Ephedrine: Fad or Friend?

Raj Utreja

 

An In-Depth Look at Ephedrine and Its Medicinal Value Versus the Side-Effects

  

 

Seeing Through the Marketing

 

“Finally, the ultimate way to burn fat and feel great about yourself. . . ” –the marketing lingo heard all too often by the American consumer. 

 

In a society where over 50 percent of the population is overweight, and the condition of being such is an issue of a drastically lowered self-esteem, it seems only natural in today’s business-oriented culture for new fat-burning schemes to pop up on a daily basis.  If one were to watch television at an hour past midnight, it would not be a surprise to find half the channels airing an infomercial on some “all new” method or supplement to facilitate weight loss.

The major problem with the availability of such products is that the American consumer is often mislead into purchasing a particular one without knowing the full extent of its effectiveness and/or side effects.  The marketer’s job is to “sell, sell, sell”– being informative and truthful is not necessarily part of the job description.  The consumer will ask, “Why should I buy this product?”  An answer looking to create a sale will not consist of highlighted side effects and clinical data that prove the uselessness of the product.  Once again, the issue at hand is “sell, sell, sell.” 

 

Lose Weight Quickly and Easily?

 

One of the questionable weight-loss products out there is ephedrine.  Is it fad or is it friend?  Of course, a company selling an ephedrine-based product will do its best to relay all the benefits.  In the example of Xenadrine®, a common ephedrine-based, weight-loss supplement, it is the “#1 performance enhancer and fat metabolizing product on the market” Xenadrine Home Page.  Although there is no justification for the statement, it sounds appealing to the uninformed consumer.  “This could be you,” they will say, and then throw a visually appealing marketing tool at the consumer–the before/after pictures:

 

                                                                                   

 

 

“Actual Xenadrine case study shows dramatic change in lean body composition in just 12 weeks. Test subject Randall Hansen lost an extraordinary 63 pounds of body fat while simultaneously adding slabs of new muscle mass” Xenadrine Case Studies.

 

How likely does it seem that this transformation could have been made in a period of only twelve weeks?  If so, this must be the miracle supplement of the century.  The question now is, how?  Is this possible?

 

What is Ephedrine and How Does It Work?

 

Ephedra is essentially the stem of the ma huang plant, which is found in China and areas of India and Pakistan.  It is cited that the plant has been used by the Chinese for over two thousand years in the treatment of colds, asthma, chills, lack of perspiration, headache, edema, and any flu symptoms.  Ephedra is now being used as an herbal stimulant in the supplementary precipitation of weight-loss.  When ingested, the ephedrine supposedly  creates a thermogenic reaction, meaning it generates heat by causing the body’s   metabolism to speed up, thus burning more fat calories than those that would be burned   without the aid.  The effects of ephedra are a primary result of ephedrine, which is an alkaloid compound found in the stem.  Ephedrine “produces central nervous system stimulation, peripheral vasoconstriction, elevation of blood pressure, broncho dilation, cardiac stimulations, and a decrease of intestinal tone and motility, among other effects” Ephedra Site Home Page.   The effects of ephedrine are very similar to the effects of epinephrine, or adrenaline, which is a natural hormonal stimulant produced in the adrenal gland Mahuang.com. 

 

What are the Claims Made About Ephedrine?

 

The following is a list of claimed effects of ephedrine, which could be true or could be mendacious marketing methods:

 

Produces euphoria!  Enhances energy levels!  Aids in weight loss!  Heightens awareness!  Increases sexual sensations!  Enhances physical performance!  Increases mental alertness!  Stimulates fat burning metabolism!  Burns stored fat!  Reduces appetite!  Controls sugar and carbohydrate cravings!  Preserves lean muscle tissue!  Aids in stopping of smoking!  Mahuang (Ephedrine): The Weight Loss Wonder Drug?

