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Experts Tie Diet Aids to Heat Deaths on Gridiron

Say circumstantial evidence links stroke to ephedrine and creatine

FRIDAY, July 26, 2002 (HealthDayNews) -- A group of sports medicine experts claim that two popular diet aids, ephedrine and creatine, may be to blame for an alarming surge in heat-related deaths among football players.

The three specialists are linking the two chemicals with a sharp rise in dehydration and heat stroke fatalities on the gridiron since the mid-1990s. Although their evidence is circumstantial, the researchers peg the rise to a 1994 federal law that exempted dietary supplements from strong regulatory oversight.

Since that year, and after a period of decline in such accidents, there have been at least 16 heat-related deaths in organized football, the physicians say. It was almost precisely a year ago that Korey Stringer, the Minnesota Vikings star tackle, collapsed on a sweltering training field and died. Initial reports that Stringer had been taking an ephedrine supplement have never been confirmed.

However, ephedrine and its kin have been linked to more than 100 deaths. They account for more cases of heart attack, stroke, high blood pressure and other side effects than all other diet aids combined, according to the advocacy group Public Citizen. The group has been petitioning the U.S. Food and Drug Administration to pull ephedrine and related products from the market.

"We have to be careful about everything and be prudent, but this aspect of unregulated supplements is something that really needs to have the light of day put on it," says Dr. Michael Apuzzo, editor of the journal Neurosurgery, which published the latest report in its August issue.

Apuzzo, a neurosurgeon at the University of Southern California's Keck School of Medicine, says his specialty has an interest in heat-related illness because the brain is frequently affected.

The report was written by Dr. Julian Bailes of West Virginia University, Dr. Robert Cantu of Emerson Hospital in Concord, Mass., and Dr. Arthur Day of Brigham and Women's Hospital in Boston.

Ephedrine, which is said to promote weight loss and boost energy, acts like an amphetamine on the heart and nervous system. It can hike core body temperature, while at the same time hamper the body's ability to shed heat. The substance is also sold as Ma-huang.

Creatine, which may lead to heat intolerance, is often used by athletes as a workout booster and is purported to help build muscle. As many as 30 percent of high school athletes, and seven in 10 Division I college athletes, reportedly have used the substance, the surgeons report.

Both the National Football League and the National Collegiate Athletic Association have outlawed ephedrine-containing products, though they have no such policy for creatine.

Heat-related deaths were once relatively common in organized football in this country, claiming four or five lives a year, according to the article. However, a concerted effort to keep players well-hydrated and cool on hot summer fields drove that number down to less than one a year by the mid-1980s. Between 1985 and 1994, only six football players died after suffering dehydration and heat stroke.

Since then, however, 16 players have died of these conditions, four each in 1995, 1998, 2000, and 2001, the surgeons say. Meanwhile, the popularity of ephedrine and creatine has soared, especially among athletes.

Dr. Gary Wadler, a sports medicine expert in New York and a spokesman for the American College of Sports Medicine, says it's plausible that dietary supplements might be behind heat-related harm on the playing fields.

"Anything that's going to increase your metabolic rate will predispose you to heat illness because you're generating more heat internally at the same time you're exposed to heat externally," Wadler says. That's especially true when these compounds are combined with caffeine, which encourages the body to shed water, he adds.

However, Wadler says the problem is undoubtedly larger than one factor, and involves failure by trainers and coaches to prevent dehydration and heat stroke. "The most important part of heat illness is prevention. Clearly, this is something that should not happen, and it's easily preventable," he says.

For starters, not holding practices between 10 a.m. and 2 p.m., typically the day's hottest hours, would help, Wadler says. Players must also be sure to drink plenty of water, and to be encouraged to do so by the team staff.

Frederick Mueller, an expert in football deaths, agrees the bulk of the problem is institutional. "Coaches have to be educated year after year after year," says Mueller, who this week released figures showing 23 football fatalities in the 2001 season.

Three of those deaths resulted from heat stroke and eight were caused by fatal injuries on the field. The rest were the result of vigorous exercise that was not directly related to football. Most of the deaths involved high school and college athletes, Mueller says.

Wes Siegner, legal counsel for the Ephedra Education Council, a trade group, said he didn't take issue with the idea that supplement use and athletics might not mix well. "I don't disagree [with the surgeons] that caution is the rule."

However, Siegner said, "there's no possible way to sort out" whether ephedrine is behind the rise in heat-related football deaths.

What To Do

If you plan to exercise in hot weather, remember to get plenty of water. Drink even if you're not thirsty, because thirst is a warning that you're already low on fluids.

To learn more about heat stroke, check out How Stuff Works or the University of Maryland.

Learn more about ephedrine from the Ephedra Education Council.

SOURCES: Michael Apuzzo, M.D., professor, neurological surgery and radiation oncology, Keck School of Medicine, University of Southern California, Los Angeles; Gary Wadler, M.D., associate professor, clinical medicine, New York University School of Medicine, New York; Frederick Mueller, Ph.D., chairman, department of exercise and sport science, University of North Carolina, Chapel Hill; Wes Siegner, legal counsel, Ephedra Education Council, Washington, D.C.; August 2002 Neurosurgery
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