Bechler death linked to ephedrine

FORT LAUDERDALE, Fla. – A weight-loss drug containing a stimulant probably contributed to the heatstroke death of Baltimore Orioles pitching prospect Steve Bechler, a coroner said Tuesday.

The Risks
The over-the-counter stimulant ephedrine, often used to increase endurance and lose weight, is under increasing scrutiny for its possible health risks.
Click here to read more …

Bechler had been taking an over-the-counter supplement that contained ephedrine, which has been linked to heatstroke and heart trouble, Broward County medical examiner Dr. Joshua Perper said.

Ephedrine has been banned by the NCAA, the NFL and the International Olympic Committee, but not by Major League Baseball.

Perper urged baseball to ban the stimulant, and its risks – along with warnings about hot weather – were a topic of clubhouse conversation throughout big league training camps.

“We’re going to wait until we know more about what happened,” baseball spokesman Rich Levin said.

Union head Donald Fehr added: “I’m not going to say anything until after the funeral and the burial. It would be inappropriate.”

Bechler died Monday, less than 24 hours after a spring training workout sent his temperature to 108 degrees. Preliminary autopsy findings indicated he died from complications of heatstroke that caused multi-organ failure, Perper said.

Giants warn players
The San Francisco Giants are warning players against taking ephedrine after the death of Orioles pitching prospect Steve Bechler was linked to possible use of the drug. Trainer Stan Conte addressed the team Tuesday morning. He also warned players to drink plenty of water during workouts.

Bechler died of heatstroke Monday – less than 24 hours after a spring training workout that sent his temperature soaring to 108 degrees.

Bechler had been taking an over-the-counter supplement that contained ephedrine, which has been linked to heatstroke and heart trouble, Broward County medical examiner Dr. Joshua Perper said.
– Associated Press

Only toxicology tests can confirm whether there was ephedrine in Bechler’s system, and those results won’t be available for at least two weeks, Perper said.

Among other factors cited by Perper as contributing to the 23-year-old pitcher’s death:

a history of borderline high blood pressure;

liver abnormalities detected two years ago but not diagnosed;

warm, humid weather during the workout when he became ill Sunday;

he was on a diet and hadn’t eaten much solid food the previous two days.

“All of those factors converged together and resulted in the fatal heatstroke,” Perper said.

But Perper spent the bulk of his 30-minute news conference focusing on ephedrine, the active substance in the plant ephedra. Though common in supplements, Perper said they’re too risky for athletes.

“I would like to hope that this very unfortunate and tragic death would prompt perhaps the baseball association and other athletic groups to ban them from their practice,” he said.

Perper, who interviewed the player’s family and Orioles officials, said he was told Bechler took three tablets each morning of Xenadrine RFA-1, a weight-loss drug that contains ephedrine.

Cytodyne Technologies, which makes Xenadrine, noted that the recommended dosage for the drug is two capsules twice a day.

“Physicians warn that many adverse events related to ephedra are due to people taking more than the recommended dosages,” the company said in a statement. “Xenadrine has been the subject of numerous clinical trials on people, which have conclusively demonstrated that the product is safe and effective when used as directed.”

A bottle of Xenadrine was found in Bechler’s locker after he became ill and shown to paramedics, Perper said. The contents couldn’t be analyzed because the bottle was inadvertently thrown away by someone with the team, he said.

“They figured it’s not important,” Perper said.

Major league teams have cautioned players in the past about the dangers of ephedrine. Medical personnel with the New York Yankees and San Francisco Giants were among those warning players anew Tuesday about the risks.

In addition, the Yankees left an article entitled, “The Effect of Heat on Athletes,” on every player’s locker room seat.

Orioles team physician Dr. William Goldiner said he hopes the coroner’s findings trigger a baseball ban.

“This is not just a problem of Major League Baseball,” Goldiner said. “This is a problem of over-the-counter supplements that are dangerous, and they are unregulated to the point where you don’t even know what’s in some of these things.”

A native of Medford, Ore., Bechler was a third-round draft pick by the Orioles in 1998. He made his major league debut last September and was expected to begin this season with the club’s new Triple-A affiliate in Ottawa.

Bechler and his wife, Kiley, were expecting their first child in April. She visited camp Tuesday and met with team officials but left without speaking to reporters.