 

Sure, this product is sounding better and better, but the fact is all of the cited websites that claim these results are trying to sell the product and have no substantive evidence for these claims.  The reader of this article may be saying this right about now: “Evidence or no evidence, the before/after picture is all I need.”  Well, according to the website itself, the weight-loss results are extraordinary and do not represent those of the typical user Xenadrine 4 Less.  If they had not put that fine print on the website, every customer following would have called and complained about not achieving the same results.

 

Aside from the before/after picture, the website uses another clever marketer’s tool–the testimonial:

 

Renowned weight-loss researcher and medical director of The Medical Weight-Control and Nutrition Group, Dr. Robert Finley says, I have extensively researched virtually every weight-loss compound available and I can say without hesitation that Xenadrine is far superior to all other thermogenic fat-loss formulas on the market today. This fact is clearly confirmed by the extraordinary magnitude of results documented through this study. But these results were no surprise to me because I've personally lost over 65 pounds using this remarkable product.  Xenadrine 4 Less

 

There is absolutely no justification to the aforementioned quotation.  There is no clinical data nor is there any record of a clinical study conducted. 

 

The ultimate, conclusive justification for buying the product, according to the website, is that Xenadrine represents the most sophisticated natural diet supplement in the world. It is research-proven, medically approved, extremely effective, and 100% natural Xenadrine Home Page.  In response, where is the research?  If the product has been “research-proven” and is “extremely effective,” then there should be substantial clinical evidence supporting it.  Who approved it?  Apparently, the product has not been approved by the Federal Drug Administration (FDA), as many ephedrine-based products have not.  Finally, simply because a product is completely natural does not mean that it is safe; therefore, it is irrelevant when trying to justify the product.  Marijuana is “100% natural,” and yet, is illegal throughout the United States. 

 

How Safe are Ephedrine and Ephedrine-based Products?

 

The reason for breaking apart the claims in the website is not to deny or accept the effectiveness of ephedrine, but to prove that not everything claimed in a document, especially on the web, is completely true.  Up until this point, the consumer has encountered no real harm, except maybe a few dollars down the drain if the product has not achieved the desired end, but it is in the website’s listing of potential side effects that the real danger lies.  In response to the frequently asked question about potential side effects, the website states:

 

Yes, you will lose weight! Some other minor side effects can include some problems sleeping if you take your pills too close to bedtime. You may notice that you feel more hot, that is just the thermogenics working to burn fat. Your body will also use more water, so drink a little extra each day. Finally you will notice that you have a lot more energy!  Xenadrine Home Page

 

The statement is quite ambiguous in the listing.  What are “some problems sleeping?”  The reason this is important is because this is where the website is not being completely honest with the potential consumer.  There are clinically proven side effects to the use of ephedrine or an ephedrine-based product.  Knowing them could affect the consumer’s decision to purchase the product.  Giving the abridged version of the side effects could lead the consumer to purchasing the product, which, in turn, could lead to undue suffering of side effects.  This is not information that should be withheld.  Here is an accurate listing of common adverse effects associated with ephedrine:

 

*profound hypertension

         *cardiac dysrhythmias

         *anxiety

         *restlessness

         *seizures

         *tremor

         *insomnia

         *dizziness

         *muscle fatigue

         *stress

         *headache

         *nausea

         *sweating and thirst

         *palpitations

         *micturation difficulty

         *stroke

         *hepatotoxicity

         *psychiatric abnormalities

         *cardiovascular toxicity

               *cardiac hypertrophy

*focal myocardial necrosis

 

Mahuang (Ephedrine): The Weight Loss Wonder Drug?

 

Apparently, there is a greater risk to using ephedrine than simply having “some problems sleeping.”

