The death of Baltimore Orioles pitcher Steve Bechler appears to be linked to a widely available and commonly used weight-loss supplement that is loosely regulated, a medical examiner said Tuesday.
The finding rekindled concerns over the safety of ephedra and calls for tighter control of the popular diet supplement by federal regulators.
Bechler, 23, had been taking Xenadrine, an over-the-counter dietary supplement containing the stimulant ephedra, and it probably contributed to his death, said Dr. Joshua Perper, the Broward County, Fla., medical examiner.
Ephedra has been associated with heart attacks, seizures and strokes and has been linked to dozens of deaths.
Ephedra, also known as ma huang, is widely used to lose weight or boost energy. It can be purchased for a few dollars under popular brand names such as Metabolife and generates more than $1 billion in sales annually.
Ephedra has been banned by many sports leagues but not Major League Baseball. It is not closely regulated by the U.S. Food and Drug Administration because it is not considered a drug.
A growing number of medical experts and lawmakers want to change that. Some want the substance banned, while others want it tightly regulated.
“I think sooner or later Congress has to revisit some of these laws, and I think sports organizations have to go the extra mile and protect these athletes,” said Dr. Gary I. Wadler, a professor at New York University School of Medicine who advises the White House Office of National Drug Control Policy on drug use by athletes.
Bechler died Monday morning, less than 24 hours after collapsing during spring training in Fort Lauderdale, Fla. An autopsy found he had died from complications of heatstroke that caused many of his organs to fail, Perper said.
His body temperature was 108 degrees, about 10 degrees above normal.
High blood pressure and liver abnormalities also contributed to Bechler’s death, Perper said. A bottle of Xenadrine was found in his locker, officials said.
Toxicology test results won’t be available for two or three weeks, but Perper said Bechler was believed to have taken three Xenadrine tablets before his Sunday workout. There was no trace of solid food in Bechler’s digestive tract, Perper said, suggesting he had been following a strict diet.
The lack of food, combined with the stimulants and the relatively warm weather 80 degrees when he collapsed probably led to his death, Perper said.
“At this time, I don’t have a complete or sufficient degree of toxicology results that I can say precisely what was in the blood and at what levels,” Perper said. “But it’s very difficult to believe in view of all the circumstances that anything else was really of importance.”
Xenadrine is made by Cytodyne Technologies, a New Jersey manufacturer of weight-loss and fitness supplements. The company issued a statement Tuesday night standing by the safety and effectiveness of Xenadrine.
“Due to the lack of medical evidence available at this time, Cytodyne is unable to specifically comment on the circumstances surrounding the tragic death of Steve Bechler,” the statement read. “Until the toxicology report becomes available, it is sheer speculation as to whether Mr. Bechler ever used Xenadrine, or whether Xenadrine played any role whatsoever in contributing to his death.”
Ephedra is an extract of the ma huang plant, and ephedrine is the key chemical in ephedra. Ephedrine is found in many over-the-counter decongestants and cold remedies and is regulated by the FDA because it is a drug. But because ephedra is a naturally occurring substance, it is considered a dietary supplement like vitamins and is not closely regulated.
Ephedra is popular with dieters because it increases energy while raising the body’s metabolism. Many athletes use the supplement to ward off fatigue so they can exercise longer and harder.
But ephedra constricts blood vessels, making it harder for the body to push hot blood to the skin’s surface where it can cool. In extreme cases and particularly when taken with caffeine the constriction can be so severe that the heat gets trapped, raising the body’s temperatures high enough that major organs can fail.
ALARMING STUDY IN 2000
Dr. Neal Benowitz, a clinical pharmacologist and professor of medicine at UC San Francisco, was among the first to sound the alarm when he and his colleagues linked ephedra to a host of deaths and disabling conditions in 2000.
Heart attacks and strokes topped the list, but the researchers also reviewed cases consistent with heatstroke, he said.
Combine that with dehydration, excess weight and poor conditioning, Benowitz said, and the results can be disastrous, even for a young athlete like Bechler who weighed 239 pounds and wanted to lose weight.
Further casting doubt on ephedra, a study released two weeks ago by researchers at the San Francisco Veterans Affairs Medical Center found that while it accounts for less than 1 percent of all herbal supplement sales, it is responsible for 64 percent of all adverse health reactions to herbs.
The study concluded that people taking products with ephedra were 200 times more likely to suffer complications than people using other diet supplements.
Efforts by the FDA to increase oversight of ephedra have been stymied by the dietary supplement industry.
The Rand think tank, at the request of the U.S. Department of Health and Human Services, is currently studying the effectiveness of ephedra and whether it causes health problems. Results are expected within a few months.
SALE TO MINORS BANNED
California law bans the sale of ephedra products to minors. Gov. Gray Davis -who has collected more than $100,000 in campaign contributions from Metabolife International Inc. since becoming governor four years ago vetoed a law two years ago that would have restricted ephedra sales.
He reversed his position in August when he signed the ban against sales to minors and called on the FDA to regulate ephedra. Rep. Susan Davis, D-San Diego, has been pushing state legislation to regulate it as well.
The National Football League, the National College Athletic Association and the International Olympic Committee have banned ephedra, but Major League Baseball has not prohibited it.
“We’re going to wait until we know more about what happened,” said baseball spokesman Rich Levin.
Major league teams, including the Orioles, have cautioned players about the dangers of ephedra. The New York Yankees and San Francisco Giants reiterated those concerns with players on Tuesday.
“We really try to educate them,” said Stan Conte, Giants head trainer. “We liken supplements to spit tobacco. Spit tobacco is legal. Study after study has proven it causes cancer, but people still do it. We can’t take it away, but we can educate them of the dangers.”
EPHEDRA, MA HUANG AND EPHEDRINE
The herbal dietary supplement ephedra -also known and sold as ma huang, the Chinese plant its extracted from is under scrutiny for its possible contribution to the death of Orioles pitcher Steve Bechler.
Properties and uses: Treats asthma by relaxing bronchial muscles and constricts small blood vessels; used in weight loss and athletic performance products
Precautions: Can raise blood pressure, accelerate heart rate
Possible adverse reactions: Heart attack, stroke, irregular heartbeat, seizure
Regulation: Ephedra, the ma huang extract, is not considered a drug and therefore is subject to very little government oversight. But Ephedrine, the key chemical in ephedra, is regulated by the Food and Drug Administration as an ingredient in many over-the-counter decongestants and cold remedies.
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