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CNN Saturday Morning News

Weekend House Call: Ephedra

Aired August 02, 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.


ELIZABETH COHEN, CNN CORRESPONDENT: Good morning and welcome to Weekend House Call.
Today we're talking about Ephedra. The FDA is reviewing whether to ban the herbal supplement. Now, people are very passionate about Ephedra. Many say it's a wonder herb that helps you lose weight and boost your metabolism. But other people say it really doesn't work and that it can be lethal.

Our Dr. Sanjay Gupta has this report.

(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN CORRESPONDENT (voice-over): Baltimore Orioles pitcher Steve Bechler was one of 12 million Americans who use Ephedra. In February, he died of heat stroke during a practice after taking the supplement. His family blames the Ephedra and they filed a lawsuit against the company that made the type he used.

His parents testified last week on Capitol Hill, asking the FDA to ban Ephedra.

PAT BECHLER, MOTHER OF STEVE BECHLER: We need to get this off the market. We've got to help other children. They want the extra boost. They think that they can make them better athletes, and it doesn't. Please, let's get this out of the hands of children.

GUPTA: The Food and Drug Administration reports 123 deaths have been linked to Ephedra. The American Medical Association wants the herb taken off the market. Manufacturers and industry support groups say Ephedra supplements are safe as long as taken as directed.

UNIDENTIFIED MALE: If it was dangerous and the clinic studies showed that it was dangerous, it would have already been pulled off the market. Ephedra is not for everybody, but there are millions of people that take it effectively without any side effects.

GUPTA: The NCAA, the International Olympic Committee and the NFL have all banned the use of Ephedra. Last weekend, Denver Bronco Lee Flowers was suspended for testing positive for Ephedra. Flowers said he wasn't aware the supplement was in his system. He said his positive test stemmed from a vitamin he took back in December.

He also criticized the NFL's drug policy.

(BEGIN VIDEO CLIP) LEE FLOWERS: I would have been better off smoking crack, I'm being honest with you, because, you know, I would have got a slap on the wrist. And that's a damn shame that, you know, here's something that we don't know what's going into these vitamins, but I could go out here and smoke crack and, you know, well, you smoked crack, you know, be careful next time.

(END VIDEO CLIP)

GUPTA: Major league baseball, the NBA and the NHL do not ban Ephedra. The FDA is still debating what to do about it.

Dr. Sanjay Gupta, CNN, Atlanta.

(END VIDEOTAPE)

COHEN: The FDA has reported more than 2,200 adverse vents linked to Ephedra. The government has also proposed putting strong warning labels on products that contain Ephedra. They'd warn of the possibility of heart attack, seizures, stroke and even death. The proposed labels would caution that the risks can increase with the dose, with strenuous exercise and with stimulants such as caffeine. Warning labels would also say that women who are pregnant or nursing and people under the age of 18 should not use Ephedra. If you have heart disease or high blood pressure, you should also not use the supplement.

We want to answer your questions. Call us at 1-800-807-2620, or you can e-mail us at housecall@cnn.com.

To help answer your questions, Dr. Steven Heymsfield from Columbia University is joining us.

He's done a lot of research on Ephedra and recently testified on Capitol Hill about his findings.

Thanks for joining us, Doctor.

DR. STEVEN HEYMSFIELD, PROFESSOR, COLUMBIA UNIVERSITY: Thank you.

COHEN: We asked a representative from the Ephedra Education Council to join us also this morning, but they declined our invitation.

Dr. Heymsfield, I'd like to get started with an e-mail question from a viewer in New York. She writers, "I've been taking Ephedra daily for several years and have never had any health related problems, except for occasional dizziness. Are there any known long- term effects from taking Ephedra to help maintain weight loss?"

Do we know about the long-term effects, Dr. Heymsfield?

HEYMSFIELD: Well, actually, there have been remarkably few long- term studies of Ephedra. The longest studies we have are only about six months. And so that's one of the very important findings of a recent study, that there's a lack of long-term studies.

COHEN: And a lack of long-term studies means that if you're taking it long-term, do you really know what the effects will be?

HEYMSFIELD: We really don't know what the effects are, either the health benefits or the risks, of going beyond several months.

COHEN: OK, we have another e-mail now from Randy in Chicago.

