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This week in the HSI forum

No doubt you’ve heard the sad news this week about the Baltimore Orioles pitcher Steve Bechler who died on Monday of multiple organ failure from heatstroke while participating in the Orioles spring training camp in Fort Lauderdale, Florida.

Much has been made about the fact that Bechler was using Xenadrine RFA-1, a weight-loss supplement containing ephedrine – a component of the herb ephedra. So once again we’re hearing loud cries for the FDA to ban ephedra, or, at the very least, step up their regulation of the herb. Unfortunately, the finer points of this situation are getting lost among the scare headlines and high emotions.

In an e-Alert I sent you last month (“Jekyll and Hyde” 1/16/03), HSI Panelist Linda Page, N.D., Ph.D., drew on her 30 years of experience as an herbalist to clarify the ephedra issue. She said, “I am continually distressed about ephedra’s misuse and abuse, most importantly the isolated component of ephedra, ephedrine. In most cases, the ephedrine is isolated and boosted so that the end result is people are taking a dangerously high amount. Further, when ephedrine is isolated and boosted, it becomes an herbal ‘drug.’ In the whole plant, ephedrine accounts for approximately 1%. In a whole herb formulation, there may be up to 50mg of ephedra, which in its whole form is an effective dose, yielding .5mg of ephedrine. Products with isolated ephedrine may be up to 20mg of ephedrine! It is no wonder there are problems!”

According to the Supplement Facts panel on labels of Xenadrine RFA-1, Ma Huang Extract (the Chinese name for ephedra) is standardized to 20mg ephedrine.

In other words, if an herb is to be blamed, it is not ephedra, but a dangerously boosted version of ephedra. Nevertheless, in most of the reports I’ve seen in newspapers and on television, all fingers are pointing at ephedra (not ephedrine) for causing this death, even though the toxicology results from the autopsy will not be available for at least two more weeks.

Steve Bechler had an enlarged heart, a history of borderline hypertension, liver abnormalities, and in the days leading to his collapse he had eaten very little. All of these factors, plus ephedrine use, add up to a disaster waiting to happen. At a press conference, Dr. Joshua Perper, the Broward County (FL) Medical Examiner, noted that, “The manufacture [sic] label says very clearly that individuals who have heart problems, hypertension or liver problems should not take this kind of medication or should be very careful taking it.”

In spite of that posted warning, this incident will no doubt fuel the fire of those (such as the pharmaceutical companies) who would like to see the FDA take a greater hand in regulating herbal and dietary supplements. But would strict FDA regulation have saved Steve Bechler’s life? That’s doubtful. It would have been harder for him to get the weight-loss supplement, and it would definitely have been more expensive, but if he was determined to lose weight quickly with the help of a supplement (and apparently he was, with the prospect of winning a spot on the Orioles starting rotation), no regulation and no ban would necessarily have stopped him.

In last month’s e-Alert, Dr. Page told us about ephedra’s value in controlling asthma and allergies. She said, “If herbalists and formulators lose the ability to use ephedra, we are losing one of the best broncho-dilators from the plant kingdom.” Without question, ephedra should be used with caution, but the ephedra that offers useful benefits to herbalists and their patients should not be confused with the boosted ephedrine that creates dangers far beyond that of herbal ephedra.

Have you ever used ephedra to treat asthma? Do you have a success story, or problems to report about ephedra or ephedrine? As always we’re very interested in hearing your opinions, comments and personal experiences through postings on the HSI Forum. Just log on to our web site at Forum topics under discussion this week include John Barron’s Baseline of Health, vertigo, Coral Calcium, statin drugs, a question about the fiber content of meat, and a thread titled “Lumpy Dog.” If your dog has lumps, this is a thread for you. And your dog.