Well, howdy, y 'all. Welcome back to yet another
episode of Your Mom on Drugs, number 14. Oh,
that is amazing. Yeah. It is. I mean, some people
have... Podcasts in the thousands, which is pretty
incredible. But for such a little fledgling like
us, we're happy to be here. My name is Josh.
I am the son. And this is Dr. Jennifer Seltzer,
the mom on drugs. and uh we are here to talk
today about a topic and that we haven't covered
before what are we talking about today mom today
we're talking about adaptogens oh adaptogens
that sounds like a fancy word what what are adaptogens
well and you had proposed this topic and neither
of us knew really what they were so here goes
so um as when i started looking into what adaptogens
are i've got a couple of definitions are kind
of, you know, kind of what they are. But an easy
thing is that they're usually certain herbs or
mushrooms that are thought to have health benefits.
That's pretty. pretty nonspecific and global.
Or they also could be natural medicines that
are supposed to increase the body's ability to
deal with stressors like anxiety, fatigue, and
trauma. And when we got into more looking at
this, that's really, I think, a target area where
people utilize these adaptogens. And it's also
thought to be a class of natural substances that
are... that may increase an organism's ability
to adapt and avoid damage from various harmful
factors. For example, the Latin word adaptere
means to adjust or fit, and the Greek word gen
means produced or generated. So it's like you're
trying to adjust or fit against stressors that
are generated or produced against your body and
stuff. Okay, so I see like maybe if you get...
sick or you start kind of feeling out of sorts,
like you have anxiety or depression, someone's
going to come along and be like, Hey, here's
this herb or mushroom that you can take. It's
going to. basically revert you back to your quote
unquote normal state. Right. And I think a lot
of, I saw a lot with stress too, just, you know,
because we've become a much more stressful society,
I think in some senses and stuff. So, so that's
definitely where it's been touted as well too.
It can be found in both natural and synthetic
sources. And interestingly, it's sold as teas
and as tinctures, which is like a little concentrated
liquid powders that you can add. to food or a
capsule. So it's been, it's, you know, it comes
in, and I also read too that it can actually,
some of these compounds have been put in skincare
products. So I'm like, I thought that was interesting.
So I didn't really go, I didn't really look at
those that much and stuff. So, but, and they've
also, these adaptogens have been used for centuries.
They were, they've been very popular in traditional
Chinese medicine, as well as in Ayurveda. which
is an ancient form of Indian healing medicine.
And it's also now they've, they've become more
popular in the Western world, but I thought it
was really interesting because I'd never heard
of Ayurveda before. And it apparently is a natural
holistic approach to physical and mental health.
It's one of the world's oldest medical systems.
And they usually, it sounds almost a little bit
kind of like evidence -based medicine without
the evidence kind of, but it's they, they, the
treatments, like I said, are derived from plants,
but they're looking at, um, um, um, I lost my
train of thought. Um, oh, oh my gosh, I lost
my train of thought. Oh, I, I'm so sorry. Would
you please pardon me? Um, so you use, so Ayurveda,
it uses, it's a combination of using these products
along with diet, exercise, and lifestyle to have
this. more balanced life. Okay. So essentially
it's like, yeah, we have these adaptogens that
will supplement alongside of having a quote unquote
healthy life, which means getting good sleep,
exercise, social connections, kind of the stuff
that we advocate today in the modern world. Right.
But you said. It kind of looks like evidence
-based evidence without the evidence. This might
be a good time for an overview for some of our
listeners of what we mean by evidence -based.
I think a lot of times we, because I know we're
going to be talking about the clinical literature
around some of these substances or lack thereof,
but it might be a good idea to talk about when
we say evidence -based medicine, what do we mean
by that? And then what are the various types
of... studies and evidence you might want to
look for, for something to be more strongly evidence
-based versus non -evidence -based. I don't know
if you want to give a brief overview. Sure. And
so evidence -based medicine means that we have
data. on a particular topic that's been researched,
that it's not just based on somebody's word of
mouth or somebody's particular experience with
a particular medication or supplement, but that
there has been an actual trial set up. The gold
standard of trials is what we call a randomized
control trial. And so what that type of trial
does is it takes the substance that you want
to study and usually pairs it against a placebo
or maybe another active medication that's already
been established. But you're looking then for
statistically significant differences between
these two treatment arms. And again, trying to
keep the two treatment arms as balanced as possible
so you don't have any confounding variables.
What that means is any distractors from the data
so that if you see a difference between those
two treatment arms, you can feel pretty confident
with the statistical results that is due to the
thing you're looking at. I see what you're saying.
