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Because of the many reports of adverse effects, and the fact that it is easy to take too much, ephedra should only be used under a doctor’s supervision.
Like many stimulants, ephedra can help to promote weight loss because it helps to suppress the appetite. Ephedra’s benefit lies in its ability to help with habit changing (e.g., helping to reduce food consumption by suppressing the appetite), not fat-burning. Although some weight-loss formulas contain both ephedra and caffeine, this combination should be avoided, as it can be taxing on the heart.
Warning: Ephedra should only be taken with medical supervision. Ephedra is not for sale in certain parts of the world.
Ephedra sinica, commonly known as ma huang, is a central nervous system stimulant. Double-blind trials have shown that ephedra or a related synthetic substance, particularly when combined with caffeine, promotes weight loss.1 2 3 A double-blind trial of ephedra alone (2 grams of powdered plant, providing 40 mg of alkaloids) found that the herb failed to increase energy expenditure and showed little potential for the treatment of obesity at the amount used in this trial.4 However, combinations of ephedra and either guaraná or kola nut, supplying 72 to 90 mg of ephedrine alkaloids and 192 to 240 mg caffeine per day, produced greater weight loss than placebos in two double-blind studies.5 6 While these studies suggest that taking a combination of ephedra and caffeine may be effective for short-term weight loss, some doctors discourage the use of ephedra as a weight-loss aid because side effects are common, including some that are potentially dangerous.7 8
Use of ephedra (and particularly ephedrine)—especially for weight loss or as a recreational drug—can lead to amphetamine-like side effects, including elevated blood pressure, rapid heart beat, nervousness, irritability, headache, urination disturbances, vomiting, muscle disturbances, insomnia, dry mouth, heart palpitations, and even death due to heart failure.9 One study has shown that a single application of ephedra caused mild elevation of heart rate but did not consistently affect blood pressure in otherwise healthy adults.10 When taken at higher levels, ephedra can cause drastic increases in blood pressure, as well as cardiac arrhythmias. Ephedrine is considered potentially habit-forming, though it is unclear if the whole herb ephedra is likely to have the same effect.11 Long-term (months or more) overdose of ephedra or ephedrine can potentially cause kidney stones composed of ephedrine, though this is rare.12 A review of 140 reports of heart and nervous-system emergencies concluded that one-third of the adverse health reports were “definitely or probably related” to ephedra and another one-third “possibly related.”13 All of the cases cited were people taking ephedra together with either caffeine and/or drugs with known cardiovascular side effects, such as theophylline and phenylpropanolamine.
Anyone with high blood pressure, heart conditions, kidney disease, diabetes, glaucoma, hyperthyroidism, anxiety or restlessness, impaired circulation to the brain, neurological disorders, benign prostatic hyperplasia with residual urine accumulation, pheochromocytoma (primary adrenal tumor), and those taking MAO-inhibiting antidepressants, digitoxin, ephedrine, or guanethidine should consult with a physician before using any type of product containing ephedra.14 Pseudoephedrine can cause drowsiness and should be used with caution if driving or operating machinery. Ephedra-based products should be avoided during pregnancy and breast-feeding and should not be used in children under the age of eighteen years without medical supervision.15
Are there any drug
interactions?
Certain medicines may interact with ephedra. Refer to
drug interactions for a list of those medicines.
Ephedra is a shrub-like plant found in desert regions throughout the world. It is distributed from northern China to Inner Mongolia. The dried green stems of the three Asian species (Ephedra sinica, E. intermedia, E. equisetina) are used medicinally. The North American species of ephedra, sometimes called Desert Tea or Mormon Tea, does not appear to contain the active ingredients of its Asian counterparts.
Warning: Ephedra should be taken only with medical supervision. Ephedra is not for sale in certain parts of the world.
*Dieters and weight-management advocates may claim benefits for ephedra based on their personal or professional experience. These are individual opinions and testimonials that may or may not be supported by controlled clinical studies or published scientific articles on ephedra. For more complete and detailed information, including references and safety information, see Ephedra as an herbal remedy.
1. Werbach MR, Murray MT. Botanical Influences on Illness. Tarzana, CA: Third Line Press, 2000, 476-80.
2. Molnar D, Torok K, Erhardt E, Jeges S. Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents. Int J Obes Relat Metab Disord 2000;24:1573-8.
3. Astrup A, Breum L, Toubro S. Pharmacological and clinical studies of ephedrine and other thermogenic agonists. Obes Res 1995;3 Suppl 4:537S-40S [review].
4. Martinet A, Hostettmann K, Schultz Y. Thermogenic effects of commercially available plant preparations aimed at treating human obesity. Phytomedicine 1999;6:231-8.
5. Boozer CN, Nasser JA, Heymsfield SB, et al. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25:316-24.
6. Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002;26:593-604.
7. Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45.
8. Cantox Health Sciences International. Safety assessment and determination of a tolerable upper limit for ephedra. December 19, 2000. Available from URL: www.crnusa.org/CRNCantoxreportindex.html))
9. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 125–6.
10. White LM, Gardner SF, Gurley BJ, et al. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol 1997;37:116–21.
11. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 125–6.
12. Powell T, Hsu FF, Turk J, Hruska K. Ma-huang strikes again: Ephedrine nephrolithiasis. Am J Kidney Dis 1998;32:153–9.
13. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. New Engl J Med 2000;343:1833–8.
14. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 125–6.
15. Cantox Health Sciences International. Safety assessment and determination of a tolerable upper limit for ephedra. December 19, 2000. www.crnusa.org/CRNCantoxreportindex.html
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires July 2004.