Stephen Bent, MD; Thomas N. Tiedt, PhD; Michelle C. Odden, BS; Michael G. Shlipak, MD, MPH
Disclaimer: The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health.
Grant Support: By grant 1 K08 AT01338-01 from the National Center for Complementary and Alternative Medicine (Dr. Bent). Dr. Shlipak is a Research Career Development Awardee from the Health Research and Development Division of the Veterans Administration.
Potential Financial Conflicts of Interest:Expert Testimony: S. Bent (Livsey vs. Metabolife; Neumann vs. Herbalife), T.N. Tiedt (cases involving Metabolife International, Cytodyne, MuscleTech, Next Nutrition, TwinLabs, Dorsey Labs, Enrich, E'Ola, GNC, Phoenix Labs, Chemins Labs), M.G. Shlipak (Livsey vs. Metabolife; McDonald vs. TwinLabs).
Requests for Single Reprints: Stephen Bent, MD, San Francisco Veterans Affairs Medical Center, 111-A1, 4150 Clement Street, San Francisco, CA 94121; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Bent and Shlipak and Ms. Odden: San Francisco Veterans Affairs Medical Center, 111-A1, 4150 Clement Street, San Francisco, CA 94121.
Dr. Tiedt: Med-Tox Group, PO Box 322, Longboat Key, FL 34228.
Author Contributions: Conception and design: S. Bent, T.N. Tiedt, and M.G. Shlipak.
Analysis and interpretation of the data: S. Bent, T.N. Tiedt, M. C. Odden, and M.G. Shlipak.
Drafting of the article: S. Bent and T.N. Tiedt.
Critical revision of the article for important intellectual content: S. Bent, T.N. Tiedt, M. C. Odden, and M.G. Shlipak.
Final approval of the article: S. Bent, T.N. Tiedt, M. C. Odden, and M.G. Shlipak.
Provision of study materials or patients: M. C. Odden.
Statistical expertise: S. Bent, T.N. Tiedt, M. C. Odden, and M.G. Shlipak.
Obtaining of funding: M.G. Shlipak.
Administrative, technical, or logistic support: T.N. Tiedt and M.C. Odden.
Collection and assembly of data: S. Bent, T.N. Tiedt, and M.C. Odden.
Ephedra is widely used in dietary supplements that are marketed to promote weight loss or increase energy; however, the safety of this product has been questioned because of numerous case reports of adverse events.
To compare the risk for adverse events attributable to ephedra and other herbal products.
Comparative case series.
American Association of Poison Control Centers Toxic Event Surveillance System Database Annual Report, 2001.
The relative risk and 95% confidence interval for experiencing an adverse reaction after ephedra use compared with other herbs. This risk was defined as the ratio of adverse reactions to ephedra versus other products, divided by the ratio of their relative use in the United States.
Products containing ephedra accounted for 64% of all adverse reactions to herbs in the United States, yet these products represented only 0.82% of herbal product sales. The relative risks for an adverse reaction in persons using ephedra compared with other herbs were extremely high, ranging from 100 (95% CI, 83 to 140) for kava to 720 (CI, 520 to 1100) for Ginkgo biloba.
Ephedra use is associated with a greatly increased risk for adverse reactions compared with other herbs, and its use should be restricted.
Ephedra (ma huang) is used in dietary supplements to promote weight loss and enhance energy. Is it safe?
This study, based on data from U.S. poison control centers and sales information, shows that products containing ephedra accounted for 64% of all reported adverse effects from herbs even though they represented less than 1% of total herbal product sales. The relative risk for an adverse effect from ephedra was 100 (95% CI, 83 to 140) compared with kava and 720 (CI, 520 to 1100) compared with Ginkgo biloba.
Ephedra is associated with greatly increased risk for adverse effects compared with other herbs.
Table. Relative Risk for an Adverse Reaction to Ephedra Compared with Other Commonly Used Herbal Products in the United States in 2001
Sensitivity analysis showing the effect of variations in the estimate of ephedra's proportion of total herbal market sales on the relative risk for an adverse reaction with ephedra compared with other herbs.
0.82% = best estimate from SPINS, Inc., San Francisco, California; 2.20% = Whole Foods Magazine survey estimate; 13.5% = high estimate assuming that ephedra sales represent half of all nonretail sales in addition to 0.82% of retail sales.
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Bent S, Tiedt TN, Odden MC, Shlipak MG. The Relative Safety of Ephedra Compared with Other Herbal Products. Ann Intern Med. ;138:468–471. doi: 10.7326/0003-4819-138-6-200303180-00010
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Published: Ann Intern Med. 2003;138(6):468-471.
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