Pro Page

Ephedrine- What's the Big Deal?

In the year 2048, all Americans will be overweight or obese. This is the prediction, based on current trends, in an article by Wang et al. published in the journal Obesity. By 2030 86.3% of Americans will be overweight. The costs of “globesity” are particularly disturbing, given the current economic crisis—predicted obesity health care costs of 860.7–956.9 billion US dollars are expected by 2030, which is 16–18% of total US health-care costs.

If a weight loss method works it should not be tossed aside based on media ramblings and poor distribution and dosing methods. The combination of ephedrine and caffeine purposes of weight loss has a bad reputation. As noted by the NY Times in 1999, ephedrine has been used as an asthma medication since the 1920s, so why is the drug suddenly so controversial? Most likely, health care professionals are disturbed by the off-label use of ephedrine and ephedra, in combination with caffeine, for weight loss in combination. Is weight loss combo effective—is it safe—how does it compare to weight loss drug that are currently approved by the FDA?

Is Ephedrine Effective?

As noted in a meta-analysis published in the Journal of the American Medical Association (JAMA), the combination of simply ephedrine and caffeine, without any other herbal components leads of a monthly weight loss 1 kilogram over placebo, this is about 2.2 pounds. The longest running ephredra trial, conducted by Boozer et al, was 6 months long, and revealed a weight loss of about 11.6 pounds for obese people taking the treatment, which was about 6 pounds more weight loss than participants who took a placebo. This level of weight loss sits comfortably within the 10 to 15 pound weight range recommended by the American Diabetes Association to help lower blood sugar, blood pressure, and blood fat levels.

Is Ephedrine Safe?

Ephedrine is a drug; ephedra is a bioactive herb. All drugs have side effects and ephedrine does as well. As detailed by the JAMA article, use of ephedrine and caffeine for weight loss may experience psychiatric, gastrointestinal symptoms, and heart palpitations. Interestingly, a meta-analysis of the drug sibutramine, by Arterburn and friends, reveals the same history of side effects for this weight loss tool. This is because both ephedrine and sibutramine work by activating the “fight or flight” response. Furthermore, cases of psychosis or death in ephedra users are associated with abuse and overdose of the drug or pre-existing heart and blood pressure problems in case reports. These side effects are evidence that a doctor should prescribe appropriate doses of the drug combination; research provides support that intelligent and appropriately dosed ephedrine and caffeine may be useful for weight loss. Ephedra is safest when it is dosed by a medical professional and side effects are regularly monitored, just like any other drug!

How Does Ephedrine Compare to Other Weight Loss Drugs?

Though permanent weight loss will NEVER be achieved without a healthy diet and consistent exercise, our society values the use of medicines for obesity intervention.
Sibutrimine and Orlistat are two weight loss drugs currently approved by the FDA. According to Arterburn above, on average, sibutramine resulted in weight loss of about 7 pounds in 3 month trials and 10 pounds after one year of taking the medication. A review conducted by Padwa et al showed that taking orlistat for a year resulted in about a 6 pound increase in weight loss over placebo. Based recent, large reviews of the weight loss research, the effectiveness of the ephedrine-caffeine combination is comparable to weight loss treatments currently approved by the FDA.

America, we’ve got bigger problems. In 2000, there were 435,000 tobacco-related deaths, 400,000 deaths related to poor diet and physical inactivity, and 85,000 deaths due to alcohol consumption (Mokdad et al, JAMA 2004),. The number of deaths related to ephedrine over the entire history of its use are minimal when compared to major sources of mortality, yet the “the dangers” of ephedrine are so widely proclaimed. Undoubtedly, watching six hours of TV a day and snacking on a donut present a far more urgent danger. Given the similar effectiveness and safety of the ephedrine-caffeine combination and currently approved weight loss medicines, is it appropriate for the media and some medical professionals to demonize ephedra? It would do the country a greater service if the FDA would ban tobacco and give lame supplement-blasting a rest.

In conclusion a quote by F.L. Greenway, M.D.:

“The benefits of caffeine and ephedrine in treating obesity appear to outweigh the small associated risks. Restriction of dietary herbal supplements containing caffeine and ephedrine, often with other ingredients, should be based on controlled clinical trials of these products.”

