Ephedra is a twiggy herb that has a definite medicinal effect. In Chinese it is called Ma Huang, which is translated as either “Hemp Yellow” or “Numb Yellow.” The FDA has announced that at the beginning of April, 2004, it will be banned from interstate commerce due to potential dangers when misused.

Chinese Medicine categorizes Ma Huang as an herb to use for “wind-cold,” which is generally a common cold with symptoms such as runny nose, cough with clear sputum, and chills. Ma Huang is a bronchodilator and can help induce a sweat (diaphoresis) that is used to “push out” an invading pathogen. Quite possibly in the increased heart rate combined with bronchodilation helps the white blood cells more quickly attack an infection trying to get into the lungs. It is also successfully used in some types of asthma treatment.

Chinese Medicine does not recommend Ma Huang for weight loss or increasing athletic performance. Regular exercise is the best answer for both of those goals! I have heard that some monks used Ma Huang to help them keep awake during long periods of meditation, though tea holds that place in the legend of Bodhidharma and the Shaolin monks.

Over the past decade, Ephedra has gained popularity as a stimulant that raises metabolism, increases wakefulness, and can create an elated sensation. Pseudoephedrine, the main ingredient in Sudafed, has also been used this way, and has been used in the illicit manufacture of methamphetamines. According to the FDA, about 150 people have died in connection with using Ephedra for weight loss and athletic enhancement. Most of these people combined Ephedra with caffeine and possibly other drugs. Many of them had likely become dehydrated, as well. However, it has also been reported that in 2002, Ephedra sales in America were $1.2 billion. In 2003, after the press alerted people to the dangers, the sales fell to about $500 million. Assuming that most bottles of Ephedra pills were $20, that indicates that about 60 million bottles were sold in 2002 alone. If each person used 10 bottles of Ephedra (a large estimate), then there were 6 million users that year. The 150 deaths were spread over several years, but if we pretend that they all happened in 2002, it would mean that there was a 0.00025% chance of dying from using Ephedra. The chance is significantly less, and to produce a dangerous situation with Ephedra most likely requires many other factors, such as obesity, hypertension, dehydration, and concurrent use with other drugs. Compared to the rates of addiction and disease for tobacco, alcohol, and even sugar, Ephedra is not a major public health concern.

Part of the FDA’s concern with Ephedra products regards unproven labeling claims that it is effective for weight loss. Frankly, I agree that claims as to medical effects should have some proof behind them, ideally with placebo-controlled double-blinded studies. It can certainly cause harm if someone claims that a rare herb can cure diabetes or cancer when there has been no supporting research. Previously, there was little hard science supporting Ephedra as a weight loss substance. However, as part of their study, the FDA hired Rand Corporation to do rigorous placebo-controlled studies of Ephedra. They concluded that it DOES help with weight loss—an average of an extra 2 pounds per month compared to placebo. In addition to proving that it does work, they conclusively showed that Ephedra raises blood pressure and heart rate. One appropriate action to take would have been to require a warning on all Ephedra containing products, similar to the warnings on cigarettes. Two significant differences between Ephedra and tobacco are that Ephedra has been shown to have a medicinal effect (both traditionally for colds/coughs/asthma and in modern research for weight loss) whereas tobacco has only been shown to have negative effects, and that Ephedra is not addictive like tobacco. The obvious difference is in the money and political power of the tobacco industry.

Don’t get me wrong—I’m not advocating Prohibition for tobacco or alcohol. As I’ve written before in this column, I am a proponent of freedom and self-responsibility, not of government regulation to protect us from making bad decisions that may lead to self-harm. I guess that makes me an American philosophically!

In January, a couple studies were published which should call more attention to a real public health threat. The scientific journal Nature published research that global warming (mainly from C02 emissions and the burning of fossil fuels) is likely to make 25% of species in most zones of the Earth extinct by 2050. The other research, widely reported in the news in early January, is that nanoparticles from burning fossil fuels (especially diesel) can not only enter the lungs to cause asthma, but can actually cross the blood-brain barrier and cause unknown amounts of brain damage. Since almost everyone is exposed to auto exhaust, and such emissions are also causing mass extinctions, this seems like the real public health threat. This is not an issue of a person making an informed decision to use an herbal drug which has a small chance of hurting them, but of large industries causing widespread disease and environmental collapse.

I will certainly follow the law and stop interstate commerce of Ephedra in late February. However, after intense consideration, I decided to continue to offer it until February 25, even adding new quantity discounts and sales. What swayed my mind was a letter from a man with narcolepsy (a disorder which causes one to unpredictably fall asleep at inopportune times such as driving or while working) who found Ephedra to be the only effective and agreeable remedy to make his life more normal. He has never had a problem with it and doesn’t have high blood pressure, so with moderate use he has essentially no risk of complications. Provigil is one of the more common prescriptions for narcolepsy, but it is very expensive and has several possible side effects, including severe nausea, diarrhea, chest pain, and abnormal ejaculation. Certainly narcolepsy patients in a free country should be able to try a variety of treatments for their condition and make an informed decision which one to use on a regular basis. I have no objection to being required to inform people that Ephedra may be dangerous or life-threatening if they have hypertension or heart disease. However, banning entirely it is too much.

One last concern is the issue of state’s rights and federal regulation. While Bush and crew once preached the importance of state’s rights, this move undercuts them again. In Oregon, where I am a Licensed Acupuncturist, my licensed scope of practice specifically covers herbs that are found in common Oriental Materia Medica texts. Ma Huang is generally the very first herb to be listed in any traditionally organized Materia Medica. It seems clear that as my license is a medical license, practicing herbal medicine acknowledges that the herbs have a medicinal (drug-like) effect. However, according to the FDA, if these substances have a strong drug-like effect, they can be classified as “unapproved drugs” and the FDA can ban interstate commerce in them. This effectively shuts down my supply line, despite the fact that the Oregon Board of Medical Examiners has determined my training to be sufficient to allow me to prescribe such “unapproved drugs.” If Oregon is concerned about inappropriate use of Ma Huang, it could limit its sale to pharmacists, licensed herbalists, and physicians.

It is quite a paradox that in seeking to prevent misleading labeling claims that Ephedra can help in weight loss, the FDA funded research which proved that it does indeed help. Instead of then promoting safe use by licensed healthcare providers with accurate informed consent as to the dangers of Ephedra, they are pulling it from the market. Does it make sense that proving an herb to be effective can lead to it being pulled from the market? Big Brother is at it again!