With ephedra out of the way, formerly second-tier products in the weight-loss supplement races have been promoted to first position, hawked as the safe and sane alternatives to their risky forebear. But there’s nothing to say these are any safer. They’re simply as unproven and untested as ephedra initially was, and so far, they haven’t proven lethal.

Bitter Orange, an orange peel extract, is the pet ingredient of the moment. Also referred to as zhi shi or citrus aurantium, it contains synephrine, a stimulant chemically similar to ephedrine.

Synephrine can increase blood pressure and constrict blood vessels, as ephedrine does. If it’s mixed with caffeine – as it usually is in supplements – that effect can be enhanced.

Bitter orange also contains furanocoumarin, a known inhibitor of one of the body's drug-metabolism routes, so researchers are also concerned about how bitter orange might interact with other substances, particularly prescription drugs. This should be of particular interest for older consumers because furanocoumarin can cause some medicines – including cough syrup and blood pressure medicines – to build up to toxic levels in the blood.

Country mallow, heart leaf and chikana are other botanicals that contain the stimulant ephedrine. But because the ephedrine content of these plants is not as concentrated as in ephedra, you have to take more to get the same effect, and then – as with bitter orange – the question arises about what other chemical components you might be ingesting.

Most familiar to Americans as the kick in their coffee or cola, caffeine can be a mild appetite suppressant and pick-me-up. But in concentrated doses, it can cause nausea, tremor and circulatory problems. Guarana, kola nut, yerba maté, paulinia cupana, and tea extracts are common sources.

What’s a concentrated dose? Who knows? Just look at the instructions on one new ephedra-free product: “Standard Serving: To maintain energy and burn fat for up to 8 hours, take two tablets daily. Super Serving: To increase energy and fat-burning for up to 8 hours, take three tablets daily. Ultra Serving: For maximum energy and fat- burning for up to 8 hours, take four tablets daily.”

This kind of more-is-better labeling encourages increased consumption without addressing any potential complications.

Remember that manufacturers of ephedra-based products were not forthcoming about the complaints they were getting from consumers and that kept the lid on the problems with ephedra for a long time. If you’re taking dietary supplements for weight loss, keep in mind that the first negative reaction you hear about could be your own.

THROUGH THICK & THIN:

“Ephedra-free!” doesn’t mean worry-free. What are you getting instead? What are the new risks to watch for? The symptoms of overdosing or negative reaction? It’s buyer beware, more than ever now. Resist being lulled by marketing that promises “natural” weight loss. Remember that many toxic poisons are completely natural. That doesn’t make them good for you.

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). Dr. Cederquist is the founder of Bistro M.D., a home diet delivery program that specializes in low calorie gourmet food that is delivered to your home or office. Bistro M.D. serves as culmination of Dr. Cederquist's expertise and experience in the world of medical weight loss.