Botanical Approaches To Stress And HPA Axis Dysregulation

Adaptogens reduce the cost of homeostasis / allostasis to the organism, preventing or delaying damaging effects caused by stress and aging. By helping to maintain a state of balance throughout the body, adaptogens hold the key to vitality.

Donald Yance

Those using this book may notice the regular inclusion of adaptogens and nervine herbs in the treatment of conditions, which on the surface may appear unrelated to the nervous system or hypothalamic-pituitary-adrenal axis. By now it is probably evident that the nervous, endocrine, reproductive, and immune systems are immutably interconnected — effects in one have a tremendous impact on the regulation of the others. Herbalists recognize the significant effects of stress on physiologic functioning as well as the role of illness increasing stress response. Therefore, many botanical protocols for chronic health problems include herbs that support the ability of the organism to respond to and withstand stress — or allostatic overload.

The primary class of herbs used to support and restore adrenal health and optimal hypothalamic-pituitary-adrenal axis functioning is known as the adaptogens. Many are considered “tonics” in traditional medicine systems (e.g., ginseng in TCM, ashwagandha in Ayurveda). Lazarev, a Russian pharmacologist, researching the resistance of organisms to stress in experimental studies and initially testing pharmacologic drugs, first coined the term “adaptogen” in 1947. To be considered an adaptogen, the substance had to demonstrate the following:

• Nonspecific effects in that the adaptogen increases resistance to a very broad spectrum of harmful factors (stressors) of different physical, chemical, and biological natures

• A normalizing effect, that is, it counteracts or prevents disturbances brought about by stressors

• It must be innocuous to have a broad range of therapeutic effects without causing any disturbance (other than very marginally) to the normal functioning of the organism

Lazarev, Brekhman, and other Russian researchers were using the terms stress and stressors in the classical sense as defined by the work of Selye, and were seeking to develop medications able to mobilize the intrinsic adaptive mechanisms to help individuals cope with and survive in situations of intense or prolonged stress while maintaining physical and mental work capacities. Adaptogens were considered to constitute a new class of metabolic regulators, of natural origin, which increased the organism’s adaptive abilities to environmental factors, and prevented damage from these factors. Most studies of adaptogens were originally conducted in Russia and focused on Eleutherococcus senticosus, Rhodiola rosea, Schisandra chinensis, and Bryonia alba. These herbs were incorporated into official medical practice in the USSR and produced as standardized extracts in various forms. Having been found quite safe, they are still used in Russia in both self-care and physician-prescribed regimens. By 1984, there were over 1500 studies in Russia alone on just three adaptogenic herbs (Eleutherococcus, Rhodiola, and Schisandra). Interest in adaptogens has also spread worldwide; the term adaptogen, for example, is recognized by the FDA as a functional term.

A substance that reduces the state and severity of stress and counteracts the effect of stressor is an adaptogen. Adaptogens contain phenolic compounds with a structural resemblance to catecholamines, suggesting an effect on the SAS, tetracyclic triterpenes similar to the corticosteroids that inactivate the stress system; and oxylipins, unsaturated trihydroxy or epoxy fatty acids resembling leukotrienes and lipoxines. Adaptogens have a wide range of effects, and appear to act broadly on tissue involved in homeostatic regulatory systems (immune, endocrine, central nervous system [CNS]) rather than having specific targets. There is significant evidence that adaptogens increase exercise capacity, endurance, stamina, cognitive function, and mental alertness, and that they increase nonspecific immunity, stress resistance, relieve fatigue, and improve energy metabolism and tissue repair. Evidence also indicates that administration of adaptogens modulates ACTH and corticosteroid formation and normalizes levels of stress hormones. They may be considered substances that allow the organism to resist stress at higher levels of challenge.

