. . . The Other Side of "Fat Burning."
what I believe to be a very diplomatic position in addressing
a product ingredient that can no longer be called "new"
and questions abound as to whether it should be referred to
as "safe." I've always felt it important to balance
information regarding the potential risks of a substance or
compound with the potential benefits and then allow educated
people to make wise choices. I have been careful in the articles
I've written, not to scare those who choose to face potential
for risk . . . cautiously . . . in the hope that they can
find some benefit. I've also been careful to be selective
in the product names I've addressed since many of my articles
are published in magazines supported at least in part by supplement
sellers. At this point in time, I believe it's time to sway
more to one side than the other. With this article, I'm going
to provide some insight into the reasoning that drives those
who aggressively oppose the sale of this particular product.
With this article, I'm naming names. Here goes . . .
Hydroxycut. Ripped Fuel. Metabolife. Metabolift. Diet Zx.
Zymax. Thermadrene. Stacker 2. Yellow Jackets. Clenbutrx.
ECA Stack. Dymetadrine. AST EPH-33. Universal Herbal Phen
Fast. Thermadrol X. Zenotrope. Thermapro. Thermo-Cuts. ProBURN.
I can keep going.
There are hundreds of these on the market. What are they?
They are all different brands, all different names for capsules
that contain ephedrine as their "active" ingredient, and they
are marketed to people who want . . . well . . . almost anything
at all. I've found ephedrine products being sold as:
- Fat Burners
- Energy Enhancers
- Stay Awake
- Sexual Aids
- Herbal Ecstasy
- Asthma Relievers
- Diet Supplements
- Appetite Suppressants
in fact a drug. It can be derived from the herbs Ephedra or
MaHuang, thus any product that contains either of those herbs
contains the drug ephedrine. When standardized extracts of
herbs are used, product manufacturers cleverly refer to these
products as "natural" or "herbal," terms
which at least a portion of the supplement buying public believe
has some direct link to safety.
a number of articles about the risks and the potential benefits
of ephedrine, but the market has gone so far overboard . .
. the products are being mass marketed with such aggressive
promotion ("the strongest fat burner in the world,"
"more effective than diet and exercise," etc.) I
feel obliged to slant this article toward "the other
side." I'm leaning, intentionally, toward the realities
that rarely make it into mass media. I'll start by sharing
an e-mail I received several days ago:
my friend who is only 38 years old, is hooked up to life support
following 3 massive strokes over the weekend. Tomorrow her
family will make the arrangements to donate her organs. The
following day her family and friends will go to her funeral.
Why? After a battery of tests, the doctors have concluded
that the strokes were caused because of her use of Xenadrine.
The doctors also mentioned they have had three other deaths
related to this product, the youngest casualty being 22 years
old. Help us to understand. Where did she go wrong? How could
this have been prevented? How can we prevent this from happening
Those who sell
ephedrine based products will claim that incidents such as
this are due to overuse, abuse, or contraindications - prexisting
conditions that should preclude people from using this drug.
Those who sell ephedrine based products are absolutely correct!
So why am I swaying the other way? Because overuse, abuse,
and misuse are, based on the cases I've personally witnessed,
are the result of flawed or omitted information. Sure, maybe
the small print on the label warns people not to use the product
if they suffer from hypertension or thyroid disease, but when
the ads blare out "Lose Weight, It's So Easy," or
"The New Weight Loss Miracle is Here," the small
print too often is ignored. I don't want to present this strictly
from conjecture so I'm about to share a mix of research info
and my own interpretation of the evidence. I will preclude
my further comments by saying that under the right circumstances,
ephedrine can be a fat burning aid. You can learn more about
"the right circumstances" by accessing an article
I'd written on Xenadrine.
a bronchodilator. It used to be sold over the counter as an
asthma medication. About a decade ago, bodybuilders found
that the asthma medication clenbuterol appeared to have some
fat burning properties and the drug found its way into the
gray market among physique athletes. It later was classified
as a Class III substance which meant the sale or importation
of clenbuterol could be punished by jail time. In the meanwhile,
research using a combination of caffeine, ephedrine, and aspirin
was proving appealing among those in search of weight loss.
