Ephedra Debate - Was Re: Creatine, to take or not to take

Bob Hubbard

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Additional Information:
http://yoga.about.com/library/weekly/aa110900a.htm
FDA Investigates Herb Ephedra
by Cathy Wong

Results from a study conducted at the University of California, San Francisco and funded by the Food and Drug Administration (FDA) were released on November 6th, more than six weeks prior to the scheduled publication date in the New England Journal of Medicine. Researchers examined the safety of popular dietary supplements containing ephedra and concluded that they pose serious health risks to some consumers, indicating a need to identify risk groups and establish guidelines for safe daily doses and warnings.

Her article further goes on to state:
Reasons for Potential Adverse Effects

1. Use of ephedra for unproven purposes. An herb with a long history of clinical use, ephedra became controversial in the United States over the past decade because of its use for unapproved purposes such as for weight loss, as a mental stimulant, to enhance athletic performance, and even as a component of an illicit drug. As a result, adverse reaction reports became increasingly common, and the FDA and government officials tried to limit the use of ephedra in supplements, the level of alkaloids per dose and per day, and, in some states, access to ephedrine-containing products.

2. Effects of ephedra are multiplied when combined with caffeine and aspirin. One of the main problems with the use of ephedra in weight loss and athletic performance preparations is that caffeine (or other methylxanthines) is often added to the preparations to increase the weight loss and stimulating effect of ephedra. In the study to be published next month, it appears that many of the ephedra-containing products studied may have contained caffeine, a combination which may be more likely to result in an adverse event. Commercial products often contain caffeine or caffeine-containing herbs such as cola (Cola nitida), guarana (Paullinia cupana), and mate (Ilex paraguariensis).

In addition, few products warn against having drinks containing caffeine, such as coffee or cola, while taking ephedra.

White willow (Salix alba) and other herbs similar to aspirin have also been found in ephedra preparations.

3. Self-prescription of ephedra without professional supervision. Ephedra has very important clinical uses and has a long history of use for treating respiratory disorders. However, each person’s condition is unique and the guidance of an appropriately trained health practitioner should be sought when considering any herbal treatment. For example, someone may not recognize guarana as a caffeine-containing herb when reading the label, or may take St. John’s Wort with ephedra, unaware that it acts as a MAO-inhibitor that should not be taken with ephedra. When seeking professional supervision, be aware that physicians often do not receive formal training in botanical medicine and may not be able to recognize these constituents.

4. Improper labeling and warnings. Herb industry groups and the American Herbal Products Association attempted to establish label warnings and dose limits in 1994. In 1997, the FDA proposed further regulation to prohibit the sale of ephedra for unproven purposes and to restrict herbal supplements from containing more than 8 mg of total ephedra alkaloids per dose, with a recommended total dose of no more than 24 mg per day. This proposal was criticized in 1999 by the U.S. General Accounting Office (GAO), a government monitoring agency. The GAO’s report, entitled Dietary Supplements: Uncertainties in Analyses Underlying FDA’s Proposed Rule on Ephedrine Alkaloids, questioned the reliability of methods used to gather adverse effect information and establish dosing guidelines.

The actual amount of ephedra in the herb preparation can also vary widely from the quantity stated on the label, especially with manufacturers of questionable quality control methods.

Her references are listed as:
References
Bensky D, Gamble, A. Chinese Herbal Medicine: Materia Medica. Seattle: Eastland Press, Inc 2000; 391.

Physician’s Desk Reference (PDR) for Herbal Medicines (2nd ed.). New Jersey: Medical Economics Company, Inc. 2000; 488-489.

The Complete German Commission E Monographs - Therapeutic Guide to Herbal Medicines. M Blumenthal, WR Busse, A Goldberg, J Gruenwald, T Hall, CW Riggins, RS Rister (eds.) S Klein and RS Rister (trans.) 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications; 125-6.

Werbach, MR and Murray MT. Botanical Influences on Illness: A Sourcebook of Clinical Research. California: Third Line Press, Inc., 2000.

Herbal Medicine Expanded Commission E Monographs. Blumental M, Goldberg A, Brinckman J. American Botanical Council with Integrative Medicine Communications First Edition. Newton, MA 2000

Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone, 2000; 57-8.