The 6-foot-2 Bechler had battled a weight problem since joining the Orioles organization and weighed 249 pounds Friday, 10 pounds above his listed weight. Struggling with his conditioning, he was unable to complete running drills Saturday and was scolded by manager Mike Hargrove.

Teammate Matt Riley said Bechler later acknowledged he had failed to train properly during the offseason.

“He was really distraught,” Riley said. “He was like, `I messed up. I want to change.’ He wanted to change his work ethic.”

The mourning Orioles resumed drills Tuesday at Fort Lauderdale Stadium, where the center field flag was at half staff, and on a cloudless day the gloom slowly began to lift during the workout.

Coach Rick Dempsey clapped his hands and shouted encouragement, and there was even an occasional joke exchanged behind the batting cage.

“We wanted to keep people busy and try to fill the day,” Hargrove said. “I think it was a good decision.”

For Hargrove, the challenge of resuming a routine was painfully familiar. He was manager of the Cleveland Indians 10 years ago when two of their players, Tim Crews and Steve Olin, died in a boat crash during spring training.

“Every circumstance is different,” Hargrove said. “What we’re having to go through is not nearly as difficult as what Kiley and the rest of the family are having to go through.”

Nightmare,

In your diet, you list ephedra. Have you experienced any problems? What are the possible dosage differences?

Tired old argument #7 — Ephedrine and caffeine are dangerous!

Explain these lists to them (after first grabbing them by the lapels):

According to the DAWN (Drug Abuse Warning Network) Detailed Emergency Department Tables of 2000, ephedrine seems to be very safe when compared to other drugs. These numbers reflect the number of mentions each drug received in regard to emergency room visits. Here’s a quick list:

Drug Name - Number of Mentions

Acetaminophen (Tylenol) - 33,613

Alcohol-in-combination - 204,524

Ibuprofen (Advil) - 17,923

Aspirin - 15,657

Fluoxetine (Prozac) - 7,938

OTC sleep aids-Sominex/Nytol - 6,609

Diphenhydramine (Benadryl) - 6,270

Naproxen (Aleve) - 5,080

Caffeine - 1,674

Chlorpheniramine/aspirin - 1,116

Pseudoephedrine - 948 (A decongestant used in every cold/sinus formula around)

Ephedrine - 1,057

According to the DAWN Annual Medical Examiner Data of 1999, ephedrine seems to be much safer than many of the commonly used drugs. These numbers reflect the number of deaths per year in which a medical examiner mentioned the drug as a possible cause of death.

Drug Name - Number of Mentions

Alcohol-in-combination - 3,916

Codeine - 1,395

Marijuana - 670

Acetaminophen - 452

Lidocaine - 384

Fluoxetine - 305

Dextromethorphan - 132 (Used in MANY cold formulas as a cough suppressant)

Chlorpheniramine - 117 (Also used in many cold and sinus formulas as an antihistamine)

Aspirin - 104

Pseudoephedrine - 67

Ephedrine - 59

So, in short, commonly used drugs, even those given to children can be more dangerous, according to these statistics, than ephedrine and caffeine.

Among other factors cited by Perper as contributing to the 23-year-old pitcher’s death:

a history of borderline high blood pressure;

liver abnormalities detected two years ago but not diagnosed;

warm, humid weather during the workout when he became ill Sunday;

he was on a diet and hadn’t eaten much solid food the previous two days.

"All of those factors converged together and resulted in the fatal heatstroke,’’ Perper said.


im not a doctor, nor do i play one on tv, but i would think that the above was more to “blame” than the ephedrine. but “pre-existing liver condition kills baseball player” doesnt grab the eyes like another ephedrine headline. good post herb!

personally i started using ephedrine because my doctor suggested it for me. i have exercise enduced ashma aswell as some pretty wicked pet alergies. we tried alot of different inhalers and i didnt like any of them, they made me light headed, i would see stars on flip turns in the pool and made my heart race. so my doctor told me to buy a bottle and try it out.

since i have no history of high blood pressure, heart conditions, pregnant or nursing, diabetes, taking any MAOI, tyroid issues etc i tried them out and it worked great. i dont use it everyday, and i will take long periods of time off it completely (i use an inhaler during these periods but only when my lunges are really tight).

i dont depend on it for weight control either, i tend to lean towards ephedra free forumulas (lean system 7 or t2 pro) aswell as CLA , bio-test t2 (old formula)and L-carnitine.

the thing that concerns me the most about this article (case) is the quote from stan conte the trainer “warning players to drink plenty of water during workouts.”

now im not knocking stan conte as i wasnt there and i dont know what was actaully said, but drinking plain water in this situation is the worst thing you can do. my endurance athletes (espically my 1/2 ironman and ironman athletes) deal with this situation at every race. here is an article discussing what i mean.