So you might have a thousand people in arm A,
a thousand people in arm B. and you might want
them to be looking very similar in terms of a
population yes equal number of men and women
yes kind of an average age it's similar maybe
similar blood pressure similar disease states
you know yes yeah because you don't want to pick
like a population of entirely quote -unquote
healthy people and then a population of all diabetics
for example because that would be a very skewed
right and then you don't know how to interpret
that type of data you know and stuff so so let's
say we have one of these roots that you talk
about or shrubs or herbs like you give them let's
say ashwagandha for example in arm a and then
you give them the the root of a pecan tree in
root B, and you grind it up, put it in a tea,
make people drink it, follow them for... And
then you've got to decide what you're going to
be... In all of these studies, you've got a hypothesis
that you're testing. So it's like, will treatment
A, let's say ashwagandha, will it cause you to
have less stress than the pecan tree? And so
then you've got to identify what your markers
are going to be to measure that so that you've
got actual data rather than just... I mean, you
can do some subjective assessments from patients,
but it's harder to do statistical analysis on
subjective assessments. Yeah, because there could
be so many things that cause stress in a day.
It might be something like cortisol levels. Right,
cortisol levels or a number of times that you
had to take Tylenol. I mean, just ridiculous
things, but it's like you're just looking for
things to measure. How do I know this is better?
And I think a lot of times these spaces were
– in these complementary medicine spaces, whether
it be homeopathy or ayurvedic medicine or traditional
Chinese medicine, they'll claim to have evidence.
They'll cite studies that say, hey, there's actually
a study that shows this benefit. But I think
you would probably say not all studies are created
equal, right? That's correct. There's this kind
of pyramid of hierarchy of quality of evidence.
Can you speak to some of the, maybe the types
of studies that some of these... these other
forms of medicine might use to claim that they're
evidence -based? Sure. So, Colin, maybe on the
bottom of the pyramid, per se, would be things
like a case report or maybe, you know, or just
kind of a random, you know. saw this kind of
thing and a case report is usually something
happened in a particular patient and then you
describe that that particular patient and what
happened but you can't really draw any bottom
line conclusions from that that you can apply
to a general population and then you're going
to move up into things like an maybe an open
label trial what that means is that there's no
you don't have any control group or any anything
to compare it to you're just recording data and
just seeing what happens. But you really don't
know if it's really better than anything else.
You do have trials, too, where you take a point
in time and you look backward. They're called
retrospective trials. So you already have the
data in the front, but then you're looking back,
kind of dredging through maybe old reports, maybe
it's hospital files or old reports, looking to
see if you can see any trends that might have
caused this. And those are not as strong as...
a randomized control trial. And then, and then,
so then randomized control trials, like I said,
are the gold standard, but above a randomized
control trial are things that are called either
meta -analyses or systematic reviews. And systematic
reviews are, are better than meta -analyses because
systematic reviews will go through the literature.
They will find clinical trials that look like
each other so that they can then make assessments
and draw conclusions from the results of these
trials to then give you this broader, like, this
is what the body of literature says about this
subject. And so it saves you some time from having
to go do a literature search on that particular
topic. And then you get kind of what are some
experts thinking about this because they'll put
a panel together of experts to do these systems.
reviews. Meta -analyses are the same kind of
thing, but what meta -analyses, how they differ
from a systematic review is that they actually
find trials. Maybe it's something that has less,
maybe individual trials have less patient population
in the trial, or it's just a harder subject matter.
It's harder to get people in that particular
trial. And they'll pool the data together and
then do statistics on them. But then they make
a lot of the trials in which they pulled those
data from may not have been similar. And so then
that can really kind of skew your results. Yeah,
like the dose that they give someone could be
different, the frequency in which they give,
you know. Or the patient, even the patient populations
can maybe look a little different and stuff.
And then the top thing that you'll see on that
pyramid is our guidelines, which again, we see
those a lot in clinical trials. And again, it's
a group of experts in a particular area on a
particular topic. And they take their expertise
as well as the... literature. And then they create
this guideline that will then kind of give healthcare
providers teeth on which to make decisions as
far as healthcare is concerned. I think that's
great. I think my last one that I want to bring
up is usually one of my favorites because I think
a lot of people in this space. of claiming to
be evidence -based use a lot whether to glorify
something or to demonize something is that they'll
use um either animal studies or rodent studies
or toxicity studies where i think my favorite
example is artificial sweeteners i think there
has been this claim going around i think i think
it started maybe a couple years ago that things
like aspartame and diet coke which if you've
been listening to this podcast you know is my
the mom on drugs favorite drug and they basically
said that it is a carcinogenic like this this
artificial sweetener um and that you should be
careful when drinking it but when you really
look at the data the only reason it's carcinogenic
is because they cited this rodent study to basically
figure out how much of aspartame can we give
these rodents before they start developing cancer.
