What are the benefits and dangers of ephedrine?

Ephedrine, the main ingredient in many popular decongestant cold remedies, is banned from the competitive arena by the IOC, the IAAF, the USOC, the NCAA, and the Boy and Girl Scouts of America, and several well-known athletes have been suspended from competition because ephedrine occupied a too-prominent position in their urine. Despite these banishments, athletes continue to use the stuff. Ice-hockey players pop ephedrine tabs before games, weight lifters swallow the stuff to give their workouts a boost, runners devour it before interval sessions, and a variety of different athletes (and non-athletes) ingest ephedrine in hopes of losing weight. Ephedrine has become one of the most popular 'supplements' used by athletes; the 'word on the street' is that it is a rather powerful stimulant which can speed up interval workouts, increase strength, and also assist with weight loss...

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Strangely enough, however, until now not a single scientific study has linked ephedrine with improved athletic performance. In fact, classic research carried out in the 1970s showed that ephedrine had no effect at all on physical work capacity. More recently, studies demonstrated that ephedrine did not improve 40-K bicycle race times, nor did it increase maximal power and muscular endurance in experienced, competitive cyclists...

But you may have noticed that we began the last paragraph with the phrase 'until now'. Indeed, there is new research which indicates that ephedrine can boost performance during intense efforts which last for about 15 minutes or so (for example, a 5-K running race). However, this new study indicates that ephedrine works its magic only when it is ingested along with caffeine...

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Putting it to the test
Scientists at the Defence and Civil Institute of Environmental Medicine in North York, Ontario, Canada, asked twelve male cyclists to take part in a rugged, exercise-cycle workout which was designed to produce complete exhaustion in about 12 to 13 minutes (in this session, the individuals simply warmed up with five minutes of easy riding and then pedalled for as long as possible at a fixed, high percentage of VO2max). On one occasion, the subjects attempted this workout 90 minutes after ingesting 1 mg of ephedrine per kilogram of body weight. On another day, the athletes hit the session 90 minutes after swallowing 5 mg of caffeine per kilo of body weight (research has shown that it takes about 90 minutes for ephedrine and caffeine to attain peak concentrations in the blood after they are ingested). In yet another situation, the athletes took both the epehedrine and caffeine before stepping on to their bikes. And of course, they also tried the red-hot session after taking in only a placebo ('Effects of Caffeine, Ephedrine and Their Combination on Time to Exhaustion during High-Intensity Exercise,' European Journal of Applied Physiology, vol. 77, pp. 427-433, 1998)...

Ephedrine, when taken alone, failed to increase performance time (which was defined as the amount of time a cyclist could sustain the required, high-percentage-of-VO2max intensity without becoming too exhausted to continue). Likewise, caffeine taken alone failed to improve performance, compared to the placebo...

However, ephedrine combined with caffeine proved to be a powerful ergogenic concoction. Average performance time increased by about 39 per cent with ephedrine plus caffeine, compared to placebo, and all eight subjects improved their performances with ephedrine and caffeine together. In addition, the subjects' heart rates were higher with the ephedrine-caffeine combo, yet the workout actually felt easier with the ephedrine and caffeine on board...

Why it works
Why did the ephedrine-plus-caffeine mix work so well? Blood-glucose levels were highest after the ephedrine-caffeine intake, suggesting that perhaps there was greater fuel available for leg muscles after ephedrine-caffeine ingestion, or that more glucose was getting to the brain, allaying mental fatigue. However, neither of these possibilities represents a likely explanation for the superiority of the ephedrine-plus-caffeine mix: The workouts were so short that fuel should not have become limiting, and indeed blood-glucose levels were normal in the placebo, isolated caffeine, and isolated ephedrine trials. In other words, there was plenty of carbohydrate fuel available in all situations...

Since the exercise felt about 25 per cent easier after ephedrine and caffeine were taken together (ie, ratings of perceived exertion were 25 per cent lower), it's likely that the ephedrine and caffeine worked together - by some as yet unknown mechanism - on the central nervous system, masking feelings of fatigue and thus allowing the athletes to work for a longer period of time. We do know (from previous research) that ephedrine and caffeine, when taken together, can fairly dramatically speed up metabolism. Thus, the ephedrine-caffeine combination may be a fairly potent stimulant of nervous-system function and may also spur other physiological processes, including muscle contractility...

However, all was not a bed of roses for the caffeine-ephedrine ingesters. About 33 per cent of them suffered from nausea during the workout after they had ingested the high-octane, ephedrine-caffeine cocktail and were unable to complete the session (thus, the number of subjects actually analyzed dropped from 12 to eight). In addition, of course, ephedrine is a banned drug, so you run the risk of being both disqualified from your race and suspended from competition indefinitely if you use it. And finally, some individuals have severe reactions to ephedrine, ranging from nervousness and irritability to irregular heart rhythms, convulsions, and even death. It's not something you want to fool around with!

