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Beware of herbs that raise blood pressure

Ephedrine alkaloids, found in many Indian herbs, are stimulants that affect the heart, says Dr KK Aggarwal.

india Updated: Feb 14, 2006 18:51 IST

US FDA off late has banned all plant-based herbal drugs containing Ephadrine alkaloids. Earlier FDA had issued a black box warning label to be put on every herbal product containing ephedra as under: "Use of ephedra has been associated with heart attacks, strokes, seizures and death".

Ephedrine alkaloids are adrenaline-like stimulants that can have potentially dangerous effects to the heart. FDA in the year 2004 declared that dietary supplements containing ephedrine alkaloids present an unreasonable risk of illness and injury.

Ephedrine, a naturally occurring compound found in species of ephedrine behaves much like the drug amphetamine and dexamphetamine used to stimulate energy, reduces obesity and promotes weight loss. It burns fat and hence became a popular source of anti-obesity pills in the West. Another chemically related compound is phenylpropanolamine (PPA), which has been withdrawn from the US market over safety problems in view of more incidence of brain hemorrhage.

There have been 17 reported deaths attributed to herbs containing ephedrine and 800 ephedrine related injuries as per FDA. A 23-year-old Boston student reportedly died after regularly drinking a protein supplement containing ephedrine after two years due to involvement of the heart. A 35-year-old man had a heart attack after having just five capsules before a work out.

Any product, which contains ephedrine, should not be consumed with coffee, tea, cola and other stimulants. Also one should not exercise after ingesting ephedrine. The combination of exercise and ephedrine can raise the heart rate, blood pressure to dangerously high levels.

Ephedrine is present in many Indian and Chinese herbs. A few examples are bala, Ma huang, square tea, Somlata etc. Bala or Sida Cordifolia is present in many Ayurvedic preparations like Mashabaladi Kvatha, Bala Tela, etc. used for hemiplegia, paralysis, headache, sciatica and nervous conditions. Bala telam is used as a cardiac tonic. Somalata is used for respiratory conditions.

Sida Cordifolia extract used in Ayurveda contained 1% of the Alkaloid Ephedrine. Ayurveda describes it as an important anti-pyretic remedy and also as an aphrodisiac.

Many other herbs can also increase blood pressure apart from Ephedra. The other common herb used in Indian practice is Licorice. It contains triterpene glycosides containing glycyrrhizic acid, which can increase the sodium content of blood and raise the blood pressure. Licorice when used in high doses specifically in the form of Licorice candy can cause high blood pressure.

The high dose of Ginseng (30 mg) can also increase the blood pressure, though in smaller doses, 3-4 mg a day, it is known to lower the blood pressure. American Academy of Family Physicians did an exercise of enlisting all the herbs which can cause blood pressure in the year 2003 and they are: Aniseed, St. Johns Wort, Capsicum, Parsley, Blue Cohosh, Vervain, Chaste Berry, Bayberry, Licorice, Ginger, Ginseng, Ephedra Pau d'Arco, Coltsfoot, Gentian, Cola alkaloids, Broom alkaloids, Calamus amines, Guarana.

Four of these herbs are used in Chinese formulary extensively and they are ma-huang, ginseng, licorice and ginger. Licorice can raise the blood pressure by 3 to 14 mmHg. A 5 mm fluctuation in blood pressure reading can alter the cardiac mortality and morbidity by up to 20%.

Most herbs however are safe if taken within the permissible limits. Both "Bala and Somlata" like any allopathic drug should be used within the prescribing limits.

Patients with hypertension should be very careful about keeping their blood pressure within acceptable limits, which is lower than 120/80 mmHg. This can often be accomplished with drugs as well as lifestyle management including proper diet and sufficient exercise. All patients with high blood pressure should know about these compounds and should check for their presence, if any, in dietary supplements and over the counter drugs. Similarly, every family physician in the country must keep this list on his table for a ready reference and check if a blood pressure patient is taking any herbal supplement. Checking for these supplements becomes especially important in patients whose blood pressure is not getting controlled or is fluctuating.

Dr. Aggarwal is President, Heart Care Foundation of India; President, Delhi Medical Association; Sr. Consultant Moolchand Medcity; and Member, Delhi Medical Council.