Talk:ECA stack

message: This article seems to downplay some of the risks of ephedrine/caffeine, and doesn't mention that it's been shown to be ineffective for long-term weight loss in a few studies. Also, it really needs to cite sources. Hence the tags. MastCell 19:03, 8 February 2007 (UTC)
replies: text: Yes, this article suggests a lot of really questionable things, like using pseudoephedrine or asthma medication to get around the FDA's ephedra ban, and claims "great effectiveness" (which is false) and minimizes the side effects. Needs a major rewrite and is even potentially dangerous. MastCell 19:38, 15 February 2007 (UTC)
replies: text: I agree with the "questionable" things. However, are you referring to the "great effectiveness" of using pseudoephedrine or the ECA stack in general? —The preceding unsigned comment was added by Aturaten (talk • contribs) 00:30, 26 February 2007 (UTC)
replies: text: The article states there's a "great deal of evidence" that ECA is effective (without providing a reference, of course). I'm not aware of a great deal of evidence - there are a number of small, older studies looking at short-term weight loss. The largest meta-analysis of ephedra (not ECA) didn't find evidence that it was effective for long-term weight loss or performance enhancement. I'd just like to see a citation for this statement, because I'm not sure it's correct. MastCell 17:59, 26 February 2007 (UTC)
replies: text: Hey, I originally wrote the article.  Yes, I should've done a better job providing references, but everything I said was qualified in my references, though I failed to link them in any sort of organized fashion.  And yes, ephedrine by itself is ineffective for weight loss-- I don't think anyone ever disputed that.  The issue at hand is that EC or ECA have been in shown in large, long-term, well-designed studies to be effective.  The initial weight loss is very significant, via loss of water weight and appetite suppression, but after that it still has a thermogenic effect noted in multiple studies and will still prevent muscle catabolism to some degree.  To be sure, this article could use a rewrite, but the fact is EC/ECA has been shown to be clinically significant both short and long term, and one of the most effective tools for improving body composition, especially in combination with a diet and exercise program.  The pseudoephedrine reference was covered here on this discussion page though I suppose I should've listed it more formally; I could not get the full text of one study so I emailed the study's author and he replied with the information I cited above, which is that PSE has 1/3rd the thermogenic effect relative to E.  It is a greatly lesser effect, but I still felt it was worth noting and was interesting.  And yes, EC/ECA can have side effects and does have risks, most of which it also shares with the FDA-approved Meridia.  Ephedrine has minimal effects on dopamine but they have been specifically quantified in at least one rat study I read.  The part about it being a reuptake inhibitor applies likely to only massive doses, and probably should be deleted if it hasn't.  There are also other theories that current peripheral cAMP-based model for ephedrine's effectiveness are simply wrong and from rat data, and the only reason it's effective is central actions at the hypothalamus.  Regardless, after seeing some of that data, I'm not even really sure I can say with confidence how the ECA stack works; the mechanisms have only truly been shown in animal models to which humans respond differently (lack of BAT); selective beta-3 agonists haven't been tremendously successful.  However, I can say that ephedrine+caffeine in combination has been shown in studies both short and long term to be a very effective means of weight loss in humans with few noted adverse effects.  