How Do Adaptogenic Herbs Benefit Hashimoto’s?

While I’ve been speaking about the effect of stress on Hashimoto’s for many years, two new studies have focused, and finally proven, the consequences of this very important trigger.

We all feel stressed at times. That’s just a part of life.

But if you start to feel like everyone around you is suddenly irritating, if your body seems weighted down by constant fatigue, and if your days have become overwhelming or anxiety-ridden, these are signals that your body needs help!

Ninety percent of people in my community identify that they have experienced a period of stressful time prior to the onset of their thyroid symptoms. In my clinical practice, I have also found that about 90 percent of my clients (who do an adrenal saliva stress test) have some degree of adrenal dysfunction, which indicates that they have an impaired ability to handle stress.

Of course it’s important to address the root cause whenever possible, and get rid of the stressor the best we can. But we can’t always get rid of the stressor (the demanding schedule, the unending commute, etc.) however, we can increase our body’s ability to react to stress with more balance. I’ve written about various strategies that can help with building resilience (a nap is one of my favorites). For the purposes of this article, I’d love to do a deep dive focus on adaptogenic herbs, as one way to to increase our body’s resilience, and lower the impact of all types of chronic stress..

I love using adrenal adaptogens, especially during my own peak periods of stress (did someone say, “holidays” or “book deadline”?) and I have joked in the past that adaptogens make all the people in my life much easier to tolerate.

Adaptogens have also been shown to have many additional health benefits. One of my favorite adaptogenic herbs, ashwagandha, for example, has been shown to be beneficial for normalizing thyroid hormone levels, as well as in reducing anxiety and improving one’s overall mood.

I often suggest people reach for an adaptogen versus rushing to get a prescription for an antidepressant! Many adaptogens are anti-inflammatory, neuroprotective, and supportive of a healthy immune function.

Would you like to know if adaptogenic herbs might be of benefit to you?

Read this article to learn:

• The qualities that make adaptogenic herbs so beneficial
• How adaptogens benefit those with Hashimoto’s
• Conventional treatments that may be replaced by adaptogens
• Over two dozen adaptogens I often recommend (and why)
• Four simple steps to building greater stress resilience

The Qualities That Make Adaptogenic Herbs So Beneficial

Adaptogenic herbs support the body’s ability to deal with stressors. Most adaptogens have been used for thousands of years in Eastern medical practices, such as traditional Chinese medicine (TCM) and Ayurveda.

In the 1940’s, Dr. Nikolai Lazarev defined adaptogens as “an agent that raises the body’s ability to resist stress by countering undesired stressors, whether physical, chemical, emotional, or biological.” In 1998, the Food and Drug Administration (FDA) defined an adaptogen as a new kind of metabolic regulator that has been proven to help in environmental adaptation and to prevent external harms.

Adaptogens are thought to work by normalizing the hypothalamic-pituitary-adrenal (HPA) axis, which may suppress the hypothalamus and pituitary gland as well as thyroid function, where it interrupts the conversion of T4 to T3, when one has adrenal fatigue. You can learn more about the HPA axis and adrenals here in the linked article.

When your body is stressed, the hypothalamus (brain) signals the pituitary to effectively deal with the stressor. The pituitary gland signals the adrenal glands to release more or less cortisol. The cortisol helps our body deal with the stress (giving us more energy or conserving it, halting the production of reproductive and digestion hormones that are not needed during the period of stress, etc.). If the stress lingers, the feedback mechanism in the HPA keeps telling the glands it needs more and more cortisol until finally the glands become exhausted and just ignore the signals. That’s when symptoms occur, our immunity breaks down, our gut can suffer and our hormones become imbalanced, including an impact on our thyroid hormones which I’ll talk about in the next section.

Keep in mind that “stress” is broadly defined as anything that impacts the body’s natural balance (called homeostasis), causing inflammation and a burden on the adrenals. So again, that can mean mental stress, environmental stress, food sensitivities, nutrient deficiencies, blood sugar imbalance, infections, and more.

In order to be considered an adaptogen, an herb must possess several qualities. First, the herb must be non-toxic at normal doses. Secondly, the herb should help the entire body cope with any type of stress. Finally, the herb should help the body to return to a “normal” state regardless of how the stress is currently affecting the person’s function. In other words, an adaptogenic herb needs to be able to both tone down overactive systems (normalize too much cortisol production) and boost underactive systems (increase cortisol production) in the body.

I actually have found that most people with Hashimoto’s have underactive adrenals and low cortisol levels. Low cortisol will result in even greater inflammation, poor tissue repair and will prevent key systems (such as the gut) from working optimally and/or healing. This can also mean fewer nutrients are absorbed. There is a cascade of issues relating to unhealthy adrenals.

While many people take adaptogens to deal with chronic mental stress, it’s important we not forget that adaptogens address all types of stress and underlying inflammation! Oftentimes, herbalists will select specific adaptogens to customize an herbal offering depending on the symptoms the patient is experiencing.

Adaptogens have been found to have one or more of the following attributes:

• Supportive of healthy adrenal function
• Immune-modulatory
•  Anti-inflammatory
• Antiviral
• Antitumor
• Antiparasitic
• Anti-fatigue
• Antidepressant
• Antimicrobial
• Antihyperglycemic (antidiabetic)
• Sexual and reproductive function enhancing
• Protective of the liver (hepatoprotective) and/or kidney
• Preventative of oxidative damage
• Cardioprotective
• Gastroprotective
• Anti-atherosclerosis
• And more…

How Adaptogens Benefit Those With Hashimoto’s

If you look at the above list of potential attributes of adaptogens you’ll see why adaptogens can be so beneficial for those with Hashimoto’s. Many of the top triggers for Hashimoto’s can be addressed by the benefits found on this list, including the ability to address: adrenal issues/stress, inflammation, viruses, parasites, blood sugar control issues, and leaky gut.

I have found that most people with Hashimoto’s are likely to have numerous signs and symptoms of adrenal dysfunction (also referred to as adrenal insufficiency, as well as hypocortisolism). Unfortunately, if left untreated – even when a person is prescribed thyroid hormone medication – many will often continue to feel fatigued, irritable, anxious, overwhelmed and just a bit crazy. That’s likely to get them a prescription for Prozac from a conventional doctor visit! Much better to support the overwhelmed adrenals!

It’s important to note that the idea of “adrenal dysfunction” is considered controversial and not subscribed to by everyone in the medical field. However, I think we can all agree that chronic stress is very real for so many of us, and finding ways to eliminate the stressors we have control over, and mitigating the effects of the ones we can’t control, will have far reaching health benefits.

Two new studies support the theory that stress can be a trigger for Hashimoto’s. In the first case, a 28 year-old woman with Hashimoto’s, whose thyroid hormone levels had been stable for 12 years, experienced a psychologically stressful event when she failed to graduate from her chosen major. When doctors examined her three months after this event, they observed moderate Hashitoxicosis (transient Hashimoto’s) which presented as fatigue and palpitations. When they tested her thyroid levels they found that her free thyroid hormones levels were 1.5 to 2-fold over the normal upper limit, TSH was suppressed, serum thyroglobulin antibodies (TgAb) were undetectable, while TPO were positive at levels threefold higher compared to the previous year (1,242.0 vs. 398 U/ml).

In the second study, 60 adult women with Hashimoto’s completed questionnaires on stress, anxiety, depression, and lifestyle at the beginning of a stress management program and again, eight weeks later. Laboratory thyroid function tests (anti-TPO, anti-TG antibodies and TSH) were also measured at baseline and at the end of the study. The program included breathing and relaxation techniques, dietary changes, cognitive therapy, and guided imagery. After eight weeks, patients in the intervention group demonstrated statistically significant beneficial decrements in the rate change of anti-TG titers and the levels of stress, depression, and anxiety as well as better lifestyle scores, compared to the control group.

I too have seen an interesting connection between stress and TG-antibodies.

Research has shown that some adaptogens may have the ability to lower levels of thyroid antibodies along with addressing triggers and symptoms of Hashimoto’s. I’ll talk about which ones I particularly like later in this article.

As I mentioned earlier, adaptogens can help with adrenal stress. Adrenal stress promotes autoimmunity by weakening our immune system; when the adrenals become stressed, the excess cortisol can lead to an increased production of inflammatory proteins associated with a heightened immune response. Also, as cortisol levels initially increase, this can decrease the liver’s ability to clear excess estrogens (which are then recirculated as toxins). This increases the level of thyroid binding globulin (TBG) which binds thyroid hormone and leads to lower levels of free thyroid hormone available for use by the body.

