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CNN Sunday Morning
Weekend House Call: Should Ephedra Be Banned?
Aired February 23, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JONATHAN KARL, CNN ANCHOR: Today on "Weekend House Call," the risks of the herbal diet supplement Ephedra. Is it safe or should it banned? Last Monday, Baltimore Orioles pitcher Steve Bechler died of complications of heat stroke, but the medical examiner says Bechler was taking a weight loss supplement that contained Ephedra and that it probably contributed to his death. Bechler's death puts the safety of Ephedra in the spotlight, and that's where our medical correspondent Elizabeth Cohen picks up the story.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Now, Ephedra is so interesting because people are so passionate about it. Some people, for example, Charles Barkley, who we'll be hearing from later, they say that it is -- lots of people say that it's a wonder herb, that it helps you lose weight, that it boosts your metabolism, but other people say that Ephedra is lethal.
(BEGIN VIDEOTAPE)
COHEN (voice-over): Ephedra is a multi-million dollar business. It's an over-the-counter herbal supplement people take to lose weight and boost energy. The Food and Drug Administration has received unsubstantiated reports of at least 70 deaths and more than 1,400 adverse events containing Ephedra, including heart attacks, strokes and seizures. The American Medical Association says the herb should be taken off the market.
So why hasn't the FDA done so? Because the FDA doesn't regulate herbs the way it regulates drugs. All the government has done so far is to recommend that companies put strong warning labels on the bottles.
Manufacturers say Ephedra supplements are safe as long as taken as directed.
According to the Broward County medical examiner, Ephedrine was a contributing factor in the death of 23-year-old Orioles pitcher Steve Bechler. He died of heat stroke, but the medical examiner said Ephedrine, along with borderline high blood pressure and a liver abnormality, played a role.
(END VIDEOTAPE)
COHEN: Let's go over some of the basics on Ephedra. It is sold over the counter. There are currently no age limits for purchase, and it was banned by the NFL, the NCAA and the IOC. Please call us with your questions at 1-800-807-2620, or e-mail us at housecall@cnn.com. To help us answer your questions, we are joined by Richard Kreider, he is a professor and chair of the Exercise and Sport Nutrition Lab at Bailor University. He was asked by the Ephedra Education Counsel to join us. They are the industry that makes these supplements.
We also have Dr. Sidney Wolfe. He is co-founder of the Public Citizen Health Group. Gentlemen, thanks for being with us. I want to get to our very first e-mail right away. It's from Rachel in Virginia and she asks: "As far as Ephedra goes, I hope researching the drug happens fast. It is sad that people have lost their lives from Ephedra, and it's addictive. I can't function without it. Personally, I've taken it for three and a half years, I exercised on a regular basis and even ran a marathon after taking it, and have had no ill side effects."
Professor Kreider, does it bother you that this viewer says she can't function without it?
RICHARD KREIDER, EPHEDRA EDUCATION COUNCIL: Well, any type of stimulant that somebody can take, whether it's caffeine, or Ephedra- based herbal supplement could be addictive, just like many things that people do. But I'll point out that there are studies that have looked at the safety and efficacy of herbal Ephedra supplements, as well as Ephedrine and caffeine. And those studies show that it can help promote weight loss in a safe manner.
COHEN: And Dr. Wolfe, Rachel says that she hasn't had any ill side effects. I mean, she says it's great.
SIDNEY WOLFE, PUBLIC CITIZEN HEALTH GROUP: Rachel's lucky, and most of the people who smoke don't have heart attacks or lung cancer, but enough do that some serious questions have been raised about it. I think that the evidence is really clear that compounds like Ephedra can cause heart attacks, strokes, heart arrhythmias, and professor Kreider himself is apparently doing some research on alternatives to Ephedra. The whole industry that sells these supplements is in the process of bailing out now and substituting something else for Ephedra.
They've been sued a lot. There are lots of reports. I've looked at medical records and coroner's reports on people who actually used it. I think that professor Kreider and I will agree at this point we don't have evidence that this Baltimore Orioles pitcher was actually using it. They have found some around, but we really need to wait to find out whether he was using it, but lots of other people who were using it where there were blood levels of the drug found are dead now or permanently paralyzed.
So this is a dangerous drug. We -- our organization, Public Citizens Health Research Group, asked the FDA a year and a half ago to take it off the market, along with a leading pharmacologist, Dr. Ray Woosley (ph). We believe it will come off the market. It's a dead product.
