The notion of herbal “health tonics” may seem like a quaint and dubious relic of the early 1900’s, conjuring up images of fast-talking hucksters selling patent medicines from the backs of their wagons as they rolled through frontier towns.

But the practice of routinely taking combinations of herbs to enhance vitality, physical and mental stamina, and immunity has a long, venerable history throughout Asia and many other parts of the world. Modern clinical investigations worldwide, though still in their earliest stages in the US, are beginning to verify many of the purported health claims for “tonic” herbs such as Eleutherococcus (“Siberian” ginseng), Panax ginseng, Schisandra, and mushrooms such as Cordyceps and Ganoderma. Perhaps it is time to reconsider the notion of herbal tonics in preventive health care.

Adaptogens and Hormesis

Panax ginseng.

In recent years, the term “adaptogen” has been circulating through the natural products world, used most often to describe tonic herbs from the Asian botanical pharmacopeia. The word generally refers to the non-specific immunomodulatory and endocrine regulatory effects of these plants that increase an individual’s ability to maintain healthy homeostasis in the face of extreme physical or emotional stress. It is being translated into marketing messages suggesting that these herbs “help you adapt to stress.”

While it is true that routine use of adaptogenic herbs will likely reduce the adverse health impacts of chronic stress, the term is somewhat imprecise, and fails to get at the physiologic nature of these effects. The most commonly used adaptogenic herbs—Eleutherococcus, Panax, Schisandra, Rhodiola, Withania (Ashwagandha), Cordyceps mushrooms, and Licorice—all have stabilizing effects on the Hypothalamus-Pituitary-Adrenal (HPA) axis, explained Jeff Bland, PhD, at the annual meeting of the American Holistic Medical Association.

Part of what makes them so interesting is that they exert seemingly paradoxical effects. The same herb may simultaneously enhance adrenal function while also helping an individual relax and sleep better. Adaptogenic herbs tend to normalize levels of HPA hormones, raising those that are low, while lowering those that are excessively elevated. Consequently, the same herb may have differing biochemical effects in different individuals, or they may affect the same individual differently at different times. The notion that a single substance can attenuate certain mediators in one person or one tissue while increasing them in others may seem paradoxical or even implausible, admitted Dr. Bland. But the phenomenon is not entirely foreign to even conventional biomedical thinking.

“Understand it in terms of the concept of hormesis—a movement toward normal balance. There are definitely hormetics in conventional pharmacology. Think about the selective estrogen receptor modifiers (SERMS) like tamoxifen. They generate $300 million in sales every year. In essence, they are adaptogens. They normalize estrogen levels but with very tissue-specific effects. In certain tissues they lower estrogen levels that are too high, while in other tissues, they increase low levels.”

Dr. Bland added that soy isoflavones have similar bivalent effects on estrogen: women with high estrogen levels who take a lot of soy isoflavones often show a lowering, while those who have low estrogen levels tend to show increases.

30 Years of Russian Data

	Eleutherococcus senticosus. Illustrations courtesy of Natura Health Products.

The term, adaptogen, was first coined in the 1960s by Russian physicians and pharmacologists studying the tonic herbs used in Asian and Russian folk medicine. Their objectives were to find low-cost, easily obtainable botanicals that could enhance performance of Olympic athletes, cosmonauts, and Russian military personnel. Over the decades, this line of work led to a vast body of research describing the non-specific, but very measurable, effects of these herbs on physical and mental performance in diverse populations.

Ben Tabachnik, PhD, was one of those researchers. For more than 30 years, he specialized in sports physiology and served as a coach for the Soviet Olympic sprinting team. He began researching adaptogenic herbs as part of a search for natural, less harmful alternatives to anabolic steroids. His work overlapped that of physiologists working in the Russian space program and the military. “We faced the same challenges in the sports programs as in the military and the space programs: How to improve peoples’ performance? How to be productive and effective under stress? The search for adaptogens was a search to find natural remedies that help us to perform under severe stress.”

Dr. Tabachnik immigrated to the US in 1990, bringing with him 3 decades of theoretical and practical knowledge of adaptogenic herbs. He began working as an herbal medicine and sports medicine consultant for the Denver Broncos, Detroit Pistons, and Chicago Bulls.

