DOCUMENT RESUME
ED 394 922 SP 036 597
AUTHOR Jenkins, Andrew P.
TITLE Herbal Energizers: Speed By Any Other Name.
PUB DATE 96
NOTE Ilp.
PUB TYPE Guides Non-Classroom Use (055)
EDRS PRICE MF01/PC01 Plus Postage.
DESCRIPTORS *Adolescents; Advertising; *Athletes; *Drug Abuse;
Drug Addiction; Drug Use Testing; High Schools;
Physiology; *Stimulants
IDENTIFIERS *Caffeine; *Food Supplements; Herbs
ABSTRACT
This guide focuses on over-the-counter (OTC)
stimulants sold to high school aged athletes and dieters as "herbal
energizers," food supplements, and fatigue reducers. While
advertising often makes them appear healthful and harmless, all of
these stimulants belong in the class "sympathomimetic amines," so
called because they mimic the sympathetic nervous system hormones.
The paper discusses how these stimulants work, indicates which drugs
are contained in various OTC stimulants, and lists adverse affects.
Sports testing limits for amateur athletes are outlined, as well as
advertising ploys to make OTC stimulants appealing, particularly to
younger users. Concerns for teachers, parents, and youth coaches
include; (1) teen athletes are particularly susceptible to persuasive
marketing and claims as well as to overuse syndromes; (2) teenage
girls are at the highest risk to anorexia and bulimia nervosa and
overuse of diet aids; (3) terms like "herbal," "natural," and "no
caffeine" are used to give a false sense of security; (4) there is a
lack of control of over distribution, sale, and use of these products
by minors; and (5) combination of symptoms and conditions associated
with stimulants as well as the combined (synergistic) effects of OTC
stimulants and caffeine can be fatal. Suggested actions include
educating adults and teens on marketing ploys and on the effects and
risks of using OTC stimulants. Also, concerned adults can request
gyms and stores to place these dangerous stimulants out of reach of
minors and to voluntarily agree to sell them only to adults. A list
of resource organizations is included. (Contains 21 references.)
(ND)
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Reproductions supplied by EDRS are the best that can be made
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Herbal Energizers: Speed By Any Other Name
by
Andrew P Jenkins, Ph.D., CHES
Health Education Programs
Central Washington University
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Office of Educehonal Research and Improvement DISSEMINATE THIS MATERIAL
EDUCATIONAL RESOURCES INFORMATION HAS BEEN GRANTED BY
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0 This document hat been reproduced Ss
received from the person or organilation
originating it.
0 Minor changes have been made to improve
reprOduCtiOn Quality
Points of view or opinions Stated in this dOCu. TO THE EDUCATIONAL RESOURCES
mint do nOt neCeUanly represent official
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2
Introduction
Currently, there are over a hundred types 0. over-the-counter stimulants sold in US. The
focus of this paper is on the stimulants sold to high school aged athletes and dieters. These
over-the-counter stimulants (OTC-S) are sold as "herbal energizers," food supplements,
and fatigue reducers. The advertising often makes them appear healthful and harmless. All
of these stimulants belong in the class, sympathomimetic amines, a potentially dangerous
and addictive class of drugs similar in structure and actions to amphetamines.
Main Effects of Sympathomimetic Amines
Sympathomimetic amines are a class of drugs that imitate the actions of the sympathetic
nervous system (Knoben, & Anderson, 1988). The sympathetic nervous system
stimulates the fight or flight responses. The fight or fight response readies the human for
extreme muscle activity such as battling a foe or running for one's life. All non-battle
activities or functions such as digestion and sexual function are shut down (see Table 1).
