Nutrition Column – Dietary Supplements Containing Ephedra Proven Harmful

Ephedra has again made headlines, this time as consumers began stockpiling the herbal supplement in anticipation of its ban in March.

The impending ban has been long and slow in coming. Under the 1994 Dietary Supplement Health and Education Act, the Food and Drug Administration is required to prove that a dietary supplement possesses a clear danger to public health before they can limit or prohibit its sale. This requires the review of years of collected data, including numerous pharmacological and clinical studies on ephedra’s safety and effectiveness, thousands of reports of adverse effects and truckloads of newly requested public comments on ephedra-associated health risks. In the end, the FDA concluded that there was little evidence of ephedra’s effectiveness except for short-term weight loss and strong evidence that ephedra raised blood pressure and otherwise stressed the circulatory system. They further linked these reactions to significant adverse health outcomes, including heart ailments and strokes.

Ephedra (also known as herbal ephedrine alkaloids) is an amphetamine-like compound found naturally in several species of plants including the ancient Chinese herb, ma huang, and Mormon tea. Its principal active ingredient is ephedrine, which when chemically synthesized is regulated as a drug. While products containing natural ephedrine alkaloids have long been used to treat certain respiratory symptoms in traditional Chinese medicine, in recent years they have been extensively promoted and used with the goals of aiding weight loss, enhancing sports performance and increasing energy. Unless labeled ephedra-free, most ‘fat burners,’ ‘metabolism boosters’ and weight-loss supplements contain ephedra.

The FDA’s concerns about dietary supplements containing ephedra arose in part from ephedra’s mechanism of action in the body. Ephedra is an adrenaline-like stimulant that can have potentially dangerous effects on the nervous system and the heart. Among the numerous side effects that have been reported by ephedra users are nausea, vomiting, anxiety, irregular heartbeat, seizures, heart attack, stroke and, in a few cases, sudden death.

A recent study published in the Annals of Internal Medicine looked at the number of adverse reactions associated with ephedra compared to the number associated with other herbal products. Ephedra-containing supplements accounted for less than 1 percent of all herbal product sales, yet they were responsible for 64 percent of all adverse reactions to herbal products in the U.S. Another study published in Neurology concluded that the risk of hemorrhagic (bleeding) strokes was significantly higher in ephedra users than nonusers.

Even before the announcement of the impending ban, many supplement manufacturers had stopped using ephedra in their products, not because their customers did not want them, but because the company’s insurance provider wouldn’t insure them if they made and sold products that had a history of causing sudden death. A wise move indeed.

Considering the seriousness of ephedra’s potential side effects, the best place for any ephedra remaining on your shelves is down the drain. Children under the age of 18, pregnant or nursing women, and adults with a history of high blood pressure, heart disease, seizures, diabetes, kidney disease, thyroid disease, depression or glaucoma are particularly advised to discontinue use of any ephedra products.

by Pat Kendall, Ph.D., R.D., Food Science and Human Nutrition Specialist, Colorado State University, Cooperative Extension