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Case Against Ephedrine Is Building

Feb 21, 2003 | Kansas City Star Many sports organizations have banned it, but you can easily find it on the shelves of your neighborhood supermarket.

Ephedra is an herbal stimulant found in a variety of products, including asthma medication, sports supplements and weight-loss pills.

The quest for quick weight loss often leads dieters to products that contain ephedra. Experts have long warned consumers to think twice about that decision.

Ephedrine, ephedra's active ingredient, has been linked to serious, even deadly, complications, especially in combination with caffeine, vigorous exercise or even hot weather.

Among the preliminary findings in the death of Baltimore Orioles prospect Steve Bechler was that he had been taking a weight-loss drug containing ephedrine. A toxicology report, due in two weeks, will determine if indeed the pitcher's system contained ephedrine.

Early autopsy findings pointed to organ failure brought on by heatstroke. Bechler's temperature had soared to 108 degrees during a spring training workout.

Although the substance isn't banned by major league baseball, it is prohibited in the NCAA, NFL and by the International Olympic Committee.

"It's an upper," said John Schafer, pharmacist at Stark Pharmacy at Menorah Medical Center in Overland Park. "It's going to increase heart rate, increase blood pressure. You combine that with dehydration and excessive exercise and it's just a formula for disaster."

Ephedrine is a derivative of the herbal stimulant ephedra, also known by the Chinese term ma huang. Medically it has been used to dilate the bronchioles, which supply oxygen to the lungs, to relieve cold and asthma symptoms.

Ephedra and ephedrine rev up the body's nervous system, which can help suppress appetite and burn calories. That's why many over-the-counter, weight-loss formulas contain the substances. They're also marketed as energy boosters.

Manufacturers contend that their formulas aren't harmful if used as directed.

Consumers can find the herb or its derivatives in such products as Metabolife 356, a popular diet product, and in Xenadrine RFA-1, the product Bechler had been taking, according to the Broward County, Fla., medical examiner.

Besides raising heart rate and blood pressure, ephedrine has a "thermogenic effect," which means it ramps up the body's heat production.

The U.S. Food and Drug Administration hasn't taken action against ephedrine, although it has issued warnings about serious side effects. The FDA has received reports of hundreds of adverse reactions, from nervousness and dizziness to heart attacks and deaths.

FDA officials promised this week they would take a hard look at the herb, citing Bechler's death. But the agency as recently as last summer delayed action on the stimulant, angering lawmakers and food safety experts who wanted warning labels or an outright ban.

Ephedra is considered a food supplement, not a drug, so federal law doesn't require manufacturers to prove its safety. The FDA would have to show it to be dangerous to remove it from the market.

The biggest worry among critics is that ephedrine in combination with other factors can bring on severe consequences. Long-term use is another caution. Using ephedrine with caffeine or during heavy exercise compounds the potential risk.

"I cannot in good conscience recommend it to my patients," said Nancy Russell, a Northland doctor. "Some people say `use caution,' but I say `no way.' "

People with heart trouble definitely should steer clear, she said. But even seemingly healthy people won't know if the extra stimulation might bring on heart problems.

In Bechler's case, the Broward County medical examiner said the athlete had a history of borderline high blood pressure, he had undiagnosed liver abnormalities that were detected two years ago, and he had been dieting.

Those who experience even minor side effects ought to reconsider, said Schafer, the Overland Park pharmacist.

"Any product that makes you feel nervous, jittery, anxious, I would say that's not the type of product you should be taking," she said.

As a weight-loss strategy, ephedrine is only temporary, Russell said. As soon as you stop taking it, your metabolism goes back to its old ways. Long-term weight loss depends on permanent changes in diet and exercise, experts maintain. Try these suggestions for keeping your metabolism stoked:

• Eat a good-sized breakfast. During the day, eat six smaller meals rather than two or three large meals.

• Walk, jog or participate in other aerobic exercises most days of the week.

• Lift weights several times a week to increase lean muscle mass, which will help burn calories even when you're not exercising.

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