Ephedra Uses, Benefits, Dosage & Safety of Ephedrine Alkaloids

Ephedra supplements are a now-banned weight loss product that boosted energy levels, increased fat metabolism and suppressed the appetite.

These fat burning-diet pills were commonly made with extracts from Ephedra Sinica plant, one of the most important herbs in traditional Chinese medicine.

This plant is a source of ephedrine and pseudoephedrine, two chemical alkaloids that act as central nervous system stimulants. They work by stimulating the same receptors in the body as the natural hormone adrenaline.

While demonstrating efficacy for body weight reduction and energy enhancement, ephedra products were found to pose an unreasonably high risk of side effects and were banned by the US FDA in 2004.

Despite the ban, ephedrine remains legal in the United States as an over-the-counter nasal decongestant medication for the treatment of asthma and allergy symptoms.

Ephedra extract supplements, made without any ephedrine alkaloids, are also still legal in the US and were not covered by the 2004 FDA ban. These products remain popular with bodybuilders as pre-workout thermogenic aids and athletic performance enhancers.

What is Ephedra?

Ephedra refers to a genus of approximately 65 species of isolated, straggling, or climbing desert shrubs.

Many different species of ephedra plants have been used in herbal medicine practices for thousands of years around the world.

Of these, the Ephedra sinica species (Chinese ephedra, Ma Huang) is the best-known. Its use in traditional Chinese medicine dates back more than five thousand years.

Ancient Chinese healers used this plant for colds, congestion, coughing, wheezing, fever, flu, headache, and asthma. [2] It was also prescribed for fatigue, low libido and to promote vigor and vitality.

The stems and leaves of the plant are used to make natural medicines, but all parts of the plants including the roots and flowers are said to contain bioactive constituents.

E. sinica is a highly concentrated source of the chemical alkaloid ephedrine, which acts as a beta-2 adrenergic receptor agonist in the human body.

Ephedrine has stimulant properties and is used in medicine as a bronchodilator and decongestant. [1] It has also been used to prevent hypotension (low blood pressure) in patients undergoing spinal anasthesia.

Not all species of ephedra contain ephedrine alkaloids. Those species that are native to North America, including Ephedra Viridis and Ephedra Nevadensis are devoid of this stimulatory alkaloid.

The National Center for Complementary and Integrative Health (NCCIH) reports that ephedrine alkaloids were studied extensively in the 1940s and 1950s. The results of that research led to the widespread use of ephedrine alkaloids as oral asthma medications.

It was not until later that the anti-obesity effects of this drug were observed. Over time, ephedrine began to be used as an athletic performance enhancer and weight loss aid. [3]

By 1999, an estimated 12 million consumers in the United States had taken ephedra diet pills to help them lose weight. At the same time, reports of serious adverse reactions involving the supplement began to increase and several fatalities were linked to its misuse.

In 2004, the United States Food and Drug Administration (FDA) banned the sale of dietary supplements that contain ephedrine alkaloids. The FDA ruled that there was little evidence of any reliable benefits and that the risk of adverse effects outweighed any possible benefits.

Using ephedra or ephedrine alkaloid products is a practice that is banned by the NFL (National Football League), the NCAA (National Collegiate Athletic Association), and the IOC (International Olympic Committee). It is also banned on US military bases.

However, the FDA ban does not pertain to certain OTC (over-the-counter) ephedrine drugs used for temporary relief of nasal congestion or chest tightness. It also does not apply to supplements made with ephedra extracts which have had the ephedrine alkaloids removed.

Ephedra Plant Description

Ephedra is an herbal preparation harvested from the dried, young branches of Ephedra sinica plant, or another related plant in the Ephedra genus [Order: Ephedrales; Family: Ephedraceae].

E. sinica is an evergreen gymnosperm shrubs that is indigenous to Mongolia and central Asia. Other species of this plant are found in northern Africa, northern China, western South America, southern Europe, and southwestern North America. [4]

Ephedra is a gymnosperm, which means that the plant does not produce true flowers. Instead, they produce spores inside conical structures similar to those found Pine, Juniper, and Spruce species.

Each node of an Ephedra branch may have one, or many, male and female cones.

