Ephedra: Herbal Wonder or Worry?

Since attracting the attention of Texas health authorities in December 1993, ephedra sinica, an herb with amphetamine-like qualities and notorious side effects, has taken hits in The Wall Street Journal and Ladies' Home Journal alike. It's the herb people love to hate — but not enough to stop buying it.

Traditionally used by Chinese herbalists to treat respiratory infections, asthma and hay fever, ephedra, also known as ma huang, undoubtedly works. The German Commission E, a respected government agency, recommends it for respiratory tract diseases with mild bronchospasms. Ephedra's most active ingredient, ephedrine, is a central nervous system stimulant that dilates bronchial muscles and contracts mucous linings in the nose. Isolated at the turn of the century, it quickly became the primary treatment for asthma. Today it crops up in common over-the-counter decongestants and antihistamines.

The adrenaline-mimicking qualities that make ephedra ideal for asthma also make it an attractive weight-loss supplement. In addition to opening the bronchi, it suppresses appetite and speeds up metabolism. Caffeine is often added to these weight-loss products to heighten the effect.

What Price Stimulus?
The question isn't whether ephedra works, but whether it's safe. The US Food and Drug Administration (FDA) came down hard on ephedra after more than 900 adverse events — from headaches to a fatal heart attack — were reported among people using ephedra products. The FDA is being taken to task for overstating the problems. In the meantime, federal hearings are being held, new dosages proposed and warning labels rewritten.

Much like caffeine, ephedrine triggers the heart-pounding sensation commonly felt before public speaking. It may also cause headache, insomnia or heart palpitations. And that's if you're healthy. If you're taking asthma medications, have heart disease, glaucoma, diabetes or other health problems, ephedra may raise your blood pressure or set off a cardiac arrhythmia.

"People who use ephedra can expect increased heart rate, some elevation in blood pressure and some wakefulness," concedes Carlo Calabrese, ND, MPH, product development manager at Rexall Sundown, which markets an ephedra weight-loss product. Sensitivity can be hard to predict. A recent study published in Obesity Research (1999, vol. 7, sup. 1) compared an ephedra-guarana weight-loss product to placebo. The ephedra product worked, "but that's not the interesting part," says Anthony Almada, president and chief science officer of Imaginutrition, a natural products consulting group in Aptos, Calif. "Twenty percent of the 100 people in the study dropped out because they couldn't handle ephedra," he says. "That has a huge impact on a study."

It gets more complicated in the real world. Theodore M. Farber, PhD, a toxicologist and risk assessment expert, reviewed for a group of ephedra manufacturers the FDA's collection of adverse events reports. What's clear from the 900-odd incidents, he says, is that many people are misusing ephedra.

Most who reported side effects "had hypertension, were diabetic, had a family history of heart disease or were taking other medications," says Farber. "One person was taking 85 pills a day."

Assess Your Risk
Don't become an FDA statistic. If you're considering taking ephedra, treat it as you would any other new diet plan and consult your doctor first.

"When used properly, under the supervision of a clinician, ephedra is very safe and very effective," says Jane Guiltinan, ND, dean of clinical affairs at Bastyr University. "Supplements are not the best way to help someone lose weight," she says, "but I would use ephedra short-term to help someone get over a hump."

"If you use ephedra for longer than seven days," writes Varro Tyler, PhD, herb expert and author of Tyler's Honest Herbal (The Haworth Herbal Press), in the September 2000 issue of Prevention, "do so only under the close supervision of a knowledgeable physician who will regularly monitor your vital signs, including blood pressure. Also, refrain from using any ephedra product containing caffeine, and steer clear of foods containing caffeine."

Assess your risk. Taken short term at the proper dosage, ephedra is probably safe. But like all stimulants, it comes at a price. Side effects such as headache, dizziness and insomnia are signs that the herb may be too much for you. If you have health problems or need your morning coffee or are prone to taking four pills when one will do, it's best to skip ephedra entirely and try another weight-loss tactic.

Catherine Monahan is a food and health writer and a frequent contributor to Delicious Living.

Photography by: Jeff Padrick