The Miracle Cure or Nightmare Drug?
By Warner W. Au
I. Introduction
II. What Is Ephedra?
III. Issues Raised
A. Professional
B. Legal
C. Ethical
A. Stakeholders
It is
pretty safe to say that the majority of the population, if given the
opportunity, would like to be in good physical shape. For men it’s the perfect “V” shape, with muscles so finely
sculpted, Michelangelo himself would be hard-pressed to mold a finer figure out
of clay. For women, the desired look is
the “hour glass” figure, with voluptuous breasts, thin and firm abs, and sharply
defined legs.
Of all those who desire to have a great body (basically everyone), an even greater majority of these people would like to achieve this with as little effort as possible. Face it, it takes discipline and dedication to mold your body to this ideal shape, but who has either one of these virtues, let alone in combination? Recent developments in the biotechnological industry boast claims that there is now a way to lose weight, gain that perfect figure we all desire, and do it all with the simple drop of a pill into our bodies. These new weight-loss products are being advertised to shed “60 pounds in four weeks!” or some other, up until this point in time, ridiculous amount of weight in such a short time. What is the secret ingredient that these companies are using to make these pills? Are their claims legit or is this one big hoax to scam innocent people by taking advantage of a basic human weakness, the desire to be physically fit with little or no effort? The answers to these questions can be answered by asking yet another question, “What is ephedra?”
Ephedra is an herb native to central Asia, which can also be found under the name Ma Huang. Many people get confused about the difference between ephedra and ephedrine, but the answer to that problem is actually quite simple: ephedra is a plant; ephedrine is the active ingredient in ephedra. This relationship is somewhat similar to that of marijuana and THC, where marijuana is the plant that is smoked with THC being the active ingredient that produces the effects that are related to marijuana.
Asian cultures were the first ones to utilize ephedra nearly 2000 years ago as a treatment for bronchial asthma. “Ephedrine mimics the effects of hormones like epinephrine (adrenaline) and norepinephrine,”[i] making it useful as a decongestant and stimulant. In addition to its effectiveness as a decongestant, ephedrine has also been found to stimulate the fat-burning processes in our bodies through thermogenesis.
Thermogenesis is a normal chemical reaction that occurs in all human beings. Basically, your body does three things with consumed calories: use them to meet its daily energy needs; store them for future energy requirements; or it wastes or burns calories in special cells in the body known as Brown Adipose Tissue, (BAT). This process is called thermogenesis, meaning the generation of heat. While thermogenesis works along with the metabolic process, it is different. Fat buildup occurs primarily when the BAT cells are not working right or not being activated often enough. The body deals with the excess dietary calories by storing them as body fat. The function of the BAT cells is to burn the calories your body doesn't need.”[ii]
Ephedrine is one of the main ingredients in today’s most popular thermogenics, products that stimulate thermogenesis. There are literally tons of thermogenics out there; some of the more popular ones are Hydroxycut, Xenadrine, Ripped Fuel, GNC Herbal Rush, Diet-Phen, and Metabolift among others. It should also be noted that in most of these products, ephedrine is combined with caffeine to produce even greater results.
Molecular biochemistry aside, does ephedrine work? “In a new report published in the American Journal of Clinical Nutrition (1998; 68:42-51), moderate amounts of ephedrine-caffeine supplements were administered to overweight and lean monkeys for eight weeks. The purpose of using laboratory monkeys was to evaluate under carefully controlled conditions the effects of ephedrine and caffeine and body weight, food intake and other metabolic parameters…here’s a fact that will gladden the hearts of human dieters: changes in body weight in both groups of monkeys were primarily the result of decreases in fat mass…this monkey study helps to validate the weight loss that can occur with the proper use of supplements containing ephedrine and caffeine.”iii
III. Some of the issues raised over ephedrine
In order to figure out the proper course of action to be taken with regard to products containing ephedrine, there are some issues that must be addressed. One of the issues that need to be examined are the professional issues, which are all issues raised due to the financial/economic aspects of this industry. Ephedrine products have been very popular in the American market. According to industry statistics, “ephedrine-containing supplements are used by about 12 million people in the United States, with some 3 billion ‘servings’ sold last year.”iv This could be explained by the fact that a good portion of the American population can be categorized as overweight, thus there is a big market for a product that burns fat and weight the way ephedrine does.
Ephedrine has
The production of ephedrine-containing products also carries some heavy legal implications. Due to the fact that there is still much debate over any potential side effects that ephedrine may bring about, ephedrine sales have been banned in 16 states. The International Olympic Committee (IOC), United States Olympic Committee (USOC), and the NCAA consider ephedrine a banned substance, thus anyone found to have ephedrine in their system during training and/or competition could find themselves disqualified, not to mention suspended or even banned from the sport. Another factor that has ephedrine its reputation as a dangerous substance is the fact that ephedrine can be converted into the street drug methamphetamine.
