Xtreme Lean. Trim Fast. Metabolife 356. Those are some of the dietary supplements that contain ephedra and are available in supermarkets and on the web. An herbal stimulant, ephedra is often combined with caffeine and acts like amphetamines, or "speed." Millions of Americans use it, mainly for weight loss or bodybuilding.

But ephedra, also known as ma huang, has been associated with serious health problems including hypertension, irregular heartbeat, stroke, and seizures. Some of those problems resulted in death or permanent injury, and occurred in previously healthy people. Recently, a federal jury in Alabama ordered Metabolife International, a San Diego-based supplements manufacturer, to pay $4.1 million to four people who had a stroke or heart attack after taking the company's diet pills containing ephedra.

Consumer Reports in 1995 was among the first publications to disclose the dangers of ephedra in dietary supplements. Consumers Union, publisher of Consumer Reports, has urged the Food and Drug Administration (FDA) to ban the use of ephedra in supplements. The American Medical Association has also called for such a ban. (The FDA in 1983 banned the combination of caffeine and ephedrine, or synthetic ephedra, in over-the-counter medicines.)

In the meantime, CU is working to educate the public and to urge the enactment of state and local laws that protect consumers from the potential dangers of ephedra. Last year, CU's advocates helped push for laws in California that now prohibit the sale to minors of supplements containing ephedra and that require packaging to contain warning labels, along with the FDA's toll-free MedWatch phone number so consumers can report health problems directly.

CU also recently asked the California attorney general to investigate whether Metabolife violated the California Corporate Criminal Liability Act. The act requires companies to notify state safety officials when they discover a serious danger with a product.

For years, Metabolife had resisted FDA efforts to obtain health complaints filed with the company. Yet in recent months, after the FDA asked the Justice Department to open a criminal investigation, Metabolife turned over 16,100 reports it had received from consumers since 1997 about its ephedra products. Nearly 2,000 reported "significant adverse reactions," including 3 deaths, 20 heart attacks, 24 strokes, and 40 seizures, according to a congressional report.

Consumers Union supported a law in Westchester County, N.Y., that now bans the sale of ephedra to minors and supports a bill in Suffolk County, N.Y., that would ban its sale completely. Ephedra is banned or otherwise regulated by 11 states.

WHAT YOU CAN DO

Do not take supplements or any products that contain ephedra. Counsel your children against taking them.

 Report adverse health effects from any dietary supplements to the FDA at 800 FDA-1088 or www.fda.gov/medwatch.

 Before you take dietary supplements, discuss them with your physician.