Table 1
Summary of Sympathetic Nervous System Arousal
Increases Decreases
alertness saliva production (cotton mouth)
anxiety digestion
heart rate sexual function
cardiac output blood to internal organs
blood pressure sleep & REM cycle
respiration rate appetite
muscle tension fatigue
perspiration concentration
urination
blood supply to skeletal muscles & brain
dilation of pupils & bronchioles
blood sugar production
The fight or flight response is what teenagers call, "an adrenaline rush." Most of the
responses are the result of the release of two hormones, epinephrine (adrenaline) and
norepinephrine (nor-adrenaline) (Marieb, 1992). Drugs that directly stimulate the
sympathetic nerves or receptors or cause the release of these excitatory hormones are
termed sympathomimetic because they "mimic" the sympathetic nervous system hormones
and its subsequent stimulatory actions (Hanson & Venturelli, 1995). Short term
stimulation of the sympathetic nervous system is not harmful since it is usually resolved
promptly and control of the body systems is returned to parasympathetic (relaxation)
nervous system domination. Most side effects and risks of sympathomimetic amines are
tied to abnormally high or chronic stimulation of the sympathetic nervous system.
The most common types of stimulants used in OTC-S's are caffeine, ephedrine,
psuedoephedrine, and phenylpropanalomine. These drugs have legitimate use as anti-
histamines, cold medications, and for asthma relief and are found in over-the-counter
medicines such as Actifed, Allerest, Contac, Nyquil, and Drixol. The desired main effects
are bronchial dilation, sinus drying, and drowsiness (Knoben & Anderson, 1988). The
FDA requires that over-the-counter medications have clear instructions and warnings.
Unfortunately, often these side effects appear even when these drugs are taken within the
recommended doses (see Table 2). Reactions to all drugs vary from person to person.
Table 2
Common Over-The-Counter Sympathomimetic Amines
Drug Cold Medicine/Anti- Exercise /Diet Aid
Histamine
Chlorprenaline Asthone (Japanese)
*Ephedrine (includes Ma High Energy Herbal Energy
Huang Chinese herbal Formula, High Energy max.
ephedra) Strength, Diet Now: Sensible Diet &
Wt. ManaFement Plan, E'Ola Drops
Thenylephrine Coricidin, Dristan, Neo-Synephrine
Pseudoephedrine Actifed, Athnol, Sudated, Drixol,
Chlortrimeton
*Phenyl propanol ami ne Allerest, Contac, 4 Way Formula, Acutrim, Dexatrim, Metabolift
Nyquil, Vicks Nighttime Cold Thermogenic Formula, Permathin-
Medicine 16 Maximum Strength,
*Caffeine (xanthine with Anacin, Exedrine, No-Doz, Caffedrine
sympathetic actions)
*Most common over-the-counter stimulants. ote: The sa e of t e com matron of these
three has been banned by the FDA.
Adverse Effects of Over-the-Counter Stimulants
The onset and nature of side effects from OTC stimulants are dependent on individual drug
reactions, dose, duration of use, and tolerance. All of these drugs can cause an increase in
physical tolerance with repeated use, therefore, the individual will need to increase the
dosage progressively in order to attain the desired results. With increased dosages comes
an increased risk of side effects. Physical tolerance and prolonged use will also be
followed by withdrawal syndrome upon cessation of use. Withdrawal symptoms can
include depression, fatigue, irritability, nausea, and headache (Holtzman, 1990).
The most common main and side effects of OTC stimulant use include, but are not limited
to, anxiety to agitation, alertness to disorientation, increased muscle tension and shakes,
mildly elevated heart rate to tachycardia or dangerously elevated heart rate levels (Boyd,
1986). Appetite is suppressed although the large intestine and bowel may be stimulated.
Urine production is increased as is blood glucose production. Temperature elevation can
range from mild to severe hyperthermia (overheating) (Appelt, 1993, Heishman &
Hennigton, 1992).
Ephedrine is particularly dangerous and the FDA is currently examining tightening of
regulations controlling its sale and distribution following twelve reported deaths due to
ephedrine overdose(Substance Abuse Funding News, 1995). Ephedrine can cause heart
palpitations, hypertension, nerve damage, muscle injury, psychosis, stroke and death.
Ohio has passed laws restricting all sales of ephedra and ephedrine following the overdose
death of a high school athlete (Consumer Reports, 1995). There is also strong concern
over the use of ephedrine in the manufacture of illegal forms of methamphetamine known
as "crank" and "crystal meth" (Kleiner, 1994). Cunently, the FDA prohibits the sale of
ephedrine in large quantities but nothing prohibits drug chemists from purchasing multiple
quantities of over-the-counter ephedrine from multiple distributors.