Please read the full article.



The NEJM lists the following documents:
http://content.nejm.org/cgi/content/abstract/343/25/1833
Morgenstern, L.B., Viscoli, C.M., Kernan, W.N., Brass, L.M., Broderick, J.P., Feldmann, E., Wilterdink, J.L., Brott, T., Horwitz, R.I. (2003). Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 60: 132-135 [Abstract] [Full Text]

Marcus, D. M., Grollman, A. P. (2002). Botanical Medicines -- The Need for New Regulations. N Engl J Med 347: 2073-2076 [Full Text]

Skinner, C. M., Rangasami, J. (2002). Preoperative use of herbal medicines: a patient survey. Br J Anaesth 89: 792-795 [Abstract] [Full Text]

Grollman, A. P. (2002). Commentary #3 on Astin's Special Theme Commentary. Acad Med 77: 871-873 [Full Text]

Markman, M. (2002). Safety Issues in Using Complementary and Alternative Medicine. J Clin Oncol 20: 39s-41 [Abstract] [Full Text]

Gilbert, G. J., Petro, D. J., Singhal, A. B. (2002). Cerebral vasoconstriction and stroke after use of serotonergic drugs. Neurology 59: 651-652 [Full Text]

Jordan, J., Tank, J., Shannon, J. R., Diedrich, A., Lipp, A., Schroder, C., Arnold, G., Sharma, A. M., Biaggioni, I., Robertson, D., Luft, F. C. (2002). Baroreflex Buffering and Susceptibility to Vasoactive Drugs. Circulation 105: 1459-1464 [Abstract] [Full Text]

Metcalfe, K., Corns, C., Fahie-Wilson, M., Mackenzie, P. (2002). Chinese medicines for slimming still cause health problems. BMJ 324: 679-679 [Full Text]

(2001). La Direction des produits de sante naturels : un peu de scepticisme naturel. Can Med Assoc J 164: 615-615 [Full Text]

(2001). Some natural scepticism about the Natural Health Products Directorate. Can Med Assoc J 164: 613-613 [Full Text]

Yanovski, S. Z., Yanovski, J. A. (2002). Obesity. N Engl J Med 346: 591-602 [Full Text]

(2000). Risks with Phenylpropanolamine and Ephedra Alkaloids. Journal Watch (General) 2000: 1-1 [Full Text]

(2001). Dangers of Dietary Supplements with Ephedra Alkaloids. Journal Watch Cardiology 2001: 3-3 [Full Text]

Haller, C. A, Dyer, J. E., Ko, R., Olson, K. R (2002). Making a diagnosis of herbal-related toxic hepatitis. eWJM 176: 39-44 [Full Text]

Ernst, E. (2001). ""Alternative"" Therapies For Asthma : Reason For Concern?. Chest 120: 1433-1434 [Full Text]

Boucher, J. L., Shafer, K. J., Chaffin, J. A. (2001). Weight Loss, Diets, and Supplements: Does Anything Work?. Diabetes Spectr 14: 169-175 [Full Text]

Margolis, M. L. (2001). A Survey of the Use of Herbal Agents Among Philadelphia Veterans Affairs Medical Center Pulmonary Outpatients. Chest 119: 1981-1982 [Full Text]

Hutchins, G. M., Traub, S. J., Hoyek, W., Hoffman, R. S., Haller, C. A., Benowitz, N. L. (2001). Dietary Supplements Containing Ephedra Alkaloids. N Engl J Med 344: 1095-1097 [Full Text]

Fleming, G. A. (2000). The FDA, Regulation, and the Risk of Stroke. N Engl J Med 343: 1886-1887 [Full Text]

Talalay, P., Talalay, P. (2001). The Importance of Using Scientific Principles in the Development of Medicinal Agents from Plants. Acad Med 76: 238-247 [Abstract] [Full Text]
 
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Kirk

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Well, my opinion on that is of course AMA physicians, who can't
get kick backs for suggest ephedra products, are of course going
to say it's bad for you. Just like they do with chiropractors and
chinese healing methods, and accupunture. What you've just
provided above is nothing but this MD or that MD, this AMA journal
of medicine, or that. Basically .. AMA/FDA people. Quote as many
as you like, you're still giving me ONE source.

