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Most truck stops have point-of-sale displays offering brightly packaged dietary supplements marketed as “energy boosters” and “fatigue fighters.” Read the fine print, and you’ll see that many of these contain ephedrine, a nervous system stimulant derived from the herb ephedra, also known as ma huang. While its makers contend ephedrine is harmless when used as directed, others believe the stimulant is dangerous, and possibly fatal.

Because ephedrine is classified as a dietary supplement, intended to assist in weight loss by increasing metabolism, it escapes regulation by the Federal Drug Administration. Sales of ephedrine products – capsules and certain energy drinks – have reached $1.1 billion a year.

“My doctor told me to stay away from ephedrine,” says Robert Hall, an owner-operator for Dakota Specialized Movers in Eagan, Minn. “I have already had one heart attack, and ephedrine increases the heart rate. I don’t need another heart attack.”

Since 1994, FDA has received reports of 800 injuries and 50 deaths that consumers blame on ephedrine. These adverse effect reports range from dizziness to heart attacks.

The Ephedra Education Council (EEC) says FDA “admits that these reports are subjective, do not represent scientific data, cannot be used as a basis for scientific regulation and ordinarily cannot be used to determine if the adverse event was caused by the product in question.”

True, the reports “do not necessarily indicate a problem with the product,” says FDA spokesperson Monica Revelle. “If we receive complaints of adverse effects, we do a scientific review,” she says. “Ephedrine is under scientific review.”

In the meantime, the agency takes a very guarded stance on ephedrine. Its website warns consumers “not to purchase or consume ephedra-containing dietary supplements. Possible adverse side effects of ephedrine range from heart attacks, strokes, seizures, psychosis and death to clinically less significant effects that may indicate the potential for more serious effects (for example, dizziness, headache, gastrointestinal distress, irregular heartbeat and heart palpitations).”

Dr. Sidney Wolfe, health research director at Public Citizen, a watchdog organization, is also alarmed. “There have been more deaths attributed to the use of ephedrine than all other dietary supplements combined,” he says. “Even at recommended doses, there is an unreasonable risk of harm. Ephedrine is banned in Canada, and the U.S. military has also banned its use.”

In July, the FDA asked the Justice Department to pursue a criminal investigation of ephedrine producer Metabolife because the company allegedly hid 14,700 adverse effect reports. “Once we get these reports, the FDA will have a special task force review them,” says FDA Deputy Commissioner Lester Crawford. Metabolife declined to comment on the investigation for this article.

EEC does not specifically address the results of ephedrine abuse other than to say high doses can cause sleeplessness if taken too close to bedtime. It says its medical experts “have reviewed all historical and clinical data available and have concluded that ephedra products are safe when taken in accordance with The American Herbal Product Association’s recommended serving limits, warnings and precautions.” Those limits are no more than 25 milligrams per serving and 100 mg per day.

A sampling of products sold at truck stops shows that it can be difficult for a consumer to know if he’s staying within those limits. The Trucker’s Luv It! label indicates 24 mg of ephedrine per capsule, and conservatively recommends one dose at mid-morning and one at mid-afternoon. Black Beauty says to take one capsule after each meal, but it does not say how much ephedrine is in each. Ultra Energy Now, which also does not list ephedrine content, directs the user to “Take one packet (three tablets) with a full glass of water once per day.”

EEC spokesman Richard Price, noting that some products do not list the amount of ephedrine content, says, “This is one difference between responsibly made products and pseudo street drugs.” Price says consumers must take responsibility for reading labels and doing their own research.

Calls to Ultra Energy Now were not returned. At NVE Pharmaceuticals, which manufactures Black Beauty, Stacker 3 and four other dietary supplements, a representative who declined to be identified also would not discuss the dosages of Black Beauty.

Mark Butterton, Operations Manager with Healthworks International, maker of Trucker’s Luv It!, says he had rarely received a complaint in his five years with the company. “One customer said he had taken 20 capsules and experienced a racing heart,” Butterton says. “I’ve also had a couple complaints about upset stomach and the jitters, but that’s all.”

Trucker’s Luv It!, which contains 75 mg of caffeine per capsule, is hardly the only caffeine-laced ephedrine product. Stacker 3, containing 25 mg of ephedrine, has 250 mg of caffeine – the equivalent of two and a half cups of coffee – in each capsule. While the caffeine in a single cup of coffee lasts one to two hours, the effect of 25 mg of ephedrine can last six to eight hours.

Jack Butera, an owner-operator since 1970 who is leased to Jones Motor of Spring City, Pa., ignores the truck stop displays for ephedrine products. “Too many of my buddies took speed,” says Butera, who believes methamphetamine (speed) abuse had harmful effects on his friends. “I know it’s not speed, but if it keeps you up, it’s doing the same thing.”

Compared to methamphetamine, ephedrine “gives a more sustained decline in alertness,” says former Australian driver Dean Croke, who had used “clout,” as ephedrine is known to Australian drivers. “I hated taking it. You feel awful when the effects wear off.”

Croke, former director of Circadian Technologies, a fatigue management firm, says that truckers’ use of stimulants touches on larger issues, such as carriers’ willingness to pressure drivers to meet unrealistic schedules. “Are we willing to compromise the health of our workers and the safety of the public to get our vegetables on time?” he says. “As long as we are willing, the products will remain available, and truck drivers will use them.”

Makers of ephedrine diet products, some of which are marketed at truck stops as a way to fight fatigue, say they are safe when used as directed.


RESOURCES

Ephedra Education Council
www.ephedrafacts.com

Ephedrine Legal Advice
www.ephedrine-ephedra.com

Food And Drug Administration
www.fda.gov

Public Citizen
www.citizen.org

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