Ephedra

Ephedra

Description

Ephedra, also known as Ma Huang, is an herb utilized by Chinese medicine for more than 2,500 years due to its ability to remedy symptoms of asthma and upper respiratory infections . A member of the Ephedracae family of herbs (Ephedra sinica ), ephedra is native to northern China and Inner Mongolia where it thrives in desert areas as a jointed, barkless plant with branches that bear few leaves and tiny yellow-green flowers that bloom in summer. While varieties of ephedra grow throughout the world, the United States version flourishes in the dry southwest.

Ephedra became popular to Mormon settlers in the early 1800s as a stimulant consumed in the form of tea in place of the coffee and black tea from which they abstained, giving the plant one of its many names, Mormon Tea. Other folk names that have resulted over time include Desert Tea, Desert Herb, and Squaw Tea. The herbal drink was named Whorehouse Tea after it was served in brothels during the 1800s due to unproven beliefs that it cured gonorrhea and syphilis .

The medicinal herb Ma Huang is made of the dried, young branchlets of ephedra. Harvested in the autumn, ephedra is reproduced from seed or by root division and the stems are dried in the sun throughout the year for production. The herb should be stored away from light. Ephedra gains its strength primarily from the alkaloid ephedrine, pseudephedrine, and norpseudephedrine. These active ingredients produce central nervous system stimulation. Other key components of ephedra include:

• tannin, an acidic substance found in the bark
• saponin, originating in the roots
• flavone, the chemical from which natural colors of many plants originate
• volatile oil

General use

A bitter-tasting herb that has been relied upon by the Chinese throughout centuries to heal ailments from fevers and chills , to nasal and chest congestion, ephedra also maintains its prominence as a strong stimulant. Contrary to its reputation, Zen monks used the herb to promote calm concentration during meditation . However, larger amounts can make a person jittery. Today, ephedra is used in the United States as an herbal medicine to treat asthma and hay fever , and the beginnings

of colds and flu. The herb is also used to raise blood pressure, cool fevers, and ease the pain of rheumatism.

While ephedrine was used in various decongestant and bronchodilator products in the United States beginning in the late 1920s through the 1940s, its potential for causing dangerous side effects led to the creation of a chemical substitute. Scientists created the equally effective, but safer, pseudephedrine that remains the active ingredient in many over-the-counter (OTC) products such as Sudafed. Primatene Mist, an OTC that contains ephedrine, is used regularly to treat asthma.

The body responds to ephedra as one of its key ingredients, ephedrine, opens bronchial passages, activating the heart and raising blood pressure while increasing metabolism. Due to its stimulating effect on the nervous system, many weight loss and energy products contain ephedra. Ephedrine increases basal metabolic rate (BMR), causing the body to burn calories faster. Dieters use ephedra-based products because they suppress the appetite and stimulate metabolism. While these diet products prove to be effective, their results are rarely permanent, and long-term use can be quite harmful. Chinese sources only recommended its use for acute situations.

As an "energy" product, ephedra increases alertness and perception. The use of ephedra in this way dates back to bodyguards of Genghis Khan, who, legend has it, fearful of being beheaded if they fell asleep on duty, consumed tea containing ephedra to stay alert. Caffeine products, such as coffee, tea, chocolate, and cola drinks, enhance the effect of energy products containing ephedra. Additional medicinal uses of ephedra include the promotion of menstruation , the decreased desire for cigarettes, and the promotion of uterine contractions. Ma Huang is also known for its ability to increase sexual sensation.

Some controversy surrounds the extended use of ephedra. It is recommended that products containing ephedra be taken only for short periods of time. Tachyphylaxis, or becoming immune to a drug's effectiveness due to overuse, and dependence on the drug may develop when taken consistently over time. Both ephedrine and Ma Huang are considered doping substances. In April 1996, the United States Food and Drug Administration (FDA) issued a warning on dietary supplements containing ephedra that were labeling themselves as safe substitutes for "street drugs," such as the illegal drug ecstasy. The FDA stated that these products could have "potentially dangerous effects on the nervous system and heart."

