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Ask The Herbalist: Is Ephedra (Ma Huang) Safe and Effective? By Andrew Gaeddert, AHG Differentiating Ephedra (Ma Huang) and EphedrineEphedra (Ma Huang) refers to the whole branchlet which is traditionally used. It is typically made as a tea by cooking in water. Ephedrine and pseudophedrine refer to alkaloid constituents of the whole herb. Although chemically derived ephedrine is used in pharmaceutical medications, dietary supplement manufacturers are required by law to use the crude herb. Typically an extraction is made to bring out the alkaloids when selling stimulant products or products for weight loss. It is common in the weight-loss industry to combine alkaloid rich extracts with caffeine or caffeine-containing herbs such as cola and guarana, and even aspirin. Typically, ephedra herb contains 0.5-2 percent alkaloids including ephedrine, pseudophedrine, norephedrine, nor-pseudophedrine, and methylephedrine. The plant also contains flavonoids, proanthocyanidines, tannins, and volatile oils. It is likely that these other constituents are buffering agents which reduce the drug-like effects of the alkaloids. This supports the hypothesis that ephedra as a whole herb extract is safer than products formulated for their alkaloid content. One recommendation is to not use more than 8 mg of ephedra alkaloids per dosage, and to not exceed more than 24 mg in one day. If an individual were to take a TCM formula in pill form, it would be very difficult to consume this amount of ephedra alkaloids. However, if one were to take a large dosage in tea form or a dietary supplement designed to contain the maximum alkaloid content, an individual would have to be careful not to exceed the recommended dosage. Historical Uses of Ma HuangEphedra has been used in China for several thousand years. The written record goes back at least 1,800 years. One Chinese herbal formula Ma Huang Tang (ephedra decoction) traces its lineage back this long and is still used today for treating cold symptoms such as chills, headache, and general body aches. It is combined with cinnamon twig (gui zhi), apricot seed (xing ren), and baked licorice (zhi gan cao). It has been recognized since ancient times that ephedra is warming and should not be used when the body is running a high fever. In Traditional Chinese Medicine (TCM), it is not used as a long-term remedy. In addition, it is contraindicated for weak patients and those prone to nosebleed. Ephedra can also be found in prescriptions for respiratory complaints. One example of this is Minor Blue Dragon (xiao qing long tang). In this ancient formula, Ma Huang is combined with cinnamon twig (gui zhi), dry ginger (gan giang), asarum (xi xin), schizandra (wu wei zi), peony (bai shao or chi shao ancient texts did not discriminate), pinellia root (ban xia) and baked licorice (zhi gan cao). This formula is used for chills, coughing, wheezing, sputum that is difficult to expectorate, and body aches. In the late 1800s, a Chinese scientist isolated ephedrine and pseudoephedrine, which are used in popular respiratory over-the-counter medicines and prescriptions today. It should be noted that it was not a popular weight loss ingredient until the 1980s. in other words, TCM practitioners do not use ephedra has a weight loss ingredient nor do ancient texts describe this use. Safety and Benefits of Ma HuangThere are over 50 clinical studies on ephedra or ephedrine in which no medically serious adverse reports were reported. In fact more than 20 studies have shown that ephedra preparations helped adults lose weight, if used as directed. Over ten million Americans safely take ephedra products each year. On the other hand, opponents of ephedra say that there have been thousands of adverse reports and a few deaths. Although this would be acceptable if ephedra was a drug, this it not considered an acceptable risk by regulatory authorities for herbs, which are regulated as food supplements. It is also important to acknowledge the intent. For example, Ma Huang is probably less safe for those using it for weight loss, as opposed to respiratory complaints. It is also less safe for individuals taking pharmaceutical and recreational drugs, pregnant women, and minors. Ephedra does have known side effects. They are dizziness, headache, rapid or irregular heartbeat, chest pain, shortness of breath, nausea, and moo d swings, and although hallucinations have been reported it is not clear if these effects were caused by ephedra itself, or in combination with pharmaceutical or recreational drugs. It is not recommended to be taken by those who have heart disease, high blood pressure, thyroid disease, seizures, mental or emotional disorders, glaucoma, or difficulty urinating. It may not be appropriate for diabetics. Current Regulations on Ma HuangCurrently Ma Huang is legal in all 50 states, with some exceptions. In California, according to SB 1884, ephedrine alkaloids should not be sold to individuals under 18 years of age. In addition the product should have the following labeling. WARNING: NOT FOR USE BY INDIVIDUALS UNDER THE AGE OF 18 YEARS. DO NOT USE IF PREGNANT OR NURSING. Consult a physician or licensed qualified health care professional before using this product if you have, or have a family history of, heart disease, thyroid disease, diabetes, high blood pressure, depression or other psychiatric condition, glaucoma, difficulty in urinating, prostate enlargement, or seizure disorder, or if you are using a monoamine oxidase inhibitor (MAOI) or any other dietary supplement, prescription drug, or over-the-counter drug containing ephedrine, pseudoephedrine, or phenylpropanolamine (ingredients found in certain allergy, asthma, cough or cold, and weight control products).
