Natural Causes Ruled Out in Girl’s Death

A coroner Friday ruled out natural causes for the massive heart attack that killed a 15-year-old Fillmore girl, and is seeking further tests to determine whether an over-the-counter energy booster played a role.

In a case that has drawn attention from national and state regulators, Rosanna Porras collapsed on the soccer field last week after ingesting a herbal supplement called Ripped Fuel. She died three days later.

The Fillmore High class president had taken the pills in the week before her death, and undissolved capsules were found in her stomach the day she collapsed.

Medical examiners will send tissue samples from Rosanna’s heart to Boston, where officials connected a young weight lifter’s death last year to a liquid form of the herbal supplement product.

A microscopic analysis of Rosanna’s heart tissues indicated massive damage to the heart muscle, said Larry Gillespie, a Santa Barbara County deputy coroner who is handling the case because she died in a hospital there.

“It appears as though the damage occurred days before she collapsed on the field,” Gillespie said. “There is essentially no other explanation, or good explanation, for a massive heart attack of this severity in a 15-year-old other than something like this product or the drug in this product.”

The energy booster contains ephedrine, a stimulant found in everything from cold medicine to illegal methamphetamine.

Twinlab, the Hauppauge, N.Y., company that manufactures the product, on Friday defended its safety.

“We do not believe Ripped Fuel had any role in this tragic occurrence,” company President Ross Blechman said in a press release.

“Ripped Fuel has a long history of safe use as a dietary supplement when taken as labeled, as part of a low-fat, low-calorie diet and exercise program to help preserve lean body mass,” Blechman said. “Millions of servings have been used by consumers for years.”

The coroner’s analysis indicated Rosanna’s heart did not have any preexisting congenital diseases, inflammation, viral infections or any other diseases related to the heart, Gillespie said. Earlier tests found no signs of other drugs in her system.

Also, Gillespie found no evidence that Rosanna’s death was connected to the single most common disease that researchers link to sudden death in young athletes--hypertrophic cardiomyopathy, a genetically transmitted heart muscle disease.

Gillespie will send Rosanna’s heart tissues to the Massachusetts chief medical examiner’s office for comparison with tissue from the weightlifter’s heart.

“We have been contacted by the Food and Drug Administration to assist in a consultative way the investigation that is underway in Santa Barbara County,” said Mark Fairbank, spokesman for the office.

“It is my understanding the FDA may have even more of these types of cases,” Fairbank said.

The Massachusetts chief medical examiner is expected to report the findings within two to three weeks.

“The ages are different, but if the history is consistent then we will be able to make that connection to the link we’ve been talking about between Ripped Fuel and this young lady’s death,” Gillespie said.

Blood Samples to Be Sent to Washington

Rosanna’s blood samples will be sent to the National Medical Laboratory in Washington for analysis because its instruments are more sensitive than those in Santa Barbara, Gillespie said. Results are expected within two weeks.

“I am concerned that they might not find any of the drug in her system, especially if she took the capsules only minutes or hours before she started playing soccer because her system wouldn’t have had a chance to fully absorb it,” Gillespie said.

“A positive toxicology for ephedrine would greatly assist our ultimate determination and conclusion, but if things match as far as the Boston case--it would be a plus on our side that there is a connection,” he said.

Along with FDA officials, Gillespie is contacting other coroners nationwide to determine whether there are other cases in addition to the Boston death. If so, Gillespie intends to involve those coroners in the investigation.

“But if the Boston case is the only one that appears to be truly connected, then obviously that’s our only hope,” he said. “I don’t know that we’re going to hang our hat on the Boston case or just the toxicological report or both. We’re virtually going to explore every avenue and see what we can find out.”

FDA and state poison control officials have already informed Gillespie of several other cases that may be either directly connected to Ripped Fuel or similar products that contain ephedrine, but coroners in those cases have not conclusively connected the drug to the deaths.

“There is a lot of technical data on this and I think we can make the connection and I honestly think that there is a connection,” Gillespie said. “It’s just a matter of being able to substantiate it as best we can.”

Rosanna’s father, Henry Porras, has vowed to take the company to court if the tests indicate the pills were at fault.

“To find out there was no preexisting heart condition or damage--I just feel anger inside of me now,” Porras said. “I am so angry that the company does not adequately warn people.

“And who the heck can read those labels and be able to know whether it is safe or not,” said the mathematician and software developer who works at Point Mugu Naval Base. “I feel like my insides are just empty now.”

Porras was not, however, surprised by the results.

“She was very healthy . . . she was just such an active go-getter, I knew there was nothing wrong with her,” he said.

Questions Persist on Safety of Ephedrine

Twinlab President Blechman said a “serving” of Ripped Fuel “contains 20 milligrams of ephedra alkaloids, much less than in many products millions of consumers have purchased over the counter in drug stores and food stores for many years.”

Many common cold and allergy remedies have ephedrine or its synthetic counterpart, pseudo-ephedrine, as a key active ingredient.

Even so, questions on the safety of ephedrine persist.

“Ninety percent of the people who smoke will never get cancer but does that mean tobacco is safe?” said Chris Grell, a San Francisco attorney who has sued several marketers of herbal remedies and dietary supplements, including Twinlab. “Most of the people who do illegal drugs don’t have heart attacks or die. Does that mean cocaine is safe?”

Grell, whose wife died six years ago after treating herself with a herbal diet tea, suggested many doctors don’t know enough about herbal ingredients to recognize their side effects.

“There are a lot of people out there who are adversely affected by products and are not aware of it,” he said. “Even their doctors don’t know enough to make the necessary causal connections.”

Even so, ephedrine products “have been around forever,” said Dr. Steven B. Karch, a cardiac pathologist who consults for Twinlab.

“They were the mainline medicine for asthma in the 1920s and ‘30s,” he said. “Amphetamine was invented so there would be enough to go around.”

Such widespread use has yielded only three cases published in scientific journals of conclusive links between ephedrine and heart disease, according to Karch. “Each one of them was taking more than 2,000 milligrams a day and had been for a number of years,” he said.

Rosanna’s death will be included in a study being conducted by the state Department of Poison Control in San Francisco, which is collecting data about adverse effects of herbal dietary supplements during 1998.

“This includes all herbal products available, such as performance enhancing supplements, St. John’s Wort, echinacea, ma huang [the Chinese herb that yields ephedrine],” said Dr. Christine Haller of the poison control department.

Although the FDA has some information on the adverse effects of some unregulated herbal supplements, it has not been published in a peer-reviewed journal, Haller said.

“This case concerns us because these types of products seem to be used quite widely among athletes, particularly adolescent athletes,” Haller said.

The combination of ephedrine with another herb in Ripped Fuel called guarana, which is a caffeine extract, seems to be particularly problematic, Haller said.

If test results ultimately indicate Ripped Fuel was the culprit in Rosanna’s death, poison control officials will issue a public alert that the product may be dangerous.

“As a poison control center our role is information providing,” Haller said. “We don’t have the authority to have products removed from the shelf, but we certainly would get the word out through many avenues about the dangers of this product in particular.”

Hobbs is a Times correspondent and Chawkins is a staff writer.