Please note: On Dec. 30, 2003, the U.S. Food and Drug Administration (FDA) issued a consumer alert regarding the safety of dietary supplements containing ephedra. The FDA has determined that consuming these supplements poses an unnecessary risk of illness or injury, and that consumers should stop buying and using ephedra products immediately. The FDA also notified manufacturers and marketers of these dietary supplements that effective 60 days (March 2004) after the publication of its final ruling, the sale of all products containing ephedra in the United States will be banned.

Physicians traditionally dispensed the herbal extract ephedra (ma huang) to treat such common conditions as respiratory infections, asthma , eczema , hay fever , and edema. Although it can still be found in a few over-the-counter drugs for asthma, physicians seldom prescribe ephedrine anymore because it mimics the effects of adrenaline, causing symptoms like rapid heartbeat, high blood pressure , agitation, insomnia , nausea, and loss of appetite.

In addition, ephedra is currently sold as a component of dietary supplements to “promote weight loss and enhance energy,” which has led to many safety concerns since these products can be sold without FDA approval. New research from the Annals of Internal Medicine highlights the relative danger of taking ephedra when compared with other herbal products.

About the Study

Researchers from the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center used data from the American Association of Poison Control Centers to examine the risk of injury from ephedra compared to other herbs like Ginkgo biloba , St. John’s Wort , and Kava . The Toxic Event Surveillance System collected this information on adverse reactions to ephedra and other herbal products during 2001, and an independent natural products consulting agency estimated the number of herbal products sold the same period. This information was then used to calculate a “relative risk,” defined as the number of adverse reactions per unit sales of ephedra divided by the number of adverse reactions per unit sales of the comparison herb.

The Findings

Products containing ephedra alone or in combination with other substances accounted for 64% of all adverse reactions (1178 total reports)—though these products represented less than 1% of herbal product sales. Taking ephedra was associated with a 520% to 1100% increase in reporting an adverse effect when compared to reports on Ginkgo biloba , a popular herb that is generally recognized as safe by most authorities.

Even when compared to Kava—an herb that has raised its own safety concerns for the role it may play in causing liver damage—ephedra was 83% to 140% more likely to have an adverse effect reported. When comparisons are made to other herbs, adverse effects were 200% to 240% more likely to be reported for ephedra than all other herbal products combined.

The major limitation of a study like this is that the number of adverse reactions used for this analysis is likely a fraction of all negative effects that actually occur with these herbs. For this analysis, the authors assumed that people using ephedra were just as likely to report an adverse effect as those using other herbs, which may or may not be the case.

How Does This Affect You?

Based upon evidence such as this, the American Medical Association and other health organizations have recommended banning the sale of ephedra. These results highlight the problems associated with the lack of FDA regulation of the herbal industry. Although most popular herbs are probably harmless, the lack of FDA regulation means the U.S. government is in no position to ensure their safety and effectiveness. Consumers are forced to be vigilant in assessing the quality, usefulness, and dangers of the herbs and supplements they are using.

Many people can be swayed by the health claims promised on herb and supplement packages, and the assumption that these products are safe because they are “natural.” Consumers can unknowingly be putting themselves at risk in their quest to find “weight loss in a bottle” or some other cure-all. In the end, tried and true solutions to many health conditions—like eating a healthful diet and getting plenty of exercise —are still the best advice for a long and disease-free life.