Using performance-enhancing drugs is an unfortunately common occurrence in sports, with many athletes having tested positive for these drugs and being suspended or disqualified from their field as a result. One example of a performance-enhancing drug is ephedrine.
Canadian cyclist Clara Hughes1 and American sprinter Mickey Grimes2 both tested positive for the stimulant ephedrine in 1994 and 2003, respectively. Argentine Diego Maradona, one of soccer's most popular players, also tested positive for five variants of ephedrine during the 1994 FIFA World Cup, and was removed from the tournament.3
But although ephedrine has gained a bad reputation, its source, an herb called Ephedra sinica, is actually often used in traditional Chinese medicine (TCM) because of perceived possible health benefits. Continue reading to discover the effects of ephedra and the potential drawbacks linked to this substance.
What Is Ephedra?
Also called ma huang, the ephedra plant (Ephedra sinica) is native to Pakistan, China and northwestern India, although some species grow in the Southwest U.S. desert regions.
Ephedra, which can be grown from seeds, is a perennial evergreen shrub that’s 1 foot tall, on average, although it can grow up to 4 feet. The plant is nearly leafless, and has slender, cylindrical, yellow-green branches and underground runners. During August, the flowers bear poisonous, fleshy red cones resembling berries.
Ephedra is mainly sourced from the dried rhizome and root. The plant’s active compounds include ephedrine, pseudoephedrine, phenylpropanolamine (norephedrine) and cathine (norpseudoephedrine).4 The first two substances are central nervous system stimulants that may act as decongestants. Although they are said to account for ephedra’s medicinal properties, be warned that they can raise blood pressure levels if taken in high doses.5
Ephedrine may be synthesized into medicines or ephedra pills, while compounds like pseudoephedrine are widely used in over-the-counter cold remedies and are regulated as a drug. Regulation of the aforementioned drugs is different from ephedrine alkaloids derived from the ephedra herb itself, which are often regulated as diet pills.6
In 2004, the U.S. Food and Drug Administration banned the sale of dietary supplements containing ephedrine alkaloids. The said substances were ingredients in some dietary supplements marked for weight loss, increased energy and enhanced athletic performance.7
What Do the Studies Say About Ephedra?
Studies surrounding ephedra's potential effects yielded mixed results. For example, a study published in the January 2018 issue of the International Journal of Biological Macromolecules showed that polysaccharides from the Ephedra sinica plant lessened airway and pulmonary inflammation, making the substance a potential treatment for chronic obstructive pulmonary diseases (COPD).8 However, there are also studies that highlight the potential drawbacks of taking this supplement. Here are a couple of examples:
• May have adverse side effects toward cardiovascular and central nervous system events. A 2000 New England Journal of Medicine study warned that usage of dietary supplements containing ephedra alkaloids can raise health risks for some people, especially toward cardiovascular and central nervous system health.9
• Has the potential to increase risk for hypertension. A January 2013 study published in the journal Plastic and Reconstructive Surgery revealed that herbal products containing ephedra can trigger hypertension.10
What’s the Typical Ephedra Dosage
At the moment, there isn’t enough information to determine a range of doses for ephedra, mainly because the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedra, ephedrine, norephredine, ma huang, Sida cordifolia or pinellia in 2004.
Furthermore, athletes are also barred from taking ephedra supplements because of its potential to boost athletic performance. If an athlete tests positive for this substance, he or she can be disqualified and/or penalized. The ban doesn’t extend to teas, however, which are regulated as conventional food, or to traditional Chinese remedies prescribed by a physician practicing TCM.11
Side Effects of Ephedra
Ephedra contains active substances that may trigger side effects and interact with other herbs, supplements or medications. Using it can lead to symptoms such as:
Insomnia and other sleep problems
However, adverse effects can also occur because of ephedra, such as worsened heart and kidney disease, high blood pressure levels, increased blood sugar levels, rapid or irregular heartbeats, seizures, stroke and even death. If you or someone you know is manifesting any of these side effects, seek medical help immediately. Meanwhile, people with the following conditions are advised to avoid taking ephedra:
High blood pressure levels
People undergoing prostate enlargement
People with impaired circulation to the brain
Women who are pregnant or breastfeeding and people taking medicines for high blood pressure or depression must avoid ephedra and ephedra alkaloids such as ephedrine.
While no interactions between the ephedra herb and conventional medicines have been reported, the active ingredients of ephedra, ephedrine and pseudoephedrine have been linked to serious drug interactions. Some medicines that have well-documented interactions with ephedra’s active ingredients include:
Amphetamine and amphetamine derivatives like dextroamphetamine: Ephedra can increase the effects of these medicines and lead to increased heart rate and blood pressure levels
Aspirin and blood-thinning medicines: Ephedra can increase bleeding in sensitive individuals, such as those taking these medicines
Antidepressants like tricyclics (clomipramine, desipramine, doxepin, imipramine and nortriptyline) and monoamine oxidase inhibitors or MAOIs (phenelzine and tranylcypromine)
Blood pressure medications such as clonidine
Caffeine and guarana (a caffeine-containing herb)
Narcotics like morphine and codeine
Theophylline, which is often used for asthma
Ephedra must only be used on a short-term basis, because prolonged use not only may trigger any of the aforementioned side effects, but possibly could lead to addiction too. Furthermore, the amount of time considered safe for ephedra use isn’t clear.12,13
Take Caution Before Deciding to Supplement With Ephedra
While ephedra’s prominence in TCM suggests potential in boosting overall health and well-being, there are major negative implications linked to this substance. Aside from side effects and contraindications with other medicines, the U.S. FDA’s ban on ephedrine alkaloids (from ephedra) is a major issue you should remember.
Therefore, I advise against taking any form of ephedra supplements. The ephedra herb itself may be a good alternative, but this must be taken carefully only under the supervision of a doctor or a specialist.
Frequently Asked Questions (FAQs) About Ephedra
Q: Where does ephedra come from?
A: Ephedra mainly comes from the Ephedra sinica plant, although the University of Maryland Medical Center highlights two other species where ephedra may come from, namely Ephedra equisetina and Ephedra intermedia.
Q: Where do you buy ephedra?
A: Ephedra supplements, particularly those containing ephedrine alkaloids, were banned for sale by the U.S. FDA in 2004.14
Q: Is ephedra safe?
A: Ephedra supplements may put you at risk for side effects such as restlessness, anxiety, nausea, vomiting, dry mouth, irritability, stomach irritation, high blood pressure levels, seizures and even death. Ephedra may also interact with drugs like narcotics, amphetamine and amphetamine derivatives, and antidepressants.