Ephedrine and its use in Weight Loss

 

Lindsay Beckner

                                                                                                  

 

                           Throughout the late nineteenth century and into the new millennium, there has been a tremendous desire among women to lose weight.  Women today will do anything to achieve their belief of the perfect figure.  While the “Barbie” look was at one time looked upon as unhealthy, it is now considered expected.  For some reason women feel the need to keep up with Hollywood and its stars.  Of course it does not help when the cover of any fashion magazine is pasted with size-zero models.  After reading a magazine filled with beautiful, skinny women, people usually feel worse about the way they look, not better.  So it is no surprise that the trend to lose weight has taken off in the past couple of years.  And with this trend comes the increased popularity in “weight-loss” products.  One can find any type of product now that claims to lose weight effectively, but at what cost to his/her health?  One very controversial herb found in diet pills or food supplements is ephedrine.

 

Purpose of Ephedrine:

                        While ephedrine is used to treat low blood pressure and chronic asthma, it is more popularly used in diet pills (http://www.ravehard.com/doctor/ephidra.htm).  Ephedrine is a natural stimulant found in many diet pills offered today.  According to the Clinical Toxicology Review, ephedrine mainly affects the cardiovascular and respiratory systems of the body.  This means that it constricts blood vessels and enhances certain actions of the heart (http://www.dr-bob.org/babble/20000401/msgs/29022.html).  In a clinical review; Capri-Mara Fillmore, Lisa Bartoli, Richard Bach, and Young Park 1999, they stated that ephedrine stimulates the sympathomimetic and central nervous system.  Ephedrine is usually mixed with other stimulants like caffeine and appetite suppressants to create a pill that companies claim help a person to lose weight without diet or exercise.

Rationale of Ephedrine:

                        Metabolife, one of the most popular diet pills, contains the herb ephedrine and according to its web site, http://www.metabolife.com/shop/356.html, Metabolife raises the body’s metabolism safely and effectively, but instead of burning both fat and muscle, Metabolife will only reduce the fat content.  Supposedly after taking this “precisely blended” pill, one will feel a dramatic increase in her energy level, but not in his/her appetite.  It sounds almost too easy to be true.  One user’s definition of how Metabolife works is that it “speeds up your heart…just like when you exercise.  And your body interprets this as exercise…” (http://athinu.com/wboard/messages/71.html).  However, Metabolife is not the only diet pill known to use ephedrine.  Another competitor, Xenadrine, also uses ephedrine in its long list of ingredients.  This company claims that if a person used its product, then he/she would experience a fat decrease of seventeen times more than if he/she only dieted and exercised.   It also says that it will keep muscle toned while losing weight (http://www.xenadrine.com).  In a clinical review by Luke Bucci (Bucci 2000  p.631S), “lean mass is preserved better with ephedrine-containing combinations during weight loss.”  Bucci also states that ephedrine is prohibited for sporting events due to its affect on physical enhancement.  Exercise in a bottle does sound inviting, but how can one be sure that these products actually do what they claim?

 

Claims on the Effectiveness of Ephedrine:

One of the most popular claims of the effectiveness of these pills that these companies use is the testimony made by customers. According to a Metabolife user, she did not notice any significant decrease in appetite, but she did feel more energized.  She felt that if Metabolife was used with a regular workout routine, a noticeable weight loss is possible.  Another client claimed to have lost forty pounds on Metabolife without working out or using any diet.  And even another woman said that while she does not notice any differences while taking Metabolife, she does feel more energetic and in control of herself.  She even goes on to say that Metebolife is a “Godsend” for those people who do not want to wait months and months to shed those extra pounds (http://www.athinu.com/wboard/messages/73.html).  On the Metabolife website itself, there are many stories from customers saying how much weight they lost, and how much energy they have now.  Then again, none of these people say how much they weighed before they got on Metabolife.  Xenadrine’s website has a section entitled “Praise from the Experts.”  In it these “leading independent doctors” praise the effectiveness of this diet pill.  Xenadrine uses doctors that sound quite impressive, including those who are authors of books and/or directors of medical groups and centers.  John Sutherland, M.D. says “…And perhaps of even more importance is that Xenadrine offers dramatic results without the side effects associated with the prescription formulas” (http://www.xenadrine.com/praise.htm).  While both of these companies claim to have found the miracle drug, to what extent are they telling their customers the truth?