Adaptogens have been used historically as general tonic medicines, thought to gently strengthen the CNS in cases of fatigue, physical exertion, aging, weakness from disease and injury, and prolonged stress. They are considered to induce “states of non-specifically increased resistance” (SNIR). Many cultures have embraced the widespread use of such herbs in older adults and infirm; Panax in China and Asia, Eleutherococcus in Russia, and Withania in India. They have been historically and clinically reported to improve diabetes, blood pressure, and cardiac action, and relieve mental confusion, headache, and weakness among older adults. These plants are also credited with an affinity for the nervous system and an ability to relieve mental stress in cases of insomnia and anxiety disorders. Muscle fatigue, physical weakness, and immune deficiency were all thought to improve with the use of such herbs. Athletes, for example, sometimes benefit from the use of adaptogens, noting improved stamina and endurance. They also may be used to improve post-surgical healing and convalescence.

It is generally recommended to give a course of adaptogens over a prolonged period of time, a minimum of 3 months generally, or on an ongoing basis for up to several years for severely depleted patients. Adaptogens may be used singly; however, it is preferable to combine them with other herbs to support, direct, and moderate their individual effects. Although adaptogens, by definition, lack serious side effects, their specific qualities may best be tempered by combination with other herbs. For example, Rhodiola or Schisandra taken alone are both quite drying and astringent, and can be tempered by combining them with herbs that are moistening and sweet, for example, licorice. Ginseng, particularly red ginseng, can be heating and stimulating. Looking at traditional Chinese medicine formulas, one quickly notices that herbs such as ginseng are one of only several of many herbs included in the formula for this very reason. Additionally, although adaptogens share many similar qualities, each individual herb possesses unique characteristics that distinguish it from the others; thus, prescribing should still be based on the individual patient. Adaptogens may be used prophylactically prior to times of physical, emotional, or mental stress, or restoratively, such as after a long illness or prolonged period of debility or stress.

Botanical Treatments for Improving the Stress Response

HERBAL ACTIONBOTANICAL NAMECOMMON NAME
AdaptogensEleutherococcus senticosusEleuthero
Panax ginsengGinseng
Panax quinquefoliusAmerican ginseng
Rhaponticum carthimoidesRhaponticum
Rhodiola roseaRhodiola
Schizandra chinensisSchizandra
Withania somniferaAshwagandha
NervinesHypericum perforatumSt. John’s wort
Lavandula officinalisLavender
Leonurus cardiacaMotherwort
Matricaria recutitaChamomile
Passiflora incarnataPassion flower
Scutellaria laterifloraSkullcap
Valeriana officinalisValerian
ParasympathomimeticsAnemone pulsatillaPulsatilla
Lobelia inflataLobelia
Piper methysticumKava kava
AnxiolyticsAvena sativaMilky oats
Eschscholzia califomicaCalifornia poppy
Lavandula officinalisLavender
Leonurus cardiacaMotherwort
Matricaria recutitaChamomile
Passiflora incarnataPassion flower
Piper methysticumKava kava
Scutellaria laterifloraSkullcap
Valeriana officinalisValerian
Verbena officinalisBlue vervain
Withania somniferaAshwagandha

The discussion that follows presents evidence on the most commonly used herbal adaptogens. Licorice, which may not be truly classified as an adaptogen, is included because of its marked cortisol-sparing, adrenal tonic effects. Calmative nervines that act as sympathetic relaxing agents such as Matricaria recutita, Scutellaria lateriflora, Avena sativa, and Passiflora incarnata, for example (Table Botanical Treatments for Improving the Stress Response), are indicated, as these may reduce stress-induced CRH stimulation of the adrenal output of corti-sol and adrenaline. Parasympathomimetics directly or indirectly increase parasympathetic function, reducing sympathetic dominance. They are indicated for anxiety and stress, and to relieve symptoms that result from adrenergic stress. Evidence for nervines and other herbs listed in Table Botanical Treatments for Improving the Stress Response are found elsewhere throughout this text. For insomnia, sedatives may be included, as for chronic musculoskeletal problems, antispasmodics incorporated into formulae. Adaptogens also may be effectively combined with herbs for individual systems, for example, hawthorn for the cardiovascular system, or chaste berry for the reproductive system.

Stress: Ashwagandha

Stress: Eleuthero

Stress: Ginseng

Stress: Licorice

Stress: Rhaponticum

Stress: Rhodiola

Stress: Schisandra