KREIDER: The problem with that is that all the clinical research studies, double blind, placebo-controlled studies show that it can be safely used in appropriate populations. If it was dangerous and a clinical study showed that it was dangerous, it would have already been pulled off the market. Millions of people use Ephedra without any problems.
KARL: We have got several phone calls coming in. Let's go to the first one. This one comes from Kimberly in Virginia. Kimberly, your question, please.
KIMBERLY: Good morning. Actually good morning to all of you. I just started an exercise program, and I'm taking this supplement early in the morning and during midday. I want to know, is it safe for me to take it twice a day and how long do you recommend for me to take it, because I'm on a 12-week program?
KARL: Well, I imagine the two of you will have very different answers to those questions. Who wants to start?
KREIDER: Well, the clinical studies show and one of the most recent studies showed that up to 90 milligrams a day of Ephedra in a weight loss herbal supplement appears to be safe and people can generally tolerate it. You should always check with your physician before you start an exercise and a dietary supplementation program. But two doses a day, which would probably be about 40 milligrams, would be within the upper limit of safety, at least from the research studies.
WOLFE: We would recommend people just not use it. Too dangerous. As professor Kreider knows, serious questions have been raised about some of the studies that are cited as evidence for safety and effectiveness. A judge in Oklahoma made public a bunch of documents in which studies done by a company called Muscletech (ph), which professor Kreider gets some funding from them -- he was not involved in these studies as far as I know -- but in some of the studies, there was manipulation of data and so forth.
So we really cannot believe a lot of these studies. We can believe than when there are no other explanations, when more than 30 people in the military have died in association with using it, where it's been banned not only, as mentioned before, by the International Olympic Committee, by the NCAA and the National Football League, but it's been banned in all Navy, Army and Air Force PXs (ph). And the reason they banned it is because they said, as long as we sell something like this, people will think it's safe, and the only way to convince people it's not safe is to stop selling it.
KARL: All right, we have to take a quick break. When we come back, the manufacturers of Ephedra products say you should follow directions on the label. That's what's safe for dosage, and how do you know what's right for you? We'll tackle that and answer your questions. Call us at 1-800-807-2620, or you can e-mail us at housecall@cnn.com.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT (voice-over): We hear the term "herbal remedies" used almost every day to treat everything from dementia to the common cold, but for many of these herbs or botanicals, the jury is still out on whether or not they really work, and if they are safe.
The testing that goes into getting a drug to market is not required for herbal supplements. Research is starting to show that some herbal supplements can be effective, but much more information is needed on possible side effects, especially when patients want to combine herbs and prescription drugs.
With one-third of Americans taking some form of herbs, consumers should first talk with their doctor and be sure to read any label warning and follow the label instructions exactly.
Dr. Sanjay Gupta, CNN.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEO CLIP)
CHARLES BARKLEY, FORMER NBA PLAYER: I use it. I think that I'm obviously going through a period where I'm trying to lose weight. I think that it is very dangerous, because when I first started, I tried to take what the bottle said. I've had it in pill form. Now I'm using it in liquid form, and my heart started racing. I got dizzy a couple of times, so what I tried to do, what I do is I just try to use half of the recommended dosage, and I think it does give me extra energy to work out, but I think it also does speed up your heart, and you just have to be -- I don't think I'm going to stop, but I think you just have to be very careful with it.
(END VIDEO CLIP)
KARL: And there you have it. Charles Barkley says he takes Ephedra, but Sir Charles cuts the suggested dosage in half. Elizabeth, you have an e-mail question, I believe?
COHEN: We do. And he's a big guy, so if he cuts it in half, it certainly makes you wonder.
D.j. from Indiana is wondering something, too. He says: "I have been taking a diet supplement with 15 milligrams of Ephedrine. The recommended dose is two pills, twice a day, total of 60 milligrams a day. What's considered too much?"
Now, professor Kreider, you were asked to come here on behalf of the folks who makes Ephedrine. We noticed when we looked at the bottles that there were all sorts of different instructions about how many milligrams to take. What's up with that?
KREIDER: Well, part of it is that over-the-counter medications available have much higher concentrations of (UNINTELLIGIBLE). The diet supplements that are mostly involved typically range from dosages between 40 and 80 to 90 milligrams of Ephedra alcoloids per day. The upper safety range has been reported in the literature appears to be about 90 milligrams per day. There are actually studies that show that even as little as 10 to 20 milligrams a day can help promote some weight loss.