Conventional Treatments that May Be Replaced by Adaptogens

When you look at the symptoms associated with adrenal dysfunction you can quickly see why anxiety meds, blood sugar meds, and sleep meds are the conventional prescription of choice.

In my own case years ago, and with many of my clients, the solution given by conventional medicine for “fatigue, irritability, anxiety and just a bit crazy” has been prescription medications such as SSRIs (selective serotonin reuptake inhibitors such as Lexapro, Prozac, Zoloft, etc.) and anxiolytic medications such as benzodiazepines (Xanax, Ativan, etc.).

As a pharmacist, while I recognize the benefit of these medications given the right situation, adrenal fatigue just isn’t the right situation. There isn’t such a thing as “Prozac deficiency,” but there are underlying root causes, such as blood sugar control issues, lack of sleep, nutrient deficiencies, etc. When those are addressed, people are more likely to feel better and not experience negative side effects.

Over Two Dozen Adaptogens I Often Recommend (And Why)

The following section is an overview of several adaptogenic herbs that may increase the body’s ability to resist stress, and have been helpful in relieving adrenal dysfunction when used in combination with vitamins and minerals. These can be used alongside other core lifestyle changes and adrenal protocols I’ve developed to heal the adrenals.

I’ll talk about which ones you might want to start with at the end.

General precautionary note:

Note that many supplements – including adaptogens – may interact with certain medications (in particular those associated with blood clotting, blood pressure and blood sugar level, and drugs you take that may impact the liver or autoimmune system, but many others) so please consult with a good functional practitioner to review your current list of medications, before starting any supplementation. Some adaptogens are not to be taken orally during pregnancy or lactation, and many have other contraindications relating to pre-existing health conditions. Where I have made specific supplement recommendations, you should find additional info and precautions at the provided link.

Aloe vera (Aloe barbadensis) 

This adaptogen may be beneficial for Hashimoto’s; it has been found to reduce thyroid antibodies as well as improve TSH and free T4 levels. It is a strong antiviral and a great adaptogen for people having herpes viruses, including the Epstein-Barr virus. This family of viruses can often be triggers for Hashimoto’s; one study done in 2015 found the Epstein-Barr virus in the thyroid cells of 80 percent of people having Hashimoto’s and 62.5 percent of people having Graves’.

Research has shown aloe vera can also be helpful for balancing blood sugar and helping with digestive issues, as well as being protective of the liver. My recommendation for a quality aloe vera supplement is Rootcology’s Aloe.

See my detailed article on aloe vera for important precautions and additional information regarding aloe vera.

American ginseng (Panax quinquefolium)

This adaptogenic herb is a favorite of mine, and I use it in my adrenal support blend, Rootcology’s Adrenal Support. In research, it has also been found to have anti-inflammation, antioxidation, anti-fatigue, antiaging, and even anticancer effects, as well as providing immunostimulatory effects.

It has been thought that its ginsenoside content plays a role in all of these benefits. Ginsenosides are also thought to be neuroprotective. Animal experiments have shown that ginsenosides are effective in treating nervous system diseases, such as Parkinson’s and Alzheimer’s disease, as well as having the ability to improve working memory (bye-bye brain-fog!).

American ginseng has also been shown to be a safe and effective adjunct treatment in the management of Type 2 Diabetes.

Some of my clients use american ginseng as a sleep aid; it can also help alleviate the effects of time differences syndrome (disruption of circadian rhythm).

Precautions: Ginseng may decrease the effect of warfarin (Coumadin), leading to an increased risk of bleeding. Some medications for depression (monoamine oxidase inhibitors in particular) such as tranylcypromine (Parnate), phenelzine (Nardil) and others may be too stimulating to take with ginseng, causing insomnia and other symptoms. Caution should be used if taking medications for blood sugar control as blood levels can drop too low. Other possible drug interactions include heart medications and painkillers such as morphine. Use caution when taking ginseng with caffeine or other stimulants.

Amla (Emblica officinalis) – Indian Gooseberry

Preclinical studies have shown that amla possesses many properties including: anti-inflammatory, immunomodulatory, antimutagenic (potentially important in the treatment of cancer), analgesic, antipyretic, antitussive, antiatherogenic, antianemia, hepatoprotective, cardioprotective, gastroprotective, antidiarrheal, anti-hypercholesterolemia, wound healing, antiatherosclerotic, nephroprotective, and neuroprotective properties.

There is also growing research relating to its potential anti-diabetic effects in preventing/reducing hyperglycemia and diabetic nephropathy; as well as providing effective support in other conditions such as protein wasting, neuropathy, cardiac complications, cataractogenesis and more. Indian gooseberry is also commonly used for high cholesterol and persistent heartburn.

Precautions: Amla may increase the risk of bleeding in some people. It might decrease blood sugar levels so use caution if you take medications for diabetes; your doctor may need to adjust your dose.

Ashwagandha (Withania somnifera) – Indian Ginseng

Ashwagandha is a popular adaptogenic herb found to have many anti-stress properties, along with being neuroprotective, anti-arthritic, anti-inflammatory, and analgesic. Unlike some adaptogens, it has more of a calming effect. I have found it to be extremely helpful for those who are fatigued during the day but have a hard time sleeping at night—those of us that can sometimes find ourselves “wired and tired.”

It is my favorite adaptogenic herb for Hashimoto’s (which is why I made it an integral part of my adrenal support blend, Rootcology’s Adrenal Support).

In my clinical practice I have seen ashwagandha help normalize thyroid hormone levels in cases of subclinical hypothyroidism. In one small study, after 8 weeks of treatment, ashwagandha was found to improve serum TSH, T3 and T4 levels, normalizing serum levels.

Ashwagandha has helped to improve mood disorders in many of my clients. Research supports that ashwagandha may offer antidepressant, antioxidant, anti-inflammatory and neuroprotective benefits on top of being an effective treatment for subclinical hypothyroidism. Still other research has shown it may reduce anxiety, improve sleep, and even help address sexual dysfunction in women.

If you are looking for a stand-along ashwagandha supplement, I recommend Ashwagandha by Pure Encapsulations.

Precautions: Ashwagandha should not be taken by pregnant or lactating women. People taking immunosuppressant medications, thyroid medications or sedatives should consult with their practitioner in regards to any potential contrary effects. It may be contraindicated for individuals having allergic reaction to nightshades (eggplant, bell peppers, white potatoes, tomatoes, cayenne pepper, etc.). Though I have not personally seen clients react to the supplemental form that is taken as a capsule, my friend Magdalena Wszelaki, a hormone specialist who is training as an herbalist mentioned that the powdered form of ashwagandha (used in a latte), caused joint pain in about one third of her clients. From attending herbal conferences, she learned that ashwagandha taken in a tincture form does not cause the same problems. It would seem that the problematic constituents are water-soluble, which is why they are not extracted into a tincture.

Asian ginseng(Panax ginseng)

Asian ginseng is often used for its stimulating properties and as an adaptogen when the body is under emotional or physical stress (such as fatigue or due to prolonged exercise). I like the supplement, Panax Ginseng by Pure Encapsulations.

Just like American ginseng, its major active ingredients are ginsenosides, which have been shown in Asian ginseng studies to have a variety of therapeutic effects, including anti-inflammatory, antioxidation, vasorelaxation, immune-modulating, antiallergic, antidiabetic, and anticancer.

Ginseng and ginsenosides have also been studied for their effect on primary cardiovascular risk factors such as oxidative stress, hypertension and hyperlipidemia. Ginseng and ginsenosides have been found to play a primary role in preventing cardiovascular disease.

There is also evidence for the use of ginseng for respiratory tract infections; it has been shown to decrease the risk of developing symptoms of an upper respiratory tract infection and to decrease the duration and severity if such an infection develops.

Precautions: Asian ginseng is not recommended for pregnant or lactating women. It can decrease blood glucose levels. Because of its stimulating properties, ginseng can cause anxiety, insomnia, heart palpitations, tachycardia and blood pressure changes. There are uncertainties about ginseng’s interaction with some medications such as warfarin (Coumadin), diabetes medications or immunosuppressants, so always consult with your practitioner.

