Deaths from heatstroke -- once occurring at a rate of four to five a year -- were nearly eliminated from U.S. football by 1985 because of active efforts to keep players supplied with water, according to Julian Bailes, M.D., principal author of the report and chair of neurosurgery at West Virginia University.

"In the ten years from 1985 through 1994, only six deaths secondary to dehydration and heatstroke were recorded among football players -- a rate of 0.6 per year," said Dr. Bailes, who is a consultant to the National Football League Players Association on health issues. "But there were four deaths each in 1995, 1998, 2000, and 2001."

All, including the widely-reported collapse and death of Korey Stringer of the Minnesota Vikings in August 2001, happened during summer practices.

Bailes, along with Robert C. Cantu, M.D., of Emerson Hospital, Concord, Mass., and Arthur L. Day. M.D., of Brigham and Women's Hospital, Boston, argue in the editorial that popular diet supplements may have a significant impact on the body's ability to remain properly hydrated during stressful exercise in hot weather.

"Athletes, coaches, trainers and team physicians should be vigilant for the signs of heat stress," Bailes said. "We have put more effort into letting players know that there are well-recognized risks in using unregulated diet supplements."

Ephedrine and related compounds, sold as "herbal energy" products, are promoted as weight-loss and energy-booster compounds. The herbal product, also sold as Ma-huang, has an amphetamine-like effect. It can have serious potential side effects on the heart and central nervous system, as well as raising core body temperature and decreasing the body's ability to cool.

Creatine monohydrate is marketed as a muscle builder. It has been shown to shift body water from the bloodstream into muscle cells, which makes heatstroke more likely.

Use of both products is common in athletes, although the NFL and the NCAA have both taken steps recently to ban ephedrine use.

A graph presented in the paper shows the rate of heat-related deaths among U.S. football players dropping steadily from 1965 to 1984 -- and trending up sharply after 1994. The authors note that the federal law that exempted diet supplements from Food and Drug Administration regulation was passed in 1994.

The editor of the journal, Michael L.J. Apuzzo, M.D., said Bailes' report provides important documentation of the use and risks of supplements in sports, "particularly during summer training camp, when intense physical and mental stress for all athletes is exacerbated by temperature and humidity."

"Unfortunately, in sports medicine, new science is often advanced only after fatalities gain media attention," said Ronnie P. Barnes, head athletic trainer for the New York Giants, and president of the Professional Football Athletic Trainers' Society. In comments published with the journal editorial, Barnes endorsed the NFL ephedrine ban and called for the adoption of a hydration plan for all athletes in all sports.

Note: If no author is given, the source is cited instead.

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