The ECA stack is a drug combination used in weight loss and as a stimulant. ECA is an acronym for ephedrine, caffeine, and aspirin. Dietary supplements based on or including elements of ECA were popular through the 1990s but the marketing of ephedra- or ephedrine-containing stimulant combinations for weight loss and bodybuilding is now restricted or illegal in the United States and Canada due to reports of heart attack, stroke, and death associated with these supplements.
Efficacy
While it was available as a supplement, ECA was marketed with claims that it would aid weight loss, improve athletic performance and increase "energy".
Fat Loss
Placebo-controlled studies have consistently found ephedrine in combination with caffeine to be effective in promoting moderate fat loss without increasing serious adverse events compared to the placebo. Herbal supplements containing Ephedra aka Ma Huang - with or without caffeine - have similarly been demonstrated to be safe and effective in studies ranging from 8 weeks to 6 months in length. A meta-analysis combining results from all available studies estimated average weight loss of 1 kg/month more than placebo.
Athletic Performance
One marketing claim made for the ECA stack was that it would increase athletic performance, but studies in the medical literature have not demonstrated a positive effect on athletic performance.
Risks
The primary risk of the ECA stack is in the effect of ephedrine on the heart. Pharmaceutical ephedrine is particularly dangerous to people with valve damage, heart problems and heart disease, but can also cause heart attacks, stroke, or death in previously healthy young adults. "Natural" supplements that contain ephedra (aka Ma Huang ) as an ephedrine substitute have been linked to cases of heart attack, stroke, and death in healthy young adults even when taken at the labeled dosage.. It is worth noting, however, that the evidence of serious harm is based only on self-reports of uncontrolled use by supplement users; when EC has been used as medically prescribed or in controlled studies , evidence of cardiovascular risk has not been found. .
A 2003 meta-analysis of all available studies and case reports concluded that "ephedrine- and ephedra-containing dietary supplements have harms in terms of a 2- to 3-fold increase in psychiatric symptoms, autonomic symptoms, upper gastrointestinal symptoms, and heart palpitations. More serious adverse effects from ephedra use cannot be excluded at a rate less than 1.0 per thousand, and case reports raise the possibility that a causal relationship with serious adverse events may exist."
Dosage
Typically the ECA stack is consumed two or three times per day in a 1:10:10 or 1:10:15 ratio of ephedrine:caffeine:Aspirin. These ratios vary across studies and across users but despite variance they all seem to be effective. Usually, no more than 25 mg of ephedrine, 200 mg of caffeine and 325 mg of Aspirin is consumed in a single dose. It is not recommended that the stack be taken past late afternoon as this may contribute to insomnia.
Legal Status
Due to deaths linked to ephedra-containing dietary supplements and the potential use of ephedrine as a precursor in illegal methamphetamine manufacture, many countries have taken steps to regulate these products.
Status in The United States
In the United States, it is illegal to market products containing ephedrine or ephedra alkaloids as a dietary supplement. In 2004, ephedra, a botanical source of ephedrine alkaloids, was banned by the U.S. Food and Drug Administration due to serious safety concerns, injuries, and deaths linked to ephedra-containing supplements. However, ephedrine itself has never been illegal in the United States and is currently available over-the-counter. Reporting requirements and quantity limitations vary by state.
Status in Canada
In January 2002, Health Canada issued a voluntary recall of all ephedrine products containing more than 8 mg per dose, all combinations of ephedrine with other stimulants such as caffeine, and all ephedrine products marketed for weight-loss or bodybuilding indications, citing a serious risk to health.
Status in EU
Ephedrine and ephedra-containing supplements are currently illegal in the European Union. Prescription use of EC was quite popular in Denmark for a while - at its peak in 1999, roughly 2% of the population was being treated with EC under the marketing name Letigen . That product's marketing was discontinued in 2002 upon the same sort of adverse reports seen in other countries but in 2008, a huge followup case-study failed to find any evidence of cardiovascular risk. Ephedrine is currently available by prescription in several EU countries.
References
- ^ a b "Dietary Supplements Containing Ephedrine Alkaloids". U.S. Food and Drug Administration. August 22, 2006 . http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152388.htm . Retrieved July 7, 2009 .
- ^ a b "Health Canada requests recall of certain products containing Ephedra/ephedrine". Health Canada. January 9, 2002 . http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2002/2002_01_e.html . Retrieved July 7, 2009 .
- ^ a b c "In total, these suggest that herbal ephedra/caffeine herbal supplements, when used as directed by healthy overweight men and women in combination with healthy diet and exercise habits, may be beneficial for weight reduction without significantly increased risk of adverse events." C N Boozer1, P A Daly, P Home, J L Solomon, D Blanchard, J A Nasser, R Strauss and T Meredith "Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial" Int J Obes May 2002, Volume 26, Number 5, Pages 593-604
- ^ Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon JL. "An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial." Int J Obes Relat Metab Disord., 2001 Mar;25(3):316-24.
- ^ a b Paul G. Shekelle, MD, PhD; Mary L. Hardy, MD; Sally C. Morton, PhD; Margaret Maglione, MPP; Walter A. Mojica, MD, MPH; Marika J. Suttorp, MS; Shannon L. Rhodes, MFA; Lara Jungvig, BA; James Gagné, MD "Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis" JAMA. 2003;289:1537-1545
- ^ "evidence to support use of ephedra for athletic performance is insufficient." Paul G. Shekelle, MD, PhD; Mary L. Hardy, MD; Sally C. Morton, PhD; Margaret Maglione, MPP; Walter A. Mojica, MD, MPH; Marika J. Suttorp, MS; Shannon L. Rhodes, MFA; Lara Jungvig, BA; James Gagné, MD Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance:A Meta-analysis JAMA. 2003;289:1537-1545.
- ^ "The use of dietary supplements that contain ephedra alkaloids may pose a health risk to some persons. These findings indicate the need for a better understanding of individual susceptibility to the adverse effects of such dietary supplements." Christine A. Haller, M.D., and Neal L. Benowitz, M.D. "Adverse Cardiovascular and Central Nervous System Events Associated with Dietary Supplements Containing Ephedra Alkaloids" New England Journal of Medicine, Volume 343:1833-1838 12/21/2000, Number 25
- ^ a b "Prescribed ephedrine/caffeine was not associated with a substantially increased risk of adverse cardiovascular outcomes in this study." Jesper Hallas, Lars Bjerrum, Henrik Støvring and Morten Andersen "Use of a Prescribed Ephedrine/Caffeine Combination and the Risk of Serious Cardiovascular Events: A Registry-based Case-Crossover Study" American Journal of Epidemiology 2008 168(8):966-973; doi:10.1093/aje/kwn191
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