Health and fitness for life.

I love the look of horror on my husband's face as I turn back side to him and ask, "Do these pants make me look fat?" I'm joking, and he wisely refuses to answer. Isn't it true that we all would love to find the latest vitamin or supplement that will give us the competitive edge to dance and look our very best? But is there a magic bullet? Look on the supplement shelf of any drugstore and you can see ephedra and ephedrine advertised in many products that make claims of increased energy and fat loss. But what are these things? Do they do what they say, and if they're on a shelf at a store, does that automatically mean they are safe? And if some of my friends are taking them should I follow suit?

We now have very good answers. According to a wonderful book, Evidence-Based Herbal Medicine by Michael Rotblatt, MD, PharmD, and Irwin Ziment, MD, FRCP (Hanley and Belfus, 2001), ephedra, or ma huang, is the herbal source of ephedrine and pseudoephedrine. The Chinese rose have used it for years primarily to treat asthma and sinus and nasal congestion. It also contains chemicals that can mimic the sympathetic nervous system reaction known as the "fight or flight" response. A few ways to think of these predator/prey behaviors are: run-so-you-don't-get-eaten, forget-eating-and-run, and be-hypervigilant-so-you-can-detect-the-predator. It's these effects on brain activity that have led commercial supplement producers to make claims of weight reduction and increased energy production in humans. However, according to Rotblatt and his fellow authors, eight different studies in humans have shown inconsistent results, plus they noted that dropout rates were high (meaning that more participants than usual dropped out of the studies before they were over).

If ephedra is so great, why did these test subjects stop? The authors list numerous adverse reactions, such as high blood pressure, excessive heart rate as well as rhythm disturbances, nervousness, trembling, strokes, and heart attack. It's also contraindicated in people with anxiety. Does all this sound good for a dancer? Even kidney stones are thought to be associated with its use, and especially its overuse. One problem with over-the-counter herbal supplements is that it is difficult to establish correct dosages per individual, potentially leading to overdose.

These authors conclude that the use of ephedra for more than a week or two, even under the supervision of a competent health care provider, should be discouraged because its benefit-to risk ratio is so high.

Also, the long-awaited Rand Report commissioned by the National Institutes for Health that officially assessed the safety and effectiveness of ephedra appeared this year in the March 26 issue of The Journal of the American Medical Association (JAMA). Their finding was that there was insufficient evidence to support claims of long-term weight loss or improvement in athletic activity. The data suggested that ephedra "is associated with increased risk of psychiatric, autonomic, or gastrointestinal symptoms and heart palpitations." It also concluded that these problems were seen two to three times more in ephedra users versus non-users. The JAMA editors strongly worded this conclusion: "Manufacturers of dietary supplements are trying to have it both ways. They claim their products are powerfully beneficial on the one hand, but harmless on the other. To claim both makes no sense, and to claim either without trials demonstrating efficacy and safety is deceptive. The public should wonder why dietary supplements have been given a free ride."

What does all this mean? Let the buyer beware. The baby boomers of my generation were simply prescribed amphetamines for weight loss. These boomers suffered the consequences in severe health problems such as addiction. Now a whole new generation can get this herbal "amphetamine," not only over the counter, but with encouragement from the world of advertising. Plus, these products don't deliver. Weight loss is what it is, a lifestyle change.

And knowledge is power. I urge my students at San Francisco Ballet School to become savvy consumers and get educated about nutrition and exercise. Start with the basics of nutrition and find out what you're eating. Eat well! And many dancers now incorporate regular aerobic exercise into their cross-training routines so that they feel slim and vibrant. It's all up to you.

Suzanne Martin maintains a private practice in physical therapy and Pilates, is the lead physical therapist for Smuin Ballet, and conducts nutrition seminars at San Francisco Ballet School.