Some other defining traits of Ephedra plants are:

• Tiny leaves that are reduced to dark scales as seasons progress;
• Found mainly in semi-desert sand, rock, mesas, and canyons;
• Photosynthesis occurs in stems because leaves are too small;
• Can grow on temperate shorelines with direct sun;
• Prefers dry, arid soil and does not require much water to grow.;

The name for Ephedra in Chinese is ma huang which means “yellow hemp”. Some other common names for various species of this plant include Belcho, Desert Herb, Herbal Ecstasy, Indian Jointfir, Joint Fir, Mahuanggen (ma huang root), Popotillo, Teamster’s Tea, and Yellow Horse. [1]

Some of the recognized species that belong to this plant family include:

• E. alata
• E. altissima
• E. americana
• E. antisyphilitica
• E. aphylla
• E. x arenicola
• E. aspera
• E. aurantiaca
• E. boelckei
• E. botschantzevii
• E. breana
• E. brevifoliata
• E. californica
• E. chilensis
• E. compacta
• E. coryi
• E. cutleri
• E. dahurica
• E. dawuensis
• E. distachya
• E. x eleutherolepis
• E. equisetina
• E. fasciculata
• E. fedtschenkoae
• E. foeminea
• E. foliata
• E. fragilis
• E. frustillata
• E. funerea
• E. gerardiana
• E. glauca
• E. holoptera
• E. intermedia

• E. x intermixta
• E. laristanica
• E. likiangensis
• E. lomatolepis
• E. major
• E. milleri
• E. minuta
• E. monosperma
• E. multiflora
• E. nevadensis
• E. ochreata
• E. oxyphylla
• E. pachyclada.
• E. pedunculata
• E. pentandra
• E. przewalskii
• E. pseudodistachya
• E. regeliana
• E. rhytidosperma
• E. rituensis
• E. rupestris
• E. sarcocarpa
• E. sinica
• E. somalensis
• E. strobilacea
• E. tilhoana
• E. torreyana
• E. transitoria
• E. triandra
• E. trifurca
• E. trifurcata
• E. tweediana
• E. viridis
• E. vvedenskyi

Ephedra vs Ephedrine

There is confusion about the differences between ephedra and ephedrine. Ephedra is the common name for a family of plants that include E. sinica, E. distachya, E. viridis, E. nevadensis, E. fragilis, E. gerardiana and E. foeminea.

Ephedrine is one of the primary alkaloid compounds found in some species of Ephedra. It is this alkaloid that is believed to give the plant many of its medicinal effects.

However, not all species of Ephedra contain ephedrine alkaloids. Some species of this plant provide higher concentrations of the alkaloid compared to others.

Ephedrine was initially detected and isolated from ephedra extract by Nagai in 1885. After observing its CNS stimulant effects, it was introduced to the market as a synthetic compound used in decongestant and bronchodilator drugs.

In the 1940’s and 1950’s, it replaced adrenaline as the standard therapy for asthma patients. However, its use in mainstream medicine soon declined as other medications with more targeted mechanisms of action were developed.

Ephedrine capsules and tablets are still prescribed by doctors to treat intermittent shortness of breath, chest tightness, and wheezing due to bronchial asthma.

It works by constricting nasal passage blood vessels, reducing swelling, and opening up the lungs airways to allow easier breathing. [5]

Drugs.com reports that Ephedrine Sulfate Injections are also used to treat hypotension (low blood pressure) resulting from the “settling” of anesthesia after surgeries. [6]

Ephedra vs Mormon Tea

Ephedra tea and Mormon Tea are often confused. They are related but not the same.

Mormon tea (Brigham tea, whorehouse tea) is beverage made form a subset of species within the Ephedra genus. The name can also refer to one of several plant varietals that grow in North America.

The species of Ephedra used to make Mormon Tea do not contain ephedrine alkaloids. Therefore, Mormon Tea does not induce the same bioactive effects that Ma Huang tea does.

It also is not associated with common side effects or toxicity of stimulant species of Ephedra. However, it is purported to promote mild stimulatory effects and to suppress the appetite.

Mormon Tea is often called American Ephedra. It is made from certain species of this plant that are found in Four-Corners states in the USA (Utah, Arizona, New Mexico, Colorado).