The primary herbs studied by Russian adaptogen researchers were: Eleutherococcus senticosus root and leaves, Schisandra chinensis (“Five taste berry”) seed, Panax quinquefolium (Panax ginseng), Rhodiola rosea (“Arctic root”), and Withania somnifera (Ashwaganda) root. With the exception of Rhodiola, the others have been widely used in Chinese medicine and Indian Ayurveda for hundreds of years.

The Russian work suggests that to varying degrees, all of these herbs can enhance adrenal function, particularly stimulation of glucocorticoid function and oxidative-reductive processes. They also stimulate anabolic metabolism while down-regulating catabolic processes, increase generation of ATP especially in the liver, which improves detoxification processes. They also improve cell-mediated immunity, particularly via increased natural killer (NK) cell activity.

In practical terms, these effects translate into increased alertness, less fatigue, improved capacity for physical work, greater ability to relax and sleep, fewer minor infections such as colds and influenza, improved glucose utilization and insulin sensitivity, greater capacity for liver detoxification, faster recovery from extreme physical or mental stress.

Cultural Biases

The common feature of adaptogenic herbs is that they have polyvalent effects influencing the function of multiple organ systems. It is precisely their non-specificity that seems to cast a shadow of questionability in the minds of many Western-trained physicians. But this attitude may reflect more about the cultural biases inherent in Western medicine than it does about the nature of these plants or their physical effects.

“Here in the West, we like the concept of highly specific pharmacologic actions. We prefer compounds that have specific, identifiable drug-receptor interactions. The ideology of Western medical science holds that anything with multiple effects either must not really work or must be dangerous. Asian medical thinking is quite different,” said Andrew Weil, MD, at a course on botanical medicine in clinical practice sponsored by Columbia University.

Dr. Weil, director of the University of Arizona’s Program in Integrative Medicine, explained that Chinese medical theory identifies three classes of herbal medicines: Inferior herbs, which have very specific actions on specific disease states; Superior herbs which have non-specific, polyvalent, or “adaptogenic” effects; and Middle (intermediate) herbs which are somewhere in between in terms of specificity of action. “The most highly prized herbal medicines are those with polyvalent effects like Panax ginseng, the genus name of which has the same Greek root as the word panacea.”

The classical definition of a “tonic,” derived from the Greek root word for stretching and strengthening, is something which given over time can strengthen resistance to infection and improve physiologic function. “We don’t have drugs in this category in the Western pharmacopeia.”

It is ironic, then, that Panax, one of the most powerful tonic herbs in Asian medicine, is indigenous to the mid-western and northeastern US. Though it was never well respected as a medicine on its home turf, many a rural American family earned its living harvesting ‘Seng for export to the Far East. Only recently, as more Americans began exploring Asian medicine, has this herb returned home.

Outside of Russia and Asia, broader use of adaptogenic herbs began in Germany, England and Italy in the 1970’s, as physicians and botanical researchers began to pick up on the work done by Russian investigators. This, combined with increased interest in Chinese medicine created an increasing demand for adaptogens in Europe. Several years later, the same trend began in the US.

Modern Formulations

A number of US botanical companies are now marketing adaptogenic herbs singly or in combination formulas. Natura Health Products, Ashland, OR, is a company Dr. Tabachnik founded with clinical herbalist Donald Yance, Jr. (www.naturahealthproducts.com). In developing adaptogenic formulas suited to modern clinical use, they bring together Mr. Yance’s knowledge of Western herbal traditions and Chinese medicine, and Dr. Tabachnik’s understanding of stress physiology and his years of research in Russia.

Dr. Tabachnik and Mr. Yance recently introduced 2 formulas: Vital Adapt, which contains combined extracts of Eleutherococcus, Schisandra, Manchurian spikenard, Rhodiola, Panax, Ashwagandha, Reishi (Ganoderma), Cordyceps, Turmeric, and several other herbs; and Power Adapt, which includes many of the same ingredients but also includes others like Rhaponticum carthamoides and Oat seed. Vital Adapt is intended for use in management of chronic stress and exhaustion, as well as for daily maintenance, while Power Adapt is specially formulated to enhance stamina and improve physical performance. Power Adapt can also be used to help rehabilitate people who are at the point of near total exhaustion.