And Randy asks, "Isn't it true that the majority of the deaths involving Ephedra were due to high dosages or abuse of the drug? Isn't it also true that the majority of the deaths from Ephedra were known to individuals -- happened to individuals already known to have health or heart related problems? Isn't Ephedra just like any other over the counter drug, if you abuse the dosage or take too many pills, you can suffer the consequences?"

Now, it's interesting, the makers of Ephedra often make those exact same arguments.

Dr. Heymsfield, what do you think about those arguments?

HEYMSFIELD: Well, there are a few things in that comment.

First, it's not an over the counter drug, it's a dietary supplement. So it is regulated differently. That's a very important distinction because the safety and effectiveness evaluation of dietary supplements is not as stringent as for over the counter drugs.

But, also, we do know that the side effects of Ephedra, or even the lethal consequences of Ephedra, can occur, even within the normal dosage range.

COHEN: So we have a phone call now from Dean in Florida.

Dean, go ahead with your question.

DEAN: Yes, good morning folks.

First, I was introduced to Ephedra some 17 years ago through an over the counter product and currently I can go down my street and buy it in a little package that looks like candy.

My question to you folks is oftentimes a prescription medicine, folks, people don't realize what you do when you cross it with other medications.

What are the effects with Ephedra, say, on common medications and prescription drugs?

HEYMSFIELD: Well, Ephedra is a stimulant and it's particularly dangerous if you mix it with certain drugs that are used for treating conditions such as depression. So that's one of the reasons there's such an important effort towards regulating it is that it can be a very serious drug to take when in combination with other agents.

COHEN: And one of those agents would be caffeine, is that right, Dr. Heymsfield?

HEYMSFIELD: One is caffeine, another stimulant, and often Ephedra is combined with caffeine to give it more potency, more punch. But there are other drugs particularly used for depression and these are called MAO inhibitors. And if you take Ephedra with those, you can have a very serious adverse reaction.

COHEN: We have another phone call from Lisa in Pennsylvania.

Lisa, go ahead with your question.

LISA: Hi. My question was what is the active ingredient in there, then, if it's Ephedra-free? Is it still going to be effective if you take these products? What is it that boosts your metabolism so that it enables you to either lose weight or cut back your appetite? I mean are they really effective if they say Ephedra-free?

HEYMSFIELD: Well, Ephedra-free could mean any number of things. For example, there is ingredients such as chromium, tea extracts and even compounds almost identical to Ephedra, such as sinephrine or bitter orange, that can be in the Ephedra-free products. And very much like Ephedra, they have not been adequately tested for safety and effectiveness for the long-term.

So one has to be very cautious about taking these. We have very little information about them. So just because something is Ephedra- free doesn't mean it's safe.

COHEN: Thank you, Dr. Heymsfield.

We have to take a break now, but when we come back, a look at some of these new Ephedra-free products. Are they a good substitute or not?

Call us with your questions. The number is on your screen, 1- 800-807-2620, or e-mail your questions to housecall@cnn.com.

We'll be right back.

(COMMERCIAL BREAK)

COHEN: Currently, products containing Ephedra are sold over the counter at many pharmacies and health food stores. There's no age limit to purchase it. But the GNC nutrition store chain now requires anyone buying Ephedra to prove that they're over 18 years old.

We're talking about Ephedra this morning and if it's safe to use. Call us with your questions. Our number is 1-800-807-2620, or e-mail us at housecall@cnn.com.

While we line up your phone calls, let's check our health quiz.

Today's question, what's the Chinese name for Ephedra? We'll have that answer in 30 seconds, so stay with us.

(COMMERCIAL BREAK) COHEN: Checking our health quiz, we asked, what's the Chinese name for Ephedra? The answer, mahuang. The Chinese have used this herb for over 5,000 years, particularly to treat asthma and reduce upper respiratory infections. The primary active ingredient of mahuang is Ephedra. It comes from a shrub like plant which is native to China.

This morning we're talking about the safety of Ephedra.

Let's recap who should avoid using it. If you have high blood pressure, heart or thyroid disease, a seizure disorder or glaucoma, you should not use Ephedra. If you have depression, diabetes, difficulty urinating or prostate enlargement, or if you're using any other prescription drugs, you should also avoid using Ephedra products.