The main species used to make Mormon Tea is Ephedra nevadensis. E. viridis, E. cutleri, and E. torreyana are also used to prepare a medicinal tea but have slightly different chemical makeups.

Historically, this beverage was prepared by Mormons as an alternative to coffee which they cannot drink due to their religion. It is reported that Native Americans introduced Mormon settlers to this brew when they travelled Westward to settle the United States.

According to folklore, this tea was believed to have a protective effect against venereal disease and was commonly consumed in brothels located in Nevada. Research does not support this health claim.

Uses for Ephedra

According to Seoul National University, Ephedra sinica (Ma Huang) has been used in TCM for more than 5000 years to treat arthralgia (joint pain), asthma, common cold, edema, and obesity. [2]

The Natural Medicines Comprehensive Database (NMCD) reports that Ephedra has been used orally for: [1]

• Increasing urine production in the kidneys (diuresis) to treat edema;
• Respiratory tract conditions including bronchitis;
• Enhancing athletic performance;
• Allergic rhinitis (hay fever);
• Weight loss and obesity;
• Nasal congestion;
• Boosting energy;
• Bronchospasm;

This plant extract has also been used orally for allergies, anhidrosis (inability to perspire normally) asthma, bone and joint pain, colds, fever, flu, headache, nephritis (inflamed kidneys), and swine flu. [1]

Before its ban as a dietary supplement ingredient in the United States, Ephedra was commonly included in weight loss and energy boosting products. Today, researchers in Japan are interested in how it might induce weight loss by altering gut microbiota. [2]

Consumers reported taking this fat-burning supplement to help them increase their metabolism, control hunger cravings, improve motivation and concentration and for bodybuilders to promote workout intensity and stamina.

This plant extract was also previously marketed and sold as a recreational drug called Herbal Ecstasy, purported to promote a “legal high” or feelings of euphoria.

However, the FDA banned this product for making unapproved drug claims. They warn that Herbal Ecstasy is subject to seizure and injunctions because it is misbranded and adulterated. [1]

Ephedrine alkaloids are prohibited by the WADA (World Anti-Doping Agency) and other sporting associations as stimulants and performance-enhancing drugs.

Further, the sale of ephedrine and pseudoephedrine are monitored in nearly all countries because they are used to manufacture the street drug called methamphetamine (“crystal meth”). [8]

How Ephedra Works in The Body

The majority of the physiological effects produced by consuming oral ephedra supplements are attributed to the content of stimulatory alkaloids, including ephedrine and pseudoephedrine.

Ephedrine is a sympathomimetic agent, meaning that it increases activation of the sympathetic nervous system. It works by binding to beta-adrenergic receptors throughout the body, which are the same type of receptors activated by the “fight-or-flight” hormone adrenaline.

Researchers from the University of Sarajevo say that, “Ephedrine stimulates the heart rate, increases blood pressure, promotes bronchodilation, and exhibits pronounced effects on the central nervous system (CNS) by binding to adrenergic receptors. Pseudoephedrine (PE) acts similarly, yet, with fewer CNS effects.” [8]

Ephedra contains various E (ephedrine)-type alkaloids of biological relevance including:

• Methylpseudoephedrine;
• Norpseudoephedrine;
• Pseudoephedrine;
• Methylephedrine;
• Norephedrine;
• Ephedrine;

Other phytochemicals identified in this plant include citric acid, malic acid, oxalic acid, saponins, kynurenines, ephedroxane, tannins, and various trace minerals.

In 2015, researchers reported that the chemical composition of Ephedra is not fully elucidated. Secondary metabolites of Ephedra include amino acids, phenolic compounds, alkaloids, volatile oils, and various other plant chemicals. [8]

NMCD reports that some preliminary animal and human research has shown Ephedra to have anti-inflammatory, antitussive, hypertensive, vasoconstrictive, energy-boosting, thermogenic, gastric-emptying, muscle-growth effects. [1]

Ephedra Benefits for Weight Loss

One of the main reasons for taking ephedra is as a diet pill to support body weight reduction. Bodybuilders will commonly use this supplement in the form of an ECA (ephedra, caffeine aspirin) stack during their cutting phase to improve muscle tone and physique.

