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Ephedra

Ephedra is a natural stimulant also known as Ma Huang.

Ephedra is a herb that is used to treat respiratory problems. [©Shutterstock, 2010]
©Shutterstock, 2010
Ephedra is a herb that is used to treat respiratory problems.

Ephedra

Ephedra, also known as Ma Huang, is an herb containing the primary ingredient ephedrine. Traditional Chinese medicine uses ephedra to treat respiratory problems, but recently it has been used as a stimulant, appetite suppressant and athletic performance enhancer . According to the University of Maryland Medical Center, ephedra works by stimulating the nervous system and increasing heart rate and blood pressure. It is also known to suppress appetite and increase energy, resulting in many ephedra-containing products promoting weight loss.

History of Ephedra

The three source species of ephedra are native to China and appear as low shrubby plants with small leaves and green stems. In the fall, parts located above ground are collected and dried for use. Ephedrine alkaloids and pseudoephedrine, the primary active compounds in ephedra, can be found in some over-the-counter decongestants, cold medicines and asthma medications. When used for weight loss, ephedra is commonly combined with a caffeine-containing supplement, such as cola nut or guarana.

The Chinese have used ephedra for more than 2,000 years in herbal medicines for ailments such as colds, flu, wheezing, bronchial asthma and edema. Ephedra was also brewed into a beverage similar to coffee or tea. Mormon tea, popular among early settlers of the southwestern United States and Mexico, is a type of ephedra tea. It was used for its stimulant effects. Clinical medicine later used ephedra to treat arthritis, allergies, hay fever and asthma. It was also used for a decongestant and fever reducer . Ephedra became popular among athletes because of its stimulant effects on muscle, fat and other tissue, increasing the body's metabolic rate. However, users who take ephedra as an athletic enhancer and weight loss aid risk heart attack, stroke, seizures and heatstroke.

Controversy and the FDA

Ephedra may cause heatstroke because it increases the metabolism and impairs the body's ability to lose heat. Increased metabolism causes the body to produce more heat and constricts the blood vessels, making it more difficult to lose that heat. Exercising on a warm day adds to the risk for heatstroke. In 2003, the death of Baltimore Orioles pitcher Steve Bechler sparked renewed attention to the safety of ephedra. Bechler died after suffering from heatstroke related to the use of an ephedra-containing dietary supplement. However, according to the Mayo Clinic, 14 percent of consumers using non-prescription weight-loss products in the United States used ephedra or ephedrine-containing products despite the serious health concerns. The National Football League, minor league baseball, the U.S. Armed Forces and the Olympics have since banned the use of ephedra.

On April 12, 2003, a ban on the sale of dietary supplements containing ephedrine alkaloids went into effect. The Food and Drug Administration (FDA), declared these supplements created unreasonable risk of illness or injury. Since the FDA does not review dietary supplements, a law requires proof of harm before banning a supplement. In 2005, the rule was overturned by the District Court of Utah then later upheld by the Tenth Circuit Court of Appeals in 2006.

Side Effects and Health Risks

Numerous side effects have been reported in relation to ephedra usage. These include headache, anxiety, dizziness, insomnia, irritability, depression, mania, suicidal thoughts, tremor, fainting, hallucinations, delirium, nausea, vomiting and diarrhea . Increasingly serious side effects include irregular heart rhythms, damage to the heart muscle, inflammation of the heart, difficulty breathing, fluid retention in the lungs, high blood pressure, liver damage and kidney stones. Certain prior conditions increase these risks, such as a history of psychiatric illness, heart disease, kidney disease, high blood pressure, insomnia, tremor and stroke . Ephedra creates risk during pregnancy to both mother and fetus. It has been found to increase fetal heart rate and may induce uterine contractions. It also passes into breast milk and causes crying, irritability, and insomnia in nursing infants.

In response to the renewed concern over the safety of ephedra, the RAND corporation analyzed reports filed with the FDA and a manufacturer of ephedra-containing products as well as case reports. Although many of the reports were not well documented and inconclusive, a number of well-documented reports did identify events that included death, stroke, heart attack, seizure and psychiatric symptoms. Creating major concern is the fact that half of these occurred in apparently healthy people under the age of 30.

Drug Interactions

Certain drugs cause increased stimulation when combined with ephedra, such as caffeine and theophylline, which may lead to nervousness, trouble sleeping and stomach upset. Using ephedrine in combination with caffeine may increase blood glucose and lactate concentration and is potentially fatal. When taken in combination with risperidone, ephedra has been associated with the onset of psychosis and autonomic hyperactivity. Bronchodilators and pseudoephedrine may have increased bronchodilating effects when combined with ephedra. Severe side effects, such as dangerously high blood pressure, irregular heart rate, fever and muscle damage, may occur when taking ephedra while using a monoamine oxidase inhibitor (MAOI). Other medications for depression and psychiatric disorders may reduce blood pressure or increase heart rate when combined with ephedra. It may reduce the effectiveness of medications that control blood pressure, heart rhythm and cholesterol. Since most herbs and supplements have not been thoroughly tested for interactions with other supplements or drugs, consulting with a physician before beginning any kind of new therapy is recommended.

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