Doctors Warn Of EphedrineJul 31, 2002 | Fort Worth Star-Telegram Birdville football coach Hank Fulkerson doesn't believe that any of the players in his program are taking dietary supplements containing ephedrine.
"It's always a concern whether it's that drug or creatine or anything else," Fulkerson said. "We don't want it, period."
Fulkerson takes a preventative approach to substance abuse, holding a parent-athlete meeting before practice starts to address such issues.
But a group of Texas cardiologists believe all coaches and the University Interscholastic League should take a closer look at the substance that high school athletes, particularly football players, might be using as they seek that extra edge this season.
The Texas chapter of the American College of Cardiology is concerned about "anyone, including athletes, taking over-the-counter substances that can have serious cardiac consequences," Dr. George Rodgers of Austin, the acting group president, said in a written statement.
Ephedrine is derived from the plant ephedra, also called ma huang. It is included in a few over-the-counter asthma medications, but the doctors' concerns involve its presence in supplements that claim to boost athletic performance and facilitate weight loss.
"That's as potentially fatal in susceptible individuals as anabolic steroids or amphetamines," said Dr. Alan Stockard, a Fort Worth sports medicine physician.
Ephedrine works in tandem with caffeine to enhance its effects. It is a stimulant that curbs appetite, increases the heart rate and raises body temperature.
It can cause seizures, heart attacks, strokes, high blood pressure, loss of consciousness and death. More moderate side effects attributed to ephedrine include nausea, vomiting, dizziness, anxiety and irritability.
The substance recently has been linked to the spike of heat-stroke deaths since 1994, the year legislation was passed liberating dietary supplements from regulation by the Food and Drug Administration. In an article published in the journal Neurology, doctors contend that ephedrine and related compounds can interfere with the brain's ability to regulate body temperature.
The Texas Department of Health has prohibited sales of ephedrine-containing products to those under 18, a ban that started in January 2001.
A study published in the New England Journal of Medicine found ephedra-containing pills often consist of inaccurate dosages. The industry "recommended" dosage is 25 milligrams per serving. The Ephedra Education Council, a group of manufacturers that promotes the standards, has adopted a warning label that indicates ephedrine products are "not intended for use by anyone under the age of 18."
Ephedrine is so pervasive on the shelves of diet and nutrition stores that even those educated to its dangers aren't always aware it might be in what they're taking. That happened to Fulkerson, who was taking the supplement Metabolife in a weight-loss context before his doctor advised him to stop.
The substance is prohibited by the NFL, NCAA and the International Olympic Committee. The UIL leaves decisions regarding substances at the discretion of school superintendents, said Mark Cousins, UIL assistant to the athletic director. Although the UIL distributes a manual addressing drugs and nutritional supplements to every school, the manual doesn't include any information regarding ephedrine.
In 2000, Dr. Charles Webb, a Fort Worth native, found that 13 percent of the 734 athletes he surveyed from six high schools during pre-participation physicals admitted to taking products containing ephedrine. Ripped Fuel was the most commonly used product, Webb said. All the ephedrine users were male.
Overall, 30 percent of those surveyed used a supplement to increase athletic performance. The most popular product was creatine, a strength-training supplement.
Webb, the director of sports medicine at Martin Army Community Hospital at Fort Benning, Ga., collected data from three Oklahoma high schools and three Texas high schools. He included his alma mater, Boswell, along with Azle.
Webb believes the use of ephedrine is a major threat to athletes, particularly in the August heat and during two-a-day practices.
"Kids are like adults in one way," Stockard said. " They go into a health-food store, they get something off the shelf and they just assume it's safe. There's no way to assume that, because nothing in a health-food store is regulated by the FDA."