Fine things are the objects of praise, base things of blame; and at the head of the fine stand the virtues, 
at the head of the base the vices; 
consequently the virtues are objects of praise, 
while the opposite are the objects of blame.
-- Aristotle, Virtues and Vices, 350 B.C.

n the pantheon of Bad Health are the deities of vice: Smoking, Stress, Drinking, Drugs, Malnutrition, Inactivity, Overwork, Being Overweight, and Obesity. Collectively they represent the base things that we blame for our physical ills. If you were to guess which of these behaviors was most responsible for women's health problems, which would it be?

According to a recent study reported in a leading medical journal, the number one health albatross of American women is weighing too much. In lean women who gain as little as 20 pounds, being overweight hastens physical dysfunction nearly three times as quickly as cigarette smoking. Thus, Being Overweight is the top god of Bad Health. As such, it is the forerunner of accelerated aging.

The Parthenon - witness to accelerated aging.

Being overweight is not the same as obesity, which is usually defined (except for those with large muscle mass, such as athletes) as being more than 20% above the normal, desirable weight for one's height. Probably the best definition of obesity is having a body-fat percentage greater than 25% for men and 30% for women. For purposes of the study, the researchers defined women to be overweight if they gained 5-20 pounds above their starting weight during its four-year course. Only 5% of the women gained more than 20 pounds.

For women who started out lean and gained 20 pounds, routine activities such as climbing stairs or walking a block became a significant burden. Excess weight causes the heart to work harder, puts more stress on the joints, and leads to various painful maladies overall.The Harvard Public Health and Medical School authors of the report in the Journal of the American Medical Association wrote of the irony of a culture geared (on the surface) to losing weight - low-fat everything on virtually every shelf in the supermarket - yet achieving just the opposite.1 In the last 15 years, the average weight of U.S. adults (aged 20-74) has increased by 7.6 lbs. And, of course, this has happened despite widespread knowledge that excess weight and obesity are known risk factors for nearly every degenerative disease, including heart disease, high blood pressure, diabetes, and arthritis. They are also known risk factors for gallbladder disease, stroke, and some forms of cancer.

The hard facts are clear: if you carry an added weight of only a few pounds year-in and year-out, you're going to suffer the consequences. Losing weight and keeping it off can help prevent, as well as help undo, some of these problems.

In the Harvard study, 40,000 female nurses (aged 46-71) answered questions, over a four-year period, about their weight change and the ability to perform routine activities such as walking around the block, picking up a bag of groceries, or walking up a flight of stairs. While 17% managed to lose weight, more than twice that number, 38%, gained weight. No matter how much the women weighed when the study began, any weight gain was consistently associated with decreased physical function and vitality, and with increased bodily pain, compared to when their weight was lower. The reverse was found to be true for the far smaller number of women who lost weight. They experienced increased physical function and vitality, and less bodily pain, compared to those who maintained their same weight at the beginning of the study. Interestingly, of the subjects who gained weight, physical decline was far more prevalent than mental health decline. The age of the subjects did not play a factor in either physical or mental decline.

For the researchers, the results "indicate a strong association between weight change and change in health-related quality of life . . . ." They conclude that it is imperative to keep excess weight off, or to shed it if you already carry it. After this, we get the usual medical-establishment litany: the benefits for health are so significant that patients should check with their physician, who "should routinely measure their [weight] and keep track of this and counsel them, if necessary, about steps they can take to avoid weight gain." Yes, see your physician, but there can be no assurances; many of these physicians are the same ones who counseled fen-phen or dexfenfluramine. Why? Because they were plugged into the drug model, the FDA, and the friendly pharmaceutical salesmen who together endorsed and sported the regular use of these inadequately tested drugs. What is a woman to do? (Or a man, for that matter.)

Veteran researcher Dr. A. V. Astrup of the Research Department of Human Nutrition at the Royal Veterinary and Agricultural University in Copenhagen knows better than to fall prey to the latest fad. For Dr. Astrup, "Obesity is characterized by pathophysiological defects affecting both sides of the energy-balance equation."2 His point is that individuals predisposed to obesity take too much energy in - they have impaired appetite control, especially when it comes to fat-rich and energy-dense foods - and their energy output is too small. They exhibit a lower-than-normal resting metabolic rate.

