, and recovery, eat high-carb snacks
between meals and drink beverages that contain carbs to help meet your car-
bohydrate goals. Warfighters at altitude should aim to consume a minimum
of 400 grams of carbs per day.20
Dehydration
Exposure to high altitude increases your loss of water, resulting in significant
risk of dehydration, cold injury, and AMS. Factors that cause dehydration
at altitude include:
Greater respiratory losses due to increased ventilation (breathing)
Increased urine output associated with altitude and cold temperatures
Failure to drink water
Limited access to water
Don’t over-exercise before a flight because strenuous exercise can deplete body
water, which might be difficult to replace quickly. Recent illness (including AMS),
fever, diarrhea, or vomiting also will greatly affect your degree of dehydration.
Warfighters at altitude should follow the same guidance for fluid intake as for
those in hot environments.20 Maintain a drinking schedule and monitor your
hydration status (see Chapter 5) daily to avoid AMS. Take regular sips of
water before you feel thirsty to help prevent dehydration as well.
MISSIONS IN WATER AND AT DEPTH

As with exposure to altitude and cold environments, water operations (es-
pecially cold-water operations such as diving) are associated with greater
energy expenditure and fluid losses.
84
Energy intake
When working at the same rate in water as on land, the energy expenditure
to accomplish the same task is greater. The reasons for this increased energy
expenditure during water operations include:
Greater resistance offered by water
Decreased efficiency of movement when thermal protective clothing is worn
Your body uses glycogen stores rapidly when you’re performing hard work
in cold water. It’s important to replace these stores between operations to
prevent performance decrements. Increasing carb intake before an anticipat-
ed dive has been shown to improve and extend exercise performance during
prolonged dives.
Fluid intake
Immersion in water alone doesn’t significantly increase hydration needs.
However, water depth and water temperature do affect hydration. Since
immersion dulls the thirst response, voluntary water intake might decrease.21
Without adequate hydration, a diver can quickly become dehydrated and
suffer performance decrements, so it’s important to consume fluids even
when you aren’t thirsty.
1. Deuster, P. A., & Singh, A. (2004). Nutritional considerations for military deploy-
ment. In P. Kelley (Ed.), Textbooks of Military Medicine: Military Preventive Medicine,
Mobilization and Deployment (Vol. 1, pp. 317–340). Washington, DC: Office of the
Surgeon General, Department of the Army, United States of America.
3. Kamimori, G. H., McLellan, T. M., Tate, C. M., Voss, D. M., Niro, P., & Lieberman, H.
R. (2014). Caffeine improves reaction time, vigilance and logical reasoning during
extended periods with restricted opportunities for sleep. Psychopharmacology,
232(12), 2031–2042. doi:10.1007/s00213-014-3834-5McLellan, T. M., Bell, D. G.,
& Kamimori, G. H. (2004). Caffeine improves physical performance during 24 h of
active wakefulness. Aviation, Space, and Environmental Medicine, 75(8), 666–672.
4. McLellan, T. M., Kamimori, G. H., Bell, D. G., & Belenky, G. (2005). Caffeine main-
tains vigilance and marksmanship in simulated urban operations with sleep depriva-
tion. Aviation, Space, and Environmental Medicine, 76(1), 39–45.
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5. McLellan, T. M., Kamimori, G. H., Voss, D., & Johnson, D. (2005). Caffeine main-
tains vigilance and improves run times during night operations for Special Forces.
Aviation, Space, and Environmental Medicine, 76(7), 647–654.
6. McLellan, T. M., Kamimori, G. H., Voss, D., & Smith, S. J. R. (2007). Caffeine effects
on physical and cognitive performance during sustained operations. Aviation, Space,
and Environmental Medicine, 78(9), 871–877.
7. Goldstein, E. R., Ziegenfuss, T., Kalman, D., Kreider, R., Campbell, B., Wilborn, C., . . .
Antonio, J. (2010). International society of sports nutrition position stand: Caffeine
and performance. Journal of the International Society of Sports Nutrition, 7(5), 1–15.
doi:10.1186/1550-2783-7-5
8. Lieberman, H., Tharion, W., Shukitt-Hale, B., Speckman, K., & Tulley, R. (2002).
Effects of caffeine, sleep loss, and stress on cognitive performance and mood
during U.S. Navy SEAL training. Psychopharmacology, 164(3), 250–261. doi:10.1007/
s00213-002-1217-9
9. Institute of Medicine (US) Committee on Military Nutrition Research. (2001). Caf-
feine for the Sustainment of Mental Task Performance. Washington, DC: National 17. Institute of Medicine, Food and Nutrition
Board, Committee on Military Nutrition
Academies Press.
Research, Marriott, B. M., & Carlson,
10. Peeling, P., Binnie, M.J., Goods, P.S.R., Sim, M., & Burke, L.M. (2018). Evidence-based
S. J. (Eds.). (1996). Nutritional Needs in
supplements for the enhancement of athletic performance. International Journal of
Cold and in High-Altitude Environments:
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Applications for Military Personnel in Field
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USDA Food Composition Databases. Retrieved 26 April 2017 from National Agri- Academy Press.
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12. Institute of Medicine, Food and Nutrition Board, Committee on Military Nutrition Re- Brooks, G. A., Sutton, J. R., & Reeves, J. T.
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Short-Term High-Stress Situations (Eds.). (2006). Nutrient Composition of Rations for Short- es weight loss in men at high altitude.
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Rations. Washington, DC: National Academy Press. management (TB MED 505). Department
of the Army, Washington, DC. Retrieved
from: http://www.apd.army.mil/epubs/
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DR_pubs/DR_a/pdf/web/tbmed505.pdf
tions for Military Personnel in Field Operations. Washington, DC: National Academy Press.
20. Montain, S. J., & Ely, M. (2012). Water
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86
CHAPTER TWELVE:
DIETARY SUPPLEMENTS
AND PERFORMANCE-
ENHANCING SUBSTANCES
CHAPTER 12: DIETARY SUPPLEMENTS AND
PERFORMANCE-ENHANCING SUBSTANCES
IN THIS CHAPTER
Dietary supplements and the law
Adverse events
How to evaluate products
Ingredients and products of concern
DS and overall health
Where to go for more information
Energy drinks
Nicotine
KEY POINTS
Dietary supplements, including those sold on military installations, are not

always safe, effective, or legal.
Manufacturers of dietary supplements are responsible for ensuring products

are properly labeled and safe.
The Food and Drug Administration (FDA) must be able to prove a dietary
supplement is unsafe before it can be taken off the market.
If you use dietary supplements, select high-quality products with third-party

certification seals.
Energy drinks can contain caffeine that is not disclosed on the label; the combi-
nations of ingredients commonly found in energy drinks have unknown effects.
The most common reasons active-duty Service Members use dietary sup-
plements (DS) include promoting general health, losing weight, improving
performance1, increasing muscle mass, enhancing energy levels, and increas-
ing strength. More than 65% of Americans take some type of DS. Sales of
vitamins, minerals, herbs, meal supplements, sports-nutrition supplements,
and specialty supplements exceeded $43 billion in 2017.2 The purpose of
this chapter is to provide an overview of dietary supplements, their regula-
tory framework, how to spot red flags, adverse events associated with some
DS, and information about some ingredients and products of concern. This
chapter is not all-inclusive; more information can be found at Operation
Supplement Safety (OPSS), the DoD-wide effort that provides up-to-date,
evidence-based information on dietary supplements.
88
DIETARY SUPPLEMENTS AND THE LAW
Regulation and oversight

In 1994 Congress passed the Dietary Supplement Health and Education
Act (DSHEA) to amend the Food, Drug, and Cosmetic Act of 1938. DSHEA
changed the regulation and labeling of dietary supplements. It gave the U.S.
Food and Drug Administration (FDA) regulatory control over DS. The law
also requires that the label of a DS provide the name and quantity of each in-
gredient or proprietary blend. The manufacturer must provide this informa-
tion, and most consumers assume that the information on labels is truthful
and not misleading. However, this is not always the case.
What is a dietary supplement?

DSHEA defines a dietary supplement as a product taken by mouth (other
than tobacco) intended to supplement the diet by increasing the total dietary
intake3 and containing one or more of the following dietary ingredients: vita-
mins, minerals, herbs or other botanicals, amino acids, and substances such
as enzymes, organ tissues, glandulars, and metabolites. Under DSHEA, DS
can be extracts or concentrates and may come as tablets, capsules, softgels,
gelcaps, liquids, or powders.
New dietary ingredients

FDA also regulates whether new ingredients are permitted. Technically,
almost any ingredient that occurs “naturally” can be sold in the U.S. as a
DS, but Federal rules don’t require makers of DS to test all their ingredients.
Instead, the law states that supplement ingredients in the food supply or sold
as DS in the U.S. before 15 October 1994 are presumed to be safe and are not
subject to FDA review for safety. However, any dietary ingredient not mar-
keted in the U.S. before 15 October 1994 is considered a “new dietary ingre-
dient” (NDI) and must undergo FDA review for safety. But no list of dietary
ingredients in DS marketed before 15 October 1994 exists, so manufacturers
and distributors are responsible to determine if an ingredient is NDI.4
Rules for manufacturing5

Facilities in which DS products are manufactured and packaged must comply
with Current Good Manufacturing Practices (CGMPs). In June 2007, FDA
announced new Federal regulations that require DS to be produced in a
manner that ensures certain quality standards, such that they do not contain
contaminants or impurities and are accurately labeled. Manufacturers are
now required to test all of the ingredients in their products to make sure they
are neither adulterated nor contaminated.6
89
The Food Safety Modernization Act (FSMA) of 2011 clarified and expanded
this to include registration and inspection of facilities that manufacture, pro-
cess, package, or hold dietary supplements for U.S. consumption.
Supplement Facts labeling requirements

FDA requires a “Supplement Facts” label on every DS product. Read the OPSS
article on labeling of dietary supplement products to learn more.
FDA also regulates what claims may (or may not) be made, while the Federal
Trade Commission (FTC) enforces unproven, misleading, or deceptive adver-
tising claims. Some DS products contain undisclosed ingredients such as
prescription and/or over-the-counter drugs, steroids, steroid-like ingredients,
and stimulants. Products marketed for bodybuilding, weight loss, and sexual
enhancement are more likely than others to contain undisclosed ingredients.
DSHEA regulations contain many gaps, including:
The manufacturer is responsible to ensure that products are properly labeled.
Supplement ingredients sold in the United States before 15 October 1994

are presumed to be safe and are not subject to FDA review for safety.
The manufacturer is responsible for providing evidence of safety.
Before a product can be removed from the market, FDA must prove it
To report an adverse is not safe.
event, or even if you
suspect one, you can fill Government resources to monitor DS quality and safety are limited.
out a form through the
Safety Reporting Portal.
ADVERSE EVENTS
“Adverse events” are unfavorable or unusual reactions/effects/illnesses that
can occur with the use of DS.
Examples of adverse events include anxiety, headaches, increased blood

pressure, vision problems, stroke, heart arrhythmia, and death. Such adverse
events might be due to one DS taken alone, combinations of DS, or interac-
tions between drugs and DS.
Be sure to listen to your body, pay attention to how you feel, and keep a
written list of all prescription drugs, DS products, and over-the-counter med-
ications you are taking. Tell your healthcare provider about all DS you are
taking and any changes in your health status, particularly if you start to feel
symptoms you did not experience prior to taking the DS. It is always best to
talk to a healthcare provider before taking any dietary supplement.
90
HOW TO EVALUATE PRODUCTS

