The legal use of ephedra

BY JULIE DAVIDOW; March 4, 2004

  Liz Walters used to spend every spring struggling to catch her breath. Scarred by a childhood illness, her lungs worked overtime when the season's fresh pollens filled the air.
  Two different inhalers and antihistamines never completely cleared the wheezing and pressure from her chest. Then, seven years ago, at the suggestion of her acupuncture instructor, she tried a Chinese herbal remedy for breathing problems.
  Minor Blue-Green Dragon, a tiny pill containing eight ingredients, including the herb ma huang, finally worked.
  "It stops me from feeling like I have someone sitting on my chest," said Walters, now a licensed acupuncturist who prescribes ma. huang, also known by its Latin name, ephedra, in her practice on Whidbey island.
 Walters, 51, takes the pills twice a day between March and May when her symptoms peak.
  Even after the Food and Drug Administration's ban on ephedra goes into effect next month, practitioners of Chinese medicine will still be allowed to dispense and prescribe the herb as they have for thousands of years.
  The government's prohibition is intended to clear store shelves and halt Internet sales of dietary supplements that contain ephedra, especially in weight-loss products. The supplements have been linked to increased blood pressure and heart rate, which can lead to stroke, heart attack and sudden death.
  However, the prohibition exempts traditional Chinese remedies, which are not marketed as dietary supplements and therefore are not covered by the rule.
  "I think the FDA saw that clearly the problem was coming from these big companies that were selling it as a weight -loss supplement in the mass market, not from some acupuncturist," said Eric Yarnell, a naturopath and adjunct professor at Bastyr. "They don't really intend to go after people who are using it responsibly."
  When mixed with other botanicals in teas, ground into powder, or cooked with honey, the twiggy herb helps patients sweat out fevers and breathe easier during colds and asthma attacks, advocates say.
  A bronchial dilator with stimulant effects, ma huang is considered a powerful herb. To minimize side effects, it's used in small doses in combination with other ingredients, said Allen Sayigh, manager of the herbal dispensary at Bastyr -University and the Seattle Institute of Oriental Medicine.
  A formula that helps break fevers, for example, includes ma huang, cinnamon twigs, apricot kernels and licorice root.
  "That prescription has been around for close to 2,000 years," Sayigh said. "You might only have to take one or two doses of tea, curt up, break a sweat and be on the road to recovery. It'd be nothing like taking a dietary supplement for weeks or months on end."
  Ma huang has not traditionally been used to boost energy or for weight loss - nor should it be, many herbalists say. Like caffeine, ma. huang can ultimately leave you drained. "(In traditional Chinese medicine) there are ways to deal with weight loss but they involve harmonizing the whole metabolism," said Sayigh.
  Many herbalists are happy to see weight- loss products that distill the herb's most powerful alkaloid taken off the market, while preserving ma huang's traditional uses.
  "It seems they've done enough of an investigation to realize it has value as an herb," said Alison Roth, a Seattle herbalist.
  Still, high insurance costs have led some distributors to stop selling the herb altogether.
  Tierney Salter, owner of an herbal remedy shop and manufacturer in Seattle, said her source of American ephedra, which does not contain the stimulating ephedrine alkaloid and is not covered by the ban, can no longer afford the insurance rates associated with selling any form of ephedra.
  Salter mixes American ephedra, or Mormon tea (which thrives in the high deserts of Utah), in a drink to ease conges-tion. She also sells the whole herb alone.
  "Because the public is being told ephedra is bad for you, are you as a small herb shop going to want to take on the risk of someone reporting an adverse reaction to it?" said Salter, standing in front of an empty canister of American ephedra.
  Several shop owners in Seattle's Chinatown are also no longer selling ma huang, even as a whole herb.
  Adon Mar, owner of Pacific Herb and Grocery, ran out of ma. huang during the height of the cold and flu season and hasn't been able to restock. "The distributor doesn't have it. They said they have a hard time getting it now," said Mar, who added he would carry the herb again if he can find it.
  "We've been using it for a long time and it's very effective," Mar said.
  Across the street, Feng Shan Zhu, an acupuncturist and herbalist who practiced in China for nearly three decades before moving to Seattle in 1996, said he's never carried ma huang in the United States. "I know in America the law is very powerful so I'm careful," said Zhu, who said he prescribed ma huang regularly in China to treat coughs and fevers.
  A couple of American women, however, have come to his office looking for the herb, he said. "They say, 'Doctor do you have any ma huang? I want to use it to get my energy up.'"
  Mayway Corp., an Oakland, Calif., company that distributes herbs grown in China, will continue to sell ma. huang, "unless insurance rates become too outrageous," said Laura Stropes, the company's herbalist.
  "Ma huang is a very important herb in Chinese medicine," said Stropes. "There's not really any substitute for it."
  Other stores that carry herbs and supplements say there's been a run on products with ephedra since the FDA first announced it would seek a ban in December.
  At Salter's store, one customer recently bought five 4-ounce bottles of liquid ephedra extract - a large amount for someone in search of a cough or cold remedy. Salter said she's never carried weight-loss products that contain ephedra, but she can't be sure how her customers plan to use the ma huang she sells.
  At VitaminLife in Redmond, the last bottles of ephedra capsules are rapidly disappearing. Since January, the store has sold 360 bottles of one ephedra product, which unlike traditional Chinese remedies, contains only one herb.
  "We've had a huge rush on sales," said Terri Marello, the store's manager. "We've probably quadrupled in the last two months." VitaminLife stopped selling weight-loss products with ephedra six months ago, but continued to sell other dietary supplements because, "A lot of people legitimately use that for respiratory purposes."

P-I reporter Julie Davidow can be reached at 206-448-8180 or juliedavidow@seattlepi.com