Milk Your Workout for all It’s Worth—5 Wheys Low-Fat Dairy is a Nutrient Powerhouse

Is your body getting what it needs after a workout? So many sports and health products are released every year; each one boasting superior benefits for workout recovery. Neon-colored drinks are posed as the best source of hydration, while formulations designed to emulate human milk are advertised as optimal muscle-building fuel, with little or no research to support the claims. If your blender is simply building clutter, and doing little for your muscles, look no further than your cooler or your local grocer or convenience store for a convenient, effective post workout. Plain old non-fat or low-fat milk is a perfect post-workout recovery drink.

�

So what are some traits of a good workout supplement?

�

1. Provides carbohydrates in the form of sugar

2. Good source of high quality protein, but is also low in fat

3. Protein content also has branched-chain amino acids

4. Contains liquid and electrolytes

5. Inexpensive and convenient

�

-------------

�

1. Provides carbohydrates in the form of sugar

�

After a workout, the body needs recovery food to completely benefit from the exercise. Carbohydrates are important after a workout for a few reasons. First of all, they help to maintain blood sugar, especially for people who are likely to experience hypoglycemic (low blood sugar) symptoms; Type 2 diabetics fall into this category.

�

Also, sugar is a potent stimulator of insulin. Following a workout, insulin binds to recpetors on the muscle and sends a“signal” that it is time to make protein. An insulin spike right after a workout tells the genes for making muscle proteins to become activated. Finally, sugar is a good source of carbohydrate for the quick replacement of glycogen stores. This is especially important for athletes (of any age and competition level) who will be playing in a tournament or several matches back to back. Athletes “hit the wall” when muscle glycogen is depleted; the sooner carbohydrate makes it to your muscles, the better. Skim milk contains the two-unit sugar lactose.

�

Also, sweetened low-fat milk products are also good to have after a workout. One study, conducted by Karp and his colleagues, compared low-fat chocolate milk to either a traditional hydration drink or another carbohydrate-containing beverage in between two hard endurance workouts. The athletes who got the chocolate milk were able to exercise longer in the second bout. In addition to chocolate milk, low-fat ice cream or low-fat yogurt are also good choices.

�

2. Good source of high quality protein, but is also low in fat

�

Once the muscles get the signal to increase protein synthesis, they need a steady stream of building blocks, or amino acids, to complete the process. Amino acids are obtained from protein in food. Milk is an especially good source of protein because it contains both quick-absorbing whey and slower-absorbing casein. Both of these protein types are shown to increase protein synthesis after a workout; however, some researchers think that the muscle-building benefits of each protein are maximized when the two are taken together.

�

Unfortunately, many high quality protein sources are in solid form and also packaged with a lot of extra fat. Fat slows the rate at which food is emptied from the stomach into the small intestine, so having too much fat after a workout slows the adsorption of much-needed sugars and amino acids into the blood. This is why high-fat post-workout drink may not be a good choice. Low-fat dairy is one of the few natural, high-quality protein, low-fat post workout options.

�

3. Protein content also has branched-chain amino acids

�

Not all amino acids are created equal. Some cannot be made in the body and are considered “essential.” Branched-chain amino acids (BCAA) and the BCAA leucine, in particular, are special for a couple of reasons. First of all, the muscle prefers to use BCAA as fuel during a workout; the body will break down your own muscle mass to get them if your supply if insufficient, since all BCAA are essential amino acids. Also, the BCAA leucine, like insulin, tells the muscles to make more structural proteins, so leucine is both a nutrient and a “signal.”

�

Low-fat milk is a great source of leucine; specifically, milk contains about 0.8g of leucine per 8oz (240mL) cup. Typically, sports nutrition experts recommend about 1.5-2 grams of leucine following a workout; therefore, 2 cups of fat-free milk would put you the ball park by providing 1.6 grams of muscle-building leucine.

�

4. Contains liquid and electrolytes

�

Until recently, it was assumed that the best post workout hydration source is an fruity electrolyte drink. However, a recent article published in the British Journal of Nutrition found that low-fat milk promotes hydration after exercise better than either commonly used sports drink or water.