And when you look at the math and you look at
how much you would have to give a human in order
for this risk to actually appear in a human population,
they would have to drink 12 Diet Cokes a day.
A day, not a week, not in a month, a day. You
would have to drink that much to get the proper
amount of aspartame or artificial sweetener to
increase the risk to be slightly carcinogenic.
So you'll see a lot of studies out there either
glorifying something. or demonizing something,
sometimes based on just an animal study or a
toxicology study that's literally just determining
the amount where it's dangerous, which is obviously
important, but people can really take that information
and skew it for bad or for good. Right. So as
we mentioned earlier, the adaptogens, they're
marketed commonly today to help people who are
facing difficult physical or emotional circumstances.
And they're also marketed to help prevent overtaxing
the body's energetic resources. And they've been
used in sports medicine. And they've been even
marketed online to counter aging or chronic fatigue
syndrome as well, too. But there's really limited
scientific evidence to support their use for
either exercise recovery or stress relief or
immune balance. And they are not regulated by
the FDA. Supplement space, correct? Supplement.
And so, yes. So, yeah. So, they aren't regulated.
And so, what that means is not only do you not
have clinical trials associated with these agents
that let you know whether or not it's safe and
effective, but also there are no purity standards
for these agents. So, that means that every bottle
that you buy of Cordyceps may not have the same
amounts in each tablet or capsule. the tinctures
that you buy may not be the same in each bottle
because there are no standards that they need
to follow in order to make them. I thought it
would be a good idea for us to just kind of talk
a little bit, since a lot of the adaptogens target
stress relief, I thought it would be a good thing
for us to just kind of briefly, and I know I'm
not an endocrinologist, I'm not good at the immune
system, but I can tell you what the literature
says as far as stress is concerned, as far as
how our bodies adapt to stress. So one of the
best, one of the simplest definitions for stress
that I found was it's the body's way of responding
to any kind of demand or change. So when we're
stressed, our body releases chemicals into the
blood that gives a person the energy to fight
or escape. It's that fight or flight mechanism.
And we can all think about those times when we're
like, we've been faced with an angry dog, you
know, or, you know, we, you know, somebody coming
at you with a knife, you know, whatever we're
going to run. So, but so Stress that increases
and it doesn't result in either that fight or
escape result can build up and it could cause
health issues. You could have increased blood
pressure or you can make your heart work harder.
And so you could have some effects on your mental
and physical health. And the system inside of
our body that is responsible for helping with
stress is called the hypothalamic pituitary adrenal
axis, or it's known as the HPA axis. And it's
a communication system between three organs,
the hypothalamus, which is located really deep
in the brain, the pituitary gland, which is also
at the base of the brain, and then the adrenal
glands, which are actually on the top of your
kidneys. and stuff. So, and so they talk to each
other and they've got a feedback loop so that
if you understand what a feed, our bodies have
several feedback loops in them, but we're just
going to target on this one today. The primary
agent that the HPA axis is regulating is going
to be cortisol, which is what gets released when
you have stress events. And so again, you've
got a feedback loop. So if you put out a whole
lot of cortisol out of the HPA axis, it'll go
back to the top and tell your hypothalamus. to
tell you to stop producing cortisol. But if you
have some defects in the system, then you could
then... And the cortisol gets released primarily
from the adrenal glands out the top of the kidney.