Dr. Steven Heymsfield joins us from New York to answer our questions.

We've got a good question from Matt in Ohio. He asks, "What information is available on the new Ephedra-free products on the market? Makers of the new generation of supplements boast of their effectiveness without the dangers of Ephedra. Are the manufacturers simply substituting Ephedra with a lesser known evil?"

Now, Dr. Heymsfield, we talked about this a bit before our break.

Can you tell us, in general, there are so many different supplements when you go to the store that claim to help with weight loss. Do you think any of them work?

HEYMSFIELD: Well, I think Ephedra does work and it does cause weight loss. The problem we have with it is that some people are predisposed to having very serious complications from it. So it works, but it has risks. There are other ingredients out there that are not effective, but they have very little risks that are associated with them.

So the buyer really has to be educated about which of these products is both safe and effective.

COHEN: Kathy from New York has a question. She asks, "Is there a safe level of Ephedra that can be taken? And, if so, what is the level?"

Dr. Heymsfield, is there some magic number that's OK?

HEYMSFIELD: Well, there was an attempt to find a safe level a number of years ago, but we've pretty much abandoned that because now we know that from a number of epidemiological studies that there are risks that increase even within the normal range of dosing for Ephedra.

So what happens is if you lower the dose greatly, to the point where it really is safe, it has absolutely no effect on body weight. So the answer is, in sum, that there is no really safe level of Ephedra.

COHEN: We have a phone call now from Tanya in Georgia.

Tanya, go ahead with your question for Dr. Heymsfield.

TANYA: Yes, I was waiting to know if Ephedra is safe to take if you're taking hormone pills, if you had a hysterectomy?

HEYMSFIELD: Well, there's no real known interaction between hormone pills and Ephedra per se. But you certainly would want to check with your physician and make sure you don't have any other medical conditions that could put you at risk from Ephedra.

COHEN: Sandy from Virginia has an e-mail question for us. She writes, "It seems that deaths related to Ephedra occur in conjunction with dehydration. Is there a safe level of Ephedra someone can take if they are properly hydrated?"

Let me ask a question, first, about Sandy's question. Is she correct, Dr. Heymsfield? Do you need to be dehydrated in order to have problems with Ephedra or can you have problems even if you're well hydrated?

HEYMSFIELD: Well, if you're dehydrated, it certainly increases the risk of Ephedra, particularly for conditions like heat stroke. But the answer is that you can be perfectly normally hydrated and still have serious adverse effects from Ephedra.

COHEN: Dr. Heymsfield, you're a weight loss doctor. You talk to people all day who need to lose weight.

HEYMSFIELD: Yes.

COHEN: Do you ever suggest that they take Ephedra products?

HEYMSFIELD: No. I wouldn't ever suggest it, although as a physician, I could examine them and make sure they're not at risk, or at least might have a serious adverse consequence from Ephedra. So that is a little edge up for people. But I don't usually recommend it because as a physician I have drugs that are equal or better in terms of weight loss and lower risk than Ephedra.

COHEN: And there's been some controversy about the effectiveness. There was a study out that says that it really doesn't even work that well, so why take the risk? In your experience, did it work that well long-term?

HEYMSFIELD: Well, Ephedra does work. It's not been studied long-term. It's usually been studied anywhere from three to six months. It does produce some weight loss, not unlike the weight loss you see with prescription medications.

COHEN: We have a phone call now from Dave in Canada.

Dave, go ahead with your question. DAVE: Hi. A while back my son was working out at a gym in Lebanese, Ontario, Canada, where I live, and was introduced by other athletes there to a cocktail of Ephedra, aspirin and caffeine pills and told that this would help him to increase his performance and not hit the wall, so to speak. And I was wondering if that cocktail was safe.

HEYMSFIELD: Well, what you're describing is called a stack. That's the three ingredients together -- aspirin, caffeine and Ephedra. And those three agents seem to work together in a way that produces an effect that's even greater than any one of them alone. And that's a very potent cocktail. It's an extreme stimulant. And so it's very dangerous to take that combination.

But whether or not it actually does what people want it to do, which is improve physical performance, is very questionable. Remarkably, there's been practically no studies of long-term effectiveness for athletic performance of that combination, the so- called stack. There have been short-term studies which are very equivocal, like with one or two dosings. But in those studies, what they show is that you can get increases in blood pressure or heart rate and other serious medical problems can arise.

