Fitness experts are renewing warnings about dietary supplements containing ephedra following the death of a major-league baseball player who officials say was taking the pills.
Temperatures were in the low 80s when Baltimore Orioles pitching prospect Steve Bechler developed the heatstroke that killed him.
It’s hardly searing heat. But when Broward County, Fla., medical examiner Joshua Perper learned that Bechler had been taking pills of a supplement containing ephedra, the doctor suspected the supplement left Bechler primed to be a victim.
Other experts agree. They say that the stimulant raises the metabolic rate the intensity at which the body burns calories above the increase that would result from exercise, even in warm weather.
“If you build up heat, that heat has to be dissipated,” said Dr. Gary Green, former chairman of the National Collegiate Athletic Association’s sports medicine committee. “When you overwhelm the body’s ability to dissipate heat, that’s when you have heat illness.”
Ephedra also inhibits the ability to shed heat through sweating, said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. The supplement does that by constricting vessels that carry blood to the skin to be cooled in sweating, the advocacy group leader said.
Wolfe, an outspoken critic of ephedra sales, also said that many ephedra supplements contain caffeine as well. Caffeine, as a diuretic, makes the body excrete water that could otherwise be used in sweat.
Bechler was running a temperature of 108 degrees after he was taken from a spring training workout on Sunday. He died Monday.
In addition, ephedra raises heart rate, which piles on the cardiovascular stresses that normally result from exercise, said Green, an associate professor of sports medicine at the University of California, Los Angeles. Ephedra has been linked to heart attack and stroke.
Ephedra had no role in Bechler’s heatstroke, argued Richard Kreider, a researcher speaking at a news conference Thursday organized by the Ephedra Education Council, an industry group.
Taking a generally recommended dose of about 30 milligrams of an ephedra supplement may add 2 to 10 calories an hour to metabolic rate, compared with exercise, which can add 600 to 1,200 calories, said Kreider, chairman of the Exercise and Sport Nutrition Laboratory of Baylor University.
Likely factors in the heatstroke were being overweight, being unused to exercise in Florida’s heat and humidity, and Bechler’s own drive to play, Kreider said.
“We had an athlete who unfortunately was pushed a little bit too hard in too hot and humid an environment,” Kreider said. “The body wasn’t ready to do it, and they didn’t recognize he was having that much problem.”
Drug tests on whether ephedrine, the active ingredient in ephedra supplements, was in the athlete’s body have not been completed, Perper said. Preliminary autopsy findings indicate heatstroke led to a major organ failure, he said.
Perper noted that Bechler had other conditions, such as a history of borderline high blood pressure and a diet in which he had not eaten much solid food for the two days before he became ill. The day’s warm temperatures also could be a factor, he said. All probably contributed to the heatstroke, the doctor said. Green agreed that the death probably had many causes.
“The heat had nothing to do with it, and it was a very temperate day,” said Dr. Arthur Grollman of the State University of New York at Stony Brook.
“He might have had the same effect if he was shoveling snow in New York, and maybe quicker.”
The death is making researchers and government officials look harder at the dangers that athletes may face from ephedra.
The Food and Drug Administration is considering whether to ban ephedra. FDA has at least 100 reports of deaths linked to the supplement. Although the FDA case reports go well beyond athletics, Commissioner Mark McClellan said sports use may well be the area of most concern. Ephedra products are commonly marketed to athletes.
Ephedra is touted as a weight loss preparation, and raising the metabolic rate burns more calories, by definition. Bechler, who was 6-foot-2, weighed 249 pounds, 10 pounds above his listed weight, just four days before his death.
But ephedra can’t keep the weight off, said Grollman, a professor of medicine and pharmacology. “There is no evidence that this provides sustained weight loss for anyone,” he said.
Ephedra also is promoted as a way to get more energy. “A lot of athletes like to get that stimulant feeling. They feel they are up for the game,” Green said. But the benefit may be all in the mind, he said: “No study has ever showed ephedra is beneficial to athletic performance.”
And athletes may apply the false principle that if a little is good, more must be better, Green said. “Athletes, like young people in general, often feel immortal and may push the envelope a little,” he said.
Perper said he had been told that Bechler was taking three tablets a day of a supplement with a label that advised only two a day.
However, the dose was diluted simply by Bechler’s size, Grollman said. “You relate the dose to the weight, so per weight he was taking lower doses than a person who would be 130 pounds,” he said.
Science cannot pinpoint which athletes could be at risk for adverse effects, Grollman said. “It’s very dangerous for a section of the population; what that section is, is very hard to be sure,” he said.
Ephedra is not banned in major league baseball, and neither league spokesman Rich Levin nor the head of the players association, Donald Fehr, indicated the policy was about to change.
Ephedra is banned for players in the National Football League, the National Basketball Association, the National Hockey League, U.S. Olympic teams and the NCAA.
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