Primary Pulmonary Hypertension(PPH)
CAUSED BY EPHEDRA IN HERBAL DIET DRUGS ?
According to medical research,
less than 1000 people as year in the United States are diagnosed with Primary
Pulmonary Hypertension (PPH). Secondary pulmonary hypertension affects
many more. Pulmonary hypertension (PH) is a state of too-high pressure
in the blood vessels inside your lungs. PH is hard to diagnose because
until it gets very bad, symptoms are vague and could be caused by almost
anything. There are lots of tiny blood vessels inside your lungs called capillaries. These
capillaries are lined with a special kind of cell called endothelial
cells. The outside of each capillary is covered with smooth muscle cells.
The endothelial cells normally keep blood from leaking out of the blood vessel.
The smooth muscle cells normally allow the vessel to expand or shrink,
depending on how much blood is inside them.
In patients with PH, some of the endothelial cells lining the capillaries
weaken, and may enlarge. Since these cells line the inside of the capillaries,
when they get bigger they make the inside of the blood vessel smaller - less
room for blood to pass through. Blood may leak out as well. Also, the outer
smooth muscle cells shrink. This muscle shrinkage tightens the blood vessels -
like holding a sponge in your hand and squeezing, the muscle cells on the
outside of the blood vessel squeeze, making the capillary smaller. This
increases the pressure inside them.
The high pressure in these capillaries resists the heart's efforts to pump
blood through them. When this happens in enough capillaries, the flow of blood
between the heart and lungs is seriously reduced.
CAUSES OF PRIMARY PULMONARY HYPERTENSION
PPH may be genetic or partly genetic - it often
runs in families. It may be set off by a "trigger" that might be
something like use of certain appetite suppressants ( Fen Phen, Pondimin
fenfluramine, dexfenfluramine, Redux), cocaine, meth (speed), amphetamines, inhaled
solvents, contaminated oils such as rapeseed oil used for cooking, or L-tryptophan.
EPHEDRA IN HERBAL DIET DRUGS
SIMILAR TO AMPHETAMINES THAT CAUSE PPH
Ephedrine (e-fed-rin) a-methylamino-l
phenyl-l propanol, is an alkaloid a Huang is a Chinese herb that is also referred to as Chinese Ephedra
and herbal ephedrine. The active compounds, ephedra or ephedrine alkaloids
are also found in other herbals such as Mormon Tea and Sida Cordifolia (there
are about 40 species of plants that contain versions of ephedra). Ma Huang,
and its various herbal cousins, functions as a sympathomimetic, meaning
that it mimics some of the effects of the body's own sympathetic (stimulant)
hormones such as epinephrine (adrenaline) and norepinephrine (either by
increasing the levels of these hormones or by reducing their breakdown).
Many of the popular herbal diet and energy products of the late 1990's
through the the ephedra ban including Metabolife 356, Metabolite,Metab-o-lite, Metabolift,
Hydroxycut, Advocare MNS Orange, Ripped Fuel, Diet Fuel, Stacker, Ripped
Force, Ephedra Ma Huang, Metab-Rx Ultra, Yellow Jackets, Metab-o-lite,
Xenaless, Stacker 2, Dexatrim Natural, and numerous other diet & nutritional
supplements, muscle enhancers, appetite suppressants, and other products.
the leaves of Ephededra equisetina, E. Sinica, and other species (family
Gnetaceae) It is also called Ephedra & Ma Huang, the plant source
the Alkaloid ephedrine. M
Ephedrine is a "non-selective" sympathomimetic, which means that it acts
as a general stimulant on many parts of the body simultaneously (lungs, heart,
blood vessels, adrenal glands, etc.). It is most often used as a central
nervous system stimulant (for alertness or energy), as a decongestant (for
asthma/breathing aid) and as an appetite suppressant in a wide variety of
weight loss and "thermogenic" type products.
Because ephedrine acts as a general sympathetic
nervous system stimulant, it can give users a "boost" or "pick up"
similar to what you might feel after a cup or two of strong coffee. By
mimicking the effects of epinephrine, ephedra can increase the output of blood
from the heart, enhance muscle contractility, raise blood sugar levels and
open bronchial pathways for easier breathing. In many cases, ephedra can
result in a temporary suppression of appetite, which may help efforts aimed at
dietary restriction and weight loss.
Primary Pulmonary Hypertension (PPH) Risk Factors
Taken from the World Health Organization executive summary,
the following risk factors have been categorized based on the strength of the
association with PPH and their probable causal role. "Definite"
indicates an association based on several concordant observations, including a
major controlled study or a clear epidemic. Definite risk factors are
considered to play a causal role in the development of the disease. "Very
likely" indicates several concordant observations (including large case
series and studies) that are not attributable to considered biases, or a
general consensus among experts. "Possible" indicates as association
based on case series, registries, or expert opinions. "Unlikely"
indicates risk factors that have been proposed but have not been found to have
any association from controlled studies.
