influenza, bronchitis, and allergy. In the 1990s ephe-
dra was marketed in the United States as a dietary
supplement that stimulated weight loss. It was also
marketed to adolescents as a mood-altering ‘‘herbal
Ecstacy’’ and to athletes to improve performance. In
2005 use of ephedra-containing supplements in the
United States was banned.Description
Ephedra is an evergreen plant with tiny leaves that
grows to a height of about 12 in (30 cm). Many species
of ephedra are found worldwide, butE. sinicaused in
herbal medicine grows mainly in dry, rocky areas of
Mongolia and northern China. The stems and roots
of the plant are used medicinally. Many other species
of ephedra, for example,E. nevadensisor Mormon tea
that grows in the western United States, do not have
the same active ingredients asE. sinica.
The active ingredients in ephedra are the alkaloids
ephedrine and pseudoephedrine. These chemicals have
effects similar to amphetamines. They stimulate the
central nervous system and affect the heart and circu-
latory system. Ephedra causes blood vessels to nar-
row, increases heart rate, and raises blood pressure.
These effects are enhanced when ephedra is taken with
caffeine. Ephedra also expands the airways, making
breathing easier. Researchers generally agree that
ephedra is effective in treating cold and allergy
symptoms.Standardized amounts of manufactured ephedrine
and pseudoephedrine, the active ingredients found in
ephedra, are used in many cold and allergy products
made by traditional pharmaceutical companies and
approved for sale by the FDA. For years, these drugs
were sold in the United States over the counter without
restrictions. Beginning in the early 2000s, a movement
developed to limit access to these drugs by placing them
behind the counter at the pharmacy, limiting the
amount an individual could buy, and requiring identi-
fication to purchase the drugs. This came about more
because ephedrine and pseudoephedrine are used in the
manufacture of illicit methamphetamines (e.g., crystal
meth) than because of safety concerns about the drugs.
Ephedrine and pseudoephedrine are also effective
appetite suppressants, especially when combined with
caffeine. Many people who took diet pills containing
ephedra or a combination of ephedra and caffeine did
lose weight. However, they also experienced an
increased risk of dangerous, sometimes fatal, side
effects. Ephedra was brought to the attention of the
FDA in the mid-1990s by a large increase in the number
of reports from poison control centers and health care
providers about serious adverse effects related to
ephedra-containing weight-loss supplements. These
side effects included dangerously high blood pressure,
fast heart rate, stoke, and heart attack. By 2003, at least
155 deaths were linked to ephedra use, including that of
Baltimore Oriole’s pitching prospect Steve Belcher.
That same year, an analysis of side effects related to
herbal therapy published in theAnnals of Internal Med-
icinefound that ephedra accounted for less than 1% of
all herbal supplement sales, but was responsible for
64% of all reported negative events caused by herbs.Ephedra and the LawThe FDA regulates ephedra and otherdietary
supplements under the 1994 Dietary Supplement
Health and Education Act (DSHEA). At the time the
act was passed, legislators felt that because many diet-
ary supplements come from natural sources such as
plants and because they have been used for hundreds
of years by practitioners of CAM, these products did
not need to be regulated as rigorously as prescription
and over-the-counter drugs used in conventional med-
icine. The legislators decided that dietary supplements
should be regulated the same way food is regulated. As
a result, manufacturers of ephedra supplements, just
like the manufacturers of cheese or cereal, did not have
to prove that ephedra was either safe or effective
before it could be sold to the public. They also were
not required to tell the public about possible sideEphedra (Ephedra sinica).(PlantaPhile Germany. Reproduced
by permission.)Ephedra