When an inherently low (genetically determined) metabolic rate is coupled with a sedentary lifestyle, there is even lower total energy output, and obesity results before too many years have passed. It can begin in early childhood, in fact, as a casual look at any schoolyard will attest.

Unfortunately, classical treatment programs for obesity provide little in the way of long-term satisfaction for most subjects, a significant portion of whom lose little weight during the therapy and tend to regain it soon thereafter anyway. These individuals have lower energy expenditures and reduced ability to mobilize fat stores - they do not burn fat readily - compared with those who are more successful at losing weight.

To reiterate what is well known, but not well considered, "doctor-knows-best" weight-loss programs do not typically result in long-term weight maintenance. The overwhelming majority of supervised dieters regain everything they lose within one year. Most programs result in dieters weighing more after one year than when they began. Worse still, they end up with a higher percentage of body fat!

There is an effective and safe way to increase energy expenditures by burning fat, the truly undesirable component of weight gain. (Rigorous exercisers and body builders gain weight in the form of muscle, which, of course, is desirable.) Used successfully for over 5,000 years, this method involves the use of ephedrine to enhance a natural biological mechanism for burning fat to produce energy, called thermogenesis. In the 1980s, the first thermogenic studies in humans demonstrated that obese women who took 20 mg of ephedrine three times per day (without changing their diet) lost about one pound per week. Ephedrine is a natural component of the herb ephedra, also known as ma huang, which has been brewed in Asia as a tea and used traditionally to help alleviate asthma, increase mental acuity, and increase energy expenditure by burning fat away.

Thermogenic therapy through the use of dietary supplementation to stimulate the fat-burning process is a reasonable way to increase one's metabolic rate. An intelligently designed dietary supplement containing ephedrine can also help satisfy appetite while stimulating energy expenditure through the burning of fat. Also at the core of a "smart" thermogenic supplement is the ingredient caffeine, which has been shown to increase the thermogenic effectiveness of ephedrine as a fat burner safely and, as a bonus, to enhance mental sharpness.

Overall, ephedrine and caffeine can increase energy expenditure by 5-10% via stimulation of the receptors in the highly specialized fat cells called brown adipose fat. These cells have more mitochondria than other fat cells, which accounts for their color. Mitochondria are the furnaces of energy production in the cell; when thermogenically stoked (by taking ephedrine and caffeine), they can dramatically increase energy expenditure through increased fat burning. When this process is not fully compensated by increased energy intake - which is possible with the appetite-satisfying aspects of a good dietary formulation - a negative energy balance occurs. In other words, more energy goes out than comes in, the net result of which is weight loss.

What's more, thermogenic weight loss resulting from ephedrine/caffeine use is likely to have more lasting benefits compared to most conventional weight-loss programs or diet fads, thus leading to long-term weight maintenance.

Using data from the 1996 state-based Behavioral Risk Factor Surveillance System (BRFSS), it was shown that more than two-thirds of U.S. adults are trying to lose or maintain weight.3 Yet whatever their intent, it's clearly not working. While the usual route to dieting entails reducing the amount of food consumed, many (especially men) attempt to "diet" by decreasing fat intake without reducing overall calories consumed. Exercise is beneficial for losing and controlling weight, yet the BRFSS data showed that only one-fifth of those trying to lose weight reported reduced caloric intake and sufficient exercise (150 minutes or more of physical activity each week). Thus, although most Americans try dieting or exercise or both for weight loss, only a small minority use the recommended combination of both.4

According to one study, the thermogenic supplements ephedrine and caffeine can enable a greater proportion of patients to maintain a satisfactory weight loss, compared with patients following conventional programs alone.5 The chances of long-term success would be even greater with a comprehensive weight-loss program involving exercise. Ephedrine and caffeine can help reduce fat stores to a lower level and stabilize the size of the fat cells, thus contributing to a decrease in the primary risk factor for degenerative diseases such as arthritis, cardiovascular disease, and diabetes, along with their associated morbidities.