A. Drugs and Toxins
- Toxic Rapeseed Oil
2. Very Likely
- Chemotherapeutic Agents
- Oral Contraceptives
- Estrogen Therapy
- Cigarette Smoking
The research findings concerning
the effects of Ma Huang and other ephedra-containing products is equivocal - some studies show
absolutely no beneficial effect, while a handful of others show a modest
increase in metabolic rate, suppression of appetite and enhanced weight loss
when compared to a placebo. A possible reason for the inconsistent findings is
the variable levels of the active alkaloids responsible for the stimulatory
effects associated with Ma Huang and other ephedra-containing products. As
with many naturally derived compounds, levels of the active chemicals can vary
significantly from product to product and from batch to batch - a MAJOR
problem when considered in light of the potential adverse side effects
associated with ephedra-containing products (see below)
Because ephedrine is a stimulant, it is logical that either a single dose
or chronic repeated use would elevate metabolic rate somewhat (meaning that
you would burn more calories at rest and during exercise). One study showed
that overweight men and women who were dieting were better able to maintain
their resting metabolic rate (which typically falls during a weight loss
program) when they consumed 150mg of ephedrine per day (although no additional
weight loss was noted). The combination of ephedrine (20-40mg) and caffeine
(200-400mg), sometimes combined with theophylline from tea (50mg) or
salicylates from white willow (100mg), has been found to work better then
either agent alone in producing a slight increase in resting metabolism and
appears to be about as effective as prescription weight loss medications
such as dexfenfluramine. In another study, ephedrine (30mg) combined with
caffeine (100mg) and aspirin (300mg) increased energy expenditure following
a meal in obese women. This combination, known to many consumers as the "ECA stack"
(for Ephedrine/Caffeine/Aspirin), has become one of the most popular weight
loss supplements on the market.Ephedrine can be converted into the street drug
methamphetamine ("meth" or "speed"). The active ingredient in Ma Huang
is ephedrine, sale of which has been restricted in 16 states. Ephedrine is
considered a banned substance by the International Olympic Committee (IOC) the
United States Olympic Committee (USOC), and the National Collegiate Athletic
Association (NCAA). The FDA has received nearly 1000 reports of "adverse
events" from consumers using one of over 100 supplements containing
ephedrine alkaloids. Complaints have ranged from nervous system and
cardiovascular system effects such as elevated blood pressure, heart
palpitations, insomnia, irritability, headaches, and serious adverse effects
such as seizures, stroke, heart attack, and even death (about 15-20 thus far).
Most of these adverse events occurred in otherwise healthy young to
middle-aged adults using the products for weight control or increased energy.
In response to the relatively large number of adverse reports (compared to
other dietary supplements), the FDA proposed to limit the amount of ephedra
alkaloids that could be consumed per dose (8mg) and per day (24mg). Quite
recently, however, the General Accounting Office (GAO) has determined that the
majority of these reports cannot be substantiated or linked directly to any
ephedra-containing product, nor did the FDA have adequate scientific evidence
that any restrictions on ephedra dosing or daily intake was needed. To put the
overall safety question into proper perspective, ephedrine-alkaloids are NOT
for everyone - but 1000 adverse reports against the backdrop of several
hundred million doses over the last couple of years hardly qualified as the
"public health menace" that many media stories have suggested
Virtually all dietary supplements that contain ephedra-alkaloids also carry a
strong warning on their labels which reads:
Women who are pregnant or nursing should avoid using ephedra-containing
products. Keep out of reach of children. Avoid using ephedra-
ephedrine-containing products if you have high blood pressure - hypertension,
heart or thyroid disease, diabetes, difficulty in urination due to prostate
enlargement, or if taking monoamine oxidase (MAO) inhibitors or any other
prescription drug. Reduce or discontinue use if nervousness, tremor,
irritability, rapid heartbeat, sleeplessness, loss of appetite, or nausea
Because ephedrine is similar
in structure to amphetamines and can increase heart rate and blood pressure
in susceptible individuals, the FDA has recommended that ephedrine consumption
should be limited to less than 24 mg per day and that dietary supplements
contain no more than 8mg of ephedrine or related alkaloids per serving
(recently, the FDA has indicated that they may be backing away from this
recommendation, but it still stands in the public record for now). It is
very important, should you decide to use ephedra-containing products, to
understand that there are a variety of ephedrine-like compounds (alkaloids)
present in Ma Huang and related herbs, including ephedrine, norephedrine,
pseudoephedrine, methylephedrine, and norpseudoephedrine - and products should be
standardized to a TOTAL ALKALOID content. For example, a product that states
356mg of Ma Huang or related herb per serving and is standardized to 6%
ephedra alkaloids, would have 21.36mg of ephedra alkaloids per serving (356 X
0.06 = 21.36) - make sure that the "standardization" is to TOTAL
alkaloids rather than simply to ephedrine
In the few studies which have been conducted on ephedra-containing products
for weight loss, the total amount of ephedrine ingested per day has ranged
between 60-75mg (usually in 3 divided doses of 20-25mg/dose).
The above dosage recommendations should be considered in light of a recent
study from the University of Arkansas which analyzed the content of ephedra
alkaloids in 20 dietary supplements. The study showed that the alkaloid
content varied considerably among products - from ZERO to 18.5mg per dose
and significant lot-to-lot variations in alkaloid content were observed for
at least 4 products (meaning that even if you selected the same brand each
time, you would be getting a different level of ephedra). For 1 product,
the alkaloid content varied by as much as 1000% between lots. Perhaps the
most disturbing finding of the study was that fully half of the products
showed discrepancies of more than 20% between the label claim for ephedra
alkaloids and the actual alkaloids measured in the study.
FOR EPHEDRA USERS WITH PPH
you or a loved one have been diagnosed with Primary Pulmonary Hypertension (PPH),
then you may have a right to file a individual legal action against the
manufacturers of the diet pills or others. Due to the nature of this serious
and devastating disease process, PPH patients are urged to contact an attorney
immediately after he or she has been informed of their Primary Pulmonary
Hypertension diagnosis. Many
important legal issues need to be addressed early after a PPH diagnosis, that
can affect the outcome of the PPH litigation. Call us for a Free Confidential
Consultation. Talk with a Board Certified Personal Injury Trial Lawyer about
your legal rights of a PPH claim against the diet drug industry and others. No
Fees or Expenses Charged unless we make a Recovery for You.
Call Us Toll Free at 1-800-883-9858
or 1-800-468-4878 or E-mail
us your questions on Free
Case Evaluation Form
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