I am having big problems trying to lose weight. My friend suggested that I buy some ephedrine hydrochloride, as that was the only thing that had ever helped her (and she has tried everything). I now have a bottle of it, but am not sure how much to take, or how often to take it.
Since the prescription weight-loss drugs fenfluramine (or fen-phen) and dexfenfluramine were taken off the market several years ago because of serious side effects, I have received many letters asking about the safety and efficacy of over-the-counter (OTC) or herbal preparations for weight-loss. Many of these contain ephedrine, a stimulant long used for treating asthma and for its cardiac stimulating effects. The possibility of serious side effects stemming from the use of these OTC or herbal preparations has been reported in the medical literature for several years. A report in Prescriber’s Letter 1999;6:16, pointed out the possible dangers associated with the use of Metabolife 356, a combination of ephedrine from the herb ma huang, and caffeine from the herb guarana. A recent review of the reported side effects associated with use of these supplements appeared in the New England Journal of Medicine (NEJM 2000;25:1833).
The NEJM article reported 11 adverse events that were definitely or probably related to the use of an ephedrine-containing supplement, and an additional 15 adverse events possibly related to such use. The probable events included two deaths after using the product Ripped Fuel, one death after Metabolife 356, one cardiac arrest following Ripped Force and one following Herbalife’s Thermojetics, and strokes following the use of Shape-Fast Plus, Total Control, Ultimate Orange and Purple Blast. Of the 11 events, three resulted in death, seven in permanent disability, and one person required coronary bypass surgery.
Of the 15 additional events possibly related to the use of one of the supplements, seven resulted in death, of which one was the death of a newborn whose mother had taken the product, and another was the death of a fetus. Six people were permanently disabled by strokes, and one required prolonged hospitalization and one coronary bypass surgery. Products involved included: Diet Fuel, Ripped Fuel, Fit America Natural Weight Control Aid, Per-Form Dieter’s Natural Tea, Shape-Fast, Herbalife’s Thermojetics, Ultimate Nutrition Product Ma Huang, Diet-Phen, Metabolife 356 and Ultimate Orange. This is by no means a complete list of supplements containing ephedrine, and readers should be wary of any ephedrine- or ephedra-containing supplements — even if they are not on this list.
As was pointed out in the NEJM article, ephedrine is rarely prescribed by doctors anymore because of the high incidence of side effects. Further, and I quote from the article, “People who take these products to increase their exercise capacity or to lose weight place themselves at risk without a substantial likelihood of benefit.” The Natural Medicines Comprehensive Database, published by Prescriber’s Letter, classifies ephedrine as, “likely ineffective … as a single agent for weight loss.” Since there is no required reporting of adverse events following the use of dietary supplements, it is likely that there are many more cardiac arrests, strokes and heart attacks out there that are related to the use of such a supplement, but are simply never reported.
All of the products contained ephedrine, and many, like the Metabolife 356, also contained substantial caffeine. The Food and Drug Administration had banned combination weight-loss products containing phenylpropanolamine (PPA) (recently totally banned) in combination with caffeine back in the 1980s because of adverse events. The NEJM article notes that the addition of caffeine to ephedrine may enhance the cardiovascular and nervous system effects of the ephedrine. Since many people using one of these products may also be drinking coffee, they may unwittingly be taking this exact combination, even if the caffeine is not in the supplement. Caffeine by itself has not been shown to be associated with such adverse events.
As pointed out in the Prescriber’s Letter article, people with hypertension, heart disease, hyperthyroidism, and diabetes may be at particular risk. However, since so many people have silent heart disease, or undiagnosed hypertension or diabetes, I would not advise the use of these products by anyone.
So what are heavy people to do to lose weight? At this time there are no short cuts, no magic pills that will allow someone to bypass the only demonstrated ways to lose weight, which are diet and exercise.