- The Washington Times - Monday, March 10, 2003

SANTA MONICA, Calif., March 10 (UPI) — An evaluation of ephedra has concluded the controversial dietary supplement is indeed linked to serious health complications and there is insufficient evidence to support its efficacy in long-term weight loss or enhanced athletic performance, researchers reported Monday.

The evaluation, based on numerous scientific reports, will be published in the March 26 issue of Journal of American Medical Association but was released earlier due to its clinical significance.

Dr. Paul G. Shekelle, a physician working with the Southern California Evidence-Based Practice Center/RAND, and colleagues examined 52 clinical trials and 65 case reports on ephedra. The popular herbal supplement is sold over the counter nationwide and is promoted to help shed pounds and boost athletic abilities.

Shekelle's team found that although ephedra might provide short-term weight loss, such benefits are limited.

"There is some evidence using edphra or ephedrine will help lose weight in the short term, a modest amount," Shekelle told United Press International. "There's no evidence it will help keep the weight off" beyond six months of ephedra use. Caffeine was found to boost ephedra's efficacy in helping a person lose weight, but the effects also were short-lived.

"There's certainly enough evidence to be worried it may cause heart attack, death and stroke in rare circumstances," he added.

Researchers reviewed more than 16,000 adverse events — including five deaths, five heart attacks, 11 strokes, four seizures and eight psychiatric cases — linked to ephedra use. They found use of the supplement was associated with two to three times higher risk of psychiatric symptoms, upper gastrointestinal problems and heart palpitations.

According to the evaluation, there was no sustainable proof ephedra did anything to improve athletic performance. The finding comes shortly after the Feb. 17 death of Baltimore Orioles pitcher Steve Bechler, a 23-year-old athlete who was found to have ephedra in his system.

Wes Siegner, legal counsel for the Ephedra Education Council in Washington, told UPI the evaluation "is affirming what the industry has been saying all along."

Siegner said "this huge debate over ephedra" has exaggerated its potential risks. "The list of side effects that they're stating are essentially identical to other side effects for other over-the-counter drugs," Siegner said.

There are numerous reported deaths from over-the-counter painkiller use, he added, but "you don't see reports on every person who dies from aspirin poisoning."

In an accompanying editorial to be published in the March 26 issue, Dr. Phil B. Fontanarosa, JAMA's deputy executive editor, wrote: "The public, aware of recent reports of deaths in young athletes reportedly taking ephedra or ephedrine, is right to be alarmed that the regulation Congress has in place do so little to protect them from the hazards posed by these potentially dangerous compounds."

Just weeks ago, officials from the Food and Drug Administration and the Department of Health and Human Services warned about the possible dangers of ephedra use. Several consumer advocacy groups and physicians have called for a ban on the product. Supporters of ephedra counter the herb is safe and effective when used appropriately.

Officials at the National Institutes of Health said the agency plans to use the information from the RAND report to better understand ephedra's risks and benefits.

(Reported by Katrina Woznicki, UPI Science News, in Washington)

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