Shop smart: Look for products that are third-party certified
Third-party certification seals confirm independent testing and evaluation
of dietary supplements and their ingredients and ensure that manufacturing
and storage facilities comply with GMP (or similar) requirements. The com-
panies that conduct such reviews vary widely in terms of how they approach
the certification process and how they test products. Certification programs
confirm that a product contains the ingredients listed on the label. They do
not ensure a product’s effectiveness or safety.
The seals of 3 of the most common organizations (BSCG, LGC, and NSF) also If you choose to use dietary
ensure a product has been tested for and does not contain ingredients banned supplements, look for products
by the World Anti-Doping Agency (WADA). Another (USP) does not test for that are third-party certified.
substances banned in sport, but it does verify the ingredients and their amounts
in products. Note: All such testing is essentially a snapshot in time of a particular
product and is no guarantee that future batches will have the same test results.
Dietary supplement red flags

Despite growing popularity among military personnel, some DS on the
market are tainted and unsafe. OPSS has an article about how to spot red
flags. Ask yourself the red-flag questions to minimize your risk of consuming
potentially harmful products. If you can answer “Yes” to any of the questions,
you might want to reconsider taking that product.
DS companies often put a seal or stamp on their website or their product

labels with words such as “Certified GMP,” “FDA Approved Facility,” or
“CGMP Inspected Facility.” There is no “official” seal or stamp, and mis-
use of FDA’s logo is illegal. FDA does not approve or certify facilities or DS
products. FDA does have the authority to inspect facilities and ensure they
comply with CGMP regulations.
INGREDIENTS AND PRODUCTS OF CONCERN

Some DS products contain ingredients that are not legitimate dietary ingre-
dients, including steroids, steroid-like substances, and other ingredients. FDA
has found that bodybuilding, weight-loss, and sexual-enhancement products
are the most common types of DS that contain undeclared drugs, which
could cause issues with drug screening.
OPSS has a web page about DoD-prohibited substances that FDA, the
Drug Enforcement Agency, and/or the U.S. Armed Forces have disallowed,
including a list prepared by OPSS of prohibited ingredients sometimes found
in products labeled as DS.
91
Stimulants PERFORMANCE-ENHANCING SUBSTANCES
Please read the OPSS articles about
the following stimulants found in
Stimulants
DS:
In general, stimulants are substances that affect the chemicals that convey
Acacia rigidula
messages between your brain and the rest of your body in a way that makes
BMPEA
you more alert. But they also can increase your heart rate and blood pres-
Caffeine sure. In some cases, stimulants also can make you feel euphoric. And some
DMAA stimulants are more powerful than others.
DMBA The OPSS article about stimulants in dietary supplements has a more
extensive list than the one at left.
Ephedra
Methylsynephrine Steroids, steroid-like ingredients,

Synephrine testosterone boosters, and SARMs
Yohimbe Anabolic steroids have been linked to liver toxicity, testicular shrinkage, breast
The OPSS article about stimulants enlargement in males, adverse effects on lipid levels, and increased risk of
in dietary supplements has a more heart attack and stroke. Anabolic steroids are classified as “controlled sub-
extensive list. stances” and are illegal to purchase, use, or possess without a prescription, as
well as banned by most athletic associations. They are not DS, although they
can be found in some products sold as DS, sometimes listed on the labels and
other times not disclosed. For more information about anabolic steroids, visit
the National Institute on Drug Abuse.
Some DS products contain synthetic anabolic androgenic steroids sometimes

referred to as “designer steroids,” “prohormones,” or “testosterone boosters.”
For more information about these, read the OPSS article about testosterone
boosters and designer steroids. There is no reliable scientific evidence that
Other ingredients of concern
prohormones and testosterone boosters are effective to improve performance or
Aromatase inhibitors increase testosterone levels, and there isn’t enough research as to their safety.
Cannabidiol (CBD)
Also of concern are SARMs—selective androgen receptor modulators. They
DHEA analogs are synthetic drugs and are not allowed for use as ingredients in DS or, cur-
Kratom rently, for any use other than research. For more information, please read the
OPSS web page about SARMs.
Peptide hormones, including
information about IGF-1 and HGH
DIETARY SUPPLEMENTS AND OVERALL HEALTH
In certain situations, some DS can benefit your health. Chapter 4 addresses
vitamin and mineral supplements. You might need a fish-oil supplement, as
discussed in Chapter 16, if foods high in omega-3s are not available. Howev-
er, they should only be taken under the supervision of a healthcare provider.
Chapter 16 also addresses joint supplements.
92
For women who are pregnant or of childbearing age, read the OPSS article
about dietary supplements while pregnant.
WHERE TO GO FOR MORE INFORMATION
OPSS
FDA: Dietary Supplements
Federal Trade Commission: Dietary Supplements
National Center for Complementary and Integrative Health:

Dietary and Herbal Supplements
Office of Dietary Supplements (ODS)
MedlinePlus: Drugs, Herbs and Supplements
ENERGY DRINKS
Energy drinks are beverages designed to give a burst of
energy. Some are classified as DS (these have a Supplement
Facts label) but nearly all are conventional foods (which
WHAT’S IN YOUR ENERGY DRINK (OR SHOT)?
carry a Nutrition Facts label). Typically, they contain a com-
bination of sugars, caffeine, B vitamins, amino acids, and/ Most energy drinks contain one servinging .
The amount of calories, sugar, caffeine,
or herbal ingredients. The long-term effects of the various or other ingredients listed is what’s in the
entire can.
energy-drink ingredient combinations are unknown. Poten-
Taurine, L-carnitine, glucuronolactone,
tial side effects of energy drinks include an increase in heart inositol, and Panax ginseng are common
ingredients in energy drinks, but they
haven’t been proven to provide additional
rate and blood pressure, anxiety, and nervousness. Energy benefit for physical or mental performance
compared to caffeine alone.
drinks should not be used while exercising, during train- Some energy drinks could contain other
stimulants in addition to caffeine.
ing or missions, or with alcohol. FDA has issued warnings
Product contains caffeine, as well as
regarding the addition of caffeine to alcoholic beverages guarana, which is another source of
caffeine.
(including energy drinks with alcohol), because caffeine can Look at the total caffeine content
from all sources.
mask the effects of alcohol.7 Manufacturers of such products

were required to remove them from the market.
Energy shots are small, but they can be a
Please see the OPSS article for more information about the more concentrated source of caffeine.
Be aware of your total caffeine intake
in a 24-hour period.
ingredients found in energy drinks.
You can’t always tell how much of each
ingredient is in a “blend.”
NICOTINE
The ingredients in energy shots can
vary. Some products contain other
ingredients that have stimulant-like
effects such as yohimbe.
Nicotine, like caffeine, exerts potent effects on the human

body.8 It is considered a psychoactive drug, which means it
alters the normal functioning of the brain by stimulating the
central nervous system. This results in a nicotine “buzz” or
93
“high.” Some people use smokeless tobacco for performance enhancement.

Smokeless alternatives can contain higher nicotine concentrations than
cigarettes.8 When smokeless tobacco 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.
Self-reported “benefits” of nicotine include:
Decreased appetite
Decreased pain
Control or reduction of body weight
Ability to focus attention
Increased energy
The reported ability of nicotine to focus attention or “enhance mental state”

is why users claim their reaction time and performance are enhanced. How-
ever, studies consistently find no differences in reaction times between users
and nonusers of smokeless tobacco.
Some studies have examined the effects of nicotine (using forms that did
not require smoking) on exercise performance.9 The results suggested that
it might have some performance-enhancing benefits, but more studies are
needed.
Nicotine has some very detrimental effects:10
It increases blood pressure, heart rate, and rate of respiration.
It constricts/tightens blood vessels, which leads to increases in blood pressure

and heart rate.
It stimulates the nervous system.
Although nicotine might have performance-enhancing benefits, they do not

outweigh the negative effects of potential nicotine dependence and with-
drawal. The Centers for Disease Control and Prevention has a fact sheet on
the health effects of smokeless tobacco, including information about nicotine
addiction. And read HPRC's article about vaping to learn why it is not a safe
alternative, with or without nicotine.
94
1. Austin, K. G., McLellan, T. M., Farina, E. K., McGraw, S. M., & Lieberman, H. R.
(2016). Soldier use of dietary supplements, including protein and body building
supplements, in a combat zone is different than use in garrison. Applied Physiology,
Nutrition, and Metabolism, 41(1), 88–95. doi:10.1139/apnm-2015-0387
2. Nutrition Business Journal. (2018). Supplement Business Report 2018. New Hope
Network. Retrieved 10 March 2022 from https://www.newhope.com/market-da-
ta-and-analysis/analyst-s-take-supplement-sales-grow-54-percent-reach-434b-2017
3. U.S. Food & Drug Administration (FDA). (19 June 2018). Questions and Answers on
Dietary Supplements. Retrieved 27 September 2017 from https://www.fda.gov/
food/dietarysupplements/usingdietarysupplements/ucm480069.htm
4. U.S. Food & Drug Administration (FDA). (29 November 2017). New Dietary Ingre-
dients in Dietary Supplements – Background for Industry. Retrieved 29 November
2017 from https://www.fda.gov/Food/DietarySupplements/NewDietaryIngredi-
entsNotificationProcess/ucm109764.htm
5. U.S. Food & Drug Administration (FDA). (2010). Guidance for Industry: Current
Good Manufacturing Practice in Manufacturing, Packaging, Labeling, or Holding
Operations for Dietary Supplements; Small Entity Compliance Guide. Retrieved 27
September 2017 from https://www.fda.gov/Food/GuidanceRegulation/Guidance-
DocumentsRegulatoryInformation/ucm238182.htm
6. U.S. Food & Drug Administration (FDA). (2008). Guidance for Industry: Final
Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated
Because They Present an Unreasonable Risk; Small Entity Compliance Guide. Re-
trieved 27 September 2017 from https://www.fda.gov/Food/GuidanceRegulation/
GuidanceDocumentsRegulatoryInformation/ucm072997.htm
7. Centers for Disease Control and Prevention (CDC). Smokeless Tobacco: Health Ef-
fects. Retrieved 27 September 2017 from https://www.cdc.gov/tobacco/data_sta-
tistics/fact_sheets/smokeless/health_effects/index.htm
8. Pesta, D. H., Angadi, S. S., Burtscher, M., & Roberts, C. K. (2013). The effects of
caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance.
Nutrition & Metabolism, 10(71), 1–15. doi:10.1186/1743-7075-10-71
9. Johnston, R., Doma, K., & Crowe, M. (2018). Nicotine effects on exercise perfor-
mance and physiological responses in nicotine-naïve individuals: A systematic
review. Clinical Physiology and Functional Imaging, 38(4), 527–538. doi:10.1111/
cpf.12443
95
CHAPTER THIRTEEN:
COMBAT RATIONS
CHAPTER 13: COMBAT RATIONS
IN THIS CHAPTER
Individual rations
Group rations
Survival rations
Special-purpose rations
Enhancement packs
Combat rations research and development
KEY POINTS
Combat rations provide optimal amounts of energy and nutrients to meet the
needs of Warfighters in various operational environments.
Good nutrition is a key enabler for successful military operations.
Enhancement packs also are available to supplement military rations with

