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The scoop on ephedrine and ma huang.

They say it will give you energy, make you lose weight, burn body fat, prevent drowsiness while driving, and improve athletic performance--and it's natural, found in an age-old Chinese herb. No wonder ephedrine (and the herb, ma huang) is one of the hottest supplements on the market today. It is sold over the counter in drugstores, health-food stores, sports shops, and truck stops, and by mail order, and is advertised all over, from Cosmopolitan to muscle magazines. It usually comes in pill or capsule form (with names such as Diet Max, Diet Pep, HerbTrim, Escalation, and Mega Trim), but sometimes in herbal teas (such as TrimTime Thermogenic Tea). It is promoted as a "thermogenic aid"--that is, as a way to boost the body's metabolic rate temporarily. But in more than a few people, ephedrine has caused severe, sometimes fatal, reactions.

Ephedrine made headlines in July when Diego Maradona, the captain of the Argentine soccer team, was removed from World Cup competition after testing positive for ephedrine (and several related compounds). The drug is banned in international soccer, as it is in the Olympics.

Ephedrine is an amphetamine-like compound. It started out as a drug for asthmatics (it's a bronchodilator--that is, it helps open bronchial tubes) and also as a decongestant. As such it has been approved by the FDA and is available in prescription and over-the-counter drugs. As an asthma drug, it is presumably taken under a doctor's supervision, and comes with a warning label about side effects. There have been studies showing that ephedrine, especially when combined with caffeine, can help obese people lose weight. But these studies were all medically supervised. People who take ephedrine on their own as a pep-up or diet pill generally don't know about dosages and potential adverse reactions, let alone deaths.

A study last year in Neurology documented three cases of stroke, two of them fatal, in people taking ephedrine. At least one of the victims was taking the pills to lose weight. Ephedrine's minor effects are restlessness and insomnia, like any "upper." It also boosts heart rate, constricts blood vessels, and increases blood pressure--thus setting up a scenario for a potential brain hemorrhage (that is, a stroke). It can also cause nerve damage, palpitations, arrhythmias, psychosis, and memory loss. Recently, the fatal heart attack of a 17-year-old high-school football player who took pep pills containing ephedrine was reported on Dateline NBC. Undoubtedly, many severe reactions go unreported. Since ephedrine pills are so inexpensive, many of the users are teenagers trying to lose weight or get an athletic edge or a cheap "high."

Why is it available?

Chinese herbal products usually contain less ephedrine than the "extracts" sold here. But who knows how much ephedrine is in, say, Diet Max or HerbTrim? Or how much is in that herbal tea, which may contain ma huang as well as added ephedrine and related stimulants?

The FDA has not approved ephedrine as a stimulant or weight-loss aid. It has not cracked down on the substance, the agency says, because it is understaffed. In addition, such "herbal" products are in regulatory limbo any way (though pure ephedrine hardly qualifies as an herbal product). According to Dr. David Kessler, head of the FDA, ma huang and ephedrine "are currently under review." Some manufacturers get around the agency by maintaining that their over-the-counter products are meant to treat asthma, though clearly they're not. Several states have acted against ephedrine: in New Mexico, it is now sold only by prescription; in Texas, minors can no longer purchase it.

Bottom line. Do not take ephedrine, unless your doctor has advised it for asthma or you're taking it in a decongestant. Especially avoid it if you have high blood pressure, heart disease, or a thyroid problem, are pregnant, or are taking another medication that acts as a stimulant. And if you have a teenager and suspect that he is taking diet or pep pills, don't shrug it off as harmless kid's stuff, just because the pills are so readily available. They shouldn't be.
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Title Annotation:Chinese herb and its derivative
Publication:The University of California, Berkeley Wellness Letter
Date:Sep 1, 1994
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