So I think that's a very risky way to improve your performance. The best thing is to work out more and to keep hydrated and healthy.

COHEN: Thank you, Dr. Heymsfield.

When we come back, we'll be taking more of your questions about Ephedra.

Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Ephedra can kill you. It is a menace. If you take Ephedra products, you are playing Russian roulette with your health and therefore it's important for us to not just ban it in Illinois, but to ban this product nationwide.

(END VIDEO CLIP)

COHEN: Welcome back to Weekend House Call.

We're talking about Ephedra's safety. In May, Illinois became the first state to ban the sale of Ephedra products. Under the new law, people who sell Ephedra can face misdemeanor charges punishable by as much as one year in prison and a $5,000 fine. California is seeking to pass a similar law.

We have an e-mail now from Diane in New Jersey. She writes, "Diet pills that contain Ephedra are the only diet pills that work. My doctor told me it was OK for me to take them because my blood pressure is at the low end of the normal range and the Ephedra brings my blood pressure up to 120 over 80. Why should I be denied access to a diet pill that works for me and has the approval of my physician?"

Dr. Heymsfield is joining us from Columbia University.

And earlier in our show, Dr. Heymsfield, you said that you don't let your patients take Ephedra.

What do you think of this situation?

HEYMSFIELD: Well, this individual is receiving Ephedra just like they would any other diet prescription medication from their physician, in a sense, because they've been medically cleared. And we're really not worried about that situation.

It's the person who goes in and doesn't know they have heart disease or some other serious condition and then takes Ephedra, a stimulant, and has the adverse consequences, such as heart rhythm disturbance or a heart attack. So it's not individuals we're worried about who are otherwise healthy. It's that one in a thousand or one in 10,000 people who walks in, takes it and has a very serious problem from it.

COHEN: And unless you're under the care of a doctor, or maybe even if you are, is there any way to know if you're one of those one out of a thousand or one out of 10,000? Is there any way of knowing that?

HEYMSFIELD: Well, one thing you can know is if you have a health condition -- and you mentioned them earlier -- such as high blood pressure, heart disease, then you, of course, you would not want to take that medication. But the problem is it's the people who have silent diseases -- and we know from the studies we've done at Columbia University that many people walk in thinking they're healthy and when we evaluate them, we find that 10 or 20 percent have these conditions that they don't know about that can put them at risk for Ephedra toxicity.

COHEN: We have a phone call now from Debra (ph) in North Carolina.

Debra, go ahead.

DEBRA: Yes, my question is I found out -- I had been taking Ephedra for about five months and then found out that I was pregnant. Is there any chance of any long-term effects both either to me or my baby because of taking it?

HEYMSFIELD: Well, that's a very serious question, and if I was you, I would check with my gynecologist to make sure everything is OK. We don't really have good information about the toxicity during pregnancy of Ephedra. But that is exactly the situation we would be worried about and I -- my advice to you would be to make sure everything is OK.

COHEN: When we come back, we'll have some final thoughts about the safety of Ephedra.

(COMMERCIAL BREAK)

COHEN: If you'd like to read more about Ephedra, check out our Web site at www.cnn.com/health. Under the diet and fitness section, you'll find stories and links to more interactive information about the herbal supplement Ephedra.

Welcome back to Weekend House Call.

We've been talking about the safety and effectiveness of Ephedra.

We've been talking with Dr. Steven Heymsfield, who's an Ephedra expert at Columbia University.

Dr. Heymsfield, do you have any final thoughts for our viewers about Ephedra?

HEYMSFIELD: Well, I think it's very important for people to remember there are no magic bullets for weight control. Even though we all hope there will be someday, right now there aren't any, and if you have questions about your weight or any products that are out there, you should consult with your health care professionals. Physicians, dietitians and other health care workers have access to the key information you need to really know whether a product is safe or effective.

COHEN: Thank you, Dr. Heymsfield, for joining us today.

And that's all we have time for.

Make sure to watch tomorrow's Weekend House Call, when we talk about kicking the smoking habit.

We'll have an expert here to go over all the new and tried and true ways to stop smoking.

That's tomorrow at 8:30 a.m. Eastern.

Thanks for watching.

