In December 2003, the U.S. Food and Drug Administration announced
it was banning the sale of products containing ephedra. This announcement
heralded the first time the agency has banned an herbal supplement.
Its decision was based on extensive research involving more than 16,000
reports of adverse health effects from products containing ephedra.
These studies clearly indicate that ephedra is dangerous. And it can
kill. Roughly 155 deaths have been blamed on the amphetamine-like stimulant,
including the 2003 death of 23-year-old Baltimore Orioles pitcher Steve
Ephedra occurs naturally in the Chinese herb ma huang and contains ephedrine
and pseudoephedrine, stimulants that can constrict blood vessels. In
low doses, they act as decongestants, but in higher doses, they can raise
blood pressure. The stimulant effect contributes to the herb's effectiveness
as an appetite suppressant, especially when combined with caffeine, aspirin,
or both. Its claims for promoting weight loss as well as for increasing
energy and alertness led athletes and average gym goers alike to take
A variety of studies associate ephedra use with cardiovascular problems,
including high blood pressure, palpitations, and heart attacks. Side
effects of the herb include heart palpitations, nausea, and vomiting.
More than 800 dangerous reactions have been reported - among them, heart
attacks, strokes, seizures, and sudden death. Psychosis, insomnia, and
heatstroke have also been reported.
The supplement has been conclusively linked to cases of healthy adults
suddenly falling ill or even dying after taking it. According to a study
in the Annals of Internal Medicine , ephedra products make up
only 1% of herbal supplement sales in the U.S. , but they are responsible
for 62% of herb-related reports to poison-control centers.
Manufacturers have insisted that studies prove their product is safe
when used properly. But several scientists said that it is impossible
to prove whether ephedra is safe based on these studies because they
screen out participants who have health problems - the people most likely
to be hurt by the supplement.
Herbal products can be as powerful as prescription drugs, but unfortunately,
under the 1994 Dietary Supplement Health and Education Act (DSHEA), companies
don't have to prove that an herbal or dietary supplement will do what's
claimed, or even that it contains what it's supposed to. That's because
under the act, substances classified as dietary supplements are not "drugs." As
a result, because ephedra is an herb, U.S. law permitted over-the-counter
sales of the supplement until the FDA could prove a clear danger to public
Some people who think ephedra helped them lose weight are looking to
new herbs and natural extracts to replace the banned dietary supplement.
Topping the list of new ingredients is caffeine. Some products deliver
the buzz of at least three cups of coffee in one dose. They don't all
mention caffeine on the label; consumers may have to learn herbal aliases
such as guarana and green tea to ensure they don't get caffeine jitters
by taking multiple supplements.
Although we have more - and growing - research data on complementary and
alternative health care, findings regarding safety, effectiveness, and
mechanism of action are often limited or controversial. What's more, most
herbs and supplements have not been adequately tested for interactions
with other herbs or supplements, drugs, or foods. It will take a lot of
additional scientific scrutiny to really understand how these substances
work in the body, and how we might harness their properties for use in
promoting health. Until then, as always, buyer beware.
March 2004 Update
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