In 1998, 31-year-old software specialist and single mother Margo Ellis weighed well over 200 pounds. "Once I started having children is when the weight happened, is when it came - my last child was the worst one. It just stuck to me like glue," she says.
There's a lot less of Margo today. She has lost more than 100 pounds - not through rigorous diet or exercise - but with the help of the herbal supplement ephedra.
It's the active ingredient, along with caffeine, in dozens of so-called natural weight-loss products.
Pharmacologist Neal Benowitz says ephedra is no miracle pill. "It causes your heart rate to go up, it causes your blood pressure to go up. It's like amphetamine, not quite as potent, but similar," he says.
Increasing a person's metabolism makes these products work, but it may also make them deadly. Dr. Benowitz looked at 140 adverse reactions reported to the U.S. Food and Drug Administration over a two-year period. He concluded that two-thirds of the medical problems reported were likely caused by supplements containing ephedra.
"There is a precedent for stimulant drugs to cause people to die suddenly, especially when you're exercising." says Benowitz.
And any underlying cardiac problem can add to the risk.
On Oct. 1, 1998, Ann Marie Capati was working out at a gym when she suffered a fatal stroke.
On the advice of a trainer at the gym, she had started taking supplements, including Thermadrene which contains ephedra and caffeine.
Her husband Doug Hanson believes that, for Ann, exercise and ephedra was a lethal combination. "She had high blood pressure, which she had during the first pregnancy with our daughter and in some women it goes away after the pregnancy's finished," explains Doug. "In other women, it carries on. It was mild high blood pressure."
He has filed lawsuits against several supplement makers, Ann's gym and her trainer who he says should have known that high blood pressure put her at high risk.
Pathologist Steven Karch is an expert on stimulant-related death. He believes critics are exaggerating ephedra's risks. "If you consider the 12 million people who took it last year, your odds are pretty small," he says. "I think people with no medical problems and no issues who need to lose weight are OK."
But even Dr. Karch, who speaks on behalf of the supplement industry, says some people should not take it: "Ephedra's not for everybody. I mean, pregnant women shouldn't ever remotely think about it, and neither should anybody who knows they have high blood pressure or a heart attack in the past or anything."
The warnings don't seem to concern a slimmed-down Margo Ellis at all. She's now back on supplements to lose another 10 pounds. "You know, it may affect somebody, you know a certain way, but it may not affect me," she says.
It's attitudes like Margo's that make ephedra's critics shudder.
"If you're a young, healthy person and you take a dietary supplemnt to help you lose weight and you drop dead, that's a pretty serious event, even if it's rare," says Dr. Benowitz. "And the question is, 'are you willing to take that chance?'"
Rick's obsession with his weight can be traced to his struggles as an overweight child.
"I was always large," he says. "I always went through school with a label...fatso, tubby, any cruel name you could think of, that's what I was called."
That he resorted to purging is not surprising to Donnellan. "Eating disorders are not about eating," he says. "They're about how you feel about yourself, it's about self-esteem and self-confidence, and your feeling of control in the world."
Rick says he is seeking help for his disorder to protect his children. "When I hear my daughter say, 'Daddy's going in the bathroom to get sick.' She knows," he says. "If they can develop this kind of illness from seeing me do it all the time, that's the last thing I want."
Anorexia sufferer Dave Scala is another o Donnellan's patients. "I wanted to have no body fat, because I'd get Muscle & Fitness (magazine) and there'd be all these guys, totally cut," he says. "I'm like, 'OK, that's a good thing to do.'"
Dave weighed 105 pounds when he arrived at the Somerset clinic early last August. He had been secretly scheming to get down to 98 pounds.
Dave, who is a researcher in marine microbiology at Rutgers University, realizes his thinking is irrational. But it's still a struggle to try to break the grip his eating disorder has on him. "If I haven't gained, you know, I'm a bad patient. And if I do gain, I'm a bad anorexic," he says. "It's kind of a self-defeating attitude but it's hard to break out of it."
After a six-month stay at the clinic, Dave was released. But he faces an uphill battle to gain control of his illness. Half of all patients with eating disorders struggle with symptoms their entire lives.
Despite the statistics he remains optimistic. "I think I'll beat it," says Dave. "I don't think success means you never have a bad day. I think it means how you cope with having a bad day."
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