Licensed health professionals are exempt from this ruling. In addition, certain jurisdictions have banned ephedra, namely Suffolk Country in New York, where there is an exception clause for practitioners. Plants which also contain ephedrine alkaloids include Mormon tea and sida cordifolia so these are included in the California ruling. Proposed federal regulations would put mandatory warning labels on all ephedra products regardless of whether they are sold over-the-counter or dispensed by a practitioner. Recently, California State Senator Jackie Speier introduced legislation which would ban ephedra. If passed, this would make California the first state to ban ephedra. Ephedra Administration by Trained HerbalistsTaking whole plants is almost always safer than taking the individual constituents of herbs. Unless ephedra is an aberation, it is probably safer than respiratory medications containing ephedrine or pseudoephedrine; however there does not appear to be comparison studies. Herbalists tend only to use ephedra in combination with other herbs that reduce its toxicity. There are rare cases when ephedra should be used for more than two weeks, especially in warm climates. By monitoring a patient's tongue, pulse and symptoms, a professional herbalist can determine if ephedra is appropriate and how long it should be used. As ephedra is energetically "hot," it is rarely used in places such as California or Florida, and may be more appropriate for cold climates such as Alaska or the Northeast. Known Drug InterationsEphedra interacts with a wide number of medications, including drugs for weight control, depression, psychiatric conditions, asthma, Parkinson's disease, high blood pressure, and respiratory or cold medications containing ephedrine or pseudoephedrine. Finally, it may reduce the effectiveness of hydrocortisone, and sedatives such as Phenobarbital. Side effects of ephedra can be increased by taking it at the same time as other stimulants such as caffeine. What is the Future of Ephedra?I have heard certain acupuncturists say that ephedra should only be available to licensed acupuncturist or trained herbalists. This is extremely unlikely. The only mechanism in the law would be to have ephedra available by physician prescription. This would prohibit herbalists from using ephedra as even a short-term respiratory herb. This would be unfortunate, since medical doctors for the most part are not trained in herbs. Of particular concern are those in the holistic community who are starting to hold ephedra out as a sacrificial lamb in the belief that if they agree to a ban on ephedra, all other herbs will exempt from regulation. On the other hand, those who have been involved in natural healing for year would argue: what's next? In other words, if the regulatory authorities succeed in banning ephedra or making it only available to physicians, what herb would be next to make the hit list? Regardless of one's perspective, due to liability concerns and difficulty getting insurance, most companies are in the process of discontinuing ephedra. This means it will only be available by the large ephedra diet companies that can afford the insurance premiums, and those who are willing to sell ephedra without insurance or those who are under-insured. Some of these companies are willing to close their business in the event of lawsuit or contact by regulatory authorities. Purchasing from such a superior means the practitioner will be left without recourse in the event of a liability or regulatory action. It is necessary that the practitioner consider substitutes for ephedra for the near future. Substitutes for EphedraFor respiratory applications perilla (zi su ye), cinnamon (gui zhi), and schizonepeta (jing jie) are possible substitutes. Other substitutes include eucalyptus, ginger, and tylophora. For increasing one's energy and to help people get off ephedra and other stimulants, I have formulated a blend called Adrenosen, which contains Adrenal cortex, PAK (pyridoxal alpha ketoglutarate), Pseudostellaria root (tai zi shen), Dioscorea rhizome (shan yao), Dolichos seed (bian dou), Schizandra fruit (we wei zi), and Oryza sprout (gu ya). One might also consider Cordyceps, which increases respiratory capacity, normalizes blood pressure and treats fatigue. The only way to lose weight is to increase exercise and reduce calories. One of the hardest things about weight loss is the first two weeks, when it is difficult, without medical fasting, to actually see the weight come off. The best use of ephedra is for helping to reduce fat storage during the first few weeks by inducing thermogensis, i.e. burning fat. Green tea is probably the safest substitute for this application, although black tea is more popular in China. Some researchers have found high dosages of carnitine (i.e. 10 grams per day) useful for the first few weeks in attempting to lose weight. I am also excited about 5HTP (5-hydroxy tryptophan). Researchers have found that when humans are fed a tryptophan-deficient diet, their appetite increases dramatically. A diet low in this amino acid leads to low serotonin levels. Without enough serotonin the brain thinks it is starving. With more serotonin, the "feel good" neurotransmitter, in circulation, the appetite regulation center receives signals that enough has been consumed. Dieting or eating too many carbohydrates reduces serotonin levels. Serotonin can be built up by eating adequate protein and also by supplementing with 5 HTP (5-hydroxy trytophan), a natural source of tryptophan. While it has been demonstrated in well designed trials to have an effect on weight loss, it is particularly noticeable clinically in helping clients to reduce carbohydrate carvings. General dosage is 50 mg one half hour before meals or snacks. Higher dosages may be used as they are needed. Be sure to select products that have been naturally extracted from Griffonia simplicifolia. It is not recommended to take 5HTP with antidepressant medication without physician monitoring.
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