Ephedra Safe for Healthy Dieters

June 6, 2002 -- Are you overweight but otherwise healthy? If so, it may be safe for you to use popular ephedra/caffeine dietary supplements.

It's unusual to see a rigorous scientific study of an herbal remedy. But that's just what Carol N. Boozer, DSc, and her Columbia/Harvard research team did. And the findings fly in the face of what many doctors would have expected.

Ephedra-containing products -- the herb ma huang is the most popular -- have been linked to heart problems and strokes. A recent review of 140 reports of ephedra causing health problems showed that 43 -- including three deaths -- were "definitely or probably related" to ephedra supplements. Another 44 cases, including seven deaths, were considered "possibly related."

"It is surprising how people's minds can be so made up based on anecdotal reports," Boozer tells WebMD. "You can't determine cause and effect from this kind of information."

Boozer, director of the energy metabolism laboratory at St. Luke's Hospital in New York, looked at 167 overweight men and women. All of them went on a diet program that included moderate exercise and reduced dietary fat. Half of them took specially formulated pills containing an herbal mixture of ephedra (in the herb ma huang) and caffeine (in kola nut) three times a day. Their total daily dose of ephedra was 90 mg and their daily dose of caffeine was 192 mg. The other patients took an identical-looking placebo.

Because of reported heart problems with ephedra, all of the study subjects underwent intensive heart and blood-pressure monitoring. Yet there was no significant difference between the two groups in heart function. The big difference was in how much weight they lost. With just diet and exercise, patients lost about 6 pounds. When ephedra/caffeine was added, they lost about 12 pounds.

"What our study showed was that healthy, overweight people who took our herbal product lost more weight and body fat than did a similar control group," Boozer says. "They didn't experience any significant adverse event."

Does this mean that it's safe to take products that contain ephedra and caffeine?

Neal L. Benowitz, MD, and Christine A. Haller, MD, are authors of the earlier study linking health problems to ephedra use. Both are researchers at the University of California, San Francisco.

"The adverse effects that occur from dietary supplements can be catastrophic, but they are uncommon," Benowitz tells WebMD. "The likelihood of detecting rare events in small trials like this one is virtually nil."

"While this study didn't show a lot of adverse effects, they didn't use an off-the-shelf supplement," Haller tells WebMD. "There are many, many other ingredients in these supplements. It is not the same as Metabolife or others. I really don't think you can use this as a study to invoke the safety of dietary supplements. This is just not what people out there are taking. Until we know about the other ingredients, we can't speak to safety."