Pitcher's death spotlights ephedra use.

Byline: The Health Files by Tim Christie The Register-Guard

The sudden death last month of Steve Bechler, a former standout pitcher at South Medford High School, has turned up the political and media heat on ephedra, an ancient Chinese herb turned hugely popular nutritional supplement.

Bechler, 23, a pitching prospect in the Baltimore Orioles' organization, died Feb. 17 of complications from heat stroke during spring training in Florida.

A supplement containing ephedra was found in his locker, and a Florida medical examiner suggested that the substance contributed to his death, but toxicology reports aren't back yet.

But whether or not ephedra played a role in Bechler's collapse has almost become beside the point.

His death has raised public awareness about the dangers of the supplement, which provides much the same boost as amphetamines, yet is largely unregulated and can be found as easily at fitness clubs as the nearest Wal-Mart.

Ephedra has been used for thousands of years in traditional Chinese medicine to treat asthma and other respiratory diseases. It's gained widespread popularity in the past decade as a weight-loss supplement and an energy booster for athletic workouts.

It's estimated that 12 million to 17 million Americans consume about $3 billion worth of ephedra products each year.

At Gold's Gym in Eugene, bottles of Xenadrine RFA-1 and Hydroxycut, both ephedra products, sit on shelves behind the front counter. They're for sale along with protein powders and other supplements.

Manager Jeff Hanneson said the gym's personal trainers will recommend ephedra products for certain customers after looking at their medical background, body weight and other factors.

"For people we do recommend take it, it's monitored all the time," he said.

Ephedra, he said, speeds the body's metabolism, raises the heart rate and boosts energy. It's not something you'd take before you go running, he said, but for lifting weights, it allows you to do more repetitions and lift more weight.

Hanneson said he doesn't think ephedra should be banned. "It is a supplement, when taken correctly, it's not going to hurt you," he said.

But the problem is that many trainers don't understand the supplements they recommend, said Shawn Healey, owner of Carpe Diem, a one-on-one fitness training center in Eugene. And the people who get into trouble with ephedra often don't follow recommended dosages, he said.

Healey will advise his customers to take multivitamins, he said, but that's about it. Ephedra, he said, "is not anything we recommend."

The benefit derived from ephedra is marginal, he said. "Most people are looking for a quick fix," he said. "If they would put that energy into looking at their diet and getting regular exercise, they'd be better off."

Ephedra safety debated

Dr. Linn Steinberg, who heads the Health Promotion and Sports Medicine division at Oregon Health & Science University in Portland, said ephedra hasn't been studied carefully. Until more is known, it needs stronger labeling and tighter regulation, he said.

If people are using it to lose weight - in effect to treat a medical condition - then it should be regulated as a medicine, he said.

Ephedra is classified as a nutritional supplement by the federal government - meaning it gets the same regulatory scrutiny as food.

Prescription drugs undergo rigorous, costly clinical testing to prove they're safe and effective before they can be sold to the public. Under a 1994 law, supplements are presumed safe and must be found to be harmful before the U.S. Food & Drug Administration can take them off the market.

The FDA has logged more than 1,400 reports of adverse effects from ephedra products, including strokes, heart arrythmia, insomnia and psychotic episodes.

Steinberg said it's "unconscionable" for trainers who know nothing about ephedra's effect on people or its interaction with other drugs to prescribe it to customers.

Existing studies give ephedra mixed results.

A study published in the current Annals of Internal Medicine found that ephedra products accounted for 64 percent of all adverse reactions from herbal supplements in the United States, even though they represent less than 1 percent of herbal product sales.

A survey by the Rand Corp. of existing ephedra studies, prepared for the federal government, found that ephedra products could help with short-term weight loss, but found no evidence that it boosted athletic performance. The study also found that the products double or triple the risk of side effects such as nausea, vomiting, jitteriness and palpitations.

Popular among baseball players

Long before Bechler's death, the American Medical Association, members of Congress and consumer groups called on the FDA to ban ephedra products.

The NCAA, the NFL and the International Olympic Committee already have banned ephedra. The NFL banned it after the death of Minnesota Viking lineman Korey Stringer collapsed and died of heat stroke at training camp in 2001.

At least two other football players - Rashidi Wheeler at Northwestern University and Florida State's Devaughan Darling - have died in recent years after taking ephedra.

Bechler's death may prompt Major League Baseball to ban ephedra. That hasn't happened yet, though the baseball organization did ban the substance for minor league players. Last week, the players' union recommended that players not take ephedra products.

Use of ephedra products - sold under names such as Metabolife, Hydroxycut, Ripped Fuel, Stacker 3 and Xenadrine RFA-1 - has become widespread in Major League Baseball in recent years, augmenting the long-established use of amphetamines, according to a recent Washington Post story.

Players say they need the extra boost to get them through the grind of a 162-game season and to stay in shape during the off-season.

Bechler, listed at 6-foot 2 and 239 pounds, reported for camp overweight and apparently was using ephedra to help him shed weight. He'd been dieting, and he collapsed after a conditioning run on an 81-degree day. At the hospital, his body temperature reached 108 degrees and he died the next day, leaving behind his pregnant wife, Kiley.

Less than two weeks later, U.S. Health & Human Services Secretary Tommy Thompson denounced ephedra and warned consumers not to take it - but stopped short of banning it. The FDA, he said, plans to put warning labels on ephedra products by the end of the year and may move to ban it.

Last week, Suffolk County, N.Y., became the first government agency in the country to ban sales of ephedra products.

Tim Christie covers health and medical issues. Call 338-2572 or e-mail tchristie@ guardnet.com.

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