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Ephedra and Energy Drinks on College Campuses by Daniel Ari Kapner

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Ephedra and Energy Drinks on College Campuses by Daniel Ari Kapner INFOFACTSRESOURCES The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention Ephedra and Energy Drinks on College Campuses by Daniel Ari Kapner The February 2003 death of Baltimore Orioles pitcher levels . alertness and perception.”6,7 Also known found. Half of the events in which ephedra was the Steve Bechler, who according to the coroner’s report as ma huang, ephedra is considered a “natural” main contributing factor affected apparently healthy died after taking ephedrine alkaloids (ephedra), has supplement7 and Chinese herbalists have used the people under age 30.13 garnered national attention for the topic of nutri- herb Ephedra for thousands of years to treat asthma The Annals of Internal Medicine published a study tional supplements and energy drinks.1 While the and colds.8 Ephedra has been used in some over-the- in 2003 suggesting that ephedra accounted for 64 headlines have focused mainly on use by professional counter cold and asthma products in the United States.9 percent of all adverse reactions from herbal products athletes, these substances have gained popularity Until recently, ephedra was found in many weight- in 2001, even though it represented only 4.3 percent of among college-age students and are associated with loss and energy-enhancing products. Popular supple- industry sales in that year.14,15 the deaths of Florida State University linebacker ments that contained ephedra included Metabolife A study published in the New England Journal Devaughn Darling, Northwestern University football and Ripped Fuel, both of which are now available in of Medicine in 2000 examined 140 cases of ephedra- player Rashid Wheeler, and the University at Albany, ephedra-free formulations. As recently as 2008, one related health incidents. They concluded that 43 cases SUNY, football player Peter Schlendorf.1, 2, 3 Internet bodybuilding retail site listed 36 products that (almost 31 percent) were “defi nitely” or “probably” Energy drinks and energy-enhancing pills, diet aids, included ephedra.6 Ephedra was the primary ingredi- ephedra-related; in these cases, three people died, muscle-enlargers, and other supplements fall under ent in herbal ecstasy, commonly sold on the Internet.10 seven became permanently disabled, and four required the 1994 Dietary Supplement Health and Education Herbal companies often misinform consumers continuing medical treatment. Another 44 cases were Act, which states that products deriving from herbs about the actual ingredients and dosages in their “possibly” related to ephedra-containing products.5, 12 10 and natural sources are classifi ed as food, rather products. Incorrect labeling may be more wide- spread than consumers realize. For instance, the Regulating Ephedra than as drugs.4 These legal substances, which produce American Council on Science and Health (ACSH) After Baltimore Orioles pitcher Steve Bechler died, appealing, steroid-like effects, are marketed heavily to reported that one product, “wild Chinese ginseng,” the FDA ordered herbal companies to print warning college-age athletes, club-goers, dancers, and partyers. lists ginseng as its only ingredient, yet ACSH labo- labels on ephedra-containing products.16 The FDA The energy drink and herbal industry’s vast marketing ratories also found caffeine and 45 milligrams of fi rst proposed limits on ephedra in 1997 due to reports presence has created an environment where students ephedra in each tablet.10 of negative health effects, which began a years-long understand little about these products’ adverse effects.4, 5 process ultimately resulting in the 2004 FDA rule to This Infofacts/Resources describes the use of Adverse Effects of Ephedra prohibit the sale of ephedra. Unlike medications, which ephedra and energy drinks on college campuses, Ephedra can induce headaches, insomnia, tremors, pharmaceutical companies must prove safe and effi ca- possible effects of their use, and recommendations for nerve damage, rapid or irregular heartbeat, high cious before marketing, ephedra was protected under institutions of higher education. blood pressure, hypertension, strokes, heart attacks, the 1994 Dietary Supplement Health and Education Act 11,12 seizures, brain damage, and death. The FDA re- (DSHEA) as a food rather than a drug. This classifi ca- ceived more than 1,500 reports of adverse reactions tion meant that to ban the substance, the FDA had to 13 EPHEDRA from ephedra prior to September 2001. bear the burden of proving that ephedra presents “an The U.S. Food and Drug Administration (FDA) According to a RAND Corporation 2003 study of unreasonable risk to those who use it.”17 banned ephedra as an energy enhancer and diet adverse reactions, ephedra was linked to fi ve deaths, In December 2003, the FDA announced that it aid in April 2004. Before being banned, ephedra fi ve heart attacks, 11 strokes, four seizures, and eight would ban the sale of all dietary supplements contain- was marketed largely to college athletes to increase psychiatric events in those cases where records were ing ephedra, effective April 12, 2004. At the time of the “strength, dynamic power, energy . endurance complete and no other contributing factors were announcement, the FDA warned 62 companies that For additional information make or sell ephedra-containing supplements to stop manufacturing and marketing the products as soon Higher Education Center for Alcohol and Other Drug Abuse and as possible. This landmark ruling was the fi rst time Violence Prevention since the DSHEA was passed that the FDA had taken Education Development Center, Inc. http://www.higheredcenter.org action to outlaw the sale of a supplement. 