In an attempt to avoid losing its business with the general public, much of the industry has resorted to deceiving consumers by using misleading labels and/or simply failing to warn consumers about the presence of ephedrine in their products, let alone any warning about any potential danger of consuming ephedrine. “Many makers of dietary supplements containing ephedra are selling products containing significantly less - or much more – ephedra than stated on the label, according to a new study published in the American Journal of Health-System Pharmacy. (In other words) consumers have no way of telling how much ephedrine they are ingesting with each tablet.”v This lack of knowledge could lead to fatal repercussions.
The deception doesn’t stop there, though, “Many companies use the term ‘Ma Huang’ instead of ‘ephedrine’ and ‘guarana extract’ instead of ‘caffeine’ on their labels which creates confusion for the consumer who often does not know that the product could contain a potentially harmful combination of ephedrine and caffeine.”v It seems that although there may be a high risk involved with the consumption of ephedrine-containing products, the industry is doing a lot to conceal these facts from the consumers.
In one particular case, misleading information provided by the manufacturer ended up costing them a lot of money, not to mention their reputation. “In February 2001, Rosalie Talbert – an Alaskan woman who suffered a major stroke after taking the weight-loss product AMP Pro II – won a $13.3 million lawsuit against the supplement’s manufacturer, E’OLA International.”vi Later that year, United States Marshals were ordered to seize 140,000 bottles of AMP Pro II because it was being marketed as a treatment for obesity, which, in fact, is a disease. The problem with making such a claim is that, by law, dietary supplements may not be marketed as a means to treat diseases.
Last, but certainly not least, there are the ethical issues that must be addressed before any verdict can be reached on this subject. As mentioned earlier, ephedrine, though effective for weight loss purposes, has been suspected to have some very harmful side effects. In a study conducted by the New England Journal of Medicine, of the 140 reports of adverse events related to the use of dietary supplements containing ephedra alkaloids, 31% were considered to be definitely or probably related to the use of ephedra alkaloids. Ten of these cases resulted in death, while 13 left the victim permanently disabled.
Ephedrine has been found to affect the lungs, heart, blood vessels, glands, and the central nervous system. More specifically, “Side effects of ephedrine include insomnia, anxiety, irritability and nervousness, as well as a dangerously fast heartbeat and a drastic increase in blood pressure. These last two effects, along with strenuous exercise, (could result) in a heart attack, stroke, or seizures.”vii The list of side effects doesn’t stop there, however, for ephedrine has also been found to cause hypertension and tachycardia.
As far as ephedrine’s efficiency as a weight loss utility, “Studies indicate that weight loss with the aid of such products is only temporary. In addition, as people continue to take ephedrine-containing supplements, the body becomes tolerant, and they must take more to get the same effect.”iv Because the body becomes tolerant to the effects of ephedrine, the potential for abuse is high. Furthermore, ephedrine-containing products are considered addictive.
While there undoubtedly are some stories that attest to the benefits of using ephedrine-containing products, there are also others stories that tell of the dangers of the same products. In the summer of 2001, a navy corporal narrowly escaped death during a routine survival swim test. The corporal, whose name has been withheld, began panicking and then slowly started sinking towards the floor of the pool. Upon being rescued, the corporal told those tending to him that he felt nauseated. “A corpsman checked him out, found his pulse and blood pressure to be excessively high, and referred him to the base hospital. A doctor diagnosed the corporal with tachycardia, which resulted from ingesting a dietary supplement called Hydroxycut (the corporal was a regular user).”vii
Rashidi Wheeler
A high-profile case involving ephedrine’s possible role in an athlete’s death occurred on August 3, 2001. Rashidi Wheeler, a Northwestern University football player collapsed and died during preseason conditioning drills. He was believed to have taken the supplement Xenadrine the day of his death. “Use of a stimulant containing ephedrine could be especially dangerous for Wheeler, a chronic asthmatic, who was carrying an inhaler with him on the field: Combining asthma medication with ephedrine is a ‘bad, bad combination,’ said Prof. Bill Gurley, an ephedrine expert at the University of Arkansas College of Pharmacy.”viii
Another not-so-talked about case involving the death of an athlete and the consumption of ephedrine is that of Devaughn Darling of Florida State University. In February of 2001, the freshman linebacker collapsed and died during workouts. Although the autopsy could not pinpoint the precise cause of Darling’s death ephedrine was found in his system at the time of his death.
Devaughn Darling
IV. What Should Be the Course of Action?
Now that the main issues have been addressed, it is now possible to formulate reasonable plans for handling the problems that ephedrine-containing products pose. First of all, probably the simplest thing to do would be to keep everything the way it is. On the opposite end of the spectrum, another possibility is to put out a complete ban on all dietary supplements containing ephedrine (the reason why I make this distinction is because ephedrine is still effective as a decongestant). Lastly, there could always be a compromise between these two options: A regulation on the sale of ephedrine-containing dietary supplements clearly stating the presence of ephedrine, especially when in combination with caffeine, as well as a clear statement of the hazards that ephedrine may cause for all consumers. This regulation would last for a period time that would allow researchers to make come to more definitive conclusions about the benefits and hazards of ephedrine-containing products.
