August/September 2020 Issue
Botanicals/Herbs: Adaptogens
By Vicki Shanta Retelny, RDN
Today’s Dietitian
Vol. 22, No. 7, P. 14
Can these herbs really reduce stress?
Under normal circumstances, managing stress is a global health concern. Throw in the emergence of the novel coronavirus late last year and it seems stress levels are higher than ever. According to a recent American Psychiatric Association national poll of 1,004 adults, 48% of Americans experience anxiety about being infected with coronavirus, and 62% are stressed about their family’s health due to COVID-19.1
Stress is a physiological condition that can lead to myriad ailments, including chronic inflammation, atherosclerosis, neurological impairment, depression, metabolic disorders, cancer, and premature aging.2 Finding innovative ways to cope with stress has been an area of scientific interest for centuries. Traditional Chinese medicine, as well as the oldest medical system, Ayurveda, encourages regular consumption of adaptogenic herbs to enhance the body’s capacity to maintain balance in the face of a wide range of stressors, such as chemical pollutants and heavy metals, physical overexertion, cold temperatures, loud noise, and efforts to balance blood glucose, blood pressure, and lipid levels, as well as maintain memory, mood, and cognitive function.3
The notion that some herbal plants may help alleviate chronic stress has existed in Western medicine for about 60 years, when midcentury researchers defined adaptogens as nontoxic compounds with several mechanisms of action and pharmacological effects related to adaptability and survival.4 With the emergence of the theory that there are three phases of stress—alarm, resistance, and exhaustion—in the mid-1940s, it was hypothesized that these herbs could reduce the effects of the “alarm” phase, when stress symptoms first appear.2 The concept of adaptogens is evolving as new science behind the functional properties of these herbs becomes clearer.
As more scientific findings are reported, Western medicine is becoming more open to the potential of adaptogenic herbs. In fact, the FDA defined adaptogens in 1998 as “a new kind of metabolic regulator that has proved to help in environmental adaptation and to prevent external harms.”
More recently, in 2017, adaptogens were defined in a review article in the Annals of the New York Academy of Sciences as “stress response modifiers that nonspecifically increase an organism’s resistance to various stressors (physical, chemical, and biological), thereby promoting adaptation and survival.”2 However, as a safety precaution, the FDA advises that consumers consult with an informed health care professional before taking any botanical or herbal supplement.
While evidence still is emerging—and research in humans is extremely limited—RDs should be familiar with adaptogens and understand how to effectively counsel clients interested in taking them.
How Adaptogens Work
The understanding of adaptogens’ properties and mechanisms of action is evolving, but they’re believed to act as eustressors, or “good stressors,” that mimic mild stress in the body and therefore decrease acute distress by modifying chronically high levels of the stress hormones cortisol and corticosterone, offering a protective effect against damaging stress.2
“Adaptogens are a class of herbs used to support the hypothalamic pituitary adrenal (HPA) axis—our central stress response system—and increase the body’s resilience to a broad spectrum of stressors. When used, these herbs may help regulate and balance the stress response,” explains Stephanie Wagner, RDN, LDN, CLT, a dietitian, health coach, and owner of Stephanie Lee Nutrition, based in Belvidere, Illinois.
The exact mechanism of the purported stress-reducing action in these herbs still is somewhat of a mystery, but experts have developed a theory of “network pharmacology” in which adaptogens interact with more than one stress receptor at a time. Individual adaptogenic herbs hold more than 100 phytochemicals, which are believed to have several targets and mechanisms of action.4 To that end, the primary understood characteristic of adaptogens is their nonspecific action in the body; they’re believed to activate certain chemical receptors in the body for energy and deactivate others to condition cells to not overreact to stress messengers.5
Synergistic Effects of Adaptogens
Although more evidence-based human clinical trials using standardized herbal preparations are needed to determine the efficacy of adaptogenic herbs, there’s significant interest in the scientific community in exploring them further. In a 2018 preliminary review in the journal Chinese Medicine, researchers found that studies on adaptogens had increased significantly since 1999.6
Clinical studies that combine herbal extracts have shown a synergy with myriad phytochemicals, which may influence each other’s activity to create beneficial outcomes.7 For example, when used in a clinical combination, three herbs—Rhodiola rosea, Schisandra chinensis, and Eleutherococcus senticosus, together known as ADAPT-232—were found to influence cognitive function in vitro when the brain was exposed to stressors such as calorie restriction, exercise, and cognitive challenges. Researchers found that ADAPT-232 may protect neurons from degenerating and promote synaptic plasticity or adaptability in stressful times.7
“Different adaptogens are responsible for up- or down-regulating the stress response to create homeostasis or balance within the body,” Wagner says.
