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The Beginning Of The End For Ephedra?
March 19, 2003
Trevor Butterworth
Time to pitch new research into effects of herbal supplement

Last week's toxiocology reports on the death of Baltimore Orioles pitching prospect Steve Bechler from heatstroke revealed that he had been taking the popular weight loss cum performance enhancing drug ephedra.

The New York Times was quick to point out that there was more to Bechler's death from heatstroke than the mere presence of the increasingly controversial herb. The 23-year old had untreated liver problems, high blood pressure, almost no food in his system thanks to a punishing diet and was wearing multiple layers of clothing to speed up weight loss in 81 degree temperatures with 74 percent humidity. Bechler also appeared to be out of shape and unable to keep up with his team mates in training exercises days before his death.

Nevertheless, the Broward (Fla.) County medical examiner said it was his

"professional opinion that the toxicity of ephedra played a significant role in the death of Mr. Bechler, although it's impossible to define mathematically the contribution of each one of the risk factors."

USA Today noted that the NFL, the NCAA and the International Olympic Committee had banned supplements containing ephedra, and that Baseball Commissioner Bud Selig had banned players with minor league contracts from using ephedra a week after Bechler's death.

The paper also noted that the
"Consumers Union, the nonprofit publisher of Consumer Reports, said the findings were the latest reminder that ephedra is dangerous and should be removed from store shelves."
 Contrary to the widespread negative press over ephedra, The Times pointed out that

"Studies show that the use of ephedra to enhance physical performance appears to be consistently effective for a modest improvement in already fit individuals. One study in the Canadian military showed that ephedra combined with caffeine had no negative effect on the ability to exercise in very extreme heat. But the studies have not been conducted in unfit exercising individuals."

The Times also cited a hot-off-the presses meta-analysis by the RAND Corporation of all the most significant studies to date on the effects and the safety of ephedra and ephedrine on weight loss or athletic performance. RAND

"found that there was not enough data to comment fully on the safety of combining strenuous exercise with ephedra and caffeine or other stimulants. The report did note that ephedra is effective for weight loss and even more so when combined with caffeine, but the studies have not covered a period longer than six months."

The Times also played down the risk of death by noting that far more people die from taking aspiring than could be conclusively linked to ephedra (104 v 22 in 1999). The only really negative note from RAND, the paper seemed to say, was that,

"when ephedra is combined with caffeine it can more than double the risk of nausea, vomiting, anxiety, change in mood, autonomic hyperactivity and palpitations. These are very real possible side effects, thus indiscriminate use is never justified."

Yet RAND's press release was far more alarmist:

"The available evidence is sufficient to conclude that these products are related to a two- or three-fold increase in side effects such as nausea, vomiting, jitteriness, and palpitations... Furthermore, the evidence suggests a link between these products and catastrophic events such as sudden death, heart attack or stroke.

With regard to catastrophic events, these findings are a strong signal that there is a link between use of ephedra or ephedrine and the occurrence of death, heart attack, stroke, seizures, and serious psychiatric symptoms," said Paul Shekelle, the RAND and Veterans Affairs physician who headed the study. "It is more likely than not that there is a relationship, although the available evidence falls short of the conventional level of scientific proof."

In addition, RAND found "no evidence that ephedra - and scant evidence that ephedrine - enhances physical performance." And contrary to the Times' reading that there "was not enough data to comment fully on the safety of combining strenuous exercise with ephedra and caffeine," RAND pointed out that the only study to assess the impact of ephedra and caffeine on exercise reported nausea and vomiting "in a third of the participants given ephedrine at a dose of 1 mg/kg with 5 mg/kg of caffeine, but not in any of those given a lower dose of 0.8 mg/kg of ephedrine and 4 mg/kg of caffeine."

Unfortunately, as RAND points out, many of the studies it looked at were poorly constructed and lacked controls. Nevertheless, it insisted there were good reasons for caution, and an urgent need for serious research into the effects of the herb.

related links:

A readable version of the study is now available on the Journal of the American Medical Association’s Web site



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