But if you have something, if you either, you
could, but you can have that function, that access
can become dysfunctional. You can have too many
stresses. So you can have constant increases
in your cortisol levels and it doesn't tell the
system to shut off. And so then you can have
a whole lot of dysfunctional things going on
in your body. Even you can have immune system
dysfunction because you, so you can have autoimmune
disorders. You can have. mood disorders, anxiety
disorders, PTSD. And then you could also have
metabolic disorders like diabetes or cardiovascular
disease. Can I give an example I think would
help ground people on this? Okay. It's a household
example. So a perfect example of a feedback loop
is your toilet. So whenever you press that, if
you've ever had a broken toilet, you probably
had to take off the top of the lid for the bowl
or the tank, I should say. And when you press
the lever, you essentially open a valve that
allows water to flush down the pipe, you know,
essentially out into the plumbing system. And
then when you release the lever, the water rushes
back in to fill the tank. And then when it comes
up to an appropriate level, it actually lifts
a balloon that essentially closes off the valve
that's releasing the water. And you have a full
tank of water to allow the water pressure to
do the flushing. But if you've ever had a time
where that bulb comes disconnected and you know
that the water is just constantly running, you
kind of want to think about like that with your
body. Basically, if there's no signal to say,
hey, we should stop secreting cortisol, that
cortisol is going to keep being secreted. And
like mom said, cortisol in the short term is
great. We need it. It allows you to take action,
especially if you're exercising. It is a great
lever to allow you to move and exercise and use
your muscles. And the body, just like chronic
water in your toilet, is going to run up your
water bills. It's going to potentially spill
onto the floor. It's going to create that awful
sound. So I think having that example in mind
when thinking about feedback systems in your
body is like cortisol isn't always bad. It's
just chronic cortisol secretion. can potentially
lead to negative outcomes down the road because
i think sometimes people hear cortisol is like
oh it's stress it's not good but no we we couldn't
function if we didn't have cortisol you know
because we we need like like josh said if we
get sick we've that that kicks in to cause our
immune system to kick in as well too and stuff
so yeah so okay so little little tiny like pharmacology
of stress or whatever so now we're going to move
on to you know How do people think adaptogens
work? And so why on earth did you talk about
the HPA axis, Jenny? What are we talking about?
And the reason is that a lot of people think
these adaptogens help to stimulate the body's
stress protection response. So I thought this
was really interesting. There are three criteria
that need to be met to be classified as an adaptogen.
The first one is, and it just kind of made me
laugh because I'm like, we could classify anything
as an adaptogen. But I'm sorry, I'm supposed
to be evidence -based only. So first of all,
adaptogens are supposed to work non -specifically.
They provide benefit for a wide range of conditions,
including biological, physical, and chemical
stress. So they are... thought to produce a response
that allows the body to cope with stress. And
there's a lot of theorized chemical elements
in these adaptogens that are supposed to do that.
The second thing, the criteria that has to be
met to be classified as an adaptogen, is that
it has to help the body maintain homeostasis,
which is a big word for saying... balance. By
any offsetting thing that could cause imbalance,
that could cause, you know, so either an external
stress or a health condition that could cause
an imbalance in your body, this substance should
help bring your body back into balance again.
They are thought potentially that they may help
to boost, they could help balance the immune
system. potentially, I mean, I'm sorry, the endocrine
system, potentially by having an effect on that
HPA axis. But it's theoretical, pretty much.
I could not find any data that actually really
showed an effect. Yeah, these are the proposed
mechanisms, but there's not evidence to suggest.
It's basically plugging that cortisol leak is
potentially what they'd be suggesting. And that
they could also have an effect on the immune
system. Energy usage, mood, you know, there are
different things, but there's really been no
definitive studies that have shown exactly how
these things work. And the third criteria to
be an adaptogen is that they cannot be harmful
to the body. So again, those three criteria are
that they work nonspecifically, that they must
help the body maintain homeostasis or balance,
and they can't be harmful. Yeah. Can I ask why
that sticks in your craw a little bit? Like when
you hear those criteria and you say, so this
could be anything, you know, like you could say
that for about water, right? It works non -specifically.
Yeah. And interestingly, you know, too much water
causes illness, you know? So it's, I think, so
I think it's, I think. I think when I hear something
that talks about that something needs to be nonspecific,
I'm like, then what are you, how do you measure
whether or not it works or not? You know, what
on earth are you looking at is kind of where
I'm coming in when I hear that nonspecific thing.
Yeah, that's a good question. I feel like based
on some of the stuff that I read. there seems
to be two schools of thought, right? There's
the evidence -based approach, which is very reductionist.
Like we're going to design this drug that binds
to this receptor and this receptor is going to
release this peptide that's going to cause this
effect in this cell. It's very well understood.
Whereas I feel like in some of these more holistic
methods, it's more about how you feel. It seems
to be more about the just... the state of what
it's like to be that thing. And it almost seems
to be folks either want to, I don't know what
the opposite of reductionist is, but it's like
this idea of just seeing something, maybe holistic
expansion. Yeah. Because I really do think a
lot of people in this space really see their
relationship, not just to themselves, but also
to nature as this very like connected experience.
And I think. that's why a lot of things that
are natural or things that come from the earth
are very popular. It's like, well, I'm consuming
something of nature. I want to be one with it.
I want to be one with myself. And so you kind
of tend to think of yourself as kind of this
ecosystem. And I think taking some of these substances
is very much like a placebo. And we'll talk about
placebo a little bit later on, but it just, I
think it's like a kind of like a little ritual.
It's like when I'm taking this thing, It signifies
that I'm this type of person who cares about
this thing. And I think if you're like, I want
to reduce my stress by feeling connected to the
earth and consuming this root, I think just even
that belief alone might be enough for people.
And I don't think the mechanism matters. I actually
think the mechanism from talking to folks like
this, I think the mechanism actually is boring
to them. And it actually gets away at the beauty
of feeling expansive. I think they see reductionism
as a limitation. of their relation to the world
and also to themselves okay where someone like
you and me is like you can't really claim that
it works and i don't think for folks like this
that's what matters so i could be talking um
i apologize if i'm misrepresenting somebody's
view on this but i just think that there are
two different ways of talking about health and
medicine so i don't know how you feel about that
or how you well i mean i just think that um And
we'll get into this, but it's like, you know,
nothing that we ingest into our bodies is completely
without some sort of side effect, adverse effect
or whatever and stuff. So I think, or drug interaction,
even these supplements, if you're having to take
other medications, it could potentially cause
a drug interaction as well too. So I think that
we can't. assume that just because we're taking
something, it doesn't mean that it's innocuous
or like harmless. With the quote that you said,
if there's no side effect, there's no effect.
Right. Yeah. And I share the view of my mom.
It's like, whether you're putting something in
your mouth that's natural, pharmaceutical or
synthetic, it's still going in your body and
it's doing something. Right. Whether you, whatever
your belief about it is, it's still a molecule
that's doing something in your body. um and that's
kind of how we approach it so we don't see a
difference between ashwagandha and acetaminophen
like these are two molecules or substances that
you put in your body that have an effect right
regardless of the ancient wisdom that it came
from or we don't we don't we're not trying to
disrespect it but it's just the idea we just
we don't see a difference between the two and
i think too i think it's just a it's a lot of
medications that are are prescriptions that are
approved came from plants, plants, you know,
you know, different types and stuff. So yeah.
Aspirin big came from the bark of the willow
tree, you know, and stuff. So yeah. I think taxol
is a, it's an anti cancer drug that came from,
I think bark of a, I can't remember another bark
of a tree, but a lot of these things are great
starting points. And then you use the evidence
-based method to, to find out. If they had an
effect. And then you can also find the chemical
within the bark that is like, oh, what is the
specific chemical within this bark that is actually
useful? Right. And then you can help. And I think,
too, on another class of medications that may
be a greater, a better comparator for things
like the adaptogens would be some of the. Psychiatric
medications like for schizophrenia or psychosis
or bipolar disorder or anxiety, some of them
have specific mechanisms. So we know exactly
which neurotransmitter they're targeting or drugs
and epilepsy. But sometimes we don't necessarily
know. And so the way, even though we don't exactly
know that. absolute mechanism of action there
are scales and things to measure that when that
patient is administered that medication that
we can see that they are actually there is a
there is actual a numerical value that can be
measured to see that they're getting better based
on that taking that medication and stuff too
i like that yeah and i think yeah going from
the Like we're trying to put a number on everything
to give something an objective measure because
I think a lot of times in evidence -based spaces,
we kind of discount our subjective feeling. It's
like, well, you could feel a certain way depending
on a lot of different reasons, which is why we
do randomized control trials, right? Like placebo
will be having a certain belief about what they're
taking versus actually the drug of interest.
And then you compare the two. And the last thing
I'll say, because I know we've been talking about
this. But I think it's really interesting. I
think there's also kind of this bias of like,
well, that's Eastern medicine. This is like Ayurvedic
or traditional Chinese. And then we have Western
medicine over here. But just to remind everybody
that in Western quote unquote medicine, we believed
in the four humors. We also believed in this
balance system that you had to balance everything.
George Washington was famously bled to death
because he thought that he had bad humors inside
of them. And they thought that you needed to
do bloodletting to get some of those humors out,
which is a terrible technique. Do you want to
tell your, no, that doesn't apply here. Sorry.
Yeah. We'll come back to that. But it's this
idea that. We've inherited a lot of these ancient
systems because a lot of times the people who
survived taking these things were alive to tell
the story of the things that they did or they
took. So the person who survived the bloodletting,
the person who survived when they took Asian
ginseng can now tell the story. I lived because
of this. But you don't get to hear about the
people who died because of that. So a lot of
times, a lot of these traditions... live on because
of the people who were alive. And there could
be some truth to some of the claims that they
make, but that's why we believe that the evidence
should also confirm those people's stories. We
never want to deny those people's stories, but
we also want to say, is that really what's going
on? Right, right. So again, just a reminder,
adaptogens don't prevent stressful events, but
they are thought to improve the body's response
to stress once it happens. I'm just looking to
see, I've really pretty much, I'm looking at
my notes here. So, cause I obviously I'm not
speaking completely off the cuff or on the cuff
or whatever and stuff. So, so I think we've kind
of covered all this stuff. So anyway, so, so
now it's like, you're like, well, what are adaptogens?
