Ma Huang (Ephedrine): The Weight Loss Wonder Drug?

By, Hannah B. Vaughan

INTRODUCTION

An increasing number of people are using products to enhance their diets.  A recent estimate indicates, “Americans are spending some $6 billion annually on nutritional supplements, and the market is growing by 20% every year” (Zahn, 1997). Of these supplements, the increase in herbal remedy use is most dramatic.  Zahn holds that the increase can be attributed to the widely held belief that herbal substances are healthy and harmless because of their natural origins (1997).  Unfortunately, research on these supplements, herbal or otherwise, has not transmitted to the public as quickly as the diet enhancers themselves.  The phenomenon leaves many consumers misguided by skewed advertising and uninformed about the potential risks involved in ingesting these seemingly harmless, over the counter substances.  The following is an attempt to look at one particular herbal supplement, Ma-Huang (active ingredient, ephedrine), more critically.

THE CLAIMS:

What is MaHuang?

MaHuang is an herbal supplement found in products such as Metabolife and SoBeTrim, which claim to stimulate weight loss.  It is available in the form of a pill, a powder, or a liquid and is often used in combination with other drugs such as caffeine and aspirin.  In addition to being used in weight loss supplements, MaHuang is also promoted as “natural ecstasy” (Theoharides, 1997) and is often abused under this guise.  MaHuang as “herbal ecstasy” is also called ultimate X-phoria or Cloud 9 (Zahn, 1997).

What does Ma-Huang (Ephedrine) claim to do?

Produces euphoria !                                      (White, et al 1997) & (Zahn, 1997)
Enchances energy levels !                              (Zahn, 1997) http://www.gethuge.net/xen3.htm
Aids in weight loss !                                      (Zahn, 1997) http://www.bennrye.com/dietfuel3.html
Heightens awareness !                                   (Zahn, 1997)
Increases sexual sensations !                          (White, et al 1997) & (Zahn, 1997)
Enhances Physical Performance !                  http://www.gethuge.net/xen3.htm
Increases Mental Alertness !                         http://www.bennrye.com/dietfuel3.html
Stimulates Fat Burning Metabolism.!             http://www.ephedra.demon.nl/
Lose weight by feeling less hungry !              http://www.bennrye.com/dietfuel3.html
Burn stored fat!                                            http://www.gethuge.net/xen3.htm
Reduces appetite !                                        http://www.ephedra.demon.nl/
Control sugar and carbohydrate cravings !     http://www.sobediet.com/html/tools.html
Preserve lean muscle tissue !                          http://www.gethuge.net/xen3.htm
Helps you stop smoking!                                http://www.ephedra.demon.nl/

These claims were made by various web-sites that sell products containing MaHuang or Ephedrine.  Although each web-site states it differently, they all agree this supplement has some impact on body size, shape, or composition.  One site claims, “this [product, which contains Ma-Huang] is the ultimate weight loss product” http://naturesrx.hypermart.net/diet_energy.htm.  Many products claim they can reduce appetite; but, one web-site goes as far as to say, “with the active ingredients Ephedra & Guarana you wont be hungry for 7 hours after just one dose” http://www.bennrye.com/dietfuel3.html.

Another web-site claims, “studies show that overweight people experience discrimination in the workplace, pay a higher premium for insurance, and sustain a disproportionate increase in health related costs” http://www.changesinternational.com/products/weight/product.cfm?productID=WM1CTL1.  Then the site goes into detail about their weight-loss product, which contains Ephedrine, indirectly implying that taking their pill will not only make you lose weight, but will also change your financial status.

Some of the web-sites encourage healthy eating and exercise http://www.ephedra.demon.nl/, but most stress the importance of their product in weight loss.  One web-site even says that dieting alone actually causes you to gain weight.  It says, “calorie-restricted diets are proving ineffective and counterproductive” http://www.gethuge.net/xen3.htm.

One web-site indicates that their product facilitates permanent weight loss http://www.gethuge.net/xen3.htm and for this reason, it is the number one choice of body-builders for fat-burning compounds.

How does it claim to work?