And the article should at least note that.  No, there haven't been any 6000-person studies published in the journal "Nature" over a 20-year time span, but I think EC/ECA has been studied in far more depth than most drugs do to gain FDA approval.  As to why EC/ECA is not a specific FDA approved process, the lack of an ability to patent it means that no pharmaceutical company could protect their investment in the research, thus there is little incentive to pursue something with a negative return on investment.  Anyway, this brick of text aside, I'm not sure I really want to rewrite the whole thing right now.  But if anyone else wants to, feel free.  —Preceding unsigned comment added by 69.146.16.67 (talk) 19:56, 10 December 2007 (UTC)
replies: text: Could you point me toward "large, long-term, well-designed studies" showing that EC or ECA is effective? MastCell Talk 21:38, 12 December 2007 (UTC)
replies: text: I don't understand why there is so much speculation regarding the efficacy of the ECA stack. Nothing is a miracle pill, but it can indeed be a *significant* aid in leaning out if you're going to eat right and exercise. As for your reseach studies, there have been a TON of them so I simply cannot believe you put any effort whatsoever into trying to find any of them if you are disputing the fact that numerous such studies have been done showing how well EC/ECA works under controlled circumstances. And who cares if there was 1 study showing that EC/ECA didn't help with long term weight loss because long term weight loss is a choice of lifestyle... of course some fat slob who is part of a study and is forced to eat right and exercise while using EC/ECA will lose weight and of course he/she is going to finish the study and have a high probability of pigging out on junk food soon after the study is over... DUH! Barring a serious medical condition, that's why fat people are fat to begin with. Anyways, here is a TINY PERCENTAGE of the research that has been done regarding EC/ECA showing it is effective... search through medical journals and you'll notice that there are LITERALLY A HUNDRED OR MORE of these studies, both experimental and theoretical:
1. Title: Effects of caffeine, ephedrine and their combination on time to exhaustion during high-intensity exercise. 
Author: Bell DG; Jacobs I; Zamecnik J 
Source: Eur J Appl Physiol, 77(5):427-33 1998 Apr 
2. Title: Safety and efficacy of long-term treatment with ephedrine, caffeine and an ephedrine/caffeine mixture. 
Author: Toubro S; Astrup AV; Breum L; Quaade F 
Source: Int J Obes Relat Metab Disord, 17 Suppl 1():S69-72 1993 Feb 
3. Title: Comparison of an ephedrine/caffeine combination and dexfenfluramine in the treatment of obesity. A double-blind multi-centre trial in general practice. 
Author: Breum L; Pedersen JK; Ahlstrøm F; Frimodt-Møller J 
Source: Int J Obes Relat Metab Disord, 18(2):99-103 1994 Feb 
4. Title: The acute and chronic effects of ephedrine/caffeine mixtures on energy expenditure and glucose metabolism in humans.
Author: Toubro S; Astrup A; Breum L; Quaade F 
Source: Int J Obes Relat Metab Disord, 17 Suppl 3():S73-7; discussion S82 1993 Dec 
5. Title: Thermogenic, metabolic, and cardiovascular responses to ephedrine and caffeine in man.
Author: Astrup A; Toubro S 
Source: Int J Obes Relat Metab Disord, 17 Suppl 1():S41-3 1993 Feb
6. Title: The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. 
Author: Astrup A; Breum L; Toubro S; Hein P; Quaade F 
Source: Int J Obes Relat Metab Disord, 16(4):269-77 1992 Apr 
7. Title: Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity.
Author: Daly PA; Krieger DR; Dulloo AG; Young JB; Landsberg L
Source: Int J Obes Relat Metab Disord, 17 Suppl 1():S73-8 1993 Feb  —Preceding unsigned comment added by 70.135.218.189 (talk) 03:19, 1 June 2008 (UTC)