Salt and the ultraendurance athlete

Recently, Americans have been urged to pay more attention to their sodium intake. Decades ago, all foods seemed heavily salted. Then, a link between sodium intake and high blood pressure was discovered. Suddenly, “sodium - free” or “low sodium” products began flooding the consumer market. Certainly, to a degree, this is justified. Many diseases are worsened by excess sodium intake, and millions of Americans must closely watch the amount of sodium in their diet.

However, sodium is a required element for normal body functions. It is lost in sweat and urine and is replaced in the diet. The body has a remarkable ability to maintain sodium and water balance throughout a variety of conditions, thus ensuring our survival. Ultraendurance events challenge this survival mechanism.

In hot, humid conditions a large amount of sweat is lost, which can disturb sodium and water balance. Adequate hydration and sodium intake – either via sports drinks or food – becomes vitally important during long races. The goal of this article is to help you determine how to maintain sodium balance during training and racing and during recovery. The information for this article came from a variety of published studies done on healthy, young athletes and may not be appropriate for everyone. Athletes who are under a physician’s care or have health problems should check with their doctor about salt and their ability to exercise in the heat.

Hyponatremia – what is it?
Hyponatremia means a low concentration of sodium in the blood. When it occurs in triathletes, it usually happens during long or ultra-distance races in the heat but may occur anytime. It is estimated that approximately 30% of the finishers of the Hawaii Ironman are both hyponatremic and dehydrated. The longer the race, the greater the risk of hyponatremia.

What causes it?
The exact mechanisms are not fully understood and I won’t go into the complex physiologic pathways of sodium and water balance. The simplest answer is that lost sweat (salt and water) is replaced by ingested water (no salt). This dilutes the sodium in the bloodstream, and hyponatremia results. Longer races carry a greater risk of hyponatremia because of the total amount of sweat lost. During exercise in the heat, more salt is lost in sweat per hour than is usually replaced by food and fluids, including sports drinks. Your body can tolerate a degree of imbalance for a short period of time, but it may decompensate if this continues for too long.

Sweat contains between 2.25 - 3.4 grams of salt per liter, and the rate of perspiration in a long, hot race can easily average 1 liter per hour. So, for a 12 hour race, one could lose approximately 27 to 41 grams of salt. If the athlete replaces only the lost water and has minimal salt intake, hyponatremia can result.

Medications and hyponatremia
Aspirin, ibuprofen, and other non-steroidal anti-inflammatory agents interfere with kidney function and may contribute to the development of hyponatremia in triathletes. The same applies to acetaminophen (Tylenol). I have seen many athletes taking these drugs during Ironman races, and I strongly recommend against this practice. They won’t make you faster and may hurt you. Under tough conditions, your kidneys need to function at 100%. Other drugs that may contribute to hyponatremia are diuretics, narcotics, and certain psychiatric medications.

What are the symptoms of hyponatremia?
The spectrum of symptoms can range from mild to severe and can include nausea, muscle cramps, disorientation, slurred speech, confusion, and inappropriate behavior. As it progresses, victims may experience seizures or coma, and death can occur. Severe hyponatremia is a true medical emergency.

Treatment
Minor symptoms, such as nausea and mild muscle cramps, can be treated by eating salty foods and hydrating with a sodium containing sports drink. More severe symptoms require treatment by qualified medical personnel. If you think you are suffering from hyponatremia or are unsure, seek medical attention immediately.