Astragalus (Astragalus membranaceus)

This adaptogen supports improved immune function and is often used to decrease fatigue. Astragalus has been shown to provide immunomodulating, antioxidant, anti-inflammatory, as well as anticancer effects. In vitro and animal studies indicate that astragalus and its constituents have anti-inflammatory, antioxidant, and antiviral activities, along with exerting protective effects on the kidney, the heart, bone health, and the nervous system

I typically suggest clients try Astragalus Root Extract by Vital Nutrients.

Precautions: There are a number of potential contraindications for astragalus. It has estrogenic properties so may interfere with hormone therapies. Its immune-stimulating properties could affect those with autoimmune diseases. Certain medications may have interaction issues, including: immunosuppressants, anticoagulants, diuretics, antihypertensive medications, P-glycoprotein substrates, and gemcitabine. Astragalus may also affect blood sugar and blood pressure levels for some people.

Chaga mushroom (Inonotus obliquus)

Extracts of chaga mushroom have been used for their favorable effects on cardiac function and lipid metabolism, as well as for anti-inflammatory, anti-bacterial, anti-oxidant, and anti-tumor activities.  

In laboratory studies chaga, has also been found to inhibit the hepatitis C virus and human immunodeficiency virus (HIV). Additionally, chaga has demonstrated antidiabetic effects as well as immunomodulating and pain-relieving properties.

Some animal studies have also confirmed these findings, with chaga displaying, antioxidant, anti-allergic, antidiabetic and cognition-enhancing effects.

Chaga extracts and constituents have demonstrated inhibitory and proapoptotic (causing apoptosis, or programmed cell death) effects against liver, lung and colon cancer cells. In animal models, it inhibited melanoma cell growth.

Precautions: Chaga mushrooms are high in oxalates and excessive intake may have toxic effects. There are potential drug interactions with anticoagulant or antiplatelet medications as well as hypoglycemic or blood sugar medications. Please consult with your practitioner for additional information.

Chinese skullcap (Scutellaria baicalensis) – Huang Qin

This adaptogenic herb has been shown to have pharmacological effects including: anti-inflammatory, anti-cancer, antibacterial, antiviral, hepatoprotection, antioxidant, neuroprotective and anticonvulsant.

In vitro and animal studies found that it lowered blood cholesterol levels and showed anticancer effects, causing apoptosis (cell death) in various cancer cells, including brain tumor cells, head and neck squamous cell carcinoma and prostate cancer cells.

It is one of the main components of an herbal remedy used today in alternative medicine (called Sho-saiko-to or SST) for liver conditions such as hepatitis, carcinoma, and hepatic fibrosis.

Precautions: While it has been promoted as protective of the liver, there have been some identified cases of liver damage while taking Chinese skullcap. Medication interactions include: blood thinners, statins, and Cytochrome P450 substrate drugs.

Cordyceps (Cordyceps sinensis)

Cordyceps is another favorite herb and adaptogen with many benefits for those with Hashimoto’s. It is antiviral, antitumor, immunomodulating, antioxidant, antimicrobial, hypoglycemic, and anti-inflammatory.

In my practice, due to cordyceps’ potent antiviral effects (confirmed in research), I often recommend Cordyceps by NOW when a client’s health timeline or testing indicates a viral infection such as Epstein-BarrVirus or another herpes virus.

I’ve also found it to support overall gut, liver, and immune functions. It seems to be particularly good at normalizing Hashimoto’s effect on the body’s immune system and has been shown to have the ability to reduce thyroid antibody levels as well.

You can read more about cordyceps here, including how it is rich in selenium (which we know can also reduce antibody levels).

Precautions: Cordyceps should not be taken by pregnant or lactating women. Cordyceps can interfere with blood clotting. People with existing autoimmune diseases (including multiple sclerosis, rheumatoid arthritis, and lupus) should consult with their physician as cordyceps could interfere with medications.

Some possible medication interactions to discuss with your doctor are: Cyclophosphamide (Cytoxan, Neosar); prednisone (Deltasone, Orasone), azathioprine (Imuran), basiliximab (Simulect), daclizumab (Zenapax), mycophenolate (CellCept), cyclosporine (Neoral, Sandimmune), muromonab-CD3 (OKT3, Orthoclone OKT3), tacrolimus (FK506, Prograf), sirolimus (Rapamune), corticosteroids (glucocorticoids), and others.

Dang Shen (Codonopsis pilosula)

Research has found many bioactive properties of Dang Shen including: anti-tumor, anti-diabetic, anti-aging, anti-inflammatory, antioxidant, and hepatoprotective. Additionally, it has shown positive effects on immunity and nervous system health. 

I’ve used Dang Shen in my practice to support the immune system and provide support for poor gastrointestinal function.

Precautions: Women who are pregnant or lactating should discuss with their doctor. Dang Shen may slow blood clotting and could lower blood pressure. Medications that may interact with Dang Shen include digoxin (Lanoxin), anticoagulants, antiplatelet medications, and warfarin (Coumadin).

Guduchi (Tinospora cordifolia)

Guduchi is used in various herbal preparations for many properties including: anti-periodic, antispasmodic, anti-microbial, anti-osteoporotic, anti-inflammatory, anti-arthritic, anti-allergic, and anti-diabetic.

This anti-stress adaptogen is also hepatoprotective, immunomodulatory and shows antineoplastic (anti-tumor) activities.

Guduchi has many biologically active compounds viewed as having potential application in clinical research. Some examples of investigations include rheumatoid arthritis treatment as well as use as an anti-osteoporotic (helping to maintain bone density). As with most adaptogens different parts of the plant are used to access different biological compounds. As one example, the stem of guduchi has been used in traditional folk medicine in the treatment of diabetes. It is reported to mediate anti-diabetic effects through mitigating oxidative stress and regulating blood glucose.

Some clinicians recommend a supplement containing guduchi during allergy season as it helps the body’s immune response during this time. That supplement is HistaEze by Designs for Health which contains an extract of the plant, Tinofend®, that has been clinically shown to regulate key immune mediators as well as help support the body in ridding itself of allergens by reducing the number of cells containing histamine.

Precautions: Guduchi might lower blood sugar levels. Those taking medications for diabetes should consult with their doctor, as the combination of diabetes medications and guduchi could cause your blood sugar to go too low. It may cause the immune system to become more active, so those with autoimmune diseases should discuss with their doctor. Medications such as immunosuppressants and corticosteroids may be affected as they could interact with guduchi.

He Shou Wu (Polygonum multiflorum)

Laboratory studies as well as clinical practice applications have shown this adaptogen (also referred to as Fo-ti in the United States) to possess many attributes including being hepatoprotective and antidiabetic. Other therapeutic actions seen are anti-tumor, anti-oxidant, antibacterial, anti-inflammatory, anti-HIV, nephroprotection (supportive of the kidney), and anti-atherosclerotic (supportive of the arteries). It has also been used as an anti-aging agent and to address insomnia.

Some animal studies have found it to be protective of neurodegenerative diseases, hyperlipidemia and cardiovascular diseases.

Precautions: While this adaptogen has been used to support the liver, there have been reports of liver damage and problems (such as hepatitis) from using it. If pregnant or lactating, there can be a laxative effect (that can also pass into breast milk). He Shou Wu might reduce blood sugar levels, so people with diabetes need to watch for signs of hypoglycemia. He Shou Wu might display estrogenic activity, so those with hormone-sensitive conditions (uterine cancer, breast cancer, ovarian cancer, uterine fibroids, endometriosis) should avoid using it. Potential drug interactions include: Digoxin (Lanoxin), anti-diabetes drugs, medications that are known to harm the liver (acetaminophen, amiodarone, carbamazepine, isoniazid, methotrexate, methyldopa, fluconazole, itraconazole, erythromycin, phenytoin, lovastatin, pravastatin, simvastatin and others), stimulant laxatives, warfarin (Coumadin), and water pills/diuretic drugs.

He Shou Wu may also have negative interactions with medications that are changed by the liver: amitriptyline, haloperidol, ondansetron, propranolol, theophylline, and verapamil.

