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The Post-Ephedra Era

It didn't take the FDA ruling banning the sale of supplements containing ephedrine alkaloids (ephedra) to dethrone the king of appetite-suppressing, fat-loss, energy-boosting, performance-enhancing supplements. Ephedra sales have been declining since it was associated with several high-profile stories in 2002 and 2003 — at what seemed to be the height of its popularity. Increased insurance costs to the manufacturers, increased liability to the retailers and growing consumer concern all contributed to the relatively quick change to ephedra-free alternative products. Many retail stores — including GNC — voluntarily stopped carrying all supplements that contained ephedra. Even before the FDA ruling, New York, Illinois and California banned ephedra sales in 2003.

The supplement industry has become much more complicated since the release of the Dietary Supplement Health and Education Act (DSHEA) in 1994. The government claimed that the supplement industry was in need of regulation, while the supplement industry felt that self-regulation would keep the industry honest and governmental regulation would limit the public's power of choice. In the end, the DSHEA gave more freedom to the supplement industry and unfortunately a window of opportunity for those questionable organizations in the supplement industry to exploit the public.

Ephedra is by no means the only supplement receiving criticism. But it is the first successfully targeted by the FDA. How does the banning of ephedra affect the sale of other supplements? Which supplement will get the axe next…citrus aurantium (bitter orange), yerba mate, gurarana, green tea extract? These compounds are ingredients in many of the new “ephedrine-free” supplements. Although none have been shown to be as risky (or effective) as ephedra, the recent FDA ruling almost guarantees that they will be closely scrutinized for safety.


How does a health professional know what supplements to recommend or sell? You need to do your homework. Scientific research in peer-reviewed journals gives legitimacy to any health-related issue, but it cannot stop there. Many weak studies make their way into journals, but more important, legitimate research studies are often misinterpreted or generalized to the wrong population. Animal studies do not necessarily cross over for humans. Findings from studies done on sedentary, ill people do not work for athletes. Even if an advertisement claims to be backed by research, always ask yourself, “who sponsored the research? Who benefits from the results?” The jury is still out on whether the FDA overreacted with the ephedrine situation.

On the other hand, history has shown us that a legitimate supplement can be damaged due to bad press. Case in point, for years many people tried to place a black mark on creatine based on a few extreme cases of adverse reactions. These cases were found to have several factors involved that were unrelated to creatine intake. Today, the “experts” agree that creatine is effective and safe when used in the right situations.

In an ideal world, a healthy, balanced diet would provide all the nutrients we need for optimal health and disease prevention. The reality is that today's hectic lifestyle has resulted in the consumption of too many processed foods and generally poor diets. In addition, people who exercise regularly may have increased needs for certain nutrients. With these factors combined, it is possible that supplementation — based on individualized need — may have some value.

If you choose to sell supplements to your clients, you need to be willing to continually do research, interpret both scientific and popular literature, and do a risk-benefit analysis of any products offered. A few ways to do this is to research specific supplement companies and offer only products from a company that you have complete confidence in. Another option is to use an independent lab to search out products. Three Web sites are, and Although there is an annual fee for full access, it is worth it.

The supplement business is complicated and risky…but it can be profitable. If you choose to recommend or sell supplements to your clients, make sure you do your homework to avoid any unfortunate situations in the future.

Christine Karpinski, M.A., R.D., owns Nutrition Edge Inc. in Wilmington, DE. She is a registered dietitian and exercise physiologist. Christine can be reached at or by phone at 302-656-FOOD.

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