COHEN: And we have a phone call now. Dr. Wolfe -- or actually, we have a phone call now.
KARL: Yes, we do.
(CROSSTALK)
KARL: Your question, please.
CALLER: Hi. Isn't Ephedrine even more harmful to people under the age of 18?
WOLFE: Yes. I don't think there's any evidence that people under or over 18 are more or less sensitive. There are genetic differences in the sensitivity of a lot of people to a number of drugs, and I think including this one. So I don't believe there really is any safe dose.
We have a lot of information about this, including lots of scientific articles on our Web site called WorstPills.org. So people can get free information on it. So I don't think the whole dose business -- huge Charles Barkley says he's got to take half a dose. One of the companies that makes this advertises right on their Web site, this can increase your pulse rate and increase your blood pressure. So despite all this claim about safety...
(CROSSTALK)
KREIDER: Well, so does exercise. I mean, the study shows that blood pressure...
KARL: There is a question about somebody under 18. Professor Kreider, what's your opinion on that?
KREIDER: My opinion is, there is only one study that I'm aware of that has actually looked at the effects of Ephedrine and caffeine in adolescents. So at this point I think it's too early to say whether it would be safe in children under 18.
So we, therefore, recommend it be used only in adults, which are the populations that's been mostly studied. Although there is one study at least that shows that adolescents did see significant weight loss over a medical supervised program. So let's just unless it's prescribed or recommended by a doctor, I wouldn't recommend a person under 18 to take it.
COHEN: All right, Gustavo from Boston has a question. He's e- mailed us. "I'm a 23-year-old student. I work out twice a week. I was taking a dietary supplement that contained 334 milligrams of Ephedra. Every time I took it, my heart beat very fast and I felt hyperactive. Is it dangerous to my health?" Before our guests answer that, we want to go over some of the recommendations about who should not take Ephedra. For example, avoid if you have high blood pressure, heart or thyroid disease, a seizure disorder or glaucoma. Also avoid if you have depression, diabetes, difficulty urinating, prostate enlargement.
Dr. Wolfe, that seems like a lot of people who should not be taking Ephedra.
WOLFE: That's right. And in fact, as an over-the-counter drug, and we are talking about Ephedra dietary supplements, 20 years ago the FDA banned the combination of Ephedrine and caffeine in pretty much the same doses that it's now being sold. They banned it as an over- the-counter drug.
Most people in this country, as recent (UNINTELLIGIBLE) polls showed, most people think that the FDA has approved these dietary supplements, which they haven't, and most people think that the claims for safety and effectiveness are approved by the government. They haven't.
If that were the case, these would be drugs, and if they were drugs, they'd be off the market as dietary supplements. I think that as a prescription drug, under the authorization and careful supervision of a doctor, they may be safe.
COHEN: Dr. Wolfe, I'm going to interrupt you here for one second, to ask professor Kreider a question. Gustavo said that when he took Ephedra, it made his heart beat fast. Professor Kreider, if you take something and it makes your heart beat fast, should you go off of it right away, or is it OK to stay on it?
KREIDER: Some people may have more of a sensitive response to taking Ephedra and caffeine. Just like some people drink one cup of coffee and have a similar type of stimulant response. That would be a sign that they may be more hyper sensitive to it, and that would mean they need to take less or just simply not take it. Ephedrine is not for everybody, but there are millions of people who take it effectively without any side effects and feel that it's very helpful for them to lose weight.
WOLFE: Just to specifically answer them. Anyone who is taking it -- let's assume there are people taking it until it comes off the market, and who experience this, a rapid increase in their heart rate, should stop taking it right away. I think professor Kreider would agree with that, because that may be an indication that they have a sensitivity, as he said, to it.
KARL: Sounds like a common sense measure. We've got to take a quick break. When we come back, will Steve Bechler's death cause Ephedra to be banned? "Weekend House Call" will be right back.
(BEGIN VIDEOTAPE)
UNIDENTIFIED MALE (voice-over): A day on the slopes can be just as harmful to your skin as a day by the pool. Ultraviolet rays intensify in higher altitudes and are 40 percent stronger when reflected off the snow. Experts suggest using sun protection or SPF of 30 or higher on exposed skin while skiing. Sunburn increases the risk of skin cancer and melanomas, the potentially deadly cancers of the skin.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
KARL: Welcome back to "Weekend House Call." We're taking your questions about Ephedra and its use in diet supplements. Earlier this week, Congressman John Sweeney called for hearings on Ephedrine, and an outright ban on the substance. Sweeney is drafting legislation which he plans to introduce next week and he has asked the FDA to ban sales of Ephedrine until Congress acts.
