Additional Information:
http://yoga.about.com/library/weekly/aa110900a.htm
Her article further goes on to state:
Her references are listed as:
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]
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 persons 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. Johns 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 GAOs report, entitled Dietary Supplements: Uncertainties in Analyses Underlying FDAs 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.
Physicians 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]