This rant is a first for me. I was invited to rant about Bechler’s death at Off Wing Opinion (a sports blog). I have a different introduction there – On Steve Bechler’s death. If you like sports, please frequent his blog – he does a wonderful job.

For many years, I have taken advantage of athletes’ deaths to make teaching points. For example, Flo Hyman (the world class volleyball player) died of Marfan’s Syndrome and subsequent dissecting aortic aneurysm. Hank Gaithers died from an arrythmia secondary to hypertrophic cardiomyopathy. Walter Payton died of cholangiocarcinoma secondary to primary sclerosing cholangitis. Each of these athletes’ deaths raise important teaching points. By understanding why someone died, we can often learn lessons which might prevent future deaths or injuries.

When I first heard that Bechler had died, I started wondering what had happened. I saw the same news reports that you had. He did not die suddenly, this “rules out” most cardiac causes. Cardiac deaths occur in young athletes, but they die almost immediately. He on the other hand made it to the ICU.

The next information that I heard was that he had had a heatstroke. This information came along with information that the ambient temperature was only 81 degrees. Heatstroke is well recognized as a cause of death in athletes, but I generally associate that cause with August football in Texas (temperatures in the 100s). But then I remembered the Corey Stringer story. At that point I wondered what Bechler had taken.

I also wondered about his underlying health. Did he have any unknown diseases? His autopsy gave some clues. Varied Factors Caused Pitcher’s Death

The autopsy performed yesterday on the Baltimore pitcher who died of heatstroke produced a portrait of a young man with an assortment of potentially dangerous medical problems who was also desperately trying to lose weight. An accompanying investigation revealed that the pitcher, Steve Bechler, was using an over-the-counter weight-loss supplement containing an ingredient that has been linked to heatstroke.

Now I understood. He was not in good shape, was trying desperately to lose weight, and probably had underlying disease.

The use of Xenadrine added to the risk factors that were present, Perper said, explaining that heatstroke was “brought about by the convergence of a number of factors.”

He listed those factors as an enlarged heart, abnormal liver functions, borderline hypertension, an overweight condition, use of Xenadrine and dieting.

I blogged earlier today on my site about the idiocy of Ephedra – Ephedra – PLEASE DO NOT TAKE!!! . Let’s look at what he was taking. SUPPLEMENT FACTS: XENADRINE® RFA-1. The dangerous ingredient is “Ma Huang?335mg – (plant)(standardized for 20mg Ephedrine)”. The problem comes from dosing. Many athletes take too much, and as the dose of Ephedrine increases, so do the problems.

The article that I cited this morning explains how Ephedra can cause heatstroke.

Ephedra can promote heatstroke in three ways, according to Neal L. Benowitz of the University of California at San Francisco. It speeds metabolism and thus creates extra heat. It constricts blood vessels in the skin, preventing the body from cooling itself efficiently. And by making the user feel more energetic and less fatigued, it keeps him exercising longer.

Since the recommended dose is 4 capsules a day, the dose of ephedrine is large enough to cause problems. Ephedrine (at these doses) is the single supplement with the most reported problems (again please read my earlier rant).

So why would an athlete take this stuff? Why would anyone ‘bet his life’ on a supplement? I guess this is really a stupid question. We all know that athletes will do anything to succeed. They rarely consider the potential consequences of drugs or supplements. Rob Dibble, the former Reds relief pitcher, writes eloquently about this attitude today – For The Love Of The Game? I highly recommend reading his confession and shuddering. He share an attitude which prevails. Here are some of his thoughts

While I don’t condone the use of potentially harmful supplements, I can honestly say that during my playing days, I would have done the same thing if I were in Steve’s position. Despite cringing at the mere thought of what I put my body through, for the chance to play professional baseball, I wouldn’t hesitate to do it all again.

And for further proof that my hypocrisy knows few boundaries, if I could take a pill that would allow me back in the game today, I’d gladly take it. I wouldn’t even consider the ramifications, because they wouldn’t matter. I’d want it that badly.

That mindset — that drive, motivation, and perhaps stupidity — doesn’t exist in everyone. But it’s common among professional athletes. And with the exception of a few rare specimens who are blessed with superior genes, the desire to succeed is only heightened by the extraordinary demands that go along with their chosen occupation.

So, when a player like Steve Bechler shows up to spring training out of shape and a few pounds overweight, his desire to shed a few pounds will override any potential warning signs or dangers to himself. Despite a family history of high blood pressure and heart disease, he was willing to risk his own health to succeed in the game.

In Steve’s case, the results were catastrophic. But for every fatality, there are many others who won’t deal with the repercussions until much later in life, maybe never. And unfortunately, many athletes are willing to roll the dice and play the odds. They cling to a notion of immortality and an “it won’t happen to me” attitude.

So they willingly play ‘You Bet Your Life’. But unfortunately, this problem does not just exist in professional sports. Our teenagers and young adults take supplements almost willy nilly. And they know that their heroes take them. They see the ads in magazines.

I rant about supplements often. I tell patients and friends not to take supplements unless they can be certain of the potency, safety and efficacy. Since the 1994 law on supplements, we have no real protection. The FDA does not approve supplements, nor are they regulated. Yet they can kill and injure. If Steve Bechler’s death influences Congress to reconsider their stance on supplements, then we will have some redemption. Otherwise, we just have another teaching case. And dammit, I have too many teaching deaths already.