Wednesday, January 4, 2012

DMAA and strokes by Jerry Brainum

Although depicted as a benign substance with effects comparable to drinking several cups of coffee, DMAA may not be so benign as originally thought. DMAA is found in several popular food supplements touted as pre-workout energy boosters. Some recent problems involving two soldiers who died from cardiac arrest   linked to their use of  DMAA-containing supplements have prompted the military to ban DMAA supplements from sale. DMAA is allowable in supplements based on its existence in germanium oil, which itself has recently come into question, since recent chemical analysis of natural germanium oil found no trace of naturally occurring DMAA.This suggests that DMAA is added to supplements, which would classify it as a drug, rather than a natural ingredient.
   Thus far, the Food and Drug Administration (FDA) has not made any overtures to remove DMAA from the market. But the FDA usually only takes this step after repeated reports of adverse effects, as occurred with ephedrine a few years ago. But some reports about adverse effects directly related to ingestion of DMAA have begun to appear. Typical of them is a new case study published in The New Zealand Journal of Medicine. In New Zealand, DMAA is used as a "party pill," and three years ago the New Zealand Ministry of Health reported three cases of severe headache,vomiting, and one case of cerebral hemorrhage (stroke) in recreational users of DMAA party pills.
     A just published study, also in the NZJM, discusses the events that led to a 21-year-old man who had ingested 2 DMAA pills (278 milligrams per capsule) having a stroke. Along with the DMAA pills, he ingested 150 milligrams of caffeine. DMAA and caffeine are typically found together in most bodybuilding supplements that contain DMAA.He had already drank a can of beer before he took the pills. Within 30 minutes, he began suffering a massive headache, to the extent that he asked a friend to drive him home. When he arrived at home, he became confused, peed in his pants, and vomited for 2-3 hours before falling asleep.When he awoke the next morning, he was drowsy and spoke with slurred speech. Since he didn't get any better as the day wore on, he went to an emergency room at 6 p.m.
    On arrival at the ER, he was still confused and his speech was slurred. He could not give the doctors a coherent history of his present problem. He also showed a right facial droop, and right-sided weakness, both signs of a stroke. Based on this, the attending doctors ordered a CT scan of his brain, which showed a large hemorrhage in the basal ganglia area, confirmed the diagnosis of stroke. An examination showed that he had trouble speaking, couldn't move fluidly, and had lost his sense of feeling and touch. While in the hospital, he suffered a seizure and was given an anti-convulsive drug. A cerebral angiogram show no signs of any condition that would account for his stroke. He showed improvement after 5 days, and was released after 15 days.
     The doctors believe that based on the timing of his ingestion of DMAA and his stroke, that DMAA was the likely cause. In addition, he showed no abnormalities that would account for his symptoms, such as high blood pressure, heart rhythm disturbances, or blood vessel structural abnormalities.The type of stroke he suffered is very rare in those under age 45, and when it does occur, it is usually the result of prior brain structural or blood vessel abnormalities. While this case involved only one person, and thus cannot be used as definitive evidence in relation to the toxicity of DMAA, the fact that it happened to a previously healthy young man with no risk factors for stroke does make you wonder just how safe DMAA really is.In addition, the dose of DMAA that he ingested may be far more than is found in most supplements aimed at bodybuilding use. This is speculative at best, since the supplements in question use labels that list "proprietary ingredients," which means that no specific amounts of the ingredients are listed on the label.Only time will tell if other cases of serious health problems emerge after the use of DMAA. I suspect that if such cases do arise, they will be linked to overuse of supplements containing DMAA. This is precisely what occurred with ephedrine. No health problems ever occurred after ingesting ephedrine in those who used suggested normal doses, or who had no previously undiagnosed health conditions that would have contraindicated the use of ephedrine.DMAA does share one property with ephedrine: both substances will cause a false positive test during a drug test for amphetamines.More problems with DMAA supplements are inevitable because of the widespread misconception that because a supplement is sold over the counter, it has to be completely safe to use in any amount. As the dictum asserts,"Only the dose determines the poison." 

Gee, P, et al. Another bitter pill: a case of toxicity from DMAA pills.NZMJ 2011;123:124-127.


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