If you followed the Olympics in 2016 to any degree, you probably noticed a recurring headline. Even with all the broken records and major upsets, these Olympics will always be known for the disqualifications and scandals surrounding the use of banned substances. Many of these substances were anabolic steroids, however, a number of disqualifications involved nutritional supplements as well. The use of nutritional supplements for ergogenic benefit has gained widespread popularity over recent years.
Because these supplements are considered natural and are available without a prescription, there is a misconception that they are all healthy and safe. Some of the more popular products are those marketed to either enhance energy or improve body composition. If you see a product marketed in such a way, it is likely that it contains the ma-huang herb, otherwise known as ephedra. Some of the more popular ones include Ultimate Orange, Ripped Fuel, Diet Fuel, Xenadrine, and Metabolift, however, there are hundreds on the market today.
In China, the dried stem of the ephedra plant has been used for centuries as a remedy for numerous conditions. In 1923, scientists discovered that the ephedra plant has two active ingredients, ephedrine and pseudoephedrine, the same drugs commonly used in many asthma and allergy medications. Ephedrine and pseudoephedrine are classified as a sympathomimetic drugs because they directly stimulate the sympathetic or “fight or flight” nervous system. This similar to the feeling you get in your body right after you slam on your brakes and come within inches of crashing your car. These drugs are structurally similar to amphetamines (speed or uppers). Because of this, they act as stimulants on the body. Furthermore they enhance the body’s response to epinephrine, otherwise known as adrenaline. Therefore, they also give the body that adrenaline rush sensation.
After ingesting a supplement containing ephedra the blood levels of ephedrine will peak in approximately 4 hours (this varies depending on the individual and the product). Once in the body, ephedrine exerts its effects primarily on the brain and cardiovascular system. Because ephedrine is a stimulant, it is commonly used as an energy enhancer. Ephedra containing products are marketed and used to reduce fatigue, increase alertness, improve reaction time, and even increase strength.
Although they are marketed towards athletes for performance enhancement, the major market appears to be those interested in mirror performance or cosmetic appearance (bodybuilders or those just wanting a lean appearance). Manufacturers claim that ephedra can improve body composition via the thermogenic (increased metabolism) and lypolytic (increased fat burning) properties of ephedrine. In fact, the most potent weight loss supplement on the market today contains a combination of ephedra (ephedrine) and guarana (caffeine) and white willow root powder (aspirin).
A number of scientific studies have shown that ephedrine and the combination of ephedrine and caffeine are effective weight loss agents. However, in many of these studies weight loss was the only variable investigated, as body composition was not assessed. Thus, it is unknown whether the weight loss was due to fat loss or lean tissue and water loss. Furthermore, not all studies have shown a weight loss effect from ephedrine. Some have found that neither caffeine nor ephedrine alone resulted in weight loss, however, the combination of ephedrine and caffeine did.
The combination of ephedrine and caffeine is very popular for two reasons. First, you get the stimulating and possible metabolic and fat burning effects of both. Second, and more importantly, caffeine enhances the effects of the ephedrine. It has been suggested that the weight loss experienced during ephedrine use is due to an increased metabolism (as opposed to a suppressed appetite). Moreover, it has been suggested that fat metabolism accounts for most of the increased energy expenditure and weight loss and results from a number of studies support these claims.
However (and this is a big HOWEVER), it must be noted that clinically obese individuals were used as subjects in most of these investigations. Thus, it is likely that these individuals may have been deficient in either metabolic rate or fat metabolism or both. In fact, when young healthy individuals have been used as subjects, the results are not as convincing. Unfortunately, it is common practice for supplement manufacturers to generalize results from deficiency studies to young, healthy, athletic individuals when they are marketing their products. Those of us in the scientific community know that this cannot and should not be done, as it misleads the consumer.
