The use of nutritional and dietary supplements continues to be on the rise among the youths of the nation. Herbal dietary supplements such as ephedrine, ginseng, etc., are particularly common among athletes and college students. As these products are classified as legal food products under the DSHEA act of 1994, they are easy to access and consequently the possibility of addiction is very high resulting in severe and sometimes fatal consequences. [Daniel Ari Kapner] Ephedrine, a crystalline alkaloid derived from the herb ephedra sinica (and other species of the ephedra genus) is widely promoted to college athletes as an enhancer of ‘strength, dynamic power, energy…endurance levels…alertness and perception’. Besides this, the high metabolic rate induced by ephedrine and the consequent weight loss motivates many young people to try this herbal product as an effective dietary supplement to manage their weight. As per a year 2000 survey, a staggering 3 billion doses of ephedrine have been sold over the counter for weight management treatments. [Robert a] However, lurking beneath these positive propaganda of the efficacy of ephedra is the dangerous and sometimes deadly side effects of the drug. Let us have a brief overview of the dangers of ephedra usage, particularly among the sports community.
Ephedrine (Usage and Adverse Effects)
In a comprehensive study by the NCAA, it was found that out of 500 campus athletic programs only 48.7% employed comprehensive drug testing. The NCCA survey also revealed that the use of ephedra among college athletes has increased from 0% in 1993 to almost 4% in 2001. Among female athletes, gymnasts and ice hockey players show the highest rate of ephedra usage. Almost 12% of women’s ice hockey team is identified to use ephedra. Similarly 8% of gymnasts use ephedrine as per the 2001 statistics. In an epidemiological study of 3 schools in Rochester, Minnesota, it was found that of the 311 respondents who participated in athletic activities, 7 students (2.3%) used ephedra. A surprising fact was that only one of the seven students knew that their supplements contained ephedra. This reflects a general scenario among athletes who consume drugs without their knowledge. [Michael P. Schaefer]
The adverse effects of ephedrine usage came to the limelight with the death of Steve Bechler, Baltimore Orioles pitcher, in 2003 after the use of ephedra alkaloids. Similarly the use of ephedrine was associated with the deaths of Devaughn Darling, the Florida university linebacker, Rashid Wheeler, the football player of Northwestern University and Peter Schlendorf another football player from the University of Alabama. Later, sources from Northwestern University confirmed that many of their players used ephedrine-containing substances regularly. [Daniel Ari Kapner]
Several studies have been conducted to understand the ergogenic properties of ephedrine. Ephedrine stimulates the central nervous system. Shekelle et al. examined 8 studies that focused on the performance enhancing properties of ephedrine. The results of the review showed that ephedrine in combination with caffeine could boost performance (increase endurance levels) for intense exercises while no such benefits were noticed for low intensity workouts. However, these studies did not separate the effects of ephedrine from that of caffeine and so more intense research is awaited in this direction. [Robert a] it is to be noted that caffeine and ephedrine work synergistically which could be dangerous in patients with pre-existing cardiac or blood pressure abnormalities. Caffeine affects the adenosine-mediated dilation of blood vessels by antagonizing its receptors. The resulting increased availability of free adenosine monophosphate furthers the activity of ephedrine and catecholamine stimulation resulting in reduced cardiac refractory periods and increased cardiac output and consequently elevated blood pressure. [Charles N. Krome]
It is necessary to look into the inherent risks associated with the use of ephedrine. Ephedrine has a very high percentage of adverse reactions compared to all other herbal supplements. As reported by Bent et al. (2003), ephedrine alone accounts for around 64% of all adverse medical reactions due to herbal products. This in view of the fact that ephedrine products constitute only 1% of the total herbal market is a shocking and revealing statistic. [Robert a] Haller and Benowitz reviewed 140 adverse cases of ephedrine usage and submitted them to the FDA between 1996 and 1999. These cases clearly indicate that ephedrine usage has both cardiovascular as well as cerebrovascular complications. Ephedrine has also been clinically documented to cause nephrolithiasis in cases of severe and long-term abuse. Cardiomyopathy, arrhythmia and sudden deaths have been reported in relatively young people. In one of the reported cases ephedrine and beta agonists (used for asthma) interacted resulting in ventricular arrhythmia followed by cardiac arrest. [Charles N. Krome]
It is a disconcerting fact that many of the athletes consume supplements without knowing the constituents. Over the last decade, ephedrine usage had continued to be on the rise among young athletes in the form of supplements. Today however, the use of Ephedrine has become a heated debate with the growing awareness about its adverse effects and with professional bodies such as MLB banning the herbal product in the wake of recent deaths of young players. While the battle between supplement manufacturers, lobbyists, and the FDA continues, it is the responsibility of sports physicians and the athletic fraternity to protect young athletes from becoming unsuspecting victims to this silent killer.
Daniel Ari Kapner, ‘Infofacts Resources: Ephedra and Energy Drinks on College Campuses,” Accessed 26th April 2008, Available at, http://www.higheredcenter.org/pubs/factsheets/energy-drinks.html
Michael P. Schaefer, Jay Smith, Diane L. Dahm and Matthew C. Sorenson, ‘Ephedra Use in a Select group of Adolescent Athletes’. Journal of Sports Science and Medicine (2006) 5, 407-414, available at http://www.jssm.org/vol5/n3/6/v5n3-6pdf.pdf
3) Robert a. Robergs1, Tommy Boone2, Donna Lockner3, “Exercise Physiologists Should not Recommend the Use of Ephedrine and Related Compounds as Ergogenic Aids or Stimulants for Increased Weight Loss,” Journal of Exercise Physiology Online, Volume 6 Number 4 November 2003, available at http://faculty.css.edu/tboone2/asep/RobergsV2.doc
4) Charles N. Krome, ‘Cardiac Arrhythmia in a Professional Football Player. Was Ephedrine to Blame?’ The physician and Sportsmedicine Vol31, No 12, Dec 2003.