What it is
Ephedra, also known as ma huang, is an herb or plant. In 2004, the Food and Drug Administration (FDA) banned the sale of dietary supplements containing
ephedra (ephedrine alkaloids) in the United States due to the cardiovascular effects associated with its use. These effects included increased blood pressure and
irregular heart rhythm. Shortly after the ban was imposed, it was challenged in the courts by the company, Neutraceutical Corp that was manufacturing a product
containing less than 10 mg of ephedra. They argued that the FDA did not have enough evidence to prove this amount of ephedra was harmful. Indeed, the
court ruled on the side of the company and the ban was lifted in 2005. Then in 2006, a federal appeals court upheld the FDA ban, consequently overturning the
2005 ruling by the lower court. The final word came from the Supreme Court in 2007 when it denied a request to review this last ruling. Thus, at this time, the
ban on ephedra in the United States stands, including the sales of products containing ephedra in quantities less than 10 mg.
Ephedra is the herb, ephedrine (an alkaloid compound) is the active ingredient of ephedra. Without ephedrine, ephedra would not have its effects. Synthetic
ephedrine and pseudoephedrine are found in over-the-counter decongestants and cold medicines and are used to treat asthma. Because ephedrine affects the
sympathetic nervous system, it is believed to increased fat burning (thermogenesis), increase metabolism and improve athletic performance (especially in
conjunction with caffeine), which have been the primary selling points for dietary supplements containing ephedra. However, because ephedra is a sympathetic
nerve stimulator, it can also cause the following: increase heart rate and blood pressure, arrhythmias, nervousness, irritability and insomnia. Ephedrine is not
approved in the United States as a drug for weight loss or to enhance athletic performance.
Before the ban, ephedra was sold in the following forms: ephedra (ma huang), ephedrine, ephedra with caffeine, and ephedra and herbs containing caffeine.
Such products included Hydroxycut, Xenadrine and Ripped Fuel. Even though ephedrine is not approved for weight loss or athletic performance, when it is
combined with another ingredient, the Drug Enforcement Agency’s ability to regulate ephedrine is hindered for some reason. As a result diet supplement
companies have developed products that include ephedrine in combination with other ingredients such as caffeine and aspirin.
You have two types of products out there that are essentially the same as ephedra and they are often marketed as ephedra-alternatives or ephedra-free
products. One type contains ephedrine and these products include EphedrineX (25 mg ephedrine, along with caffeine and aspirin), Vasopro ephedrine (25 mg
ephedrine and another ingredient that is challenging to pronounce, guaifeniesin), and Ephedrine P57 (10 mg ephedrine and a substance called hoodia). The other
type of ephedra-alternative product does not contain ephedrine but may contain any one or combination of the following ingredients: guarana, bitter orange, green
tea extract, hoodia gordinii and chá De Bugre. Guarana and bitter orange work just like ephedrine; essentially they are the same with respect to physiological
effects. Hoodia gordinii is also similar, but possibly through different mechanisms. It has received a lot of attention since the 60 minutes report that came out a
couple years ago, but in a nutshell, it is an appetite suppressor. chá De Bugre is an herb growing in Brazil and is also an appetite suppressor. In addition to all
these ephedra-free products, I was able to find ephedra-containing products. Metabadrine is one of those products and it contains 10 mg ephedra, bitter orange
and guarana extract.
Just because ephedra is banned does not mean you cannot get it. You can, it’s just coming in different forms, all having the same effect. These diet
supplements are primarily sold for weight loss but are essentially, energy pills. And as an energy pill, it is a tempting supplement for the endurance athlete.
The evidence
Before the ban was imposed, the US Department of Health and Human Services requested a synthesis of evidence regarding the safety and effectiveness of
ephedra (ephedrine alkaloid). A meta-analysis was performed and the results were published in the Journal of the American Medical Association (Shekelle, et al)
on March 26, 2003). A meta-analysis is a statistical evaluation of the compilation of studies on the specific topic of ephedra and its effectiveness and safety.