COHEN: Now, Dr. Wolfe, we have a question for you. We know that you're in favor of a ban, but isn't it possible just to regulate Ephedrine so that it can be used safely?
WOLFE: I don't believe so, because as professor Kreider agrees, there is a lot of individual difference and sensitivity to these products. They have been banned as over-the-counter drugs 20 years ago. Most of the companies making these products are stopping the manufacture and switching to something else. We don't know the safety of the something else either.
So I don't think it's possible, because a number of companies have already had warning labels on it, and the deaths, heart attacks, strokes, seizures continue to pile up. The FDA has more reports of deaths, seizures, heart attacks, strokes, high blood pressure crises with Ephedra than all other dietary supplements combined.
COHEN: Professor Kreider, do you think -- do you think that we ought to just leave it as it is, leave it as something you can just walk into a mall and get, or do you think we ought to be regulating it more?
KREIDER: Well, there may be some things that can be done. For example, they may restrict purchase from individuals less than 18 years old, but this is one thing just like many things that we do in our lifestyle. There has to be some prudent thought before one tries it. Whether it's caffeine or any other type of over-the-counter medication, people need to know what they're doing before they start doing it and check with a doctor.
I think that it's a shame that if we ban something like Ephedrine simply because there are some anecdotal reports when we ignore the scientific evidence that shows safety they we are then basing our public policy on hearsay rather than the scientific evidence.
KARL: OK. We've got a call. This one from Diane in New Hampshire. Diane, what's your question?
DIANE: My question is, is there any effect that Ephedra is known to have on the kidneys? And also, for those of us with asthma, I know you're focusing on weight loss, but for those of us with asthma, is there safety in moderation?
WOLFE: Well, Ephedra used to be sold as a treatment for asthma, and that was one of the uses when it was banned as an over-the-counter drug 20 years ago. In the prescription form, it's still available, although it's been superseded by much better and safer drugs for treating asthma. So I don't think anyone now in 2003 would recommend using this drug for asthma.
COHEN: Dr. Wolfe, we have an e-mail for you. This is from Quint in Gainesville, Florida. He asks: "Why does one death from this drug cause such a furor when other, more common drugs, like alcohol and tobacco, cause exponentially more deaths?"
I think what he's trying to say here is that alcohol, which nobody says don't drink, causes more deaths than Ephedra. Why not get all upset about alcohol?
WOLFE: First of all, the one death that's precipitated we don't even know whether that person really was ever using Ephedra. The FDA has reports of over 100 deaths...
(CROSSTALK)
KREIDER: But last year, the CDC reported 30,000 deaths due to alcohol. There were 1,400 college-age individuals that died of alcohol intoxication. For the NFL to ban Ephedra while they openly endorse alcohol being sold at their stadiums and advertised to me is hypocrisy.
WOLFE: Alcohol is not promoted as a drug.
COHEN: When we come back after this, Dr. Wolfe, we'll get to you after the break. When we come back after this, final thoughts from both of you. Stay tuned.
(COMMERCIAL BREAK)
COHEN: We'd like to thank our guests today for joining us to talk about Ephedra on "Weekend House Call." Professor Richard Kreider and Dr. Sidney Wolfe. Gentlemen, give us a one-sentence final thought. Dr. Kreider, why don't you go first.
KREIDER: Mr. Bechler's death is tragic, but it's an example of how not to train athletes who are unacclimatized, out of shape, pushed to the point where they collapse during training. Our focus should be on how to prevent these type of deaths rather than on dietary supplement we don't even know that this individual took.
COHEN: Dr. Wolfe?
WOLFE: Again, for more information look at our Web site, WorstPills.org. The reason the government regulates these products is because they're making claims of performance enhancement, weight reduction and so forth, and unlike alcohol, which is making those kinds of claims, Ephedra is. Ephedra products will be banned. We hope people stop using them now before there is yet another victim of these terrible products.
COHEN: Thank you, Dr. Wolfe. I have a final thought, which is that earlier in the show, we heard professor Kreider, who represents the Ephedra industry, say, that before you take Ephedra you should talk to your doctor. I'd like to know how many people who walk into malls and buy Ephedra have spoken to their doctor about it.
