In reaction to last week’s article on the banning of over-the-counter sales of diet pills containing ephedrine or nor-pseudo-epinephrine, many readers have been asking how safe other readily available diet pills are.
A host of over-the-counter diet pills, particularly herbal products, contain extracts of a plant called "ephedra", which can be just as dangerous as pharmaceutically produced ephedrine pills.
US ephedra ban
According to the Mayo Clinic, products containing the herb ephedra, or any of its extracts, were banned in the USA in February 2004 by the US Food and Drug Administration (FDA). The reasons given for this ban of the popular herbal slimming aid were that dietary supplements containing ephedrine alkaloids (ephedra) presented an unreasonable risk of illness or injury.
The FDA was already in possession of a file on ephedra casualties including more than 100 deaths due to the use of various preparations containing ephedra or ephedrine, when an American major league baseball player died after using an ephedra product. This event prompted the total ban of ephedra products in the USA.
In 2005, the legislation was temporarily overturned in the State of Utah, but was reversed after four months. At the moment, any diet pill, sports supplement and/or dietary supplement that contains ephedra is banned in all states.
What is ephedra?
Ephedra sinica is a small, evergreen shrub. Its dried stems and roots are primarily used in herbal pills and potions. Ephedra stimulates the heart and central nervous system, increases perspiration, suppresses the appetite and can act as a diuretic. It's often used in slimming preparations and sports supplements.
The main ingredient in this herb is ephedrine (a so-called phenylethylamine alkaloid), and it also contains pseudoephedrine (Ageless, 2008).
The side effects of ephedra are similar to those listed for pharmacologically manufactured ephedrine, namely:
- Abdominal distress (vomiting, diarrhoea, loss of appetite, constipation)
- Anxiety, euphoria, irritability, and in severe cases hallucinations, seizures and delirium
- Dizziness and insomnia
- Tremors or shakiness
- Muscle weakness and damage
- Depression, suicidal behaviour
(Mayo Clinic, 2008)
People with the following conditions are particularly vulnerable to the effects of ephedra:
- Pregnant and breastfeeding women. Ephedra may induce contractions in pregnant women. It can also cross the placenta and increase the unborn baby’s heart rate. During breastfeeding, ephedra is excreted in breast milk and causes crying, irritability and insomnia in babies.
- Children and teenagers.
- Patients with high blood pressure or those who've suffered previous strokes or mini-strokes (also called "transient ischaemic attacks").
- Anyone suffering from psychiatric illnesses (depression, anxiety, schizophrenia), particularly patients taking monoamine oxidase inhibitors (MAOIs).
- Patients with respiratory problems, because ephedra can restrict breathing.
- Anyone with heart disease, because ephedra causes irregular heartbeats, ventricle dysfunction and may even trigger heart attacks.
- Liver and kidney damage, including kidney stones. Patients with prostate conditions should not take ephedra as it can inhibit urination.
- Patients with thyroid disorders and glaucoma (pressure build-up in the eye(s)).
(Mayo Clinic, 2008)
All in all, the number and severity of side effects associated with the use of ephedra fully justify its banning.
Too many names
At the last count, there were 108 different names for ephedra listed on the Mayo Clinic Website. The names include: Ma huang, desert tea, horsetail, Mexican tea, natural ecstasy and synephrine, to name but a few (Mayo Clinic, 2008).
This makes it difficult to figure out if a herbal slimming or sports product contains some or other variation of ephedra that can put you at risk.
As a rule of thumb, avoid buying or using herbal slimming products (from pharmacies, health shops or the Internet), and if you insist on trying them for weight loss and other purposes, check the list of ingredients for words such as:
- Ma huang
Also ask your chemist to look up the ingredients in his reference books (e.g. Pharmacopoeia) to see if the innocent-sounding product you intend to buy can cause negative side effects.
Also check products that declare that they're “Free of ephedrine”, but on closer scrutiny contain an ingredient such as synephrine or ma huang. This type of misinformation is particularly common in diet and sports products.
Poor control of potentially dangerous products
As mentioned above, ephedra has officially been banned in the USA since early in 2004, but recently a group of researchers checked on the ingredients of 12 different weight-loss products that are readily available to the American public. Most of them contained mixtures of up to seven different herbal extracts and many of them included some or other version of the banned ephedra, such as “ma huang” (Health24, 2008).
If this is the situation in the USA, where ephedra has been officially banned for four years, we can be sure that there are plenty of slimming and sports products available in South Africa that contain a form of the dangerous herb.
Our market has recently been flooded with all kinds of slimming teas and potions from the Far East, which all promise to make you lose weight in a jiffy or turn you into a super athlete. If you've bought one of these teas, infusions, drops or tonics to try to lose weight or build muscles, then check the label for mention of ephedra. If the label doesn't list the ingredients, get rid of it immediately.
Even though it's desirable to lose weight, it's not worth endangering your health and your life by taking such products. Stick to a well-balanced diet and get plenty of exercise to lose weight and avoid "magic" pills and potions that may be dangerous. The same goes for athletes who should keep in mind that ephedra is classified as a doping substance in sport, which means that it could ruin your sporting career.
- (Dr I.V. van Heerden, DietDoc, June 2008)
(Ageless (2008). Ephedra. www.ageless.co.za.herb-ephedra; Health24 (2008). Online diet pills may hurt heart. www.health24.com/news/DietFood_News-Feed/1-3420,46431.asp; Mayo Clinic (2008). Ephedra (Ephedra sinica). Drugs & Supplements. www.mayoclinic.com/ health/ephedra/NS_patient-ephedra ;)
Any questions? Ask DietDoc