That being said ...
This link starts with a Harvard study, and if you keep
scrolling, there's more. E.g. St. Luke's Hospital / Columbia
University.

I found independent studies galore. The results, yes were
published on a suplement company's website, but the results
were not only posted, but the company doing the test was
listed. In short order I called Miami Research Associates who
were listed by one company. I asked them if they truly did do
the study (which was in fact listed on MRA's site). I told them
what the company's claim of their research was about ephedra,
and asked if in fact it was truley thier findings. They said it was. (I spoke with Mary in the nutrion research department).
 
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Kirk

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The biggest problem now is that I have personally given an
endorsement to take ephedra, when I in fact don't take it
myself. I have in the past, and got REALLY wired and shaky as
a result. I also heard that one shouldn't be taking it if you have
a heart condition. While I don't have a heart condition a bunch of
my family members do, so I've opted to try ephedra free products.

So DO NOT take my word for it.
 
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Sanddragon

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Quick Question here, I read thru mounds of info, the flames, the attacks, the claims that I am this and I am that. That ephedra is a killer and that no it is the best thing since partially burned toast with Jam. However I did not ever see an answer to the question that all this was about. Creatine and if it is benificial or not?

Now I may have missed it but I saw everyone get worked up about many things mentioned above and no indepth posting about creatine. I apologize if I missed it but after reading this entire expectionally long winded thread this is were it lead me.
 

Bob Hubbard

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SandDragon, you make a -very- good point, and it is to answer it I just finished pulling out the Creatine information and putting it in its own thread.


Administrator Note:

The discussion of Creatine has been moved to its own thread, due to this one turning into a supliment debate. As there is much value in this debate, and to seperate the original intent (which has gotten lost in here I think) we have refocused -this- thread on the topic of Supliment usage pros/cons.

Thank you.
 

Nightingale

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Kirk,

The study you referenced was a "double blind" with a total of 167 people. That means that 84 people received a placebo, and 83 received the actual drug.

83 people is an extremely small sample size, but the researchers did note that the participants experienced rapid heart rates, increased blood pressure, along with quite a few other side effects.

Also, take note that the participants of this study underwent heavy medical screening prior to starting the program. They were given EKGs, heart monitors to wear for 24 hours straight, screened for QT duration, tachycardia, premature heartbeats, and other heart problems. Anyone with any abnormalities, no matter how insignificant, was excluded.

The average person cannot undergo this kind of health screening prior to starting a fitness regime. A large concern with ephedra products is that they may aggrivate conditions that are already present but yet undiscovered. People cannot afford (and their health insurance will not cover) this kind of cardiac workup.

I'm not saying that its something you shouldn't do because of a possible pre-existing condition. However, the studies I referenced did state that ephedra poses a risk even if there is no preexisting condition (and I quoted more than the AMA).
 

Nightingale

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sorry, Kaith...lol. you and I posted at the same time. can you move my post to the new thread?




mod note: hit edit instead of quote...sorry :)
 
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Kirk

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Originally posted by nightingale8472
Kirk,

The study you referenced was a "double blind" with a total of 167 people. That means that 84 people received a placebo, and 83 received the actual drug.

83 people is an extremely small sample size, but the researchers did note that the participants experienced rapid heart rates, increased blood pressure, along with quite a few other side effects.

Also, take note that the participants of this study underwent heavy medical screening prior to starting the program. They were given EKGs, heart monitors to wear for 24 hours straight, screened for QT duration, tachycardia, premature heartbeats, and other heart problems. Anyone with any abnormalities, no matter how insignificant, was excluded.

And can you provide proof that the same thing did NOT happen
in the studies you quoted? That's how research works, and that's
the whole entire point I've been trying to make.

Originally posted by nightingale8472
and I quoted more than the AMA

In my opinion, you didn't. Is the doctor a U.S. physician? Then
he's a member of the AMA. Docs do NOT want to cross them, they
screw their careers up if they do. Was the journal a medical
journal?? Then it's the AMA (written by U.S. Doctors).
 

Bob Hubbard

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Originally posted by nightingale8472
sorry, Kaith...lol. you and I posted at the same time. can you move my post to the new thread?


Actually, I think it fits here, unless you were writing about Creatine?
 

Nightingale

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Originally posted by Kirk
And can you provide proof that the same thing did NOT happen
in the studies you quoted? That's how research works, and that's
the whole entire point I've been trying to make.



In my opinion, you didn't. Is the doctor a U.S. physician? Then
he's a member of the AMA. Docs do NOT want to cross them, they
screw their careers up if they do. Was the journal a medical
journal?? Then it's the AMA (written by U.S. Doctors).

so you're saying that every single study done in the united states is biased?! :rofl:

and doctors are not required to be members of the AMA. The AMA is a private organization. Many doctors are not members.

I have three doctors and one medical researcher (PhD, not MD) in my extended family. Two of the three doctors are not AMA members, and neither is the PhD.
 
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Kirk

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Originally posted by nightingale8472
so you're saying that every single study done in the united states is biased?! :rofl:

and doctors are not required to be members of the AMA. The AMA is a private organization. Many doctors are not members.

I have three doctors and one medical researcher (PhD, not MD) in my extended family. Two of the three doctors are not AMA members, and neither is the PhD.

Well not card carrying members .... but they still are IMO. This is
where we split, and can't discuss any further. You believe a Phd
said it, and MD said it .. so it must be true. And I just don't buy
that for one second. Ask these same friends of yours about
accupuncture, and chiropracty. On second thought, don't.
Because if you come back and say that they endorse either one,
I won't believe you anyway. I don't buy that western medicine
knows all, sorry. And I never will.

Dr Barry Sears, the author of the zone diet books has been
ridiculed by the medical community. He's earned his medical
degree just the same as the others. But he has opposed them.
So many in the medical community call him a quack. But
THOUSANDS of people have been able to stop taking diabetes
medication because of him. By the logic you've presented on this
thread, he's still WRONG. Because so many independent studies
prove that his high protein diets are so terrible. Yet TENS OF
THOUSANDS of people are healthier now than they have been,
ever in their lives?
 

Bob Hubbard

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The american medical community is begining to open their eyes top eastern concepts. My own doctor recomended I see a chiropractor for an injury I had, and we had a long discussion about accupuncture and herbs. He was also a younger doctor, not one thats 30+ years out of school and behind in his journals. In fact my health plan covered herbs, accupuncture and chiro as part of the package.

There is extensive information going back thousands of years on these herbs in Chinese medicine.

From Herbalist Review, Issue 2000 #2:
http://www.rmhiherbal.org/review/2000-2.html
[2] Proper and improper uses of ephedra

Ephedra, or ma huang, is a useful herb if used as
indicated, but can be dangerous if used to excess
or for conditions for which it may only mask
symptoms. Many of the currently popular uses of
ephedra would be considered inappropriate from the
perspective of the TCM pharmacopoiea. The TCM
pharmacopoiea states that it
- Releases the Exterior and disperses Cold;
indicated for TaiYang-stage Exterior Chill; acts by
inducing sweating.
- Circulates Lung Qi; relieves cough and asthma.
- Promotes urination and relieves edema
accompanying External Evil.

Ephedra is to be avoided or used cautiously in
Deficiency conditions characterized by excessive
sweating; it may aggravate high blood pressure and
cause restlessness and tremors.

One of the primary active ingredients of ephedra
is ephedrine, which is a bronchodilator and is
especially effective when bronchospasm is present.
It is also diaphoretic, vasoconstrictive, and
raises blood pressure.

To use ephedra for weight loss or as a stimulant,
two popular uses, risks exhausting the Qi, resulting
in adrenal exhaustion and chronic fatigue. Its
classification as a "tonic" by certain sources is
misleading, as its long-term side effects are just
the opposite, resulting in exhaustion. As for
weight loss, ephedra can temporarily increase
metabolic rate and diuresis, which can enhance
short-term weight loss, but if underlying metabolic
factors are not corrected, long-term consumption
of ephedra will lead to not only exhaustion, but a
rebound of weight gain.

Furthermore, many Americans are already suffer some
type of exhaustion (of Qi, Yin, Yang, or Blood) due
to stress, overwork, and poor diet, and any use of
ephedra, especially without counteraction by other
herbs, may risk aggravating the condition.

Another detailed description of Ephedra is at
http://www.drgenie.com/Naturaopathic/E/Ephedra.htm


From : EPHEDRA NEWSLETTER #1 by Lennart & Sanne The Ephedra Site
http://www.ephedra.demon.nl/news/newsletter1.html
-------------------------------------
A word of warning
From HeK
-------------------------------------
The problem with Ephedra sinensis (and other Eurasian
species of Ephedra - there is no ephedrine to speak of
in the American species) is that we as are a culture are
-used- to 4- or 5-hour drugs. Take coffee, or aspirin,
and it'll be out of your system in 4-5 hours. Ephedrine
will let you stay jittery for 8 hours - but because you're
used to dosing yourself every 3-4 hours you overdose -very-
easily on ephedrine. Especially if you abuse the plant
(ie. you use it to keep awake), or worse, mix it with
things like caffeine and aspirin to -really- get that
weight down.

That way lays your first (and perhaps last) heart attack.
That way lay a -lot- of jittery nervous overstrung
adrenergic problems. And that way lays madness. Chinese
Ephedra (Ma Huang) is not -used- by the great unwashed
masses in the US, it's -abused-. That's a big difference,
even if it only looks like two letters.

As an herb Ma Huang has its uses in TCM, and in western
herbalism it's used in small discrete doses for things
like bronchial spasms. NOT long-term, nor for frivolous
things like "but I have to keep awake". Herbalists try to
keep you -in- balance, not get you -out- of balance.
If you value your health you should do the same.

--
Deze twee artikelen zijn ook te vinden op:
ftp: metalab.unc.edu or sunsite.sut.ac.jp
/pub/academic/medicine/alternative-healthcare/herbal-medicine/faqs/
--

==================================
http://www.eardoc.com/Ma-Huang.htm
A Note about Ma-Huang (Ephedra)
Ma Huang, otherwise known as Ephedra, is a commonly used herb in the Oriental Pharmacy. It is rarely used by itself, but is utilized as an ingredient in formulas, which can protect the body from the dispersing qualities of MaHuang.

The properties of Ma Huang are:

Increasing urination, sweating, and reduces edema [lung]
Clears the lungs, useful for either interior [asthma,COPD] or exterior [colds,flues] wheezing and coughing.
In combination with other herbs, has a long history of treating various respiratory diseases.
Research has shown:

Ephedra can lower body temperature in rats, but overdose raises the temperature in humans.
It has a systemic diaphoretic effect [sweating].
Ephedra raises blood pressure and vasoconstricts, but it can vasodilate coronary blood vessels.
Can cause insomnia, restlessness, and tremors.
Overdose can cause arrhythmias.

CAUTION! CAUTION! CAUTION!

When used with cardiac glycosides [ginseng is loaded with these], ephedra can cause cardiac arrhythmias. Chinese medicine practitioners know these precautions and use herbs correctly. Many companies that are out to just make a buck do not use herbs correctly. Please beware of bad formulations. Get advice from a knowledgeable person.


I am finding Non-US, Non-AMA related sites indicating the correct use of this herb, and its not for weight gain or an energy boost.
 

arnisador

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Originally posted by Kirk
Is the doctor a U.S. physician? Then
he's a member of the AMA.

No, not necessarily.


Was the journal a medical
journal?? Then it's the AMA (written by U.S. Doctors).

I'm not sure how you mean this--certainly, not all medical journals are formally associated with the AMA. See this site for the AMA's journals.

Note, physicians are often influenced by pharmaceutical reps., though the situation is improving somewhat. They are rarely influenced by makers of supplements however.
 
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JDenz

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Pretty much every issue in the health field ends in this debate. The AMA and FDA have dropped the ball so many times that they are definitly not up on breaking issues and medicines. Any thing that involves politics is always going to be a flawed system. The same arguements that we are going through now can be made for anything. I can say the AMA FDA has dropped the ball on steriods. Then I would say that the government aproves giving out steriods and growth hormone. Then we would argue about that. No one can win these arguements. Like Kirk said you can't just do a study then make a claim on a prodect.
By the way in that mustletecarticle talking about hydroxycut they are not talking about Ephedra.
 

