Ephedrine - once again available at your local health food store


Each year 80 to 100,000 Americans die suddenly from heart attacks without ever having had any symptoms of heart disease. In some cases, the victims of these unheralded sudden cardiac deaths had been taking dietary supplements containing ephedrine. In a new study in the Oct. 26, 2004 issue of the Journal of the American College of Cardiology, researchers show how ephedrine can cause sudden cardiac death in those who are asymptomatic of heart disease.

Philip B. Adamson, M.D., associate professor in the department of physiology and the department of medicine - cardiovascular diseases at the University of Oklahoma Health Sciences Center in Oklahoma City, Okla. and lead author of the study, states, "Ephedrine mimics the sympathetic nervous system, the part of the nervous system that makes the heart beat stronger and faster. In past experiments on obese, otherwise healthy individuals, ephedrine did not raise their heart rates when they were either at rest or exercising.

"In ischemic heart disease, the blood supply to the heart becomes constricted, causing damage to the heart muscle and heart disease. However, sometimes the condition develops without any symptoms, leading to a sudden heart attack. Death can be the first symptom people with ischemic heart disease experience," Dr. Adamson said. "We wanted to determine how ephedrine, taken as directed, might cause someone with ischemic heart disease to have a potentially fatal heart attack."

"Ephedrine looks benign when you look at its effects on normal heart rates, but when there is a blockage, boom, ephedrine causes a potentially lethal arrhythmia," Dr. Adamson said. "The heart starts beating so fast, it can no longer pump blood."

Ephedrine was marketed for many years as an aid to weight loss and an enhancer of athletic performance, but has never been systematically studied, although it has been implicated in hundreds of adverse reactions.

"We have been studying how the sympathetic nervous system destabilizes the heart's electrical system and increases the risk of arrhythmia for some time. We didn't expect such a dramatic response to ephedrine," he said. "The sympathetic nervous system was super-powered by the ephedrine, greatly increasing the risk of causing an instability of the electro-physiology of the heart."

"This study certainly supports the FDA's decision to ban ephedrine from dietary supplements (the ban went into effect in February 2004)," Dr. Adamson said. "I hope it will also offer us additional insights into the nature and causes of unheralded sudden death."

Follow-up note: This ban was lifted after Utah-based Nutraceutical Corporation challenged it in court. They make an ephedra product with less than 10 mg of ephedra. The judge ruled, in accordance with the DSHEA, that the FDA could not place the burden to prove safety on dietary supplement manufacturers as it does for drug and device makers. Congress intended , with the DSHEA act, that dietary supplements be treated as a subset of foods and, like other foods, are "presumed to be safe."

In this case, the FDA "must establish that (ephedra supplements) pose a significant or unreasonable risk by a preponderance of the evidence," the judge wrote. He said that the FDA couldn't prove this with low doses of ephedra.

It allows the company to resume selling its whole herb ephedra product with less than 10 mg of naturally occurring ephedrine alkaloids per daily dose