Acid reducers such as omeprazole (Prilosec), lansoprazole (Prevacid), as well as pantoprazole (Protonix), diazepam (Valium), carisoprodol (Soma) and nelfinavir (Viracept) may also have negative interactions. There are many others, including ibuprofen (Motrin), celecoxib (Celebrex), warfarin (Coumadin), fexofenadine (Allegra), etc. Please do consult with your doctor when taking any new supplements; this is especially true for one with so many contraindications.

Holy basil (Ocimum sanctum) – Tulsi

The anti-inflammatory effects of holy basil have been documented in many in vitro and in vivo studies.

As an adaptogen, preclinical studies have demonstrated that holy basil provided anti-stress effects comparable to antidepressant drugs. Some two dozen studies have found it has favorable clinical effects across multiple areas including metabolic disorders, mood conditions, immunity and infections.  

There are additional studies evaluating it for its anticancer, immunomodulatory, antimicrobial and neuroprotective effects. It has been found to have a pain lowering effect in animal studies having surgically induced brain injuries (shown to reduce oxidative damage and neurological deficits).

Numerous studies have found it has potent pharmacological actions that include the above, as well as being hepatoprotective, antidiabetic, and as an antioxidant.

I love drinking Tulsi tea to support my overall stress levels. This has become my go-to adaptogen during lactation, as it is also a galactagogue.

Precautions: Discuss with your doctor if pregnant or lactating. Holy basil might lower blood sugar levels or could potentially lower thyroxine levels; medications may need to be adjusted. Medications that may have contraindications include: Those that slow blood clotting such as warfarin (Coumadin), aspirin, clopidogrel (Plavix) and others. Taking holy basil with pentobarbital may cause excessive drowsiness.

Jiaogulan (Gynostemma pentaphyllum)

Research has found jiaogulan to have many adaptogenic properties including being anti-inflammatory, antioxidative, neuroprotective, lipid metabolism regulatory (important for fat metabolism), antiproliferative (antitumor) and anxiolytic (anxiety reducer).

It is used as an adjunct herbal treatment in diabetes, cardiovascular disease, hepatitis and cancer.

Drinking jiaogulan tea has been shown to reduce fasting blood sugar levels and improve insulin sensitivity in people with diabetes.

Taking jiaogulan may decrease total cholesterol levels while increasing the “good” high-density lipoprotein (HDL)/total cholesterol ratio in people with high cholesterol levels.

Precautions: Do not use if pregnant as one of the chemicals in jiaogulan has been linked to possible birth defects. Jiaogulan may cause the immune system to become more active; especially if you have an auto-immune condition, be sure to consult with your doctor before taking jiaogulan. It may slow blood clotting or lower blood sugar. Medications that may interact with jiaogulan include those that decrease the immune system (corticosteroids, prednisone, others) and those that slow blood-clotting (anticoagulant and antiplatelet medications).

Licorice (Glycyrrhiza glabra)

Licorice is another great adaptogen that has strong anti-stress properties as well as a number of other clinical uses. I recommend it as an antiviral, as well as for gastrointestinal support (it can reduce inflammation and irritation of the GI tract) and as an expectorant. It contains chemicals thought to thin mucus secretions and decrease swelling. I like to use licorice cough drops.

I also use it for clients having fatigue due to low cortisol, as it contains an enzyme that increases circulating cortisol (rather than allowing it to be broken down into inactive cortisone). Keeping cortisol around longer prevents the body from stealing pregnenolone in order to make more cortisol and may be helpful for adrenal insufficiency. I have often found it helpful for those with low cortisol and low blood pressure. However, those with high blood pressure should avoid it.

Licorice has also been found in research to be: anti-inflammatory, spasmolytic, laxative, anti-depressive, antibacterial, anti-ulcer and anti-diabetic.

Licorice is part of my adrenal support blend, Rootcology’s Adrenal Support.

Precautions: Licorice can contribute to sodium and water retention and excretion of potassium, resulting in elevated blood pressure. Caution should be used when considering licorice for susceptible individuals. Do not take orally during pregnancy as chemicals within licorice may be toxic. Licorice side effects are increased for those with: hypertension, old age, prolonged gastrointestinal transient time, hypokalemia, and are more prevalent in women.

Other people who might want to avoid licorice include: people who eat a lot of salt or have heart disease, kidney disease, hormone-sensitive conditions, or a muscle condition called hypertonia.

Additional side effects can include absence of a menstrual period, fatigue, headache, and decreased sexual interest and function in men.

Potential medication interactions include warfarin (Coumadin), Digoxin (Lanoxin), oral estrogens, ethacrynic acid (Edercrin), Furosemide (Lasix), medications for high blood pressure, those for inflammation (such as hydrocortisone, prednisone, dexamethasone, etc.), water pills, and medications that are changed by the liver. Always discuss your current health condition and medications with your doctor before taking new supplements.

Lycium (Lycium chinensis) – Goji berries

Goji berries have many components that show health-promoting properties including: strong antioxidant activity, immune supportive, anticancer, antiaging, anti-radiation and hemopoiesis (supportive of blood cell formation).

As an adaptogen, goji berries have been shown to alleviate oxidative stress and offer protective benefits, such as preventing free radicals from damaging DNA, proteins and lipids. It has shown some beneficial pharmacological activities related to disease management (atherosclerosis, hypertension, and diabetes).

Lycium is rich in betaine and it is useful in supporting liver and stomach function. Studies have reported on all of these benefits. 

Please note that goji berries are part of the nightshade family and should be avoided by those with a sensitivity.

Precautions: Use precaution during pregnancy; in animal studies goji berries can cause the uterus to contract. Some people are allergic to goji berries (those having allergies to peaches, nuts, tomatoes, and tobacco, in particular). Medications that show potential interaction issues include: diabetes medications (goji might lower blood sugar), blood pressure medications (goji might lower blood pressure), medications that are changed by the liver (such as warfarin, diazepam, amitriptyline, diclofenac, fluvastatin, and many others).

Maca (Lepidium meyenii)

Maca is a well-known adaptogen that supports our body’s stress response and adrenals. I have found that it helps my clients with their energy levels and overall mood, as well as symptoms of hormone imbalance (brain fog, memory, metabolism, hot flashes). One study with perimenopausal women found that maca reduced symptoms such as insomnia, hot flashes, and depression by 74-87 percent!

There is growing research that supports these benefits, as well as showing that maca may provide fertility-enhancer properties (as well as support improvements to libido and sexual function).

Maca has been shown to reduce anxiety and depression. Clinical trials found that it may also improve sexual desire. Additional studies have shown maca has antioxidant and neuroprotective effects. Maca is packed with nutrients including many important minerals for those with Hashimoto’s (magnesium, zinc, potassium, etc.) along with essential amino acids, vitamins, and fatty acids. It also contains glucosinolates, which are believed to have anti-cancer benefits.

I love adding maca to my delicious anti-inflammatory green smoothie in order to benefit from its hormone balancing abilities! However, not everyone will respond well to maca. Please be on the lookout for side effects like heart palpitations or jitters.

I also like the product, Maca – 3 by Pure Encapsulations and Femmenessence. 

Precautions: There isn’t a lot of research or data on side-effects or drug interaction concerns with maca. In general, even though maca has not shown to be estrogenic, if you have any hormone-sensitive condition you should consult with your doctor.

Prince Seng (Pseudostellaria heterophylla)

Prince Seng has many attributes, including being antifungal, anti-fatigue, antioxidant, antidiabetic, antitussive and immunomodulatory. It has been used in traditional Chinese medicine to treat issues relating to the lungs and is being studied for potential use in treating lung conditions such as COPD.

It has also been shown to have protective effects on retinal injury as well as exercise-induced oxidative stress. Additionally, it has shown benefits in treating chronic fatigue syndrome. 

Herbalists sometimes recommend prince seng for cases of fatigue as well as for coughs (as an antitussive).

Reishi (Ganoderma lucidum)

Reishi is a medicinal mushroom used for over 2000 years. While there is a good deal of in vitro research and animal studies, there is little well-orchestrated clinical research to draw upon. Having said that, I have seen good results using Reishi mushroom for its immune-boosting effects (in particular for upper respiratory viral infections) as well as for reducing overall stress.

Available studies have shown reishi to have antiviral, antibacterial, anti-inflammatory, anticancer and immunomodulating effects. Studies (mostly in animals) have also suggested that reishi helps in modulating blood glucose levels as well as having a hepatoprotective effect. 

