Ephedrine and its parent herb, mahuang, are two of the most popular and effective thermogenic food supplements available—but perhaps not for long. Reports concerning the alleged dangers of ephedrine use are appearing regularly in mainstream media, and the deaths of several high-profile professional athletes who used ephedrine supplements have added to the impetus to remove ephedrine and mahuang from over-the-counter sales due to their inherent “toxicity.”
Those reports imply that ephedrine is a dangerous and unpredictable substance for everyone, but that simply doesn’t jibe with most available scientific evidence on ephedrine. In fact, as I’ve said in this column before, most cases of serious health problems involving ephedrine or mahuang are due to idiosyncratic reactions. In short, many of the people who experience serious side effects from using ephedrine or related compounds do so because of either existing health problems that contraindicated the use of ephedrine or from using too high a dose.
Ephedrine is a sympathomimetic drug, meaning that it acts similarly to or promotes the release of sympathetic hormones in the body, such as epinephrine and norepinephrine. Those hormones are also known as “fight-or-flight” hormones because of the reactions they promote during stress, including higher blood pressure due to vascular constriction, release of glucose and release of fat into the blood. A healthy person can easily tolerate those effects, but for someone who already has cardiovascular disease, such reactions could prove dangerous, particularly if he or she used too high a dose.
Since ephedrine shares some properties of other substances known to affect brain function, such as cocaine and amphetamine, it’s reasonable to assume that ephedrine affects behavior. Higher doses of ephedrine produce mental effects that in a broad sense mimic the effects of amphetamines, although published research shows that ephedrine doesn’t share the addictive potential or the immediate cardiac and brain toxicity linked to amphetamines.
People who are unaffected by mental illness experience a slight sense of euphoria coupled with a feeling of heightened energy when they use ephedrine. That effect is amplified in the mentally ill, who often overdose on ephedrine-containing supplements, since they’re more readily available than cocaine or amphetamines. In fact, ephedrine is so close in structure to amphetamines that if a person takes it before a drug test, he or she will test positive for speed. A follow-up test can distinguish the two drugs.
Recent reports in the medical literature cite adverse mental effects supposedly induced by ephedrine. One report described a 19-year-old man who suffered from decreased sleep, increased aggression and disorganized behavior after using two of the most popular ephedrine-containing food supplements.1 He was using so much of the supplements that he decided to open up the capsules and snort them like cocaine. Yet he was described as having no previous psychiatric history.
In another case a 21-year-old man took increasing doses of a popular thermogenic supplement and soon developed mania and psychosis, along with delusions. No dosages were mentioned, other than that he increased the dose regularly. A brain scan showed cerebral atrophy—not a usual finding in someone his age—a condition that could cause adverse mental symptoms.
Previous reports linking ephedrine to mental problems show that the typical dose used before symptoms occurred was 510 milligrams daily. Contrast that with the maximum suggested safe dose of 90 milligrams a day or the typical 25 milligrams found in a single capsule of most ephedrine supplements. The symptom most commonly linked to ephedrine use appears to be mania, and again, in nearly all cases the people had the condition before they took any ephedrine or mahuang supplement. In most cases they overdosed, which could cause similar problems in anyone. As the saying goes, “Only the dose determines the poison.”