Ephedra, Ma Huang, safety and risks

Ephedra (also known as Ma huang, Chinese Ephedra and epitonin) appears to pose a real risk of heart attack and other serious and even deadly complications in people who use it, researchers say. Ephedrin is a popular ingredient in herbal weight loss products.

Ephedra is an herb used for centuries in China. In the United States, it has become a common ingredient in numerous dietary supplements.

Ephedra works by stimulating the central nervous system, much like adrenaline and caffeine. Advocates say the herb can help people lose weight. Products containing ephedra also are marketed to athletes as energy boosters.

Products containing the herb have become very popular and now include everything from capsules to powders to energy bars. Products containing ephedra have names like "Diet Pep," "Ripped Force," "Ripped Fuel" and "ThermoSlim." Some of the most popular brands are made by the Metabolife company. (See the list of products containing ephedra.)

Medical experts suggest that the stimulant can raise blood pressure and heart rate, cause vomiting, heart palpitations, dizziness, nervousness and more serious reactions, including heart attacks, seizures and strokes.

U.S. FDA has said that between 1997 and 1999 it had received 140 reports of illness or death linked to ephedra alkaloids. Since then, the agency has gotten another 103 such reports, but those haven't been investigated.

The FDA had asked researchers at the University of California at San Francisco to evaluate the 140 cases of suspected adverse events.

Dr. Christine Haller, a UCSF toxicologist and lead author of the study said that he recommend that people not take this herbal product due to the serious risk of complications and minimal benefit to offset it.

Of the 140 incidents, 31 percent were "definitely or probably" the result of ephedra, the researchers claim, accounting for five cases of cardiac arrest, four strokes and three deaths. An additional 31 percent were "possibly" tied to the compound.

Taken together, these two groups accounted for 10 deaths and more than a dozen cases of permanently disabling injuries. Ephedra was also implicated in high blood pressure, abnormal heart rhythms, seizures and palpitations.

For some time the jury was on out on the safety of ephedra especially when used as a weight loss supplement or as a stimulant. In June 1997, the FDA proposed a rule that would have limited the amount of ephedra that could be added to dietary supplements to 8 milligrams. It would also have put warning labels on the products cautioning against taking them for more than a week, and advising consumers not to combine them with other stimulants. On strong criticism from the General Accounting Office (GAO), that the agency needed more evidence before it can conclude that the herbal therapy was truly dangerous. FDA later retracted the dosage recommendation. However, it has kept the warning against mixing ephedrine with other stimulants.

Not everyone shares the opinion that ephedra is dangerous. The Council for Responsible Nutrition, a trade group, believes that ephedra is both effective and safe. They cite a new report by Harvard and Columbia University researchers showing that people who took a combination of 90 milligrams of ephedra and caffeine lost more weight -- but had no more adverse events -- than those who took placebo.

American Herbal Products Association and the Consumer Healthcare Products Association, wants FDA to require that the supplements with ephedra carry warning labels cautioning its use only by people over 18. They want the use of ephedra be limited to no more than 25 milligrams per serving.

The proposed label also warns against mixing ephedra products with prescription drugs, as well as nonprescription drugs containing PPA, a chemical common in diet pills and cold remedies. PPA has been implicated in stroke risks.

Related Topic: Products Containing Ephedra

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