The potential risks of using popular pick-me-up ephedra or Ma Huang were highlighted again recently in a speech by Dr Richard A. Cytryn of the New Jersey Chapter of the American College of Cardiology (NJ-ACC).
Cytryn, who is director of Non-Invasive Cardiology at St. Peter's University Hospital, said the start of the new year was a popular time for consumers to turn to herbal stimulants and weight loss products such as ephedra.
"In an effort to lose the weight gained over the holiday, some people resolve to put in more time at the gym. They also look to the wide market of preparations that promise increased energy, athletic prowess, and suppressed appetite," he said.
"The NJ-ACC is concerned that these energy products contain a class of components called sympathomemetics. These substances - including ephedra or ephedrine, or Ma Huang, a less processed form - share adrenaline-like stimulating properties similar to cocaine and certain amphetamines. These so-called 'natural preparations' are not regulated and may contain varying potencies and a host of related compounds with similar adverse properties."
Cytryn said that there was still insufficient scientific evidence to claim that ephedra was safe for regular use, and pointed out that much of the recent evidence points rather to the fact that it can cause strokes, heart attacks or even death.
"At this point, until there is a more abundant collection of studies, the medical community still relies heavily on anecdotal reports after patients have encountered negative reactions or even death." A related compound used in both cold and diet preparations, phenylpropanolamine, has been recently linked to strokes and has now been removed from the marketplace.
"We do not have total insight into the numbers of people buying these drugs or ordering them through websites without supervision or investigation into pre-existing conditions that should send up a warning flag. Until we do have definitive numbers, it is unlikely that we will obtain the kinds of control that can prevent the worst side effects.
He continued: "One of the major issues involves combining ephedra-containing supplements with over-the-counter (OTC) medicines for colds. The majority of cold remedies also contain ephedrine-like substances, and that means that many people could in fact be taking a double dose of the drug, compounding their vulnerability to its side effects. This can have potentially deadly results."
Ephedra acts to constrict blood vessels and actually is present in some prescription medications that control respiratory illnesses like asthma. "Used indiscriminately or in combination with contraindicated OTC medications, certain other herbs and even with caffeine, ephedra supplements can lead to severe physiological responses," Cytryn said.
"Although the supplement industry may be claiming that supervision is unwarranted, and that container disclaimers are clear and adequate and the percentage of bad reactions is low, when one family loses someone to this type of product, the impact for that family is one hundred percent."
Cytryn and the NJ-ACC urged strict caution when considering use of these products and recommended further investigation by the US government and product manufacturers regarding the risks and benefits of this class of substance.