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Ephedra (Ma Huang)

This is a form of the active ingredient used in many decongestants and asthma drugs. It raises heart rate and blood pressure, and is dangerous for those with high blood pressure, heart disease, or diabetes. It should be banned. Numerous alternatives are now being used in supplements—they may not be safer than ephedra.

In March federal officials finally proposed putting warning labels on dietary supplements containing ephedra. This happened a week after the death of 23-year-old pitcher Steve Bechler, who was using a weight-loss aid containing ephedra when he died during spring training. The government’s action is too little and very late.

The proposed label will warn that heart attacks, strokes, seizures, and deaths "have been reported" after consumption of ephedra. That’s not going to deter many people, I’m afraid. Ephedra is a huge business; it’s in countless dietary supplements promoted to reduce weight, boost energy, and improve athletic performance. The government will forbid claims that the herb builds muscle or improves athletic performance, but claims about weight loss will continue, though there’s no evidence that ephedra produces long-term weight loss.

Researchers have known for years about the dangers of ephedra, which contains the chemical ephedrine. The latter was used as an asthma drug until the early 1980s, when doctors stopped prescribing it because of its dangerous effects on the heart and blood pressure. The synthetic form of another ephedra ingredient, pseudoephedrine, is still used in many over-the-counter decongestants, which carry strong warning labels and are meant for only short-term use.

The Wellness Letter first warned readers not to take ephedra (also called ma huang) in 1994. Though especially risky for people who have high blood pressure and cardiovascular disease, this herbal stimulant can cause serious reactions in even apparently healthy young people. It’s often combined with other stimulants, such as caffeine, which can amplify the herb’s effects and increase the dangers. Such products have been linked to about 100 deaths, including many young athletes, and 1,500 reports of serious health problems. That’s just the tip of the iceberg, since it’s estimated that only 1% of adverse effects are reported. A recent study found that ephedra was responsible for a whopping 64% of all herb-related reports to poison control centers in 2001.

The FDA has been trying—unsuccessfully—to restrict the use of ephedra for more than seven years. It has been blocked by the powerful supplements industry and its political allies. The main problem is that the agency has had little effective control over supplements since 1994, when Congress passed the Dietary Supplement Health and Education Act, which requires the FDA to prove a supplement is a public danger before ordering it off the market. As the ephedra story shows, this is very hard to do. If, despite the overwhelming evidence, the FDA can’t remove ephedra from the shelves, it probably can’t safeguard us against any dangerous supplement. In contrast, the Canadian government acted against many ephedra supplements last year.

Ephedra should be banned now. And the law should be changed so that all supplements can be properly regulated.

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