According to the paper published in the Swedish medical journal Läkartidningen, a healthy 53-year-old woman without risk factors for vascular disease suffered a cerebral haemorrhage after taking Jacked Power, an own brand product of Swedish retailer MM Sports. Jacked Power's ingredient list included β-phenylethylamine and its derivative N,N-dimethyl-phenylethylamine, substances which were structurally very similar to amphetamine, the doctors said.
The Swedish National Food Agency (NFA) and its regional authorities have launched an investigation into the product and its implicated ingredients – and to establish whether it is still on sale elsewhere. In their warning, they urged consumers to turn any tubs already purchased in to their local pharmacy or return them to the retailer.
The product has already been withdrawn voluntarily by MM Sports. Talking with NutraIngredients, Petra Bergkvist, government inspector for the NFA’s control support division, said: “This product is not, as far as we know, available in Sweden, so we can’t say that it has been banned. If we had found it [on the market] we would have banned it, but it had already been voluntarily removed.”
MM Sports confirmed it was no longer selling the product. "The product has not been sold for about six months, we did not at that time know about this report."
It added that it had had contact with the Swedish authorities when the medical report first came out two weeks ago, but had not had any contact with the doctors or the patient herself.
According to recent reports from the Swedish press, the woman who suffered the stroke during a training session back in January is now recovering from a sensory and motor loss in her left arm and hand, although she is not yet back at work.
The woman had never previously taken the product nor any other similar supplements. She is said to have taken the recommended dose of 13 g – which contained about three times more caffeine than a cup of coffee.
MM Sports said: "If there was a risk it is strange that we did not get the info when it happened."
Adding it was hard for it to comment on the medical report since it was not, "conclusive that it was the product".
Molecule by molecule
Bergkvist said the Swedish Parliament had already made the decision to add the highly contentious DMAA, another amphetamine-like substance included in the past in pre work out supplements, to its banned list.
“Still, phenylethylamine is not added to the list, as this is not one substance, but a range of chemically resembling substances. Some of those substances are suspected to be slowly metabolised in the body and yielding negative health effects, connected to the effects of amphetamine.”
However, she said some of its other substances were structurally “more simple”, and even naturally occurring in cocoa.
“Thus, the ban on the group of phenylethylamines has to be taken more or less molecule by molecule.”
She said this posed a challenge in barring potentially dangerous substances quickly.
Adding: “There are some people who are always keen to develop new substances that yield high effects when used by athletics, but the people developing the substances are reckless regarding the health hazard the products might exert.”
She said the legislation regulating these substances could not be “synchronised” with this development, yet added newly developed chemical substances generally came under EU novel food laws which required pre-market approval.
MM Sports said different phenylethylamines had been around for more than 10 years in the EU and US with no negative reports to its knowledge.
"What we can say is that we don’t have different phenylethylamines in our products anymore."
The retailer said there were no question marks about any of its other EU-manufactured Jacked products, which were, "safe and approved for sale".
Control authorities in Gothenburg, Stockholm and Malmö are still investigating Jacked Power and its sale. Since control responsibilities are devolved in Sweden, it is not possible to impose a country-wide ban on products. Instead, local authorities must investigate and decide individually, with information being shared on a centralised website, Bergkvist said.
Suspect substances
She said as far as she was aware this was the first reported case of problems with these substances, although similar issues with the much debated DMAA, otherwise known as methylhexanamine or 1,3-dimethylamylamine, had arisen in the past.
DMAA, now banned by Swedish authorities, was linked to the death of a London marathon runner last year, according to the coroner’s report. New Zealand and Hawaiian authorities also reported similar cases of liver problems and fatalities.
Jack3d, a similarly named but different pre-workout product, as well as Craze, were mentioned in the medical report as examples of when suspicions had been raised about the relationship between amphetamine-like substances in sports nutrition and incidences of strokes and heart attacks.
Owned by US firm USPlabs, Jack3d is an entirely different brand to Jacked Power, the latter of which has been a registered trademark for over five years.
Regarding this specific case, USPlabs’s legal representative told NutraIngredients it had, “no knowledge of this product whatsoever”, other than it appeared to be manufactured by a company by the name of MM Sports, which had no connection with USPlabs.
However, Rickard Zeijlon, one of the doctors who treated the woman and author of the report, told us that paradoxically a 'notorious' reputation directly or by association may appeal to some regular consumers of these products, with this culture often being demonstrated in forum discussions on how to get hold of outlawed products and substances.
Jacked Power also contained amino acid taurine, which the medical report said had been linked in recent years through its inclusion in some energy drinks to possible harmful effects to the heart and kidneys and as a suspected, but not proven, cause of seizures and even death.