Ephedrine is purported to increase thermogenic activity and to be muscle-sparing. This means it causes your body to burn more calories at rest (resting energy expenditure) and preferentially break down fat for fuel rather than protein in muscle tissues.

Some clinical research suggests that use of an oral Ephedra product can increase weight loss results by two pounds per month. Results have been observed in research trials lasting for up to six months, but there are no studies on its use as a long-term weight management aid.

This weight loss effect is fairly reliable and has been documented in studies involving men, women, trained and untrained athletes as well as obese and overweight individuals. Research also demonstrates a reliable appetite-suppressant effect, making it easier to adhere to a calorie-restricted diet.

Multiple studies suggest that caffeine provides additive fat-burning effects when used in a stack. Kola Nut and Willow Bark may also act synergistically for weight loss.

While this supplement does appear to work for weight loss, it poses a high risk of serious side effects. For many, the purported benefits do not outweigh the potential health risks. [2]

According to NMCD, “Despite the possible effect on weight, using ephedra-containing products may be associated with significant adverse effects. Even in carefully screened and monitored otherwise healthy adults, ephedra combinations can cause small changes in blood pressure and heart rate.” [1]

Long-term use of this supplement can put excessive strain on the heart and lead to cardiovascular problems. In some individuals, serious adverse reactions have occurred even when taking this supplement for short periods of time in standard therapeutic dosages.

For this reason, the FDA banned the sale of ephedrine-based weight loss products in the United States in 2004. Other governments in countries including Canada, the United Kingdom, Australia and New Zealand also banned the sale of these supplements at the same time.

How to Use Ephedra

While ephedrine is banned in dietary supplements around most of the world, the ephedra plant remains legal to buy as a raw herb for use in traditional medicine. Ephedra extract supplements with the active alkaloids removed are also still legal to buy.

Furthermore, in the United States, Canada and the UK, consumers are still legally able to purchase ephedrine HCL pills as an over-the-counter nasal decongestant and asthma remedy. It is also sold as a prescription bronchodilator drug.

Use of ephedra for weight loss is considered off-label. Do not take this product unless you are under the guidance of a qualified physician or licensed herbal medicine practitioner.

The recommended dosage of ephedra will depend on the species of plant being used as well as the concentration of active alkaloids. In general, dosages are standardized to the ephedrine content.

NMCD reports that ephedrine alkaloids are typically administered in doses between 15-40 mg and taken up to 3 times daily. Caffeine is commonly stacked with this stimulant in divided dosages of between 100 – 210mg to enhance its efficacy. [1]

In some studies, 60 mg ephedrine has been combined with unspecified amounts of Kola Nut and Willow Bark. [1] Many dosage protocols used in research trials will provide 25 mg of ephedrine per administration, taken 2-3 times per day.

In one study, an EC stack (ephedrine/caffeine) was used at a dosage of 90mg/192mg per day for a six month period. In another study, dosages of 72mg ephedrine and 240mg caffeine daily were used for 8 weeks.

In one small study of obese Korean women, 4 grams of Ephedra sinica (ma huang) water extract was administered daily for 8 weeks. [2] This amount was roughly equivalent to 24 grams of crud, unprocessed herb.

It is recommended to avoid taking this weight loss supplement late in the evening to prevent insomnia from developing. Drink plenty of water when using this product and avoid other sources of caffeine.

Most sources recommend starting at a low dose to gauge individual tolerance. Do not increase your dosage unless you experience no side effects.

Do not exceed 90 mg of ephedrine alkaloids per day. Taking more than this amount significantly increases the risk of adverse reactions and may not lead to better weight loss results.

Ephedra Legal Status

Is ephedra legal to buy in the United States or has it been banned? The legal status of this plant is often incorrectly reported online.

It is important to distinguish between the legal status of the herb itself, the ephedrine alkaloid, supplements made with these ingredients and pharmaceutical drugs made with ephedrine.

The Ephedra herb remains legal in the United States, although its use in finished goods in restricted. Sale and distribution of the herb is heavily regulated, but consumers can purchase it from traditional Chinese medicine practitioners or grow it on their own.

