Herbal ecstasy, or relief for respiratory problems?

Supplements containing ephedra products are very popular in the United States. Today they are commonly used as energy boosters to enhance physical performance, or as appetite suppressants to aid in weight-loss regimes. Truck drivers have also used these supplements to sustain alertness and reduce fatigue.

Ephedra has been used for thousands of years in traditional Chinese medicine to treat bronchial asthma, colds and flu, coughs and wheezing, fevers, bronchitis, and nasal congestion, and to induce sweating. Today ephedra products continue to provide help for respiratory ailments. However, misuse and abuse of the ephedra products, especially when combined with caffeine, has led to dozens of deaths and hundreds of reports of adverse effects, prompting a closer look at such products.

What Is Ephedra?

Ephedra is a small perennial shrub that grows to a height of about one foot. It is native to China, Japan, northwest India, and Pakistan. Today ephedra species are widely cultivated throughout Europe and North America. Most of the ephedra in the marketplace is derived from the dried stems of three species– Ephedra sinica, Ephedra intermedia, and Ephedra equisetina. In China the various ephedra species are collectively known as ma huang.

What Does It Contain?

Ephedra plants owe their activity to their content of alkaloids. These compounds include ephedrine, pseudoephe-drine, norephedrine, methylephedrine, and norpseudoephedrine. These compounds have a structure very similar to that of adrenaline and amphetamine, so they can be expected to have similar physiological effects on the body.

The response obtained from using ephedra products will depend upon the actual composition of the supplement. A recent analysis of commercial ephedra-containing products found that they actually contained amounts markedly different from that claimed on the label. Some products had only one quarter or one fifth the amount claimed on the label, while others had 30-50 percent more than the label claimed. Twenty-five percent of the products were found to contain the controlled substance norpseudoephedrine, while one product had no detectable alkaloids.

What Are the Effects of Using Ephedra?

Ephedrine and pseudoephedrine (the major alkaloids in ephedra) are known to stimulate the central nervous system, increase the heart rate, elevate blood pressure, and act as a bronchodilator and decongestant. Ephedrine also enhances alertness and decreases reaction time in response to an emergency. Ephedra also has antiallergenic effects and can induce perspiration.

The Food and Drug Administration (FDA) has approved the use of the ephedra alkaloids as ingredients in over-the-counter (OTC) medications to relieve nasal congestion and to treat cold and flu symptoms and allergies. Ephedra compounds also appear in OTC bronchodilators for mild or chronic asthma. Recently ephedra and ephedrine have become controversial because of their popularity as ingredients in dietary supplements promoted for uses other than the ones approved by the FDA.

Contraindications and Side Effects

The American Herbal Products Association has issued a warning statement to appear on the label of all ephedra products. It states that children and persons with high blood pressure, heart disease, glaucoma, thyroid disease, diabetes, prostate enlargement, women who are pregnant or breast-feeding, or persons taking monoamine oxidase (MAO) inhibitors or other drugs for depression, should not use ephedrine-containing products.

The side effects that may be seen with use of ephedrine-containing products include sleeplessness, restlessness and anxiety, irritability, headaches, loss of appetite, nervousness, tremors, nausea, rapid heartbeat, cardiac arrhythmias, heart attack, stroke, or seizure. A state of dependency may also develop.

Recommended Dosage

The German Commission E recommends that ephedra preparations should be used only short-term because of the danger of addiction and possible side effects. Daily dosages recommended for adults are one to two grams of cut herb or 15 to 30 milligrams of ephedrine, with a maximum daily adult dosage of 23 grams of cut herb or 300 milligrams of ephedrine.

High Alert

More than 800 reports of adverse reactions and even some 39 fatalities from using ephedra or ephedrine-containing products triggered a high level of concern and a reassessment of the safety of ephedrine. Hence, the federal government has attempted to impose stricter regulations for ephedra supplements and to limit the use of ephedrine.

Combination Products

The greatest concern regarding ephedrine and ephedra-containing supplements exists when high doses are consumed or when the supplements also contain another stimulant such as caffeine, or a caffeine-containing herb such as guarana or mate. Such combination herbal supplements are commonly promoted for enhanced athletic performance or weight loss.

A series of carefully conducted experiments in Canada provided evidence of the beneficial effect of ephedrine on aerobic performance. The time taken to reach physical exhaustion by male volunteers on a bicycle test increased 20 percent when 70-80 milligrams of ephedrine was consumed. However, the time to reach exhaustion increased by 40 percent when 400 milligrams of caffeine was consumed along with the ephedrine.

European researchers have used ephedrine to help promote weight loss, especially in the morbidly obese. Several studies have suggested that ephedrine administered concurrently with caffeine suppresses appetite and is a useful aid in weight loss.


Ephedra has a long history of safe useage in the treatment of respiratory problems. However, self-dosing with ephedra or ephedrine products can be dangerous. The alkaloid content of these supplements is quite variable and unregulated, and it is possible to ingest dangerously high levels of ephedrine. Ephedra is not risk-free, and because of the potentially serious side effects, it should be used under the supervision of a health-care practitioner. While supplements containing both ephedrine and caffeine appear to be effective for enhancing aerobic performance and weight loss, their use is associated with serious risk.

Remember: Herbal products and dietary supplements can have pharmacological effects, may produce adverse reactions in some people, and could interact with over-the-counter and prescription medications you may take. Discuss with your physician your decision to use any herbal product. Anything mentioned in this article is not intended to diagnose, prescribe, or treat any ailment.

Winston J. Craig, Ph.D., R.D., is a professor of nutrition at Andrews University, Berrien Springs, Michigan.

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