Lose weight. Boost energy. Perform better. Those claims have cast ephedra in the spotlight of late. The buzz over this stimulating herb and its derivatives has raised questions over its safety, especially in the wake of last summer when three football players died after allegedly using ephedrine. None of the deaths was directly attributed to ephedra, but the headlines underscored the need to use dietary supplements with caution.
Herbal lore traces the use of ephedra back 5,000 years to China, where the stem of the almost leafless shrub – known by its Chinese handle “ma huang” – was used to treat colds, asthma and hay fever. The plant, which thrives in sunny, dry climates, is also found in the southwestern United States. Native Americans introduced the powder brewed in hot water to the Mormons when they arrived in Utah in 1847. The piney-tasting drink came to be known as Mormon tea, substituted for the taboo coffee and black tea. In the Old West, ephedra was even reputed to cure syphilis and gonorrhea, making it a popular brothel beverage: “Whorehouse tea.”
In modern times, natural ephedra alkaloids and their laboratory counterparts have been used to treat asthma, emphysema, colds, allergies, arthritis and rheumatism. They’ve been packaged in a smorgasbord of over-the-counter products marketed to aid weight loss, increase energy, enhance performance and even stop smoking. On the illicit end, ephedra has been used to manufacture methamphetamine, which goes by the street names Crystal, Ice and Meth.
Ephedra products used by some 12 million Americans rank among the most lucrative and controversial of dietary supplements. Ephedrine and pseudoephedrine, the herb’s two primary active ingredients, resemble adrenaline in the way they stimulate the nervous system. The alkaloids relieve swelling of the mucous membrane and open the bronchial passages, making a variety of over-the-counter cold and allergy medications containing ephedra alkaloids or ma huang the natural decongestant and antihistamine of choice for many.
Simple side effects of ephedra in any form include increased urination and dry mouth. The ephedra alkaloids also suppress appetite and speed metabolism, causing the body to burn calories faster. That trait has made ma huang an attractive weight-loss shortcut in a nation where 40 million adults are obese, though health experts maintain that the herb is a poor substitute for the tried-and-true formula of reduced caloric intake and regular aerobic exercise. One study suggests that ephedra alkaloids can suppress nicotine urges, a plus for those who want to quit smoking. But no evidence – other than folklore – exists to support the myth that Whorehouse tea cures sexually transmitted diseases.
Energy products employ the ephedra alkaloids – often combined with caffeine – to provide an energy jolt comparable to drinking a six-pack of Mountain Dew. Bodybuilders claim the products help them lift harder and longer. Other users also report sustained stamina along with heightened intensity, alertness and perception. While that appeals to athletes from football players to figure skaters, they should be forewarned that the National Collegiate Athletic Association, United States Olympic Committee and National Football League (among other athletic governing bodies) have banned ephedra products for the competitive edge they provide and the risk they pose to those ingesting them.
While ephedra is generally considered safe when used by healthy adults (in moderate amounts and for a limited period of time), it can cause adverse effects ranging from headaches, dizziness, insomnia, anxiety and tremulousness to strokes, heart attacks, psychosis, seizures and death.
An article published in the December 21, 2000, New England Journal of Medicine (NEJM) reported the results from a study involving 140 adverse events occurring from the use of dietary supplements containing ephedra alkaloids, including 13 cases of permanent disability and 10 deaths. The authors concluded, “The use of dietary supplements that contain ephedra alkaloids poses a serious health risk to some persons.”
Since 1997, the Food and Drug Administration (FDA) has sought to impose tighter controls on ephedra products, limiting the legal dose to 8 milligrams and restricting the 24-hour maximum intake to 24 mg, well below the American Herbal Product Association’s limit of 25 mg per serving with daily consumption not to exceed 100 mg. The FDA also wants to ban the marriage of ephedra and caffeine because the combination has a synergistic effect believed to increase the incidence of adverse reactions. The FDA also seeks to outlaw labeling claims that ephedra products can cause weight loss.
Meanwhile, the Ephedra Education Council reported in November 2001 that two studies by separate researchers confirm that ephedra is safe and effective for weight loss when consumed and used as directed. “This research is the latest in a series of clinical studies that support the safety of ephedra at a time when there is no clinical research linking dietary supplements containing ephedra to significant adverse events,” said Wes Siegner, spokesperson for the Ephedra Education Council. “While longer-term studies ultimately will be more conclusive, the findings of these clinical trials continue to confirm ephedra’s safety.”
Yet, the FDA asserts it has on file reports of more than 1,200 adverse events – including 70 deaths – associated with the use of ephedra-laced products. Of particular sobering note, the FDA has found in reviewing those adverse events that “most occurred in young to middle-aged otherwise healthy adults using the products for weight control and increased energy.”
Christine Haller, M.D., and Neal Benowitz, M.D., authors of the NEJM report, likewise frown upon ma huang. They point out that it is rarely prescribed by Western physicians for medical purposes and, unlike vitamins and minerals, it is not essential to proper nutrition. They find even the purported benefits negligible. “People who take these products to increase their exercise capacity or to lose weight place themselves at risk without a substantial likelihood of benefit,” the authors write.
Concerns over ephedra’s safety have rendered the herb illegal in Nebraska and have restricted sales in Texas to those 18 or older. Elsewhere, consumers are left to their own judgment. Regarding purchase and use of the ancient Chinese herb, the Latin wisdom seems appropriate: caveat emptor (buyer beware).
- Since the herb causes uterine contractions, it is not recommended for pregnant women. Also, those with high blood pressure risk serious adverse effects from ephedra alkaloids.
- The American Herbal Products Association recommends no one under the age of 18 use products containing ephedrine or pseudoephedrine. To avoid passing along ma huang to infants, women should suspend use during the months they’re nursing.
- Anyone with heart disease, diabetes, glaucoma or an overactive thyroid gland would be wise to consult a physician before experimenting with ma huang. Likewise, if using any prescription medication or an over-the-counter product to treat allergy symptoms, asthma or colds, talk to your doctor first.
- To be safe, if the use of ephedra causes insomnia, nervousness, stomach upset, heart palpitations or general weakness, cease use and call a physician.
It’s in There!
Here’s just a sampling of products containing natural ephedra or similar synthetic compounds: Ripped Force, Ripped Fuel, Ultimate Orange, Sudafed, Metabolife 356, Shape-Fast Plus, Herbalife’s Thermojetics, Total Control, Purple Blast, Diet Fuel, Diet Phen, Magic Herb, and Herbal Phen-Fen (a combination of ephedra and St. John’s Wort).
MedWatch, the FDA medical products reporting program: www.fda.gov/medwatch
Ephedra Education Council: www.ephedrafacts.com
The New England Journal of Medicine: http://content.nejm.org