Ephedra---Help for Dieters?

Several months ago, one of my patients come to me with complaints of dizziness, rapid heartbeat and anxiety of about a week's duration. When I asked her what medication she was taking, she told me she presently had a respiratory infection and was using a common cold remedy containing pseudoephedrine (marketed under the brandname of Sudafed). I determined she was taking the medication appropriately. Upon further questioning, she finally admitted to using an over-the-counter herbal preparation for weight loss as well. It was then that I told her I had her problem solved.

My patient was unwittingly overdosing on a potentially dangerous combination of medicines. The herbal supplement she was taking contained ephedra, a natural substance derived from a Chinese plant called Ephedra sinica. What my patient didn't know was that the active ingredient in the cold medication and the ephedra in the herbal remedy she was using are essentially the same chemical substance. Both cause constriction of the blood vessels in the nasal passages and dilatation of the bronchial tree which account for their effectiveness in respiratory conditions. Unfortunately for my patient, both also have side effects which include dizziness, high blood pressure, irregular heartbeat and anxiety. These side effects are what is behind the present-day controversy surrounding the use of ephedra.

Ephedra's original uses were less controversial than they are today. The herb was first mentioned in Chinese medical literature in the first century A.D. Known as ma-huang, it was used for the treatment of asthma, respiratory infections and to promote the excretion of urine.

In the last century, however, its use expanded to include the treatment of obesity and for use in bodybuilding where its "thermogenic" or "fat-burning" properties were highly regarded. Combined with herbs containing caffeine and aspirin, it was believed that ephedra helped improve exercise performance and promote the loss of body fat. Unfortunately, the use of ephedra, especially in combination with caffeine or other stimulants, proved to be fatal in a number of incidents where the herb was used inappropriately. As a result, ephedra was banned by the International Olympic Committee and the National Collegiate Athletic Association. In 1997, the Food and Drug Administration (FDA) issued strong warnings against its use in doses higher than 24 milligrams per day. Since then, many states have passed even stricter legislation limiting its sale, particularly to young people, in whom the potential for addiction was high. In spite of the warnings, ephedra remains available to the general public. As a weight-loss product, ephedra is often combined with St. John's Wort and is marketed as "herbal phen-fen" in reference to the popular prescription diet plan. There is no scientific data, however, to back up the claim that these herbs are effective in reducing appetite or in losing weight. Certainly, the potential exists for health risks which may outweigh any benefit one might get from using the remedy.

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