New supplements filling ephedra gap

WASHINGTON — People who think ephedra helped them lose weight are looking to new ingredients with names like guarana, bitter orange and green tea extract to replace the soon-to-be-banned dietary supplement.

There's little proof yet that ephedra alternatives actually burn pounds, and scientists warn that some come with health considerations of their own — including an ephedra mimic that might interact dangerously with medicines the dieter also swallows.

"There are a number of, quote-unquote, 'ephedra substitutes' on the market now where even less is known about potential side effects," Food and Drug Administration Commissioner Mark McClellan cautioned in an interview last week.

The FDA will pull ephedra off the market soon and wants consumers to stop immediately using the herbal stimulant, which is linked to 155 deaths and dozens more heart attacks and strokes.

Many consumers are ignoring that advice. There has been a run on remaining ephedra supplements since FDA's warning two weeks ago, even though studies show ephedra helps people lose only a few pounds more than dieting alone.

Still, as January ushers in postholiday diets, Americans are turning to the burgeoning ephedra-free market, too. Topping the lists of new ingredients are caffeine-containing supplements, some that deliver the buzz of at least three cups of coffee in one dose. Not all mention caffeine on the label; consumers may have to learn herbal aliases such as guarana and green tea to ensure they don't get caffeine jitters by taking multiple supplements.

The ingredient drawing the most attention is bitter orange, which McClellan says the FDA is monitoring closely because it contains synephrine, a stimulant chemically similar to ephedra.

Also called citrus aurantium, the peel of this very sour "Seville orange" is found in some foods like orange marmalade.

"It's not as potent as ephedra unless you take it in much higher doses," says Mark Blumenthal of the American Botanical Council.

But some scientists note that synephrine can increase blood pressure and constrict blood vessels, as ephedra does, and question whether using it with caffeine could worsen those effects the way taking ephedra with caffeine does.

"There's not really a reason to think citrus aurantium will be safer," says Dr. Adriane Fugh-Berman of Georgetown University, an expert on herbal supplements.