Safety concerns regarding ephedrine-type alkaloid-containing dietary supplements

Objectives: The U.S. Air Force has adopted a policy "strongly discourag(ing) the use of... ephedra." However, the literature regarding this topic is limited and widely opinioned. In light of growing public and medical debate over the safety and efficacy of ephedrine-type alkaloid-containing dietary supplements, a review of the literature and assessment of the data were accomplished. Methods: Studies regarding Ma Huang, ephedra, ephedrine-type alkaloids, ephedrine, and dietary supplements were reviewed (from databases Medline, HealthSTAR, CINAHL, Cochrane Clinical Trials Database). Food and Drug Administration and Government Accounting Office documents (including reports and interagency communications) were reviewed. Results: Significant manufacturing quality control issues exist. Few studies support their efficacy or safety. Weight loss and athletic performance appear to be only modestly improved, for short durations, in the setting of large numbers of (some serious) adverse event reports. Studies examining over-the-counter use are minimal. Conclusions: The current U.S. Air Force policy strongly discouraging the use of ephedrine-type alkaloid-containing dietary supplements appears to be supported.