Currently the research concerning ephedra and performance in an athletic population is limited. However, the investigations that have been performed are not in agreement with manufacturers’ claims. Various studies have investigated strength, speed, endurance, power, and reaction time. At this time there are no studies showing improvements following ephedra ingestion. One study did report a greater cycling time until exhaustion. Ephedrine itself (as opposed to ephedra) was used in that study and the authors suggest that the improvement was due to the stimulating effects, as no changes were noted in metabolism or fat utilization.
The spectrum of adverse health events associated with the use of ephedrine containing products cannot be overlooked. These side effects can be variable and do not always depend on the dose consumed (you don’t have to overdose). Although it is likely that the occurrence of side effects in many cases was the result of misuse, they have also been regularly observed in subjects involved in clinical trials in which the dosages were controlled. Ephedrine can cause increases in heart rate, contractility (the strength of each beat), cardiac output (the amount of blood pumped per minute), and peripheral resistance (blood pressure). Thus, increases in both heart rate and blood pressure are common observations following ephedra ingestion. These effects are usually unwanted and are, therefore, considered side effects.
Other than the tachycardia (increased heart rate) and hypertension (high blood pressure), tremors, restlessness, palpitations, headache, anxiety, and insomnia commonly occur during ephedra use. Although these effects are not serious in most users, the consequences can be severe in those with underlying heart disease, hypertension, diabetes, and those sensitive to adrenaline. The recent death of a client at one of the more well known fitness centers in New York City brought public awareness to the dangers of ephedra. She was being treated for high blood pressure (with medication) at the time she was advised to use ephedra, which has been attributed to her death. As you might have guessed, law suits immediately followed. The more serious side effects include seizures, severe hypertension, arrhythmias (irregular heart rhythms), psychosis, hepatitis, stroke, myocardial (heart) injury, and intracranial (brain) hemorrhage. Once again, the adverse effects do not always depend on the dose consumed, as serious problems can occur in susceptible persons with use of low dosages.
Although fatal intoxication following ephedrine ingestion is rare, it does occur. The more common causes of death are heart attack and stroke. As mentioned previously, many products combine ephedra with guarana (caffeine). This combination can obviously increase the risks of side effects. The death of a young apparently healthy male college student brought further attention to the possible dangers associated with ephedra products, particularly those containing guarana also. The individual regularly consumed a product containing the combination of ephedra and guarana (Ripped Fuel). In fact, the official autopsy report and death certificate read “patchy myocardial necrosis associated with ephedrine toxicity from protein drink containing ma huang extract.”
Blood and urine ephedrine levels suggest that the death was not caused by an acute poisoning, but was the result of prolonged use. One of the primary concerns is that companies do not have to list the ingredients on the labels of natural supplements. One product labeled “no side effects” was found to contain 45-mg of ephedrine and 20-mg of caffeine in a single tablet, despite the fact that it listed Chinese ginseng as the only ingredient. The label also instructed users to take five tablets, which represents a total ephedrine dosage of approximately 11 times the usual recommended OTC dosage.
Ephedrine was banned by the IOC in 1972 because of its cardiac stimulating and mood altering effects, and it is also banned by the NCAA. Products containing ephedra have warning labels instructing consumers not to use it if they suffer from hypertension or any form of cardiovascular disease. Furthermore, the instructions state to discontinue using the product if hypertension or any form of cardiovascular disease develops.
Products containing ephedra are considered nutritional supplements and are therefore not regulated by the Food and Drug Administration (FDA). However, because of the numerous reports of side effects associated with ephedra use, the FDA is attempting to limit the ephedrine dosage to 8-mg/dose or 24-mg/day. If you are considering using a product containing ephedra, or any supplement for that matter, you need to ask two questions; one, does it work and, two, is it safe? As mentioned before, the claims of increased metabolism and fat burning have only been observed in clinically obese individuals, and not those considered healthy and athletic.
The ephedra products, without a doubt, do have stimulating potential, however, this has not resulted in increased performance. So the answer to question number one; it does not appear so. There are numerous substantiated reports of both minor and serious side effects as a result of ephedra ingestion. So the answer to question number two; apparently not. However, each individual’s reaction is different and for some the only side effect may be wasted money.