Evidence in Support of  Ephedrine’s Effectiveness:       

                        Many of these companies will tell their customers almost anything in order to make a profit.  Metabolife tells the readers that it has done extensive research to ensure its effectiveness, but then no real research evidence is mentioned.  The website claims that research has been performed by doctors, a pharmacologist, and a toxicologist, but they remain nameless.  It then goes on to say that two laboratories and two major universities have tested Metabolife for safety.  Once again there was no additional information available about these “studies”  (http://www.metabolife.com/).  Xenadrine’s studies were not even mentioned in its website.  While they had a section titled “research studies and laboratory tests,” once one entered in it, the screen simply said “Coming Soon.”  So no real proof of Xenadrine’s safety or effectiveness could be found.  In another website stating that ephedrine was in fact bad for a person’s health, it had comments made by the Food and Drug Administration and the National Council Against Health Fraud against ephedrine.  The Post and Courier described the drug “ Profit without Honor” (http://www.ageless.com/ephidrine.htm).  So neither company had any type of hard evidence to back up their claims; however, several groups among the medical realm have performed extensive studies regarding ephedrine and its affect on weight loss. 

Clinical Trials:

Arne Astrup, Leif Breum, Soren Toubro, Pia Hein, and Flemming Quaade (1992), performed a double blind, placebo controlled study on the effect and safety of an ephedrine/caffeine compound and compared it to ephedrine, caffeine, and placebo in obese subjects on an energy-restricted diet.  There were 180 patients ranging from 20 to 65 years old. In this study, the researchers had four groups: ephedrine+caffeine, ephedrine only, caffeine only, and placebo.  Their two main goals were to see whether giving the E+C was more effective than the other three supplements, and whether E+C produced a greater supra-additive effect on weight loss.  The patients were given their dosages three times a day, one hour before each meal.  They were seen every two weeks during the 24-week study.  During each visit, the patient’s hip and waist circumference, weight, blood pressure, resting heart rate, and side effects were measured.  Their results showed that 141 patients completed the study.  The mean hip and waist ratio did not show a significant decrease difference between the groups.  The mean weight loss of E+C was greater than any of the other groups showing a P value ranging from .04 to .01.  The researchers also found that the supra-additive effect was only found from week eight to week twenty with a P value of .04.   Blood pressure decreased in all groups, but heart rate decreased the most in C and in the placebo group (P value of less than .01).  Side effects were most commonly noted in the E+C, E and C groups through week four, but after eight weeks the complaints were gone.  The most common side effects found in the E+C group were insomnia, dizziness, and tremor.  In the E group, the side effects were insomnia and tremor.  The C group complained mostly of dizziness and headaches, while the placebo group complained of insomnia.  These findings showed that while ephedrine and caffeine alone do not show significant decrease in weight, the combination of the two does affect weight loss.

In another study performed by PA Daly, DR Krieger, AG Dulloo, JB Young, and L Landsberg (1993), ephedrine was combined with caffeine and aspirin.  They used 24 obese individuals in a randomized double blind placebo-controlled study for an eight-week study followed by two other long-term studies.  The purpose of this experiment was to determine the efficacy and safety of ECA.  The first phase of the study included the administration of treatments three times a day, 30 minutes before meals.  They measured weight, blood pressure and heart rate, and side effects at the end of week 1, 4, 6, and 8.  The mean weight loss for ECA was significantly higher than the placebo group (P value of .003).  There were no significant differences between ECA and placebo concerning blood pressure and heart rate.  Side effects for the placebo group consisted of dry mouth (2), constipation (1), and jitteriness (1).  The ECA group had complaints in each of these areas; 2, 2, and 3 respectively.  In phase two of this study, nine patients were used and evaluated at the end of week 2, 4, 6, and 8.  This study was performed five months later for another eight weeks; however, this time it was an un-blinded study.  The mean weight loss of ECA was significantly greater, providing a P value of .09.  Once again there was no significant difference between these groups with respect to blood pressure and heart rate.  Side effects were only found in ECA consisting of dry mouth.  This did not continue throughout the experiment.  In the last phase, six of these subjects were used and evaluated every month ranging from 7 to 26 months.  The increase in weight loss was significant statistically and clinically because the weight loss happened without the restriction of calorie intake.  In conclusion of this experiment, the ECA group lost more weight than the placebo group.  It was also concluded that ephedrine taken over an extended period of time was still safe and still provided weight loss. 