components tailored to specific operational environments.
Military rations are the cornerstone of combat and field feeding. The type of
ration a Warfighter needs depends on his or her unit’s mission, location, and
availability of personnel and equipment to prepare meals. All military rations
are designed to meet or exceed the nutritional standards in AR 40-25, OPNA-
VINST 10110.1/MCO 10110.49, and AFI 44-141: Nutrition and Menu Standards
for Human Performance Optimization.1 Warfighters should consume all or most
of the rations provided because they’re specially formulated to provide the
fuel needed for optimal performance. This chapter provides an overview
and descriptions of selected rations. Combat Rations Database (ComRaD)
provides detailed nutrition information for Meal, Ready-to-Eat (MRE), First
Strike Rations® (FSR), Meal, Cold Weather (MCW), and others. All of these
are available in multiple menu options.2
INDIVIDUAL RATIONS
Meal, Ready-to-Eat (MRE)

MRE is the primary general-purpose ration for the individual Warfighter. Is-
sued as a self-contained combat ration, it’s designed for use as a single meal.
Each MRE provides about 1,285 calories, including 40 grams protein, 176
97
grams carbohydrate, and 47 grams fat, meeting or exceeding the nutritional

standards for operational rations.
Several ration components are fortified with specific vitamins and minerals
to optimize nutritional content.3 In a field environment, however, Warfighters
often remove ration components to reduce weight. If you choose to “field
strip,” don’t remove your entrée or fortified items such as beverage bases,
chocolate protein drink, cheese spread, peanut butter, crackers, snack breads,
pudding, fruits, and First Strike bars. Otherwise, you won’t have the energy
and nutrients you need to perform optimally.
Warfighters can consume MREs as their sole source of nutrition for up to

21 days. When MRE is the sole ration, units also should be provided with
supplements (for example, milk) and enhancements (for example, bread and
fresh fruit) whenever possible. After 21 days, other appropriate rations should
be included in the daily field-feeding plan.
Meal, Cold Weather (MCW)

MCW is an individual ration designed for use during missions in extreme
cold weather. The lightweight MCW contains dehydrated, precooked entrees
and other low-moisture foods (granola, dried fruits, nuts, ramen noodle soup)
that will not freeze. Each menu includes several beverages to encourage
water consumption and prevent dehydration during cold-weather activities.
Approximately 28–40 ounces of potable water are needed to rehydrate the
ration components within each menu.
Each MCW menu provides an average of 1,600 calories, including 51 grams

of protein, 227 grams of carbohydrates, and 58 grams of fat. Three MCWs
(food for 24 hours) provide more than 4,500 calories, which is needed to meet
the increased energy requirements when conducting operations in extreme
cold-weather environments.
First Strike Ration® (FSR)

FSR is a compact, eat-on-the-move assault ration designed for use by an
individual during short-duration, high-intensity missions.3 FSR is substantial-
ly lighter and more compact than MRE, enhancing Warfighter consumption,
nutritional intake, and mobility. FSR contains familiar, eat-out-of-hand foods
that require little or no preparation.
Each FSR (food for 24 hours) provides around 2,900 calories, including 91
grams protein, 421 grams carbohydrates, and 98 grams fat.
98
GROUP RATIONS
The family of Unitized Group Rations (UGR) provides high-quality group
meals to Warfighters during operations that allow organized food-service
facilities. Each UGR contains all the items necessary for field-feeding 50 War-
fighters, allowing culinary specialists to focus on food preparation instead of
administration.
There are multiple ration types in the UGR family, including UGR-A, UGR-Heat
& Serve (UGR-H&S), UGR-Marines (UGR-M), and UGR-Express (UGR-E).
UGR-A
UGR-A consists of both shelf-stable and perishable components. It delivers the
highest-quality, most fresh-like field-feeding ration available anywhere. UGR-A
is the only military operational ration that contains frozen food components.
For this reason, it’s based on a build-to-order assembly process that requires
refrigerated or frozen storage and a field kitchen for preparation. The average
UGR-A menu, including shelf-stable milk, provides approximately 1,270 calo-
ries, including 52 grams protein, 161 grams carbohydrates, and 45 grams fat.
UGR-A, Short-Order expands the variety of food choices, offering a choice

between standard UGR-A “mainline” and “short-order” dinners.
UGR-H&S
UGR-H&S is the first group ration available for use in theater. Used in com-
bination with MRE for daily feeding, its components are shelf stable and can
be prepared in field kitchens without refrigeration. Each menu contains an
entrée, starch, vegetable, and dessert.
The average UGR-H&S menu, including shelf-stable milk, provides approxi-

mately 1,370 calories, including 47 grams protein, 183 grams carbohydrates,
and 50 grams fat.
UGR-M
UGR-M (formerly UGR-B) is the primary group ration for the Marine Corps.
It meets the Marines’ expeditionary requirements for high-quality group
rations that are shelf stable (no refrigeration needed), quick, and easy to
prepare. The average UGR-M menu, including shelf-stable milk, provides
approximately 1,300 calories, including 46 grams protein, 176 grams carbo-
hydrates, and 46 grams fat.
99
UGR-E
UGR-E provides complete group meals for Warfighters in remote locations
where group field feeding wouldn’t otherwise be possible. In addition, these
meals don’t require cooks or a field kitchen for preparation. With the simple
pull of a tab, UGR–E is ready to serve in 30–45 minutes. One UGR-E module
provides everything needed for a complete meal, including entrées, starches,
vegetables, desserts, drink pouches, snacks or candies, dining trays, season-
ings, disposable eating and serving utensils, condiments, beverages, napkins,
wet-naps, and trash bags.
Each meal provides approximately 1,360 calories, including 39 grams pro-

tein, 179 grams carbohydrates, and 55 grams fat.
SURVIVAL RATIONS
Survival, General Purpose
Survival, General Purpose can sustain anyone in survival situations (including
escape and evasion, all environmental conditions, and when potable water
is limited) for periods up to 5 consecutive days. The ration contains 5 com-
pressed bars (2 cereal bars and 3 cookie bars), wintergreen tablets, lemon tea,
and soup base. Each packet provides approximately 1,450 calories, including
18 grams protein, 200 grams carbohydrates, and 63 grams fat. This ration
provides crucial nutrients and minimizes carry weight (one packet weighs 11.4
ounces). You’ll need 14 oz water to reconstitute the lemon tea and soup.
Survival, Abandon Ship

The Navy uses this ration when it’s necessary to abandon ship. Designed to
fit in the storage areas of lifesaving craft, each packet contains a minimum
of 6 individually wrapped bars (2 per day for 3 days) to sustain one person.
The ration is strictly short-term survival food to minimize the effects of acute
starvation. Each 20-ounce packet provides approximately 2,400 calories
(54% carbohydrates) and is compatible with potable water restrictions.
Survival, Aircraft, Life Raft

The Navy uses this ration to sustain personnel who survive aircraft disasters at
sea. The packet, along with other essential equipment, is supplied in emergen-
cy kits on naval aircraft. The ration weighs 3.5 ounces and contains hard candy
and candy-coated chewing gum. It also includes an instruction sheet explain-
ing that the food is good for a 24-hour period, even when water supply is limit-
ed. Each packet provides approximately 300 calories (100% carbohydrates). It’s
strictly short-term survival food to reduce the effects of acute starvation. The
components also are compatible with potable water restrictions.
100
SPECIAL-PURPOSE RATIONS
Meal, Religious, Kosher/Halal
The Meal, Religious, Kosher/Halal is for those who maintain a strict religious
diet. Each meal consists of one Kosher- or Halal-certified entrée and other
religiously certified or acceptable complementary items. Like MRE, it’s a
complete, self-contained meal that provides approximately 1,330 calories,
including 36 grams protein, 178 grams carbohydrates, and 53 grams fat. A
Kosher for Passover version also is available.
ENHANCEMENT PACKS
Modular Operational Ration Enhancement (MORE)
Warfighters in extreme environments such as cold weather, high altitude, or
elevated temperature require extra calories beyond the standard operational
rations in order to combat weight loss and decreased physical and cognitive
performance. MORE provides extra calories for these unique environmental
scenarios. It isn’t intended to replace a ration. Instead, these are nutritionally
balanced additions that help ensure peak performance, even in harsh battle-
field conditions.
MORE contains lightweight, compact, eat-on-the-move components that

are easy to consume and digest. Each pack weighs about 0.75 pounds and
provides approximately 1,000 calories per pack.
COMBAT RATIONS RESEARCH AND DEVELOPMENT

