AF Surgeon General issues NOTAM on ephedra risks

The Air Force Surgeon General has issued a "Notice to Airmen" on the potential risks associated with dietary supplements that contain ephedra, following the death of a young Air Force member in early November.

NOTAMs are released by the Clinical Quality Management Division of the Air Force Medical Operations Agency to disseminate lessons learned from medical incident investigations and other pertinent events.

"What we know is that this young man took dietary supplements, including ephedra," said Royal Air Force Wing Commander (Dr.) Victor Wallace, of the Aerospace Medicine Division at the Air Force Medical Operations Agency. "Although there was insufficient evidence to be causal, the changes seen in this young man's cardiovascular system can be associated with ephedra use."

"The purpose of the NOTAM is to ensure that Air Force personnel and their attending medical staff remain alert to the risks and can provide appropriate advice and education," said Wallace, an RAF exchange officer.

The Air Force Surgeon General issued a revised policy covering dietary supplements containing ephedra on Sept. 5, 2002, that strongly discouraged the use of such supplements and highlighted associated risk factors.

The revised AFSG policy was followed by a memorandum from the Air Force Services Agency, which called for services activities to remove such supplements from their resale inventories.

"Since ephedra and its alkaloids have several different names, products should be evaluated by [major command] and base-level dietitians to ensure all items known to include this herb/ingredient are identified and removed from your operations," the services memo read.

In late August, the Army and Air Force Exchange Service also removed the products from its inventories.

According to a statement issued from AAFES headquarters in Dallas: "Due to health and safety concerns, AAFES has replaced all 'performance enhancing' dietary supplements that contain ephedra with ephedra-free products. All products with ephedra have been removed from AAFES' stores, along with those operated by AAFES concessionaires. Signs have been posted to encourage customers to carefully read the labels of all dietary supplements to help them make informed choices."

Air Force Surgeon General officials have repeatedly "strongly advised" people to contact their physicians or health care providers before taking dietary supplements containing Ma Huang, ephedra or ephedra alkaloids.

"Consultation is especially necessary if an individual has pre-existing medical problems, is taking other medications or exercises vigorously as part of (his or her) occupation or fitness program," Wallace said.

Such supplements, which include so-called energy boosters, over-the-counter diet pills and bodybuilding drinks or mixes, may pose health and occupational risks even for those not taking other prescribed drugs, Wallace said.

Today, at least 20 states and the National Football League are among those who have banned or restricted use of ephedrine products.