The public's mixed feelings about the popular dietary supplement ephedra — since the death of Baltimore Orioles pitching prospect Steve Bechler last week — can be found at the Hi-Health store on North Miller Road in Scottsdale.
Many customers are being extra cautious to make sure the weight-loss and energy-boosting products they buy are labeled "ephedra-free," said store manager Bev Kemp.
But threats from federal agencies that the stimulant could be banned have caused others to hoard the stuff. "People are so afraid of ephedra going away that they're coming in and buying several bottles," Kemp said.
Ephedra products are some of the store's top sellers — especially for women looking to slim down, she said. The supplement is available at many East Valley retailers, including Walgreens, Wal-Mart and Target.
But many local medical authorities and high school coaches discourage the use of the herbal extract, and say that the recent death is just the latest example of why more regulation is needed for such supplements.
A Florida medical examiner said last week that ephedra may have played a role in the heat stroke that killed Bechler. Some athletes use ephedra to lose weight or increase performance.
Ray Ballesteros, 32, said he has used ephedra products for seven years without any side effects. The Tempe resident, fitness consultant and avid bodybuilder, said ephedra products are a "pick-me-up, and help me stay lean."
He is adamant about using the products safely — taking the stimulant three days per week for three months on, three months off, and regularly rotating the brands to avoid building a resistance.
"I hate to see these products get a bad rap," said Ballesteros, who manages the House of Fitness supplement shop in Mesa. "People do abuse it just like they abuse alcohol and other drugs."
Ron Estabrook, head football coach for Chaparral High School in Scottsdale, is one of several local high school coaches who said they discourage their athletes from doing anything except eating healthy and weight training to control their weight.
"Their bodies are still developing," Estabrook said. "They don't need to get into that stuff."
But Estabrook said that herbal supplements of all types are marketed to young people. "Like cigarette advertising or beer advertising, they go after the kids," he said.
Ephedra is found in hundreds of products from unregulated herbal supplements to pharmaceuticals sold by prescription and over the counter. Many of these products have been proven to help sufferers of asthma, bronchial problems and low blood pressure, said Dr. Steven Curry, director of medical toxicology at Good Samaritan Regional Medical Center in Phoenix.
"The fact that (Bechler) was taking an agent — allegedly — doesn't in and of itself mean it has anything to do with his death," Curry said.
Ephedra speeds heart and metabolic rates and should be taken with caution by those with a variety of health conditions, Curry said. The Food and Drug Administration lists more than 100 deaths tied to the herbal supplement. But there are no studies that definitively prove it is dangerous if taken according to manufacturer recommendations, he said.
Still, Curry and others said taking ephedra and other herbal supplements is a crap shoot, because there is no regulation on the quality and potency of the product.
Neerja Sethi, a family nurse practitioner who specializes in weight management and bariatrics at Medical Solutions weight-loss clinic in Scottsdale, never suggests her patients take ephedra supplements.
"Just because it's herbal doesn't mean it's safe," Sethi said. "(The recent ephedra scare) is indicative of a bigger problem: There's no criteria for dosing."
Sethi and other medical professionals said they would like to see federal regulation of herbal supplements. Supplements are classified as food, not drugs, and are therefore not regulated by the FDA unless the federal agency has reason to believe the product is dangerous. Since toxicology reports have linked the death of Bechler to ephedra, the FDA has made an investigation into the supplement high priority.
Liba Lerner, owner of Herbs and More in Mesa, is quick to point out the countless deaths related to pharmaceutical drugs approved by the FDA after multiple double-blind studies.
Lerner said that while it is difficult for supplement consumers to get good, accurate information about such products, she is skeptical of federal regulation.
"Honestly it's one of those things that has good points and bad points," she said. "When things get under control and regulated, that's not always as good either — lots of times there's money involved."
Local supplement vendors said they have noticed the industry has started self-regulating more closely in recent years amid reports that ephedra may be dangerous. Ephedra supplement bottles are more explicit in their warnings, which encourage consumers to stop taking the product and see a doctor at the first sign of side effects. And some brands are are discontinuing their ephedra products in lieu of similar, ephedra-free supplements.
Hi-Health keeps ephedra products behind locked cabinets and has recently stopped selling these supplements to people under age 21. Ballesteros said that while House of Fitness is careful to counsel customers to use their products in a healthful way, anyone of any age can purchase ephedra supplements.