Pseudoephedrine, is nearly identical in structure and effects to ephedrine and is also derived
from plant sources of the genus, Ephedra (McEvoy, 1990). Like ephedrine, it may be sold
as a "natural" herbal stimulant and manufacturers may tout it's ergogenic or sports
enhancing effects, none of which are supported by research (Clemons, & Crosby, 1993
4
Collins, 1993). The main effects, side effects, and risks are essentially the same between
the ephedrine and psuedoephedrine and both drugs are on the banned lists for most athletic
unions.
A false sense of security may surround the use of over-the-counter stimulants but these
drugs are only safe when used as recommended and in the doses recommended. The
uninformed user of these drugs may accidentally overdose as the result of the combined or
synergistic effects of multiple drug use. The deadly triple combination of ephedrine,
caffeine, and phenylpropanalomine has been banned by the FDA since 1982. The potential
still exists, however, for an individual to combine phenylpropanalomine and ephedrine,
wash them down with a cup or two of coffee or a double latte and end up in a critical
overdose situation!
Phenylpropanalomine by itself can cause nervousness, restlessness, insomnia, headache,
nausea, elevated blood sugar, and elevated blood pressure. The Public Citizen Health
Research Group (1991) has reported that some research indicates that at least twenty
percent of people using the drug have severe reactions to phenylpropanalomine.
Most research indicates that low doses of caffeine in the 100-300 mgs/day (1 to 3 cups/day)
range do not likely cause any serious side effects of health detriments (Heishman &
Hennigton, 1992). However, it should be noted that individual reaction to any drug varies.
Hypercaffeinism results from high or prolonged doses of caffeine. Doses in excess of 300
mgs/day may produce elevated heart rate, blood pressure, diarrhea, gastric upset, insomnia
REM deprived sleep, anxiety, tension, nervousness, muscle twitches. Extremely high
doses in excess of 500 mgs/day (over five cups/day) can result in psychotic disorders,
convulsions, muscle spasms; extreme anxiety, paranoia, respiratory collapse, heart
palpitations, even death (Heishman & Hemngton, 1992, Wisconsin Clearinghouse, 1986).
Caffeine is an addictive substance and tolerance is developed over time. Increased
tolerance causes a need for progressively larger doses over time. Acute withdrawal will set
in within 24 hours of cessation of use resulting in headache, fatigue and lethargy,
decreased alertness, and nervousness, flu-like symptoms, muscle pain, and nausea. Most
withdrawal symptoms pass within seven days of cessation of caffeine use (Holtzman,
1990).
Those caffeine side effects of greatest concern for high school coaches and school medical
personnel are: inability to concentrate, anxiety, tachycardia (high heart rate), dehydration
from increased urine output, and loss of muscle coordination (Knoben & Anderson, 1988).
Although caffeine has been found to increase the availability of certain fatty acids under
aerobic conditions (Mc Naughton, 1987), the possible performance enhancing effects of
caffeine and other OTC stimulants are usually negated by the side effects (Casal & Leon,
1985, Rogers, 1985).
Regardless of the cause, whether it is drug or stress induced, prolonged stimulation of the
fight or flight response results in chronic stress syndrome. Chronic fatigue, anxiety,
adrenal depletion, and even paranoid delusions and psychosis may result (see Table 3).
5
Table 3
Summary of Risks to Stimulant Abuse
Acute psychiatric disorders
Addiction/dependence
Anxiety disorders
Cardiac disorders and arrhythmias
Chronic fatigue syndrome
Chronic stress syndrome
Dehydration
Depression
Disqualification from athletic event
Heart failure
Hyperthermia (high body temperature)
Hypertension (high blood pressure)
Nervousness
Muscle spasms and injury
Respiratory collapse
Stroke
Shakes and tremors
Tolerance
Withdrawal syndrome
Stimulants and Sport Drug Testing Limits
Most drug testing programs for amateur athletics are modeled after the International and US
Olympic Committees (IOC and USOC) drug testing programs. The lists of banned
substances such as anabolic steroids, amphetamines, and other stimulants are comparable,
if not identical, in most cases.
