I've taken what I believe to be a very diplomatic position in addressing a product ingredient that can no longer be called "new" and questions abound as to whether it should be referred to as "safe." I've always felt it important to balance information regarding the potential risks of a substance or compound with the potential benefits and then allow educated people to make wise choices. I have been careful in the articles I've written, not to scare those who choose to face potential for risk . . . cautiously . . . in the hope that they can find some benefit. I've also been careful to be selective in the product names I've addressed since many of my articles are published in magazines supported at least in part by supplement sellers. At this point in time, I believe it's time to sway more to one side than the other. With this article, I'm going to provide some insight into the reasoning that drives those who aggressively oppose the sale of this particular product. With this article, I'm naming names. Here goes . . .
Xenadrine. Hydroxycut. Ripped Fuel. Metabolife. Metabolift. Diet Zx. Zymax. Thermadrene. Stacker 2. Yellow Jackets. Clenbutrx. ECA Stack. Dymetadrine. AST EPH-33. Universal Herbal Phen Fast. Thermadrol X. Zenotrope. Thermapro. Thermo-Cuts. ProBURN.
I can keep going. There are hundreds of these on the market. What are they? They are all different brands, all different names for capsules that contain ephedrine as their "active" ingredient, and they are marketed to people who want . . . well . . . almost anything at all. I've found ephedrine products being sold as:
Fat Burners
Metabolism Boosters
Energy Enhancers
Stay Awake Pills
Sexual Aids
Herbal Ecstasy
Asthma Relievers
Diet Supplements
Appetite Suppressants
Ephedrine is in fact a drug. It can be derived from the herbs Ephedra or MaHuang, thus any product that contains either of those herbs contains the drug ephedrine. When standardized extracts of herbs are used, product manufacturers cleverly refer to these products as "natural" or "herbal," terms which at least a portion of the supplement buying public believe has some direct link to safety.
I've written a number of articles about the risks and the potential benefits of ephedrine, but the market has gone so far overboard . . . the products are being mass marketed with such aggressive promotion ("the strongest fat burner in the world," "more effective than diet and exercise," etc.) I feel obliged to slant this article toward "the other side." I'm leaning, intentionally, toward the realities that rarely make it into mass media. I'll start by sharing an e-mail I received several days ago:
Today, my friend who is only 38 years old, is hooked up to life support following 3 massive strokes over the weekend. Tomorrow her family will make the arrangements to donate her organs. The following day her family and friends will go to her funeral. Why? After a battery of tests, the doctors have concluded that the strokes were caused because of her use of Xenadrine. The doctors also mentioned they have had three other deaths related to this product, the youngest casualty being 22 years old. Help us to understand. Where did she go wrong? How could this have been prevented? How can we prevent this from happening again?
Those who sell ephedrine based products will claim that incidents such as this are due to overuse, abuse, or contraindications - prexisting conditions that should preclude people from using this drug. Those who sell ephedrine based products are absolutely correct! So why am I swaying the other way? Because overuse, abuse, and misuse are, based on the cases I've personally witnessed, are the result of flawed or omitted information. Sure, maybe the small print on the label warns people not to use the product if they suffer from hypertension or thyroid disease, but when the ads blare out "Lose Weight, It's So Easy," or "The New Weight Loss Miracle is Here," the small print too often is ignored. I don't want to present this strictly from conjecture so I'm about to share a mix of research info and my own interpretation of the evidence. I will preclude my further comments by saying that under the right circumstances, ephedrine can be a fat burning aid. You can learn more about "the right circumstances" by accessing an article I'd written on Xenadrine.
Ephedrine is a bronchodilator. It used to be sold over the counter as an asthma medication. About a decade ago, bodybuilders found that the asthma medication clenbuterol appeared to have some fat burning properties and the drug found its way into the gray market among physique athletes. It later was classified as a Class III substance which meant the sale or importation of clenbuterol could be punished by jail time. In the meanwhile, research using a combination of caffeine, ephedrine, and aspirin was proving appealing among those in search of weight loss. When clenbuterol became a black market product, bodybuilders began to make the switch to ephedrine and with time, enough people were losing enough weight for ephedrine based products to become big sellers. There are some things you should understand about ephedrine before you believe it will just jump in and start burning up fat. In addition to its bronchodilation properties, it is also a stimulant. It elevates heart rate and can also elevate blood pressure. When you combine caffeine, another stimulant, with ephedrine, of course the "speed" effect is enhanced. In the 1970's, "diet pills" were all the rage. By combining caffeine and ephedrine, supplement sellers now had legal speed. It that being a bit harsh of overblown, equating ephedrine to speed? I don't think so. In fact, ephedrine is the raw ingredient used in underground methamphetamine labs to create one of the most addictive stimulants to enter the world of illegal drugs.
