Ephedra

Claims, Benefits: Causes weight loss, builds muscle, improves athletic performance.

Bottom Line: This is a form of the active ingredient used in many decongestants and asthma drugs. It raises heart rate and blood pressure, and is dangerous for those with high blood pressure, heart disease, or diabetes. It should be banned. Numerous alternatives are now being used in supplements—they may not be safer than ephedra.

Full article, Wellness Letter, May 2003:

The Ephedra Effect

In March federal officials finally proposed putting warning labels on dietary supplements containing ephedra. This happened a week after the death of 23-year-old pitcher Steve Bechler, who was using a weight-loss aid containing ephedra when he died during spring training. The government’s action is too little and very late.

The proposed label will warn that heart attacks, strokes, seizures, and deaths "have been reported" after consumption of ephedra. That’s not going to deter many people, I’m afraid. Ephedra is a huge business; it’s in countless dietary supplements promoted to reduce weight, boost energy, and improve athletic performance. The government will forbid claims that the herb builds muscle or improves athletic performance, but claims about weight loss will continue, though there’s no evidence that ephedra produces long-term weight loss.

Researchers have known for years about the dangers of ephedra, which contains the chemical ephedrine. The latter was used as an asthma drug until the early 1980s, when doctors stopped prescribing it because of its dangerous effects on the heart and blood pressure. The synthetic form of another ephedra ingredient, pseudoephedrine, is still used in many over-the-counter decongestants, which carry strong warning labels and are meant for only short-term use.

The Wellness Letter first warned readers not to take ephedra (also called ma huang) in 1994. Though especially risky for people who have high blood pressure and cardiovascular disease, this herbal stimulant can cause serious reactions in even apparently healthy young people. It’s often combined with other stimulants, such as caffeine, which can amplify the herb’s effects and increase the dangers. Such products have been linked to about 100 deaths, including many young athletes, and 1,500 reports of serious health problems. That’s just the tip of the iceberg, since it’s estimated that only 1% of adverse effects are reported. A recent study found that ephedra was responsible for a whopping 64% of all herb-related reports to poison control centers in 2001.

The FDA has been trying—unsuccessfully—to restrict the use of ephedra for more than seven years. It has been blocked by the powerful supplements industry and its political allies. The main problem is that the agency has had little effective control over supplements since 1994, when Congress passed the Dietary Supplement Health and Education Act, which requires the FDA to prove a supplement is a public danger before ordering it off the market. As the ephedra story shows, this is very hard to do. If, despite the overwhelming evidence, the FDA can’t remove ephedra from the shelves, it probably can’t safeguard us against any dangerous supplement. In contrast, the Canadian government acted against many ephedra supplements last year.

Ephedra should be banned now. And the law should be changed so that all supplements can be properly regulated.

UC Berkeley Wellness Letter, May 2003

Full article, Wellness Letter, October 2003:

Beyond Ephedra

Weight-loss products containing the herb ephedra, also called ma huang, may soon be required by the government to carry a warning label about its potential serious side effects (heart attacks, seizures, and strokes), as we reported in May. California already requires such labels and is considering legislation to ban ephedra. Thus, manufacturers are hastening to put alternatives on the market. If you’ve been in a health-food store lately, you’ve probably seen racks of products labeled "ephedra-free." Some of the alternative ingredients are chemically similar to ephedra, some quite different. What they have in common is that nobody knows if they really promote weight loss or are safe. It would require a catalog to list them all, but here’s a sampling:

Green tea extract: Because of its high caffeine content, as well as its polyphenols, this might (at least in theory) speed up calorie-burning. But while green tea is a healthy drink, high doses of the extract may cause nervousness, insomnia, and restlessness.

Bitter orange extract: Also called Citrus aurantium, this is derived from the rind of Seville oranges. It contains synephrine, which is similar to the potent chemical in ephedra. Presumably it acts like ephedra and speeds up calorie-burning, but it may also raise blood pressure and heart rate. Another of its ingredients is methyltyramine, also known to raise blood pressure. Don’t take it.

DMAE (dimethylaminoethanol): Once sold as a prescription drug (Deanol) for the treatment of learning difficulties, it was taken off the market because of insufficient evidence that it worked. Yet it’s allowed in supplements. It is known to raise blood pressure and cause insomnia.

To add to the confusion, there are other products or ingredients that contain ephedra or relatives of it, though you wouldn’t know from the labels. For instance, Sida cordifolia (country mallow) supplies ephedra compounds. Mormon Tea and Desert Tea are actually types of ephedra. Ephedra itself is broken down in the body to norephedrine: some supplements contain this rather than ephedra. Its supporters claim it’s safer than ephedra, but norephedrine may actually be worse. A citizens’ group has asked the FDA to take action against products containing such compounds.

And then there are products that combine many of the ingredients mentioned above for a stronger wallop—and thus increased risks. Some manufacturers also add other herbs, such as guarana, yerba mate, and kola nut (all high in caffeine). Then there are a range of products that purport to stimulate the thyroid. It’s risky to take anything that might boost thyroid hormones, and the FDA has seized some of these supplements.

And by the way: Ephedra itself has hardly vanished. According to the New York Times, many doctors are now selling ephedra and other such supplements to their patients. This is not illegal—only unethical. If your doctor sells supplements, we advise you to find another doctor. Avoid ephedra and its alternatives. They are unproven and possibly dangerous ways to try to shed a few pounds.

UC Berkeley Wellness Letter, October 2003