What Is It?
The Herb ephedra, also known by its Chinese name Ma huang, has been used in Traditional Chinese Medicine since 3000 B.C. to treat colds, asthma, and other upper-respiratory disorders. An evergreen shrub, ephedra (usually Ephedra sinica) over the centuries has traditionally been dried as a whole herb and then added in very small amounts to a tea, along with other herbs, to help ease congestion. Preparations made from two other species, E. intermedia and E. equisetina, have also been used in Traditional medicine, but generally have a less potent therapeutic effect. Traditional East Asian herbal medicines containing ephedra were generally herbal combination formulas designed for specific short-term usage. These would be used in illness conditions where the action of ephedra would counteract certain types of unhealthy symptoms.
While ephedra helps lessen congestion by dilating (opening up) bronchial and nasal passages, it also speeds up the heart rate, raises blood pressure, and has a Diuretic effect. These and many other medicinal actions are the result of its seven active compounds (called alkaloids). Two in particular–ephedrine and pseudoephedrine–are powerful stimulants. They’re stronger than caffeine but weaker than amphetamines or the Hormone epinephrine (adrenaline), which the body releases in anticipation of a stressful situation (the “fight-or-flight” response).
In fact, many over-the-counter and some prescription medicines for treating allergies, nasal congestion, asthma, and other upper respiratory symptoms contain laboratory-synthesized ephedra alkaloids, specifically ephedrine and pseudoephedrine. Products containing these synthetic substances are sold (and regulated) as drugs in the United States
However the use of ephedra has become quite controversial because high doses of the herb have been linked to serious health problems, including heart attack, stroke, and even death. This has happened because consumers have misused (or been misled about) dietary supplements containing concentrated forms of this herb. This has happened primarily with products aimed at reducing weight, enhancing athletic performance, and boosting energy. Some healthy young adults (including trained athletes) who took high doses, even for a short time, have become seriously ill, and a few have died.
While some people experience no side effects at all, research indicates that enough people have serious enough reactions to warrant public health regulations. An increased heart rate is common, for instance, even at recommended doses. Also common, especially at higher than recommended doses, or if ephedra is taken for long periods, are such reactions as nervousness and insomnia. Other dangerous reactions include high blood pressure, stroke, and seizures. Sudden death has occurred as well. Among the less common side effects are dizziness, loss of appetite, nausea and vomiting, muscle cramps, tingling, headache, kidney stones, and difficult or painful urination.
By early 2003, adverse effects from the herb had caused enough concern that top U.S. health officials began warning consumers about their risks. The FDA initiated a new program to analyze herbal ephedra supplements to confirm that they contain only natural ingredients, not the chemically synthesized ephedrine alkaloids that are regulated as drugs. Dozens of manufacturers received warning letters from the Food and Drug Administration (FDA) telling them to revise their product labels, striking any unsubstantiated claims regarding ephedra’s ability to boost weight loss or improve athletic performance.
Finally, based on the accumulating evidence of the risks of these products, the US FDA banned the sale of ephedra-containing products in December 2003. It is important to note that adverse reactions and concerns about ephedra have related primarily to its sale as an unregulated, poorly labeled dietary supplement, not to its use as a regulated drug. Botanicals such as ephedra are considered dietary supplements. The ban of ephedra was the first such supplement ban by the US government since the passage of a 1994 dietary supplement law that limited government actions against supplements to stopping false labeling claims and to removing supplements with proven safety concerns.
This action against ephedra was similar to the action that the FDA took against a synthetic drug, phenypropanolamine (PPA) that was once considered useful in over-the counter weight loss and nasal Decongestant products. Eventually evidence accumulated of the risk of stroke in users of PPA. In November 2000, the FDA required manufacturers to cease using PPA in both OTC and prescription drug products.
Forms
- Tincture
- tablet
- dried herb/tea
- capsule
General Interaction
- An ephedrine overdose can result from taking ephedra along with over-the-counter cold remedies or other medications containing ephedrine or pseudoephedrine.
- Because the body is affected in similar ways, ephedra can cause very serious problems when combined with other nervous system stimulants, including herbal ones. These include caffeine and other herbal stimulants, such as yerba mate, kola nut, guarana, or even black tea.
- Ephedra interacts with numerous medications, including prescription drugs for heart disease and high blood pressure (such as diuretics), and various drugs used in hospitals, such as the anesthetic halothane or oxytocin (used to treat uterine bleeding).
- Ephedra interacts with MAO inhibitors taken for the treatment of depression; seriously high blood pressure, headache, and elevated body temperature can result.
Possible Side Effects
Much remains to be learned about the health risks associated with ephedra, particularly when the herb is taken in doses higher or longer than those traditionally recommended.
While some people experience no side effects at all, research indicates that enough people have serious enough reactions to warrant public health cautions. An increased heart rate is common, for instance, even at recommended doses. Also common, especially at higher than recommended doses, or if ephedra is taken for long periods, are such reactions as nervousness and insomnia.
Other dangerous reactions include high blood pressure, stroke, and seizures. Sudden death has occurred as well. Among the less common side effects are dizziness, loss of appetite, nausea and vomiting, muscle cramps, tingling, headache, kidney stones, and difficult or painful urination.
Cautions
- Even at recommended doses, complications can occur. Too much can cause serious adverse reactions.
- Ephedra can make blood sugar levels rise
- Ephedra could trigger early labor if taken during pregnacy
- Tolerance to ephedra-containing products can develop, meaning that over time, one’s body starts to require higher doses to produce the same effect.
- Ephedra can dangerously elevate blood pressure, increase chest pain, and interfere with heartbeat rhythm, rate and force, even if you are under medication treatment for high blood pressure, heart disease or a heart rhythm disorder. Even with the ephedra ban, read product packaging carefully. Ephedra may masquerade on labels as epitonin, joint fir, sea grape, desert tea, popotillo, herbal ecstasy, teamster’s tea, yellow astringent, and yellow horse.
- Don’t take ephedra; there are safer self-care options, and there are effective prescription drugs for the medical conditions for which ephedra was traditionally used.
Be well,
David Edelberg, MD