Ephedra, a short form for the scientific name ephedra sinica, is also known as ma huang, Mormon tea, and other descriptions. Ephedra leaves have been a component of the holistic practices known as traditional Chinese medicine (TCM) for over 3,000 years. The healing and recuperative qualities of the ephedra leaves have been highly valued in the treatment of numerous physical conditions.

Ephedra is a green shrub-like plant native to various parts of China, Japan, and eastern Asia. A similar species was discovered by the settlers to the western United States in the early 1800s, and the plant is now cultivated in various parts of the world. Ephedra is particularly effective in the reduction of swelling in the mucous membranes of the nose and the breathing passages leading to the lungs. Breathing disorders such as asthma and hay fever have proven especially responsive to ephedra treatments. Ephedra leaves, when administered either as a tea or in combination with other herbs, were also known to create a general stimulant effect on the heart and the central nervous system. Ephedra remains a popular natural supplement in both sports specific formats as well as those intended to promote general health and wellness.

The substance that provides ephedra with its therapeutic properties are the alkaloids (a nitrogen-based substance that is neutralized by acids) known as ephedrine and pseudo-ephedrine. Both ephedrine and pseudo-ephedrine are stimulants, each very similar in chemical composition to the other, and each possessing properties similar to those of the natural hormone and stimulant adrenaline. Depending upon the source of the ephedra, ephedrine will comprise between 30% and 90% of the active stimulant in ephedra. Ephedrine is extracted from ephedra leaves to produce crystals that are highly soluble in water; for this reason ephedrine may be readily added to powdered solutions or used in the manufacture of tablets.

The important effects of ephedrine upon the systems of the human body are: central nervous system stimulation; a restriction of blood vessels in the extremities of the body; an increase in heart rate; a corresponding increase in blood pressure; an opening of the bronchial passages and ease of breathing.

Since the 1970s, ephedra has attracted significant attention in North America for its perceived enhancement of athletic performance as a stimulant and its weight loss capabilities. It also acts as an agent to induce thermogenesis, which is the utilization of body fat stores as an energy source. All of these applications have generated controversy centering on the safety of ephedrine usage.

Ephedrine, as a component of over-the-counter cold medications, enjoyed a strong underground reputation as a stimulant among athletes in many sports. National Hockey League (NHL) players have been reputed to be among the most persistent ephedrine users, who consume the substance in the form of Sudafed, an over-the-counter cold medication. Hockey players are on the ice in shifts lasting no more than 60 seconds at a time, and the players have found that the ephedrine seems to provide an edge in their performance. The World Anti-Doping Agency (WADA) lists ephedrine as a prohibited substance, rendering an athlete liable to disqualification from an international sporting event and accompanying suspension, if the ephedrine found present in the athlete's system exceeds 10 micrograms per milliliter (mcg per ml). There is a consensus in the international sport science community that ephedrine is a reasonably effective performance-enhancing drug. Given the wide availability of ephedrine in commercially available formulations, elite athletes who are subject to rigorous drug testing and formidable consequences for a positive test, must themselves be very cautious regarding what supplements they consume as part of their preparation for competition, as the chance of an inadvertent consumption of ephedra or ephedrine is always present.

Ephedrine has generated controversy in a number of countries for its effects in addition to those regarding athletic performance. Ephedra, in its herbal form (and refined ephedrine) were long-time staples in various weight-loss formulations. Stimulants of all types are known to depress appetite; research—including that conducted by the U.S. Food and Drug Agency (FDA)—tended to demonstrate an increase risk of heart attack among some type of ephedra users, particularly those with pre-existing high blood pressure. The FDA moved to ban the sale of all ephedra supplements in the United States in 2004, in the face of significant public protests.

Thermogenesis (expenditure of energy by the body) became a popular athletic training concept, particularly among body builders seeking to reduce body fat content. Thermogenesis supplements sought to force the body, in some circumstances, to utilize fat stores for the production of energy during exercise as opposed to carbohydrate stores. A number of supplements were formulated using ephedrine, often in combination with caffeine, to stimulate the body. The true effectiveness of thermogenetic products is not well established; the use of stimulants, especially in combination, poses risks to persons with pre existing heart or circulatory problems.

SEE ALSO Caffeine; Doping tests; Nervous system; Stimulants; World Anti-Doping Agency (WADA).