The mission of the DoD Combat Feeding Research and Engineering Program is to provide an operationally relevant re-
search-and-development base to deliver solutions for evolving field-feeding challenges.
The Combat Feeding Directorate is responsible for the research, development, engineering, integration, and technical
support for the entire family of operational rations.2 The program is driven by Warfighter recommendations and feedback.
1. Headquarters, Departments of the Army, the Navy, & the Air Force. (2017). Nutrition and menu standards for human performance
optimization (AR 40–25/OPNAVINST 10110.1/MCO 10110.49/AFI 44–141). Departments of the Army, the Navy, and the Air Force,
Washington, DC. Retrieved from: https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/AR40-25_WEB_Final.pdf
2. Defense Logistics Agency. Rations Programs/Products. DLA Troop Support Subsistence. Retrieved 27 April 2017 from http://www.dla.
mil/TroopSupport/Subsistence/Operationalrations/RationsPrograms.aspx
3. Institute of Medicine, Food and Nutrition Board, Committee on Military Nutrition Research, & Committee on Optimization of Nutrient
Composition of Military Rations for Short-Term High-Stress Situations (Eds.). (2006). Nutrient Composition of Rations for Short-term,
High-intensity Combat Operations. Washington, DC: National Academies Press.
101
CHAPTER FOURTEEN:
EATING ABROAD
CHAPTER 14: EATING ABROAD
IN THIS CHAPTER
Cultural awareness
Foodborne illness
Water purification
Prevention and treatment of foodborne illness
When to seek medical help
KEY POINTS
When dining abroad, be aware of basic customs, dining habits, and other
cultural differences associated with mealtimes.
Take extra precautions with raw meat, poultry, shellfish, eggs, fresh produce,
and other foods associated with foodborne illnesses.
Carefully wash your hands before you eat and after you use the bathroom in
order to prevent illness and the spread of infection to others.
Make sure to purify your water; drinking contaminated water can put you at
risk of serious illness.
Carry an antibiotic (prescribed by your physician) and seek medical treatment

for symptoms of foodborne illness from contaminated foods or beverages.
Most operations take place on the soil of other countries, and each country,
region, and even town might have its own distinct customs. Food is a large
part of any culture, so sharing meals can be a great way to interact and form
relationships with local people. Enjoying the local cuisine is important, but
some foods or approaches to preparing meals can lead to illness for those
unaccustomed to such practices. This chapter covers cultural differences and
how to avoid foodborne illnesses.
CULTURAL AWARENESS
Cultural awareness means recognizing, understanding, appreciating, and
respecting the different perspectives and customs of other cultures. Become
familiar with the local customs and cultures to avoid stereotyping, prejudice,
and insulting your host, particularly when it comes to dining. Since each
country has its own distinct culture and customs, there are things to consider
and research before you deploy.
103
Basic customs
Know whether punctuality is or is not emphasized.
Use the appropriate customary greeting (handshake, bow, etc.).
Learn if it’s customary to bring a gift, food, or beverages to your host’s home
or office. In some cultures, it’s impolite to do so and implies that you’re paying
for your meal, or it might even be an insult to your host’s cuisine.
Know whether it’s customary to eat everything or leave some food on your
plate. Don’t waste food, because your host might have gone to great expense to
prepare an extravagant meal. On the other hand, don’t gorge yourself. In some
cases what you consume might be at the expense of feeding your host’s family.
Avoid rushing through a meal. Eating with others is often as much for social
interaction as it is for nourishment.
Learn whether a certain prayer or phrase is spoken before or after meals and
be respectful during this ritual.
Be respectful to the food and your host. Food has different meanings in other
countries, and some items or practices might be considered sacred.
Find out who is supposed to eat first. Is it your host, other guests, or the per-
son of highest status?
Soup and appetizers
Is slurping soup considered rude, or is it acceptable or even a complimentary

sign of enjoyment?
Is it customary for appetizers or soup to be served before your meal? Avoid

filling up on these items, so you can enjoy your main course.
Meat and fish
Some religions don’t allow certain meats to be consumed. For example, laws in
Islam and Judaism prohibit eating pork. Some Jews also don’t eat shellfish or
catfish. Similarly, Hindus don’t eat beef.
In some parts of the world, dogs, cats, and horses are pets, while in others they
might be food animals. Don’t be surprised or put off if your host serves lamb,
goat, horse, dog, camel, or monkey.
In many cultures, people eat or cook with all parts of an animal, including
brains, organs, feet, intestines, and more.
104
Hospitality
Observe how your host treats you or others visiting his or her office, which
might include serving food or beverages. Then behave similarly and, if you’ve
learned it’s appropriate, serve something when others visit your office.
In some cultures, refusing beverages and food when offered is considered

rude. In others, it might be a gesture that should be refused altogether or ac-
cepted only after a certain number of offers.
Mealtimes
Some meals are eaten at hours you might find unusual. Don’t expect or ask to
eat at other times.
Meals might last longer than what you consider normal, so diners can digest,
talk, and relax. Don’t ask to leave too early.
Muslims fast from sunrise to sundown during the month of Ramadan.
Eating utensils
Some diners use forks as primary eating utensils while others use their hands,
spoons, or chopsticks. Try to become familiar with the different utensils, in-
cluding how and when they should be used during mealtimes.
Learn where to place your utensils when they’re not being used. For example,
in some Asian countries, it’s disrespectful to stick your chopsticks upright in
your rice. Place them on your plate or on a chopstick rest if one is available.
Follow your host’s lead. For example, does he or she push rice from the bowl
directly into his or her mouth or eat it with a utensil? And does your host use a
spoon to consume soup or drink directly from the bowl?
Sometimes hand preference is important. For example, Bosnian Muslims eat

with the left hand, while Arab Muslims eat with the right hand. Saudis consider
the left hand unclean because it’s typically used to maintain personal hygiene.
Proper attire
Dress appropriately and not too informally.
In some cultures, it’s important to remove your shoes as you enter your
host’s home.
105
Paying the restaurant bill
In some countries, it’s customary for the host to pay the restaurant bill. How-
ever, if you invite someone to eat out, expect to pay for his or her meal.
In addition to learning the food customs of other cultures, it’s a good idea to
find out what foods are commonly eaten in the country you’ll be in, so you don’t
come across any surprises. Visit foodbycountry.com for more information.
FOODBORNE ILLNESS
Deploying to other countries can increase your risk of foodborne illness or in-
fections if you consume foods or water that contain certain bacteria, viruses,
or parasites. The risk of infection varies depending on where the food is eat-
en. Food prepared in a private home is generally considered moderate to high
risk, depending on the hygiene. However, your risk is higher if you purchase
ready-to-eat food from street vendors.
The 250+ different foodborne diseases have different symptoms, so there’s

no particular “syndrome” that describes foodborne illness.1 The “culprit” is
most often a bacterium that enters your body through the gastrointestinal
(GI) tract, which causes the first symptoms: nausea, vomiting, abdominal
cramps, and diarrhea. Roughly 50% of travelers in high-risk destinations
develop “traveler’s diarrhea.” Bacterial infections can last 3–5 days, viral
infections can last 2–3 days, and those caused by parasites can last 2 weeks
or longer. In addition, persistent abdominal symptoms can develop after the
infection has ended.
Foods associated with foodborne illness

Certain foods are typically associated with foodborne illnesses. Raw foods,
particularly of animal origin, can be a major concern. Warfighters should
avoid raw meat, poultry, fish, shellfish, eggs, unpasteurized milk, and fresh
fruit or vegetable juice. Raw fruits and vegetables, such as salads and alfalfa
and bean sprouts, can be just as risky as raw meat and fish. That’s because
washing can reduce, but not eliminate, contamination, in part because
the water might be contaminated too. High-salt, high-sugar, and high-acid
levels keep bacteria from growing, which is why salted meats, jams, and pick-
led vegetables are traditional preserved foods and usually safe to eat.
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Make wise food choices

To maintain operational readiness and reduce your risk of foodborne illness,
pay close attention to what you eat and drink and always wash your hands
before eating. Try to follow these tips when eating abroad.
“Street food”
Avoid “street food” if possible.
However, if you choose to eat “street food,” make sure it’s cooked in front of
you and steaming hot.
Don’t choose anything that might have been cooked hours ago.
Cooked foods
Cooked food that’s still hot is usually safe. Don’t consume foods left at room
temperature for longer than 2 hours.
Most bakery products are safe, but avoid those with cream or meat fillings.
Order hamburgers cooked “well done” and without lettuce or tomato. Meat,
poultry, fish, and eggs also should be cooked thoroughly.
Staple items such as pasta, rice, potatoes, or other root vegetables that have
been boiled or cooked over high heat are safe.
Fruits and vegetables
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.
Fresh fruits and vegetables with skins are usually fine if cleaned thoroughly.
Scrub the skin with purified water or soap and water and then peel. If not
cleaned first, surface contamination might be transferred to the fruit or vegeta-
ble during the peeling process.
Avoid fruits and vegetables that have been peeled already.
Beverages
Choose bottled or boiled water, hot beverages (such as coffee or tea) made
with boiled water, and canned or bottled carbonated beverages, beer, and
wine. Don’t drink from containers that have been opened already.
Avoid ice in beverages because it might have been made from contaminated
water.
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Use purified or bottled water to brush your teeth. Don’t even use small
amounts of untreated water to rinse your mouth.
Avoid milk, other dairy products, and juice that have not been pasteurized.
You can get a handy pocket guide, “Tips for Eating Local,” from the U.S.
Army Public Health Command.
WATER PURIFICATION
Contaminated drinking water or food grown or prepared with contaminated
water can increase your risk of traveler’s diarrhea. Boiling is the most reli-
able method to make water safe to drink. Bring water to a rolling boil for one
minute, and then allow it to cool. Boil drinking water for 3 minutes if you’re at
altitudes higher than 6,500 feet.2
You also can purify water with chemical disinfecting agents, specifically
iodine or chlorine. These chemicals might not make water taste like bottled
water from home, but they will decrease your risk of developing traveler’s di-
arrhea. The disinfection capabilities of iodine have been recognized for many
years, and iodine tablets are widely used as an emergency drinking-water
disinfectant. Chlorine also is a reliable water disinfectant. Issued by the
military, water purification tablets that contain chlorine kill Giardia lamblia
cysts, bacteria, viruses, and other harmful microorganisms; they also remove
sediment. Follow the manufacturer’s instructions on the package for which-
ever method you choose.
You can use filters to reduce microorganisms in water too. However, this
method depends on the pore size of the filter and the amounts and sizes of
the contaminants in the water. It’s important to carefully choose your filters
because they might not effectively remove all viruses and bacteria. If a filter
has a chemical disinfectant matrix, it’s more likely to be effective against
some viruses. Just as with chemical disinfectants, carefully read and follow
the manufacturer’s instructions on the package.
PREVENTION AND TREATMENT OF