That's all we have time for today. Make sure to catch us next weekend at 8:30 a.m. Eastern on Saturday and Sunday. This is the place for the answers to your medical questions. I'm Elizabeth Cohen. Thanks for watching. "CNN SUNDAY MORNING" continues now.
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Aired February 23, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JONATHAN KARL, CNN ANCHOR: Today on "Weekend House Call," the risks of the herbal diet supplement Ephedra. Is it safe or should it banned? Last Monday, Baltimore Orioles pitcher Steve Bechler died of complications of heat stroke, but the medical examiner says Bechler was taking a weight loss supplement that contained Ephedra and that it probably contributed to his death. Bechler's death puts the safety of Ephedra in the spotlight, and that's where our medical correspondent Elizabeth Cohen picks up the story.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Now, Ephedra is so interesting because people are so passionate about it. Some people, for example, Charles Barkley, who we'll be hearing from later, they say that it is -- lots of people say that it's a wonder herb, that it helps you lose weight, that it boosts your metabolism, but other people say that Ephedra is lethal.
(BEGIN VIDEOTAPE)
COHEN (voice-over): Ephedra is a multi-million dollar business. It's an over-the-counter herbal supplement people take to lose weight and boost energy. The Food and Drug Administration has received unsubstantiated reports of at least 70 deaths and more than 1,400 adverse events containing Ephedra, including heart attacks, strokes and seizures. The American Medical Association says the herb should be taken off the market.
So why hasn't the FDA done so? Because the FDA doesn't regulate herbs the way it regulates drugs. All the government has done so far is to recommend that companies put strong warning labels on the bottles.
Manufacturers say Ephedra supplements are safe as long as taken as directed.
According to the Broward County medical examiner, Ephedrine was a contributing factor in the death of 23-year-old Orioles pitcher Steve Bechler. He died of heat stroke, but the medical examiner said Ephedrine, along with borderline high blood pressure and a liver abnormality, played a role.
(END VIDEOTAPE)
COHEN: Let's go over some of the basics on Ephedra. It is sold over the counter. There are currently no age limits for purchase, and it was banned by the NFL, the NCAA and the IOC. Please call us with your questions at 1-800-807-2620, or e-mail us at housecall@cnn.com. To help us answer your questions, we are joined by Richard Kreider, he is a professor and chair of the Exercise and Sport Nutrition Lab at Bailor University. He was asked by the Ephedra Education Counsel to join us. They are the industry that makes these supplements.
We also have Dr. Sidney Wolfe. He is co-founder of the Public Citizen Health Group. Gentlemen, thanks for being with us. I want to get to our very first e-mail right away. It's from Rachel in Virginia and she asks: "As far as Ephedra goes, I hope researching the drug happens fast. It is sad that people have lost their lives from Ephedra, and it's addictive. I can't function without it. Personally, I've taken it for three and a half years, I exercised on a regular basis and even ran a marathon after taking it, and have had no ill side effects."
Professor Kreider, does it bother you that this viewer says she can't function without it?
RICHARD KREIDER, EPHEDRA EDUCATION COUNCIL: Well, any type of stimulant that somebody can take, whether it's caffeine, or Ephedra- based herbal supplement could be addictive, just like many things that people do. But I'll point out that there are studies that have looked at the safety and efficacy of herbal Ephedra supplements, as well as Ephedrine and caffeine. And those studies show that it can help promote weight loss in a safe manner.
COHEN: And Dr. Wolfe, Rachel says that she hasn't had any ill side effects. I mean, she says it's great.
SIDNEY WOLFE, PUBLIC CITIZEN HEALTH GROUP: Rachel's lucky, and most of the people who smoke don't have heart attacks or lung cancer, but enough do that some serious questions have been raised about it. I think that the evidence is really clear that compounds like Ephedra can cause heart attacks, strokes, heart arrhythmias, and professor Kreider himself is apparently doing some research on alternatives to Ephedra. The whole industry that sells these supplements is in the process of bailing out now and substituting something else for Ephedra.
They've been sued a lot. There are lots of reports. I've looked at medical records and coroner's reports on people who actually used it. I think that professor Kreider and I will agree at this point we don't have evidence that this Baltimore Orioles pitcher was actually using it. They have found some around, but we really need to wait to find out whether he was using it, but lots of other people who were using it where there were blood levels of the drug found are dead now or permanently paralyzed.