All of the common stimulants found in over-the-counter medications and herbal energizers
are listed as banned substances by the International and US Olympic Committees (USOC)
and the National Collegiate Athletic Association (USOC 1988, Benson, 1991). These
stimulants include, but are not limited to, ephedrine in both natural and synthesized form,
psuedoephedrine, phenylpropanolamine, and caffeine.
The US Olympic Committee (1988) caffeine limit is any concentration greater than 12
mcg/m1 in the urine, this would be equal to six to eight cups of drip brew coffee in a two
hour period, however, it is entirely possible for an athlete to use several stimulants and
drink a variety of beverages and reach this limit unknowingly. Two cups of coffee would
result in 3 -6 mcg./ml, two colas would produce .59 - .70 mcg./ml, one No-Doz, 1.5
mcg./ml. in the urine Suprisingly, only one cup of guarana tea, which contains as high as
six percent caffeine, could cause an unacceptable level of caffeine in an athlete's urine
(Merdink & Woo ley, 1990).
It is suggested that before taking any over-the-counter of prescription anti-histamine,
asthma medication including mists, cold medicine or stimulant, the athletic union and/or
your team physician be contacted. The US Olympic Committee reports that OTC cold
medications and anti-histamines can be detected up to 72 hours after last use (USOC,
1988).
6
Advertising Ploys
Advertisers of food supplements, some of which contain stimulants, target young
weightlifters, bodybuilders, and athletes by using words and phrases which remind the
reader of anabolic steroids such as "..has twice the anabolic effect." They use terms like
"herbal," "natural," and "nutrition supplement" to give the impression that these are
healthful and harmless substances.
The advertisers balance these safe and gentle words and phrases with powerful hyperbole
meant to appeal to the sports minded, hard working young athlete: "T & M Delivers!,"
"Performance-Enhancing," "high intensity," "explode," and "break through." "Kickers"
are ephedra tablets packaged in a bright orange and silver envelope with a karate champion
on the front to emphasize the power of the drug and to make the sports link. These sell for
a dollar a piece at mini-markets and are one of the most popular OTC stimulants on the
market.
Some of the advertising campaigns are fully confrontational and appeal to an athlete's risk
taking tendencies and sense of pride. One advertisement, aimed at young bodybuilders,
even states outright, this product is "Not for every Pencil-Necked Ding Dong in your gym"
and then challenges the athlete, "If you're sick and tired of taking mamby pamby-feel
nothing-do little supplements...then Ultimate Orange is for you."
Diet aids aimed at women and girls are now being sold out of home business. Signs are
appearing on lawns and telephone poles which call their product, "Will Power in a Bottle"
and claim "Lose up to 30 lbs. In 30 days...without exercising! ," "Great for men's spare
tire," and "Lose weight and inches." Most of these products contain ephedrine and
caffeine. Most of the home dealers of these stimulants have no medical training and little or
no knowledge of the effects of sympathomimetics.
What's in a name?
Packaging and advertising of diet products aimed at young women and dieters are no less
suggestive than those aimed at athletes. Names like "Dexatrim," "Diet Now," "Mini-Thin,"
and "Permathin" give the clear impression that the drug is going to contribute to significant
weight loss and "thinness."
For the student studying late or the drowsy driver there are products sold over-the-counter
at truck stops and mini-marts called "Super Ener-Max," Super Pep Extra Strength," and
"Mega-Blast," "Ultra Energy Now," and simply, "UP-Time." The OTC stimulants are
often shaped to resemble more powerful and dangerous amphetamines. Mini-Thins are
white with a fine cross on the top to imitate the prescription stimulant, Benzedrine (see
Table 4).