I'm Elizabeth Cohen.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired August 2, 2003 - 08:29   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN CORRESPONDENT: Good morning and welcome to Weekend House Call.
Today we're talking about Ephedra. The FDA is reviewing whether to ban the herbal supplement. Now, people are very passionate about Ephedra. Many say it's a wonder herb that helps you lose weight and boost your metabolism. But other people say it really doesn't work and that it can be lethal.

Our Dr. Sanjay Gupta has this report.

(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN CORRESPONDENT (voice-over): Baltimore Orioles pitcher Steve Bechler was one of 12 million Americans who use Ephedra. In February, he died of heat stroke during a practice after taking the supplement. His family blames the Ephedra and they filed a lawsuit against the company that made the type he used.

His parents testified last week on Capitol Hill, asking the FDA to ban Ephedra.

PAT BECHLER, MOTHER OF STEVE BECHLER: We need to get this off the market. We've got to help other children. They want the extra boost. They think that they can make them better athletes, and it doesn't. Please, let's get this out of the hands of children.

GUPTA: The Food and Drug Administration reports 123 deaths have been linked to Ephedra. The American Medical Association wants the herb taken off the market. Manufacturers and industry support groups say Ephedra supplements are safe as long as taken as directed.

UNIDENTIFIED MALE: If it was dangerous and the clinic studies showed that it was dangerous, it would have already been pulled off the market. Ephedra is not for everybody, but there are millions of people that take it effectively without any side effects.

GUPTA: The NCAA, the International Olympic Committee and the NFL have all banned the use of Ephedra. Last weekend, Denver Bronco Lee Flowers was suspended for testing positive for Ephedra. Flowers said he wasn't aware the supplement was in his system. He said his positive test stemmed from a vitamin he took back in December.

He also criticized the NFL's drug policy.

(BEGIN VIDEO CLIP) LEE FLOWERS: I would have been better off smoking crack, I'm being honest with you, because, you know, I would have got a slap on the wrist. And that's a damn shame that, you know, here's something that we don't know what's going into these vitamins, but I could go out here and smoke crack and, you know, well, you smoked crack, you know, be careful next time.

(END VIDEO CLIP)

GUPTA: Major league baseball, the NBA and the NHL do not ban Ephedra. The FDA is still debating what to do about it.

Dr. Sanjay Gupta, CNN, Atlanta.

(END VIDEOTAPE)

COHEN: The FDA has reported more than 2,200 adverse vents linked to Ephedra. The government has also proposed putting strong warning labels on products that contain Ephedra. They'd warn of the possibility of heart attack, seizures, stroke and even death. The proposed labels would caution that the risks can increase with the dose, with strenuous exercise and with stimulants such as caffeine. Warning labels would also say that women who are pregnant or nursing and people under the age of 18 should not use Ephedra. If you have heart disease or high blood pressure, you should also not use the supplement.

We want to answer your questions. Call us at 1-800-807-2620, or you can e-mail us at housecall@cnn.com.

To help answer your questions, Dr. Steven Heymsfield from Columbia University is joining us.

He's done a lot of research on Ephedra and recently testified on Capitol Hill about his findings.

Thanks for joining us, Doctor.

DR. STEVEN HEYMSFIELD, PROFESSOR, COLUMBIA UNIVERSITY: Thank you.

COHEN: We asked a representative from the Ephedra Education Council to join us also this morning, but they declined our invitation.

Dr. Heymsfield, I'd like to get started with an e-mail question from a viewer in New York. She writers, "I've been taking Ephedra daily for several years and have never had any health related problems, except for occasional dizziness. Are there any known long- term effects from taking Ephedra to help maintain weight loss?"

Do we know about the long-term effects, Dr. Heymsfield?

HEYMSFIELD: Well, actually, there have been remarkably few long- term studies of Ephedra. The longest studies we have are only about six months. And so that's one of the very important findings of a recent study, that there's a lack of long-term studies.

COHEN: And a lack of long-term studies means that if you're taking it long-term, do you really know what the effects will be?

HEYMSFIELD: We really don't know what the effects are, either the health benefits or the risks, of going beyond several months.

COHEN: OK, we have another e-mail now from Randy in Chicago.

