As the federal ban on the dietary supplement draws close, experts say there really are no other herbal alternatives.
By SUSAN ASCHOFF
Published February 24, 2004
[Times art: Rossie Newson]
Diet aids containing ephedra already had disappeared from most stores when the Food and Drug Administration said it would ban sales. The prohibition, which likely will take effect in April, had been urged for years because of the herb's links to heart problems. The ephedra ban is the first time the FDA has pulled a dietary supplement from the market, yet it fails to answer a larger question:
Do other supplements which, like ephedra, tout weight loss, safely deliver what they promise?
"There are no alternatives to ephedra. It was really effective, and there's no other plant that (works) in this way," says Veronika Butterweck, an assistant professor at the University of Florida College of Pharmacy.
The difficulty, she says, is getting patients to take only so much for only so long.
Ephedra, also known as ma huang, has a history of medicinal use in India and China in treating colds and respiratory ailments. In the early 1990s, ephedra and its main chemical component, ephedrine, became popular in the United States as a supplement to promote weight loss and energize workouts.
Ephedrine is a close chemical relative of pseudoephedrine, a decongestant found in many over-the-counter cold remedies. Teenage girls have been known to take Sudafed, the allergy and sinus medicine, because it contains pseudoephedrine and provides an energy jolt while suppressing appetite.
Ephedra was considered a safer choice than drugs or caffeine to lose pounds or enhance physical performance. Between 12- and 17-million Americans took ephedra, packaged in about 200 dietary supplements sold over the counter and promoted at health food stores and Web sites. Last year in the United States, ephedra sales hit $1.4-billion.
"I do like to use ephedra. It works well if it's used correctly," says herbalist Rose Kalajian, who promotes wellness through herbs, diet and yoga for clients at her herb farm in Wesley Chapel.
But ephedra, particularly when used for more than a few months and in excessive amounts, stresses the body. More than 150 fatalities have been attributed to ephedra products. It was blamed in the death of 23-year-old Baltimore Orioles pitcher Steve Bechler last year. Previously, it was banned by the National Football League and other sports organizations. Although products with ephedra make up less than 1 percent of dietary supplement sales, they account for 64 percent of serious side effects, including heart attacks, strokes and irregular heart rhythms, the Annals of Internal Medicine reported.
The FDA first proposed curbs in 1997 but the industry said there was too little proof ephedra was dangerous.
Last December, FDA notified 62 companies selling ephedra products that it intended to ban sales. Most manufacturers and retailers voluntarily stopped sales, pending the ban's implementation.
"It's good to have limits on sellers of these products. On the other hand, how do you stop the FDA from controlling supplements that may be good? For every individual, it's different," says Ron Shemesh, an obstetrician and gynecologist who practices integrative medicine in Tampa.
Alternatives to ephedra often contain high amounts of caffeine, or act as diuretics or laxatives, with temporary effects. Some are placebos, affording a psychological boost but no proven physical one. Even ephedra users averaged weight loss of only 2 pounds a month.
Shemesh recommends green tea to many of his patients but uses hypnotherapy and nutrition planning to guide them to a goal of not merely weight loss, but improved health.
"A lot of times people are looking for that quick fix," says clinical psychologist Curtis Takagishi of Tampa, who counsels clients on obesity and weight management. They need to consider what they want, Takagishi says.
"(Is) it weight loss? Or are they looking to be healthy for life?"
Kalajian advises her clients to rev up their metabolism not with caffeine but by eating more raw foods. The body uses more energy to process raw vegetables, fruits, nuts and other foods, increasing calories burned as well as nutrients ingested.
Herbs typically recommended to aid weight loss include guarana, kola nut and tea extracts. (See accompanying list.) Some contain as much caffeine as six cups of coffee. People with high blood pressure, heart and liver problems, or other health issues should be particularly cautious.
"I would do a lot of research on what I was purchasing," says Kalajian.
Consumers may worry they have little to go on. The FDA has a different set of rules for dietary supplements, vitamins, minerals, herbals, botanicals, amino acids, enzymes and animal extracts - than for pharmaceuticals. Under the Dietary Supplement Health and Education Act of 1994, the FDA must prove a product is harmful rather than require a manufacturer to prove it is safe, which is the standard for prescription drugs.
Before starting any supplement, consumers are advised to check with their physician, particularly if taking other prescription or over-the-counter medications.
Dietary supplements are required by law to carry a label headlined "supplement facts." Read it for ingredients and quantities.
Beware of false claims. Promises that a product is a cure-all, totally safe, all-natural, a scientific breakthrough, secret ingredient, ancient remedy, or a hurry-this-offer-will-not-last buy may indicate the only weight loss will be to one's wallet.
Supplements sold as weight-loss aids
Bitter orange, also called citrus aurantium, the peel of the very sour Seville orange; contains synephrine, a stimulant similar to ephedra; proven risk of interference with other drugs (remember the grapefruit rule).
Caffeine
Cayenne
Chaparral, an American Indian medicine marketed as an antioxidant
Chromium, or chromium picolinate
Coleus, or coleus forskohlii
Fiber, to satiate hunger
Garcinia, or garcinia cambogia, also called hydroxycitric acid or HCA
Germander
Green tea extract
Guarana, contains two to three times as much caffeine as coffee
Kola nut
Linoleic acid
Lobelia
Magnolia-stephania
Paullinia cupana
Seaweed, also called kelp, nori and agar Starch-blockers, most made with kidney bean extract
Willow bark, contains salicin, which converts to an ingredient similar to aspirin
Yohimbine, found in yohimbine bark
Before you buy
-- Think twice about chasing the latest headline. Science generally does not proceed by dramatic breakthroughs, but small steps.
-- Natural does not necessarily mean safe or wholesome or mild.
-- Do not believe that even if a product fails to help at least it will not hurt. Some ingredients can be toxic or dangerously interact with other supplements or medicines. Some impact surgeries. The amount taken and for what length of time also makes a difference.
-- Safety first. Do not self-diagnose. Do further research and consult with a doctor, nurse, dietitian, pharmacist or others.
-- Costs can be high, especially for a product that may prove ineffective. Be sure to discuss options with a knowledgeable caregiver.
-- If you suffer an adverse effect from a supplement, report the incident or have your health-care provider do so by calling the Food and Drug Administration toll-free at 1-800-332-1088 or going online to www.fda.gov/medwatch/how.htm