When clenbuterol became a black market product, bodybuilders
began to make the switch to ephedrine and with time, enough
people were losing enough weight for ephedrine based products
to become big sellers. There are some things you should understand
about ephedrine before you believe it will just jump in and
start burning up fat. In addition to its bronchodilation properties,
it is also a stimulant. It elevates heart rate and can also
elevate blood pressure. When you combine caffeine, another
stimulant, with ephedrine, of course the "speed"
effect is enhanced. In the 1970's, "diet pills"
were all the rage. By combining caffeine and ephedrine, supplement
sellers now had legal speed. It that being a bit harsh of
overblown, equating ephedrine to speed? I don't think so.
In fact, ephedrine is the raw ingredient used in underground
methamphetamine labs to create one of the most addictive stimulants
to enter the world of illegal drugs.
has a diuretic effect and it alters neurotransmission to minimize
appetite. The end result is often less food intake and a body
that is cranking up in high gear. Calorie deprivation is NOT
an effective way to boost metabolism, yet many who depend
on these ephedrine based supplements for weight loss wind
up using it as an aid in simply minimizing caloric intake.
Residual water loss contributes to the illusion that it is
really having a very significant effect on fat loss.
point that is often neglected in warning labels is the fact
that ephedrine is addictive at some level. Combine it with
caffeine, and the propensity for addiction elevates. What
a great bonus for supplement sellers! If they can get you
addicted, you're going to buy more, and more, and more!
I have met with
many people who had negative experiences with ephedrine, and
in every such case, the person was misinformed about the value
or risk of the product they were taking. "Friends"
often tell "friends" to take a "great supplement,"
and if you can't trust your friends, who can you trust? If
the user of a "metabolism boosting" formula containing
ephedrine and caffeine fails to recognize the risks, regular
consumption of coffee, diet cola, cold medicine, and the "Ripped"
drink they have before a workout in the health club, can stack
up to create serious potential for risk.
in judging the value and potential for risk is certainly important,
but I don't believe research can actually prove that something
is safe. I believe that ongong research can suggest that risks
might be unlikely, but a single episode in a single study
can invalidate all prior research
attempting to prove safety if it leads to death or injury.
Take a look at the following abstract:
Gurley BJ, Gardner
SF, White LM, Wang PL. Ephedrine pharmacokinetics after
the ingestion of nutritional supplements containing Ephedra
sinica (ma huang). Ther Drug Monit. 1998 Aug;20(4):439-45.
supplements containing Ephedra sinica (ma huang), a botanical
source of ephedrine alkaloids, have been linked to several
episodes of ephedrine toxicity and at least 17 deaths, yet
these products remain unregulated. Ten subjects were enrolled
in a randomized, crossover study aimed at characterizing
the pharmacokinetics of ephedrine after the ingestion of
three commercially available ma huang products compared
with a 25-mg ephedrine capsule. Pharmacokinetic parameters
for botanical ephedrine were similar to those for synthetic
ephedrine hydrochloride. Gender-based comparisons of Vss/F
and CL/F revealed higher values for women than for men (Vss/F,
3.49 +- 1.04 vs 2.98 +- 0.73 l/kg; CL/F, 0.48 +- 0.11 vs
0.37 +- 0.11 1/hourcntdotkg). The current study suggests
that the increased incidence of ma huang toxicity does not
stem from differences in the absorption of botanical ephedrine
compared with synthetic ephedrine; rather, it results from
accidental overdose often prompted by exaggerated off-label
claims and a belief that "natural" medicinal agents are
There are some key points to take
- There were at least 17 deaths
linked to ephedrine toxicity.
- Increased incidence of toxicity
results from accidental overdose.
Ephedrine sellers went on the warpath,
and understandably. Ephedrine is big business and this information
could have proven alarming and crippling to fat burner product
sales. They took a counter spin on the theory that ephedrine
supplementation can be lifethreatening. They delved into the
incidents referenced in the above abstract to question whether
there were definitive links to ephedrine products. They also
questioned whether the FDA had adequate evidence to suggest
a control on ephedrine. While the FDA reports over 1000 reports
of adverse effects, ephedrine sellers minimized the reference
by noting that there have been several hundred million doses
over the last couple of years.
My conclusion is not that ephedrine
is in fact safe, but that at least some people died that didn't
have to because they were misinformed about the supplements
they were taking. If some people died, I believe it's important
that people become fully educated before opting to put something
into their mouths that may in fact threaten their lives.
