Ephedrine . . . The Other Side of "Fat Burning."

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:

Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. NEJM, 2000

Abstract: Background: Dietary supplements that contain ephedra alkaloids (sometimes called ma huang) are widely promoted and used in the United States as a means of losing weight and increasing energy. In the light of recently reported adverse events related to use of these products, the Food and Drug Administration (FDA) has proposed limits on the dose and duration of use of such supplements. The FDA requested an independent review of reports of adverse events related to the use of supplements that contained ephedra alkaloids to assess causation and to estimate the level of risk the use of these supplements poses to consumers. Methods: We reviewed 140 reports of adverse events related to the use of dietary supplements containing ephedra alkaloids that were submitted to the FDA between June 1, 1997, and March 31, 1999. A standardized rating system for assessing causation was applied to each adverse event. Results: Thirty-one percent of cases were considered to be definitely or probably related to the use of supplements containing ephedra alkaloids, and 31 percent were deemed to be possibly related. Among the adverse events that were deemed definitely, probably, or possibly related to the use of supplements containing ephedra alkaloids, 47 percent involved cardiovascular symptoms and 18 percent involved the central nervous system. Hypertension was the single most frequent adverse effect (17 reports), followed by palpitations, tachycardia, or both (13); stroke (10); and seizures (7). Ten events resulted in death, and 13 events produced permanent disability, representing 26 percent of the definite, probable, and possible cases. Conclusions: The use of dietary supplements that contain ephedra alkaloids may pose a health risk to some persons. These findings indicate the need for a better understanding of individual susceptibility to the adverse effects of such dietary supplements.

Even with FDA guidelines for dosages that would cross into the "risk" category, the health challenges run even further in that consumers must then trust product sellers to accurately label their products. Since the herbs MaHuang and Ephedra are often used, the actual content of ephedrine alkaloids can vary wildly. Adequate policing to make certain products contain what their labels claim they contain is certainly far from being in place. The following study led by Bill J. Gurley, Ph.D, of the University of Arkansas for Medical Sciences, brings the realities to the limelight.

Gurley, Bill J. Content versus label claims in ephedra-containing dietary supplements ; American Journal of Health System Pharmacy 2000. 57: 963-969

Twenty different ephedrine based products were analyzed. The products were purchased in 1999 from local retailers or the Internet. The study found great discrepancies between label claims and ephedrine alkaloid content:

• Half of the products tested had content versus label discrepancies greater than 20 percent.
• One product had no active ingredient.
• In some instances, there was great content variability even between different lots of the same product.
• Some products had potentially dangerous combinations of active ingredients.
• Five products contained substantial quantities of norpseudoephedrine, a Schedule IV controlled substance.

So, even if there were imposed regulation, even if warning labels spelled out the risks with excessive dosages, and even if people learned to be "cautious," random contents can lead even the cautious to meet with accidental overuse.

Probably the most publicized ephedrine related incident was the death of Anne Marie Capati. At 37 years old, following the written advice of her personal trainer, she began taking an ephedrine based supplement . . . a "fat burner." During a workout she collapsed and later that night, after doctors at St. Vincent's Hospital in New York determined she had suffered a stroke, excessive and uncontrollable bleeding in her brain led to her death. The publicity has emerged out of a 320 million dollar lawsuit against Crunch fitness, the trainer, the supplement manufacturer, and the store where the supplement was purchased. I don't pretend to know who should be held liable, but I do know that if someone had explained to Ann Marie Capati the possible ramifications of ephedrine use, she likely would have decided not to use it. Capati had pre-existing high blood pressure.

Dan Duchaine was infamously known as the Steroid Guru. He developed a reputation as the expert in anabolic steroid use for athletes. Dan was extremely controversial and he was a guest on my radio show several times, once from prison where he was being held for charges of smuggling clenbuterol from Mexico. On that particular show he spoke about how he believed steroid risks were overblown in the media and the medical community and how careful use can even be a health benefit. It led to some interesting debate. One point Dan brought up was the fact that he had never suffered any ailment from steroid use . . . but he suffered a stroke from ephedrine! Dan has since passed away in his 40's of what the doctor's apparently referred to as "natural causes." Dan was reputed to be a human guinea pig. Did ephedrine have anything to do with his untimely death? Who knows. If someone takes a supplement that leads to a stroke, there can be long term health issues that make that person subject to further vascular incident.