 

The Studies

 

Efficacy

 

There was a clinical trial published in a December, 2000 issue of the International Journal of Obesity & Related Metabolic Disorders focused on investigating the efficacy of a caffeine/ephedrine mixture in obese adolescents.  The study was conducted by D. Molnar, K. Torok, E. Erhardt, and S. Jeges and is as follows:

        

Thirty-two (male/female ratio = 16/16) obese children were included into the study.  They were treated by diet (calculated daily energy requirements minus 500 kcal) and were either given the ephedrine/caffeine mixture (CE) or a placebo (PL) for twenty weeks in a randomized double-blind placebo-controlled trial.  Those weighing less than 80 kg took one tablet three times (100mg/10mg), whereas those weighing more than 80 kg took two tablets three times per day.  There were three dropouts (girls) from the placebo group.  The age, weight, body mass index (BMI) values (mean (range)) of the PL and CE groups were 16.0 (14.3-17.6) and 16.0 (14.2-17.7) y, 103.0 (77.2-126.4) and 104.8 (69.8-150.2) kg, 35.2 (28.3-42.3) and 36.5 (31.3-51.8) kg/m2, respectively. 

 

The decrease in relative body weight (BMI and body fat), measured by bioelectric impedance, was significantly (P < .05) greater in the CE group (mean +/- s.d.; 14.4 +/- 10.5 %, 2.9 +/- 1.9 kg/m2, 6.6 +/- 6.0 kg) than in the PL group (2.2 +/- 5.8%, .5 +/- 1.6 kg/m2, .5 +/- 2.7 kg).  Basically, the relative body weight decreased by more than 5% in 81 % of those who took the ephedrine/caffeine supplement; however, the placebo group did not have such results—only 31 % of the placebo group lost at least 5 % of their relative body weight. 

 

The results of this experiment lead to a conclusion that ephedrine is, in fact, an effective compound for the treatment of obesity in adolescents, especially when combined with caffeine. 

 

Safety

(1)

Robin R. Capwell wrote an article in the American Journal of Psychiatry in 1995 entitled Ephedrine-Induced Mania From an Herbal Diet Supplement.  In it, he addressed a common side effect associated with ma huang (ephedrine) through the manic episode of a forty-five-year-old male. 

 

The man, who Capwell addressed as Mr. A, had absolutely no history of psychiatric illness or substance abuse.  In fact, aside from stress at work, he had been living an exceptionally healthy life.  After taking daily doses of an ephedrine-based supplement for two months, Mr. A started experiencing personality and behavior changes.  He began to get restless and experienced insomnia.  He became very irritable and disorganized, so much so that he was asked by his employer to take a leave of absence.  He was unusually aggressive and began to verbally abuse his wife.  After putting up with it for two months, she brought him into the emergency room. 

 

After examining Mr. A and diagnosing hypertension, the physician suggested discontinuation of the herbal supplement.  After a couple of nights of restful sleep, Mr. A was back to normal.  There was no evidence of lingering mood or thought disorder.  His wife stated that this incident had been the first of its kind in twenty happy years of marriage.

 

Capwell concluded his article with the following recommendation:

 

Intoxication with ephedrine can occur in the context of incidental exposure for persons who take formulations for weight loss or other health benefits or in the context of stimulant abuse by drug-seeking persons.  Chronic ephedrine use can produce delusional disorders as well as manic conditions that may be more likely in predisposed individuals.

 

I strongly urge physicians who are evaluating persons with recent onset of psychotic or manic symptoms to consider ephedrine intoxication in their differential diagnosis and to ask specifically about use of diet supplements that contain ma huang.

 

(2)

Karl M. Jacobs, M.D. and Kenneth A. Hirsch, M.D., Ph.D., published an article entitled Psychiatric Complications of Ma-Huang in a 2000 issue of Psychosomatics.  According to them, the use of dietary supplements containing ma huang . . .  has caused a significant rise in adverse health consequences attributable to the sympathomimetic and central stimulant properties of ephedrine.  They presented two case studies in which abnormal behavior, similar to that discussed by Capwell, occurred. 

 

In case 1, a single, twenty-seven-year-old male Marine sergeant made a faulty judgment-call while working as an avionics technician.  He became unusually agitated and threatened to go home and kill himself.  There was no previous record of such behavior; however, the man was taking an ephedrine-base supplement at the time.

