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Editorial Suggests Ephedra, Creatine Linked to Athletes' Deaths

MORGANTOWN, W. Va.--Creatine and ephedra use may have contributed to an increased number of heatstroke-related deaths among athletes since 1994, according to an editorial published in the August issue of Neurosurgery (51, 2:283-88, 2002) ( By reviewing data from the National Center for Catastrophic Sports Injury Research, authors--led by Julian Bailes, M.D., of West Virginia University--noted there were six heatstroke-related deaths among U.S. athletes between 1985 and 1994, but there were four deaths each in 1995, 1998, 2000 and 2001. The authors claimed the "deregulation" of the dietary supplement market and subsequent "explosion" in supplement sales since the 1994 passage of the Dietary Supplement Health and Education Act (DSHEA) contributed to the increased number of deaths among athletes since 1994.

"There are statements that appear repeatedly throughout the editorial that are unfortunate because they promote 'myths' that are incorrect," said Wayne Silverman, Ph.D., chief administrative officer of the American Botanical Council (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 dietary supplements are unregulated--quite the contrary. It provided clear guidelines for FDA [Food and Drug Administration] to regulate dietary supplements. Those regulations may be selectively enforced but there are clear regulations. Whether the supplements were a key factor in the deaths is also questionable."

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

"Another problem with the piece is that it makes a direct link between ephedrine and amphetamines and attributes problems to these 'amphetamine-like compounds,'" Silverman said. "Expounding on the dangers of amphetamine-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 in deaths among athletes since 1994, Bailes and his colleagues also commented on the athletes' individual weights and training conditions. "Most recent heatstroke deaths have been in very large athletes who were starting their conditioning in very hot, humid conditions, sometimes in an attempt to lose weight," the authors wrote. "Greater concern exists, however, with regard to the prevalent use of certain dietary or nutritional supplements."

Silverman added, "There are other factors that [the authors] didn't look into or comment on in the story that may have been relevant and may have been a factor in this. One is 'hot, humid' weather, which is certainly a factor. Have the weather conditions under which training is taking place changed over the time 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 the bodies of the football field are larger, that might have an effect on heat dissipation. Why wouldn't that be a significant factor to examine, perhaps a more significant factor than 'unregulated' dietary supplements?"

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