So this is a dangerous drug. We -- our organization, Public Citizens Health Research Group, asked the FDA a year and a half ago to take it off the market, along with a leading pharmacologist, Dr. Ray Woosley (ph). We believe it will come off the market. It's a dead product.
KREIDER: The problem with that is that all the clinical research studies, double blind, placebo-controlled studies show that it can be safely used in appropriate populations. If it was dangerous and a clinical study showed that it was dangerous, it would have already been pulled off the market. Millions of people use Ephedra without any problems.
KARL: We have got several phone calls coming in. Let's go to the first one. This one comes from Kimberly in Virginia. Kimberly, your question, please.
KIMBERLY: Good morning. Actually good morning to all of you. I just started an exercise program, and I'm taking this supplement early in the morning and during midday. I want to know, is it safe for me to take it twice a day and how long do you recommend for me to take it, because I'm on a 12-week program?
KARL: Well, I imagine the two of you will have very different answers to those questions. Who wants to start?
KREIDER: Well, the clinical studies show and one of the most recent studies showed that up to 90 milligrams a day of Ephedra in a weight loss herbal supplement appears to be safe and people can generally tolerate it. You should always check with your physician before you start an exercise and a dietary supplementation program. But two doses a day, which would probably be about 40 milligrams, would be within the upper limit of safety, at least from the research studies.
WOLFE: We would recommend people just not use it. Too dangerous. As professor Kreider knows, serious questions have been raised about some of the studies that are cited as evidence for safety and effectiveness. A judge in Oklahoma made public a bunch of documents in which studies done by a company called Muscletech (ph), which professor Kreider gets some funding from them -- he was not involved in these studies as far as I know -- but in some of the studies, there was manipulation of data and so forth.
So we really cannot believe a lot of these studies. We can believe than when there are no other explanations, when more than 30 people in the military have died in association with using it, where it's been banned not only, as mentioned before, by the International Olympic Committee, by the NCAA and the National Football League, but it's been banned in all Navy, Army and Air Force PXs (ph). And the reason they banned it is because they said, as long as we sell something like this, people will think it's safe, and the only way to convince people it's not safe is to stop selling it.
KARL: All right, we have to take a quick break. When we come back, the manufacturers of Ephedra products say you should follow directions on the label. That's what's safe for dosage, and how do you know what's right for you? We'll tackle that and answer your questions. Call us at 1-800-807-2620, or you can e-mail us at housecall@cnn.com.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT (voice-over): We hear the term "herbal remedies" used almost every day to treat everything from dementia to the common cold, but for many of these herbs or botanicals, the jury is still out on whether or not they really work, and if they are safe.
The testing that goes into getting a drug to market is not required for herbal supplements. Research is starting to show that some herbal supplements can be effective, but much more information is needed on possible side effects, especially when patients want to combine herbs and prescription drugs.
With one-third of Americans taking some form of herbs, consumers should first talk with their doctor and be sure to read any label warning and follow the label instructions exactly.
Dr. Sanjay Gupta, CNN.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEO CLIP)
CHARLES BARKLEY, FORMER NBA PLAYER: I use it. I think that I'm obviously going through a period where I'm trying to lose weight. I think that it is very dangerous, because when I first started, I tried to take what the bottle said. I've had it in pill form. Now I'm using it in liquid form, and my heart started racing. I got dizzy a couple of times, so what I tried to do, what I do is I just try to use half of the recommended dosage, and I think it does give me extra energy to work out, but I think it also does speed up your heart, and you just have to be -- I don't think I'm going to stop, but I think you just have to be very careful with it.
(END VIDEO CLIP)
KARL: And there you have it. Charles Barkley says he takes Ephedra, but Sir Charles cuts the suggested dosage in half. Elizabeth, you have an e-mail question, I believe?
COHEN: We do. And he's a big guy, so if he cuts it in half, it certainly makes you wonder.
D.j. from Indiana is wondering something, too. He says: "I have been taking a diet supplement with 15 milligrams of Ephedrine. The recommended dose is two pills, twice a day, total of 60 milligrams a day. What's considered too much?"
Now, professor Kreider, you were asked to come here on behalf of the folks who makes Ephedrine. We noticed when we looked at the bottles that there were all sorts of different instructions about how many milligrams to take. What's up with that?
