NEW YORK (Reuters Health) - Dietary supplements containing the herb ma huang can increase the risk of heart attack, stroke and sudden death--even in healthy people who take the recommended doses, a new study reveals.

Ma huang, an herbal source of ephedrine, is found in some weight-loss and energy-enhancement supplements. While the herb has been used in Chinese medicine for more than 5,000 years, it has not been proven effective by Western scientific standards, note researchers in the January issue of Mayo Clinic Proceedings. Many studies, in fact, have found an association between ma huang and the risk of heart attack and death.

The current review of information from a US Food and Drug Administration (FDA) database found that more than 926 cases of possible ma huang poisoning were reported between 1995 and 1997. Researchers from the New England Medical Center in Boston, Massachusetts took a closer look at 37 reports of serious herb side effects in patients aged 20 to 69. Patients in 43% of these cases suffered strokes, 27% had heart attacks and 30% died suddenly.

Nearly all of the patients took doses within recommended levels and only one patient had a history of heart disease, the report indicates.

The new findings support previous studies demonstrating that ma huang may increase the risk of heart attack and death, and suggest that the current FDA system of monitoring the safety of dietary supplements may not go far enough to protect consumers.

``The adverse effects of ma huang documented in this report and others raise several issues regarding the risk of this agent, which has no scientifically proven benefit,'' Dr. David Samenuk and colleagues conclude.

Under the Dietary Supplement Health and Education Act of 1994, all dietary supplements, which include everything from vitamin pills to herbal remedies, must be proven unsafe before a manufacturer can be required to take them off the market. Manufacturers do not need FDA approval for a dietary supplement before selling it to the public.

In an accompanying editorial, Dr. Bruce D. Lindsay from Washington University School of Medicine in St. Louis, Missouri, writes that the findings underscore the need for physicians to warn their patients about the potentially harmful effects of some dietary supplements.

``As physicians, we should educate and caution the public about possible risks associated with the use of dietary supplements containing ephedrine. Additionally, we should urge Congress to consider new regulations that would protect the public from dietary supplements that lack adequate testing for safety and efficacy,'' Lindsay suggests.

Ephedrines are a group of naturally occurring chemical stimulants that increase heart rate and raise blood pressure.

SOURCE: Mayo Clinic Proceedings 2002;77:7-9, 12-16.

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