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Supplemental danger

Ephedrine, an unregulated drug common in dietary and energy supplements, can kill. The NFL and NCAA are trying to spread the word and keep it out of locker rooms.

By BRIAN LANDMAN, Times Staff Writer
© St. Petersburg Times
published August 15, 2002

TAMPA -- During his time at Georgia Tech and his first season in the NFL, Bucs backup quarterback Joe Hamilton admitted he didn't know much about it.

"Through the grapevine, I'd heard players say they thought it enhanced them ... that it would help you get stronger, help you get faster, help you get better," he said.

The various bottles were in his sight, pervasive in the locker stalls of teammates, innocuously blending into the background like a set of car keys or cellular phone.

"But ephedrine?" Hamilton said. "I was more in tune to steroids, more in tune to creatine. I hadn't really heard of ephedrine."

He has now.

He is aware that ephedrine, a derivative of the herb ephedra, is a stimulant found in hundreds of over-the-counter dietary supplements, especially those touting effectiveness as a performance enhancer or a fat burner.

However, more than 1,400 adverse reactions and 80 deaths have been associated with supplements containing ephedra or ephedrine since 1994.

Last summer, Minnesota Vikings offensive lineman Korey Stringer died from heatstroke during training camp. Although an autopsy revealed no ephedrine in his system, team officials found an empty bottle of Ripped Fuel in his locker. That raised the specter the performance-enhancing supplement could have been a contributing factor.

That should not have come as a shock.

"I don't think it's any big secret that the most abused drug in the history of the NFL has not been steroids, it's been stimulants," said Mark Asanovich, the former Bucs strength and conditioning coach now with the Ravens.

Less than two months after Stringer's death, the NFL joined the International Olympic Committee and the NCAA in banning ephedrine. It's the only professional sports league to do so, and beginning this season, it will test for it. A positive test will result in a four-game suspension.

"Unfortunately, it has to take something like (Stringer's death) to be a (catalyst)," Asanovich said. "But remember. It took a Lyle Alzado to get steroids banned."

On July11, the league and NFL Players Association sent a jointly written memo to all players stressing the potential risks of ephedrine and reminding them of the testing policy. (Pseudoephedrine, a common ingredient in cold medicine, will not produce a positive result if taken at or near the recommended dosage.)

"We have very aggressively made our players aware of the dangers of the misuse of ephedrine," league spokesman Greg Aiello said. "With supplements being unregulated and readily available, it was clear that use among athletes, not just NFL players, has grown and become fairly common. It is a major concern."

Especially at this time of year, when a player can suffer dehydration during strenuous two-a-day workouts in the searing heat. Researchers warn ephedrine can exacerbate problems with heat.

"If one wants to do all he can to prevent heat injury and heat deaths in these athletes," said Priscilla Clarkson, a Ph.D. who has written many articles about sports supplements, "the one thing that can be done is certainly not allow ephedrine."

For thousands of years, the Chinese have used ephedra, also known as ma huang, to treat colds, asthma and nasal congestion.

More recently, folks realized that by stimulating the central nervous system, ephedra and its derivatives could increase the heart rate -- thus the potential energy boost.

They also noted it enhanced the production of heat from stored calories -- thus the fat-burning/weight loss potential.

But the first warnings of adverse effects, including hypertension, heart disturbances and cerebral hemorrhage, soon followed. By the early 1980s, medical researchers found the risks even greater when ephedrine was combined with another stimulant, such as caffeine.

Despite those concerns, the passage of the Dietary Supplement Heath and Education Act by Congress in 1994 opened Pandora's box. The Food and Drug Administration, essentially, lost its regulatory power with regard to supplements. So companies could develop and sell products unfettered by the sometimes difficult, often prolonged, process of seeking the FDA's approval. During the past eight years, supplements have grown into a multibillion-dollar business.

"People felt that we don't need to regulate vitamins and minerals," Clarkson said. "Well, of course, you can see what's happened with the plethora of supplements that have appeared on the market. And a lot of them are dangerous."

Not just to the athlete looking to run a bit faster or shed a few pounds.

In March 1997, Barbara Michal's son, Kristopher, began taking an ephedrine-containing supplement to, she said, stay awake during long work days. She said the stimulant disrupted his heart rhythm and he died. He was 24.

"That stuff is nothing more than legalized speed," said Michal, who founded a nonprofit organization, Halt Ephedrine Use Today, a year later and since has testified several times at state and federal hearings.

"To the industry, I'm that (expletive) redhead. But if one person throws that bottle in the garbage, I've done my job. It's my mission."

Calls from her and other equally vociferous fronts, such as the Ralph Nader-founded Public Citizen Health Research Group, to ban ephedrine haven't accomplished the mission. In mid June, Tommy Thompson, the secretary of the Department of Health and Human Services, announced the RAND Corp. will launch a start-from-square-one study of ephedra.

"That should result in the firing of all officials in HHS and the Food and Drug Administration who are responsible for this dangerous cowardice," wrote Dr. Sidney Wolfe, the director of Public Citizen.

Meanwhile, the Council for Responsible Nutrition, a trade organization, acknowledges there are safety concerns about ephedra but mainly for those with pre-existing conditions such as high blood pressure, heart disease, kidney problems and prostate problems. Ephedra products, the CRN said, now carry a laundry list of at-risk groups on their labels.

"There are a significant number of adverse effects reported for people who have taken ephedra products. Nobody's going to deny that," said John Cardellina, a Ph.D. and vice president of botanical science and regulatory affairs for the CRN. "Taken as a whole, what those adverse effect reports indicate is that there is the potential for problems with ephedra.

"But we can identify groups of people who are at risk and should not be taking these products. If people read the instructions and are not in one of the do-not-take categories and follow the instructions, they should be fine taking the product."

He also stressed the product labels say it is not recommended for anyone younger than 18. Some states prohibit the sale to anyone younger.

The NCAA banned ephedrine in 1997. But last August, Northwestern football player Rashidi Wheeler died during a preseason workout. An autopsy found Wheeler, an asthmatic, took the supplement Xenadrine, billed as a rapid fat loss catalyst, but it was not named as a factor in his death.

It contains ephedrine.

His death, along with Stringer's and Florida freshman football player Eraste Autin's from heatstroke complications in July 2001, prompted the NCAA to conduct a major educational program for schools.

"We want to inform them of the risks of heat illness for this football season," said Dr. Bryan Smith, chairman of the NCAA's Committee on Competitive Safeguards and Medical Aspects of Sports. "Supplements are a part of that."

A big part.

The fear is talk won't be enough.

It might not have been in the NFL last season. Many believe a significant number of pros used ephedrine-containing supplements even though they were banned last season. Giants trainer Ronnie Barnes recently estimated 20 of his players fell into that category.

"I think it still was real prevalent," said Asanovich, who has been an outspoken critic of dietary supplements. "You have to put testing behind it to sink teeth into it."

Yet Asanovich lamented that players who are on the "fence talent-wise" or have lost a step with age could take the risk of discovery and a month's loss of pay to keep their roster spots. Much could depend on what he and his fellow coaches preach to players at the start of camps.

"Over and beyond telling them about the four-game suspension, which is a pretty loud message, the thing you tell them is that when you buy a dietary supplement, you're dealing with a product that's totally unregulated," he said.

"It's like buying something on the black market. It may contain an ephedrine-containing product, but it may be something different. It may be totally inert. So we tell them what you're doing is you're playing supplement roulette with your health."

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