KREIDER: Well, part of it is that over-the-counter medications available have much higher concentrations of (UNINTELLIGIBLE). The diet supplements that are mostly involved typically range from dosages between 40 and 80 to 90 milligrams of Ephedra alcoloids per day. The upper safety range has been reported in the literature appears to be about 90 milligrams per day. There are actually studies that show that even as little as 10 to 20 milligrams a day can help promote some weight loss.
COHEN: And we have a phone call now. Dr. Wolfe -- or actually, we have a phone call now.
KARL: Yes, we do.
(CROSSTALK)
KARL: Your question, please.
CALLER: Hi. Isn't Ephedrine even more harmful to people under the age of 18?
WOLFE: Yes. I don't think there's any evidence that people under or over 18 are more or less sensitive. There are genetic differences in the sensitivity of a lot of people to a number of drugs, and I think including this one. So I don't believe there really is any safe dose.
We have a lot of information about this, including lots of scientific articles on our Web site called WorstPills.org. So people can get free information on it. So I don't think the whole dose business -- huge Charles Barkley says he's got to take half a dose. One of the companies that makes this advertises right on their Web site, this can increase your pulse rate and increase your blood pressure. So despite all this claim about safety...
(CROSSTALK)
KREIDER: Well, so does exercise. I mean, the study shows that blood pressure...
KARL: There is a question about somebody under 18. Professor Kreider, what's your opinion on that?
KREIDER: My opinion is, there is only one study that I'm aware of that has actually looked at the effects of Ephedrine and caffeine in adolescents. So at this point I think it's too early to say whether it would be safe in children under 18.
So we, therefore, recommend it be used only in adults, which are the populations that's been mostly studied. Although there is one study at least that shows that adolescents did see significant weight loss over a medical supervised program. So let's just unless it's prescribed or recommended by a doctor, I wouldn't recommend a person under 18 to take it.
COHEN: All right, Gustavo from Boston has a question. He's e- mailed us. "I'm a 23-year-old student. I work out twice a week. I was taking a dietary supplement that contained 334 milligrams of Ephedra. Every time I took it, my heart beat very fast and I felt hyperactive. Is it dangerous to my health?" Before our guests answer that, we want to go over some of the recommendations about who should not take Ephedra. For example, avoid if you have high blood pressure, heart or thyroid disease, a seizure disorder or glaucoma. Also avoid if you have depression, diabetes, difficulty urinating, prostate enlargement.
Dr. Wolfe, that seems like a lot of people who should not be taking Ephedra.
WOLFE: That's right. And in fact, as an over-the-counter drug, and we are talking about Ephedra dietary supplements, 20 years ago the FDA banned the combination of Ephedrine and caffeine in pretty much the same doses that it's now being sold. They banned it as an over- the-counter drug.
Most people in this country, as recent (UNINTELLIGIBLE) polls showed, most people think that the FDA has approved these dietary supplements, which they haven't, and most people think that the claims for safety and effectiveness are approved by the government. They haven't.
If that were the case, these would be drugs, and if they were drugs, they'd be off the market as dietary supplements. I think that as a prescription drug, under the authorization and careful supervision of a doctor, they may be safe.
COHEN: Dr. Wolfe, I'm going to interrupt you here for one second, to ask professor Kreider a question. Gustavo said that when he took Ephedra, it made his heart beat fast. Professor Kreider, if you take something and it makes your heart beat fast, should you go off of it right away, or is it OK to stay on it?
KREIDER: Some people may have more of a sensitive response to taking Ephedra and caffeine. Just like some people drink one cup of coffee and have a similar type of stimulant response. That would be a sign that they may be more hyper sensitive to it, and that would mean they need to take less or just simply not take it. Ephedrine is not for everybody, but there are millions of people who take it effectively without any side effects and feel that it's very helpful for them to lose weight.
WOLFE: Just to specifically answer them. Anyone who is taking it -- let's assume there are people taking it until it comes off the market, and who experience this, a rapid increase in their heart rate, should stop taking it right away. I think professor Kreider would agree with that, because that may be an indication that they have a sensitivity, as he said, to it.
KARL: Sounds like a common sense measure. We've got to take a quick break. When we come back, will Steve Bechler's death cause Ephedra to be banned? "Weekend House Call" will be right back.
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KARL: Welcome back to "Weekend House Call." We're taking your questions about Ephedra and its use in diet supplements. Earlier this week, Congressman John Sweeney called for hearings on Ephedrine, and an outright ban on the substance. Sweeney is drafting legislation which he plans to introduce next week and he has asked the FDA to ban sales of Ephedrine until Congress acts.