When compiling these studies, specific criteria must be met to include a study. For instance, studies for weight loss must have lasted at least 8 weeks. Once the
studies are identified, the results are pooled and analyzed. They found that ephedra, ephedrine, or ephedra with caffeine promoted unremarkable weight loss over
the short-term (about 2 lb per month more than a placebo). These data were based on 20 studies. There were no data concerning long-term weight loss. As far
as athletic performance was concerned, they found insufficient data to draw a conclusion (7 studies). Concerning safety of ephedra use, data from 50 trials
determined a 2.2 to 3.6 times greater incidence of psychiatric (irritability), autonomic (nervous), or GI symptoms, and heart palpitations.
The results from the 7 studies on athletic performance were not pooled because different types of exercise were used with difference outcomes measured. Six
of these 7 trials came from the same lab and all of these trials assessed exercise capacity in a small group of healthy men. Alone, ephedra or caffeine did not
improve muscle endurance, aerobic capacity, run times, body temperature, anaerobic power or time to exhaustion on a cycle ergometer. But together, ephedra
and caffeine were consistent in improving performance by 20% to 30%. No increase in body temperature was reported with ephedra. One third of the
participants reported nausea and vomiting when given a dose of 1 mg/kg ephedrine and 5 mg/kg caffeine, but not at lower doses. The seventh study, published
in 1977 (Sidney & Lefcoe) did not report any significant improvements in various physical fitness tests including aerobic capacity, reaction time, muscle endurance
and power, hand-eye coordination, speed and self-perceived exertion from ephedrine alone.
Two additional studies published since the meta-analysis resulted in similar results in that the combination of ephedra and caffeine has modest effects on athletic
performance. Here is a summary of the results from these studies:
Time to exhaustion while riding a cycle ergometer: increase 38%.
Time to complete a 3.2km (2 miles) run while wearing 11 kg of gear: decrease 4.5%
Time to complete a 10km (6 miles) run while wearing 11 kg of gear: decrease 2%
Power output during a 30-sec anaerobic test (Wingate): increase 1-2% during first 10 sec
Total work performed during 3 supersets of leg press/bench: increase 20% (due to increase in number of repetitions during first set only)
Amount of weight lifted during a 1 repetition maximum bench press: increase 2%
No studies are available on ephedra’s effect on aerobic endurance performed more than an hour, nor are their any studies to indicate that ephedra promotes fat
burning during exercise. In fact, use of ephedra alone and in combination with caffeine results in higher lactate levels which is an indication of increased use of
glycogen or carbohydrates during exercise.
The bottomline
There is no indication that ephedra would be beneficial to an athlete performing an aerobic activity for long periods of time (more than an hour). For weight loss
purposes, the effects are not remarkable. For anaerobic/power type performance, ephedra alone does not seem to have any effect on performance, but in
combination with caffeine, the effects are positive but very modest. Thus, an athlete in the weight room may get some benefits from ephedra and caffeine and
enhance his or her workout. However, there seem to be a relatively high incidence of side effects such as nausea and vomiting, and heart palpitations, which
may override any modest improvements in performance.
The final score for ephedra out of a possible 5 points: 0
References
Beck TW, Housh TJ, Schmidt RJ, Johnson GO, Housh DJ, Coburn JW, Malek MH. The acute effects of a caffeine-containing supplement on strength, muscular
endurance, and anaerobic capabilities. J Strength Cond Res. 2006 Aug;20(3):506-10.
Bell DG, McLellan TM, Sabiston CM. Effect of ingesting caffeine and ephedrine on 10-km run performance. Med Sci Sports Exerc. 2002 Feb;34(2):344-9.
Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc. 2002 Jan;34(1):181-2.
Jacobs I, Pasternak H, Bell DG. Effects of ephedrine, caffeine, and their combination on muscular endurance. Med Sci Sports Exerc. 2003 Jun;35(6):987-94.
Magkos F, Kavouras SA. Caffeine and ephedrine: physiological, metabolic and performance-enhancing effects. Sports Med. 2004;34(13):871-89.
Shekelle PG, Hardy ML, Morton SC, Maglione M, Mojica WA, Suttorp MJ, Rhodes SL, Jungvig L, Gagné J. Efficacy and safety of ephedra and ephedrine for
weight loss and athletic performance: a meta-analysis. JAMA. 2003 Mar 26;289(12):1568-70.
Written in 2007
All Rights Reserved
Copyright Constance Mier, 2007-09
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