We shouldn't only consider "absence
of directly linked deaths" in deciding whether or not
a product is safe. Research has unquestionably linked ephedrine
to specific health issues. Here's an abstract that should
support that statement:
T. ; Fong Fu Hsu ; Turk, J. Ma-Huang Strikes Again: Ephedrine
Nephrolithiasis. American Journal of Kidney Diseases,
Ephedrine and its metabolites are naturally occurring alkaloids
that can be derived from evergreens worldwide and have been
used as medicinals for hundreds of years. Because they have
"real" pharmacological alpha and beta catecholamine effects
and are "natural" products, the alternative medicine industry
has popularized them for multiple uses, including asthma,
weight loss, energy and sexual enhancement, and euphoria.
Several recent reviews have documented the dangerous nature
of using these "drugs" unsupervised, including multiple
deaths, and the FDA is currently reviewing ephedrine's use
in the alternative medicine industry. We report a new toxicity,
ephedrine nephrolithiasis, in a patient using an energy
supplement, Ma-Huang extract, which contains ephedrine.
Although previously not reported, the Louis C. Herring and
Company kidney stone database show that this is an endemic
complication of ephedrine with hundreds of previous episodes.
Are kidney stones going to kill
you? Not likely, but again, if there is any risk to be considered
in evaluating a product, it should be addressed adequately
so that anyone who wishes to avoid such risk can make an educated
decision. The FDA, in trying to take some action to control
ephedrine, requested an independent review of the reports
of adverse effects. The review was reported in the New England
Journal of Medicine:
cardiovascular and central nervous system events associated
with dietary supplements containing ephedra alkaloids. NEJM,
Background: Dietary supplements that contain ephedra alkaloids
(sometimes called ma huang) are widely promoted and used
in the United States as a means of losing weight and increasing
energy. In the light of recently reported adverse events
related to use of these products, the Food and Drug Administration
(FDA) has proposed limits on the dose and duration of use
of such supplements. The FDA requested an independent review
of reports of adverse events related to the use of supplements
that contained ephedra alkaloids to assess causation and
to estimate the level of risk the use of these supplements
poses to consumers. Methods: We reviewed 140 reports of
adverse events related to the use of dietary supplements
containing ephedra alkaloids that were submitted to the
FDA between June 1, 1997, and March 31, 1999. A standardized
rating system for assessing causation was applied to each
adverse event. Results: Thirty-one percent of cases were
considered to be definitely or probably related to the use
of supplements containing ephedra alkaloids, and 31 percent
were deemed to be possibly related. Among the adverse events
that were deemed definitely, probably, or possibly related
to the use of supplements containing ephedra alkaloids,
47 percent involved cardiovascular symptoms and 18 percent
involved the central nervous system. Hypertension was the
single most frequent adverse effect (17 reports), followed
by palpitations, tachycardia, or both (13); stroke (10);
and seizures (7). Ten events resulted in death, and 13 events
produced permanent disability, representing 26 percent of
the definite, probable, and possible cases. Conclusions:
The use of dietary supplements that contain ephedra alkaloids
may pose a health risk to some persons. These findings indicate
the need for a better understanding of individual susceptibility
to the adverse effects of such dietary supplements.
Even with FDA guidelines for dosages
that would cross into the "risk" category, the health
challenges run even further in that consumers must then trust
product sellers to accurately label their products. Since
the herbs MaHuang and Ephedra are often used, the actual content
of ephedrine alkaloids can vary wildly. Adequate policing
to make certain products contain what their labels claim they
contain is certainly far from being in place. The following
study led by Bill J. Gurley, Ph.D, of the University of Arkansas
for Medical Sciences, brings the realities to the limelight.
Bill J. Content versus label claims in ephedra-containing
dietary supplements ; American Journal of Health System
Pharmacy 2000. 57: 963-969
different ephedrine based products were analyzed. The products
were purchased in 1999 from local retailers or the Internet.
The study found great discrepancies between label claims
and ephedrine alkaloid content:
of the products tested had content versus label discrepancies
greater than 20 percent.
product had no active ingredient.
some instances, there was great content variability even
between different lots of the same product.
products had potentially dangerous combinations of active
products contained substantial quantities of norpseudoephedrine,
a Schedule IV controlled substance.
So, even if there were imposed
regulation, even if warning labels spelled out the risks with
excessive dosages, and even if people learned to be "cautious,"
random contents can lead even the cautious to meet with accidental
Probably the most publicized ephedrine
related incident was the death of Anne Marie Capati. At 37
years old, following the written advice of her personal trainer,
she began taking an ephedrine based supplement . . . a "fat
burner." During a workout she collapsed and later that
night, after doctors at St. Vincent's Hospital in New York
determined she had suffered a stroke, excessive and uncontrollable
bleeding in her brain led to her death. The publicity has
emerged out of a 320 million dollar lawsuit against Crunch
fitness, the trainer, the supplement manufacturer, and the
store where the supplement was purchased. I don't pretend
to know who should be held liable, but I do know that if someone
had explained to Ann Marie Capati the possible ramifications
of ephedrine use, she likely would have decided not to use
it. Capati had pre-existing high blood pressure.
