From the Journal of Endurance, a biweekly online publication for the endurance athelete, www.e-caps.com

Is ephedra a dangerous dietary supplement?

A baseball player known to have been taking ephedra died recently after a training workout. Ephedra is a controversial dietary supplement associated with a higher risk of adverse reactions than other herbal preparations. Baltimore Orioles pitcher Steve Bechler, 23, died of heatstroke after his body temperature rose to 42C. The Broward County medical examiner, Dr Joshua Perper, concluded that he died of complications of heatstroke, which resulted in multiorgan failure. Dr Perper said that he was told that Bechler was taking three Xenadrine RFA-1 capsules, an over the counter dietary supplement, every morning for weight reduction. Each capsule contains 20 mg of ephedrine. It will not be known how much of the supplement may have contributed to Bechler's death until toxicology reports are completed in 2-3 weeks [1].

Ephedra is widely used in dietary supplements that are marketed to promote weight loss or increase energy; however, the safety of this product has been questioned because of numerous case reports of adverse events. Comparative case series from the American Association of Poison Control Centers Toxic Event Surveillance System Database Annual Report, 2001, were studied to determine the risk for adverse events attributable to ephedra and other herbal products. The relative risk and 95% confidence interval for experiencing an adverse reaction after ephedra use compared with other herbs. This risk was defined as the ratio of adverse reactions to ephedra versus other products, divided by the ratio of their relative use in the United States. Products containing ephedra accounted for 64% of all adverse reactions to herbs in the United States, yet these products represented only 0.82% of herbal product sales. The relative risks for an adverse reaction in persons using ephedra compared with other herbs were extremely high, ranging from 100 (95% CI, 83 to 140) for kava to 720 (CI, 520 to 1100) for Ginkgo biloba. Ephedra use is associated with a greatly increased risk for adverse reactions compared with other herbs, and its use should be restricted [2].

COMMENT: Ephedra is safe for a few people at no more than 5-15 milligrams, but for the rest of us even that dose may exaggerate extraordinary fluid loss and cardiovascular stress beyond tolerable safe levels. One serious problem with this plant extract is that it fools the body into pressing well beyond safe normal exercise levels by the inhibiting warning signals that may prevent over-reaching physiological limitations. Three years ago, I argued against the use of the Caffeine-Aspirin-Ephedra [CAE] stacking protocol (popular amoung weight lifters) at the sportscience moderated discussion list. Our vigorous discussion was published among Sportscience Ph.D.'s, Dr.'s, Professors from learned higher institutions of learning. I was shocked to find widespread opposition to my anti-ephedra doctrinal position, which suggests that CAE stacking is harmful to long term health. The argument favoring CAE stacking is that no evidence against its safety exists. Now, I wonder what they are saying now. Should I ask them? In the meantime, do not use a supplement laced with either Ma Haung or Ephedra.

REFERENCE

[1] BMJ 2003;326:464 (1 March)@: http://bmj.com/cgi/content/full/326/7387/464/b

[2] Ann Intern Med. 2003;138:000-000 @: http://www.acponline.org/journals/annals/ephedra