FOODBORNE ILLNESS
You might be able to prevent or treat many foodborne diseases. In addition to
making wise food choices and drinking safe water, wash your hands before
eating and after using the bathroom. If soap and water are unavailable, use an
alcohol-based sanitizer (containing at least 60% alcohol) to clean your hands.3
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Another preventive approach is to use Pepto-Bismol (brand name for the

antacid bismuth subsalicylate). You can take it before and during internation-
al travel to help prevent diarrhea; doing so will reduce your risk of disease
by half.3 Take 2 ounces of the liquid medication 4 times daily, or 2 tablets 4
times daily, for no longer than 3 weeks. You also can use Pepto-Bismol to
treat diarrhea and reduce the duration and severity of your illness.
Possible side effects of Pepto-Bismol include temporary blackening of your

tongue and stools, occasional nausea and constipation, and rarely, ringing in
your ears. Check with your healthcare provider before taking Pepto-Bismol,
especially if you are using other medications or supplements.
You also can try probiotics (healthy bacteria or yeast), but they don’t seem
to work consistently. While antibiotics are effective, you shouldn’t take them
to prevent traveler’s diarrhea unless even a short bout of diarrhea might af-
fect your mission. Seek medical advice from your healthcare provider before
going abroad.
The treatment of foodborne illnesses depends on your symptoms and the

need to cure your infection in a timely manner. Illnesses that primarily cause
diarrhea or vomiting can lead to dehydration. So, treating your traveler’s
diarrhea also requires you to replace lost fluids and electrolytes. Early and
effective treatment also can lead to a quicker recovery.
Sometimes food-borne illness can cause severe dehydration, especially
if you experience frequent vomiting. Symptoms include thirst, less-frequent
urination that is unusually dark, dry mouth, fatigue, dizziness, and light-head-
edness (as discussed in Chapter 5). If you experience severe dehydration, use
oral rehydration salts (ORS) solution to restore fluid losses. ORS packets—
available at stores or pharmacies in almost all developing countries—are
similar to Pedialyte®. Prepare ORS by adding one packet to boiled or treated
water. Follow packet instructions to ensure the salts are added to the correct
amount of water.
Since bacteria cause the majority of traveler’s diarrhea, the Centers for
Disease Control and Prevention recommend treatment with an antibiot-
ic. Treatment with an antibiotic (often a single dose or one-day course) can
reduce the duration and severity of traveler’s diarrhea.4 Before your deploy-
ment, your physician might provide you with an antibiotic to take with you,
or you might have to seek medical care when affected to obtain this prescrip-
tion treatment.
In addition to antibiotics, you can use other medications—such as loper-
amide (including over-the-counter Imodium®) or Lomotil (by prescription
only in the U.S.)—to improve your symptoms. These are particularly ef-
fective when used with antibiotics. However, you should avoid such medi-
cations if you have a high fever or bloody stools because they could make
your illness worse.
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WHEN TO SEEK MEDICAL HELP

Foodborne illnesses can be dangerous, so it’s important to seek treatment.
Consult a healthcare provider when your GI illness is accompanied by:
High fever (temperature over 101.5°f, measured orally)
Blood in your stools
Prolonged vomiting that prevents keeping liquids down
Signs of dehydration, including a decrease in urination, dry mouth and throat,

and feeling dizzy upon standing
Diarrhea that lasts more than 3 days
Persistent GI symptoms lasting 2 weeks or longer after infection
For more information on avoiding foodborne illness abroad, visit the Centers
for Disease Control and Prevention (CDC) article on food and water safety.
1. Centers for Disease Control and Prevention. (2016). Foodborne Germs and Illnesses.
Retrieved 26 April 2017 from https://www.cdc.gov/foodsafety/foodborne-germs.
html
2. Centers for Disease Control and Prevention. (2009). A Guide to Drinking Water
Treatment and Sanitation for Backcountry & Travel Use. Retrieved 26 April 2017
from https://www.cdc.gov/healthywater/drinking/travel/backcountry_water_
treatment.html
3. Connor, B. A. (2015). Travelers’ diarrhea. CDC Yellow Book: CDC Health Informa-
tion for International Travel (2014 online ed.). cdc.gov: Centers for Disease Control
and Prevention. Retrieved from https://wwwnc.cdc.gov/travel/yellowbook/2016/
the-pre-travel-consultation/travelers-diarrhea.
4. Yates, J. (2005). Traveler’s diarrhea. American Family Physician, 71(11), 2095–2100.
110
CHAPTER FIFTEEN:
RETURNING TO HOME BASE
CHAPTER 15: RETURNING TO HOME BASE
IN THIS CHAPTER
The return home
Reintegration and stress
Sleep and rejuvenation
Physical activity
Alcohol
Putting it all together with Total Force Fitness
Use nutrition to break the cycle
KEY POINTS
Emphasize rest and rejuvenation upon return from deployment to re-optimize

your mental and physical performance.
Consistently getting quality sleep is essential to recover from deployments.
Good nutrition and regular exercise are excellent antidotes to stress.
Avoid binge eating and drinking upon returning from deployments. Excess
food and alcohol intake can lead to unwanted weight gain and is detrimental to
your overall health.
Warfighters who have been away from home for extended periods of time for
deployments and training missions probably need to recalibrate basic health
behaviors when they return home. During those times away, food and bever-
age options might not always be optimal. You might experience weight loss
or weight gain during deployment depending on access to nutritious food,
opportunities to exercise, and your body’s response to stressful situations.
Upon returning home, many Warfighters overindulge in food and alcohol,
which can impact the ability to perform well. This chapter explores the web
of connections between stress, sleep, exercise, and nutrition and how this can
impact your health during reintegration.
THE RETURN HOME

While on deployment, Warfighters have to adjust their sleep and nutrition
habits to meet mission constraints and limitations that come with being
downrange. But habits that were helpful in theater might be harmful in a
garrison environment.1 Many military personnel have concerns about their
112
eating and drinking behaviors upon returning home after a deployment.

Stress from deployment can sometimes lead to unhealthy nutrition decisions
that add greater stress to an already hectic transition. For some Warfight-
ers, weeks or months away from home also can result in feelings of having
been deprived of comforts, which might promote binge eating and drinking.
Significant problems—such as weight loss and/or gain, alcohol dependency,
domestic problems, and even work-related conflicts—might occur that can
affect overall military performance and general health and well-being.
Opt for nutritious food and other positive lifestyle choices to lay the
foundation for a smooth transition. Healthy food choices and limited alcohol
consumption also can help you maintain a healthy weight. It’s important to
understand that food choice is just one piece of the equation: Adequate rest
and recovery, healthy sleep habits, stress-management strategies, and physi-
cal activity all contribute to Warfighter well-being. This chapter looks at each
of these pieces in turn and discusses how they relate to nutrition.
REINTEGRATION AND STRESS

Reintegration back home can feel hectic, and dealing with your own stress
as well as the stress of your family can create even more stress. You might
struggle to adapt to routines that developed in your absence, cope with the
loss or injury of a teammate, or return to your role as a parent. Loved ones at
home might feel stressed asking about your experiences or just bringing you
back into the fold on the home front. Each of you perceives your own particular
stressors as very important, and it can be difficult to understand one another.
Upon returning from combat, Warfighters often use alcohol and drugs to re-
duce stress, but these solutions provide only short-term relief from stress and
actually contribute to stress over time. Stress also can make you more likely
to smoke, have poor dietary habits, and be physically inactive. Extreme un-
treated stress lingering from combat can lead to violent, abusive, or threaten-
ing behaviors. And chronic stress can disrupt the body’s normal patterns,
putting you at greater risk for illness, injury, and mental-health issues.
Conversations with healthcare professionals and fellow Warfighters about

deployment experiences are healthy and can be cathartic. Military commands
have embedded operational, combat-focused psychologists who are familiar
with unit missions, demands, and lifestyles and are available to speak with you
at any time. In addition, Family Services are available on Navy, Marine Corps,
Army, and Air Force bases. These services provide resources to help you man-
age stress, relationships, money, and family and other personal issues.
113
It’s important to remember that not all stress is bad. Change and stress
are inevitable, but they often provide opportunities for growth and develop-
ment. Sleep, physical activity, and nutrition provide a foundation
for effective stress management and maximize your opportunities for
post-deployment growth.
SLEEP AND REJUVENATION

Most operations away from home prevent optimal sleep, so getting
high-quality, restorative sleep should be high on a Warfighter’s priority list
upon returning home. In fact, rest is one of the most important aspects
of recovery, especially during times of change and transition. The mental
and physical stressors of deployment might make it necessary to reset your
stress-response system upon returning home. Lack of sleep, stress, and in-
adequate nutrition disrupt your body’s finely-regulated internal systems. You
need time off when you return from deployment to reconnect with family and
friends, normalize routines within your household, and recover both mental-
ly and physically. But many Warfighters returning home from deployments
experience a variety of behavioral and emotional responses—including sleep
problems—related to their war experience and combat occupational stress.
Insomnia, nightmares, and sleep disturbances are common, as the often-un-

predictable environment and thoughts of the war zone can disturb sleep cycles,
sleep quality, and sleep quantity. Sleep disturbances also are core features
of the most common post-deployment mental health diagnoses, including
post-traumatic stress disorder (PTSD), depression, and traumatic brain injury
(TBI). Sleep is vital to re-establish the normal daily patterns needed for op-
timal mental and physical performance, immune function, and growth. Sleep
loss also can be a risk factor for the development of a number of mental-health
issues, including panic disorders, PTSD, depression, and suicide.
While the amount of sleep needed varies among individuals, most adults
need regular sleep of 7 or more hours per night for optimal health.2 The time
of day you sleep depends on circadian rhythms regulated by your brain.
Circadian rhythm is linked to core body temperature, so the best time to
sleep is at night, including the hours between 0300 and 0500 when core body
temperature is lowest.3
Whether deployed or in garrison, Warfighters often don’t have control over

how much and when they sleep. To perform optimally under such conditions,
you need to be aware how your sleep habits impact your ability to be mission
ready. Once you’re aware and mindful of what can disrupt your sleep, you
can take an active role in cultivating healthy sleep habits to take advantage of
the time you do have to recover.
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Sleep disruptors
Many factors, including some within your control, can prevent a good
night’s sleep:
Caffeine blocks the receptors that trigger sleep, so limit your intake and avoid
it at least 4–6 hours before bedtime.
Nicotine acts as a stimulant and decreases your ability to fall asleep. In addi-
tion, nicotine withdrawal might cause early awakening.
Alcohol is a sedative that prevents deep, restful sleep.
Pain and pain relievers. Some pain relievers contain caffeine, but if your pain
is severe enough to interfere with your sleep, then it might be worthwhile to
take one. Work with your healthcare provider to find what works best for you.
Exercise, done regularly (at least 150 minutes each week), can improve sleep qual-
ity.4 For some people, exercising too close to bedtime might interfere with sleep,
but you can experiment to find what schedule works best for you and your body.
Medications such as decongestants, steroids, and beta-blockers can reduce

restorative sleep.
Late-night eating might throw off your body’s internal clock and keep
you awake.
Electronic devices such as smartphones, tablets, and computers give off “blue
light,” which can disrupt sleep. Avoid them within 2 hours of bedtime if possible.
Mission priorities often give Warfighters little choice but to exercise close to
bedtime, eat late at night, and engage in other kinds of behaviors that disturb
sleep while deployed. Among Warfighters, common sleep disruptors such as
caffeine and nicotine are widespread downrange and often help Warfighters
perform optimally. However, habitual use of caffeine (such as from energy
drinks) and tobacco is difficult to change and can contribute to sustained
sleep problems upon returning home.5
Healthy sleep habits

