Adaptogens (General Antistress Supplements)
One of the primary traditional approaches to dealing with chronic stress involves the use of a class of herbs referred to collectively as adaptogens. (An adaptogen is a substance that helps one adapt to stressful situations.) These herbs-most notably ginseng, ashwagandha, schisandra, rhodiola, astragalus, suma, and several Asian mushrooms (reishi, maitake, and shiitake)-are thought to alleviate many symptoms and side effects of chronic stress because they help to bring many metabolic systems back toward normal ranges. While the mechanisms of action for these antistress effects are not completely understood for most adaptogenic herbs (and for suma and the Asian mushrooms there is a lack of Western scientific evidence to support their centuries-old use for treating fatigue, anxiety, and stress), across the studies that have been conducted, it is clear that at least part of this adaptogenic response is due to effects of the herbs within the adrenal glands, the same place where cortisol is produced.
A variety of experiments have demonstrated similarities among the various adaptogenic herbs in affecting both the adrenal glands and the HPA axis. (Recall from earlier chapters that the HPA axis is the system of three hormonal glands that together mediate our response to stress.) In animal experiments, the range of compounds isolated from adaptogenic herbs appears to provide a "buffering" or "balancing" action that counteracts an exaggerated adrenal response to stress and reduces cortisol secretion while also stimulating adrenal-gland activity during periods of fatigue and low energy levels.
Ginseng is perhaps the most potent (or at least the best known) of the adaptogens. A strain of ginseng known as panax ginseng (also called Korean ginseng) provides the most well-substantiated effects. Other forms, such as American and Siberian ginseng, contain some of the same compounds found in the Korean species, but in slightly different proportions that provide slightly different effects in terms of antistress benefits. Numerous animal and human studies show that ginseng can increase energy and endurance, improve mental function (learning and maze tests), and improve overall resistance to various stressors including viruses and bacteria, extreme exercise, and sleep deprivation. Human studies have shown improved immune function and reduced incidence of colds and flu following a month of supplementation with 100 mg per day of panax ginseng. In a handful of studies, ginseng supplementation has also provided benefits in mental functioning in volunteers exposed to stress; improvements in ability to form abstract thoughts, in reaction times, and in scores on tests of memory and concentration. In studies that measure general quality-of-life issues, ginseng supplementation at doses of 100-200 mg per day tends to result in improvements in mood, energy levels, stamina, and overall well-being.
In traditional Chinese medicine (TCM), panax ginseng is used as a tonic herb (a substance used to generally strengthen and invigorate the body) with adaptogenic properties. Some studies of ginseng have shown increased energy levels in fatigued subjects, but the majority of ginseng studies (mostly looking at athletic performance) have shown little to no effect. The differences between study results may be due to the fact that many commercially available ginseng supplements actually contain little or no ginseng at all, because the "real stuff" is very expensive.
Siberian ginseng (Eleutherococcus senticosus; eleuthero for short) is not truly ginseng, but it's a close enough cousin to deliver some of the same energetic benefits. Eleuthero is also known as ciwujia in popular sports/energy products. The Siberian form of ginseng is generally a less expensive alternative to Asian/Korean or panax ginseng, though it may have more of a stimulatory effect rather than an adaptogenic effect-not necessarily a bad thing if you just need a boost. Often promoted as an athletic performance enhancer, eleuthero may also provide mild to moderate benefits in promoting recovery following intense exercise, perhaps due in part to an enhanced delivery of oxygen to recovering muscles.
The active compounds in ginseng are known as ginsenosides, and most of the top-quality ginseng supplements will be standardized for ginsenoside content. It is thought that the ginsenosides interact within the hypothalamic-pituitary-adrenal (HPA) axis to balance the body's secretion of adrenocorticotropic hormone (ACTH) and cortisol. ACTH has the ability to bind directly to brain cells and can affect a variety of stress-related processes in the body.
In general, 100-300 mg per day of properly standardized ginseng can improve general indices of stress and reduce the cortisol-to-testosterone ratio, which is a general gauge of overall stress. Ginseng is one of the many herbal supplements that can be purchased readily as a whole root, a dried powder, or a standardized extract. Because roots and powders can vary widely in their content of active compounds, the most precise approach to ensure that you are getting an effective product is to use a standardized extract. It is also very important to select your ginseng supplement from a reliable manufacturer, as there are numerous examples of commercial products that provide little or no actual ginseng. Products should be standardized to contain 4-5 percent ginsenosides (for panax ginseng) or 0.5-1.0 percent eleutherosides (for Siberian ginseng). A daily intake of 100-300 mg for three to six weeks is recommended to produce adaptogenic and energetic benefits.
For the most part, plants in the ginseng family are generally considered to be quite safe. There are no known drug interactions, contraindications, common allergic reactions, or toxicity associated with Siberian ginseng, panax ginseng, or American ginseng. However, a word of caution is recommended for individuals with hypertension, as the stimulatory nature of some ginseng preparations has been reported to increase blood pressure. Additionally, individuals prone to hypoglycemia (low blood sugar) should use ginseng with caution due to the reported effects of ginseng to reduce blood-sugar levels.