And so that was interesting. It's like, cause
I, I really didn't know what an adapt, what was
considered an adaptogen. What specific substances
are like, how do you get into this club? Yeah.
Yeah. What do you take that? And that makes you
say, I'm an adaptogen user, you know? So, um,
so I identified 10 different agents and again,
there's. Probably more, but these seem to be
the ones that were cited in the resources that
I was looking at most commonly. And so I put
them in alphabetical order, not in any order
of use or importance, but just kind of what I
found in the literature. And basically what I
did was I looked at the name of the agent and
it's. And we, you know, when we, when we do our
podcast, we don't really get caught in the weeds
too much about how things work or dosages and
stuff, but it's just, it's just kind of a global
kind of like, this is what we found. And this
is what, why these things are considered adaptogens.
So the first one, and I may butcher a lot of
these names, but the first one is astragalus
membranaceus. And this is an agent that is supposedly
touted to improve immune response. And it may
have antioxidant effects by inhibiting free radical
production. So that means free radicals are things
that can get released in your body and they cause
a lot of toxic effects. And so if it had these
antioxidant effects, it could maybe help. And
so again, you've got some... And let me also
say, and as I went and looked at all of these
adaptogens, especially in one of my more uh respected
resources they've been used in a ton of different
disease states but there aren't data necessarily
to confirm that they're actually effective you
know so okay so they're purported to be used
for things like you know improving immune function
or you know controlling the mechanisms and he
likes here's the here's the uses some of the
uses for astragalus astragalus astragalus Sorry.
It's okay. Cancer. Or it could protect against
heart disease or aging or upper respiratory tract
infection it could prevent. But there aren't
really any. studies that really support this.
The studies that are available for this particular
agent are older, they're lower quality, and they
really don't have any data that really recommend
its use for any indication. And as far as adverse
effects associated with this agent are concerned,
the thing that I found that stood out most was
allergic reactions and stuff. So astragalus is
one agent. The next one is cordyceps. I thought
this was really interesting. It's actually a
fungus, but even though it is a fungus, which
would be more like. plant -based kind of or nature
-based you know kind of they're very different
than plants yeah sorry mr biologist um it's it's
nature -based or um it's not an animal anyway
but um but it's actually interestingly cordyceps
it's what i found was that it's primarily made
in a laboratory setting for for commercial use
even though it's a fungus so i thought that was
really interesting And it has immune boosting
and suppressing properties. And again, in animals,
they thought maybe it had some anti -cancer effects,
or could it possibly improve heart health or
anti -aging? But they're really... There were
no well -controlled trials that supported this.
And it also can cause a lot of gastrointestinal
adverse effects. It can cause constipation, diarrhea.
It can also cause dry mouth and some abdominal
discomfort. So again, like I said, they're not
without some things that go along with them.
The next one is called Eleuthero, E -L -E -U
-T -H -E -R -O, or Siberian ginseng is another
name for this one. And it has proposed that it
could, possibly modulate that hpa access and
help control um uh cortisol levels as well as
nitric oxide as well too which is in um i think
it can have effects on the heart uh improvement
in nitric oxide yeah also blood flow and vasodilation
so so it's it is actually labeled and and potentially
could be used for stress. Other things that potentially
could be used for because of its maybe immune
modulation type stuff is rheumatoid arthritis
or flu or upper respiratory infections. But again,
like I said, no data are available. And then
again, it is another agent that has a lot of
gastrointestinal, maybe adverse effects associated
with it. Another one that's called Reishi, it's
got a scientific name as well, but we'll just
leave it for Reishi. It touts itself as its mechanism
of action is having immune boosting effects.
So could it be used in reducing stress or reducing
the incidence of upper respiratory infections?
Again, limited clinical studies and side effects
that I saw with it were dizziness, dry mouth,
and it can also be a skin irritant. The next
one is called holy basil or Tulsi. It supposedly
has anti -stress effects without a real specific
mechanism of action being described. So does
it improve stress or reduce stress or improve
anxiety? Those are the things that it's touted
for. But again, limited clinical trial data.