 

In case 2, a twenty-year-old male working as a Marine private first-class was evacuated from his ship in the Persian Gulf due to “acute psychosis and agitation.”  The gentleman complained of an “imbalance in [his] head.”  At the time, he had been taking two ephedrine-based supplements, along with ginseng, DHEA (dehydroepiandrosterone), creatine monohydrate, and a great deal of coffee. 

 

At the conclusion of their article, Jacobs and Hirsch explained the three circumstances under which ephedrine-induced psychosis occurs:

1.     The abuse of over-the-counter asthma medications in otherwise psychiatrically well individuals.

2.     The abuse of ephedrine for its central nervous system-stimulant properties alone.

3.     Ma huang combined with other stimulants.

 

The Debate

 

The debate about ephedrine still continues.  The Food and Drug Administration (FDA) is especially concerned with the topic and is trying to establish regulations on ephedrine-based products, especially those used as weight-loss supplements.  Between 1993 and 1997, the FDA received notices of thirty-four deaths and about eight hundred medical and psychiatric complications directly linked to ma huang (Hirsch, 2000).

 

Even individual states are making an attempt to regulate the administration of ephedrine and ephedrine-based products.  The Texas Department of Health (THD) has proposed banning over-the-counter supplements used in aid of weight loss-- those made by dietary companies such as the one that produces Xenadrine® Herb Research Foundation.

 

Conclusion

 

In conclusion, the debate over the promise of ephedrine is a still a moot point.  Do the overall benefits outweigh the potential risks?  That question can be answered on only an individual basis.  The studies show both that ephedrine facilitates fat loss to some degree (especially when used in conjunction with caffeine) and that it is the cause of harmful side effects.  The main point addressed in this work is the mendacious claims made by marketers trying to sell products.  They will say what the consumer wants to hear.  Since the “perfect body” is such an ideal thing to strive for in this culture, there is a potential for business providing a means to achieve such a goal.  It is important that the consumer be critical of all unsubstantiated material, questioning its legitimacy.  In the case of ephedrine, it works, but it is not as efficient to provide results such as the before/after picture and is not as safe as to be limited by a few mere “problems sleeping.”  If taking ephedrine, it is important to consume the appropriate dosage.  Overall, there is no miracle that will replace good old-fashioned exercise and controlled eating habits. 

 

 

 

 

References

 

Capwell, R.R. (1995).  Ephedrine – induced mania from an Herbal Diet Supplement.  American Journal of Psychiatry, 152(4), 647.

 

Erhardt, E., Jeges, S., Molnar, D., & Torok, K. (2000).  Safety and efficacy of treatment with an ephedrine/caffeine mixture.  The first double-blind placebo-controlled pilot study in adolescents.  International Journal of Obesity & Related Metabolic Disorders, 24(12), 1573-8.

 

Hirsch, K.A., & Jacobs, K.M. (2000).  Psychiatric Complications of Ma-Huang.  Psychosomatics, 41, 58-62.

 

McCaleb, Robert S.  “Perspectives on Ephedra Ephedrine and Caffeine.”  The Herb Research Foundation.  http://www.herbs.org/greenpapers/tdh-pres.html.  10 Oct. 2001.   

 

Lennart. The Ephedra Site.  http://www.ephedra.demon.nl/.  14 Sept. 2001.

 

Vaughan, Hannah B.  “Ma Huang (Ephedrine): The Weight Loss Wonder Drug?”    http://www.vanderbilt.edu/AnS/psychology/health_psychology/Mahuangwebpage.htm.  14 Sept. 2001.

 

Warren, Neal and Teri.  Chinese Herb Ma Huang/Ephedra.  http://www.mahuang.com.

         15 Sept. 2001.

 

Xenadrine.  http://www.xenadrine.com.  13 Sept. 2001.

 

Xenadrine 4 Less.  http://www.xenadrine-4less.com/.  15 Sept. 2001.