Ephedrine also has a diuretic effect and it alters neurotransmission to minimize appetite. The end result is often less food intake and a body that is cranking up in high gear. Calorie deprivation is NOT an effective way to boost metabolism, yet many who depend on these ephedrine based supplements for weight loss wind up using it as an aid in simply minimizing caloric intake. Residual water loss contributes to the illusion that it is really having a very significant effect on fat loss.
One important point that is often neglected in warning labels is the fact that ephedrine is addictive at some level. Combine it with caffeine, and the propensity for addiction elevates. What a great bonus for supplement sellers! If they can get you addicted, you're going to buy more, and more, and more!
I have met with many people who had negative experiences with ephedrine, and in every such case, the person was misinformed about the value or risk of the product they were taking. "Friends" often tell "friends" to take a "great supplement," and if you can't trust your friends, who can you trust? If the user of a "metabolism boosting" formula containing ephedrine and caffeine fails to recognize the risks, regular consumption of coffee, diet cola, cold medicine, and the "Ripped" drink they have before a workout in the health club, can stack up to create serious potential for risk.
Extensive research in judging the value and potential for risk is certainly important, but I don't believe research can actually prove that something is safe. I believe that ongong research can suggest that risks might be unlikely, but a single episode in a single study can invalidate all prior research attempting to prove safety if it leads to death or injury. Take a look at the following abstract:
Gurley BJ, Gardner SF, White LM, Wang PL. Ephedrine pharmacokinetics after the ingestion of nutritional supplements containing Ephedra sinica (ma huang). Ther Drug Monit. 1998 Aug;20(4):439-45.
Abstract: Nutritional supplements containing Ephedra sinica (ma huang), a botanical source of ephedrine alkaloids, have been linked to several episodes of ephedrine toxicity and at least 17 deaths, yet these products remain unregulated. Ten subjects were enrolled in a randomized, crossover study aimed at characterizing the pharmacokinetics of ephedrine after the ingestion of three commercially available ma huang products compared with a 25-mg ephedrine capsule. Pharmacokinetic parameters for botanical ephedrine were similar to those for synthetic ephedrine hydrochloride. Gender-based comparisons of Vss/F and CL/F revealed higher values for women than for men (Vss/F, 3.49 +- 1.04 vs 2.98 +- 0.73 l/kg; CL/F, 0.48 +- 0.11 vs 0.37 +- 0.11 1/hourcntdotkg). The current study suggests that the increased incidence of ma huang toxicity does not stem from differences in the absorption of botanical ephedrine compared with synthetic ephedrine; rather, it results from accidental overdose often prompted by exaggerated off-label claims and a belief that "natural" medicinal agents are inherently safe.
There are some key points to take note of:
There were at least 17 deaths linked to ephedrine toxicity.
Increased incidence of toxicity results from accidental overdose.
Ephedrine sellers went on the warpath, and understandably. Ephedrine is big business and this information could have proven alarming and crippling to fat burner product sales. They took a counter spin on the theory that ephedrine supplementation can be lifethreatening. They delved into the incidents referenced in the above abstract to question whether there were definitive links to ephedrine products. They also questioned whether the FDA had adequate evidence to suggest a control on ephedrine. While the FDA reports over 1000 reports of adverse effects, ephedrine sellers minimized the reference by noting that there have been several hundred million doses over the last couple of years.
My conclusion is not that ephedrine is in fact safe, but that at least some people died that didn't have to because they were misinformed about the supplements they were taking. If some people died, I believe it's important that people become fully educated before opting to put something into their mouths that may in fact threaten their lives.
We shouldn't only consider "absence of directly linked deaths" in deciding whether or not a product is safe. Research has unquestionably linked ephedrine to specific health issues. Here's an abstract that should support that statement:
Powell, T. ; Fong Fu Hsu ; Turk, J. Ma-Huang Strikes Again: Ephedrine Nephrolithiasis. American Journal of Kidney Diseases, 1998
Abstract: Ephedrine and its metabolites are naturally occurring alkaloids that can be derived from evergreens worldwide and have been used as medicinals for hundreds of years. Because they have "real" pharmacological alpha and beta catecholamine effects and are "natural" products, the alternative medicine industry has popularized them for multiple uses, including asthma, weight loss, energy and sexual enhancement, and euphoria. Several recent reviews have documented the dangerous nature of using these "drugs" unsupervised, including multiple deaths, and the FDA is currently reviewing ephedrine's use in the alternative medicine industry. We report a new toxicity, ephedrine nephrolithiasis, in a patient using an energy supplement, Ma-Huang extract, which contains ephedrine. Although previously not reported, the Louis C. Herring and Company kidney stone database show that this is an endemic complication of ephedrine with hundreds of previous episodes.
Are kidney stones going to kill you? Not likely, but again, if there is any risk to be considered in evaluating a product, it should be addressed adequately so that anyone who wishes to avoid such risk can make an educated decision. The FDA, in trying to take some action to control ephedrine, requested an independent review of the reports of adverse effects. The review was reported in the New England Journal of Medicine: