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Old 02-19-2003, 12:32 PM   #1  
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Post The end of ephedra?

I'm sure that most of you who watched the evening news last night saw this story, but I liked the San Francisco Chronicle's take on it:
The death of Baltimore Orioles pitcher Steve Bechler appears to be linked to a widely available and commonly used weight-loss supplement that is loosely regulated, a medical examiner said Tuesday.

The finding rekindled concerns over the safety of ephedra and calls for tighter control of the popular diet supplement by federal regulators.

Bechler, 23, had been taking Xenadrine, an over-the-counter dietary supplement containing the stimulant ephedra, and it probably contributed to his death, said Dr. Joshua Perper, the Broward County, Fla., medical examiner.

Ephedra has been associated with heart attacks, seizures and strokes and has been linked to dozens of deaths.

Ephedra, also known as ma huang, is widely used to lose weight or boost energy. It can be purchased for a few dollars under popular brand names such as Metabolife and generates more than $1 billion in sales annually.

Ephedra has been banned by many sports leagues -- but not Major League Baseball. It is not closely regulated by the U.S. Food and Drug Administration because it is not considered a drug.

A growing number of medical experts and lawmakers want to change that. Some want the substance banned, while others want it tightly regulated.

"I think sooner or later Congress has to revisit some of these laws, and I think sports organizations have to go the extra mile and protect these athletes," said Dr. Gary I. Wadler, a professor at New York University School of Medicine who advises the White House Office of National Drug Control Policy on drug use by athletes.

Bechler died Monday morning, less than 24 hours after collapsing during spring training in Fort Lauderdale, Fla. An autopsy found he had died from complications of heatstroke that caused many of his organs to fail, Perper said.


His body temperature was 108 degrees, about 10 degrees above normal.

High blood pressure and liver abnormalities also contributed to Bechler's death, Perper said. A bottle of Xenadrine was found in his locker, officials said.

Toxicology test results won't be available for two or three weeks, but Perper said Bechler was believed to have taken three Xenadrine tablets before his Sunday workout. There was no trace of solid food in Bechler's digestive tract, Perper said, suggesting he had been following a strict diet.

The lack of food, combined with the stimulants and the relatively warm weather -- 80 degrees -- when he collapsed probably led to his death, Perper said.

"At this time, I don't have a complete or sufficient degree of toxicology results that I can say precisely what was in the blood and at what levels," Perper said. "But it's very difficult to believe in view of all the circumstances that anything else was really of importance."

Xenadrine is made by Cytodyne Technologies, a New Jersey manufacturer of weight-loss and fitness supplements. The company issued a statement Tuesday night standing by the safety and effectiveness of Xenadrine.

"Due to the lack of medical evidence available at this time, Cytodyne is unable to specifically comment on the circumstances surrounding the tragic death of Steve Bechler," the statement read. "Until the toxicology report becomes available, it is sheer speculation as to whether Mr. Bechler ever used Xenadrine, or whether Xenadrine played any role whatsoever in contributing to his death."

Ephedra is an extract of the ma huang plant, and ephedrine is the key chemical in ephedra. Ephedrine is found in many over-the-counter decongestants and cold remedies and is regulated by the FDA because it is a drug. But because ephedra is a naturally occurring substance, it is considered a dietary supplement like vitamins and is not closely regulated.

Ephedra is popular with dieters because it increases energy while raising the body's metabolism. Many athletes use the supplement to ward off fatigue so they can exercise longer and harder.

But ephedra constricts blood vessels, making it harder for the body to push hot blood to the skin's surface where it can cool. In extreme cases -- and particularly when taken with caffeine -- the constriction can be so severe that the heat gets trapped, raising the body's temperatures high enough that major organs can fail.


Dr. Neal Benowitz, a clinical pharmacologist and professor of medicine at UC San Francisco, was among the first to sound the alarm when he and his colleagues linked ephedra to a host of deaths and disabling conditions in 2000.

Heart attacks and strokes topped the list, but the researchers also reviewed cases consistent with heatstroke, he said.

Combine that with dehydration, excess weight and poor conditioning, Benowitz said, and the results can be disastrous, even for a young athlete like Bechler -- who weighed 239 pounds and wanted to lose weight.

Further casting doubt on ephedra, a study released two weeks ago by researchers at the San Francisco Veterans Affairs Medical Center found that while it accounts for less than 1 percent of all herbal supplement sales, it is responsible for 64 percent of all adverse health reactions to herbs.

The study concluded that people taking products with ephedra were 200 times more likely to suffer complications than people using other diet supplements.

Efforts by the FDA to increase oversight of ephedra have been stymied by the dietary supplement industry.

The Rand think tank, at the request of the U.S. Department of Health and Human Services, is currently studying the effectiveness of ephedra and whether it causes health problems. Results are expected within a few months.

California law bans the sale of ephedra products to minors. Gov. Gray Davis -- who has collected more than $100,000 in campaign contributions from Metabolife International Inc. since becoming governor four years ago -- vetoed a law two years ago that would have restricted ephedra sales.

He reversed his position in August when he signed the ban against sales to minors and called on the FDA to regulate ephedra. Rep. Susan Davis, D-San Diego, has been pushing state legislation to regulate it as well.

The National Football League, the National College Athletic Association and the International Olympic Committee have banned ephedra, but Major League Baseball has not prohibited it.

"We're going to wait until we know more about what happened," said baseball spokesman Rich Levin.

Major league teams, including the Orioles, have cautioned players about the dangers of ephedra. The New York Yankees and San Francisco Giants reiterated those concerns with players on Tuesday.

"We really try to educate them," said Stan Conte, Giants head trainer. "We liken supplements to spit tobacco. Spit tobacco is legal. Study after study has proven it causes cancer, but people still do it. We can't take it away, but we can educate them of the dangers."


The herbal dietary supplement ephedra -- also known and sold as ma huang, the Chinese plant its extracted from -- is under scrutiny for its possible contribution to the death of Orioles pitcher Steve Bechler.
-- Properties and uses: Treats asthma by relaxing bronchial muscles and constricts small blood vessels; used in weight loss and athletic performance products

Precautions: Can raise blood pressure, accelerate heart rate

Possible adverse reactions: Heart attack, stroke, irregular heartbeat, seizure

Regulation: Ephedra, the ma huang extract, is not considered a drug and therefore is subject to very little government oversight. But Ephedrine, the key chemical in ephedra, is regulated by the Food and Drug Administration as an ingredient in many over-the-counter decongestants and cold remedies.

Use: About 3 billion doses a year
Whether or not it was responsible for the death of this young athlete, I think that 2003 will see a very large drop in the manufacture and sale of ephedra based dietary supplements -- you might have noticed the major brands of OTC diet pills (Xenadrine, Hydroxycut, EAS, Dexatrim, etc) coming out with their 'new, improved' ephedra-free products which are by all intents and purposes meant to phase out the old formulas. I believe that this is not due to any pressure by the FDA - as their hands have been tied by the 1994 Dietary Supplement Act (see "How the Dietary Supplement Health & Education Act of 1994 Weakened the FDA" at ) but rather by the insurance liability carriers, who are drastically raising the premiums of supplement companies which manufacture and/or market ephedra-based products - anticipating a plethora of lawsuits much like the tobacco lawsuits that have been flooding the courts in the past years.

As any person versed in the legal world can tell you, whether or not the plaintiff wins their lawsuit, the legal fees (which are mostly paid by the insurers) which are incurred in the filing, discovery, and processing of these suits and appeals can be considerable to say the least. I wonder how much the recent McDonald's negligence suit (which was dismissed by the judge recently) cost the company?

Just a few musings here on a grey Wednesday morning...
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Old 02-20-2003, 04:33 PM   #2  
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I wondered the same thing when I heard about this. How many more lives will be lost before the "powers that be" take action? The press should give this much coverage to ANYONE that is harmed by ephedra or other dangerous supplements. Think of the mothers and teenagers that have also lost their lives, or had their health seriously and permanently damaged simply because the FDA had their hands tied. What more will it take?
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Old 02-21-2003, 04:46 PM   #3  
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Exclamation Article about Ephedra in OWH

I read an article today in the Omaha World Herald that it doesn't matter to alot of people they will jeopardize their health inorder to curb their appetites. NO SENSE.

Miss Chris

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Old 02-21-2003, 06:16 PM   #4  
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In defense of appetite suppresents.....I have been taking Xenadrine EFX (WITHOUT Ephedra) on and off for a few months now...and it really works...I am also eating 4-5 small meals a day, lots of water and plenty of exercise...

I had a real problem with confusing thirst for hunger, and eating out of bordem...But now, I don't do that anymore...

I only take half the dose that is recommended on the back of the bottle...and it seems to be helping me...
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Old 02-22-2003, 08:56 AM   #5  
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For several years I have been aware of the dangers of ephedra (ma huang) and am amazed that it is still allowed on the market. Unfortunately far too many people don't do personal research on products but simply take them for a "magic" way to lose weight. And sadly, far too many people suffer serious side effects or even death. <sigh>

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Old 02-23-2003, 03:13 PM   #6  
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Same things you are guys are saying can be applied to fast food places if you think about. So why don't they regulate fast food? Hmmm?

I think if they regulate Ephedra it can be used in a safe manner. Along with good common sense.
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Old 02-23-2003, 10:02 PM   #7  
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It's already being regulated in California - the governor signed legislation that went into effect last month...
Governor Gray Davis has signed two bills to require label warnings on products containing the herbal dietary supplement ephedra, which have been linked to as many as 54 deaths across the nation.

SB 1884 by Sen. Jackie Speier (D-Hillsborough) requires that labels of dietary supplements containing ephedrine display specific warnings and the toll-free number for consumers to report adverse reactions of the U.S. Food and Drug Administration's (FDA) adverse events reporting program and would prohibit the sale of these products to individuals under 18 years old.

SB 1948 by Sen. Liz Figueroa (D-Fremont), a companion bill to SB 1884, will require warning labels on dietary supplements to be clear and conspicuous.

"I vetoed a similar bill two years ago citing the need for federal regulatory action. It was my expectation that the federal government would take a more aggressive regulatory approach toward this substance," said Gov. Davis. "While regulation of dietary supplements and interstate commerce is the responsibility of the federal government, Californians can't wait for federal action that is too long overdue."

In June, U.S. Dept. of Health and Human Services Secretary Tommy Thompson ordered a review of reports on the adverse effects of ephedra. On August 16, 2002, Gov. Davis directed California Department of Health Services Director Dr. Diana Bonta, to send a letter to the FDA requesting aggressive action to regulate the sale or inform the public of the possible health risks associated with products containing ephedra.

The federal government has failed to act, leading Gov. Davis to sign the two bills.
Historically, the manufacturers of ECA stacks (your traditional 'fatburner') are accustomed to making huge profits on these products - the ingredients are cheap to produce, and there's little or no regulation by the government due to the 1994 Dietary Supplement Act. I have read that the average markup on ECA stacks is 10 or more times the cost of producing the product - in other words, a bottle of Hydroxycut that cost you $30 was produced for around $3 (I believe this includes advertising costs). With insurance premiums rising, the supplement companies' profits will be severely cut (not to mention the resulting bad publicity) so it's just easier for them to 'phase out' the products containing ephedra for 'new, improved' ephedra-free versions.

Here's an interesting article...
Herbalife, Other Ephedra Marketers
Face Soaring Insurance Rates

David Evans
2002 Bloomberg, LP
April 11, 2002
Herbalife International Inc. continues to sell weight-loss products containing ephedra, following lawsuits blaming the substance for customer deaths, and a six-fold increase in product-liability insurance expense. Herbalife, which faces two wrongful death suits blaming its ephedra weight-loss products, still includes the herb in its line of diet products, which made up 42.7% of last year's $1.66 billion in sales, according to its annual report.

Late yesterday, the company agreed to be taken private for $685 million, or $19.50 a share, by Whitney & Co. LLC and Golden Gate Capital Inc.

Robert Hartwig, chief economist for the Insurance Information Institute, said ephedra insurance premiums have increased along with adverse incident reports and lawsuits. "You have a situation where the house is on fire," said Hartwig. "If your house was already on fire, it's very unlikely we'd write a policy."

More than a half dozen other publicly traded companies also continue to sell ephedra products, while unable to obtain desired levels of insurance.

Herbalife said in its federal filing that its product- liability insurance premium soared from $400,000 in 2000 to $2.5 million last year, even as its deductible increased 10-fold to $5 million, and its coverage limit fell by $10 million to $40 million.

Ephedra is an herbal stimulant also used for bodybuilding. The National Football League banned ephedra last year after it was linked to the deaths of several athletes. Health Canada ordered a voluntary recall of the products in January, after finding "these products pose a serious risk to health."

Dozens of Deaths
Ephedrine, the active ingredient in ephedra, also called ma huang, is a chemical cousin of amphetamines and increases both blood pressure and heart rate, say experts. The U.S. Food and Drug Administration has linked ephedra to hundreds of adverse reactions and dozens of deaths.

Herbalife, based in Los Angeles, said in its annual report it might discontinue selling ephedra products because insurance is "becoming prohibitively expensive." It said the company had "substantial defenses" to the lawsuits and said "they will not have a material impact on us." An Herbalife spokeswoman, Tammy Taylor of Sitrick & Co., said Herbalife believes ephedra products are "safe and effective when used as directed." Francis Tirelli, company president, didn't return telephone calls.

Nine other public companies say they sell ephedra products. Advantage Marketing Systems Inc. received 52% of its $28.4 million of 2001 revenue from ephedra. The company's product liability insurance excludes ephedra claims, according to its annual report. The company didn't indicate any ephedra lawsuits in its annual report. Reggie Cook, chief financial officer, said the coverage would be too costly. "If I paid $100,000, I could get $100,000 of coverage," he said.

No Complaints
Natrol Inc. of Chatsworth, California, has sold ephedra supplements for 18 years, without a single complaint, said Elliot Balbert, president and founder. Still, the company can't find product-liability insurance for the products, which include Natrol High, Metabolfirm and Therma Pro.

"We couldn't even get a damn bid," said Balbert. "I don't like the exposure." He said Natrol might stop selling ephedra products, which generate less than 3% of revenue.

Three other public companies said they are selling ephedra products although their insurance now provides less protection.

Wrongful Death Suit
Twinlab Corp. of Hauppauge, New York, faces a lawsuit over a customer death following use of its Metabolift ephedra product. Chattem Inc. of Chattanooga, Tennessee, cautioned in its annual report it might not have sufficient insurance coverage to cover sales of Dexatrim after its policy expires on May 31.

Weider Nutrition International Inc., which distributes diet products from its Salt Lake City headquarters, is defending three ephedra lawsuits. Daniel Thomson, Weider's general counsel, didn't return telephone calls. William Rizzardi, Twinlab's chief information officer, and Scott Sloat, Chattem's controller, declined to comment.

Four other companies that sell ephedra products don't indicate any lawsuits in their annual reports. Nutraceutical International Corp. said its liability insurance excludes ephedra, and the Park City, Utah-based company said it recently halted sales of some ephedra products. Les Brown, chief financial officer, didn't return telephone calls.

Mannatech Inc. of Coppell, Texas, reported selling ephedra products. Steve Fenstermacher, chief financial officer, didn't return phone calls.

Both Nature's Sunshine Products Inc. of Provo, Utah, and NBTY Inc. of Bohemia, New York, sell ephedra supplements. Harvey Kamil, NBTY's chief executive, didn't return telephone calls. Nature's Sunshine Products executives weren't available.

'Natural Reaction'
Among a group of 140 FDA adverse reaction reports, 104 show ephedrine was the "very likely" cause of a medical problem, according to Ray Woosley, who examined the reports. Woosley, dean of the University of Arizona College of Medicine, said there were 10 reported ephedrine cases of "sudden death" and 15 severe strokes.

Woosley, who joined Public Citizen in its petition for an FDA ephedra ban, said he's not surprised that insurers are shying away from companies selling ephedra. "That's a natural reaction to reckless behavior," he said.
This last article pretty much sums it up...
Safety issues killing popularity of ephedra

Tuesday, January 07, 2003

By Shari Roan, Los Angeles Times

When the wildly popular drug combo phen-fen was pulled from the market in 1997, people were forced to look elsewhere for weight-loss help. Many turned to a then-mysterious Chinese herb known as ma huang.

The supplement, commonly known as ephedra, seemed less risky than the prescription medicines, which had been linked to heart valve problems. But now the federal government is reviewing the supplement's safety, and one manufacturer of ephedra is under criminal investigation by the Justice Department. Once again, many consumers are searching for a safe alternative.

Although supporters contend that ephedra is safe, some major sellers already are scaling back or abandoning sales of products containing the herb.

The maker of one of the most popular supplements, Ripped Fuel, said last month that it will discontinue it and other ephedra products.

Dietary supplement giant Herbalife has begun phasing out its three ephedra products and is instead promoting a new ephedra-free line of supplements.

General Nutrition Centers, the largest retailer of dietary supplements, announced Nov. 6 that it will request proof of age from customers purchasing products with ephedra to stop sales to minors.

The moves follow several months of particularly bad publicity. Although ephedra may indeed help the body burn fat -- it's known as a thermogenic aid, meaning it raises metabolism and increases heart rate -- that weight-loss potential may come with a risk. Some studies have linked use of the herb to stroke, heart attack, seizures and sudden death. The Food and Drug Administration says it has received more than 1,200 reports of adverse events linked to ephedra, although supplement makers say the health problems could have occurred even if people hadn't taken ephedra.

Growing concern over the safety of ephedra prompted the Bush administration, in June, to order a scientific review of the herb. Two months later, the Justice Department announced it was conducting a criminal investigation to probe whether a major manufacturer of ephedra, Metabolife, lied about the safety of its products.

"Ephedra is getting a very bad name, even though a definitive review of the safety of ephedra hasn't been published," said Mark Blumenthal, executive director of the American Botanical Council, a nonprofit educational and research organization.

Manufacturers trace their flagging support for ephedra to consumer unease about the herb's safety, the rising costs of liability insurance and the threat of a possible government crackdown. It doesn't hurt that they also seem to have found a promising alternative called "bitter orange."

Bitter orange, or Citrus aurantium, is emerging as the central ingredient in a new generation of herbal weight-loss products. Both Twinlab and Herbalife announced the demise of their ephedra products at the same time they introduced those containing Citrus aurantium. Several other supplement makers also have launched ephedra-free formulations containing bitter orange, including Xenadrine EFX and TurboTrim Plus Ephedra Free.

"We've been happy with the [ephedra] products. They've worked very well. But, basically, it's the media attention and the FDA circling around. We've decided to go the high road," said Dr. Jamie McManus, senior vice president of the Herbalife medical advisory board. The company is introducing an ephedra-free formulation called Total Control.

But some experts say exchanging ephedra for Citrus aurantium may not protect consumers from harm or manufacturers from controversy. Because the herb is chemically similar to ephedra, it could cause similar health problems.

Although several supplement companies say they've tested Citrus aurantium, the results of that research have not been published or peer-reviewed for scientific validity. The studies that have been published have been small; one 1999 U.S. study of 23 people showed those taking Citrus aurantium for six weeks experienced a decrease in body fat of about 6 pounds.

"It's a new kid on the block. But we don't know if it's a good kid or a bad kid," said Bill Gurley, a professor of pharmaceutical sciences at the University of Arkansas. Manufacturers "really don't have to do any research before putting these things on the market. So how do you really know if they're safe?"

Citrus aurantium is made from the immature fruit of a plant known in various parts of the world as bitter orange, sour orange or Seville orange. In China, the fruit is known as "zhi shi" and is used in traditional Chinese medicine to relieve chest congestion and indigestion. Its active substance, synephrine, is chemically similar to ephedra, and both are considered thermogenic weight-loss aids.

Some supplement makers say that bitter orange will work as well as ephedra but without affecting the central nervous system or the heart. Gurley agrees that Citrus aurantium by itself probably has little effect. But herbal weight-loss products are mixtures of various herbs, such as caffeine to boost metabolism and herbs that act as diuretics. Blending several herbs increases effectiveness. So mixing Citrus aurantium with other herbs may make it more effective and, potentially, more dangerous to some users.

Another potential problem with Citrus aurantium is prescription drug interactions. Citrus aurantium inhibits an enzyme in the small intestine that can alter the metabolism of drugs, boosting their activity.

"We know this enzyme is responsible for the metabolic activity of 50 percent of all prescription medications," he said. "We know that Seville orange juice can wipe out those enzymes. It would be reasonable to think that these concentrated extracts would do the same."

But until more is known about Citrus aurantium weight-loss products, however, Gurley urges caution. "It's like where we were six years ago with ephedra."
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Old 02-24-2003, 11:35 AM   #8  
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I think that it should not be taken off the market.
I have used ephedra products on and off for years and I have no problems. I think that the problems with anything begin when a handful of people abuse it. Sure if you take double the dose as I heard on the news that the baseball player was taking well duh your going to give yourself a heart-attack!!!
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Old 02-27-2003, 12:23 PM   #9  
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For those of you saying it didn't hurt you, good for you. BUT, for someone with undiagnosed heart problems or high blood pressure, just one of these pills could kill you. There was a story in the news about a mom that was taking it and she sadly had an undiagnosed heart problem. She died, leaving her husband and small children behind. She thought it was perfectly safe for her. She was young, no high blood pressure and one morning she dropped dead at the gym. She wasn't as lucky as some of you. There's also the fact that you may have lingering liver problems from this stuff that won't be obvious at first. Is it worth it????

It's a dangerous drug and now another young athlete is dead. It's tragic. This crap speeds up your heart. It's the same as anthpetemines. (sp) and I'll cheer when it's off the market.

AND have you ever taken your vitamin and forgotten and taken another one???? What if you did that with Ephedra and it killed you, by accident of course? How can you so callously say Duh it will kill??? He was about to be a father and desperate to lose weight to make the team. He probally thought it was safe. AL he did was take one extra pill. Are you all one pill from a heart attack when you are on ephedra??

What if you had a daughter that took a double dose, not knowing, and died? Would that be the same Duh......??? Just curious.

Most people fail to research it because ther perceive it as safe because all the bottles say in big bold letters "ALL NATURAL, SAFE, EFFECTIVE."

I get soooo uptight because when I did LASW, back in 99 before there was bad press about the Ephedra, it was in their Tri-Max and Ma Hung. They bestowed it's virtues to me and I believed them. It made me jittery, nauseous, and one night I awoke with a shooting pain in one arm. I then did my research and threw the crap away. Was I one pill away from a heart attack or stroke???

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Old 03-14-2003, 09:04 AM   #10  
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Hi Dana

I agree completely! Once unknowingly I took a supplement purchased from my gym and which they "guaranteed" was really good for you and didn't contain "any bad stuff." I took it for about a week and was totally on a high, jittery, etc. So I began doing research -- fortunately I am "Internet savvy" but what if I hadn't been?

I was able to diagnose what was causing it and found out about ephedra and ma huang. What makes it even worse is that I have a neurological imbalance and take anticonvulsants... nobody bothered to warn me that this stuff CAUSES convulsions and liver damage (which I have to be tested for every six months anyway because of my meds). I just want to lose weight and get in shape... I don't want to DIE over any of this stupid stuff!

Sure we are all responsible for ourselves and what we eat or ingest. Still, to have something on the market which is knowingly killing people who are unaware is just plain irresponsible in my opinion.

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Old 11-26-2004, 04:31 PM   #11  
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Hi Ladies, and thanks for bringing up this subject. I am super-sensitive any kind of stimulant, and my husband refuses to prescribe any appetite suppressants for me. I get nervous, palms sweat, and become a raving insomniac. So, what is a fat chick to do? When-- even though she eats sensibly, has dieted, and is involved in sports regularly-- she cannot seem to lose more than a meager 1-3 lbs., after much struggle. He (Hubby, M.D.) finally prescribed Topamax, an anti-manic and migraine prophylactic that has a cool side effect: appetite suppression. And did it work? Sure. Miracles on my girlfriend, but made me a little nauseous and somnolent. Yes, my appetite was suppressed. I am not recommending this to anyone. GO AND SEE YOUR PHYSICIAN. At least you will be armed with one more nugget of information, if you cannot/will not take ephedra and other such controversial drugs. Research and knowledge are the key, not to mention small dosing initially to see how these things work on you personally. Many drugs are concocted for one ailment, and ultimately are found to have wonderful "side effects" that work on something related or different.

Once again: see your physician, ask intelligent questions, have knowledge to debate with, but follow the doctor's advice first and foremost. You may say goodbye to a big appetite eventually. Good Luck to all!
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Old 11-26-2004, 08:09 PM   #12  
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personally i dont' see the point in arguing to ban ephadrine and relatated products i feel there are much more important issues to be argued with regards to health like banning public smoking.
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Old 11-27-2004, 11:47 AM   #13  
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Well, since ephedra *has* been banned for almost a year in the US now, this whole thread is probably a moot point anyway...

Kind of a 'blast from the past' as it were.
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