A very important habit you can develop, especially when you’re back home,
is to prepare your body, mind, and space for good sleep. Consider these
preparations:
Take a warm bath or shower before bed.
Find a therapeutic pillow that cradles your neck and allows you to sleep on
your side.
Make your bedroom a place to sleep, so your body knows it’s a place for rest.
115
Making certain your bedroom has adequate airflow and isn’t too hot or too
cold.
Use a fan to block out potentially disturbing noises.
Dim the lights; darkness tells your body it’s time to sleep.
Turn off all electronic devices at least 2 hours before bed.
Follow the same relaxing sleep ritual every night.
You can use questionnaires such as the Epworth Sleepiness Scale and the
Pittsburgh Insomnia Rating Scale to assess the overall quality of your sleep
Learn more about exercise and your risk of experiencing daytime sleepiness due to poor sleep. Track-
to improve your endurance, ing your sleep also can help you be more aware of patterns that help or hurt
strength, and flexibility. your sleep habits. Try a sleep log such as HPRC’s two-week sleep diary or a
sleep-tracking function on a mobile or wearable device to shed light on your
existing sleep routines and what might impact your quality of sleep. If you
continue to have a hard time sleeping, the same tools also can help you gath-
er information to share with your doctor, so you can work together better to
improve your sleep habits. To learn more about how sleep impacts Warfighter
performance and how to combat sleep debt, visit HPRC’s sleep infographic.
PHYSICAL ACTIVITY
Physical activity can effectively relieve stress. The act of physical exertion
causes your body to release chemical substances (endorphins) similar in
nature to opiates (sleep-inducing chemicals). Endorphins make you feel good
and have no adverse effects, unlike many drugs. Regular exercise should be a
scheduled part of any return-home plan. It even can be in the form of enjoyable
recreational activities such as camping, hiking, basketball, cycling, running, or
weight lifting. You also can share exercise activities with family members and
friends to help your reintegration process. Or you can use exercise to create
“alone time” if you need it. Making room for exercise will help keep life issues
under control and promote relaxation.
ALCOHOL
Post-deployment, Warfighters often turn to alcohol to cope with stress and
insomnia.6 In fact, returning home from deployment is a common time for
alcohol abuse to surface. However, alcohol provides no nutritional value, and
it’s high in calories (see Table 15–1), even more so when mixed with sug-
ar-sweetened beverages such as soda or juice.
116
TABLE 15–1. CALORIC CONTENT OF ALCOHOLIC BEVERAGES 7*
Alcoholic Beverages Serving Size Total Calories

(ounces)
Beer 12 153
Light beer 12 103
Red wine 5 125
White wine 5 121
Dessert wines 3.5 157–165
Distilled spirits (gin, rum, vodka, 1.5 110

whisky; 90 proof)
Mixed drinks 8 **
* Content can vary with brand or variety.
** Mixed drinks can contain even more calories due to the addition of soda, juice,
and/or syrups.
Furthermore, alcohol affects mental health and performance, making it more

difficult for a Warfighter to readjust to home life. Heavy alcohol consumption
can have other negative effects on the body:
Liver. Your liver processes alcohol, which is why so many alcoholics and heavy
drinkers experience liver damage that might not be reversible.
Pancreas. Alcohol also can damage your pancreas, which is involved in diges-
tion. Pancreas damage can affect what you’re able to eat and drink.
Heart. Alcohol increases blood pressure and puts you at risk for stroke and
cardiovascular disease.
Immune system. Excessive drinking puts your immune system at risk, so

you’re more susceptible to infections and diseases such as cancer.
How much alcohol is acceptable?

Drinking 1–2 servings of alcohol per day is considered moderate. See Table
15–1 for typical single-serving sizes. For many people, red wine in moder-
ation (2 drinks a day for men and one drink a day for women) can increase
good cholesterol (HDL) and protect from heart disease. However, beyond
these amounts, alcohol has many harmful effects.8
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Binge drinking
Approximately one-third of active-duty Service Members report binge drink-
ing.9 Binge drinking is defined as a pattern of drinking that leads to a blood
alcohol concentration of 0.08 g/dL or more.8 In practical terms, this means 5
or more drinks for men and 4 or more drinks for women in a period of about
2 hours. Repeated intoxication prevents full participation in normal activities
and fulfillment of other obligations and significantly increases the risk for al-
cohol-related hospitalizations. Binge drinking is a sign of being overstressed.
To learn more about the dangers of binge drinking and how to get help, visit
Military OneSource.
PUTTING IT ALL TOGETHER WITH

TOTAL FORCE FITNESS
Health behaviors are all interconnected. Total Force Fitness (TFF) is the
concept that optimal performance requires a connection between mind,
body, spirit, and family and social relationships. Eight domains make up
TFF: physical, nutritional, medical and dental, environmental, behavioral,
psychological, spiritual, and social. HPRC provides in-depth information and
resources for most of these.
When your health in one domain takes a downturn, another domain like-
ly will be affected, causing you to get stuck in a vicious cycle. Stress and
insufficient sleep often go hand-in-hand because stress keeps you awake,
and in turn, your inability to sleep might increase your feelings of stress.
During sleep your body releases important hormones. If you don’t get enough
sleep, the altered levels of these hormones can have serious repercussions
for your health and well-being, including increased risk of obesity, diabetes,
cardiovascular disease, and mood disturbances. Lack of sleep also affects
your ability to make sound moral judgments and other decisions and regulate
your emotions. It also increases cognitive impairments. Sleep loss even can
affect your family and social relationships by lowering your ability to interact,
communicate, and interpret the emotions of others.
Sleep impacts your eating habits too. Sleep deprivation can cause you to
make poor food choices, which can increase your risk of diabetes.10 Shorter
sleep times also are associated with higher Body Mass Index (BMI) and im-
balances in the hormones that regulate hunger and appetite. Weight gain can
give rise to sleep apnea and other issues that further negatively impact sleep,
creating a vicious cycle.
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USE NUTRITION TO BREAK THE CYCLE

When you return home from deployment, you might go for “comfort” (high-
fat and high-sugar) foods. Research continues to show strong relationships
between nutrition and stress and between exercise and stress. A high-fat,
high-sugar diet combined with chronic stress is a major factor in developing
obesity. In contrast, meals rich in vegetables, fruits, whole grains, and lean
protein provide essential nutrients that promote mental health and contribute
to a healthy weight.11 The minerals zinc and magnesium and vitamins C, B
complex, and E are important to combat stress.12 B vitamins and magnesium
also are involved in producing serotonin, a hormone that helps regulate
mood and relieve stress. Making wise food and exercise choices will promote
faster readjustment when returning home from deployment.
Substances likely to aggravate stress include:
Caffeine
Alcohol
Tobacco
Fried and highly-processed foods
Around the world, traditional foods are served to promote healthy sleep. In
many Western countries, a glass of warm milk or a cup of chamomile tea
before bed is considered a tranquilizing beverage with sleep-inducing capa-
bility. Cherries are a natural source of the sleep hormone melatonin, and tart
cherry juice has been found beneficial to improve sleep duration and qual-
ity.13 Tryptophan, found in foods such as turkey and pumpkin seeds, might
affect sleep, but it depends on what else you eat at the same time. In general,
it requires large amounts of tryptophan-containing foods to affect your sleep.
Finally, almonds and spinach are rich in magnesium, which is known to pro-
mote sleep and relax muscles.
Taking care of yourself in all the domains of TTF is essential for optimal
health, wellness, and resilience, especially if you’re a Warfighter returning
home. Nutrition plays an integral part in recovery after deployment. Positive
nutrition habits can promote positive changes in the other domains, leading
to a successful return to home base.
1. Adler, A. B., Britt, T. W., Castro, C. A., McGurk, D., & Bliese, P. D. (2011). Effect of
transition home from combat on risk-taking and health-related behaviors. Journal of
Traumatic Stress, 24(4), 381–389. doi:10.1002/jts.20665
119
2. American Academy of Sleep Medicine, & Sleep Research Society. (2015). Rec-
ommended amount of sleep for a healthy adult: A joint consensus statement of
the American Academy of Sleep Medicine and Sleep Research Society. Journal of
Clinical Sleep Medicine, 11(6), 591–592. doi:10.5664/jcsm.4758
3. Caldwell, J. L. (2002). Efficacy of napping strategies to counter effects of sleep
deprivation, in Sleep/Wakefulness Management in Continuous/Sustained Operations
(pp. 4.1–4.11). Neuilly-sur-Seine Cedex, France: North Atlantic Treaty Organisation,
Research and Technology Organisation.
4. Loprinzi, P. D., & Cardinal, B. J. (2011). Association between objectively-measured
physical activity and sleep, NHANES 2005–2006. Mental Health and Physical Activity,
4(2), 65–69. doi:10.1016/j.mhpa.2011.08.001
5. Toblin, R. L., Clarke-Walper, K., Kok, B. C., & Thomas, J. L. (2012). Energy drink
consumption and its association with sleep problems among U.S. service mem-
bers on a combat deployment—Afghanistan, 2010. Morbidity and Mortality Weekly
Report, 61(44), 895–898.
6. Roehrs, T., & Roth, T. (2001). Sleep, sleepiness, sleep disorders and alcohol use and
abuse. Sleep Medicine Reviews, 5(4), 287–297. doi:10.1053/smrv.2001.0162
USDA Food Composition Databases. Retrieved 10 March 2022 from National Agri-
cultural Library https://fdc.nal.usda.gov/
8. National Institute on Alcohol Abuse and Alcoholism. Alcohol’s effects on the body.
Retrieved 26 April 2017 from http://www.niaaa.nih.gov/alcohol-health/alco-
hols-effects-body
9. Barlas, F. M., Higgins, W. B., Pflieger, J. C., & Diecker, K. (2013). 2011 Department
of Defense health related behaviors survey of active duty military personnel. TRI-
CARE Manage Activity, United States Coast Guard, Fairfax, Virginia. Retrieved
from: https://www.documentcloud.org/documents/694942-2011-final-depart-
ment-of-defense-survey-of.html
10. Boyko, E. J., Seelig, A. D., Jacobson, I. G., Hooper, T. I., Besa Smith, Smith, T. C.,
& Crum-Cianflone, N. F. (2013). Sleep characteristics, mental health, and diabetes
risk: A prospective study of U.S. military service members in the Millennium Cohort
Study. Diabetes Care, 36(10), 3154–3161. doi:10.2337/DC13-0042
11. Jacka, F.N., Maes, M., Pasco, J.A., Williams, L.J., & Berk, M. (2012). Nutrient intakes
and the common mental disorders in women. Journal of Affective Disorders, 141(1),
79–85. doi:10.1016/j.jad.2012.02.018
12. Kennedy, D.O., Veasey, R., Watson, A., Dodd, F., Jones, E., Maggini, S., & Haskell,
C.F. (2010). Effects of high-dose B vitamin complex with vitamin C and minerals on
subjective mood and performance in healthy males. Psychopharmacology, 211(1),
55–68. doi:10.1007/s00213-010-1870-3
13. Howatson, G., Bell, P.G., Tallent, J., Middleton, B., McHugh, M.P., & Ellis, J. (2012).
Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep
quality. European Journal of Nutrition, 51(8), 909–916. doi:10.1007/s00394-011-
0263-7
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CHAPTER SIXTEEN:
SUSTAINING HEALTH FOR THE
LONG-TERM WARFIGHTER
CHAPTER 16: SUSTAINING HEALTH
FOR THE LONG-TERM WARFIGHTER
IN THIS CHAPTER
Principles of high-performance eating
Antioxidants and phytonutrients
Omega-3 fatty acids
Dietary fiber
Probiotics and prebiotics
Joint health
Strategies for the long-term Warfighter
KEY POINTS
Eating a variety of foods is one key to healthy living and lifelong performance.
Promote lifelong health by eating many different colorful foods, which contain
important protective compounds such as antioxidants and phytonutrients.
Omega-3 fatty acids reduce the risk of several diseases. However, try to get
your omega-3s from food instead of supplements.
Plants are rich sources of fiber, which contributes to a healthy gut and reduces
the risk of certain chronic diseases.
Products containing probiotics (yogurt, kefir, sauerkraut) might help you

maintain a healthy digestive tract.
Foods rich in vitamin C and omega-3s can help with joint health. But talk to a
healthcare provider before you start using a joint supplement.
Years of heavy physical activity can take a toll on Warfighters. However, it is

possible to be a long-term Warfighter if you build good habits early and sustain
them throughout life. These good habits include a well-balanced eating plan,
structured exercise program, and healthy body weight. A health-promoting
lifestyle can minimize your risks of many of the chronic diseases or condi-
tions associated with aging, such as arthritis, musculoskeletal injuries, weight
gain, hypertension, heart disease, Type II diabetes, metabolic syndrome, and
cancer. This chapter discusses some nutrients that might help you maintain a
healthy life for the long run.
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PRINCIPLES OF HIGH-PERFORMANCE EATING

