....but better now than never. Ephedra is bad news. Phenylpropanolamine (PPA,
used in OTC "weight loss" pills) and pseudoephedrine (Sudafed) deserve
similar consideration. All of these are CNS stimulants---they simulate
epinephrine's effects on vital organs, the CNS, and blood vessels. Heart
rate and blood pressure increase, as may anxiety. Divers who take them could
well be more susceptible to underwater panic. And then there are drug/drug
interactions, which can cause hypertension, changes in sensorium, and any
number of problems that are well known to the FDA but are not widely
publicized.

The bottom line: If you take a medication or, especially, a dietary
supplement, do your homework. The FDA approves medications based on
recommendations of physicians who work with the manufacturer and/or who
participate in clinical trials. More frightening are the unregulated drugs,
such as ephedra, ma huang, homeopathic remedies and botanicals. These
remedies usually are extracts of herbs, barks, or other plant substances and
can have extremely potent effects. The consumer has no way of knowing what
s/he's ingesting.

Don't wait for a government agency or for anyone to warn you about these
issues. Ephedra should have been pulled from the market years ago. I predict
that we'll see either 1) more of these "natural" substances being banned  by
FDA or 2) the pharmaceutical companies getting into the business of
"legitimizing" the so-called natural medications. The "snake oil" effect and
profit potential create too lucrative a marketing opportunity to pass up.

Best,
Barbara/San Francisco


----- Original Message -----
From: "anthony rue" <true@gu*.co*>
To: <quest@gu*.co*>
Sent: Tuesday, November 07, 2000 7:37 AM
Subject: Stroke Alert (ephedra health risk)


> http://www.nejm.org/content/haller/1.asp
>
> Just released this morning, by The New England Journal of Medicine:
>
> Because of its potential public health implications, this article is being
> released before its publication date. The final version of the report will
> be published on December 21.
>
> 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.
> ...
>
> Ephedrine and related alkaloids have been associated with adverse
> cardiovascular events, including acute myocardial infarction, severe
> hypertension, myocarditis, and lethal cardiac arrhythmias. (10,11)
> Constriction of coronary arteries and, in some cases, vasospasm are
believed
> to be the mechanisms of myocarditis and myocardial infarction. The
> adrenergic effects of ephedrine shorten cardiac refractory periods,
> permitting the development of reentrant cardiac arrhythmias. Ephedrine can
> predispose patients to both hemorrhagic and ischemic stroke. (12)
> Subarachnoid hemorrhage is thought to be a result of the hypertensive
action
> of ephedrine, which can be short lived, or of cerebral vasculitis, which
has
> been described in association with a variety of sympathomimetic drugs.
> (13,14) Thrombotic stroke is presumably related to vasoconstriction of
large
> cerebral arteries, which leads to local thrombosis as a result of stasis
and
> sympathomimetic-induced platelet activation.
>
> Because of the severity of the adverse events that we reviewed and, in
> particular, the occurrence of events that caused permanent disability and
> death, we conclude that dietary supplements that contain ephedra alkaloids
> pose a serious health risk to some users. Although the incidence of
serious
> adverse effects cannot be determined from our analysis, our findings
arouse
> concern about the risks of these products, given that they have no
> scientifically established benefits. Our findings indicate the need for a
> better understanding of the determinants of individual susceptibility to
the
> serious adverse effects of dietary supplements containing ephedra
alkaloids
> so that appropriate dosing guidelines and warnings can be devised.
>
>
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