As a naturopathic doctor practicing in the downtown Toronto area, I've learned that stress is almost always a factor affecting my patients' health concerns.
And it's no surprise – a 2010 report conducted by Statistics Canada revealed that over 1 in 4 Canadians described their lives as highly stressful, with 62% identifying work as their main source of stress.
The body's stress response, also known as the "fight-or-flight" response, is a physiological response that helped humans survive threats like animal attacks, fires, floods, and conflict with other humans. Today, dangers like those aren't the main things that trigger the stress response. However, transient stressful episodes – such as meeting a work deadline, worrying about losing a job, or anything that we perceive as threatening – can trigger the same physiological stress response. Over time, the effects of chronic stress can take a toll on the body. Research suggests that prolonged stress contributes to high blood pressure, promotes the formation of artery-clogging deposits, and causes brain changes that may lead to anxiety, depression, and even addiction.
While there are many things that we can do to help manage our stress (for example, meditation, journaling, exercise), some people need more than lifestyle recommendations. In a conventional medical setting, your doctor might prescribe anti-anxiety or anti-depressant drugs. But there are also natural alternatives. There is a class of medicinal herbs known as adaptogens – natural substances that help the body adapt and increase its resistance to stress by regulating the hormones involved in the stress response. Two of the most commonly prescribed herbal adaptogens that I use in practice are: Ashwagandha (Withania somnifera) and Rhodiola (Rhodiola rosea)
Ashwagandha has been used in traditional Indian (Ayurvedic) medicine to relieve general debility, as a tonic to the nervous system, and to enhance memory. It has a calming, sedative-like effect to help ease stress and anxiety, and it can also be used to support a restful night's sleep. Ashwagandha contains withanolides, specific compounds in the plant which have GABA-like effects on the nervous system. GABA is a neurotransmitter in the brain that decreases excessive neuron activity and nerve firing that would promote anxiety and depression, leading to a more relaxed and calm state. In a randomized, double-blind clinical trial, Ashwagandha improved symptoms of perceived stress by 44% compared to baseline levels, as well as other measures of anxiety and depression by about 70%. Almost 30% also decreased blood levels of cortisol (commonly known as the "stress hormone") in those supplementing with the medicinal herb. Preliminary studies also demonstrate that Ashwagandha has potential in integrative oncology, as it what shown to help with chemotherapy-induced fatigue and to improve the quality of life in breast cancer patients.
Rhodiola is considered by naturopathic doctors as a stimulating adaptogen because it has stimulant and anti-stress actions without making you feel burned out after taking it. Rhodiola has been researched in the USSR/Russia since the 1960s and was even used by Russian Olympic athletes (before they resorted to anabolic steroids) to enhance their performance for competition. The active compound in Rhodiola are its rosavins and salidrosides, which have shown to influence the production of serotonin, dopamine, and norepinephrine in different parts of the brain, leading to improved mood and energy levels. In a double-blind cross-over study assessing the mental performance of physicians during night shifts, those supplementing with Rhodiola extract reported less fatigue and performed better on perceptive and cognitive cerebral functions, such as associative thinking, short-term memory, calculation and ability of concentration, and speed of audio-visual perception, when compared to placebo.
A Note on Quality, Efficacy, and Safety
When supplementing with herbal medicines, it is important to use standardized extracts from reputable or professional brands to ensure that the quality and dosage is true to what the label claims and have a therapeutic effect. Quality is especially important considering that in 2015 the New York Attorney General’s office discovered that four out of five of the supplements sold by major retailers, including GNC and Walmart, didn’t contain any of the herbs on the label, and were sometimes filled with cheap fillers like powdered rice.
Herb-drug interactions may exist so if you are taking other medications, talk to your naturopathic doctor to see if this approach is suitable for you.
Dr. James Yoon is a licensed naturopathic doctor that practices at Infinity Health Centre in downtown Toronto and Lakeside Natural Health Centre in Port Credit, Ontario. He uses a combination of traditional therapies and evidence-based medicine to apply a functional approach to your health. Common medical concerns that he sees in practice include mental health (stress, anxiety, fatigue, depression, sleep issues, low libido), digestive health (GERD, IBS, IBD), cardiovascular disease (high cholesterol, hypertension), endocrine health (diabetes, PMS, PCOS, fertility, menopause), skin and hair health (acne, eczema, hair loss), sport nutrition and supplementation, pain management, and auto-immune disease.
Biswal, BM et al (2012). Effect of Withania somnifera (Ashwagandha) on the Development of Chemotherapy-Induced Fatigue and Quality of Life in Breast Cancer Patients. Integrative Cancer Therapies 12(4): 312-322.
Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-62
Darbinyan V et al (2000). Rhodiola rosea in stress induced fatigue - A double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine 7(5): 365-371
O'Connor, A. (2015). New York Attorney General Targets Supplements at Major Retailers. The New York Times. https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/?_r=0
Mehta AK, Binkley P, Gandhi SS, Ticku MK (1991). Pharmacological effects of Withania somnifera root extract on GABAA receptor complex. Indian J Med Res 94: 312-15.
Rhodiola rosea – monograph (2002). Alternative Medicine Review 7(5): 421-423.
Statistics Canada (2010). What's stressing the stressed? Main sources of stress among workers. http://www.statcan.gc.ca/pub/11-008-x/2011002/article/11562-eng.htm