Diet pills, ephedra, Zhi Shi, Bitter Orange, Citrus aurantium, stimulants, adverse effects,

Ask the Doc: Ephedra Substitutes

Ask the Doc: Ephedra Substitutes

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I know that ephedra, which was a component in many herbal weight loss formulations, was withdrawn due to safety issues. I’m now seeing ads for new natural weight loss products that are said to be safe and effective. What’s your opinion? J. L.

Dear J. L.:

Ephedra, an herbal stimulant, was commonly combined with other stimulants such as caffeine to increase metabolism and boost energy. With the passing of ephedra other stimulants are being used to create a similar effect. One of the most commonly used is Zhi Shi (also called Bitter Orange, Citrus aurantium and shangzhou zhiqiao fructus Aurantii).

Zhi Shi contains synephrine. It is closely related to the nasal decongestant sold as Neo-Synephrine. The label of Neo-Synephrine gives a clue to synephrine’s health risks: Side effects: General stimulation causing increased heart rate and blood pressure, insomnia, nervousness, anxiety, tremor, dry mouth, blurry vision, and headache. It may also cause an inability to urinate . . . Also, combining decongestants with other other-the-counter or prescribed medicines with similar side effects may lead to dangerous complications. Unfortunately, manufacturers of Zhi Shi products almost always include other substances with similar side effects in their formulations..

Stimulants make most people feel good, usually from the first dose, and, because they artificially speed up metabolism, cause weight loss. Amphetamines are the most effective, but are also the most dangerous. Phenylpropanolamine was commonly used in weight control/energy formulations until it was banned by the FDA in November, 2000 because of an inordinately high risk of stroke. Ephedra was banned by the FDA because of deaths associated with its use.

Stimulants do not provide a permanent solution to weight control and do not address any underlying cause of "tiredness" or "lack of energy". Stimulant medications and herbal formulations ultimately harm the health of many users by adversely affecting blood pressure, triggering heart arrhythmias, and aggravating underlying conditions such as nervous disorders, seizures, & prostate problems. More importantly, an underlying condition that is causing someone to feel less energetic will not be addressed by the use of a stimulant preparation.

Because of their immediate "feel good" properties, their addictive nature, and the need to increase doses to achieve the same "good feelings" over time, stimulant products are a great opportunity for promoters to make a lot of money, provided they ignore the risks or deny that they exist. People's appetite for stimulants is insatiable, and the new generation of herbal stimulant products is seeing much success.

While the promoters of these products claim they are safe and do not carry the risks of their predecessors, reports of serious adverse effects with the new products have been published. I find this very significant considering that they have been available for a relatively short time. It is worth remembering that the promoters of phenylpropanolamine and ephedra products proclaimed their safety through the day they were taken off the market. I have consistently seen addiction and tolerance to stimulant products over the past 35 years. I am extremely doubtful that the latest herbal stimulant formulations will be the exception to the rule. – Dr. Peterson

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