Teen Herbicide

Dietary supplements can be deadly. So why are they being marketed to kids?

For a high-school inside linebacker, Greg Davis was a pretty tough player. He was captain of his football team at San Ramon Valley High School in Danville, California, averaged 11.5 tackles per game, and was picked for the Contra Costa County all-star team his senior year. Davis had a knack for reading the other team's offense and hit very hard, but at 5 feet 9 inches tall and 185 pounds he was clearly undersized for his position. Still, if he could bulk up by about 15 pounds, he knew Division I-A scouts might recruit him to play safety at the college level.

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To increase muscle mass, Davis took a page from slugger Mark McGwire and started using "andro," a so-called steroid precursor that, once ingested, metabolizes into an anabolic steroid (serious side effects can include violent mood swings). To burn fat and increase his energy, Davis took ephedra, the cardiovascular and central nervous system stimulant also known as Ma Huang. He was not the only athlete at his school using largely unregulated, but widely available, dietary supplements to improve performance: As nutritional expert Mike Perko notes in his book Taking One for the Team, today supplements "are as much a fixture in sports participation as mouth guards and athletic tape." But in Davis' case, they were nearly fatal.

Davis began to have seizures while on ephedra. The first came the night of his junior prom in 1999; doctors were unable to determine the cause. The next came a year later. "I lost consciousness behind the wheel, the car veered off the road, and I ended up right against a tree near a dry creek bed," says Davis, now 20 and a student at the University of California-Berkeley. "I was lucky, because there was a 20-foot fall." A blood test found Davis positive for amphetamines, which he had never taken. But it's not uncommon for those with high levels of ephedra alkaloids in their blood to test falsely positive for speed. Amphetamines and ephedrine (the main active ingredient in ephedra) are close chemical cousins. They have similar effects on the body, especially when ephedra is mixed with caffeine, as is often the case in sports supplements.

After ephedra was implicated in the death of Baltimore Orioles pitcher Steve Bechler from heatstroke in February, the media widely reported its linkage to strokes, heart attacks, and numerous deaths. But the focus has been on celebrity athletes rather than high schoolers like Davis and Sean Riggins -- a 16-year-old Illinois football player and wrestler who died of heart failure after taking the ephedra supplement Yellow Jacket -- who, unlike their professional and collegiate counterparts, have no one looking out for them. The National Football League, National Collegiate Athletic Association, and International Olympic Committee have all banned ephedra, but such actions do nothing to protect adolescent athletes, who may be more susceptible to supplement dangers because their bodies are still developing. "A middle schooler is not at less risk for ephedra -- physiologically, they are at higher risk," explains Dr. Bernard Griesemer, a sports-medicine expert with the American Academy of Pediatrics. Since ephedra and other sports supplements are frequently marketed to help burn fat or chisel muscles, adolescents who feel acute pressure to be thin and beautiful -- or buff and muscular -- may take them even when not involved in sports.

While clearly the most dangerous, ephedra is just one of many unregulated dietary supplements. The reason for this proliferation is that in 1994, partly at the urging of Utah Republican Senator Orrin Hatch, whose state is home to a large swath of the supplements industry, Congress passed the so-called Dietary Supplement Health and Education Act (DSHEA), which one legal commentator called "the most important example of deregulation of a federal health and safety program." Before DSHEA, most supplements had to go through the same safety testing as food additives. But the new law allowed anything from ordinary vitamins to herbal remedies to sports supplements -- some of which have no "dietary" or nutritional benefit -- to be sold without first being proved either safe or effective, as is required of prescription and over-the-counter drugs.

The only major restriction on supplements under current law is that manufacturers can't claim their products treat specific diseases. But they can make a wide range of vague health claims, such as "allows your muscles to generate more contraction force increasing strength immediately" -- the promise made by 3 Andro Extreme, which blends steroid precursors, ephedra, and caffeine. The Food and Drug Administration can act against supplements only after they have already been proved dangerous, a dramatic shifting of the burden of proof onto the government and away from industry. In fact, supplement manufacturers don't even have to report "adverse events" related to their products to the FDA.

DSHEA was passed just before the Gingrich Revolution swept Congress, at the height of deregulatory fervor. Supplement-industry lobbyists whipped up support for the bill by claiming that the FDA was going to take away the public's vitamins. They also drew on a widespread sense that "natural" cures, frequently sold in health-food stores and promoted by alternative healers, were inherently beneficial. In fact, a specific finding of DSHEA was that supplements were "safe within a broad range of intake." That may be true of some supplements, especially vitamins, but today the slew of adverse events related to ephedra and other herbs such as kava kava and aristolochia paints a very different picture.

Herbal supplements frequently contain powerful pharmacological agents, which is why they often interact dangerously with prescription drugs. But, unlike pharmaceuticals, they're not required to have carefully standardized doses. A study of 20 ephedra products by Dr. Bill Gurley of the University of Arkansas for Medical Sciences, for example, found that "total alkaloid content" fluctuated from "as little as zero percent to more than 154 percent of the label claim." "If I as a physician prescribe four times the dose of a medicine that was safe at one dose but not safe at another, I'd be in trouble," says Dr. Linn Goldberg, a supplements expert at the Oregon Health & Science University. "But here, there's nobody in trouble."