Most web-sites claim that MaHuang works through a process called Thermogenesis.  Thermogenesis is a process in which the body’s metabolism speeds up, burning more fat calories than the fat calories burned from normal daily activities http://www.sobediet.com/html/tools.html..  The body’s metabolic activity is raised by using fatty acids as a source of energy for muscle cells during intense exercise http://midwestsupplements.com/midwestsports/thermocuts.html. The increase in the body’s basal metabolic rate increases the number of calories burned per day http://www.changesinternational.com/products/weight/product.cfm?productID=WM1CTL1.  Mahuang facilitates this process because it is a “powerful natural thermogenic agent that causes brown fat in the body to burn excess ordinary fat to create heat” http://naturesrx.hypermart.net/diet_energy.htm.

How effective does it claim to be?

As for the effectiveness of Ma-Huang, one web-site brags that people have lost up to 40 pounds a month while taking their product.  And even those who don’t lose 40 pounds in a month, lose more fat using this product than with any other product including some prescription medications http://www.gethuge.net/xen3.htm.

Another web-site claims that some have increased their rate of fat loss by 300%.  They say that their product out performs even the most potent prescription weight loss formulas by 29%.  They claim this product is the #1 physique transformation tool in the world.  The evidence for this claim is a survey of consumers which reveals 97.3% rated our product (Xenadrine) as the most effective physique enhancement product they've ever used http://www.chathamhealth.com/accord/toneitfast.html.

Some web-sites suggest that weight loss can be further stimulated by combining ephedrine products with other drugs.  One suggestion is to combine ephedrine with a plain aspirin, St. John’s Wort and Chitosan Plus http://naturesrx.hypermart.net/diet_energy.htm.  Another site encourages people to try their ephedrine product (Diet Fuel) with their other products (Fat Magnet and Cellasese) for a super fat burning effect. http://www.bennrye.com/dietfuel3.html.  The web-sites offer no evidence that these combinations are any more effective than the products alone.

None of the web-sites offer evidence that their products really do what they claim to do.  No clinical studies or experiments were performed to show whether or not ephedrine products are effective.  Customer satisfaction is the only factor that was measured, but there isn’t enough information about the survey to know whether it was biased in any way.

Who is presenting the information and why?

Marketers want to present their product in the best way possible in order to make a sale.  They appeal to what the consumer wants to hear.  These companies have found a weakness in the American consumer and are preying on these insecurities.  Americans are obsessed with their body image and are willing to spend their money to change their appearance.  But consumers are only going to put their money where they believe they will get the best results.  So the Marketers’ trick is to convince the consumer that their product is uniquely effective.
 

 THE RESEARCH:

What is Ephedrine?

Ma-huang (Ephedra) is the dried stem of one of three ephedra species indigenous to northwest India, Pakistan, and China.  It has been used in China for over 5,000 years as a medicinal agent to treat hay fever and asthma (White et al, 1997).  The plant has two active ingredients: ephedrine and pseudoephedrine.  Ephedrine is a sympathomimetic alkaloid and can cause vasoconstriction and cardiac stimulation, which may produce acute increases in blood pressure and heart rate, mydriasis, insomnia, vertigo, headache, and nervousness (White et al, 1997).  Pseudoephedrine has properties, which enhance bronchodilation and relieve symptoms of nasal congestion (White et al, 1997).

Is Ephedrine effective for weight loss?

Carek and Dickerson found that combining ephedrine and caffeine was useful in treating obesity because of its anorectic and thermogenic properties involving only mild, transient adverse effects (1999).  In this review, 20 mg of ephedrine and 200mg of caffeine were administered to 180 patients 3 times daily for 24 weeks.  This combination was found to be more effective than placebo, caffeine, or ephedrine given separately (Carek and Dickerson, 1999).  The adverse effects of the combination include tremor, insomnia, and dizziness.  These effects were transient.  However, muscle fatigue and stress were found after long term administration.  Also mentioned were possible acute and chronic effects including cardiac arrhythmia, increased energy expenditure, increased lipolysis, hyperglycaemia, hyperinsulinaemia, weight loss, body fat loss, muscle hypertrophy, and improved insulin sensitivity (Carek and Dickerson, 1999).