And Randy asks, "Isn't it true that the majority of the deaths involving Ephedra were due to high dosages or abuse of the drug? Isn't it also true that the majority of the deaths from Ephedra were known to individuals -- happened to individuals already known to have health or heart related problems? Isn't Ephedra just like any other over the counter drug, if you abuse the dosage or take too many pills, you can suffer the consequences?"

Now, it's interesting, the makers of Ephedra often make those exact same arguments.

Dr. Heymsfield, what do you think about those arguments?

HEYMSFIELD: Well, there are a few things in that comment.

First, it's not an over the counter drug, it's a dietary supplement. So it is regulated differently. That's a very important distinction because the safety and effectiveness evaluation of dietary supplements is not as stringent as for over the counter drugs.

But, also, we do know that the side effects of Ephedra, or even the lethal consequences of Ephedra, can occur, even within the normal dosage range.

COHEN: So we have a phone call now from Dean in Florida.

Dean, go ahead with your question.

DEAN: Yes, good morning folks.

First, I was introduced to Ephedra some 17 years ago through an over the counter product and currently I can go down my street and buy it in a little package that looks like candy.

My question to you folks is oftentimes a prescription medicine, folks, people don't realize what you do when you cross it with other medications.

What are the effects with Ephedra, say, on common medications and prescription drugs?

HEYMSFIELD: Well, Ephedra is a stimulant and it's particularly dangerous if you mix it with certain drugs that are used for treating conditions such as depression. So that's one of the reasons there's such an important effort towards regulating it is that it can be a very serious drug to take when in combination with other agents.

COHEN: And one of those agents would be caffeine, is that right, Dr. Heymsfield?

HEYMSFIELD: One is caffeine, another stimulant, and often Ephedra is combined with caffeine to give it more potency, more punch. But there are other drugs particularly used for depression and these are called MAO inhibitors. And if you take Ephedra with those, you can have a very serious adverse reaction.

COHEN: We have another phone call from Lisa in Pennsylvania.

Lisa, go ahead with your question.

LISA: Hi. My question was what is the active ingredient in there, then, if it's Ephedra-free? Is it still going to be effective if you take these products? What is it that boosts your metabolism so that it enables you to either lose weight or cut back your appetite? I mean are they really effective if they say Ephedra-free?

HEYMSFIELD: Well, Ephedra-free could mean any number of things. For example, there is ingredients such as chromium, tea extracts and even compounds almost identical to Ephedra, such as sinephrine or bitter orange, that can be in the Ephedra-free products. And very much like Ephedra, they have not been adequately tested for safety and effectiveness for the long-term.

So one has to be very cautious about taking these. We have very little information about them. So just because something is Ephedra- free doesn't mean it's safe.

COHEN: Thank you, Dr. Heymsfield.

We have to take a break now, but when we come back, a look at some of these new Ephedra-free products. Are they a good substitute or not?

Call us with your questions. The number is on your screen, 1- 800-807-2620, or e-mail your questions to housecall@cnn.com.

We'll be right back.

(COMMERCIAL BREAK)

COHEN: Currently, products containing Ephedra are sold over the counter at many pharmacies and health food stores. There's no age limit to purchase it. But the GNC nutrition store chain now requires anyone buying Ephedra to prove that they're over 18 years old.

We're talking about Ephedra this morning and if it's safe to use. Call us with your questions. Our number is 1-800-807-2620, or e-mail us at housecall@cnn.com.

While we line up your phone calls, let's check our health quiz.

Today's question, what's the Chinese name for Ephedra? We'll have that answer in 30 seconds, so stay with us.

(COMMERCIAL BREAK) COHEN: Checking our health quiz, we asked, what's the Chinese name for Ephedra? The answer, mahuang. The Chinese have used this herb for over 5,000 years, particularly to treat asthma and reduce upper respiratory infections. The primary active ingredient of mahuang is Ephedra. It comes from a shrub like plant which is native to China.

This morning we're talking about the safety of Ephedra.

Let's recap who should avoid using it. If you have high blood pressure, heart or thyroid disease, a seizure disorder or glaucoma, you should not use Ephedra. If you have depression, diabetes, difficulty urinating or prostate enlargement, or if you're using any other prescription drugs, you should also avoid using Ephedra products.

Dr. Steven Heymsfield joins us from New York to answer our questions.