Probably the most promising area that reishi is being studied for is its anticancer properties, which have been attributed to pharmacologically bioactive compounds such as polysaccharides, glucans, and triterpenes. Glucans may activate the immune system, while triterpenes may have a toxic effect against cancer cells.

Precautions: If pregnant or lactating, please consult with your doctor before taking this product. Those taking blood thinning medications should not take reishi without consulting their doctor. Other possible side-effects include nosebleeds, mild gastrointestinal upset, dry mouth and throat, and dizziness.

Rhaponticum (Rhaponticum carthamoides or Stemmacantha carthamoides) – Maral root

Maral root has exhibited numerous biological effects including: adaptogenic, antiparasitic, antimicrobial, antioxidant, immunomodulatory, antitumor, and anticancer. Some people take maral root for improved athletic performance, to increase energy or endurance, to treat muscle overstrain, or to increase muscle mass. Some may use it as a stimulant or to improve male sex dysfunction.

In one animal study, maral root supplementation improved glucose and lipid metabolism and showed it to be helpful in addressing metabolic syndrome, inflammation, and stress. Maral root exhibited better results than two commercially available alternatives (that promoted they offered anti-obesity and antidiabetic properties). 

In other laboratory research, maral root effectively treated cancer cells.

Precautions: If pregnant or lactating please, consult your doctor. Maral root may cause blood clotting to slow.

Rhodiola (Rhodiola rosea)

I love rhodiola (which is why it is included in my Rootcology’s Adrenal Support blend).

It is a wonderful adaptogen, sometimes referred to as Golden Root, that not only helps us maintain a healthy stress response, but has been found to improve depressive symptoms, insomnia, low mood, and mood instability. It has a stimulatory effect on people in a state of fatigue. I think of rhodiola as the adaptogen focused on our nervous system health. In particular I have found rhodiola to be helpful for my clients with depressed cortisol levels.

One of the main chemicals in rhodiola is salidroside, found to have neuroprotective effects that reduce the impact of stress on the immune system and the neuro-endocrine system. Studies have found an anti-fatigue effect along with cognitive function improvements, such as memory (during stressful conditions), when people took rhodiola. Clinical studies have also shown it could diminish depressive symptoms. In one study, those taking rhodiola significantly reduced depressive symptoms, including emotional instability and insomnia.

In animal studies, rhodiola has also been shown to have an inhibitory effect on the development of hypertension and hyperglycemia (two of the major risk factors for vascular disease). Other findings in animal studies indicate it may also play a protective role in supporting healthy heart muscle function and blood flow.

Because of its pharmacological properties, it is also being looked at for possible therapeutic value in other diseases, such as Parkinson’s disease, Alzheimer’s disease, cerebrovascular disease, and diabetes.

While I usually prefer clients start with my adrenal support blend, I do also recommend Rhodiola Rosea by Pure Encapsulations.

Precautions: Rhodiola may be contraindicated for individuals taking antidepressant medications, adrenergic-blocking and antiarrhythmic medications. Some people may react to its stimulatory effect and experience insomnia, headache, irritability or excitement.

Schisandra (Schisandra chinensis)

Schisandra is another good anti-stress adaptogen that has also been studied for its central nervous system effects. It has been shown to have antihepatotoxic, anti-inflammatory, antioxidant, anti-viral, antibacterial, immunomodulatory, and antitumor activities. 

Studies relating to acetaminophen-induced liver injury demonstrated strong hepatoprotective effects. Many additional studies have shown that the chemicals in schisandra may be able to improve liver function by promoting liver cell growth and stimulating enzymes in the liver.

Schisandra has been shown to help in states of exhaustion, to increase alertness, improve the ability to learn and memorize, and improve mental performance and overall concentration. As such, it has been used as an adjunct treatment for a number of conditions, including Parkinson’s, Alzheimer’s disease, ADHD, and depression. It has also been found to be beneficial as a sleep aid as well as an adaptogen that can alleviate circadian rhythm disruptions due to time changes.

In animal studies, it has also been found to work as an antiasthmatic treatment, as it may lower airway hyperresponsiveness. It appears to also reduce pulmonary inflammation and cough frequency.

Precautions: If you are pregnant or lactating, consult your doctor before using schisandra; it may cause the uterus to contract. Those with high blood pressure, diabetes, on psychiatric medications, or who are sensitive to mildly stimulating herbs (having epilepsy, for example) should use caution. People taking medications for GERD or peptic ulcers may want to avoid schisandra due to it causing a potential increase in stomach acid.

Shatavari (Asparagus racemosus)

I often talk about shatavari as an adaptogen for women, as historically it has deep roots relating to its ability to address women’s stress, including psychological stress as well as inflammation of the female reproductive system. The word Shatavari itself means “woman of a hundred husbands.” I’m not sure if the interpretation is focused on the stress of having a hundred husbands or the fertility requirement (since the herb is thought to increase vitality and fertility)! I just know that I only have one husband and adaptogens have helped me to keep up with him and my son! 🙂

Pharmacological properties of shatavari, most identified through laboratory studies, include: antiulcer, antitussive, antioxidant, antidiabetic, antidiarrheal, antibacterial, antiprotozoal, anti-inflammatory, antidepressant, and immunomodulatory. It has been used as an aphrodisiac.

It is used for a number of nervous disorders, cough, bronchitis, inflammations, neuropathy and hepatopathy. Relating to the female reproductive system, it is used for hormonal imbalance, follicular growth and development, polycystic ovarian syndrome (PCOS), oocyte quality and infertility. Possible mechanisms for how it works include the reduction of oxidative stress along with it being a powerful antioxidant.

Precautions: Shatavari is contraindicated for those who are pregnant or are taking lithium.

Shilajit (Ashphaltum bitumen)

Shilajit is an interesting adaptogen made from decomposed organic matter that has hardened into rock. About 60-80 percent of shilajit consists of fulvic acid, the rest consisting of minerals and other properties, including selenium (which we know helps lower thyroid antibodies). (88) Fulvic acid is a potent antioxidant.

Along with its anti-stress effects, other properties of shilajit include: anti-inflammatory, antiulcerogenic, antidiabetic, cognitive and memory enhancer, antianxiety, antiallergic, immunomodulatory, analgesic, antifungal and neuroprotective. 

It has been used for a variety of disease treatments, including as a neuroprotective agent supporting cognitive function. It improves memory, and in vitro studies have shown it to act as an anti-aggregation factor of tau protein (found in Alzheimer’s disease).

It appears to have protective properties for people in high altitudes, exhibiting a number of important actions, including: transporting nutrients into deep tissue to overcome lethargy and fatigue; energy production, preventing hypoxia due to cold exposure, etc.

It has been used for a variety of nervous disorders, insomnia, anemia (it contains a high level of iron), digestive disorders, joint disorders (it appears to reduce joint inflammation and pain) and rheumatoid arthritis, gastric issues, stomach ulcers, asthma, chronic bronchitis, colitis, diabetes, and a number of other diseases.

Precautions: Fulvic acid in shilajit might increase activity of the immune system. Fulvic acid is responsible for the mild hypothyroid effect of humic (soil) substances.

Siberian ginseng (Eleutherococcus senticosus) – Eleuthero

Another one of my favorites, eleuthero is also part of my adrenal support blend. It is anti-stress and adrenal supportive, as well as antibacterial, antioxidant, anti-fatigue, antimicrobial, chemoprotectant, and immunomodulating. It has been shown to boost one’s immunity as well as to increase endurance and performance, improve recovery from overtraining, and enhance mitochondrial activity and energy levels. 

I often say that eleuthero is my go to for those who work too hard and play too hard (and those likely to not get enough sleep!)…anyone out there have those Type A characteristics?

Research has found that eleuthero may be supportive of antidiabetic effects. One study concluded that chemicals found in eleuthero can enhance glucose uptake, improve insulin resistance, and help regulate glucose metabolism. 

Precautions: Eleuthero may increase blood pressure, cause palpitations, increase blood sugar, and increase bleeding, so people with hypertension, cardiovascular disease, diabetes or blood clotting issues should discuss with their doctor. Side effects can include irritability, anxiety, melancholy, mild drowsiness, and uterine bleeding at higher doses.

Suma (Pfaffia paniculata) – Brazilian ginseng

Suma is used for its anti-fatigue, anti-inflammatory, anti-stress, antitumor and immune supportive properties. Most data comes from laboratory studies. It has been found to be effective in relieving pain and as an anti-inflammatory drug (antitumor).