In a study of the effectiveness of an ephedrine-caffeine-aspirin combination in the treatment of obesity, Krieger et al determined this combination produced modest weight loss without caloric restriction (1990).  Twenty-five women were randomly assigned to a placebo group and an experimental group receiving the drug trio. While the difference between the two groups was not statistically significant, the experimental group revealed a significant drop in weight over time.  During the 8-week period, no adverse side effects were noted (Kreiger et al, 1990).

The first study arrives at a conclusion that does not take all of the information into account.  With so many side effects and adverse reactions to the drug combination, how can the researchers promote it?  Although the drug did appear to have an effect on weight loss, I object to the authors’ classification of the numerous adverse effects as mild.  Perhaps, a person would lose weight but it seems that complications might arise.  I do not believe this is a safe way to lose weight, even if it is effective.

The second study shows no significant difference between the two groups of women over time.  However, it does show a significant weight loss in the experimental group.  This could be attributed to other factors. For example, it is possible that the women in the experimental group were eating better or exercising more regularly than the women in the placebo group.  These factors were not controlled in the study and perhaps should have been.  Additionally, the treatment group did report side effects of jitteriness and dry mouth.  But, the side effects were not significantly different from the side effects reported by the placebo group according to Fischer’s exact test, so they were not reported in the results.  This discrepancy shows a weakness in the way side effects were measured.

How does it work?

The mechanism behind the weight reducing effects of ephedrine-caffeine are not well understood (Carek, 1999).  But Theoharides states, “These stimulants are structurally related to amphetamines, and they augment the availability and the action of the natural neurotransmitters norephinephrine and epinephrine” (1997).  Carek adds that ephedrine while increasing the release of noradrenaline, decreases food intake, and stimulates heart rate, blood pressure, and enhance thermogenesis (1999).  “Because of its similarity to noradrenaline, ephedrine is thought to suppress food intake via adrenergic pathways in the hypothalamus and related structures”, states Carek. (1999).

Here again, the concept of thermogenesis arises.  It seems that the research supports the claims about thermogenesis effecting metabolism.  But information on the mechanisms of how ephedrine works in the body was sparse.  This is probably due to Carek’s admission that the weight loss effects of the drug are not well understood (1999).

Is Ephedrine Safe?

The area where the most information exists on ephedrine is with regard to safety of the drug. White et al states, There is no clinical evidence that products containing Ma-huang are safe or that they produce the claimed effects (White et al, 1997).  “Ephedrine has been linked to more than 500 known incidences of serious adverse reactions, including 15 fatalities, in at least half of which death was attributed to myocardial infarction or cerebrovascular accidents”(Theoharides, 1997).  According to Zahn, “the U.S. FDA is aware of at least 15 deaths and 400 lesser incidents due to chronic use or overdoes of ephedra-containing products”(1997). “Products containing ephedrine can cause serious adverse effects particularly for those individuals with underlying heart disease, hypertension, and diabetes, who may self-medicate with ma-huang (White et al, 1997)”.  These statements lead me to believe that the risks involved with taking ephedrine supplements far outweigh the hopeful benefit of losing weight.

Some of the most common adverse effects of ephedrine use include:

profound hypertension (Zahn, 1997)
cardiac dysrhythmias (Zahn, 1997)
anxiety   (Zahn, 1997)
restlessness  (Zahn, 1997)
seizures    (Zahn, 1997)
tremor    (Carek, 1999)
insomnia  (Carek, 1999)
dizziness  (Carek, 1999)
muscle fatigue  (Carek, 1999)
stress    (Carek, 1999)
headache  (Zahn, 1997)
nausea   (Zahn, 1997)
sweating and thirst (Zahn, 1997)
palpitations  (Zahn, 1997)
micturation difficulty (Zahn, 1997)
stroke   (Zahn, 1997)
hepatotoxicity  (Zahn, 1997)
psychiatric abnormalities (Zahn, 1997)
cardiovascular toxicity  (Zahn, 1997)
cardiac hypertrophy (Theoharides, 1997)
focal myocardial necrosis  (Theoharides, 1997)