Recommendations
There are no clear cut guidelines, and recommendations need to be individualized for each triathlete. Some authorities recommend drinking less water to rebalance sodium and water intake. However, given the risk of dehydration and heat injury, this is not a practical recommendation. To reiterate, all of the hyponatremic athletes in the Hawaii Ironman were also dehydrated. Others recommend increasing salt intake, and this seems more prudent. By ingesting more sodium, hydration with water is balanced and dilution of blood sodium does not occur.

for coaches and athletes in warm/hot weather situations i strongly reccomend an electrolyte drink. in my opinion, the best one on the market is a product called “G-PUSH”, more specifically their G1 formula. it is 50 calories per 16oz (all coming from non-insulin dependant carb Galactose, has a GI of .21) and more importantly provides 340 mg sodium and 80mg potassium.

thie G1 formula is designed for aerobic activity under 90 minutes or sports events that are of a stop and go nature. ie hockey, lacross, football etc. might also be a good addition to the cupboards of track athletes that are doing longer workouts (90min+) and need to stabilize blood sugar levels and avoid dehydration.

for more info check out www.gpush.comand i think free sample packs are still available from their website.

GREAT INFORMATION! THANK YOU!:clap:

Comparisons are my personal favourite! So taking Ephedrine’s safer than drinking bleach. Good to know!

“You can use statistics to prove anything, 9 out of 10 peole know that” (Homer Simpson)

I am no expert on supplements, far from it. But stats can be misleading. 104 deaths were linked to the use of Aspirin, for example, 59 linked to ephedrine. But when one considers the amount of deaths relative to both number of users and amount consumed is the figure for ephedrine not very high?

I first took ephedrine based supplements about 12 or 13 years ago. BAD JUJU man! I’ve taken it recently in very small doses. Still bad juju. I like to have a functioning prostate and I do not like heart palpitations. Think of ephedra as your first days in prison in pill form.:o

This is sad to hear but do we really know what he was taking. Was ephedrine really the problem. Did he have a heart problem all ready. Could other supplements enhancers played a role in it. These are answers we will never know. And finally doesnt caffiene cause heart problems too. If the coronor claimed that ephedrine caused the death then how much ephedrine was he taking?

More than likely this guy had a bunch of negative factors which teamed up to prove his demise. The aforementioned statistics are interesting; but we can make statistics say about anything…“Most people who die in car accidents do so within 10 miles of their home…” Well, duh? They spend 99% of their time within 10 miles of their homes…

Good point bohersh!

When someone CLEARLY has a series of health issues, ephedrine is bad news and the results speak for themselves.

Here is Will Brink´s take on ephedra from 2.3.2003. He is a body building nutrition expert.

My only comment: the following quote does not necessarily reflect the view of the poster!! Here it is, from Will Brink:

The anti ephedrine camp seems to be making another wave of
worthless emotional based statements, which as usual, lack
any real data. This tactic is of course an old one.

As the once man said:

‘All propaganda has to be popular and has to adapt its
spiritual level to the perception of the least intelligent
of those towards whom it intends to direct itself.’ -
Adolf Hitler, Mein Kamp

Most of you may have heard of a new ‘study’ supposedly
showing how dangerous ephedrine is and the death of baseball
player Steve Belcher is being blamed on ephedrine.

Both are complete shams!

Ok, below is my lay commentary of this ‘study’ followed by
BrinkZone members Doug Kalman MS, Jose Antonio, Ph.D.,
FACSM, and Richard B. Kreider, PhD, letter to the editor of
the journal that published the study with a nice analysis of
the data of the study.

Finally, is a link to a press released from Miami Research
Associates (also written by Doug Kalmen) that looks at the
death of this base ball player the media is blaming in
ephedrine.

Enjoy the read

  • ‘Anti Ephedrine Campaign’s latest bogus study’.
    By Will Brink

Well gang the anti supplement powers that be, are at it
again with a new ‘study’ that supposedly shows the dangers
of ephedrine.

Typical of the ‘don’t confuse us with the facts’ media, this
study is being plastered all over the news and held up as a
reason to pull ephedrine containing products off the market.

At this point, it appears they are so desperate to find
proof that ephedrine is a health hazard, they are willing
stretch the truth to absurd levels.

What am I referring to? A new study called ‘The Relative
Safety of Ephedra Compared with Other Herbal Products’
published in Annals of Internal Medicine (2003;138:000-000).

This study is not bad science, it’s not science at all.

What the authors did was examine reports put into the
American Association of Poison Control Centers Toxic Event
Surveillance System Database Annual Report for 2001, and
make conclusions about the safety of ephedra based on
those numbers.