Ephedra is classified as a dietary supplement, and unlike pharmaceutical companies that must follow strict rules regarding safety, efficacy, and quality set by the FDA, manufacturers of supplements are not held to these guidelines. In 1994, the regulation of herbal medicine-type products in the United States changed with the passage of the Dietary Supplement Health and Education Act (DSHEA). At this time, herbal products were reclassified, along with vitamins and minerals, as dietary supplements. When classified in this grouping that falls somewhere between food and over-the-counter drugs, herbal supplement manufacturers were then able to begin making "structure-function" claims for a product on its label if there is scientific evidence supporting these claims. When appropriate, supplement manufacturers are allowed to use three types of claims: nutrient-content claims, disease claims, and nutrition support claims. These claims are made to guide the buyers of supplements, but supplement manufacturers may use the claims without FDA authorization, and are not required by law to conduct scientific studies on their products. In March 1999, the placement of a "Supplement Facts" panel became a requirement on the labels of most dietary supplements. In January 2002, The United States Pharmacopeial Convention announced it would launch a dietary supplement verification program. Though voluntary, the program would allow supplement manufacturers to provide documentation that they had a quality standard system in place, the organization would audit that system, then verify the quality of the supplement as long as the manufacturer continued to meet the criteria.

While questions surround the correct use of ephedra in the United States, the German government's Federal Institute for Drugs and Medical Devices (Commission E) certifies that ephedra herba, ephedra, and Ma Huang is an approved remedy for diseases of the respiratory tract with mild bronchospasms. Approval from Commission E, however, is not equivalent to the FDA's higher standards of drug approval. Some states in the United States have limited the use of ephedra, or banned the drug completely.

Preparations

Ephedra is available over the counter as a fluid extract, in tablet form, or as a dried bulk herb at Chinese pharmacies, Asian markets, and health food stores where it is permitted throughout the United States. When purchasing the herb, be certain to avoid those that look dry or have a greenish-brown cross section.

Chinese herbalists prepare ephedra for use by combining one part honey, four parts dried herb in combination with other herbs, and a small amount of water in a wok. The herbs are simmered over low heat until the water has evaporated and the herb begins to turn brown. Other forms of preparation include frying ephedra in vinegar or wine to improve its tonic effect on blood circulation, and toasting it to an ash so that it may increase its ability to stop bleeding.

To treat fever and chills, Chinese herbalists recommend combining ephedra with cinnamon twig and other herbs. Coughing and wheezing are remedied with a mixture of ephedra and apricot seed , while licorice is added to the herb for stomachaches . An upper respiratory infection, or congestion, is treated with a combination of ephedra and ginger . The powder form, mixed with rehmannia, is also used by the Chinese to treat kidney energy (yin) deficiency. It is recommended to consult a Chinese medicine practitioner, or physician for detailed information on mixtures of ephedra and doses of the herb.

As the United States has adopted the herb for its healing properties, the variety of ephedra preparations has increased. The average single dose of ephedrine for adults is 15–30 mg, with a maximum allowed daily dose of 300 mg per day. When consumed as a tea, 1 teaspoon (5 ml) of ephedra is boiled with 1 cup (250 ml) water for 15–20 minutes, with up to 2 cups (500 ml) of the tea allowed per day. This tea (also known as a decoction) is prescribed by herbalists for asthma. The tincture preparation is used in treatments to ease the aches and joint pains caused by rheumatism. The amount of tincture recommended is 1/4 teaspoon (1.25 ml)–1 teaspoon (5 ml) in combination with other herbs, up to three times a day.

As a dietary supplement, there is no FDA control over the manufacturing of ephedra, including what is in the pill, additional ingredients added to the pill, how it is produced, or what part of the plant it is made from. For example, when the whole ephedra plant is used for treatment, the side effects are minimal. When key ingredients, such as ephedrine, are isolated from the herb, the strength of the drug increases, therefore increasing the side effects. The potencies and purity within supplements vary greatly by brand and by bottle, resulting in the difficulty of exact dosage recommendations. It is recommended that directions on the product's label are followed exactly for proper use.

Precautions

While ephedra may be taken safely in the correct doses, the supplement has shown to be harmful to children, adolescents, older or chronically ill people, and pregnant women or women who are breastfeeding. Those with heart disease , high blood pressure, prostate enlargement , pheochromocytoma, diabetes, glaucoma , thyrotoxicosis, overactive thyroid gland (hyperthyroidism ), nervousness, anorexia, insomnia , suicidal tendencies, stomach ulcers, or bulimia should not take ephedra. It is also recommended that the herb be avoided by those with diarrhea or abdominal bloating.

It should be noted that ephedra is an ingredient in many weight-loss aids. While it is effective for a dieter's purpose as it accelerates his/her metabolism, the excess stimulation can cause dangerous consequences. The strength of the herb is extremely powerful as a stimulant, with its active ingredient epinephrine mimicking the effects of adrenaline. The molecular structure of epinephrine is close to methampetamine, also known as speed, and the use of ephedra can result in a positive test for amphetamines in the urine. Regular use of ephedra has shown to lead to dependence on the herb.