We've got a good question from Matt in Ohio. He asks, "What information is available on the new Ephedra-free products on the market? Makers of the new generation of supplements boast of their effectiveness without the dangers of Ephedra. Are the manufacturers simply substituting Ephedra with a lesser known evil?"

Now, Dr. Heymsfield, we talked about this a bit before our break.

Can you tell us, in general, there are so many different supplements when you go to the store that claim to help with weight loss. Do you think any of them work?

HEYMSFIELD: Well, I think Ephedra does work and it does cause weight loss. The problem we have with it is that some people are predisposed to having very serious complications from it. So it works, but it has risks. There are other ingredients out there that are not effective, but they have very little risks that are associated with them.

So the buyer really has to be educated about which of these products is both safe and effective.

COHEN: Kathy from New York has a question. She asks, "Is there a safe level of Ephedra that can be taken? And, if so, what is the level?"

Dr. Heymsfield, is there some magic number that's OK?

HEYMSFIELD: Well, there was an attempt to find a safe level a number of years ago, but we've pretty much abandoned that because now we know that from a number of epidemiological studies that there are risks that increase even within the normal range of dosing for Ephedra.

So what happens is if you lower the dose greatly, to the point where it really is safe, it has absolutely no effect on body weight. So the answer is, in sum, that there is no really safe level of Ephedra.

COHEN: We have a phone call now from Tanya in Georgia.

Tanya, go ahead with your question for Dr. Heymsfield.

TANYA: Yes, I was waiting to know if Ephedra is safe to take if you're taking hormone pills, if you had a hysterectomy?

HEYMSFIELD: Well, there's no real known interaction between hormone pills and Ephedra per se. But you certainly would want to check with your physician and make sure you don't have any other medical conditions that could put you at risk from Ephedra.

COHEN: Sandy from Virginia has an e-mail question for us. She writes, "It seems that deaths related to Ephedra occur in conjunction with dehydration. Is there a safe level of Ephedra someone can take if they are properly hydrated?"

Let me ask a question, first, about Sandy's question. Is she correct, Dr. Heymsfield? Do you need to be dehydrated in order to have problems with Ephedra or can you have problems even if you're well hydrated?

HEYMSFIELD: Well, if you're dehydrated, it certainly increases the risk of Ephedra, particularly for conditions like heat stroke. But the answer is that you can be perfectly normally hydrated and still have serious adverse effects from Ephedra.

COHEN: Dr. Heymsfield, you're a weight loss doctor. You talk to people all day who need to lose weight.

HEYMSFIELD: Yes.

COHEN: Do you ever suggest that they take Ephedra products?

HEYMSFIELD: No. I wouldn't ever suggest it, although as a physician, I could examine them and make sure they're not at risk, or at least might have a serious adverse consequence from Ephedra. So that is a little edge up for people. But I don't usually recommend it because as a physician I have drugs that are equal or better in terms of weight loss and lower risk than Ephedra.

COHEN: And there's been some controversy about the effectiveness. There was a study out that says that it really doesn't even work that well, so why take the risk? In your experience, did it work that well long-term?

HEYMSFIELD: Well, Ephedra does work. It's not been studied long-term. It's usually been studied anywhere from three to six months. It does produce some weight loss, not unlike the weight loss you see with prescription medications.

COHEN: We have a phone call now from Dave in Canada.

Dave, go ahead with your question. DAVE: Hi. A while back my son was working out at a gym in Lebanese, Ontario, Canada, where I live, and was introduced by other athletes there to a cocktail of Ephedra, aspirin and caffeine pills and told that this would help him to increase his performance and not hit the wall, so to speak. And I was wondering if that cocktail was safe.

HEYMSFIELD: Well, what you're describing is called a stack. That's the three ingredients together -- aspirin, caffeine and Ephedra. And those three agents seem to work together in a way that produces an effect that's even greater than any one of them alone. And that's a very potent cocktail. It's an extreme stimulant. And so it's very dangerous to take that combination.

But whether or not it actually does what people want it to do, which is improve physical performance, is very questionable. Remarkably, there's been practically no studies of long-term effectiveness for athletic performance of that combination, the so- called stack. There have been short-term studies which are very equivocal, like with one or two dosings. But in those studies, what they show is that you can get increases in blood pressure or heart rate and other serious medical problems can arise.

