These days it seems like everyone is taking Ashwagandha, Reishi or some other plant-based supplement to decrease stress and anxiety and promote health and wellness. It turns out that while the term “adaptogens” may be newer in origin, the medicinal use of plant extracts has been around for thousands of years as a mainstay of disease treatment in different parts of the world.

What are adaptogens?

Adaptogens (natural compounds and plant extracts) are a group of herbal and nutritional products that are used to help promote adaptability, resilience and survival in times of stress. They do this through modulating the neuroendocrine and immune systems. The term adaptogens was first coined by the Soviet toxicologist Lazarev who was researching natural stimulants to increase the attention and endurance of pilots during WWII.

The use of adaptogens is common practice in Traditional Chinese, Japanese and Korean medicine as well as Indian (Ayurvedic) and middle Asia (Yunani), with usage dating back 5000 years. In Traditional Chinese Medicine and Ayurvedic medicine, disease states are thought to be caused by imbalances in physical, emotional or spiritual health. In these holistic approaches to medicine, disease states are treated by rebalancing with adaptogens.

Well over 100 adaptogens have been identified as adaptogens or rejuvenating medicinal plants.

What do they do?

There are several different proposed mechanisms of action for adaptogens. At a cellular level they trigger intracellular and extracellular pathways that promote cell survival and resilience in times of stress. As well as regulating metabolism and cellular equilibrium by modulating the expression of stress hormones and their receptors.  

In a broader sense they restore balance and homeostasis- remember, in TCM and Ayurvedic medicine, disease states are thought to be caused by imbalances- different adaptogens are used to restore this balance and thereby rid the body of disease.

Some adaptogens are polyphenols, if you’ve already read my article on polyphenols, this might help explain the proposed mechanism of action. In addition to their potent antioxidant and anti-inflammatory properties, polyphenols are largely metabolized by the gut microbiome which then impact cell signaling pathways, intestinal barrier function (involved in immunity) and the further diversification of our gut microbiome, which we already know impacts our overall health.

In the US, adaptogens are commonly marketed to decrease stress induced fatigue, to improve mental health and improve focus/ attention.

There is still a lot of research that needs to be done when it comes to the use of adaptogens in treating disease states, that being said, they are generally well tolerated by adults and may be a beneficial addition in a preventative approach to stress management, along with proper lifestyle measures.

Which ones should I take?

While there are well over 100 studied adaptogens, I will try to cover the ones that are the most studied.

Adaptogen	Beneficial claims	Side effects & cautions
Ashwagandha (aka winter cherry or Withania somnifera)	Used for insomnia and anxiety, support for physical and mental stress, to reduce inflammation, can support thyroid function   Dosage: 500mg twice daily	GI upset, diarrhea, vomiting and nausea Caution if autoimmune disease, do not use with overactive thyroid or in pregnancy
Ginko Biloba (maidenhair tree)	Used to improve memory, may thin blood, dilate blood vessels (to improve blood flow)   Dosage: 120-240mg daily	Headache, dizziness, nausea, may cause bleeding, reduce seizure threshold   Do not take without consulting PCP- has MANY drug interactions
Reishi (mushroom)	Boosts immune system, being studied in cancer treatment	Upset stomach, liver damage, skin rash, nosebleeds, bloody stool Do not take without consulting PCP- has MANY drug interactions
Schisandra (magnolia berry)	Used for energy, coordination and endurance, blood sugar stabilization, liver health, menopausal hot flashes	Reflux and appetite suppressant
Tulsi (holy basil)	Used to increase focus, decrease anxiety and boost the immune system, antibacterial, antifungal	Avoid if allergic to mint, may thin blood, especially at high doses.
Rhodiola Rosea	Used for relief from stress, fatigue and weakness	Dizzy, dry mouth, sleep problems, jitteriness, mild stimulant effect
Panax Ginseng	Used to support memory and cognitive function	Trouble sleeping, rash, liver damage
Astragalus	Used for Hay fever, kidney disease and diabetes	Diarrhea, nausea and rash, may worsen symptoms of autoimmune disease
Eleutherococcus (Siberian Ginseng)	Used for weakness, tiredness, loss of strength	Diarrhea, upset stomach, headache

Given the potential for side effects with all supplements, it is best to consult with your PCP for dosage, duration of use and potential interactions.

How much should I take?

Adaptogens have different dosing recommendations based on the indication. It is best to consult with your physician on this one so you can come up with a dose that is most likely to provide benefit while minimizing harm.

What are the potential pitfalls of supplementation?

It seems that adaptogens are well tolerated by adults with the most common side effects including headache, dizziness, nausea, upset stomach and/or dry mouth.

A word of caution- just because it is “natural” it does not mean it is “safe”, be sure to discuss any supplement use with your doctor. Here is why:

1. The supplement market is not regulated, and you can’t be certain that your supplement is free of additives, or that it even has the active ingredient that it claims to. Make sure you get something that is “third party tested” like USP (US pharmacopeia) NSF (National Sanitation Foundation) or Consumer lab.
2. Some supplements can impact the efficacy of your prescription medication (making them more or less potent)- let your doctor know if you’re considering starting an herbal supplement so you can discuss the potential interactions and decide if the benefits still outweigh the risks.  
3. Usage may delay seeking professional treatment. It can be tempting to click the “buy now” button on prime, a solution, delivered to your front door by 5pm that day, but sometimes it’s best to talk to your doctor first so you can hear all your options and make an informed decision.
4. The anxiolytic and antidepressant effects of adaptogens are applicable to mild symptoms. For those suffering from moderate-severe depression/anxiety, studies did not show significant improvement with adaptogens, especially when compared to SSRIs.

Adaptogens have been used in traditional Chinese and ayurvedic medicine for thousands of years. The potential benefits of these plant and herbal supplements are vast, and for the most part, side effects are tolerable and seem to be minimal with appropriate dosages. Unfortunately, the supplement market remains unregulated and there is a risk of additives and contaminants, as well as difficulty verifying product authenticity. Adaptogens, like all medications, have the potential for drug-drug interactions, which may alter the efficacy of prescription medication.

I hope this article has been helpful and I wish you the best on the journey to less stress, better focus, and a stronger immune system.

Sincerely,
CorsanoMD- your friendly neighborhood PCP

Evolution of the adaptogenic concept from traditional use to medical systems: Pharmacology of stress‐ and aging‐related diseases (wiley.com)

Adaptogenic Herbs: Benefits and Effectiveness (healthline.com) Adaptogens 101: Boosting Your Body’s Resilience and Balance | U.S. News (usnews.com)

What Are Adaptogens and Are They Healthy? (clevelandclinic.org)