Natura’s formulas are based largely on Dr. Tabachnik’s research, and they are formulated according to the dose levels established to be effective in the Russian research. Many of the herbs used in their formulas are harvested from their native regions in Russia. They imported to the US and processed here, according to good manufacturing practices.

“I spent at least 25 or 30 years experimenting with different herbs, learning how to combine them together,” said Dr. Tabachnik. The Natura formulas differ significantly from many of the adaptogen combinations on the market. “For example, our Schisandra seed extract is the one on which all the Russian Schisandra research has been done. A lot of people promote Schisandra in this country as an adaptogen, but their products contain Schisandra fruit (berry). I’m not going to say that the berry extract is not a good medicine. It’s actually a kidney/lung tonic in Chinese medicine. But it’s not the seed extract, and there are different compounds in the seeds that have enormous anti-fatigue activity, improve eyesight, night vision. It is also a very good liver detoxifier.”

Stress and the Autonomic Yin-Yang

To get a better grasp of how adaptogenic herbs function, it helps to look at stress physiology and the yin-yang relationship between the parasympathetic and sympathetic branches of the autonomic nervous system. The sympathetic branch, characterized by increased vasoconstriction, cortisol activation, and heightened physical responsiveness can be considered the more “yang” or active aspect, while the parasympathetic, characterized by vasodilation, muscle relaxation, and repose, is the more “yin” or passive aspect.

The two branches have seemingly antagonistic effects, but in a healthy individual they are balanced and work more or less harmoniously together. Chronic dominance of either branch predisposes an individual to disease and dysfunction.

Many Americans are in a state of near constant sympathetic overdrive. Job and family stress, long work hours, financial worries, and the rapid pace of life keep many people in a hyper-alert, agitated and driven state, with few opportunities for deep relaxation. Under constant hypothalamic demand, the adrenals continue to pump out glucocorticoids (cortisol) and catecholamines (epinephrine and norepinephrine), rapidly burning up their metabolic resources, until they reach a point of exhaustion. At this point, many individuals experience states of fatigue or exhaustion, hypoglycemia, sleep dysregulation. They become less able to respond to genuine stressors in their lives.

Constantly elevated cortisol levels predispose the body to a catabolic state characterized by neuronal atrophy, loss of bone density, and sometimes loss of lean muscle mass. It also increases insulin resistance and adversely effects blood lipid profiles. In some people, stress-induced hypercortisolemia is also associated with increased abdominal lipid deposition independent of calorie consumption, a process that is mediated in part by conversion of testosterone to estrogen in both men and women. Chronic cortisol elevation is also associated with increased production of inflammatory cytokines and simultaneous inhibition of NK cells and T-cells. In other words, an individual is more prone to inflammatory states, and less able to fend off infections.

Adaptogens and Stress-Related Disease

“People don’t realize that their bodies redirect homeostasis to different levels to compensate for stress,” said Mr. Yance, who is also founder of the Center for Natural Healing in Ashland, OR, and Darien, CT. “In other words, as we get older and we’re under all kinds of stress, not just emotional stress, but environmental stress, chemical stress, stress from artificial light, all these have a cumulative effect and our bodies have greater need to compensate for those stresses. Something has to re-prioritize itself and something has to suffer. So sometimes, the liver becomes impaired in its ability to adequately deal with detoxification. Sometimes we’re not able to deal with insulin disposal, insulin sensitivity. And people start gaining weight. Nobody would ever think that stress is a cause of weight gain. But it is a great missing piece to why, I think, people are overweight and why there’s so much hyperthyroidism. These adaptogenic plants are all about delaying that.”

He added that stress is not just a momentary, transient phenomenon for most people. “Stresses accumulate and your body makes compromises so that you get through the day. You produce more hormones to get through specific stressful events. But the body has to make compromises in order to do that. And those compromises vary from one person to the next. I believe osteoporosis is an accumulation of stress. Nobody would ever see that. But if the body hasn’t had enough ability to generate energy for anabolic function, you start to see loss of bone and lean muscle mass.”