55 Chapel Street 1-800-676-1730; TDD Relay-friendly, Dial 711 The FDA ruling states that use of ephedra supple- Newton, Massachusetts 02458-1060 [email protected] • Fax: 617-928-1537 ments has little positive effect aside from short-term Funded by the U.S. Department of Education weight loss.17 Tommy G. Thompson, Secretary of August 2008 ☞ INFOFACTS The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention http://www.higheredcenter.org Health and Human Services, declared that supplements of ephedrine use now appears to start prior to Major corporations such as Pepsico, Coca-Cola, An- containing ephedra “pose unacceptable health risks, college.28 Use of ephedrine among student athletes heuser Busch, Miller Brewing Company and Cadbury and any consumers who are still using them should has remained stable since it was fi rst measured in Schweppes all produce their own energy drinks. stop immediately.”18 Moreover, referring to research by 1997.29 Ice hockey athletes report among the high- Some energy drinks are now being produced with the National Institutes of Health, the FDA reported that est rates of ephedra use, with 12 percent of female alcohol mixed in, and critics claim these drinks are ephedra is associated with heart palpitations, psychi- athletes and over 5 percent of male athletes report- being marketed to underage and vulnerable youth. atric effects, tremors, insomnia, and upper gastroin- ing use.29 Water polo had the most male ephedrine In 2008, Anheuser Busch responded to threats of testinal effects, especially when use is combined with users in 2005, at 7.9 percent.28 litigation from the Center for Science in the Public caffeine or other stimulants.17 Interest and an investigation by 11 state attorneys If manufacturers continue to market ephedra- ENERGY DRINKS general by agreeing to stop producing and market- containing supplements, the FDA can prohibit the Energy drinks are beverages loaded with caffeine, ing caffeinated alcoholic beverages such as Bud products from being sold or take action to remove sugar, and other ingredients such as ginseng, Extra and Tilt.40 the supplements from the market. Some ephedra- taurine, guarana, and B-complex vitamins.29, 30 containing products are not affected by the ban, includ- Before the FDA ban, energy drinks very popular Adverse Effects ing traditional Chinese herbal medicines, herbal teas, on campus, such as Extreme Ripped Force, 4m Energy drinks can become dangerous when 31, 32 and medications that contain chemically synthesized energizer, and Xtreme NRG, contained ephedra. consumed in large quantities, taken after exercise 17 ephedra as an ingredient. Extreme Ripped Force contained 25 milligrams of or mixed with alcohol.9,41 Adverse effects include Even before the FDA’s ban on sales of ephedra ephedra, more than three times the limit the FDA dehydration, insomnia, headaches, nervousness, 29, 30 supplements, three states had banned ephedra dietary recommended in 1997. One energy drink, Han- nosebleeds, and vomiting. Reports claim that energy supplements. Illinois passed legislation in May 2003, sen Beverage Company’s Hard E, contains 5 percent drinks have caused even more severe reactions, such alcohol.33 With the recent FDA ruling banning following the death of a 16-year old football player who as seizure, heart arrhythmia, and death.9, 42 In a 2006 had a heart attack and died after using ephedra.19 New ephedra in supplements, many of the manufactur- survey, college students reported a signifi cantly higher York became the second state to ban ephedra, passing ers of ephedra-containing energy drinks introduced prevalence of alcohol-related consequences when a bill in June 2003.20 The California State Senate ap- ephedra-free alternatives.29 combining energy drinks, even after adjusting for the proved a ban in May 2003.21 Energy drinks are marketed to students, athletes, amount of alcohol consumed. These consequences Prior to the FDA ban, sports organizations realized and active individuals between the ages of 21 included being taken advantage of sexually, riding the adverse effects of ephedra. The National Collegiate and 35. Often taken after exercise or mixed with with an intoxicated driver, and being physically hurt Athletic Association (NCAA), the International Olympic vodka, energy drinks are promoted at nightclubs, or injured.37 The stimulating effect of energy drinks is Committee, and NASCAR banned the use of ephedra by bars, universities, concerts, and other events that competitors prior to its nationwide ban.
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