What happened to caffeine?
Why didn't caffeine boost exercise performance, since a number of other studies have shown it to be an ergogenic substance? For one thing, the participants in the Ontario study were regular caffeine users (they drank at least seven cups of caffeinated coffee per week), so perhaps they were less sensitive to caffeine than irregular users would be (research suggests that caffeine's effects are blunted if it is ingested frequently). The subjects were also not in a high state of fitness, and there is some evidence that caffeine works better in highly trained athletes, compared to average people...

As we have mentioned before in Peak Performance, caffeine - taken in moderate amounts - is a 'legal' performance booster. Taking too much of the stuff will get you banned, but as it turns out, the amount needed for banishment actually hurts performances, while lesser quantities increase athletic capacity...

The true scoop on caffeine is as follows:

1. Although most endurance runners believe that caffeine can help marathon performances, the truth is that it helps individuals engaged in shorter races, but not marathoners. Not a single published study has linked caffeine intake with improved marathon performance, but strong evidence indicates that caffeine (specifically, the amount in about two cups of strong coffee, which is a legal intake) can improve one-mile race time by about four seconds and also heighten kicking speed at the end of a 1500-metre or one-mile race by around 3 per cent ('Effect of Caffeinated Coffee on Running Speed, Respiratory Factors, Blood Lactate, and Perceived Exertion during 1500m Treadmill Running,' British Journal of Sports Medicine, vol. 26(2), pp. 116-120, 1992)...
2. The caffeine in a caffeine tablet is much more effective (ie, performance-enhancing) than the caffeine in coffee, because coffee itself contains chemical constituents which dull caffeine's physiological activity (please see next point)...
3. It's likely that caffeine can add some real sizzle to 10-K performances. In a recent study carried out at the University of Guelph in Canada, subjects were asked to run for as long as possible at an intensity of about 91 per cent of maximal heart rate (similar to the heart rate which prevails during the greater portion of a 10K). Individuals who ingested placebo (sugar) tablets lasted only 22 minutes at this intensity, while runners who took in decaf coffee, regular coffee, or decaf coffee plus added caffeine kept going for 26 minutes. The best strategy by far, however, was using caffeine tablets, which allowed athletes to buzz along for 41 minutes at 91 per cent of max heart rate ('More Buzz about Joe,' Running Research News, vol. 11 (1), pp. 10-11, 1995). All of the runners improved their performances after taking in caffeine pills, compared to swilling real coffee. The dosage used in all cases was 4.5 mg of caffeine per kilogram of body weight (which usually leads to perfectly legal caffeine concentrations in the urine)...
4. Caffeine can also improve the quality of interval workouts. One piece of research determined that ingesting six mg of caffeine per kilogram of body weight (approximately the amount in three to four cups of strong coffee, which will still be a legal dose for most athletes) boosts performance by about 20 per cent during an interval workout which consists of two-minute intervals at an intensity of 100% VO2max...
5. Other studies have linked caffeine with improvements in both sprinting ability on a bicycle and 100-metre swim times ('Benefits of Caffeine Ingestion on Sprint Performance in Trained and Untrained Swimmers,' European Journal of Applied Physiology, vol. 64, pp. 377-380, 1992)...
6. Although caffeine can act as a diuretic, it does not appear to increase the risk of dehydration when taken shortly (about an hour) before exercise, probably because the exercise itself tends to tone down urine production. For example, in one study, a jolt of caffeine exaggerated urine production by 31 per cent when no exercise was undertaken but had basically no effect on urine output when the caffeine was combined with exercise...
7. If you are interested in using caffeine to put a charge in your interval sessions or race performances, the 'right' dose appears to be about 300 mg, taken 60 to 90 minutes before you start exercising. This practice is legal, but is it ethical? If you always drank three cups of coffee one hour before your races or intense workouts, even before you knew that caffeine was ergogenic, you could argue that your caffeine intake was a normal and natural part of your life, ie, that you were just following your routine dietary practices (however, bear in mind that coffee is less ergogenic than straight caffeine). However, in other situations, the truth is that caffeine intake is not ethical. You are basically using a drug to enhance your performance, and the only reason such a practice won't lead to penalties is that the governing bodies are too stupid to recognize the ergogenic potential of small quantities of caffeine...
8. Caffeine is not included in most sports drinks, but it would probably have great performance-promoting value there. For example, in research carried out at McMaster University in Ontario, Canada, cyclists who ingested caffeine exhibited greater strength and endurance at the end of prolonged rides. This may be one reason why so many athletes sip Coke during extended race efforts...
9. Should you try ephedrine - or mix ephedrine with caffeine - prior to your rugged workouts or race efforts? Not a chance! Ephedrine plus caffeine would probably be an ergogenic combination for many athletes, but ephedrine produces too many side effects to be used safely, and the amount required to produce an effect is definitely illegal...

Jim Bledsoe

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