Ma huang (raw Ephedra herb)

Tier 4 — risky / avoid · Cardiovascular death

The raw herbal form of ephedra, which contains variable and unpredictable amounts of the stimulant ephedrine. FDA banned ephedra supplements in 2004 after linking them to 155 deaths including heart attacks, strokes, and seizures. The raw herb is even more dangerous than standardised extracts because you cannot control the dose. Still sold in some markets.

Dose: AVOID — 155+ deaths documented; FDA banned in 2004; unpredictable ephedrine content