Nightingale

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hydroxycut contains ephedra.

and my uncle, the PhD medical researcher, uses accupuncture himself for residual pain from a back injury (a few fused vertebrae from a motorcycle accident). a quote from him: "western medicine is very good at treating the big things, the cancers, the heart conditions, the organ failures, the major trauma. We cut people open, fix what's wrong, and sew them back up again. We are not, however, good at handling chronic problems and chronic pain. Eastern medicine is much better at this, and we have a lot to learn." He actually referred me to an accupuncturist to treat a stomach problem, but I haven't had a chance to go yet. I'll probably go sometime in march.

Not all American doctors are corrupt, evil pawns of the AMA, Kirk.
 

arnisador

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Originally posted by Kirk
Well not card carrying members .... but they still are IMO.

It is accurate in this sense: The AMA is authorized to set standards for allopathic medical practice and I believe medical education (through an associated organization, the CME), much as the lawyers and engineers have their own groups that accredit law and engineering schools, and accreditation is necessary for licensing. See here.

Of course, this still does not affect osteopathic physicians, who are governed by the AOA. There is also a sense in which dentists and podiatrists, and in some states naturopaths and I believe chiropractors, are also physicians (with limited authority).
 
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JDenz

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agian
By the way in that mustletecarticle talking about hydroxycut they are not talking about Ephedra.
They are talking about another ingredant they put in there. Hydroxy cut is one of the most tame mu hung products out there I bet there isn't even what they put on the label in there. i never even got a little buzz on it. Although I think it is way better the rip fuel. I haven't taken to many fat burners so I can't comment on them. But Hydroxy cut worked great for me. No I don't work for musle tech and there protein is way over priced
 

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I believe the comment about Hydroxycut was about the claims being made, not the ingredients. According to the graphic on the website, it looks like the product is ephedra free now, but had it at one time. No indication if there is 2 versions of the product.

http://www.buy-hydroxycut-supplement.com/
lists the ingredients as Hydroxagen, Hydroxycitric Acid, HydroxyTea, Guarana, L-Carnitine, Mahuang (which contains Ephedra) and Willow Bark Extract.
I would bet the 'active' ingredient mentioned is L-Carnitine.

http://healthandfitness.com/bbs/nutri/messages/2998.html
lists the ingredients as:
Hydroxagen(garcinia cambogia)(50%)....2000mg
Green Tea(22%)..............910mg
Sida Cordifolia(6%).............334mg
White willow bark...............100mg

http://www.drugstore.com/qxp74244_3...cut/advanced_weight_loss_formula_capsules.htm lists the ingredients as:
Hydroxycut® Proprietary Blend Ingredients:

Hydroxagen® (Garcinia cambogia)(fruit & rind)(standardized for 1000mg hydroxycitric acid)
HydroxyTea™: Guarana Extract (seed), Green Leaf Tea Extract, (standardized for 95% polyphenols [70% catechins (45% epigallocatechin gallate - 90mg EGCG)]), (standardized for 200mg caffeine)
Ma-Huang Extract (stem & leaf) (standardized for 20mg ephedra alkaloids)
Willow Bark Extract (purple & white) (standardized for 15mg salicin)
L-Carnitine Tartrate

So I find conflicting information on the product on if it does or does not currently contain ephedra.

This is the text from the mussletech site "A new, advanced Hydroxycut formula is coming soon, and one of its cutting-edge compounds just got better. " that is paired with a graphic of a bottle with a lable saying ephedra free.

As to the price, the few times I looked for L-Carnitine, I found it to be pricey. That -may- be part of the cost factor. If anyone happens to stop at a GNC or similar and could check the shelf and see if theres 2 versions of the product?
 

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THE FOLLOWING IS AN UNSOLICITED TESTIMONIAL.

My intermittent cycling of Ma Huang, into my supplement regimen, has helped my fat loss, repair time, circulation and flexibility.

The downside is not having eyebrows, my fillings pick up my next door neighbors cell phone and I sleep every two days in the closet hanging upside down by my ankles like Grandpa Munster. :)

All kidding aside, I approach things with the words of Jack LaLanne. "With anything positive, one must use moderation".

white belt
 
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JDenz

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As far as I know HC has never contained Ephedra as long as I have used it the only thing they have changed is the compond that is supposed to bond to carbs so they are not stored as fat. Which after further testing didn't work like they thought it did so they changed the formula.
 

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