Editorial Suggests Ephedra, Creatine Linked to Athletes'Deaths

MORGANTOWN, W. Va.--Creatine and ephedra use may havecontributed to an increased number of heatstroke-related deaths among athletessince 1994, according to an editorial published in the August issue of Neurosurgery(51, 2:283-88, 2002) (www.neurosurgery-online.com).By reviewing data from the National Center for Catastrophic Sports InjuryResearch, authors--led by Julian Bailes, M.D., of West VirginiaUniversity--noted there were six heatstroke-related deaths among U.S. athletesbetween 1985 and 1994, but there were four deaths each in 1995, 1998, 2000 and2001. The authors claimed the "deregulation" of the dietary supplementmarket and subsequent "explosion" in supplement sales since the 1994passage of the Dietary Supplement Health and Education Act (DSHEA) contributedto the increased number of deaths among athletes since 1994.

"There are statements that appear repeatedly throughout the editorialthat are unfortunate because they promote 'myths' that are incorrect," saidWayne Silverman, Ph.D., chief administrative officer of the American BotanicalCouncil (ABC). "[The authors] keep saying 'unregulated dietary supplements'have contributed to the death of athletes. Saying that supplements are'unregulated' is just incorrect. DSHEA did not create a situation where dietarysupplements are unregulated--quite the contrary. It provided clear guidelinesfor FDA [Food and Drug Administration] to regulate dietary supplements. Thoseregulations may be selectively enforced but there are clear regulations. Whetherthe supplements were a key factor in the deaths is also questionable."

The two supplements Bailes and his colleagues took particular exception towere creatine and ephedra, which they said interfere in the body's ability toremain hydrated. Ephedrine and related compounds have an amphetamine-like effectand can raise the body's core temperature and decrease the body's ability tocool, according to researchers. Additionally, they said creatine can shift bodywater from the bloodstream into muscle cells, making heatstroke more likely.

"Another problem with the piece is that it makes a direct link betweenephedrine and amphetamines and attributes problems to these 'amphetamine-likecompounds,'" Silverman said. "Expounding on the dangers ofamphetamine-like compounds in relation to this situation is a distortion.Ephedrine is not an amphetamine."

While their main argument is that supplements contributed to the rise indeaths among athletes since 1994, Bailes and his colleagues also commented onthe athletes' individual weights and training conditions. "Most recentheatstroke deaths have been in very large athletes who were starting theirconditioning in very hot, humid conditions, sometimes in an attempt to loseweight," the authors wrote. "Greater concern exists, however, withregard to the prevalent use of certain dietary or nutritional supplements."

Silverman added, "There are other factors that [the authors] didn't lookinto or comment on in the story that may have been relevant and may have been afactor in this. One is 'hot, humid' weather, which is certainly a factor. Havethe weather conditions under which training is taking place changed over thetime that was analyzed? And the second thing they say is 'very large athletes.'... Perhaps the size of athletes has increased over this time. If indeed thebodies on the football field are larger, that might have an effect on heatdissipation. Why wouldn't that be a significant factor to examine, perhaps amore significant factor than 'unregulated' dietary supplements?"