For example, the authors state:

‘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.’

Translated: they have already decided that ephedra is unsafe
and are going to prove it no matter what they have to do.
Hence, the authors were biased (more on that in a minute)
from the start and made it their job to confirm their biased
belief.

Basically what these authors did was compare the adverse
reaction reports from American Association of Poison Control
Centers Toxic Event Surveillance System vs reports on other
herbs and shock of all shocks, conclude that compared to
other herbs such as ginko and kava, that ephedra has more
side effects.

Well Duh. They concluded that ephedra containing products
accounted for 64% of all reported adverse effects from herbs
compared with kava and Ginkgo biloba (see letter data
showing that’s not even true).

They state:

‘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.’

Translated: a fancy way of saying that they compared apples
to oranges (ephedrine vs ginko or Kava) and concluded
ephedrine accounted for a higher rate of reported side
effects.

This is equivalent to comparing coffee (a stimulant) to
fruit juice and coming to the shocking conclusion that
coffee has more side effects than fruit juice!

Now, why didn’t they compare it to say other diet products,
in particular diet drugs with similar mechanisms?

You would find that pharmaceutical diet drugs are involved
in considerably more adverse events than ephedrine based
products, and those events, on average, are of a more
serious nature.

(Very Important Point…)

Let’s not forget the recent study published in the Journal
of Strength and Conditioning Research, that found an
ephedrine caffeine based supplement was superior for
weight loss with less side effects than the popular diet
drug Xenical (Orlistat), one of the most commonly
prescribed diet drugs in the United States.

Of course, in truth none of this info from this new report
from the Poison Control Centers can be used to represent the
true risk of any drug or nutrient as it is simply people
calling into claim some product made them ill.

It does tell public health officials if some product in
particular should be looked for un expected side effects,
etc, but it’s of little use in making real decisions
regarding the safety profile of any drug or nutrient.

That’s what true double blind placebo controlled human
studies are for, of which there are MANY with ephedrine.

What about those studies with ephedrine? Every single study
to date with more than a decade of research-has concluded
the side effects are minor, transient, and short lived.

The authors didn’t bother to mention any of the real data
that exists on ephedrine but focused on a single study that
had a high drop out rate from the study.

Of course ephedra is not without risk and there are many
people who should not use it, such as those with high
blood pressure and other contraindications, but as weight
loss compounds go, it is exceedingly safe.

Safer in fact than most over the counter medications found
in stores, such as aspirin and acetaminophen.

Bottom line is, considering the billions of doses sold of
ephedra containing products and the millions of people using
such products, the number of adverse events reported is
amazingly small.

The authors of this bogus study conclude:

‘Ephedra use is associated with a greatly increased risk for
adverse reactions compared with other herbs, and its use
should be restricted.’

Translated: they had an agenda to show ephedra was unsafe,
and found a unscientific way of showing it vs following the
real data that exists or comparing ephedra to drugs for the
same purpose that are more toxic than ephedrine.

But wait, it gets better.

If you recall I mentioned the authors were clearly biased.
Why? All of the authors of this so called study have worked
for various lawfirms who are involved in anti-ephedra
lawsuits!

That’s right, the authors of this report are paid by law
firms and called as expert witnesses in cases against
companies (e.g., Cytodyne, MuscleTech, Next Nutrition,
TwinLabs, GNC, Phoenix Labs, Chemins Labs, etc.) that
produce and market supplements containing ephedra!

Yes folks, that’s how low the anti ephedra camp is willing
to go; to any lengths to get ephedra banned, and the facts
based on science be damned.

If you would like to read the full study can view it on
line at:
http://www.acponline.org/journals/annals/ephedra.htm

And if you would like to view the annual poison control
data to see what crazy things are reported can see it at the
Poison Control Center web site at: http://www.aapcc.org/

Bechler had lost alot of weight before his demise, so it’s safe to say that he found ephedrine to be a very effective weight-loss product. What sort of arguement is that?
As for comparisons aspirin has well known risks and acetominiphen is just being found to be the biggest cause of liver failure. The risk to benefit ratio for ephedrine is such that you have to think it should be regulated, at least in some way. For example, should it be provided in a sport-drink form, where its comsumption will, most likely, rise dramatically in blazing hot conditions- precisely the conditions where its use should be curtailed?