So I think that's a very risky way to improve your performance. The best thing is to work out more and to keep hydrated and healthy.

COHEN: Thank you, Dr. Heymsfield.

When we come back, we'll be taking more of your questions about Ephedra.

Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Ephedra can kill you. It is a menace. If you take Ephedra products, you are playing Russian roulette with your health and therefore it's important for us to not just ban it in Illinois, but to ban this product nationwide.

(END VIDEO CLIP)

COHEN: Welcome back to Weekend House Call.

We're talking about Ephedra's safety. In May, Illinois became the first state to ban the sale of Ephedra products. Under the new law, people who sell Ephedra can face misdemeanor charges punishable by as much as one year in prison and a $5,000 fine. California is seeking to pass a similar law.

We have an e-mail now from Diane in New Jersey. She writes, "Diet pills that contain Ephedra are the only diet pills that work. My doctor told me it was OK for me to take them because my blood pressure is at the low end of the normal range and the Ephedra brings my blood pressure up to 120 over 80. Why should I be denied access to a diet pill that works for me and has the approval of my physician?"

Dr. Heymsfield is joining us from Columbia University.

And earlier in our show, Dr. Heymsfield, you said that you don't let your patients take Ephedra.

What do you think of this situation?

HEYMSFIELD: Well, this individual is receiving Ephedra just like they would any other diet prescription medication from their physician, in a sense, because they've been medically cleared. And we're really not worried about that situation.

It's the person who goes in and doesn't know they have heart disease or some other serious condition and then takes Ephedra, a stimulant, and has the adverse consequences, such as heart rhythm disturbance or a heart attack. So it's not individuals we're worried about who are otherwise healthy. It's that one in a thousand or one in 10,000 people who walks in, takes it and has a very serious problem from it.

COHEN: And unless you're under the care of a doctor, or maybe even if you are, is there any way to know if you're one of those one out of a thousand or one out of 10,000? Is there any way of knowing that?

HEYMSFIELD: Well, one thing you can know is if you have a health condition -- and you mentioned them earlier -- such as high blood pressure, heart disease, then you, of course, you would not want to take that medication. But the problem is it's the people who have silent diseases -- and we know from the studies we've done at Columbia University that many people walk in thinking they're healthy and when we evaluate them, we find that 10 or 20 percent have these conditions that they don't know about that can put them at risk for Ephedra toxicity.

COHEN: We have a phone call now from Debra (ph) in North Carolina.

Debra, go ahead.

DEBRA: Yes, my question is I found out -- I had been taking Ephedra for about five months and then found out that I was pregnant. Is there any chance of any long-term effects both either to me or my baby because of taking it?

HEYMSFIELD: Well, that's a very serious question, and if I was you, I would check with my gynecologist to make sure everything is OK. We don't really have good information about the toxicity during pregnancy of Ephedra. But that is exactly the situation we would be worried about and I -- my advice to you would be to make sure everything is OK.

COHEN: When we come back, we'll have some final thoughts about the safety of Ephedra.

(COMMERCIAL BREAK)

COHEN: If you'd like to read more about Ephedra, check out our Web site at www.cnn.com/health. Under the diet and fitness section, you'll find stories and links to more interactive information about the herbal supplement Ephedra.

Welcome back to Weekend House Call.

We've been talking about the safety and effectiveness of Ephedra.

We've been talking with Dr. Steven Heymsfield, who's an Ephedra expert at Columbia University.

Dr. Heymsfield, do you have any final thoughts for our viewers about Ephedra?

HEYMSFIELD: Well, I think it's very important for people to remember there are no magic bullets for weight control. Even though we all hope there will be someday, right now there aren't any, and if you have questions about your weight or any products that are out there, you should consult with your health care professionals. Physicians, dietitians and other health care workers have access to the key information you need to really know whether a product is safe or effective.

COHEN: Thank you, Dr. Heymsfield, for joining us today.

And that's all we have time for.

Make sure to watch tomorrow's Weekend House Call, when we talk about kicking the smoking habit.

We'll have an expert here to go over all the new and tried and true ways to stop smoking.

That's tomorrow at 8:30 a.m. Eastern.

Thanks for watching.

I'm Elizabeth Cohen.

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