Still other studies have shown it to have antitumor and cancer chemopreventive activity, and it has demonstrated intestinal anti-inflammatory activity as well.

There have additionally been some studies showing improvements in learning and memory in both aged animals and elderly human subjects.

Four simple steps to building greater stress resilience

So before you say, “But what should I try first, and at what dose?” Let me give you some suggestions about starting out with adaptogens.

1. First, please have a good integrative or functional practitioner that you can work with, in order to evaluate your overall health as well as your Hashimoto’s root causes and adrenal health. Conventional doctors will likely not know a lot about adaptogens, especially relating to what would work best for your particular Hashimoto’s root causes. Having a functional doctor will really make a difference.

2. Second, remember you can’t just supplement away your lifestyle decisions. Adaptogens, while amazing, are not a substitute for making healthy decisions elsewhere in our life (such as choosing a better diet to support our thyroid, removing known food sensitivities, toxins and stressors, and addressing other underlying root causes for Hashimoto’s). You’ll find that addressing your root causes, even just one at a time, will result in you feeling better and will likely improve your thyroid hormone levels as well.

3. Third, start with a proven blend that contains a mix of (the best!) adrenal supporting supplements at an easy recommended dose. You will likely have better results as you’ll get a great blend of all the best anti-stress nutrients in one supplement. This will also ensure you have minimal side-effects.

For example, Rootcoogy’s Adrenal Support supplement contains many of my favorite adaptogens including: American ginseng, Siberian ginseng/Eleuthero, Ashwagandha, and Rhodiola. I especially like that ashwagandha has research-supported benefits specific for thyroid health. I also added licorice to the blend to help with overcoming fatigue (Licorice was one of the herbs that really helped me!) This blend also contains needed B and C vitamins. It’s a great way to start out on adrenal recovery.

I generally recommend continuing this adrenal support blend long-term, as life is inevitably full of stress. For added convenience, you can subscribe to get Adrenal Support delivered straight to your door on a schedule of your choosing. As a bonus, the Subscribe & Save option will give you a 10 percent off discount!

You might want to talk with your functional doc about other adaptogens on my list that might make sense for you to try, given their specific benefits to your unique root causes and symptoms. There are several that are helpful for blood sugar, and others to help deal with viruses.

4. Four, add some “me time” in your day, each day. If you are suffering from adrenal dysfunction, there are many things that you can do that can help support your adrenals and make you feel better! Try a few starting today!

• Make an intentional effort to get more quality sleep. Getting more sleep makes 74 percent of my clients feel better!
• Spend time with loved ones. 73 percent of my clients say this washes away a lot of their perceived stress. Yes, the stressor doesn’t go away, but you can at least put it away and deprioritize it for awhile.
• Get out in nature! 71 percent appreciate connecting with the out-of-doors and natural light.
• Go for a walk. 66 percent enjoy getting some movement in as well as taking a breather from other more focused and/or stressful work.
• Get a massage. 62 percent find this relaxing (extra points if your spouse/partner is giving you your massage, or you giving them theirs!)
• Read a good book. 61 percent of you find this a great de-stressor.
• Just sit on a bench! 60 percent say this downtime is a great chance to relax the mind and reboot one’s system (extra points if the bench has a view or you are sitting there with your beloved or your beloved pet).

All of these simple things can add to your resilience to counter stress. And if you are looking for more info about the adrenal glands I cover adrenal protocols in my book Hashimoto’s Protocol.

Please let me know about your experiences with adaptogens!

P.S. For continued updates and interaction, please become a part of our Facebook community and sign up for my newsletter to get a free book chapter from my first book, recipes, a Thyroid Diet start guide, and notifications about my latest research.