Table 4
Common OTC Stimulants
(often sold at mini-marts and gas stations)
Brand Name Dm! Dose
Kickers Chinese Herbs Ma Huang (Chinese ephedrine) Not revealed
Ultra Energy Now Ma Huang (Chinese ephedrine) Not revealed
46
Guarana Extract (caffeine)
44
Kola (caffeine)
Mini-Thin Ephedrine HCL (stimulant, anti- 25 mgs
histamine)
Gin Zing Ma Huang (Chinese ephedrine) 1000 mgs.
Guarana (caffeine) 500 mgs
Mega BLAST High Energy Ma Huang (Ch.nese ephedrine) 450 mgs
formula Gota Kola (caffeine) 225 mgs
Caffeine 150 mgs
Super PEP Extra Strength Kola Nut (cat feine) Not revealed
44
Guarana (caffeine)
Gota Kola (caffeine) 46
Super Ener-Max Ma Huang (Chinese ephedrine) 220 mgs.
Green Tea Extract (caffeine) 100 mgs.
Kola Nut Extract (caffeine)SOLg s.
7...11:1-ime Food Supplement Caffeine Not revealed
Common "Herbal" Stimulants
The following is a list of the most common herbal stimulants sold in over-the -counter
herbal energizers and food supplements:
Ma Huang (ephedra) contains the drug, ephedrine, in it's natural form. There is no
pharmacological difference in the natural or synthesized form of the drug--the effects are
the same on the human body.
Guarana (paullnia cupana) is a bean much like the coffee bean, however, it contains much
more caffeine. Caffeine content in the guarana bean is between 2 and 6 percent.
Green Tea (camellia sinensis) contains between 3 and 4 percent caffeine.
Coffee (coffea arabica) is a bean and contains between 0.8 and 2.4 percent. The average
cup of drip coffee contains 110 to 150 mgs of caffeine.
Kola nut contains only a minuscule amount of caffeine. Most of the 33 to 60 mgs of
caffeine found in cola soft drink3 is added in it's synthetic form.
Cocoa (theobroma cacao) contains small amounts of caffeine which is present in chocolate
candy and coca drinks. Chocolate bars contain approximately 22 mgs. Of caffeine whereas
hot cocoa contains around 5 mgs. of caffeine.
Concerns for Teachers, Parents and Youth Coaches
1) Teen athletes are particularly susceptible to persuasive marketing and claims
2) Teenage girls are at the highest risk to anorexia and bulimia nervosa and overuse of diet
aids
3) Teens are susceptable to overuse syndromes e.g., If one works, ten will work ten times
better.
4) Terms like "herbal," "natural" and "no caffeine" are used to give a false sense of
security.
5) There exists lack of control over distribution, sale, and use of these products by minors.
6) The combination of symptoms and conditions associated with OTC stimulants use may
become fatal. Example: Athletes or dieters who are dehydrated may suffer cardiac arrest
from the combined effects of low blood volume and high heart rate.
7) The combined (synergistic) effects of OTC stimulants and caffeine can be fatal.
Example: The deadly combination of ephedrine, caffeine, and phenylpropanalomine has
been banned by the FDA since 1982.
8) The failure of athletic drug tests and subsequent penalties negates the use of OTC
stimulants.
What Can be Done?
Parents, coaches, and teachers can take action in two ways: First, they should educate
themselves and then educate teens on the marketing ploys, the main and side effects, and
the risks of over-the-counter stimulants. The American Council for Drug Education and the
National Federation of Parents for Drug-Free Youth can be contacted for information and
teaching resources. Many states have coalitions such as The Wisconsin Clearinghouse for
Drug Information and the Washington State Substance Abuse Coalition that readily provide
information, education, and referrals for teachers, parents and coaches working with and
educating youth.
Secondly, concerned adults can request gyms, stores and mini-markets to place these
dangerous stimulants out of reach of minors and to voluntarily agree to only sell them to
adults. Most stores are acting within the limits of the current laws which permit them to sell
any OTC medication to minors or adults. Many business owners, however, are unaware
themselves of the potential dangers of OTC stimulants and are resceptive to community
concerns. Organized citizen groups can appeal to city councils who can pass ordinances
restricting or prohibiting businesses from selling arc stimulants to minors. The state
pharmaceutical board can also be contacted and they can ask vendors for voluntary
compliance with restricted sale of OTC stimulants to minors.