�

5. Inexpensive and convenient

�

Last, but certainly not least, you shouldn’t have to go out of your way to give your body what it needs after a hard day and an even harder workout. Low-fat milk, ice cream and yogurts are everywhere! In summary, according to Karen Kafer, RD, National Dairy Council, “[Milk is a] nutrient-rich package…for athletes: protein, carbohydrates, fluid and electrolytes, and vitamins and minerals. The vitamin and mineral package in milk includes calcium, phosphorus, vitamin D, vitamin A, riboflavin, vitamin B12, niacin and potassium. Together these help with strong bones, convert energy to fuel working muscles and maintain fluid and mineral balance."

All-Natural, Gluten-Free Date Soy Cups

Elemental Nutrition Vanilla Soy Protein
3 Tbsp unsweetened soy milk
2 ½ Tbsp regular Molasses
1 large egg
¼ tsp nutmeg
1 tsp cinnamon
¼ tsp cloves
½ tsp ginger
1 tsp natural vanilla flavor
juice from 1 lemon
Preheat oven to 350 F

Instructions
1. Toast pumpkin seeds for 3-5 minutes, until light golden brown (if raw)
2. Process next ten ingredients in a food processor
3. Pour batter into equal parts into 8 muffin container* spaces
4. Top each with one Tbsp of toasted pumpkin seeds
5. Bake for 15-20 minutes until completely set

Nutrition
235 Calories, 11 g protein, 7 g fat, 1.5 g sat fat, 36 g carbs, 5 g fiber

*I used silicone containers because they do not have to be greased. If using a aluminum container, spray with cooking spray or use paper holders.

Muscle Inferno: How many Calories is your Lean Mass Actually Burning?

If your answer is 30-50 extra Calories per pound of added muscle, you are ... dead wrong! This muscle myth is a wide-spread and detrimental piece of misinformation; extra muscle mass will improve health, improve functional strength, and make you sizzle, but the amount of muscle gained through resistance training in the short term will not send the metabolism soaring.

A top notch article (1: Best Pract Res Clin Gastroenterol. 2004 Dec;18(6):1009-29) reviewed the impact of various kinds of exercise on weight loss and metabolism, which was compiled for the American College of Sports Medicine (ACSM). To write this kind of paper, the authors searched extensively for the relevant scientific research about a topic and then combine all the results statistically to draw a conclusion.

The article states that 1 kg of muscle mass burns an additional 25-50 calories; the high estimate would translate to an additional 11.4 Calories per pound of lean muscle mass added. Consequently, this value is very similar to a value of 13 Calories/pound that I determined by statistically analyzing the data from my lab at Baylor University. The most conservative estimate predicts that an extra pound of muscle burns only about 7 Calories/pound.

A value of 30-50 kcal/lb of lean muscle is unrealistic and untrue, though it is published a lot in popular media. Numbers this high do not make practical sense. For instance, suppose a typical male bodybuilder has 100 lbs of muscle mass (not including the bone, organs and other components of fat-free mass), the mythical numbers would suggest that his muscle alone is burning between 3000-5000 Calories a day. On top of that, organs burn far more Calories per pound than muscle, so based on popular dogma, the man above maybe about 6000 Calories/day. I've measure the metabolism of countless athletic men, and roughly 3000 total Calories per day would be high for an athletic man of this size.

When high values are provided in articles, they are not supported by scientific literature; however, articles that reference research always suggest lower number, which generally range between 5-15 Calories per pound of muscle. Another good article that addresses this topic is below:

http://www.optimalhealthpartner.com/Media/Myth%20of%20muscle%20as%20calorie%20burner.htm

Worried About Wheat? Celiac and Giving up Gluten

Hi Jean,

I wanted to ask you if you had any experience with the “making” of food. I know that you are a nutritionist and are in a PhD program, but have you ever made specific food before?

I’m inquiring because I’m looking into “wheat and gluten free” products. My mother and sister cannot eat wheat; they have celiac disease, and are on a wheat free diet. They are doing fine, and there are a number of products available for them to eat.

I think that the whole “wheat free” diet could be a fast catching and healthy fad. It seems to me that it eliminates most carbs. Not sure where “wheat” stands on the healthy scale, or what the real health value of the food that they replace it with( rice based, gluten free products) is. But I wanted to ask if you knew anything about this.