References

1. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9
2. Panossian A. Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. Ann N Y Acad Sci. 2017;Aug;1401(1):49-64.
3. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 2010;3(1):188–224.
4. Kim JH, Yi YS, Kim MY, Cho JY. Role of ginsenosides, the main active components of Panax ginseng, in inflammatory responses and diseases. J Ginseng Res. 2017;41(4):435–443.
5. Zheng M, Xin Y, Li Y, et al. Ginsenosides: A Potential Neuroprotective Agent. Biomed Res Int. 2018;2018:8174345.
6. Lee, D. Yang, C. Chik, S. et al. Bioactivity-guided identification and cell signaling technology to delineate the immunomodulatory effects of Panax ginseng on human promonocytic U937 cells. Journal of Translational Medicine. 2009;34(7):1
7. Zheng M, Xin Y, Li Y, et al. Ginsenosides: A Potential Neuroprotective Agent. Biomed Res Int. 2018;2018:8174345.
8. Scholey A, Ossoukhova A, Owen L, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology (Berl). 2010;212(3):345–356. doi:10.1007/s00213-010-1964-y
9. Vuksan V, Xu ZZ, Jovanovski E, Jenkins AL, et al. Efficacy and safety of American ginseng (Panax quinquefolius L.) extract on glycemic control and cardiovascular risk factors in individuals with type 2 diabetes: a double-blind, randomized, cross-over clinical trial. Eur J Nutr. 2019 Apr;58(3):1237-1245.
10. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57.
11. Baliga MS, Dsouza JJ. Amla (Emblica officinalis Gaertn), a wonder berry in the treatment and prevention of cancer. Eur J Cancer Prev. 2011 May;20(3):225-39.
12. D’souza JJ, D’souza PP, Fazal F, Kumar A, Bhat HP, Baliga MS. Anti-diabetic effects of the Indian indigenous fruit Emblica officinalis Gaertn: active constituents and modes of action. Food Funct. 2014 Apr;5(4):635-44.
13. Singh N, Bhalla M, de Jager P, et al. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-13.
14. Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med.2018 Mar;24(3):243-248.
15. Gannon JM, Forrest PE, Roy Chengappa KN. Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder. J Ayurveda Integr Med.2014;5(4):241-5.
16. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014;20(12):901-8.
17.  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 Jul;34(3):255-62.
18. Kaushik MK, Kaul SC, Wadhwa R, et al. Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction. PLoS One. 2017;12(2):e0172508.
19. Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154.
20. Kim JH. Pharmacological and medical applications of Panax ginseng and ginsenosides: a review for use in cardiovascular diseases. J Ginseng Res. 2018;42(3):264–269.
21. Kim JH. Pharmacological and medical applications of Panax ginseng and ginsenosides: a review for use in cardiovascular diseases. J Ginseng Res. 2018;42(3):264–269.
22. Auyeung KK, Han QB, Ko JK. Astragalus membranaceus: a review of its protection against inflammation and gastrointestinal cancers. Am J Chin Med. 2016;44(1):1-22.
23. Memorial Sloan Kettering Cancer Center. Astragalus. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/astragalus. Published July 10, 2019. Accessed August 22, 2019.
24. Arata S, Watanabe J, Maeda M, et al. Continuous intake of the Chaga mushroom (Inonotus obliquus) aqueous extract suppresses cancer progression and maintains body temperature in mice. Heliyon. 2016;2(5):e00111. Published 2016 May 12.
25. Memorial Sloan Kettering Cancer Center. Chaga mushroom. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/chaga-mushroom. Published April 11, 2019. Accessed August 22, 2019.
26. Memorial Sloan Kettering Cancer Center. Chaga mushroom. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/chaga-mushroom. Published April 11, 2019. Accessed August 22, 2019.
27. Memorial Sloan Kettering Cancer Center. Scutellaria baicalensis.. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/scutellaria-baicalensis. Published August 22, 2018. Accessed August 22, 2019.
28. Zhao Q, Chen XY, Martin C. Scutellaria baicalensis, the golden herb from the garden of Chinese medicinal plants. Sci Bull (Beijing). 2016;61(18):1391–1398.
29. Zhao Q, Chen XY, Martin C. Scutellaria baicalensis, the golden herb from the garden of Chinese medicinal plants. Sci Bull (Beijing). 2016;61(18):1391–1398.
30. Lin B, Li S. Cordyceps as an herbal drug. In: Benzie IFF,Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92758/ accessed August 22, 2019.
31. He T, Zhao R, Lu Y, Li W, Hou X, Sun Y, Dong M, Chen L. Dual-Directional Immunomodulatory Effects of Corbrin Capsule on Autoimmune Thyroid Diseases. Evid Based Complement Alternat Med. 2016;2016:1360386. Epub 2016 Sep 18.
32. Jing Ji, Juan Liu, Haijuan Liu, et al. Effects of fermented mushroom of cordyceps sinensis, rich in selenium, on uterine cervix cancer. Evidence-Based Complementary and Alternative Medicine, vol. 2014, Article ID 173180, 7 pages, 2014.
33. He JY, Ma N, Zhu S, Komatsu K, Li ZY, Fu WM. The genus Codonopsis (Campanulaceae): a review of phytochemistry, bioactivity and quality control. J Nat Med. 2015;69(1):1–21. doi:10.1007/s11418-014-0861-9
34. Gao JP, Wang D, Cao LY, Sun HF (2015) Transcriptome Sequencing of Codonopsis pilosula and Identification of Candidate Genes Involved in Polysaccharide Biosynthesis. PLoS ONE 10(2): e0117342.
35. Saha S, Ghosh S. Tinospora cordifolia: One plant, many roles. Anc Sci Life. 2012;31(4):151–159. doi:10.4103/0257-7941.107344
36. Saha S, Ghosh S. Tinospora cordifolia: One plant, many roles. Anc Sci Life. 2012;31(4):151–159. doi:10.4103/0257-7941.107344
37. Bounda GA, Feng YU. Review of clinical studies of Polygonum multiflorum Thunb. and its isolated bioactive compounds. Pharmacognosy Res. 2015;7(3):225–236.
38. Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567. doi:10.1155/2017/9217567
39. Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567. doi:10.1155/2017/9217567
40. Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567. doi:10.1155/2017/9217567
41. Ahmad A, Rasheed N, Gupta P, et al. Ocimumoside A and B as anti-stress agents: modulation of brain monoamines and antioxidant systems in chronic unpredictable stress model in rats. Phytomedicine. 2012 May 15;19(7):639-47.
42. Gupta P, Yadav DK, Siripurapu KB, Palit G, Maurya R. Constituents of Ocimum sanctum with antistress activity. J Nat Prod. 2007 Sep;70(9):1410-6. Epub 2007 Sep 13.
43. Cristina M. Uritu, Cosmin T. Mihai, Gabriela-Dumitrita Stanciu, et al., “Medicinal Plants of the Family Lamiaceae in Pain Therapy: A Review,” Pain Research and Management, vol. 2018, Article ID 7801543, 44 pages, 2018.
44. Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567.
45. Li Y, Lin W, Huang J, Xie Y, Ma W. Anti-cancer effects of Gynostemma pentaphyllum (Thunb.) Makino (Jiaogulan). Chin Med. 2016;11:43. Published 2016 Sep 27.
46.  WebMD. Vitamins and Supplements. Jiacogulan. https://www.webmd.com/vitamins/ai/ingredientmono-265/jiaogulan. Accessed August 22, 2019.
47. WebMD. Vitamins and Supplements. Jiacogulan. https://www.webmd.com/vitamins/ai/ingredientmono-265/jiaogulan. Accessed August 22, 2019.
48. Dastagir G, Rizvi MA. Review – Glycyrrhiza glabra L. (Liquorice). Pak J Pharm Sci. 2016 Sep;29(5):1727-1733
49. Shah SL, Wahid F, Khan N, et al. Inhibitory Effects of Glycyrrhiza glabra and Its Major Constituent Glycyrrhizin on Inflammation-Associated Corneal Neovascularization. Evid Based Complement Alternat Med. 2018;2018:8438101. Published 2018 Apr 23.
50. Pastorino G, Cornara L, Soares S, Rodrigues F, Oliveira MBPP. Liquorice (Glycyrrhiza glabra): a phytochemical and pharmacological review. Phytother Res.2018 Dec;32(12):2323-2339.
51. Ma ZF, Zhang H, Teh SS, et al. Goji Berries as a Potential Natural Antioxidant Medicine: An Insight into Their Molecular Mechanisms of Action. Oxid Med Cell Longev. 2019;2019:2437397. Published 2019 Jan 9.
52. Potterat O. Goji (Lycium barbarum and L. chinense): Phytochemistry, pharmacology and safety in the perspective of traditional uses and recent popularity. Planta Med. 2010 Jan;76(1):7-19.
53. Lee HW, Kim YH, Kim YH, Lee GH, Lee MY. Discrimination of Lycium chinense and Lycium barbarum by taste pattern and betaine analysis. Int J Clin Exp Med. 2014;7(8):2053–2059. Published 2014 Aug 15.
54. Meissner HO, Reich-Bilinska H, Mscisz A, Kedzia B. Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) used as a Non-Hormonal Alternative to HRT in Perimenopausal Women – Clinical Pilot Study. Int J Biomed Sci. 2006;2(2):143–159.
55. Gonzales GF. Ethnobiology and Ethnopharmacology of Lepidium meyenii (Maca), a Plant from the Peruvian Highlands. Evid Based Complement Alternat Med. 2012;2012:193496.
56. Meissner HO, Kapczynski W, Mscisz A, Lutomski J. Use of gelatinized maca (lepidium peruvianum) in early postmenopausal women. Int J Biomed Sci. 2005;1(1):33–45.
57. Meissner HO, Reich-Bilinska H, Mscisz A, Kedzia B. Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) used as a Non-Hormonal Alternative to HRT in Perimenopausal Women – Clinical Pilot Study. Int J Biomed Sci. 2006;2(2):143–159.
58. Meissner HO, Mscisz A, Reich-Bilinska H, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (III) Clinical responses of early-postmenopausal women to Maca in double blind, randomized, Placebo-controlled, crossover configuration, outpatient study. Int J Biomed Sci. 2006;2(4):375–394.
