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SINGAPORE - With the haze gone and the running season back on, it might be good for runners to be aware of the trouble that a little-known supplement can cause.
In the last stretch of the 2012 London Marathon, a runner collapsed and died. The coroner ruled that Ms Claire Squires, 30, had "taken a supplement containing DMAA which... in combination with extreme physical exertion, caused acute cardiac failure".
DMAA causes arteries to constrict (narrow), thus raising blood pressure which can lead to arrhythmias (irregular heart beats), heart attacks, bleeding in the brain, seizures, hallucinations, paranoia and bizarre behaviour.
Anyone taking the chemical, young or old, fit or not, is as liable to suffer these effects.
In August last year, about four months after Ms Squires' death, the British regulator decided to classify DMAA as an unlicensed medicinal product.
Late last month, the United States Food and Drug Administration (FDA) seized 1,500 cases of supplements with DMAA from a certain supplement chain. This was after the regulator had, in April last year, requested 11 major supplement companies to voluntarily withdraw all pills with DMAA.
The FDA had, in recent years, received 86 reports of adverse effects including deaths, heart problems and neuropsychiatric issues with supplements containing DMAA, first marketed in 1971 as a nasal decongestant called Forthane.
Because it caused blood vessels to constrict, vessels found in the nose lining had less blood flowing through them and thus less nasal discharge resulted. It did work, but Forthane was withdrawn in 1983 after adverse effects were reported.
These side effects - raised blood pressure, headaches and tremors - mimicked those of amphetamines.
DMAA molecules resemble amphetamines so much that they interfere with the measurement of blood amphetamine levels.
DMAA, like amphetamines, also stimulates the brain. In fact, some pills containing DMAA are even marketed as Herbal Ecstasy for legal "highs".
This is because the party drug called Ecstasy is methamphetamine, the parent drug to amphetamine. The human body metabolises Ecstasy into and excretes it as amphetamine.
Amphetamines stimulate the brain to cause euphoria and an energy surge; they are addictive too.
One non-profit group lists 79 different products that contain DMAA sold by about as many companies in stores and online.
Supplement makers are required by US law to notify the FDA whenever they add a new man-made ingredient. But no firm had submitted such evidence before marketing supplements with DMAA, as it was supposedly a "natural" extract.
US law requires the FDA, not the maker, to bear the sole burden of showing a natural extract to be harmful.
Of 11 major supplement firms asked by the FDA to voluntarily withdraw all pills with DMAA in April last year, only one had not complied a year later.
That company submitted to the FDA three China-based studies it funded to prove that DMAA was a natural constituent found in geranium, a flower allegedly used for centuries in traditional medicine.
However, the FDA found all three studies to be methodologically flawed. And the same three China-based research groups funded by the company to produce the studies showing DMAA in geranium were themselves unable to replicate these results in subsequent studies they carried out unfunded by the firm.
US-based research groups have not found DMAA in geranium. Thus, DMAA is not found naturally. In fact, it is a synthetic amphetamine-like molecule.
Since amphetamines are not sold over the counter, DMAA shouldn't be either.
In Singapore, "DMAA is classified as a medicinal ingredient: supplements are not allowed to contain any Western active ingredients", according to the Health Sciences Authority (HSA), which says it "has not approved any medicinal product containing DMAA".
The HSA lists DMAA as "not suitable for use in health supplements" but it doesn't screen or check supplements before they are allowed on the market because they "generally contain ingredients that are low risk and are used for maintaining or enhancing health". That no pre-market approval is necessary "is an approach used by FDA too", it said.
That is, there are no pre-market approval, licensing and registration for supplements sold here. Instead, dealers are responsible for the products' quality and safety.
When adverse effects happen and are reported to its Vigilance Branch by doctors who see affected consumers as patients, HSA then steps in to investigate.
Thus, in the infamous Slim 10 saga in 2002, local actress Andrea De Cruz suffered liver failure after consuming a Chinese diet pill called Slim 10. The pills were freely sold until this adverse effect was reported by attending doctors, and HSA stepped in and tested 45 slimming products.
Consumers can contact the HSA's enforcement branch to report any supplement with illegal ingredients like DMAA being sold here.
Also, HSA has an ongoing post-market sampling of health products to stem out illegal ones.
Responding to The Straits Times' queries, HSA said it has rejected commercial imports of DMAA-containing products and has not to date received any adverse reports linked to its use here. It has now "initiated surveillance checks on the presence of DMAA products on the market".
Such sales risk "a fine of up to $5,000 and/or imprisonment".
A concerned runner or family member can go the extra step to be vigilant: scrutinise the label to avoid DMAA anyway.
But dealers have used other names for it, like Pelargonium graveolens extract; Geranium extract; Geranamine; Dimethylamylamine; 1,3-Dimethylamylamine; 1,3-Dimethylpentylamine; Methylhexanamine; 2-Amino-4-methylhexane; 2-Hexanamine; Methylhexanenamine; 4-Methyl-2-hexanamine; or 4-Methyl-2-hexylamine.
So, consumers beware.
andyho@sph.com.sg
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