ECA stack
Encyclopedia
The ECA stack is a drug combination used in weight loss and as a stimulant
. ECA is an acronym for ephedrine
, caffeine
, and aspirin
, with variants of it including the EC stack, which removes the aspirin for those that can not tolerate it. Dietary supplements based on or including elements of ECA were popular through the 1990s and early 2000's, 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.
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." A more recent (2008) case-crossover study that focused on the alleged cardiovascular risks concluded that "prescription of an ephedrine/caffeine product was not associated with adverse cardiovascular outcomes. This was found across a wide range of patient subgroups, different cardiovascular outcomes, different assumptions about exposure, and different utilization patterns. "
manufacture, many countries have taken steps to regulate these products.
. 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.
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.
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
. ECA is an acronym for ephedrine
Ephedrine
Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....
, caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, and aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
, with variants of it including the EC stack, which removes the aspirin for those that can not tolerate it. Dietary supplements based on or including elements of ECA were popular through the 1990s and early 2000's, but the marketing of ephedra- or ephedrine-containing stimulant combinations for weight loss and bodybuilding is now restricted or illegal in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
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.Mechanism
Ephedrine-caffeine stimulates noradrenaline secretion, which then stimulates activity of cyclic AMP. Caffeine inhibits phosphodiesterase, the enzyme that metabolizes cyclic AMP, and thereby enhances noradrenaline. Aspirin enhances noradrenaline activity by inhibiting adenosine, which is involved in noradrenaline inactivation.Athletic Performance
One marketing claim made for the ECA stack was that it would increase athletic performance. Studies in the medical literature generally support this claim. While a wide degree of variability exists as to the specific effects seen, preparations containing all three ingredients in the proper dosages have all shown positive effects on increasing workload and decreasing perceived exertion.. Experts recommend taking a one week 'washout period' following ECA cycles. Obviously research exists which suggests no to little benefit, but these are generally done with subjects who have already built up a tolerance to stimulants through the use of caffeine and/or caffeinated beverages. To be successful, a washout week should contain no caffeine or ephedrine of any form in order to achieve best results.Risks
"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 . 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 proven.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." A more recent (2008) case-crossover study that focused on the alleged cardiovascular risks concluded that "prescription of an ephedrine/caffeine product was not associated with adverse cardiovascular outcomes. This was found across a wide range of patient subgroups, different cardiovascular outcomes, different assumptions about exposure, and different utilization patterns. "
Use in Denmark
An EC formulation called Letigen which combined 20 mg of synthetic ephedrine and 200 mg of caffeine (recommended dose: 1-3 pills per day depending on user tolerance) was approved for sale by prescription in Denmark in 1990. During the peak of its use (in 1999) roughly 2% of the Danish population was using it.. 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.Legal status
Due to deaths linked to ephedra-containing dietary supplements and the potential use of ephedrine as a precursor in illegal methamphetamineMethamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
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 supplementDietary supplement
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...
. In 2004, ephedra
Ephedra
Ephedra refers to the plant Ephedra sinica. E. sinica, known in Chinese as ma huang , has been used in traditional Chinese medicine for 5,000 years for the treatment of asthma and hay fever, as well as for the common cold...
, 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 CanadaHealth Canada
Health Canada is the department of the government of Canada with responsibility for national public health.The current Minister of Health is Leona Aglukkaq, a Conservative Member of Parliament appointed to the position by Prime Minister Stephen Harper.-Branches, regions and agencies: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.