The Insider 

Is ephedra worse than people think?

Is ephedra worse than people think?

One of the biggest current stories on the sporting scene concerns the tragic death of 23-year-old Baltimore Orioles pitching hopeful Steve Bechler, who suffered heatstroke on Feb. 16 during a typical workout and, following massive organ failure, expired the next day in a Ft. Lauderdale hospital. Bechler, listed at 6-feet-2-inches, 239 pounds, had come to training camp overweight and had been using an ephedra-based diet pill, Xenadrine RFA-1, which, according to Broward County medical examiner, Dr. Joshua Perper, probably contributed to the player’s death.

There may be hell to pay now. Bechler left a young pregnant wife, and there are rumblings of legal action against the team, the American League and Cytodyne Technologies, the Manasquan, N.J.-based manufacturer of Xenadrine and a range of other weight-loss and muscle-enhancing dietary supplements. When asked for comment, Shane Freedman, in-house counsel for Cytodyne, would only say, “At this time, we have no comment on the case. We’ll have to wait till all the evidence is in.” The final toxicology reports on Bechler were scheduled for release this week.

Sports and the use of performance-enhancing drugs is not a new topic. Athletes look for the edge. The late Lyle Alzado (1949-1992), a defensive star for three NFL teams during a long and successful career, paid a horrible price—he died an ugly death at age 43 from brain cancer brought on by excessive steroid use. Mark McGwire’s use of the muscle-building steroid compound androstenedione was a huge media story in the late '90s, when the hulking St. Louis Cardinals home-run king was assaulting records left and right. Recently retired, the post-andro McGwire seems to be a noticeably pudgier, much softer physical specimen. In fact, there is a lack of long-term data on the use of andro and its second cousin, creatine. Studies continue.

But while steroids have at least been generally considered mostly the province of serious-minded athletes only, perhaps what is most troubling about the Bechler death is that ephedra-based products are readily available to anybody and everybody, with estimates of some 15 million Americans currently using it in one form or the other. Which is why awareness of what ephedra is and what it does is important.

Ephedra, also known as ma huang, is an herb that has been used for thousands of years in India and China to treat asthma, bronchitis and coughs. More recently, it has been widely promoted in the U.S. as an over-the-counter (OTC) appetite suppressant and weight-loss aid in products such as Xenadrine. The reports of ephedra’s links to illness and sudden death—which will now be mightily fueled by the Bechler incident—have led to earnest debate over its safety.

The two main chemicals in ephedra, ephedrine and pseudoephedrine, are stimulants that lead to the constriction of blood vessels. In low doses, they act as decongestants. In higher doses, they can raise blood pressure. The stimulant effect contributes to the herb’s effectiveness as an appetite suppressant but can also lead to severe cardiovascular reactions. (Consumption of ephedra can also result in a false-positive for amphetamines in urine tests.)

Some studies have linked ephedra to cardiovascular problems, including high blood pressure, palpitations and heart attacks. (Bechler reportedly had an enlarged heart, abnormal liver functions, borderline hypertension, and was overweight and dieting. The use of Xenadrine added to the risk factors that were present, according to Dr. Perper, who was quoted as stating that Bechler’s heatstroke was “brought about by the convergence of a number of factors.”)

Strokes, seizures, psychosis and insomnia have also been linked to ephedra, as have cases of otherwise healthy adults suddenly taking ill or even dying. People with high blood pressure, heart disease, anxiety, glaucoma, enlarged prostate or hyperthyroidism are strongly advised to avoid taking the herb at any dose. In addition, some research has reported that persons taking ephedra products are 200 times more likely to suffer complications than are users of other herbal supplements. Ephedra is responsible for 64 percent of all adverse reactions from the use of herbal supplements, although ephedra products make up less than 1 percent of all herbal supplements sold in the U.S.

Unsurprisingly, manufacturers claim that ephedra-based products are safe when “taken as directed,” a dictum that may be broadly interpreted. (See for a supporting response.) Interestingly, ephedra is banned by the NFL, the NCAA and the International Olympic Committee but not, as of yet, by Major League Baseball.

Doug Scopel, media relations director for the AAA minor league Nashville Sounds, confirms that testing for ephedra will now become a part of the random drug testing that already goes on in baseball’s minor leagues. “But Sounds players who are a part of the parent Pittsburgh Pirates’ 40-man roster would be exempt,” he says, “since they are technically members of the Major League Baseball Players Association (MLBPA).” Bechler, for example, would have fallen into this category.

The Bechler incident does not surprise John E. Tiedt, an attorney with the Los Angeles-based firm of Moore Winter Shebba & McLennan, which has led individual and class-action lawsuits against the ephedra industry. “I expected it,” he says. “What surprises me is the failure of Major League Baseball to ban what is essentially herbal speed. By not doing so, the union has made a cognitive mistake. If they had consulted with even one cardiologist, they’d have banned ephedra products long ago. And just because a product is legal doesn’t mean it’s safe. The FDA pronounced on the toxicology of ephedra in 1996.” (For important related information on ephedra and other botanical dietary supplements, see the U.S. Food and Drug Administration’s FDA Medical Bulletin, September 1994 at

Tiedt claims that he has yet to find an ephedra product that is formulated by a medical professional. “The marketers of these products have no background in pharmacology or toxicology. The products are sold freely because there is an FDA loophole on dietary supplements. There’s a special exemption for herbal-based products, and there’s no regulation whatsoever.

“I think Major League Baseball has a duty to ensure the safety of their players. They were advised of ephedra’s effects. They failed to heed the warnings and establish appropriate rules. And yes, it’s too high a price to pay.

“Ever see The Insider?” says Tiedt. “That film parallels what’s going on here. These companies are in the business of delivering a product that, according to some German studies, is addictive.”

The Bechler/Xenadrine story has legs, and another shoe will drop when the official toxicology report is delivered. Then the legal jockeying will really begin. In the meantime, for weekend warriors and inveterate dieters who are looking for an edge, here’s some timeworn advice that can’t be repeated too often: Where drugs or dietary supplements are concerned, never ignore label warnings, never exceed dosages and never take anything, however seemingly harmless, when experiencing contraindications. Like the guy on Hill Street Blues used to say, “Let’s be careful out there.”


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