Side Effects of Ephedrine:

                        According to the FDA, ephedrine can cause nausea, irregular heartbeats, insomnia, and nervousness (http://ageless.com/ephidrine.htm).  In Texas there have been two deaths linked to ephedrine products.  The Metabolife label has a long list of different diseases or problems that should be advised before taking Metabolife.  Another FDA report stated that ephedrine can also cause high blood pressure, tremors and headaches, seizures, heart attacks, strokes and in extreme cases like in Texas, death (http://www.ukcia.org/news/1997/news/st1215.htm).  In the clinical study, PA Daly et al (1993 p.77S), “the side effects are dose related, and they appear to diminish over time; however Bucci (2000) states that it can cause adverse side effects if taken in high dosages.  Therefore, the FDA has attempted to place restrictions on the dosage and duration of ephedrine found in dietary supplements.  This however, is still under consideration (Gurley 2000).  In a clinical review, GA Bray 1999, it was found that ephedrine affects thermogenesis and it also “delays gastric emptying…which may represent a mechanism for decreased hunger” (p.144). 

 

Presenters and their Motives:

                        The most common supporters of ephedrine were the companies that were trying to sell their products.  They gave one just enough information to make one believe them without questioning their claims.  If they did give the reader any information pertaining to ephedrine’s safety, it was extremely vague.  There were a few web sites that protested against ephedrine’s safety.  Most of these web sites were either doctors or sites that dealt with a person’s health. 

 

Conclusion:

While the effects of ephedrine sound appealing, the effectiveness is only short-lived.  It may be true that one will lose weight while taking diet pills that contain ephedrine, but once he/she is off of these pills he/she will gain weight if good nutrition and exercise are not continued.  It is true that ephedrine works, but in order to maintain the weight loss, one must continue taking the pills.  Ephedrine is a very controversial drug that has been clinically proven to have adverse side effects if not taken properly.  It has also been proven to be effective in weight loss studies.  It is up to the consumer whether he/she should take this drug.  In conclusion, to maintain a healthy body, one must make an effort to take care of it.

 

Bibliography:

Astrup, Arne; Leif Breum, Soren Toubro, Pia Hein, Flemming Quaade (1992).  The Effect and Safety of an Ephedrine/Caffeine Compound Compared to Ephedrine, Caffeine and Placebo in Obese Subjects on an Energy Restricted Diet, A Double Blind Study.  International Journal of Obesity and Related Metabolic Disorders,16, 269-277.

Bray, GA (1999).  Drug Treatment of Obesity.  Baillieres Best Practice and Research-Endocrinology and Metabolism,13, 131-48.

Bucci, Luke R (2000).  Review: Selected Herbals and Human Exercise Performance. American Journal of Clinical Nutrition, 72(Suppl. 2), S624-S36.

Daly, PA; DR Krieger, AG Dulloo, JB Young, L Landsberg (1993).  Ephedrine, Caffeine, and Asprin: Safety and Efficacy for Treatment of Human Obesity.  International Journal of Obesity and Related Metabolic Disorders, 17(Suppl. 1), S73-8.

Fillmore, Capri-Mara; Lisa Bartoli, Richard Bach, Young Park (1999).  Review: Nutrition and Dietary Supplements.  Physical Medicine and Rehabilitation Clinics of North America. Vol 10. No.3 Aug 1999, 673-683.

Gurley, Bill (2000). Letter to Editor: Extract Versus Herb: Effect of Formulation on the Absorption Rate of Botanical Ephedrine from Dietary Supplements Containing Ephedra(Ma Huang).  Therapeutic Drug Monitoring, 22, 497.

 

                                                                                                                                                                              

 

 

 

 

 

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