text:  I spot-checked and it seems like it's true - there are indeed lots of studies demonstrating ECA is safe and effective at least in the short term. Unless somebody comes back with a raft of *specific* contrary studies, I see no reason to consider the question under dispute. Thus, I've started adding more specific citations to the main article. And since there doesn't seem to be an active dispute, I also removed the "dispute" tag. (The citation-needed tag is still necessary and appropriate, though. For now.) --Blogjack (talk) 01:59, 24 May 2009 (UTC)
thread_title:  Tags 

message: Themogenics is also the practice of deliberately exposing the body to very cold temperatures to raise Basal Metabolic Rate (BMR). This is usually done by soaking the body in icy cold water until a person can not tolerate it any longer almost to the point of inducing hypothermia. This then causes a release of thyroxine from the thyroid gland by means of the sympathetic nervous system thus raising BMR resulting in an overall increase in body temperature. The ancient Vikings used to practice this method of thermogenics. This method of thermogenics combinded with the ECA Stack mentioned above will produce a very powerful thermogenic responce. Dr CareBear 07:13, 12 July 2007 (UTC)
replies: text: Reliable sources? MastCell Talk 16:51, 12 July 2007 (UTC)
thread_title:  See this that I added to the Thermogenics article. 

message: Could someone please explain to me why aspirin is used in the stack in place of other NSAIDS/COX inhibitors such as Ibuprofen and acetominophen?  I realize that aspirin is an irreversible inhibitor of COX, and would mostly like work longer because more enzymes would have to be made to reverse its effects, but by the logic presented in the article, couldn't other reversible inhibitors contribute the same effect?  Would a regimen of aspirin staggered out with tylenol and ibuprofen increase the thermogenic effect? It is nearly impossible to find good information online, because everyone has their own anecdotal evidence with NO FACTS to ever back it up.  -wamerocity
:I will say only that acetaminophen is neither an NSAID nor a COX inhibitor. Beyond that, you might want to try the reference desk. MastCell Talk 00:45, 15 February 2009 (UTC)
replies: text: Well, ibuprofen doesn't "stress the liver"; its side-effect profile differs significantly from that of acetaminophen. Again, try the reference desk, or consider looking for a useful source for the article. MastCell Talk 18:32, 4 May 2009 (UTC)
thread_title:  Quick question 

message: What, exactly, is up for debate here?
What is lacking factual accuracy?
Greggor88 (talk) 16:56, 4 May 2009 (UTC)
thread_title:  Factual Accuracy? 

message: Check my math on this. the NEJM estimates 12 million Americans used Ephedra supplements in 1999. If the risk of any reportable adverse effect were as high as 1 in 10,000, we'd expect that much use to produce 1,200 adverse effects per year of which they expect ~15% would actually get reported to the FDA. So we'd expect to see 180 adverse events reported to the FDA per year. The actual number of adverse events recorded was 140 over 21 months = 80/year, suggesting my initial 1-in-10k estimate is too high by about a factor of 2.25. Thus, the chance of a reportable adverse event is closer to 1 in 22,500. ~20% of the actually reported adverse events resulted in death or permanent impairment, so the risk of death-or-disability is: 1 in 112,500, aka 0.0008%. And your risk of specifically being killed from taking ephedra supplement is half of that, or roughly equivalent to the risk of being hit in your home by a crashing airplane. Is that about right? --Blogjack (talk) 18:01, 4 August 2009 (UTC)
replies: text: As with your inadvertent advocacy for dexfenfluramine, you're either intentionally or mistakenly omitting significant context which undercuts your argument. The NEJM paper was published in 2000, and summarized reports to the FDA from 1999. Subsequently, in 2002, Metabolife was compelled by the Justice Dept to turn over their adverse-event files. As it happens, they had collected over 15,000 adverse event reports, ranging from insomnia to death, which they withheld from the FDA. So the calculations in the NEJM article were major underestimates, as Metabolife had short-circuited the FDA reporting process by intercepting adverse-event reports and suppressing them. Do the calculations again, if you'd like, using the real numbers.A more useful statistic is, of course, readily available - ephedra accounted for 64% of the herbal adverse events in the US, despite making up only 0.82% of herbal sales (). Ephedra was dramatically riskier than other herbal supplements, which themselves have very checkered safety records (cf. kava). If you're interested in what reliable sources have to say, and in accurately representing relevant context rather than cherry-picking numbers that are well-known to be outdated and erroneous, then let's talk. It would be a more useful way to go rather than simply using this platform to claim that ephedra is safe. MastCell Talk 22:43, 4 August 2009 (UTC)
replies: text: If House Report is accurate, Metabolife had 114 incidents that should have been reported to the FDA, including 3 new deaths, over 5 years. Reworking the figures as if the FDA saw all of those but leaving everything else the same produces an ephedra risk of "adverse events" of 1 in 13,592 (0.0073%) and ephedra risk of death of 1 in 285,068 (0.000035%) - so we're still in "hit by a crashing plane" territory. We may have to disagree on how useful the herbal supplement comparison stat is.But to take this back out of OR: what source do you recommend that you think accurately calculates the *actual* risk of death and risk of adverse effects of ECA in its various forms? In terms of probability, I mean. I found a dozen articles that say "we didn't find anything serious but can't exclude the possibility of 1-in-a-thousand risks". I also found articles about the FDA reports but most of them were innumerate, just counting deaths and bad outcomes but not looking at them in proportion to the number of users or the magnitude of their likely net consumer surplus. You clearly think the risk is substantial, but the sources you point to as evidence of this don't really bear that out as far as I can tell. I'd especially like to see a criticism from "the other side" of that huge 2008 Denmark case-control study. I do want to accurately represent relevant context and I really appreciate the sources you've provided so far. It's been informative and the article is already the better for it. --Blogjack (talk) 05:54, 6 August 2009 (UTC)
replies: text: Out of respect for the badly abused and battered talk page guidelines, let's agree to disagree, and go back to using this page for its intended purpose. You are free to take that as a complete and unmitigated concession to your correctness if it will move things along. I ask in return only that you read WP:NOT and cease using this page to advance your personal views on the safety of ephedra, and that we return to discussing reliable sources and their content rather than original research. MastCell Talk 04:23, 6 August 2009 (UTC)
thread_title:  How risky is ECA, exactly? 