It’s thought that other adaptogenic herbs may have synergistic effects as well, but more research is needed.
Common Adaptogens
The following are popular adaptogenic herbs RDs and clients may see as single ingredients or in combination in supplements. Each description includes what the available research says about their efficacy for stress relief.
Ashwagandha (Withania somnifera)
Prized in Ayurvedic medicine, this herb has been used for more than 3,000 years for stress management, energy elevation, and improving cognitive health and to reduce inflammation, blood sugar levels, cortisol, anxiety, and depression. With its “horselike” odor, ashwagandha lives up to its name, which is derived from the Sanskrit ashva, meaning “horse,” and gandha, meaning “smell.”
Until recently, there weren’t many clinical trials that had investigated ashwagandha; now it’s been examined in several randomized, double-blinded, placebo-controlled trials for several health conditions, including stress. An eight-week, prospective, randomized, double-blinded, placebo-controlled study examined the effects of a high concentration of ashwagandha root extract at various dosages on 60 healthy men and women who had significant stress levels. The participants were examined at baseline and at four and eight weeks; findings revealed that dosages of 250 mg/day and 600 mg/day showed a reduction in perceived stress and cortisol levels.8
Holy Basil (Ocimum tenuiflorum)
Holy basil, also known as tulsi, is highly valued in Eastern medicine circles and has been called the “elixir of life.” It’s been the subject of hundreds of in vitro human and animal studies that have reported its ability to help promote homeostasis and adaptation to stress. Tulsi’s pharmacological actions are believed to help the body and mind cope with a wide range of stressors and restore physiological and psychological function.3
A recent review of 24 studies in Evidence Based Complementary and Alternative Medicine examined the therapeutic effects of tulsi in humans. The reviewed studies suggest that tulsi plays a stress-reducing role and can help combat psychological stress and support immunity and neurocognition. More human studies are needed to determine the proper dosage, preparation, and ideal candidates for treatment with holy basil.9
Turmeric (Curcuma longa)
Well known for its anti-inflammatory properties, turmeric root resides in the ginger family. Studies have suggested that turmeric’s active compound, curcumin, may have adaptogenic properties due to its effects on the production of cortisol, a hormone secreted during stressful times. Curcumin’s actions on cortisol are complex and not fully understood, but curcumin has been found to play a role in inhibiting large increases in cortisol production, which can protect against the damaging effects of stress that may lead to a variety of diseases.10 However, more studies in humans are needed.
Turmeric can be used fresh from the root but more commonly is used in dried form alone or in a blend of spices known as curry powder. It’s also frequently used alongside black pepper, a combination that increases the body’s absorption of curcumin. Turmeric is used in curry dishes and Indian dahl, a red lentil stew, but it also can be shaved fresh for use in teas, sauces, soups, and salads.
“I personally like to use turmeric in turmeric milk with black pepper to aid absorption, since it tends to have a soothing effect on me before bed,” explains Melissa Nieves, MPH, RD, LND, a Puerto Rico–based dietitian and owner of the Fad Free Nutrition Blog.
Ginseng (Panax ginseng)
Ginseng contains natural antioxidant compounds called ginsenosides, which are believed to have multiple pharmacological effects. Although more high-quality studies are needed on ginseng’s mechanism of action in the body, recent research findings showed that this herb is involved in controlling stress hormones such as cortisol via the HPA axis.
One of the most widely studied adaptogenic herbs, ginseng shows promise in helping people regain homeostasis amid abnormal physiological changes caused by persistent stress, such as increased cortisol levels, as well as fend off chronic inflammation.11
Ginseng extract primarily is used in supplements, and interaction with other medications is low. However, the National Center for Complementary and Integrative Health recommends practicing caution when using ginseng and taking medications such as blood thinners and blood pressure–reducing and blood sugar–lowering drugs. Short-term use of ginseng appears to be safe, but long-term use for children and pregnant and breastfeeding women isn’t recommended.
