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Ephedra (ma huang)
Questions and Answers
Andrew Gaeddert, CEO, Health Concerns
What is the difference between ephedra (ma huang) and ephedrine?
Ephedra (ma huang) refers to the whole branchlet that is traditionally used. It is typically made as a tea by cooking it 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.
Ephedra herb contains 0.5-2 percent alkaloids including ephedrine, pseudophedrine, norephedrine, norpseudoephedrine, and methylephedrine. The plant also contains flavonoids, proanthocyanidins, tannins, and volatile oils. It is likely that these other constituents are buffering agents that 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 either a 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.
What are the historical usages for ma huang?
Ephedra has a history of use in China for several thousand years. The written record goes back at least 1800 years. One Chinese herbal formula, ma huang Tang (Ephedra Decoction), traces its lineage back this far 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, and sputum that is difficult to expectorate, and body aches.
In the late 1800's a Chinese scientist isolated ephedrine and pseudoephedrine, which are used in popular over the counter respiratory medicines and prescriptions today. It should be noted that it was not a popular weight loss ingredient until the 1980's. In other words TCM practitioners do not use ephedra as a weight loss ingredient nor do ancient texts describe this use.
Is ma huang safe, are there benefits?
There are over fifty clinical studies on ephedra or ephedrine in which no medically serious adverse results were reported. In fact more than twenty 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 is 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 probably is less safe for those using it for weight loss as opposed to respiratory complaints.
Many people trying to lose weight do not consume adequate amounts of food or water in the dieting process. Also we have noticed in our clinic that dieters often assume that if two is good, four or six might help them lose more weight. We have not observed this with clients taking ephedra for asthma or bronchitis. 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 mood swings. 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.
Can you speculate about 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 be exempt from regulation. On the other hand, those who have been involved in natural healing for years would argue: what's next? 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 your 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 supplier 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.
What are substitutes for ephedra?
For respiratory applications in TCM perilla (zi su ye), and cinnamon (gui zhi) are possible substitutes. Other substitutes include eucalyptus, ginger, and tylophora. These have been incorporated into the ephedra-free versions of Minor Blue Dragon, Nasal Tabs, and Clear Air.
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 (wu wei zi), and oryza sprout (gu ya). One might also consider Cordyceps PS, which increases respiratory capacity and normalizes blood pressure, and treats fatigue.
The only true 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 for this application. I am also excited about Griffonex 5HTP (5-hydroxytrytophan).
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 Griffonex-5HTP, 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 cravings. General dosage is 50 mg one half hour before meals or snacks. Higher dosages may be used as they are needed. It is not recommended to take Griffonex-5HTP with antidepressant medication without physician monitoring.
How will this effect Health Concerns' Nasal Tabs, Clear Air and Minor Blue Dragon?
We are currently reformulating all our products to be ephedra free. We are confident that the new formulas will be as good if not better than the originals.
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