Ephedra supplements that contain ephedrine alkaloids are illegal and have been banned outright in the USA under the governing authority of the Food and Drug Administration.

However, ephedra supplements that do not contain these alkaloids (known as “ephedra extract” supplements) are legal.

Here is an overview of the key developments that lead to this ruling: [7]

• The FDA restricted ephedrine content in over-the-counter drugs to a maximum dose of 8 mg per serving and no more than 24 mg per day in June 1997.
• In 2004, the FDA banned all ephedrine-containing dietary supplements inside the USA.
• The supplement industry challenged the FDA’s ban.
• A federal judge from Utah struck down the FDA ban in 2005.
• An appeals court reversed the federal judge’s decision in 2006, reinstating the ban on ephedrine alkaloids in dietary supplements.

The ephedrine alkaloid is a controlled substance under US law. Its sale is highly restricted and subject to intense legal scrutiny under the Combat Methamphetamine Epidemic Act of 2005.

However, ephedrine remains FDA-approved as an over-the-counter drug for the alleviation of asthma, colds, allergies, and symptoms of other bronchial conditions. Depending on which state you live in, you can buy it without a doctor’s prescription.

While medications like Bronkaid (Ephedrine sulfate) and Primatene (Ephedrine hydrochloride) are still legal in the United States, they cannot be marketed for weight loss, energy enhancement or athletic performance enhancement.

Ephedra Extract Supplements

The FDA ban of 2004 pertained specifically to the inclusion of ephedrine and pseudoephedrine alkaloids in dietary supplements. Thus, species of ephedra that are devoid of these alkaloids or extracts that have been processed to remove the alkaloids remain legal as supplement ingredients within the United States.

All ephedra fat burners sold online at the current time are made with ephedrine-free extracts of this plant. Some examples of products made with this legal form of the extract include:

• Lipodrene, Lipodrene Elite, Lipodrene Hardcore
• Yellow Bullet Extreme
• Green Stinger
• Ultimate Burn
• Yellow Bullet
• Lean & Hot
• Demon Seed
• Superdrine RX-10
• Stimerex Hardcore
• Hellfire EPH 150
• EPH 100 Fat Burner
• ECA Xtreme
• ECA Elite
• Diablos ECA Fire Caps
• Black Spider 25
• Black Widow
• Black Mamba Hyperrush

NMCD reports that there are currently 248 different supplements available that contain Ephedra extracts. The ingredients list and dosages vary greatly between these products.

NCCIH reports that some species commonly used for manufacturing supplements include E. sinica, E. distachya, E. vulgaris, E. equisetina. E. gerardiana, E. intermedia, and E. sinensis.

The dried stems and leaves are used to make teas, liquid extracts, tinctures, capsules, tablets, powders, energy drinks and more. [3]

Most of the purported weight loss benefits of taking ephedra are attributed to the ephedrine content found in this plant. There is limited research available to determine the efficacy of ephedra extract without these active alkaloids.

All of the above-mentioned supplements replace the missing ephedrine content with other stimulating herbal ingredients, such as synephrine from Bitter Orange extract (Citrus Aurantium).

While these alternative ingredients may contribute to weight loss results, they may also pose a risk of side effects on their own. Before deciding to purchase an ephedra extract supplement, investigate all of the ingredients listed on the label and consult with a doctor to determine whether these products are appropriate for you.

Ephedra Extract Without Ephedrine Alkaloids

The primary biological effects of Ephedra are believed to be caused by the E-type alkaloids, especially ephedrine and pseudoephedrine.

However, 2017 research from Kitasato University in Japan suggests multiple pharmacological actions of non-alkaloidal factions of Ephedra. Some of these effects include: [10]

• Antimetastatic effects (inhibits cancer from spreading to new locations);
• Anti-influenza effects (works against the fu);
• Antitumor effects (inhibits tumor formation);
• Analgesic effects (relieves pain);

In a different 2017 study from Kitasato University, alkaloid-free Ephedra extract was found to strongly activate the TRPV1 (transient receptor potential vanilloid 1) pain signaling pathway.