Quite the opposite: Since 1994 the dietary-supplement industry has grown from $4 billion in annual sales to $17.7 billion. Plenty of those sales have been to kids. According to the ncaa, most college athletes who use ephedra start in high school. Indeed, a 2001 national survey by the Blue Cross and Blue Shield Association found that a third of teens aged 15 to 17 knew someone using sports supplements. Teens learn about them from trainers, coaches, parents, and especially peers -- not to mention the Internet, television, radio, and muscle mags. Greg Davis, for example, began using creatine and protein powder purchased at General Nutrition Center (GNC).Then he went online for more powerful body-building products.

For just one example of online marketing to children, consider Teen Advantage Creatine Serum, "developed especially for young aspiring athletes 8-19 years of age," which can be purchased for $31.89 a bottle on one website. Creatine is thought to be relatively harmless compared with ephedra and andro, but those substances are no tougher to get hold of. "My nine-year-old son can walk into some supplement stores right now, and I assure you that if I give him fifty dollars, [he] could probably come out with androstenedione in a supplement," says Terry Madden, CEO of the U.S. Anti-Doping Agency.

When it comes to young athletes, there's no strong enforcement body capable of ensuring that they stay away from supplements. While the National Federation of State High School Associations takes an anti-supplement position, the organization hardly wields the clout the NCAA does at the college level and can't police coaches or athletic trainers who may be selling or recommending supplements to athletes. "At the high-school level the power rests with the states, not a national organization," says Frank Uryasz, who established the NCAA's national drug-testing program and is now president of the National Center for Drug Free Sport in Kansas City.

Uryasz also points out that drug testing in high schools, rare to begin with, almost always consists of screening for street drugs like marijuana, not supplements. The NCAA's "full menu" drug test for banned substances, including supplements, costs $175 per person, which high schools simply can't afford.

Senator Richard Durbin of Illinois has called for a ban on ephedra and held hearings, and after Bechler's death the FDA proposed warning labels for ephedra products and basic quality-control measures for all supplements. But thus far the influence of the dietary-supplements industry, which contributed almost $1 million to candidates in the 2002 election cycle, has helped stymie more substantial federal regulatory action. Meanwhile, some localities have acted. In March, Suffolk County, New York, became the first government to ban ephedra dietary supplements, thanks in part to the advocacy of legislator Jon Cooper, who promised the parents of a 20-year-old who died from ephedra use that he would push for a ban.

Reached by phone after his legislative victory, Cooper was elated but admitted that those seeking ephedra could simply go online or to the next county. California has prohibited the sale of ephedra and andro to minors, and state Senator Jackie Speier has pledged to push for a statewide ephedra ban. Such a ban could impact the national ephedra market significantly, but it still wouldn't deal with the supplement industry's tendency to elude regulation.

For example, Twinlab Corp. of Hauppauge, New York, recently announced that it would stop selling ephedra products, but it now sells "ephedra free" Ripped Fuel. As Arthur Grollman, a pharmacologist at the State University of New York-Stony Brook points out, however, this substance contains a chemically similar ingredient called synephrine, which comes in an herbal extract called citrus aurantium. "It's got a couple of functional groups moved around, and basically it acts like ephedra," notes Grollman. (Twinlab did not return calls for comment.) To Larry Sasich of Public Citizen's Health Research Group, such developments only serve to emphasize that the fundamental problem is the 1994 dietary-supplements law. "The way DSHEA is written, you could go after one supplement at a time from here to eternity," he says.

In the meantime, numerous double standards have resulted from the special regulatory category carved out for supplements. "It kind of makes our war on drugs look like a joke," says Kevin Riggins, the father of Sean Riggins, who died from taking ephedra. Riggins, an Air Force veteran, continues: "They say marijuana is a gateway drug, and the most horrible thing on the planet, but we let this other stuff out there that's killing people." In fact, under current regulations it's illegal to combine synthetic ephedrine with caffeine, but perfectly okay to do the same with herbal ephedra. The contradictions are perhaps most pronounced in Utah, where the Mormon Church forbids alcohol consumption, a view that to some extent is reflected in state laws. But Utah is the nation's supplement haven, and despite supplements' powerful druglike properties, no similar restrictions, religious or legal, are applied.

Industry groups such as the Ephedra Education Council say their products should be used only for weight loss, and not by anyone under 18, but are safe when used as directed. In November of 2002, GNC announced that it would card to keep kids from using products meant for adults. Critics aren't impressed at all by these measures, however. "And I bet you never got into an R movie when you were 16 years old, either," says Uryasz.

Perhaps the most troubling thing about supplements is that there's been little scientific investigation of their long-term effects. "We believe it's a public-health crisis, because what these kids are doing today, we're going to be seeing in doctors' offices in 10 or 15 years," says Iris Shaffer, spokeswoman for the Blue Cross and Blue Shield Association.

Shaffer doubts the death of Steve Bechler will finally force meaningful federal action on supplements. But Greg Davis, who's become something of an activist, believes tougher regulation will happen eventually. "We're dealing with high-school students who think they're untouchable, and that things won't happen to them," says Davis. "If we're so worried about high schoolers getting illegal drugs and alcohol, shouldn't we also protect them from legal stimulants with similar side effects?"