And it can also cause diarrhea and nausea. Panax
ginseng is the next one or Asian ginseng. It
has some antioxidant effects potentially or anti
-fatigue effects. Could it be an adaptogen and
have anti -stress effects? It has shown some
potential effects on the HPA axis in animals,
but we don't know whether or not that happens
in humans or not. So does it improve physical
performance or can it help with chronic fatigue
syndrome or fibromyalgia or improve cognitive
function or could it protect against the flu?
Those are things that... it's touted to be used
for. Again, limited clinical trial data. There's
also, so that's Panax ginseng. There's also a
Panax quincafolius, which is known as American
ginseng. It's going to be similar to Panax ginseng
as far as what it's touted to be used for. There
is some clinical trial data with American ginseng
with the results being mixed. And it was also,
the data were older with smaller with smaller
sample sizes so again if you saw something that
was maybe effective in 2003 or 2005 and it's
2025 why haven't we seen more you know so it
may that that always when i see things like that
it makes me think hmm i mean it may not have
been as good as it as they thought it was initially
and stuff when they see yeah i think another
thing along with the idea of evidence and clinical
trials is like you want to have results be repeated
Like one study can say we have a positive or
statistically significant effect. Great point.
But if the other nine don't, then it probably
just means that that study was a bit of a fluke.
So if you should have an effect, you should see
that most of the time with each study. It gives
this idea that you're on to something. Great.
That's a great point, Josh. And also I'm wondering
too is like I know you need to go through your
list. No, it doesn't matter. If these – substances
became more popular recently. I'm just wondering
if the scientific community is catching up to
studying these more rigorously. If we have these
kind of sparse studies from the past, I'm wondering
if there's going to be renewed interest now.
that the market is, you know, people are consuming
these things more readily. Right. I'd say a lot
of these started getting used after the pandemic.
That was such a stressful time for the whole
world and stuff. And so, so yeah. But I had,
I didn't really see a real uptick in a lot of
the clinical trials with these agents, but again,
there were, because there were so many of them,
it, I mean, and time limitations for us to prepare
this, it just made it almost impossible for me
to go through all the literature, but even so
there, Again, the trials that were available,
I was not really that impressed with and stuff.
And somebody could certainly refute me on that
as well. Rhodiola rosea is the next one. It supposedly
has some adaptogenic effects and may improve
mental and physical fatigue. It's been shown
to provide protection from stressors in animal
studies, but could it increase work capacity
or decrease fatigue? You know, those are just
things that it's been touted for, but the clinical
trial data are ambiguous. And that's just like
they, some might say maybe yeah, and then some
might say maybe no. And so not everybody's saying
the same thing. So the next one is Shisandra.
Again, it supposedly has some adaptogenic effects.
And in animal studies, it did show some increased
concentration and endurance and decreased fatigue,
but we cannot, we cannot, we cannot trans, pose
results that we find in animal studies onto human
beings. They're just not the same. We take those
data from animal studies and then we do human
clinical trial data to see whether or not we
can repeat those results because we're not the
same as animals. Our bodies are just not the
same. These, again, that Schisandra, again, has
limited clinical trial data as far as its benefits
in physical performance, endurance, or stress
relief. And then the last one is called, the
scientific name is Withania somnifera. I should,
anyway, but it's, this is ashwagandha. And this
one has, this agent is probably the one that
people hear about the most. It has more clinical
trial data. available for it. There were some
positive data that showed its usage in stress,
anxiety, and sleep, because it may have some
central nervous system effects on cortisol levels,
and it potentially could have effect on some
other neurotransmitters in the brain that could
help with either like anxiety or sedation. And
so it has been touted for use as an anti -stress
agent, an antidepressant, an anxiolytic, which
means an anti -anxiety agent, or possibly a sleep
aid. and some other potential uses as well. It
does have some gastrointestinal side effects.
And the one thing about ashwagandha that came
out more than with other agents was that this
agent may have some liver injury associated with
it. So the other things, you get a little upset
stomach, maybe you have some nausea, maybe you
have some vomiting. rarely or whatever but when
you talk about liver injury that's significant
and so so this is not innocuous so and i again
i did not take a deep dive into um Is it dose
related or is it duration related as far as the
liver injury? But it's just something to be aware
of. Yeah, that's a crummy thing about this space
in the supplement space because not all ashwagandha
tablets are created equally. And one study could
be about you give somebody an ashwagandha tea
and the other one is you give them a tincture
and the other one you give them. So it's so hard
to standardize. And basically what the definition
of an adaption is that it's nonspecific. So it's
like, okay, if it's nonspecific, then that means
that it can also help in all these areas. But
that also means it can hurt in all these areas.
