A Hidden Danger?

The dietary supplement ephedra, an herb found in weight-loss and body building supplements has been a controversial subject after serious health risks have reportedly been linked to the product.

Stacy Wagner, the Chief Clinical Dietitian for Huntsville Memorial Hospital said ephedra can benefit people who need help starting their weight loss program, but she did not recommend taking the product.

“(Ephedra) is a central nervous system stimulant, and people think it raises your metabolism and it does; actually it is an amphetamine type of response,” Wagner said. “When you raise that central nervous system, and when you stimulate it, it will cause you not to be hungry.”

Ephedra stimulates the sympathetic nervous system by causing blood vessels in the lining of the nose to constrict, dilating bronchial tubes and stimulating the heart.

Ephedra contains six ephedrine alkaloids, among which ephedrine is predominant. The dietary supplement industry reported approximately 12 million individuals were using ephedra in 1999.

Wagner said this type of supplement could be an aid in weight loss if people follow the directions on the package.

“What happens is when people take it, they over take it,” she said. “They think a little bit did them well so they think they will take more and they take beyond what is really prescribed. In essence it is probably not a good idea, maybe on a short-term basis it is okay, but for a long-term basis it is not a good idea to keep stimulating that central nervous system falsely.”

For adults a typical dosage of ephedra is 15 to 30 milligrams of the total alkaloids calculated as ephedrine. The FDA recommends ephedra products not be used longer than seven days, and that dosage of ephedra should not provide quantities of ephedrine exceeding eight milligrams every six hours, or 24 milligrams per day.

“It is supposed to be taken for a short period of time so that you can lose weight, and hopefully then get off of it and eat a healthy diet and not have to need it anymore,” Wagner said.

The Dietary Supplement Health and Education Act of 1994 reported half of the United States population used dietary supplements. A list of these supplements includes: vitamins, minerals, amino acids, enzymes, herbs and other botanicals as dietary supplements.

As an alternative to ephedra, Wagner recommended using a multivitamin mineral supplement.

“I always recommend a good multivitamin mineral supplement, but not all are created equal,” Wagner said. “I recommend, and you do not always find these in stores, but Metagenics is one good company. Douglas Labs is a more comprehensive multivitamin and it is not going to cut your appetite, but it is something with a little bit of chromium pecolonate in it, and some antioxidants which can help you as a (dietary) cushion.”

The chromium and magnesium in the multivitamins can cut the body’s craving for sugar; therefore, offering an alternative to dietary supplements, she said. A combination of this, learning to eat well by constructing a healthy diet and exercising will help in weight loss.

“Ephedrine will get you started maybe, but I don’t really recommend it,” Wagner said. “For some people they need a little help along to cut their appetite right in the beginning, and it wouldn’t be harmful on a short-term basis.”

The safety and effectiveness of ephedra has not been proven or unproven since the government, the FDA under the DSHEA, has to prove that the supplement shows a significant or unreasonable risk of illness or injury under the conditions suggested on the dosage guidelines on the label.

No ephedrine products have been approved for long-term use.

Epheda has a similar effect to that of caffeine, but is more powerful than caffeine and will last longer.

“You don’t want to use (ephedra) in combination with caffeine or other stimulants because you get just an increased effect,” Wagner said. “You could get the heart rhythm problems and things of that nature.”

The FDA has reports linking 100 deaths to ephedra, used by people trying to lose weight.

The United States has banned ephedra in professional football, college athletics and minor-league baseball. The International Olympic Committee has also banned the herb.

A Florida medical examiner recently linked the Feb. 17 death of Baltimore Orioles pitcher Steve Bechler to ephedra, but Bechler’s official cause of death was a heatstroke.

Bechler was taking the product to help him lose weight after allegedly attending training camp out of shape.

A lawmaker from Houston plans to introduce a bill next week to ban the sale of dietary supplements containing ephedra in Texas.

“It has resulted in a number of deaths,” State Rep. Ron Wilson, D-Houston, told KRIV-TV in Houston on Friday. “There’s no controversy about that.”

Similar legislation filed in 1996 failed, but because the product is an herb, U.S. law allows ephedra to be sold over the counter.

“(Ephedra) was banned at one time in 1997, and (officials) proposed restrictions on ephedrine content of dietary supplements, new warning labels of ephedrine alkaloid containing products and a prohibition on combination products,” Wagner said.

When the FDA moved to restrict access to ephedra with a proposed regulation in 1997, an independent report by the General Accounting Office concluded that the available evidence did not support the FDA’s proposed restrictions on dosage limits.

“Eventually restrictions were taken off and the FDA is currently reviewing 273 adverse event reports involving ephedrine alkaloid containing products, including 134 cases of reported serious injury or death with 140 of the reports receiving in-depth clinical review by FDA and outside experts (in 2000),” Wagner said.

Wilson said he thinks things will be different this time around.

“With these high-profile deaths that have occurred recently, I think the chances are really good to pass it,” he said.

Chinese physicians have used the herb ephedra, also known as Ma Huang in Chinese, to treat asthma, hay fever, nasal and chest congestion for over 5,000 years.

On Feb. 28 the Department of Health and Human Services sent warning letters about the product to manufactures and proposed warning labels for ephedra products. The FDA announced they were seeking comments from health professionals, the supplement industry and the general pubic for additional information on ephedra’s safety.

The FDA and the Federal Trade Commission are assessing whether further enforcement actions are warranted against other manufacturers, since there is limited evidence on the benefits and adverse effects of ephedra.

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