The 3 principles of high-performance eating are variety, moderation, and
quality. These principles are especially important for the long-term Warfight-
er to optimize health and performance. Consuming a variety of foods will
help you obtain all the essential nutrients for a strong, healthy body. Eating
the same foods is not only boring but decreases the opportunity to obtain all
the essential nutrients from your diet. However, eating in moderation also
promotes good health. Eating too much of anything can lead to overcon-
sumption of calories, resulting in unhealthy weight. Finally, eat a variety of
foods that are of high quality. Fruits, vegetables, whole grains, nuts, seeds,
eggs, dairy products, lean meat, poultry, and fish are all high-quality nutri-
tion. They provide a ready supply of energy, vitamins, minerals, and other
nutrients to keep your body healthy.
ANTIOXIDANTS AND PHYTONUTRIENTS

Antioxidants and phytonutrients in foods offer potential health benefits
beyond basic nutritional needs. Possible benefits of antioxidants and phyto-
nutrients include:
Optimizing muscle strength and endurance
Preventing muscle and joint injuries or fatigue
Enhancing immune function
Preventing heart disease and diabetes
Preventing high blood pressure
Reducing pain and inflammation
It’s better to get antioxidants and phytonutrients from whole foods rather
than supplements. Research suggests eating more of foods rich in antiox-
idants might protect against disease, but the same result has not been
found for antioxidant supplements.1
Antioxidants
Oxidation, or the production of free radicals, is a normal consequence of
metabolism, strenuous exercise, and exposure to sunlight, pollutants, chem-
icals, and extreme environments. Accumulation of free radicals in your body
can result in structural and functional damage such as inflammation, infec-
tion, and muscle injury from exercise. It also contributes to aging and a host
123
of illnesses, including cancer and heart disease. Antioxidants are molecules

that can neutralize free radicals and render them harmless.
A well-balanced eating plan that consists of fruits, vegetables, whole grains,

nuts, and seeds will provide antioxidants and other nutrients to support the
body’s natural defense against free-radical threats and protect against
tissue damage. The most well-known antioxidants are vitamins A, C, and E,
beta-carotene, and the mineral selenium. However, those are only a few of
the many substances. For a list of major antioxidants and food sources, see
Table 4–2, Chapter 4.
Phytonutrients
Phytonutrients are chemical compounds found in plants that have numerous
desirable effects on the human body. They can act as antioxidants, anti-in-
flammatory agents, or other protective agents. Eating a variety of colorful
foods that contain phytochemicals (Table 16–1) might decrease the risk of
developing certain cancers, diabetes, hypertension, and heart disease. At
present, a recommended daily allowance for phytonutrients does not exist,
but eating a variety of foods—including plenty of fruits and vegetables—will
ensure adequate intake.
For more information on phytonutrients, visit the Produce for Better Health
Foundation.
TABLE 16–1. COMMON TYPES AND FOOD SOURCES

OF PHYTONUTRIENTS 2
Type Food Sources
Anthocyanins Red and blue fruits such as acai, blueberries, blackber-

ries, raspberries, cherries, plums; and vegetables such
as eggplant, red onions, red potatoes, and radishes
Beta-carotene Leafy green, orange, and yellow vegetables such as

broccoli, spinach, collard greens, kale, sweet potatoes,
carrots, and cantaloupe
Flavanones Citrus fruits
Flavonols Apples, apricots, beans, broccoli, cherry tomatoes,

kale, pear, onions, cherries, tea, and dark chocolate
Flavones Celery, parsley, thyme, and oregano
Isoflavones Soybeans and soybean products such as tofu and soy

milk, and edamame
124
Type Food Sources
Lutein Leafy green vegetables such as kale,spinach, turnip

greens, and lettuces, as well as broccoli, Brussels
sprouts, and artichokes
Lycopene Tomatoes, watermelon, pink grapefruit, and red peppers
Zeaxanthin Green vegetables, citrus fruits, and eggs
OMEGA-3 FATTY ACIDS

Omega-3 fatty acids are polyunsaturated fatty acids (PUFA) that are import-
ant for cell and tissue development and, particularly, heart and brain health.
The important omega-3 fatty acids are alpha linolenic acid (ALA), eicosapen-
taenoic acid (EPA), and docosahexaenoic acid (DHA).
Fish (particularly oily fish such as sardines, salmon, trout, mackerel, herring,
and anchovies) and seafood are excellent sources of EPA and DHA. The
American Heart Association recommends eating two 3½-ounce servings of
fatty fish per week.3 In general, the health benefits of eating fish outweight any
risks associated with heavy metal (mercury) toxicity.
Sources of ALA include tofu and other soybean products, canola and soy-
bean oils, walnuts, Brazil nuts, and flaxseed. Flaxseed (linseed) oil is the most
concentrated source of ALA.
HPRC’s article on omega-3 fatty acids in food has more information, includ-
ing a list of various foods high in omega-3s.
Fish-oil supplements
It’s best to get omega-3s from foods, but many people do not like or do not
have access to foods high in omega-3s, so they commonly take fish-oil sup-
TABLE 16–2. FIBER-RICH FOODS
plements. As with other dietary supplements, fish-oil supplements should be Insolu- Wheat bran, whole
taken only under the supervision of a healthcare provider, especially if you ble Fiber grains, whole wheat, nuts,
have health conditions or take medications, because fish-oil supplements can seeds, barley, brown rice,
prolong bleeding time and interact with some medications and health condi- celery, broccoli, onions,
tomatoes, grapes, and
tions.4 Fish-oil supplements are generally well tolerated, but possible unwant-
dark leafy vegetables
ed effects include fishy aftertaste and gastrointestinal complaints.
Soluble Oatmeal, barley, nuts,
DIETARY FIBER Fiber seeds, beans, lentils,
peas, apples, oranges,
Dietary fibers—non-starch forms of carbohydrate obtained from plants—are pears, berries, cucum-
bers, and carrots
structural components that the human body cannot digest.5 Dietary fibers are
125
TABLE 16–3. DAILY FIBER CHAPTER 16: SUSTAINING HEALTH
RECOMMENDATIONS 6
Age Men Women
19–30 34 g 28 g
classified as soluble or insoluble, and most fiber-rich foods contain some of
31–49 31 g 25 g both types (Table 16–2). These two types function differently in the body.
over 50 24 g 22 g
Insoluble fiber adds bulk to stools and promotes regular bowel movements.
A diet high in insoluble fiber commonly helps your body digest and eliminate
meals faster and increases stool weight.
Soluble fiber absorbs water and turns into gel in the intestines. This helps slow
digestion and might have a positive effect on your cholesterol levels.
Because your body doesn’t digest or absorb dietary fiber, it isn’t considered a
nutrient (unlike vitamins, minerals, protein, fats, and carbohydrates), but it is
still an essential part of a healthy diet. Dietary fiber plays a role in reducing
your risk for various chronic conditions such as gastrointestinal diseases,
hypertension, diabetes, heart disease, and several types of cancer, including
colon cancer. For these reasons, it’s important to get the daily recommenda-
tion for fiber (Table 16–3).
It’s important to increase your intake of fiber gradually because eating too
much fiber in a short period of time can cause bloating, cramping, and gas
until your gut gets used to more fiber. Also remember to drink plenty of fluids
throughout the day to help fiber pass through your gut. Fruits, vegetables,
whole grains, and beans and legumes are great sources of fiber. Table 16–4
includes examples of foods and their fiber content. You also can find the
grams of fiber in packaged foods by looking at the Nutrition Facts label. In
general, Americans don’t consume enough fiber because their intake of fruits,
vegetables, and whole grains is low.6
TABLE 16–4. FIBER CONTENT OF VARIOUS FOODS 7
Food Grams of Fiber
Apple with skin (3” diameter) 4
Orange (3” diameter) 3
Banana (7–8 inches long) 3
1 cup whole strawberries 3
½ cup black beans 8
1 cup cooked green beans 4
1 cup cooked asparagus 4
1 cup cooked spinach 4
126
PROBIOTICS AND PREBIOTICS

