Pitcher's Death Spotlights Stimulant
MEDICAL EXAMINER: SUPPLEMENT WAS PROBABLY A FACTORFeb 19, 2003 | San Jose Mercury New
The heatstroke death of Baltimore Orioles pitching prospect Steve Bechler has put yet another chink in the reputation of performance-enhancing ephedra supplements, which a medical examiner said probably contributed to the athlete's death.
From high school athletes to die-hard dieters, the widely available herbal stimulant promises to boost energy and improve athletic prowess. But to a growing chorus of medical experts, the drug has dangerous side effects and should be banned from the market.
As a dietary supplement, ephedra is not federally regulated. The herbal form has been used for centuries as a folk remedy for asthma and bronchitis, and the chemical, also known as ephedrine, shows up in some over-the-counter cold remedies.
But packaged in weight-loss concoctions such as Metabolife and in sports supplements such as Ripped Fuel, the powerful alkaloid, which constricts blood vessels while boosting energy and suppressing appetites, has been implicated in scores of heart-attack and stroke cases, critics say. Ephedra supplements account for more than $1 billion in sales annually.
The 23-year-old Bechler had been pushing himself in warm, humid weather during spring training in Florida when he collapsed Sunday from heatstroke with a temperature of 108. He died Monday morning at Northridge Medical Center in Fort Lauderdale.
Medical officials won't know until the autopsy is completed whether he had any stimulants in his system.
They said other factors such as borderline high blood pressure and liver abnormalities could have contributed to the death of the 6-foot-2, 239-pound pitcher. Broward County medical examiner Dr. Joshua Perper said that a bottle of Xenadrine that was found in the athlete's locker was probably a factor. Xenadrine is one of the best-selling ephedra products.
Perper on Tuesday urged Major League Baseball to outlaw the supplement. The substance already has been banned by the National Collegiate Athletic Association, the National Football League and the International Olympic Committee.
Sports medicine experts, including the authors of a landmark UC-San Francisco report that found ephedra caused an abnormally high rate of medical problems among supplement users, also have called for its ban in baseball.
Shane H. Freedman, a spokesman for Cytodyne Technologies Inc. which manufactures Xenadrine, said it was ``sheer speculation'' whether the supplement played any role in contributing to Bechler's death. ``What is clear is that Xenadrine has been the subject of numerous clinical trials, which have conclusively demonstrated that the product is safe and effective when used as directed.''
Dr. Gary I. Wadler, a professor of medicine at New York University and author of ``Drugs and the Athlete,'' said the risks are serious. Ephedra, a substance derived from the ma huang herb, has been shown to provide patients relief from allergies and asthma. But has also been linked to heart attacks, strokes, seizures, and sudden death -- especially among those who combine the substance with caffeine.
Wadler said heatstroke can occur when taking ephedra because the drug increases metabolism, which in turn raises body temperature. As a result, it takes longer to cool down. Experts say most athletes who have had problems with the drug were beginning the season in hot weather. Those who reported to practice out of shape were more susceptible.
``People are seduced by the marketing and have an insatiable desire to lose weight,'' and improve their athletic performance, said Wadler. ``But I advise patients not to take it. The risk outweighs the benefits. Exercise and diet are the answer to weight management, not pill-popping.''
State Sen. Jackie Speier, D-San Mateo, was so concerned about the health consequences that she sponsored a California law that went into effect last month banning sales to minors of any of the hundreds of the products that contain ephedra. The law also requires that ephedra products feature an 800 number to allow consumers to report adverse side effects to the U.S. Food and Drug Administration.
An explosion in the number of dietary supplements and other herbal remedies occurred after 1994, when Congress passed the Dietary Supplement Health and Education Act that allowed consumers more access to alternative remedies. As a result of the law, the FDA does not scrutinize these products as closely as prescription drugs, and in exchange manufacturers are barred from making certain medical claims.
Ephedra has become one of the supplements of choice among teen athletes feeling the pressure to perform.
Daniel Puder, a 21-year-old former wrestler for Monta Vista High School who tried Ripped Fuel was alarmed when he took the drug to boost his performance on the mat.
``It's kind of like caffeine and really speeds up your heart,'' he said. ``But six months ago I threw up after taking it because I was working out too hard. I'm never touching it again personally. It scared me.''