An article February 12, 2001, in U.S. News and World Report outlined stories of death and injury due to misuse of ephedrine. I don't need to reiterate the stories here. If you want to find more I'm sure that article is accessible on the Internet or by contacting U.S News directly. The issues related to ephedrine have been before Congress, have been addressed on almost every TV Network, have been explained and explored in Consumer Reports, publications by the national Council Against Health Fraud, and an ever-growing number of consumer advocacy groups.

Here's a less publicized study since it doesn't appear to address the impact of "fat burners" on people, but I can draw my own conclusion from the abstract.

Suspected caffeine and ephedrine toxicosis resulting from ingestion of an herbal supplement containing guarana and ma huang in dogs: 47 Cases (1997-1999). Journal- american veterinary medical association

Records of dogs that had ingested an herbal supplement containing ma huang and guarana between July 1997 and October 1999 were retrieved from the National Animal Poison Control Center database. Results: Most dogs (80%) developed clinical signs of toxicosis within 8 hours of ingestion, and clinical signs persisted for up to 48 hours. Hyperactivity, tremors, seizures, and behavior changes were reported in 83% of dogs; other signs included vomiting (47%), tachycardia (30%), and hyperthermia (28%). Seventeen percent of the dogs died. Conclusions and Clinical Relevance: Accidental ingestion of herbal supplements containing primarily guarana and ma huang in dogs can lead to a potentially lethal condition that may require prompt detoxification and supportive treatment for several days. Most dogs recovered with supportive treatment.

Let's think. Dogs are smart, but not smart enough to go down to the local health food store and purchase ephedrine based products in the hope that they'll shed fat. If enough dogs accidentally ingested something their owners no doubt had in their respective supplement collections, it's quite clear that use of this potentially dangerous substance is abundant.

I can keep going . . . and going. There is extensive research available, and the longer research on ephedrine continues, the more the risk questions will obviously rise to the surface. I speak to scores of people each week who suffer at least minor issues (termors, jitters, headaches, nervousness) from their fat burners. With that said, I don't believe I need to go on any further. Although the length of this piece would be extended, my conclusions would be unchanged . . . so I'll conclude with my opinion.

Ephedrine is a drug and has definitive drug effects. Thus, while I'm not certain what's fair in terms of regulation, it should be sold, not only with small print, but with inserts explaining the risks, just as you'd receive with any packaged medication. Claims for "safe, quick, easy weight loss" should be aggressively policed by the FTC and severe rather than token fines should be incurred as punishment for fraudulent or misleading claims. If people come to understand the potential risks, will ephedrine sales cease? I doubt it. People flock to take weight loss drugs where potential side effects are publicized in the the hope that the benefit will outweigh the risk. The want for weight loss is so great I don't believe a consistent message being sent out outlining the reasons you might not want to even consider ingesing ephedrine will put even a single supplement manufacturer out of business. Supplements are sold under the guise of "health" products, and Responsible sale and distribution of these products can only exist with adequate warnings.

If you were to ask me if I think you should take an ephedrine supplement in the hope it will help you lose weight, boost metabolism, summon up energy, or have better workouts, my answer would be clear and consistent. No.

Related Pages:

Thermogenics
Fat Burners
Metabolism Boosters
Supplements

Other Pages to Explore:

[ Fitness Superstore ]  [ MENU ]  

[ Solutions ]  [ TRANSFORM ]  [ ANSWER ]

[ Feedback ]

e-mail Phil Kaplan

site designed and operated by
Phil Kaplan
Phil Kaplan's Fitness Associates
1304 SW 160th Ave., #337
Fort Lauderdale, Florida 33326
(305) 824-5044  (954) 389-0280
Fax (954) 742-3173