Ephedra: all it's stacked up to be?

FRIDAY, JULY 04, 2003

Could a natural herb with centuries of medicinal use to its name really turn into a natural born killer? Ephedra, one third of the popular ECA weight loss stack, is known for many health and performance-related benefits, yet it continues to draw a stack of bad press.

In Australia, ephedra and its active constituent ephedrine are both banned from sale. Pseudoephedrine, a synthetic pharmaceutical form of ephedrine, is a common ingredient in cold, sinus and headache medications which are available by prescription only, and are not permitted for use in health or sports supplements.

Australian supplements seeking to mimic the effects of American weight loss products commonly replace the ephedrine ingredient with synepherine (a compound found in bitter orange or citrus aurantium) which gives a herbal stimulating action similar to ephedrine but without the side effects.

Since its inclusion in weight loss and performance aids on the US market, ephedra has had a dubious record. One recent tragedy in the Major Baseball League may have been the last straw for US health officials, who are now considering the Australian course of action: banning ephedra and ephedrine sales altogether.

It happened one sunny Florida morning of February 16, 2003. While doing sprints at a spring-training camp, promising 23 year old pitcher for the Baltimore Orioles, Steve Bechler, complained of dizziness, collapsed and was rushed to hospital.

In a media statement the following morning, the Orioles team physician shattered fans with the news that Bechler died from multiple organ failure due to heat stroke. An autopsy found that caffeine and ephedra contributed to Bechler's heat stroke.

A tragic story but surely an isolated case?

No, says the US Department of Health and Human Services which had already had ephedra under close scrutiny for its reported dangers.

Less than two weeks after the Bechler incident, the department, in conjunction with the US Food and Drug Administration, released an independent scientific report titled: "Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects."

The report concluded that ephedra was associated with higher risks of mild to moderate side effects such as heart palpitations, psychiatric and upper gastrointestinal effects, and symptoms of autonomic hyperactivity such as tremor and insomnia, especially when it is taken with other stimulants.(2)

With the FDA claiming to have submitted for investigation more than 1400 cases of adverse side effects concerning ephedra, the department announced a series of steps to protect American consumers from potentially serious risks of dietary supplement products containing ephedra and ephedrine.

"We are particularly concerned about the risks of using products containing ephedra during heavy workouts, with caffeine and other stimulants, in a diet program that stresses the cardiovascular system, or by people under the age of 18," FDA commissioner Mark McClellan said.

"We are also concerned about potential stresses to the body caused by the long-term use of ephedra. The standard for regulating the safety of dietary supplements is largely untested, but we are committed to finding the right public health solution." (2)

But where did this herb originate and how did it go from humble to hazardous?

Ephedra is a shrub-like plant found in desert regions throughout the world. The dried green stems of the Asian species are used medicinally for cough, asthma, hay fever and sinus congestion.

The Chinese have used ephedra medicinally for over 5000 years. It is listed as one of the original 365 herbs in Shen Nong's classical first century CE text on Chinese herbalism and was one of the earliest herbs to successfully migrate from Eastern to Western medicine. Its historic uses included the alleviation of sweating, lung and bronchial constriction, and water retention. Conditions such as coughing, shortness of breath, the common cold and fevers were all known to be alleviated with its use.

It was not until 1887 that its active constituent, ephedrine, was isolated. It then took another 40 years for the herb to gradually win the respect of US physicians who began to prescribe ephedra for its bronchodilating and decongesting properties.

In the ensuing decades, the sports elite, recognising ephedra's potential to promote blood flow, adopted the herb for performance enhancement. Yet despite its continuing widespread use among athletes, ephedra, and its active constituents both natural and synthetic, are illegal under Olympic codes and banned in many sports. Even in the US where sales are legal, sporting bodies such as the NCAA (college sports), NFL (grid iron) and Minor League Baseball all prohibit players from using ephedra-containing substances.

Once athletes embraced the herb, bodybuilders soon noticed the potential for ephedra to assist in the cutting up phase of contest preparation, paving the way for its foray into the lucrative weight loss market. The past few decades have seen many combinations or "stacks" of ephedra-based products come and go.

So how does it affect weight management?

Both ephedrine and pseudoephedrine stimulate the central nervous system, dilate the bronchial tubes, elevate blood pressure, and increase heart rate. The theory is that by lifting basal metabolic rate and core body temperature, ephedra helps increase the rate of fat burning at rest as well as during exertion.

Nutritionist Luke Summers says users of ephedra, ephedrine and pseudoephedrine for weight loss need to be mindful of the risk to heart health as well as the strain on the adrenals which ultimately can sabotage weight loss efforts.

"In professional hands, Ephedra is quite safe, but abuse of ephedra, ephedrine and pseudoephedrine, especially for weight loss, can lead to stimulant-like side effects, including elevated blood pressure, rapid heart beat, heart palpitations, and even death due to heart failure.

"Even the 'healthiest' people can have undetected high blood pressure or a congenital heart condition, and endanger their lives taking ephedra products.

"While many see great short term benefits for weight loss or cutting up, you need to weigh up this result not only with the health risks but your weight management over the long term.

"Using a stimulant to keep the metabolic rate fired up day and night exhausts the body and places a huge strain on the adrenals. You may be burning some fat, but you're also burning yourself out. Your body needs a chance to rest and recuperate through its own natural cycles. These processes are disrupted by stimulants.

"You can achieve healthier, more sustainable results without stressing your adrenals: simply by keeping up your physical activity levels each day, eating smaller more frequent meals with a good balance of protein, carbohydrates and fat, drinking lots of water and getting plenty of sleep each night."

"Non-stimulant fat mobilisers such as L-Carnitine are useful and effective supplements that can encourage the loss of body fat without the dangerous side-effects associated with many stimulants.

Without the availability of ephedra products in Australia, Summers said that some people were using homeopathic ephedrine as part of an ECA (ephedrine, caffeine and aspirin) stack for accelerated fat burning.

"Homeopathic ephedrine contains zero ephedrine but has been produced with the philosophy that the energy results can be matched homeopathically."

For an independent, comprehensive and up-to-date outline of ephedra, its benefits, risks and side effects, refer to the American Botanical Council's monograph.

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