Researchers at the Pennington Biomedical Research Center in Baton Rouge, LA set out to evaluate the costs of treating obesity with a variety of the leading drug combinations, including fenfluramine/mazindol, fenfluramine/phentermine (fen-phen), and mazindol alone, as well as ephedrine/caffeine. The results of evaluating the drug or supplement costs incurred by 73 of 220 subjects were interesting.6 All subjects were between 18 and 60 years of age and overweight. Some had been taking various drugs before the study, including medications for diabetes, high cholesterol, or high blood pressure. Weight losses of 6% to 10% of initial body weight were accompanied by improved insulin resistance, lower cholesterol, and lower blood pressure. Pharmacy costs were reduced substantially for all who had previously been undergoing treatment for diabetes and high cholesterol, but not for high blood pressure. However, ephedrine/caffeine was found to be the most cost-effective of the three treatments in reducing weight, cardiac risk, and LDL (low-density lipoprotein, or "bad" cholesterol).

Studies have shown that the most effective amount of ephedrine/caffeine is 20 mg of ephedrine with 100-200 mg of caffeine - sensitivities to these items will vary. Although the studies used three servings per day one hour before meals, two or even one serving can be on target, especially when initiating a program, as well as for maintenance. If you have difficulty sleeping, cut out the last serving of the day (dinner or lunch).

From time to time in the last few years, there have been scare stories about ephedrine and ma huang in the press, emanating from politically oriented health centers with an axe to grind. However, ephedrine has been found to be quite safe when used at the recommended levels. In fact, studies have shown that the regular use of ephedrine does not, at recommended levels, result in any kind of toxic effects. In one study, it increased the life span of female rats: 78% of the rats given ephedrine were still alive at two years, versus only 54% of the control group.7 The ephedrine-fed animals maintained body weights 5-18% below those of the controls.

One of the worst things about being overweight is the scorn that others - and we ourselves, often - heap upon the condition. How deeply hurtful that can be, especially when others strike out at those who are overweight as if it were a character flaw. The tragedy is that many of us ultimately give up and blame ourselves, contributing to what becomes a self-fulfilling prophecy.

But life enhancement is about what we can do to make ourselves healthier and happier, and fat loss definitely falls into that category. Nonetheless, a concerted weight-control program may fail, even with caloric restriction and exercise, if we are not strongly motivated to stay the course, and especially after backsliding. Because of its mental-enhancement benefits, as well as many other scientifically supported reasons, the thermogenic duo ephedrine/caffeine can help you to stay on track. In Greek mythology, the gods who inhabit Mount Olympus (and who are also found represented in the Parthenon) have all the flaws of humans, yet they never grow old or have problems with their health. And they never get fat! We mere mortals can avoid getting fat too, but we must practice the virtue of taking care of ourselves. A good start is a thermogenic program as an integral part to help win the battle of the bulge, and leave blame to the gods.

It is not advisable for people with cardiovascular disease, angina (chest pain), high blood pressure, thyroid disease, or a history of drug abuse, or for men with enlarged prostate, to use ephedrine - without medical supervision, that is. Even though ephedrine may help with some of the above conditions - for example, weight loss helps to improve high blood pressure - it is important that its use by people with these conditions be supervised by a medical professional.


  1. Fine JT, Colditz GA, Coakley EH, Moseley G, Manson JE, Willett WC, Kawachi I. A prospective study of weight change and health-related quality of life in women. JAMA 1999;282:2136-42.
  2. Astrup A, Lundsgaard C. What do pharmacological approaches to obesity management offer? Linking pharmacological mechanisms of obesity management agents to clinical practice. Exp Clin Endocrinol Diabetes 1998;106 Suppl 2:29-34.
  3. Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for controlling weight. JAMA1999;282:1353-8.
  4. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995. Washington, DC: US Dept of Agriculture, Agricultural Research Services, 1995.
  5. Toubro S, Astrup A. Randomized comparison of diets for maintaining obese subjects' weight after major weight loss: ad lib, low fat, high carbohydrate diet v fixed energy intake. BMJ 1997;314:29-34.
  6. Greenway FL, Ryan DH, Bray GA, Rood JC, Tucker EW, Smith SR. Obesity research recently evaluated. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res 1999 Nov;7(6):523-31.
  7. NTP technical report on the toxicology and carcinogenesis studies of ephedrine sulfate. National Toxicology Program. U.S. Dept. of Health and Human Services. 86-2563. Series title: Technical report series; no. 307, 1986.