Ashwagandha (Withania somnifera) is an herb from India that is sometimes called Indian ginseng-not because it is part of the ginseng family, but to suggest energy-promoting and antistress benefits that are similar to the ones attributed to the more well known Asian and Siberian ginsengs. Although very little research has been done on ashwagandha, herbalists and natural-medicine practitioners often recommend the herb to combat stress and fatigue. Traditional use of ashwagandha in Indian (Ayurvedic) medicine is to "balance life forces" during stress and aging.
Commercial ashwagandha products are available in a variety of forms-from tablets and capsules to teas and liquids. Standardized powders provided as tablets or capsules generally provide the most stable and convenient form. General dosage recommendations for ashwagandha range from 500 to 1,000 mg per day of an extract standardized to 1-2 percent withanolides, the herb's primary active component. Withanolides are thought to contribute to the calming effects of ashwagandha during periods of stress and may account for the use of ashwagandha as both a general tonic during stressful situations (where it is both calming and fatigue fighting) and as a treatment for insomnia (where it promotes relaxation).
No long-term safety studies have been conducted on ashwagandha, but no reports of adverse side effects have been reported. Because of the effects of ashwagandha on muscle relaxation and as a mild central nervous system depressant, the herb should not be combined with alcohol or other sedatives, sleep aids, or anxiolytics (antianxiety medications). Pregnant women are advised to avoid ashwagandha due to its reported abortifacient (abortion-inducing) effects and potential to induce premature labor.
Tracy was a nurse in a critical-care hospital unit-and the long hours and irregular sleep schedule were beginning to wear her down. Strangely, despite her extreme level of fatigue when she eventually returned home each night, she had a great deal of trouble relaxing and falling asleep. Tracy tried several over-the-counter sleep remedies without much success, and she hated the hungover feeling they left her with the next morning. By incorporating a daily supplement of ashwagandha (150 mg in the a.m. and 300 mg in the p.m.), Tracy was able to control her feelings of stress while at work, without feeling sleepy, as well as to induce relaxation and restful sleep at night.
Suma (Pfaffia paniculata) is a large ground vine native to Central and South America; it is most notably from Brazil and often called Brazilian ginseng. Traditional use of suma has been for improving overall health and as a treatment for virtually every illness, leading to its native name of para toda (which literally translates to "for everything"). Modern recommendations for suma include claims of effects as an adaptogen, an immune booster, and a treatment for chronic fatigue and anxiety.
According to most contemporary herbalists, suma is best understood as an adaptogen, a substance that helps one adapt to stress and fight infection. Along with other adaptogens, such as eleuthero, Russian Olympic athletes have used suma in the belief that it will enhance sports performance. In the United States, suma is often recommended as a general strengthener of the body, as well as for treatment of chronic fatigue syndrome, ulcers, anxiety, impotence, and low resistance to illness-each of which is related to stress. Few studies have been conducted on suma, but those that are available (in animals) show an immune-strengthening and sexual-stimulation effect, providing at least a small measure of support for the traditional use of the plant.
The typical dosage of suma is 500-1,000 mg per day during periods of heightened stress, anxiety, or fatigue. Suma is rarely found as a stand-alone commercial product, but is typically combined with other ingredients for targeting a specific condition (e.g., suma might be added to ginger and fiber to treat stress-induced ulcers).Schisandra
The fruit of the schisandra plant (Schisandra chinensis), also known as wu-wei-wi and sometimes spelled with a z (schizandra), has a long history of use in traditional Chinese medicine as an herb capable of promoting general well-being and enhancing vitality. In addition to its traditional uses for promoting energy and alleviating exhaustion and immune-system disturbances caused by stress, schisandra has historically been taken to strengthen the sex organs and promote mental function.
Schisandra is touted as a member of the adaptogen family, along with ginseng and related herbs, because of the presence of compounds thought to balance bodily functions related to stress. Lignans are a main constituent of schisandra and may be responsible for the herb's effects in stimulating the immune system, protecting the liver, increasing the body's ability to cope with stress, and inducing a calming (mild sedative) effect.
A few scientific studies have been conducted to test specific effects resulting from schisandra supplementation. In one study, patients with a certain heart malady (dilated cardiomyopathy) were given a combination of panax ginseng, radix ophiopogonis, and schisandra. The subjects' improvement was measured via an echocardiogram as well as a treadmill tolerance test. After taking the herbal blend for forty days, heart function improved significantly and exercise tolerance increased by more than 67 percent. Studies of exercise have shown schisandra to increase work capacity (in running mice) and lessen the rise in cortisol in athletes undergoing heavy training.
Schisandra is generally considered to be safe and nontoxic when used as directed. Typical dosage recommendations are in the range of 100-500 mg per day. Commercial schisandra supplements may be found as stand-alone products or as blends with multiple ingredients (such as ginseng and rhodiola) targeting energy and performance. Reported side effects resulting from schisandra ingestion include mild indigestion and skin rash. Because schisandra may induce uterine muscle contractions (similar to the effects of ashwagandha), pregnant women should not take the herb.
