(Cox News Service) -- A preliminary finding by a Florida medical examiner Tuesday linked a dietary pill containing ephedra to the death of Baltimore Orioles pitcher Steve Bechler.

The determination comes as the diet supplements face their greatest challenge from government health authorities.

Bechler, 23, had been taking Xenadrine, an over-the-counter drug containing ephedra, which has been linked to heatstroke and heart trouble, Dr. Joshua Perper said.

Bechler died Monday in Fort Lauderdale, Fla., less than 24 hours after a spring training workout sent his temperature to 108.

Products that contain ephedra may be banned by the government after an independent safety review panel releases its findings, expected in March or April. If the report, ordered by the Bush administration, finds the products to be hazardous, the Department of Health and Human Services could initiate taking them off the market.

If that happens, it would be the first time the federal government will have limited or banned a dietary supplement under the 1994 Dietary Supplements Health and Education Act.

Unlike prescription drugs, dietary, herbal and vitamin supplements are not required by the U.S. Food and Drug Administration to undergo rigorous scientific studies to prove efficacy and safety.

Ephedra, however, is the subject of a thorough independent investigation by the Rand Corp., after thousands of consumer complaints of adverse health effects were reviewed by the FDA.

A stimulant derived from the herb ma huang, ephedra initially was used in Chinese medicine for respiratory problems. Ephedra supplements became widely popular in the 1990s among dieters, bodybuilders and athletes. The stimulants rev up the body's metabolism and nervous system, which can promote weight loss, enhance athletic performance and help define muscles.

Many of the supplements also contain caffeine, and doctors say the combination can lead to serious side effects, including heart attacks, strokes and even death. The FDA says dietary products containing ephedra have been linked to 80 deaths and 1,500 reports of health problems, including hallucinations, seizures, and high blood pressure.

Over the years, many organizations, including the American Medical Association and the Public Citizen Health Research Group, have called for the ban of such products.

However, manufacturers of the dietary supplements have long insisted their products are safe and effective for weight loss.

The Ephedra Education Council, an organization founded by ephedra makers, says no clinical study has yet to prove that ephedra causes any adverse health effects. The council's Web site (www.ephedrafacts.com) cites at least 55 studies that it says proves ephedra's safety when it is taken as directed.

The dietary supplement industry estimates that 15 million to 17 million Americans use ephedra products, and about 3 billion doses are sold each year.

Some stores have banned ephedra products or allow them to be sold only in asthma, allergy and cold remedies. General Nutrition Centers, the nation's largest retailer of dietary supplements, requires customers be at least 18 to buy.

Use of ephedra by athletes has been banned by the NCAA, the NFL and the International Olympic Committee, but not by Major League Baseball.

"Because of collective bargaining, Major League Baseball doesn't test for ephedra and they don't ban it," said Dr. Gary Wadler, a sports physician at the New York University School of Medicine and expert on performance-enhancing drugs. "It should not be available as a dietary supplement. We know that people who take it don't take it in recommended dosages and the risk of seizure, stroke and death is just too great."

Copyright 2003 Cox News Service. All rights reserved.