message: How shall I express how infuriated I am with the changes you two have made to this article without compromising my reliability as an editor?
This is the article that I first laid eyes upon when I went in search of knowledge -- when I began researching ECA:
http://en.wikipedia.org/w/index.php?title=ECA_stack&diff=306630724&oldid=251342304
Look at the difference. You transformed an informative, well-written article into a page filled with legal information and a curt mention of ECA and its effects on the human body. You allowed your petty argument over the risks of ECA to utterly compromise your usefulness as editors and publishers of information that many people consult for knowledge. 
This article is barren. It isn't even two pages long. A first-time reader would look at it and think the following:
*I know what ECA stands for
*It could kill me
*It looks like it does it what it was designed for
*It's vaguely legal? I can't really tell.
Please note that I actually called a passerby to my office to ask his initial reactions to the article. Where are the mentions of its mechanism of effect? How about symptoms and side-effects? Common dosage? Is there anything remotely useful that can be gleaned from the current article?
In conclusion, I guess I can only express my disappointment. I have neither the skills nor the prestige to bring this article back to the useful page it used to be. I can only hope my words have some sort of impact. --Greggor88 (talk) 19:45, 24 August 2009 (UTC)
replies: text: That "article you first laid eyes on" was almost entirely composed of unreferenced claims that would require a lot of specialized knowledge to verify so I'm not surprised it got cleaned out and reset. If you've got info you'd like to add to the current version, be bold and add it! Especially if you can give a reference - any reference - to justify what you're adding. I agree the current article is a bit of a mess. I've been meaning to improve it, but I kind of got burned out on the subject after doing a lot of work just to establish that it "looks like it does it what it was designed for" in the face of opposition. FWIW, my research convinced me to try it; I've lost 15 lbs in 3 months so far. --Blogjack (talk) 22:02, 31 August 2009 (UTC)
replies: text: Thanks for the encouragement. I will get to work on the article as soon as I have some more free time. FWIW, my research (starting, but certainly not ending with the wiki page that I described) convinced me to also try it. I have lost 38lbs and 8% bodyfat since February by adding ECA, healthier foods, and running to my ordinary workout routine. Greggor88 (talk) 16:38, 2 September 2009 (UTC)
thread_title:  Disappointment 

message: The neutrality of this article is kind of botched. While I can say that the majority of articles out there will be politically correct, what about actual statistic for the folks who don't die instantly? Any article that has a "this is bad, mkay" approach will steer people who are going to do this regardless to an article that has no balanced information WITH warnings.  —Preceding unsigned comment added by 167.211.190.10 (talk) 21:15, 14 January 2011 (UTC)
thread_title:  Also Disappointed 

message: as to why even basic information such as the ratio of ingredients in the ECA stack (20 mg ephedrine/200 mg caffeine/325 mg aspirin) is neglected in the article?
No criticism intended, you guys work hard on these articles, just curious as to the sparsity of information.  —Preceding unsigned comment added by 69.227.94.182 (talk) 15:01, 11 September 2009 (UTC)
thread_title:  Just curious 

message: As promised long ago, I'm beginning work on this page. It will mostly consist of adding information, since the article is really quite barren. First order of business - information on the mechanism of action of the Ephedrine, Caffeine, and Aspirin combination in particular. I hope no one objects if I pull relevant data from the Ephedrine page, Caffeine page, and Aspirin page?
Greggor88 (talk) 19:53, 20 November 2009 (UTC)
thread_title:  Beginning to Edit 

message: One thing missing from this page is the status of the drug wrt WADA. I believe it is a banned stimulant, which is not mentioned!  — Preceding unsigned comment added by 178.111.197.37 (talk) 16:12, 5 January 2012 (UTC)
thread_title:  Athletic Performance 

message: Should there be a mention that Anders Breivik used this stuff to give him a bit of a buzz during his killings? See: http://www.bbc.co.uk/news/world-europe-18282760
:No. No there shouldn't. If we included every minor instance of somebody using X drug while doing Y, the articles for every drug would be a mile long. Greggor88 (talk) 00:40, 19 June 2012 (UTC)
thread_title:  Anders Breivik