Introduction

Note:  Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind.  Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

Adaptogens are herbs that support the body’s ability to deal with stress—whether that stress is from anxiety, fatigue, trauma, infection, etc.  They are used to strengthen the immune system and increase overall vitality.  Studies of adaptogens are limited, and many have focused on isolated properties of the herbs rather than the whole plants, which are traditionally used.  One theory is that adaptogens work by influencing the hypothalamic-pituitary-adrenal (HPA) axis which orchestrates the stress response and also plays a significant role in immune regulation, digestion, metabolism, and mood.  For example, ashwagandha has been found to decrease urinary markers of stress in animal models and rasayana given to rats exposed to chronic stress showed smaller rises in corticosterone and fewer gastric ulcerations.  Another theory is that adaptogens have the ability to strengthen the antioxidant status of mitochondria.^1,2

There are three main qualities an herb must have to be considered an adaptogen:

1. It must be nontoxic at normal doses.
2. It should support the entire body’s ability to cope with stress.
3. It should help the body return to a state of homeostasis regardless of how the body has changed in response to stress—i.e.,  it should temper that which is hyperfunctioning and support that which is hypofunctioning.²

The most effective use of specific adaptogens comes with the knowledge of the constitution of the patient, the particular actions of the individual herbs, and how these two interface.  Herbal medicine in general is an art and a science.  Understanding which parts of the plants are most potent and how they should be harvested to reap their full medicinal value are important aspects of herbalism.  Because herbs and supplements are not regulated by the Federal Drug Administration, it can be tricky to find a quality product.  Looking for a product that is standardized to the active or marker components can be helpful, as can knowing the actual therapeutic doses used either traditionally or in available research—unfortunately, many products on store shelves contain very low doses of multiple herbs that may not be of benefit.  Resources such as the Natural Medicines Comprehensive Database can provide some of this information.  Also, unless the growing and manufacturing processes of a company are well known to the individual or provider, looking for products that have a United States Pharmacopeia (USP) or Good Manufacturing Practice (GMP) seal can help ensure a quality product.