The following are a few case studies I found with regards to otherwise healthy people who died due to use of an ephedrine related substance:

A 23 year old healthy college student’s death was related to ephedrine toxicity from a Ma Huang containing drink.  The drink is called “Ripped Fuel” and is advertised as a thermogenic protein drink.  The deceased consumed the drink according to the stated directions once or twice per day for more than 6 months but had not taken any the day before his death.  His adherence to directions was verified by checking the level of ephedrine in the urine.  The autopsy report says “patchy myocardial necrosis associated with ephedrine toxicity from protein drink containing ma huang extract” (Theoharides, 1997).  The ephedrine drink had caused irreparable heart damage through constriction of small blood vessels and myocyte toxicity (Theoharides, 1997).

Bruno, Nolte, and Chapin studied three patients who suffered strokes associated with ephedrine use (1993).  One patient used ephedrine as a weight loss supplement.  One patient had a history of drug abuse and probably consumed an excess amount of ephedrine for a high.  The last patient had no prior history of ephedrine use.  Ephedrine was confirmed as the cause of each stroke through autopsy and submission of pills with ephedrine as the only active ingredient.  The findings indicate ephedrine can predispose people to strokes.  Excessive use of ephedrine may be an important stroke risk factor (Bruno, et al, 1993).

Zahn, Raymond, and Purssell (1997) present an episode of cardiovascular toxicity due to abuse of herbal ecstasy (ephedrine and caffeine).  A 21 year old male was admitted to the ER with ventricular dysrhythmias and blood pressure of 220/110 after ingesting four capsules of herbal ecstacy.  He had multiple ventricular ectopic beats and bigeminy.  He was treated with lidocaine and sodium nitropursside.  His symptoms resolved in 9 hours and the doctors discussed the pathophysiology and the clinical course of ephedrine toxicity with the patient.  The patient recovered but was lucky.  Abuse of herbal products can be fatal (Zahn, 1997).

CONCLUSION

Ma Huang may evoke weight loss in some people, but overall, it should not be considered effective or safe until further research is performed.  Supplements containing Ma Huang should be monitored strictly by the FDA.  And, perhaps the FDA should re-evaluate whether or not ephedrine-containing products should be as readily accessible (without a prescription) as they are now.  Consumers also need to be well-informed about the substances they are ingesting and the appropriate dosages, so they can make knowledgeable choices.

 REFERENCES

http://www.bennrye.com/dietfuel3.html
http://www.ephedra.demon.nl/
http://naturesrx.hypermart.net/diet_energy.htm
http://www.sobediet.com/html/tools.html
http://www.changesinternational.com/products/weight/product.cfm?productID=WM1CTL1
http://midwestsupplements.com/midwestsports/thermocuts.html
http://www.chathamhealth.com/accord/toneitfast.html
http://www.gethuge.net/xen3.htm
 

Bruno, A., Nolte, K.B., and Chapin, J. (1997). Stroke associated with ephedrine use. Neurology,
        43, 1313-1316.

Carek and Dickerson (1999). Current Concepts in the Pharmachological Management of Obesity.
         Drugs, 57(6), 883-904.

Kreiger, D.R., Daly, P.A., Dulloo, A.G., Ransil, B.J., Young, J.B., Landsberg, L.  (1990).
        Ephedrine, Caffeine and Aspirin Promote Weight Loss in Obese Subjects. Trans
        Associations of American Physicians, 103,  307-12.

Theoharides, T.C. (1997). Sudden Death of a Healthy College Student Related to Ephedrine
        Toxicity from a Ma Huang – Containing Drink.  Journal of Clinical Psychopharmacology,
        17(5), 437-8.

Zahn, K.A., Raymond, L. L., Purssell, R.A. (1997). Cardiovascular Toxicity after ingestion of
        Herbal Ecstacy.  Journal of Emergency Medicine, 17(2), 289-291.
 

 

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