Dan Duchaine was infamously known
as the Steroid Guru. He developed a reputation as the expert
in anabolic steroid use for athletes. Dan was extremely controversial
and he was a guest on my radio show several times, once from
prison where he was being held for charges of smuggling clenbuterol
from Mexico. On that particular show he spoke about how he
believed steroid risks were overblown in the media and the
medical community and how careful use can even be a health
benefit. It led to some interesting debate. One point Dan
brought up was the fact that he had never suffered any ailment
from steroid use . . . but he suffered a stroke from ephedrine!
Dan has since passed away in his 40's of what the doctor's
apparently referred to as "natural causes." Dan
was reputed to be a human guinea pig. Did ephedrine have anything
to do with his untimely death? Who knows. If someone takes
a supplement that leads to a stroke, there can be long term
health issues that make that person subject to further vascular
An article February 12, 2001, in
U.S. News and World Report outlined stories of death and injury
due to misuse of ephedrine. I don't need to reiterate the
stories here. If you want to find more I'm sure that article
is accessible on the Internet or by contacting U.S News directly.
The issues related to ephedrine have been before Congress,
have been addressed on almost every TV Network, have been
explained and explored in Consumer Reports, publications by
the national Council Against Health Fraud, and an ever-growing
number of consumer advocacy groups.
Here's a less publicized study
since it doesn't appear to address the impact of "fat
burners" on people, but I can draw my own conclusion
from the abstract.
caffeine and ephedrine toxicosis resulting from ingestion
of an herbal supplement containing guarana and ma huang
in dogs: 47 Cases (1997-1999). Journal- american veterinary
of dogs that had ingested an herbal supplement containing
ma huang and guarana between July 1997 and October 1999
were retrieved from the National Animal Poison Control Center
database. Results: Most dogs (80%) developed clinical signs
of toxicosis within 8 hours of ingestion, and clinical signs
persisted for up to 48 hours. Hyperactivity, tremors, seizures,
and behavior changes were reported in 83% of dogs; other
signs included vomiting (47%), tachycardia (30%), and hyperthermia
(28%). Seventeen percent of the dogs died. Conclusions and
Clinical Relevance: Accidental ingestion of herbal supplements
containing primarily guarana and ma huang in dogs can lead
to a potentially lethal condition that may require prompt
detoxification and supportive treatment for several days.
Most dogs recovered with supportive treatment.
Let's think. Dogs are smart, but
not smart enough to go down to the local health food store
and purchase ephedrine based products in the hope that they'll
shed fat. If enough dogs accidentally ingested something their
owners no doubt had in their respective supplement collections,
it's quite clear that use of this potentially dangerous substance
I can keep going . . . and going.
There is extensive research available, and the longer research
on ephedrine continues, the more the risk questions will obviously
rise to the surface. I speak to scores of people each week
who suffer at least minor issues (termors, jitters, headaches,
nervousness) from their fat burners. With that said, I don't
believe I need to go on any further. Although the length of
this piece would be extended, my conclusions would be unchanged
. . . so I'll conclude with my opinion.
Ephedrine is a drug and has definitive
drug effects. Thus, while I'm not certain what's fair in terms
of regulation, it should be sold, not only with small print,
but with inserts explaining the risks, just as you'd receive
with any packaged medication. Claims for "safe, quick,
easy weight loss" should be aggressively policed by the
FTC and severe rather than token fines should be incurred
as punishment for fraudulent or misleading claims. If people
come to understand the potential risks, will ephedrine sales
cease? I doubt it. People flock to take weight loss drugs
where potential side effects are publicized in the the hope
that the benefit will outweigh the risk. The want for weight
loss is so great I don't believe a consistent message being
sent out outlining the reasons you might not want to even
consider ingesing ephedrine will put even a single supplement
manufacturer out of business. Supplements are sold under the
guise of "health" products, and Responsible sale
and distribution of these products can only exist with adequate
If you were to ask me if I think
you should take an ephedrine supplement in the hope it will
help you lose weight, boost metabolism, summon up energy,
or have better workouts, my answer would be clear and consistent.
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