Increases in blood pressure may pose particular problems because ma huang is a common ingredient in over-the-counter diet aids, he says. "An obese patient is already likely to have [high blood pressure], so taking a product to lose weight, which is a desirable goal for decreasing the risk of heart disease, may actually put the person at increased risk because of its effect on blood pressure."
Supplements cited by Jacobs as potentially problematic are "Herbal Ecstasy," "Nature's Sunshine," and "Metabolife." Randy Smith, MD, medical director of Metabolife, tells WebMD that while he agrees with Jacobs's recommendation that clinicians should monitor all supplement use, he has no knowledge of ephedrine-induced psychoses or mood disorders associated with use of his company's product.
Smith confirms that Metabolife is standardized to contain 12 mg of naturally occurring ephedrines, which are derived from the ma huang plant. But he says that even though approximately 2 million Americans use Metabolife, "we just don't see significant health problems when the product is taken as directed by healthy adults."
Smith, admits, however, that the product can cause temporary mild side effects. "Anyone taking ephedrine and caffeine to create a [fat burning] effect is likely to show some mild side effects during the first two weeks of use. These side effects could include insomnia, jitteriness, dry mouth and restlessness," he says, but the person will "adapt and after two weeks the symptoms will return to baseline, and the effect that persists is essentially the [fat burning] or weight-loss effect."
In 1995, the FDA proposed rules for supplements containing ma huang. Not yet adopted, the new rules would prohibit supplements from containing more than 8 mg of ephedrine per dose and prevent supplements from containing combinations of ephedrine with other stimulants. The rules would also require improved information labels for consumers.
- Ma huang, a traditional Chinese medicine, seemed to cause violent and suicidal mood swings and psychoses in otherwise healthy Marines. The effects were reversed when they stopped taking ma huang.
- Americans may be attracted to the health claims of this 'natural' product, but the FDA reports between 1993 and 1997, ma huang use led to 34 deaths and 800 medical and psychiatric complications.
- Patients should tell their physicians about all the supplements they take. Alternative therapies can sometimes cause complications that patients may not realize.