Many cases of Ma Huang toxicity have been reported to the FDA and possibly serious cardiovascular effects have been associated with its use. Health Canada issued a recall for products containing more than recommended levels of ephedra in early 2002 because of serious, possibly fatal, side effects. The dose limits set by Canadian authorities were more than 8 mg of ephedrine or a label that recommended more than 8 mg per dose or 32 mg per day. It also included products recommended use exceeding seven days.

A 2002 study concluded that use of Ma Huang could be associated with serious complications including increased risk of stroke, heart attack or even sudden death and that the effects were not limited to massive doses.

Side effects

Side effects of ephedra include insomnia, dry mouth , nervousness, irritability, headache , and dizziness . The following side effects are considered serious: increased blood pressure, increased heart rate, and heart palpitations. If these develop, the use of ephedra should be stopped and a physician should be consulted immediately.

In 2000, the FDA reported that the herb ephedra when used as a weight-loss product could result in serious side effects, including heart attack, stroke, and high blood pressure. These potentially life-threatening outcomes, especially to those people with heart problems, are a result of those products that combine ephedra with other stimulants, such as caffeine. At this time it is estimated that four million people safely use products that contain the combined ingredients of ephedra and caffeine.

Ephedra may be life threatening if taken in very high dosages (over 100 g, lethal dosage when taken orally corresponding to approximately 1–2 g L-ephedrine). Signs of poisoning by the herb include severe outbreaks of sweating, enlarged pupils, spasms and elevated body temperature, with heart failure and asphyxiation causing death. To treat the symptoms of poisoning caused by ephedra, seek medical attention immediately.

Interactions

While ephedra may be taken safely on its own, several adverse effects may result from taking the herb along with other drugs.

Drugs that may cause adverse effects if combined with ephedra include:

• methyl xanthines, such as caffeine
• beta blockers
• Dexamthasone
• Reserpine
• Amitriptyline
• urinary alklinizers, such as sodium bicarbonate
• unrinary acidifiers, for example, ammonium chloride
• monoamine oxidase inhibitors, such as heart glycosides
• secale alkaloid derivatives, such as oxytocin
• Yohimbine
• Gaunethidine, which leads to the enhancement of the sympathomimetic effect, or stimulation of the nervous system

Those who are taking any of the aforementioned drugs should avoid ephedra. The isolated drug ephedrine (the active ingredient of ephedra) has also been shown to cause side effects if combined with other drugs, including: antidepressants that increase the overall effect of ephedrine; methyldopa, due to possible increased blood pressure; and ergot preparations that may lead to serious blood pressure problems. Other substances that may cause alarming circumstances if combined with any form of ephedra include cocaine, marijuana , and caffeinated drinks. While it is known that Ma Huang taken with certain drugs and other substances may causes adverse effects, overall drug interactions with the supplement ephedra have not been thoroughly studied. It is recommended that a physician be notified before beginning the use ephedra in any form, or of any herbal supplement.

Resources

BOOKS

Chevallier, Andrew. "Ephedra sinica." In The Encyclopedia of Medicinal Plants. New York: DK Publishing Inc., 1996.

The Editors of Time-Life Books. "Conventional and Natural Medicines." In The Medical Advisor: The Complete Guide to Alternative & Conventional Treatments. Richmond, VA: Time-Life Inc., 1996.

Fleming, Thomas. "Ephedra sinica." In PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company Inc., 1998.

Griffith, H. Winter. "Ephedrine." In Complete Guide to Prescription & Nonprescription Drugs. New York: Berkley Publishing Group, 1998.

PERIODICALS

Binkley, Alex. "Health Canada Issues Ephedra Recall." Food Chemical News 43, no.49 (January 21, 2002):19.

Kurtzwell, Paula. "An FDA Guide to Dietary Supplements." FDA Consumer no. 99 (September/October 1998): 2323.

Levy, Sandra. "Watch for New Seal of Approval on Dietary Supplements." Drug Topics 146, no.29 (January 7, 2002):29.

Samenuk, David. "Adverse Cardiovascular Events Temporarily Associated with Ma Huang, an Herbal Source of Ephedrine." JAMA, Journal of the American Medical Association 287, no. 12:1506.

Taylor, David. "Herbal Medicine at a Crossroads." Environmental Health Perspectives 104, no.9 (September, 1996).

ORGANIZATIONS

American Botanical Council. PO Box 201660, Austin, TX 78720–1660.

Food and Drug Administration, Office of Consumer Affairs. HFE-88, Rockville, MD 20857.

Herb Research Foundation. 1007 Pearl Street, Suite 200, Boulder, CO 80302.

OTHER

Drug Digest. http://www.drugdigest.org (January 17, 2001).

The Ephedra Site. http://ephedra.demon.nl/index.html

WebMD. http://WebMD.com

Beth Kapes

Teresa G. Odle