Resources
American Council for Drug Education (301) 294.0600
National Clearinghouse for Alcohol & Drug Information,
PO BOX 2345, Rockville MD 20852
National Federation of Parents for Drug-Free Youth: 800-554-KIDS
National Institute on Drug Abuse 800-662-HELP
National Institute on Drug Abuse, US Dept. Of Health and Human Services 800-638-2045
Parents Resource Institute for Drug Education (404) 577-4500
PRIDE Drug Information Line 800-241-9746
Wisconsin Clearinghouse (608) 263-2797
Washington State Substance Abuse Coalition 800-662-9111
Washington State Pharmacists Association (206) 228-7171
Washington State Board of Pharmacies (206) 753-6834
Schools Without Drugs: The Challenge (202) 732-4161
References
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Nonprescription Drugs, 10th ed. (339-49), Washington DC, American Pharmaceutical
Association.
Benson, M. (1991). NCAA drug testing/education programs. Overland Parks, KS, The
National Collegiate Athletic Association.
Boyd, J. R. (1986). Nonprescription drug screening. American Pharmacology, 26, 22-
14.
Casal, D. C. , & Leon, A. S. (1985). Failure of caffeine to affect substrate utilimtion
during prolonged running. Medicine and Science in Sports and Exercise, 17(1), 174-
179.
Clemons, J., & Crosby, S. (1993). Cardiopulmonary and subjective effects of a 60 mg.
Dose of pseudoephedrine on graded treadmill exercise. The Journal of Sports Medicine
and Physical Fitness, 33(4), 405-412.
Collins, L. H. (1993, July/August). Doping in sports, Journal of the American Academy
of Physician Assistants, 465-476.
Consumer Reports (1995, November). Herbal roulette. Consumer Reports, 698-705.
Hanson, G. & Venture Ili, P. (1995). Drugs and society (4th Ed.), Boston, MA: Jones and
Bartlett Publishers, 262.
Heishman, S. & Henningfield, J. (1992). Stimulus functions of caffeine in humans:
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287.
Holtzman, S. (1990). Caffeine as a model of drug abuse. Trends in Pharmacological
Sciences, 11, 355-56.
Merdink, J. & Woo ley, B. (1990). Drug testing: history, philosophy, and rationale. In
Tricker, R. & D. Cook (Eds.), Athletes at Risk: Drugs and Sport. (pp. 161-171).
Dubuque, IA, W.C. Brown.
Kleiner, K. (1994). Drug laws crack down on crank. New Scientist, 147(1994), 9.
Knoben, J. E., & Anderson, P. 0. (1988). Handbook of clinical drug data. Hamilton,
Ill., Drug Intelligence Publications.
Marieb, E. (1992) Human Anatomy and Physiology, 2nd Ed., Redwood City, CA, The
Benjamin/Cummings Publishing Company, Inc.
Mc Naughton, L. (1987). Two levels of caffeine ingestion on blood lactate and free fatty
acid responses during incremental exercise. Research Quarterly for Exercise and Sport,
58(3), 255-259.
Public Citizen Health Research Group (1991). Do not use phenylpropanolamine-
containing products. Public Citizen Health Research Group Newsletter, 7(1), 3.
Rogers, C. C. (1985). Cyclists try caffeine suppositories. The Physician and Sports
Medicine, 13(3), 38-39.
Substance Abuse Funding News (1995, October 18). FDA may tighten ephedrine limits.
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US Olympic Committee (1988). Sportsmediscope: USOC Sports Medicine and Science
Division Newsletter, 7(7). Available from USOC Sports Medicine & Science Division,
Committee on Substance Abuse Research and Education, 170 Flist Boulder Street,
Colorado Springs, CO 80909-5760.
US Olympic Committee (1988). USOC Drug testing program: Questions and answers.
Pamphlet available from USOC Sports Medicine & Science Division, Committee on
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