59. Gonzales GF. Ethnobiology and Ethnopharmacology of Lepidium meyenii (Maca), a Plant from the Peruvian Highlands. Evid Based Complement Alternat Med. 2012;2012:193496.
60. Gonzales GF, Gonzales C, Gonzales-Castañeda C. Lepidium meyenii (Maca): a plant from the highlands of Peru–from tradition to science. Forsch Komplementmed. 2009 Dec;16(6):373-80.
61. Rodríguez-Huamán Á, Casimiro-Gonzales S, Chávez-Pérez JA, et al. Antioxidant and neuroprotector effect of Lepidium meyenii (maca) methanol leaf extract against 6-hydroxy dopamine (6-OHDA)-induced toxicity in PC12 cells. Toxicol Mech Methods. 2017 May;27(4):279-285.
62. Vecera R, Orolin J, Skottová N, Kazdová L, Oliyarnik O, et al. The influence of maca (Lepidium meyenii) on antioxidant status, lipid and glucose metabolism in rat. Plant Foods Hum Nutr. 2007 Jun;62(2):59-63.
63. Pang W, Lin S, Dai Q, Zhang H, Hu J. Antitussive activity of Pseudostellaria heterophylla (Miq.) Pax extracts and improvement in lung function via adjustment of multi-cytokine levels. Molecules. 2011;16(4):3360–3370. Published 2011 Apr 19.
64.  Hu DJ, Shakerian F, Zhao J, Li SP. Chemistry, pharmacology and analysis of Pseudostellaria heterophylla: a mini-review. Chin Med. 2019;14:21. Published 2019 May 23.
65. Hu DJ, Shakerian F, Zhao J, Li SP. Chemistry, pharmacology and analysis of Pseudostellaria heterophylla: a mini-review. Chin Med. 2019;14:21. Published 2019 May 23.
66. Wachtel-Galor S, Yuen J, Buswell JA, et al. Ganoderma lucidum (Lingzhi or Reishi): A Medicinal Mushroom. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 9. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92757/
67. Cizmarikova M. The efficacy and toxicity of using the lingzhi or reishi medicinal mushroom, Ganoderma lucidum (Agaricomycetes), and its products in chemotherapy (Review). Int J Med Mushrooms. 2017;19(10):861-877.
68. Unlu A, Nayir E, Kirca O, Ozdogan M. Ganoderma Lucidum (Reishi Mushroom) and cancer. J BUON. 2016 Jul-Aug;21(4):792-798. Review.
69. Kokoska L, Janovska D. Chemistry and pharmacology of Rhaponticum carthamoides: a review. Phytochemistry. 2009 May;70(7):842-55.
70. Dushkin M, Khrapova M, Kovshik G, et al. Effects of rhaponticum carthamoides versus glycyrrhiza glabra and punica granatum extracts on metabolic syndrome signs in rats. BMC Complement Altern Med. 2014;14:33. Published 2014 Jan 20.
71. Dushkin M, Khrapova M, Kovshik G, et al. Effects of rhaponticum carthamoides versus glycyrrhiza glabra and punica granatum extracts on metabolic syndrome signs in rats. BMC Complement Altern Med. 2014;14:33. Published 2014 Jan 20.
72. Skała E, Synowiec E, Kowalczyk T, et al. Rhaponticum carthamoides transformed root extract has potent anticancer activity in human leukemia and lung adenocarcinoma cell lines. Oxid Med Cell Longev. 2018 Dec 9;2018:8198652.
73. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 2010;3(1):188–224. Published 2010 Jan 19.
74. Zhuang W, Yue L, Dang X, et al. Rosenroot (Rhodiola): Potential Applications in Aging-related Diseases. Aging Dis. 2019;10(1):134–146. Published 2019 Feb 1.
75. Zhuang W, Yue L, Dang X, et al. Rosenroot (Rhodiola): Potential Applications in Aging-related Diseases. Aging Dis. 2019;10(1):134–146. Published 2019 Feb 1.
76. Szopa A, Ekiert R, Ekiert H. Current knowledge of Schisandra chinensis(Turcz.) Baill. (Chinese magnolia vine) as a medicinal plant species: a review on the bioactive components, pharmacological properties, analytical and biotechnological studies. Phytochem Rev. 2017;16(2):195–218.
77. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 2010;3(1):188–224. Published 2010 Jan 19.
78. WebMD, Vitamins and Supplements. Schisandra https://www.webmd.com/vitamins/ai/ingredientmono-376/schisandra. Accessed August 22, 2019.
79. Szopa A, Ekiert R, Ekiert H. Current knowledge of Schisandra chinensis(Turcz.) Baill. (Chinese magnolia vine) as a medicinal plant species: a review on the bioactive components, pharmacological properties, analytical and biotechnological studies. Phytochem Rev. 2017;16(2):195–218.
80. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 2010;3(1):188–224. Published 2010 Jan 19.
81. Szopa A, Ekiert R, Ekiert H. Current knowledge of Schisandra chinensis(Turcz.) Baill. (Chinese magnolia vine) as a medicinal plant species: a review on the bioactive components, pharmacological properties, analytical and biotechnological studies. Phytochem Rev. 2017;16(2):195–218.
82. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16.
83. Szopa A, Ekiert R, Ekiert H. Current knowledge of Schisandra chinensis(Turcz.) Baill. (Chinese magnolia vine) as a medicinal plant species: a review on the bioactive components, pharmacological properties, analytical and biotechnological studies. Phytochem Rev. 2017;16(2):195–218.
84. Alok S, Jain SK, Verma A, Kumar M, Mahor A, Sabharwal M. Plant profile, phytochemistry and pharmacology of Asparagus racemosus (Shatavari): A review. Asian Pac J Trop Dis. 2013;3(3):242–251.
85.  Pandey AK, Gupta A, Tiwari M, et al. Impact of stress on female reproductive health disorders: Possible beneficial effects of shatavari (Asparagus racemosus). Biomed Pharmacother. 2018 Jul;103:46-49
86. Gautam M, Saha S, Bani S, et al. Immunomodulatory activity of Asparagus racemosus on systemic Th1/Th2 immunity: implications for immunoadjuvant potential. J Ethnopharmacol. 2009 Jan 21;121(2):241-7.
87. Vadivelan R, Gopala Krishnan R, Kannan R. Antidiabetic potential of Asparagus racemosus Willd leaf extracts through inhibition of α-amylase and α-glucosidase. J Tradit Complement Med. 2018;9(1):1–4. Published 2018 Apr 30.
88. Carrasco-Gallardo C, Guzmán L, Maccioni RB. Shilajit: a natural phytocomplex with potential procognitive activity. Int J Alzheimers Dis. 2012;2012:674142.
89. Carrasco-Gallardo C, Guzmán L, Maccioni RB. Shilajit: a natural phytocomplex with potential procognitive activity. Int J Alzheimers Dis. 2012;2012:674142.
90. Meena H, Pandey HK, Arya MC, Ahmed Z. Shilajit: A panacea for high-altitude problems. Int J Ayurveda Res. 2010;1(1):37–40.
91. Schepetkin IA, Xie G, Jutila MA, Quinn MT. Complement-fixing activity of fulvic acid from Shilajit and other natural sources. Phytother Res. 2009;23(3):373–384.
92. Ahn J, Um MY, Lee H, Jung CH, Heo SH, Ha TY. Eleutheroside E, An Active Component of Eleutherococcus senticosus, Ameliorates Insulin Resistance in Type 2 Diabetic db/db Mice. Evid Based Complement Alternat Med. 2013;2013:934183.
93. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from http://www.ncbi.nlm.nih.gov/books/NBK501806/
94. Kuo J, Chen KW, Cheng IS, et al. The effect of eight weeks of supplementation with Eleutherococcus senticosus on endurance capacity and metabolism in human. Chin J Physiol. 2010 Apr 30;53(2):105-11.
95. Ahn J, Um MY, Lee H, Jung CH, Heo SH, Ha TY. Eleutheroside E, An Active Component of Eleutherococcus senticosus, Ameliorates Insulin Resistance in Type 2 Diabetic db/db Mice. Evid Based Complement Alternat Med. 2013;2013:934183.
96. Pinello KC, Fonseca Ede S, Akisue G, et al. Effects of Pfaffia paniculata (Brazilian ginseng) extract on macrophage activity. Life Sci. 2006 Feb 16;78(12):1287-92. Epub 2005 Oct 7.
97. Costa CA, Tanimoto A, Quaglio AE, et al. Anti-inflammatory effects of Brazilian ginseng (Pfaffia paniculata) on TNBS-induced intestinal inflammation: experimental evidence. Int Immunopharmacol. 2015 Sep;28(1):459-69.
98. Carneiro CS, Costa-Pinto FA, da Silva AP, et al.. Pfaffia paniculata (Brazilian ginseng) methanolic extract reduces angiogenesis in mice. Exp Toxicol Pathol. 2007 Aug;58(6):427-31.
99. da Silva TC, Cogliati B, da Silva AP, et al. Pfaffia paniculata (Brazilian ginseng) roots decrease proliferation and increase apoptosis but do not affect cell communication in murine hepatocarcinogenesis. Exp Toxicol Pathol. 2010 Mar;62(2):145-55.
100. C.A.R.A. Costa, A.E.V. Quaglio, L.C.Di Stasi. Pfaffia paniculata (Brazilian ginseng) extract modulates Mapk and mucin pathways in intestinal inflammation. Journal of Ethnopharmacology. Volume 213, 1 March 2018; pages 21-25. Accessed at https://www.sciencedirect.com/science/article/pii/S0378874117320585?via%3Dihub#ab0010.
101. C.A.R.A. Costa, A.E.V. Quaglio, L.C.Di Stasi. Pfaffia paniculata (Brazilian ginseng) extract modulates Mapk and mucin pathways in intestinal inflammation. Journal of Ethnopharmacology. Volume 213, 1 March 2018; pages 21-25. Accessed at https://www.sciencedirect.com/science/article/pii/S0378874117320585?via%3Dihub#ab0010.
102. Vita R, Cernaro V2, Benvenga S. Stress-induced hashitoxicosis: case report and relative HLA serotype and genotype. Rev Assoc Med Bras (1992). 2019 Jul 22;65(6):830-833. doi: 10.1590/1806-9282.65.6.830.
103. Markomanolaki ZS, Tigani X, Siamatras T, Bacopoulou F, Tsartsalis A, Artemiadis A, et al. Stress Management in Women with Hashimoto’s thyroiditis: A Randomized Controlled Trial. J Mol Biochem. 2019;8(1):3-12.
104. Vucskits AV, Hullár I, Bersényi A, Andrásofszky E, Kulcsár M, Szabó J. Effect of fulvic and humic acids on performance, immune response and thyroid function in rats. J Anim Physiol Anim Nutr (Berl). 2010 Dec;94(6):721-8. doi: 10.1111/j.1439-0396.2010.01023.x.