COHEN: Now, Dr. Wolfe, we have a question for you. We know that you're in favor of a ban, but isn't it possible just to regulate Ephedrine so that it can be used safely?
WOLFE: I don't believe so, because as professor Kreider agrees, there is a lot of individual difference and sensitivity to these products. They have been banned as over-the-counter drugs 20 years ago. Most of the companies making these products are stopping the manufacture and switching to something else. We don't know the safety of the something else either.
So I don't think it's possible, because a number of companies have already had warning labels on it, and the deaths, heart attacks, strokes, seizures continue to pile up. The FDA has more reports of deaths, seizures, heart attacks, strokes, high blood pressure crises with Ephedra than all other dietary supplements combined.
COHEN: Professor Kreider, do you think -- do you think that we ought to just leave it as it is, leave it as something you can just walk into a mall and get, or do you think we ought to be regulating it more?
KREIDER: Well, there may be some things that can be done. For example, they may restrict purchase from individuals less than 18 years old, but this is one thing just like many things that we do in our lifestyle. There has to be some prudent thought before one tries it. Whether it's caffeine or any other type of over-the-counter medication, people need to know what they're doing before they start doing it and check with a doctor.
I think that it's a shame that if we ban something like Ephedrine simply because there are some anecdotal reports when we ignore the scientific evidence that shows safety they we are then basing our public policy on hearsay rather than the scientific evidence.
KARL: OK. We've got a call. This one from Diane in New Hampshire. Diane, what's your question?
DIANE: My question is, is there any effect that Ephedra is known to have on the kidneys? And also, for those of us with asthma, I know you're focusing on weight loss, but for those of us with asthma, is there safety in moderation?
WOLFE: Well, Ephedra used to be sold as a treatment for asthma, and that was one of the uses when it was banned as an over-the-counter drug 20 years ago. In the prescription form, it's still available, although it's been superseded by much better and safer drugs for treating asthma. So I don't think anyone now in 2003 would recommend using this drug for asthma.
COHEN: Dr. Wolfe, we have an e-mail for you. This is from Quint in Gainesville, Florida. He asks: "Why does one death from this drug cause such a furor when other, more common drugs, like alcohol and tobacco, cause exponentially more deaths?"
I think what he's trying to say here is that alcohol, which nobody says don't drink, causes more deaths than Ephedra. Why not get all upset about alcohol?
WOLFE: First of all, the one death that's precipitated we don't even know whether that person really was ever using Ephedra. The FDA has reports of over 100 deaths...
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KREIDER: But last year, the CDC reported 30,000 deaths due to alcohol. There were 1,400 college-age individuals that died of alcohol intoxication. For the NFL to ban Ephedra while they openly endorse alcohol being sold at their stadiums and advertised to me is hypocrisy.
WOLFE: Alcohol is not promoted as a drug.
COHEN: When we come back after this, Dr. Wolfe, we'll get to you after the break. When we come back after this, final thoughts from both of you. Stay tuned.
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COHEN: We'd like to thank our guests today for joining us to talk about Ephedra on "Weekend House Call." Professor Richard Kreider and Dr. Sidney Wolfe. Gentlemen, give us a one-sentence final thought. Dr. Kreider, why don't you go first.
KREIDER: Mr. Bechler's death is tragic, but it's an example of how not to train athletes who are unacclimatized, out of shape, pushed to the point where they collapse during training. Our focus should be on how to prevent these type of deaths rather than on dietary supplement we don't even know that this individual took.
COHEN: Dr. Wolfe?
WOLFE: Again, for more information look at our Web site, WorstPills.org. The reason the government regulates these products is because they're making claims of performance enhancement, weight reduction and so forth, and unlike alcohol, which is making those kinds of claims, Ephedra is. Ephedra products will be banned. We hope people stop using them now before there is yet another victim of these terrible products.
COHEN: Thank you, Dr. Wolfe. I have a final thought, which is that earlier in the show, we heard professor Kreider, who represents the Ephedra industry, say, that before you take Ephedra you should talk to your doctor. I'd like to know how many people who walk into malls and buy Ephedra have spoken to their doctor about it.
That's all we have time for today. Make sure to catch us next weekend at 8:30 a.m. Eastern on Saturday and Sunday. This is the place for the answers to your medical questions. I'm Elizabeth Cohen. Thanks for watching. "CNN SUNDAY MORNING" continues now.
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