Who stands to gain/lose from these decisions in regards to the future handling of ephedrine? First off, the most obvious stakeholders are those people who are looking for easiest way to lose weight. Then there are the companies that produce these dietary supplements, who stand to make a lot of money off of these products if they are allowed to continue selling them, of course. In the case of athletics, there are those who take these supplements, who take dietary supplements in order to increase athletic performance, but what about those athletes that do not take these supplements, many of which have been deemed banned substances by some of sport’s governing bodies? Lastly, there are those who would be a part of the research process, both scientists and test subjects, whose lives would be greatly impacted by any decision regarding the regulation of ephedrine.
To fully realize one’s actions, it is best to understand the consequences that would result before any action is even taken. In the case of keeping the status quo in check, things would most likely continue on their current path. In all likelihood, the sale of these products will not diminish, which is obviously a benefit for the companies producing these supplements, because as long as there are lazy, overweight people these same people will continue to look for the quickest and easiest methods for losing weight. Of course with this in mind, it should come as no surprise that there would be people who abuse this drug, whether its due to a lack of knowledge about ephedrine or because of plain addiction. In the case of athletics, ephedrine is currently regarded as a banned substance, which is similar to the bans imposed by the IOC, USOC, and NCAA on anabolic steroids. Even though the substance is illegal in competition and training, those athletes that are willing to risk the consequences of using ephedrine can continue to do so through over-the-counter ephedrine products, thereby putting all other “clean” athletes at a disadvantage. Although the manufacturers’ right to conduct business without interference is upheld, the consumers’ right to know what they are introducing into their bodies is simultaneously denied.
If a total ban on ephedrine were to be issued, it should come as no surprise that certain people’s lives would undergo some drastic changes. Certainly, the manufacturers of these products stand to lose a lot of money if the selling of ephedrine were to be prohibited. Don’t feel so bad for these companies, though, because more than likely, they have a few tricks up their sleeves. With all the money they’ve made up until the ban, these companies would undoubtedly pour a lot of money into the research of a new drug that could produce similar, if not better, effects as ephedrine. As ridiculous as it may sound now, a ban on ephedrine could potentially make the demand for it similar to that of many other illegal drugs, like marijuana and cocaine. Just because a product becomes illegal, it doesn’t necessarily mean that the demand for it will go down; in fact, in some cases, the demand for such a product may actually go up! Of course, this would largely hinge on whether or not a new alternative could be developed. If no suitable substitute were found, the prices of ephedrine would undoubtedly skyrocket as a result of the risk that goes along with smuggling anything that’s illegal. If a safer and more effective method of weight-loss were discovered, the demand for ephedrine would slowly wither away to nothingness. Athletes could still get their hands on ephedrine by simply going to a place where there are no restrictions, such as Mexico, where substances banned in the US are bought by American athletes on a regular basis. People may wonder how this would change an athlete’s life if they can still obtain this drug through little or no effort. Their lives would change if they were ever caught in the US with ephedrine, because since it is considered an illegal drug, these athletes, who would usually face disqualification and suspension/banishment for their sport, would now also be risking the possibility of winding up in prison.
Lastly, there is the option of require proper labeling of all ephedrine-containing products while more research is conducted. In this case, the chance of abuse is reduced considerably. Although there will continue to be those who abuse this drug for their own self-gratification, there should be a sharp reduction in the amount of abuse by consumers who usually would not know any better because now, consumers would be aware of all the hazards that come with ephedrine. In this case, consumers are granted the right to choose whether or not they want to introduce a potentially harmful substance into their system. The manufacturers would continue to make an exorbitant amount of money as a result of continuing to sell these popular products, upholding their right to make a living. Scientists would be able to further their understanding of this drug, while at the same time, new alternatives could also be developed. In a way, the test subjects’ rights are upheld because in this case, they still have the right to do their duty for the betterment of humanity. Of course, this period of required labeling could possibly only temporary. If research proved that ephedrine posed a serious health risk, then all ephedrine-containing products would be banned. If not, the sale of ephedrine, still with proper labeling, would continue.
After examining the most feasible options, it should be quite clear that ephedrine can continue to be sold, but only if it is labeled in a way that makes it clear to general consumers that they are taking a drug that is known to have severe side-effects and may even cause death if not used properly. This goes especially for those consumers who are at a high-risk due to existing health conditions, “Since ephedrine-containing supplements are stimulants, we suspect that the people who should avoid them are those who have kidney disease, those with pre-existing heart disease, high blood pressure, over-active thyroid, or psychiatric disorders, and those with autonomic insufficiency – abnormailities in the nerves controlling their cardiovascular system – and those with histories of seizures and diabetes,”iv says Dr. Neal Benowitz, a UCSF professor of medicine, psychiatry, and biopharmaceutical sciences at the San Francisco General Medical Hospital Medical Center. Clearly, ephedrine, particularly when it is combined with caffeine, is very effective for weight-loss, when used properly. Those who are interested in taking it should do some careful research to determine whether or not this drug is right for them because, as it has been pointed out, these products are not for everyone. Although, ephedrine has not been found to pose a serious risk to the general public, more scientific studies must be conducted in order to make a more permanent decision regarding ephedrine. Of course, for those who truly wish to lose weight and keep it off, nothing can replace a practical diet in combination with exercise.