In the last several years the promotion and sale of dietary supplements with ephedra have increased substantially. In 1999 approximately 12 million people consumed products with ephedra alkaloids as a primary ingredient. Supplements such as Metabolife, Ripped Fuel, Diet Fuel, Xenadrine, and Hydroxycut are used for reducing weight, increasing exercise intensity, staying awake, improving attention, or to just get a surge. I hope you read on before you run out to GNC, CVS, or Rite Aid to make a purchase, or take another dose.

Ephedra, also know as Ma Huang, is an herb that has been used historically and somewhat successfully to treat asthma, hay fever, congestion, obesity and a variety of other ailments. Since it is a stimulant ephedra suppresses appetite and increases metabolic rate. Most of the products on the market also contain caffeine or guarana (the herbal form of caffeine). So, when you take a product like Metabolife (and the others listed) you are taking between 20-25mg of ephedra and 200mg of caffeine (about 2 cups of coffee) in a single dose. The directions tell you take 2 or 3 doses a day. If you read carefully you will probably see a recommendation to start with a lower dose to "assess tolerance". Why? The manufacturers don't want you to have a negative experience the first time you use. They also know that you will build tolerance during the first several days.

Read the warning labels. Many will read like the one on Ripped Fuel. "Exceeding recommended serving may cause serious health effects including heart attack and stroke. Discontinue use if you experience rapid heart beat, dizziness, severe headache, shortness of breath, or other similar symptoms."

Dr Andrew Weil, an expert on herbs, psychoactive drugs, and complementary approaches to medicine, wrote the following when asked if he had any thoughts about these kinds of supplements. "I can sum up my thoughts on thermogenics (weight loss supplements with stimulants) in two words: stay away!" Weil has often warned against ephedra especially when combined with caffeine.

Alarming results of a research study were recently reported in the New England Journal of Medicine (Dec.2000). The authors concluded, "ephedra alkaloids pose a serious health risk to some persons." One hundred forty (140) reports of adverse events related to the use of ephedra/caffeine supplements were reviewed.

Of the 140 cases, 47% of the adverse events were cardiovascular symptoms, 18% were related to the central nervous system (strokes, seizures), and 26% involved death or a permanent impairment. The researchers were surprised to find that often the dose associated with the adverse symptoms was less than or equal to the typical dose of 25 to 50 mg.

There are several factors that account for toxic effects.

First, some people have a biological sensitivity to ephedra or the combination of ephedra and caffeine. An increased sensitivity means that toxic effects will result from a lower than "normal" dose.

Second, toxic effects are often experienced when more than the prescribed amount is taken. They can also result when the recommended dose is taken, but the individual is consuming caffeine in other products or taking certain medications.

Third, it has been found that even though the potency is listed on the bottle it is not always accurate. Sometimes the potency is higher than listed.

Fourth, some pre-existing medical conditions (known or unknown) lower a person's ability to tolerate stimulants.

Fifth, food restriction, sleep deprivation, and dehydration increase the probability of serious adverse consequences.

Sixth, use of these supplements along with the use of alcohol, marijuana, ecstasy, or other drugs severely creates an imbalance in the nervous system, is extremely hard on the liver and other organs, and can result in acute (short-term) or chronic (long-term)psychological deficits and physiological disorders.

Risks and adverse consequences linked to weight reduction aids are not new. In 1983 the FDA banned an ephedrine alkaloid called phenylpropanolamine. A significant number of people experienced serious adverse effects. It is important to note that phenylpropanolamine was also paired with caffeine.

With ephedra products, just like any other substances that affect the systems of the bodymind, it is important to balance the truths and think carefully about the costs and benefits.

The following statements are true.

Ephedra is an herb. It's natural and has been used for centuries. It is sold in drug stores and health food stores. It has been used to treat health related problems. When combined with caffeine there is an additive or increased effect. For a limited amount of time many people lose weight and feel energized when using ephedra/caffeine supplements.

The following statements are also true.

Ephedra, like other stimulants, is addictive when the quantity, frequency, and duration of use reach a certain threshold. Ephedra, particularly when combined with caffeine, can cause significant side effects and is associated with serious health problems. The negative effects and life threatening consequences are acknowledged by the companies that produce the supplements, experts in the field, the FDA, and previous users in our community and across the country.

One formula for living in this real world is to put energy into thinking about, and giving weight to, competing truths.

Oh, one final truth. It is better to prevent or reduce harm than to cause or increase it.

If you are using any products with ephedra and are willing to be interviewed, or if you have any questions/comments about these or other supplements or drugs please write to Mike Kuba, Director of Counseling at kuba_m@wvwc.edu.