Rhodiola (Rhodiola rosea)
The rhodiola plant’s roots contain approximately 140 bioactive compounds, which is where its stress-protective potential resides. This herb has been noted to interact with the HPA system to reduce cortisol production and in turn stimulate the central nervous system, which may help dampen the effects of chronic stress in the body.12
Rhodiola is commonly used as an extract in supplement form and in combination with other herbs. “One of my favorite adaptogen combinations is ginseng and rhodiola. This combination tends to be uplifting and awakening, which is perfect for those with stress-related fatigue or low energy,” Wagner says.
Dosage, Forms, and Cautions
Adaptogens often are included alone or in combination in herbal teas, smoothies, plant-based protein powders, bottled juices, and supplements. Dosage and formulations may vary widely, so it’s essential for RDs to evaluate each product individually.
Nieves approaches the subject of adaptogens with clients cautiously. “I’m usually very careful with recommending adaptogens to my clients since we still have more research to do in terms of recommended doses, safety, and efficacy,” she says.
As with other supplements, it’s essential that RDs and other health care providers make informed decisions about recommending adaptogenic herbal remedies because the FDA doesn’t approve supplements for safety before they’re sold. Furthermore, some manufacturers may try to cut costs and use less herbs and more contaminants.
Moreover, adaptogens aren’t safe for everyone, as they may interfere with certain medications, and their use is contraindicated in pregnant and breast-feeding women due to a risk that these botanicals may affect hormone levels.
RDs should approach dosages with special care and advise clients to do the same. “When it comes to taking adaptogenic supplements, dietitians need to remind clients that taking more isn’t always better,” says Kelly Jones, MS, RD, CSSD, LDN, owner of Kelly Jones Nutrition in the Philadelphia area. “Many supplements come in high dosages that may not be supported by research and therefore are risky to take. Before recommending dosages and specific types of adaptogens, you may want to do more research and engage in continuing education.”
The bottom line is daily stress is a part of life, and many lifestyle choices—including food, physical activity, sleep, and mental health outlets such as meditation, yoga, Pilates, and deep breathing—affect stress management. Although adaptogens may be a promising adjunctive therapy for stress, the science behind them continues to emerge. Side effects are rare and there appears to be a variety of therapeutic uses, but it’s important to practice caution and understand potential contraindications based on an individual’s health status when discussing or recommending these botanicals.
— Vicki Shanta Retelny, RDN, is a nationally recognized registered dietitian nutritionist, lifestyle nutrition expert, speaker, writer, and culinary and media consultant. She’s the author of two books: The Essential Guide to Healthy Healing Foods and Total Body Diet for Dummies. Shanta Retelny’s passion is helping others evolve their eating to a more healthful place by encouraging them to get into the kitchen with nourishing, empowering foods for a lifetime of health and happiness. She lives to eat well with her husband and two teenage children in Chicago. Her recipes and writings can be found on her blog, Simple Cravings. Real Food. Follow her @vsrnutrition.
References
1. New poll: COVID-19 impacting mental well-being: Americans feeling anxious, especially for loved ones; older adults are less anxious. American Psychiatry Association website. https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious. Published March 25, 2020.
2. Panossian A. Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. Ann N Y Acad Sci. 2017;1401(1):49-64.
3. Cohen MM. Tulsi - Ocimum sanctum: a herb for all reasons. J Ayurveda Integr Med. 2014;5(4):251-259.
4. Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress-protective activity. Pharmaceuticals (Basel). 2010;3(1):188-224.
5. Panossian A, Wikman G, Wagner H. Plant adaptogens. III. Earlier and more recent aspects and concepts on their mode of action. Phytomedicine. 1999;6(4):287-300.
6. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57.
7. Panossian A, Hamm R, Kadioglu O, Wikman G, Efferth T. Synergy and antagonism of active constituents of ADAPT-232 on transcriptional level of metabolic regulation of isolated neuroglial cells. Front Neurosci. 2013;7:16.
8. Salve J, Pate S, Debnath K, Langade D. Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: a double-blind, randomized, placebo-controlled clinical study. Cureus. 2019;11(12):e6466.
9. Jamshidi N, Cohen MM. The clinical efficacy and safety of tulsi in humans: a systematic review of the literature. Evid Based Complement Alternat Med. 2017;2017:9217567.
10. Enyeart JA, Liu H, Enyeart JJ. Curcumin inhibits ACTH- and angiotensin II-stimulated cortisol secretion and Ca(v)3.2 current. J Nat Prod. 2009;72(8):1533-1537.
11. Lee S, Rhee DK. Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. J Ginseng Res. 2017;41(4):589-594.
12. Panossian A, Wikman G, Sarris J. Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine. 2010;17(7):481-493.