Rhodiola (Rhodiola rosea/Rhodiola crenulata) comprises several species of plants from the Arctic mountain regions of Siberia. The root of the plant is used medicinally and is also known as Arctic root or golden root and more recently as crenulin. Rhodiola has been used for centuries to treat cold and flulike symptoms, promote longevity, and increase the body's resistance to physical and mental stresses. It is typically considered to be an adaptogen (like ginseng) and is believed to invigorate the body and mind to increase resistance to a multitude of stresses. The key active constituents in rhodiola are believed to be rosavin, rosarin, rosin, and salidroside.
In one open clinical trial, rhodiola rosea extract was effective in reducing or removing symptoms of depression in 65 percent of the patients studied. In another open-label study, twenty-six out of thirty-five men suffering from weak erections or premature ejaculation reported improvements in sexual function following treatment with 100-150 mg of rhodiola rosea extract for three months. In another study, of physicians during nighttime hospital duty, 175 mg per day of rhodiola (standardized to 4.5 mg salidroside) for two weeks resulted in a significant improvement in associative thinking, short-term memory, concentration, and speed of audiovisual perception. An additional study of students undergoing a stressful twenty-day period of exams showed that 50 mg per day of rhodiola alleviated mental fatigue and improved well-being.
Overall, rhodiola rosea extract appears to be valuable as an adaptogen, specifically in increasing the body's ability to deal with a number of psychological and physiological stresses. Of particular value is the theoretical role for rhodiola in increasing the body's ability to take up and utilize oxygen-an effect similar to that of cordyceps (see above)-which may explain some of the nonstimulant "energizing" effects attributed to the plant. Rhodiola is often called the poor-man's cordyceps because of ancient stories in which Chinese commoners used rhodiola for energy because the plants grew wild throughout the countryside, while only the emperor and his immediate family and concubines were allowed access to the rare cordyceps mushroom.
Rhodiola rosea extract is thought to be quite safe. There are no known contraindications or interactions with other drugs or herbs, but potential exists for mild allergic reactions (rashes) in some individuals. General dosage recommendations for rhodiola rosea extract are typically in the range of 300-600 mg per day. Like schisandra, rhodiola can be purchased either as a stand-alone product or in combination with other ingredients.
Astragalus is an herb recommended as much for stimulation of the immune system as for its energy-promoting properties. Perhaps because chronic stress can both deplete energy levels and increase the risk of illness and infection, astragalus may be particularly beneficial in individuals who feel fatigued due to high levels of emotional and physical stress. Athletes in particular may benefit from astragalus supplementation because intense training and competition are often associated with an increased incidence of colds and other upper-respiratory-tract infections, conditions for which astragalus is thought to be most effective.
Astragalus has been used as an herbal tonic for centuries in traditional Chinese medicine (TCM) and in Native American folk medicine. As a tonic, astragalus is used primarily as a "prevention" herb throughout the cold and flu season-a different usage from that associated with the popular herb echinacea, which is best used for early-stage treatment as soon as you feel a cold or the flu coming on. In TCM, astragalus is often combined with other tonic herbs, such as ginseng, cordyceps, or ashwagandha, to keep the immune system humming during periods of high stress.
There have been some clinical tests of astragalus on humans, most of which come from China, wherein the herb appears to stimulate the immune system in patients with infections. At least one clinical trial in the United States has shown astragalus to boost levels of T cells (a type of infection-fighting white blood cell) to near-normal ranges in some cancer patients, suggesting the possibility of a synergistic effect of astragalus with chemotherapy. Most of what we know about astragalus, however, comes from test-tube and animal experiments, which show that it can help fight bacteria and viruses by enhancing various aspects of the body's normal immune response; specifically, it enhances function of specific immune-system cells such as T cells, lymphocytes, and neutrophils. In animal studies, astragalus extracts are effective in preventing infection of mice by the influenza virus, possibly by increasing the phagocytotic activity of the white blood cells of the immune system.
When used as recommended, astragalus has no known side effects, although at high intakes gastrointestinal distress and diarrhea are possible. While astragalus is available as a single-ingredient supplement (250-500 mg per day), it may be even more effective in lower doses (100-200 mg per day) when combined with other immune-stimulating herbs and nutrients.
As part of the hierarchy of natural cortisol-controlling compounds, adaptogens certainly represent a powerful and effective solution for counteracting many of the detrimental effects of stress. Within this hierarchy, however, the adaptogenic herbs are probably best thought of as "reinforcements" during periods of particularly high stress.
In this context:
- A solid foundation of multivitamin and multimineral supplementation (featuring vitamin C, calcium, magnesium, etc.) is the first step in a good plan for fighting stress.
- The next step should be targeted modulation of cortisol, HSD, and testosterone (via PMFs, eurycoma, theanine, etc.).
- Then should come the reinforcements against episodes of stress in the form of a balanced adaptogen regimen.