Both probiotics and prebiotics can help you maintain a healthy gastrointesti-
nal tract.8, 9 Probiotics are “good” or “friendly” bacteria, while prebiotics are
food compounds that promote the growth of “good” bacteria.10
Probiotics
Probiotics are live microorganisms (in most cases, bacteria) that help main-
tain the natural balance of bacteria in your intestines and promote a healthy
digestive system. Food sources of probiotics include:
Yogurt
Fermented milk such as kefir or buttermilk
Aged cheeses such as cheddar or Gouda
Tempeh, a food made by controlled fermentation of cooked soybeans
Soy beverages
Sauerkraut, finely sliced cabbage fermented by various lactic acid bacteria
Kimchi, a fermented dish made of seasoned vegetables, often cabbage
Kombucha, a beverage produced by fermenting sweet tea with a culture of

yeast and bacteria
Miso, a Japanese food produced by fermenting rice, barley, and/or soybeans

with salt and a mold
Daily consumption of probiotic-containing foods not only improves gut

health but also might offer other health benefits such as reducing your risk
of colon cancer, lowering blood pressure, improving immune function, pre-
venting infections, and improving mineral absorption.
Consuming probiotics can be especially important during times of illness or

injury when the “good bacteria” in your gut can be destroyed. This includes
preventing the diarrhea caused by antibiotics. Antibiotics eliminate harmful
bacteria that might cause illness, but they also destroy your “good bacteria.”
A decrease in the number of beneficial bacteria can lead to other compli-
cations, such as intestinal illnesses and flare-ups of inflammatory bowel
disease. Taking probiotics might help replace the “good bacteria” destroyed
by antibiotics and restore the balance between “good” and “bad” bacteria in
your intestines.
127
Prebiotics
Prebiotics are non-digestible carbohydrates that support the growth and
activity of probiotics in your intestines.8 Prebiotics occur naturally in plants
such as garlic, asparagus, and onion. Other foods containing prebiotics
include oatmeal, barley, beans, whole grains, leafy green vegetables, berries,
bananas, yogurt, and milk. Because prebiotics can boost the effects of
probiotics, food manufacturers add synthetic prebiotics to many foods. Two
prebiotics added to many foods are inulin and fructo-oligosaccharides (FOS).
It’s important to consume both probiotics and prebiotics for optimal gut
health, ideally those that occur naturally in foods. For example, combining
Greek yogurt with a banana offers both probiotics and prebiotics.
JOINT HEALTH
Military training puts stress on your body. Over time, this can lead to dam-
aged joints and other musculoskeletal injuries. A healthy weight and nutri-
ent-rich foods, along with regular exercise (with rest days) and stretching,
can help optimize the long-term health and performance of your joints. In
particular, eat foods—such as oranges, Brussels sprouts, strawberries, red
peppers, and kiwis—that are rich in vitamin C, an antioxidant that plays a
role in the formation of collagen (the main component of connective tissue).
Other foods such as salmon and other fish, English walnuts, flaxseeds and
their oil, and canola oil provide omega-3 fatty acids, which help reduce your
body’s inflammation.
Many people with joint problems turn to dietary supplements to improve

their joint health. Before taking dietary supplements for your joints, talk
to your healthcare provider to determine the cause of your joint pain and
appropriate treatment strategies. Much of the research looking at the effects
of certain dietary supplements for joint pain have been conducted in patients
with knee osteoarthritis. Although some people with osteoarthritis might
experience small reductions in joint pain, the use of any dietary supplement
should be discussed with a healthcare provider. In general, there isn't enough
scientific evidence to recommend any particular dietary supplement or ingre-
dient to improve joint health.11-20
STRATEGIES FOR THE LONG-TERM WARFIGHTER

Good nutrition can keep you in top condition for a long and healthy career
despite years of high stress, physically demanding trainings, and missions
that take a toll on even the most agile Warfighter. As you think about your
128
eating plan, focus on whole foods that are rich in vitamins, minerals, antioxi-
dants, phytochemicals, omega-3s, and fiber.
Remember that good nutrition is a lifestyle. In other words, eating a recovery

snack after a workout won’t optimize your performance if you don’t eat
balanced meals throughout the day too. Once you have the basics down,
special attention to nutrition and hydration before, during, and after exercise
will help keep you mission ready. Nutrition is an integral part of Warfighter
health, performance, and readiness, but enough sleep and exercise, good
mental health, and healthy relationships also are essential to achieve Total
Force Fitness.
1. National Center for Complementary and Integrative Health. (2013, November
2013). Antioxidants: In Depth (NCCIH Pub No. D483). Retrieved 26 April 2017 from
https://nccih.nih.gov/health/antioxidants/introduction.htm
2. Produce for Better Health Foundation. What Are Phytonutrients? Fruits & Veggies:
More Matters: Fruit & Veggie Info. Retrieved 26 April 2017 from http://www.fruit-
sandveggiesmorematters.org/what-are-phytochemicals
3. American Heart Association. (2016, 24 March 2017). Fish and Omega-3 Fatty
Acids. Retrieved 26 April 2017 from https://healthyforgood.heart.org/Eat-smart/
Articles/Fish-and-Omega-3-Fatty-Acids - .WBthufkrK00
4. Natural Medicines. (24 April 2017). Fish oil (monograph). Natural Medicines Compre-
hensive Database. Retrieved 26 April 2017 from http://naturaldatabase.therapeuti-
cresearch.com/nd/Search.aspx?cs=DOD&s=ND&pt=100&id=993&ds=&name=FI
SH+OIL&searchid=60821242
ton, DC: The National Academies Press. doi:10.17226/10490
6. U.S. Department of Health and Human Services & U.S. Department of Agricul-
ture. (2015). Shifts needed to align with healthy eating patterns 2015–2020 Dietary
Guidelines for Americans (8th ed., pp. 37–62). Washington, DC: Health and Human
Services Dept. and Agriculture Dept.
8. Gibson, G. R., Rastall, R. A., & Fuller, R. (2008). The Health Benefits of Probiotics
and Prebiotics. In R. Fuller & G. Peridigón (Eds.), Gut Flora, Nutrition, Immunity and
Health (pp. 52–76). Oxford, UK: Blackwell Publishing Ltd.
129
9. Kechagia, M., Basoulis, D., Konstantopoulou, S., Dimitriadi, D., Gyftopoulou, K.,
Skarmoutsou, N., & Fakiri, E. M. (2013). Health benefits of probiotics: A review.
ISRN Nutrition, 2013(Article 481651), 1–7. doi:10.5402/2013/481651
10. Academy of Nutrition and Dietetics. (2016). Prebiotics and probiotics: Creating a
healthier you. Retrieved 27 April 2017 from http://www.eatright.org/resource/
food/vitamins-and-supplements/nutrient-rich-foods/prebiotics-and-probiot-
ics-the-dynamic-duo
11. Cameron, M., & Chrubasik, S. (2014). Oral herbal therapies for treating osteoarthri-
tis. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD002947.pub2
12. Daily, J.W., Yang, M., & Park, S. (2016). Efficacy of turmeric extracts and curcum-
in for alleviating the symptoms of joint arthritis: A systematic review and me-
ta-analysis of randomized clinical trials. Journal of Medicinal Food, 19(8), 717–729.
doi:10.1089/jmf.2016.3705
13. Kongtharvonskul, J., Anothaisintawee, T., McEvoy, M., Attia, J., Woratanarat, P., &
Thakkinstian, A. (2015). Efficacy and safety of glucosamine, diacerein, and NSAIDs
in osteoarthritis knee: A systematic review and network meta-analysis. European
Journal of Medical Research, 20(1). doi:10.1186/s40001-015-0115-7
14. Liu, X., Machado, G.C., Eyles, J.P., Ravi, V., & Hunter, D.J. (2018). Dietary supple-
ments for treating osteoarthritis: a systematic review and meta-analysis. British
Journal of Sports Medicine, 52(3), 167–175. doi:10.1136/bjsports-2016-097333
15. Onakpoya, I.J., Spencer, E.A., Perera, R., & Heneghan, C.J. (2017). Effectiveness of
curcuminoids in the treatment of knee osteoarthritis: a systematic review and me-
ta-analysis of randomized clinical trials. International Journal of Rheumatic Diseases,
20(4), 420–433. doi:10.1111/1756-185x.13069
16. Ragle, R.L., & Sawitzke, A.D. (2012). Nutraceuticals in the management of osteoar-
thritis. Drugs & Aging, 29(9), 717–731. doi:10.1007/s40266-012-0006-3
17. Rutjes, A.W.S., Nüesch, E., Reichenbach, S., & Jüni, P. (2009). S-Adenosylmethi-
onine for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews.
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18. Senftleber, N., Nielsen, S., Andersen, J., Bliddal, H., Tarp, S., Lauritzen, L., . . . Chris-
tensen, R. (2017). Marine oil supplements for arthritis pain: A systematic review and
meta-analysis of randomized trials. Nutrients, 9(1). doi:10.3390/nu9010042
19. Simental-Mendía, M., Sánchez-García, A., Vilchez-Cavazos, F., Acosta-Olivo, C.A.,

Peña-Martínez, V.M., & Simental-Mendía, L.E. (2018). Effect of glucosamine and
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130
Main phone number
240-694-2000
Headquarters
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WARFIGHTER NUTRITION GUIDE

Chapter One: Nutrition for the Warfighter 3

Chapter Two: Balance Your Energy Tank 6

Chapter Three: Macronutrients for Everyday Fueling 13

Chapter Four: Micronutients for High Performance 21

Chapter Five: Hydrate with Fluid 29

Chapter Six: Build a Performance Plate in

Chapter Seven: Fueling at Home 44

Chapter Eight: Optimal Choices for Eating Out 52

Chapter Nine: Nutrient Timing and Training 59

Chapter Ten: Fuel for Your Optimal

Chapter Eleven: Mission Nutrition for

Chapter Twelve: Dietary Supplements and

Chapter Thirteen: Combat Rations 96

Chapter Fourteen: Eating Abroad 102

Chapter Fifteen: Returning to Home Base 111

Chapter Sixteen: Sustaining Health for

Nutrition as a key to success

What to expect in WNG

NUTRITION AS A KEY TO SUCCESS

This Guide includes a variety of materials—from short summaries to de-

WHAT TO EXPECT IN WNG

Chapters 2–5 provide general background information about energy

Chapters 9–12 review important information on using nutrition to excel. They

Chapters 13 and 14 explore nutrition strategies while deployed, including

Chapter 16 provides information on how to be a long-term warrior and what

Warfighters need effective

Energy balance: Energy intake versus energy expenditure

Fuel your tank

Assess your food intake

Body mass index

Personalized nutrition needs

Calculate your Estimated Energy Requirements (EER) to determine how much

CALORIES: UNITS OF ENERGY

ENERGY BALANCE: ENERGY INTAKE VERSUS

Basal metabolic rate

Energy used in digesting foods (“thermic effect of food” or TEF)

Energy intake and energy expenditure together make up energy balance.

Basal Metabolic Rate

Institute of Medicine equation1:

EER for Men: 662 – (9.53 × age

187 pounds ÷ 2.2 = 85 kg Sedentary Men: 1.00 A person with a sedentary

85 kg × 15.91 = 1352 Very active Men: 1.48 A competitive athlete engaging

TABLE 2–2. FOOD GROUPS AND RECOMMENDED DAILY AMOUNTS 2

Food Recom- What Examples of one serving

Vegetables 2½ cups 1 cup 1 cup cooked leafy greens (for

Fruits 2 cups 1 cup 1 large banana (8” to 9” long)

Grains 6 ounce- 1 ounce- 1 slice whole-wheat bread

Dairy 3 cups 1 cup 1 cup dairy or soy milk

Proteins 5½ ounce- 1 ounce- 1 oz meat, fish, or poultry

Remember that good nutrition is a lifestyle and all about consistency.

Warfighters also should be mindful of portion size—the amount of food you

ASSESS YOUR FOOD INTAKE

Write down all foods and drinks you consumed.

Do you ever eat when you aren’t hungry?

How many meals and snacks do you eat in a day?

BODY MASS INDEX

PERSONALIZED NUTRITION NEEDS

2. United States Department of Agriculture. What is MyPlate? Retrieved 30 July 2018

ARE: FUELS FOR ENERGY