-PJ

I actually worked as a healthy cooking instructor for a little over a year while I lived in Buffalo, NY. Though I didn't have a lot of cooking experience when I started, the cooking school was required to have an RD (registered dietitian) to teach their general health and fitness cooking class. Since the manager already knew me, I got the job, though I floundered a lot in the beginning. Let me just say, it's hard to cook four-five courses for 30 people in two hours! In any case, I'm certainly not a chef, but I do develop recipes that fit clear nutritional considerations-- my recipes are generally low-processed, high-protein, low-fat, and rich in antioxidant vitamins and minerals.

Celiac disease (CD) is a autoimmune condition (the mounts and inflammatory response against itself); the disease may be "triggered" by stressful or traumatic event, including surgery, pregnancy, childbirth, or severe infections. A person dealing with CD has a body responds very badly to the gluten protein found in wheat and some other grains, specifically: rye barley, and oats (to some extent). Gluten is created in foods when two proteins, glutenin and gliadin, are processed together to make the gluten product. For example, when kneading homemade bread-the gluten forms gives the dough elasticity and allows the bread to rise and hold a shape. Thus, it is very hard to produce gluten-free breads, because it is difficult to find a good substitute with the same shape-holding ability of gluten. Furthermore, CD is distinct from a gluten allergy.

A food allergy generally results when a whole food protein or peptide is absorbed and the body mounts a immune response to protein, which the body see as an "invader." The body's response to the food is a lot more damaging the actual food protein, but that's how allergies work! Celiac disease, on the other hand, just completely screws up the small intestine and makes it nearly impossible for the person with CD to absorb nutrients, vitamins, or minerals. CD individuals also experience, bloating and other stomach problems, unexplained rashes, loss of energy, joint pain or may have no symptoms at all. If a CD patient continues to eat wheat, and other gluten containing foods, he or she will be at increased risk of malnutrition and other diseases over time.

For people who do not have a wheat allergy, gluten allergy, or Celiac disease, wheat is NOT unhealthy. I think the primary problem with wheat is that is such a dominant grain in our diet that dietary "variety" for many is defined as: wheat bagel for breakfast, wheat crackers for a snack, whole wheat bread at lunch, and whole wheat pasta at dinner-- catch my drift? It's all wheat and your body is continually exposed to the same irritant over and over if you have an intolerance!

There are many other good sources of carbohydrates in the Americans diet that are wheat-free for instance: rice, corn, all fruits, starchy vegetables (potatoes, peas, sweet potatoes), and legumes (including lentils and beans). Carbohydrates are a NEEDED part of the diet and should not be considered unhealthy, especially by athletes. My own carbohydrate intake ranges typically from 40-50% of my total calorie intake and my body fat has not been above 17.5% on the DXA in the last three years, this is despite an "off-season" where I do limited cardio and eat a lot more overall calories. Carbs are not bad. The wrong carbs (added sugars, corn/rice syrups, white flour, including rice flour!), over-representation of wheat in the general diet, and high intake of highly processed foods are unhealthy.

There are many gluten-free processed products out there. Except for the case of CD, I would not consider gluten-free processed products inherently healthier than regular highly-processed wheat products. On the other hand, an individual can make a healthy and varied gluten-free diet by focusing on whole foods. In fact, eating too many processed products that claim to be gluten-free may place individuals who have the problem at greater risk, since many factories may manufacture both kinds of products, which presents a risk of cross-contamination!

If someone wanted to make a fad out of wheat/gluten-free, I think it's possible; however, it already been a fad for years in the bodybuilding world and in some health circles. It would also be unethical to manipulative advertising to convince the general population that they should be on a gluten-free diet. About 1% of the American population has CD; however, the number of people currently diagnosed with CD about 0.25%; so, for every person found to have CD, there are 3 to 10 more who are ignorantly living with the disease, symptoms, and chronic health risks. Personally, I would love to see population-wide Celiac testing-- a number of serious genetic condition are tested for at birth in the US, which have much lower prevalence (though more immediate detrimental effects). Though CD cannot be tested for until the age of two, the implications are serious and the incidence, 1 in 100, is high enough that early screening could improve the health of Americans and reduce long-term health care costs resulting from CD-associated chronic diseases.