This is the same biological pathway activated by the primary bioactive constituent of hot chili peppers (capsaicin) and some other pungent plants. [11]

Activation of the TRPV1 pathway is associated with numerous physiological effects including pain relief, enhancing the production of heat in the body (thermogenesis), and improving peripheral circulation.

Research on Ephedra that does not contain ephedrine alkaloids is a new field. More research is needed to understand the possible benefits and safety of these novel extracts.

Ephedra extract supplements that do not contain any ephedrine alkaloids are still legal in the United States and are often promoted for potential fat loss effects. However, there are no studies available to determine whether these extracts are effective for promoting weight loss.

In almost all cases, these ephedrine-free supplements are made with other stimulant ingredients like synephrine, guarana extract, cayenne, green tea extract, phenylethylamine, forskolin and caffeine anhydrous to boost metabolism.

Safety and Side Effects

Researchers from University of Sarajevo state, “Contrary to most other herbal supplements, Ephedra products carry a remarkable health risk, which is aggravated by their misuse and/or abuse.” [8]

The US FDA banned Ephedra dietary supplements that contain active alkaloids because of excessive reports of serious side effects including hypertension (high blood pressure), rapid heartbeat, heart attack, stroke, seizure, and sudden death.

More than 800 dangerous adverse reactions have been attributed to using oral Ephedra supplements, such as the popular Xenadrine and Metabolife products. [9]

Harvard University reports, “According to a study in the Annals of Internal Medicine, ephedra products make up only 1% of herbal supplement sales in the U.S., but they are responsible for 62% of herb-related reports to poison-control centers.” [9]

Use of products that contain this herbal extract is linked to a 200-300% increase in the following symptoms: [9]

• Jitteriness, nervousness, trouble sleeping, and other autonomic symptoms;</li
• Psychiatric symptoms like irritability and anxiety;
• Heart palpitations;
• Upset stomach;

Some evidence suggests that taking more than 32 milligrams of ephedrine alkaloids in one 24-hour period may triple the risks for subarachnoid hemorrhage, intracerebral hemorrhage, or hemorrhagic stroke. [9]

Generally, using oral Ephedra supplements that contain E-type alkaloids is discouraged due to very serious health risks.

Drug Interactions

Ephedrine alkaloids alter the biological effects and side effects of numerous pharmaceutical medications, herbs, and other supplements. Seek medical advice and use extra caution if you are currently taking prescription drugs including: [1]

• CNS Stimulants like phenylpropanolamine, pseudoephedrine, and diethylpropion;
• Antidiabetes drugs like insulin, Amaryl, Actos, Diabeta, Avandia, and PresTab;
• QT Interval-Prolonging drugs like Cordarone, Pronestyl, Mellaril, and Corvert;
• Anticonvulsant drugs like Dilantin,Mysoline, Depakote, and phenobarbital;
• Beta-adrenergic agonists like Alupent, Isuprel, Proventil, and Bricanyl;
• MAOIs (monoamine oxidase inhibitors);

Ephedra supplements can interact with hundreds of hepatotoxic drugs and other substances that elevate CYP1A2 liver enzymes. Several of these are Tylenol, Valium, Zyprexa, Lipitor, Lopid, Sporanox, Cognex, Zocor, Lamisil, and Rheumatrex.

Be careful combining Ephedra with caffeine-containing products like coffee, green and black tea, kola nut, willow bark, guarana, mate, and various others. This could cause excessive stimulation of the Central Nervous System effects and increase the risks for negative side effects.

Ephedra supplements can cause false-positive results on drug screening assays used to detect methamphetamine or amphetamine use. They can also affect results of lab tests that measure blood glucose levels, blood lactate levels, and thyroid function.

Products that contain ephedrine alkaloids can exacerbate symptoms of various health conditions including angina, anxiety, arrhythmia, diabetes, essential tremor, hypertension, hyperthyroidism, kidney stones, narrow-angle glaucoma, long QT interval syndrome, and seizure disorders.

Discontinue using OTC ephedrine medications at least two weeks before a scheduled surgery.

Oral Ephedra supplements are not recommended for children under 18 years of age, or women who are pregnant or breastfeeding, due to risks of toxicity or death. [1]

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