Adaptogenic herbs induce non-specific responses, and this mirrors the way external stresses affect human physiology. “Stress affects us in very non-specific ways. It affects all our body functions. Usually, it is the weak system in our bodies that begins to show symptoms or breakdowns. For some people it can be headaches or some people it’s depression. For some people it’s liver problem. For some people it’s chronically catching colds,” said Mr. Yance.

Adaptogen Safety

There are few published reports of adverse events associated with use of Panax, Eleutherococcus, Rhodiola or other common adaptogenic herbs. In fact, one of the original criteria defining adaptogens in the original Russian research was that these substances must exert potentially beneficial effects without inducing any harmful side effects.

These herbs have not been studied thoroughly in clinical settings with patients on multiple medications, so there are no definitive answers about the degree to which they can be combined with conventional medications. The effect of Eleutherococcus on several liver enzyme systems has been assessed, and the data suggest that this herb does not have any negative effect on the cytochrome P2D6 or 3A4 pathways, meaning that it will not likely alter the plasma levels of drugs metabolized via these enzyme pathways (Donovan JL, et al. Drug Metab Dispos. 2003; 31 (5):519–22).

There is one report in the English language literature implicating an interaction between ginseng and warfarin in a case of thrombosis of a prosthetic aortic valve (Rosado MF. Cardiology. 2003; 99 (2):111). And there are also several reports indicating that components in Eleutherococcus, Panax ginseng and Schisandra have warfarin-like or antiplatelet effects, and that these herbs can modulate serum warfarin levels (Dasgupta A, et al. Am J Clin Pathol. 2003; 119 (2):298–303. Lee IS, et al. Biol Pharm Bull. 1999; 22 (3):265–7). Investigators from the department of anesthesia and critical care, University of Chicago have suggested that ginseng extracts may increase perioperative bleeding and that these herbs are contraindicated in patients undergoing surgery (Ang-Lee MK, Moss J, Yuan CS. JAMA. 2001; 286 (2):208–16).

There is also a report suggesting that ginseng may exacerbate seizures in patients with epilepsy, though the author concedes that this is strictly anecdotal and there are no data on the subject (Spinella M. Epilepsy Behav. 2001; 2 (6):524–532). In general, however, the commonly used adaptogenic herbs have long histories of safe use.

Adaptogens as Therapeutic Adjuncts

In practice, adaptogenic formulas can be used as adjunctive therapies for many different conditions. “Say a patient came in with psoriasis that comes and goes. It seems like it comes on going into the winter, and fades in warm weather. It also exacerbates when the patient is under a lot of personal stress. A traditional herbal practitioner might formulate two or three favorite herbs for psoriasis,” said Mr. Yance. “In doing a deeper interview with the patient, he or she might discover a couple of areas or body systems that are particularly weak. So he or she would recommend plants that support those organ systems. But they’re still not addressing the deeper causes. How do we implement a strategy that maybe gets inside the limbic system, to help modulate the deeper stress responses?”

This is where the adaptogenic herbs might fit. “We can put together plants which are adaptogenic along with the specific plants for the skin condition. We individualize the formula not only to be effective against the skin condition, but also to modulate the stress response, so over time the psoriatic symptoms do not recur. In essence, that’s how I formulate.”

But Dr. Tabachnik stressed that while adaptogenic tonics can help in management of many disorders, they are not magic bullets. “People need to be aware of making changes in their lives. And the first change is how they choose to respond to events in their life. I always say that stress is 90% how you choose to react and 10% what’s really happening. So, you need to combine taking adaptogens with really re-evaluating your life, making different choices on how you decide to live your life. Maybe cut down on your intake of the news, or maybe less TV in general. Choose not to drink soda. Start exercising. Eat a healthier diet. Then think of adaptogens as a companion to those things. Adaptogenic herbs are not going to replace doing those things. People still need to make changes in their lives.”

To learn more about the Natura Health Products adaptogenic formulas visit www.naturahealthproducts.com or call (541) 488-0210.