Like it's not going to know exactly how to bring
something in or out of balance. Right. Yeah.
The other thing, too, with the clinical trials
that are available, the longest I think that
I saw with ashwagandha was 12 weeks. So we're
talking about three months. So we're talking
about relatively short term use of these agents.
And really, I think all of them, any of the studies
were not very long. So we're not talking about
you don't use these things for a year. There
are no data that showed. that you know so i mean
do you are you having a stressful time in your
life and you need something for a month maybe
you know and stuff but these are not long -term
use agents i've found no clinical trial data
even the bad clinical trials that use it for
long term yes we're kind of ignorant about that
and i imagine if people are using it for sleep
they might use it every night they could you
know something melatonin right um so and we just
don't know you know, the appropriate safe dosage
that you can take every day and be fine. I imagine
a lot of those damages are from people who take
really high doses. We just don't know what those
are. I mean, we could definitely look that up
if somebody needs to know that and stuff. The
other thing, so as we plan these podcasts, I'll
be walking through my house and I'll think, what's
the next thing that I would want to know? And
the next thing that I wanted to know was, How
much do these things cost? You know, because,
oh my gosh, I found this particular like market
trend study and these agents are sold. I mean,
that's a global market for them. And in 2023,
10 .3. billion dollars were spent on adaptogens
all over that was those were us dollars i think
it's us dollars but i think it was worldwide
i think but i'm not positive it was worldwide
but but it's supposed to continue to increase
by seven percent a year for the next five years
and stuff so this is a really big thing in the
market. I, and again, I say it's $10 .3 billion.
Sounds like an awful lot of money to me and stuff,
but I didn't compare it either to, you know,
like if you have to take Eloquist, you know,
what's the market, you know, I still think pharmaceutical
companies still have a much larger market share.
I mean, I think, I think you're right. I think
it's hundreds of billions of dollars and stuff.
So. Yeah. And, but obviously those companies
are making a lot more products and this is a
very niche space. And I think it's. I think it
is kind of geared towards those people. We call
them, at least the people that I affectionately
call the health optimizers or the biohackers.
They're always looking for little edges to make
themselves just a little bit healthier. Right.
And yeah. And that is it. That's the people who
use these. The consumers that use adaptogens
are looking for health benefits and stress relieving
activity. So wanting to just have a like a more
balanced life, you know, stuff. So, yeah. And
like I said to the COVID pandemic was really
a big driver for adaptogen use. So I thought
so again, I thought, OK, well, is this going
to break somebody's bank by using these things?
And so I just did some sample costs. I just Googled
on. Walmart and Amazon, like if you wanted to
order, another little, here's another little
aside before I give you these prices. It was
really interesting too, when I did this, a lot
of products that are available put several of
these in the same capsule. So then you're like,
oh my goodness, which one works? You know, when
you do that and there aren't a lot of data to
support it, you don't know, is it all together?
Is it nothing working? Is it all working? Don't
really know. But so when I broke them down for
the individual, I looked primarily at ashwagandha.
And I looked at one ounce tincture bottle was
$18. And I think you use a drop a day. And I
forgot to do the math as far as how long that
would last. It might last for two months, you
know, one to two months. So it wasn't going to
break the bank. But, or then rhodiola for 60
capsules, it was $18 and 50 cents. That's 60
capsules. And you just take one a day. So that
could last for two months. So not bad, you know?
Yeah. And just, and just to give an idea of like
what some of these are, especially like ashwagandha
and rhodiola, these are root, I don't know if
you call them root vegetables, but they're definitely
roots. Root plants. Root plants. I remember my
brother was in the Peace Corps in this island
called Vanuatu and they had a root there called
the taro root. They also had something called
kava and essentially, What they would do during
the times where they would have these just kind
of communal celebrations, they would take these
roots and they'd essentially grind them into
tiny little pieces. And then they would then
put them in a solution. Usually it was water.
And then that was essentially consumed. So that
was the idea of like, this is how you take the
root and consume it, which is I imagine how they
get these tinctures as well. But you, I mean,
a big root can go a long way. So, and it's relatively
inexpensive to harvest these things and to grind
them. So I imagine the profit, it would be interesting
to look at the profit margin of some of these
substances. Right. But also like mom said is
like, these are not regulated. So when you buy
these tinctures, you're not really sure. How
much of it is ashwagandha? How much ashwagandha
is in there, yeah. It could be a dilute. It could
be nothing. Water or alcohol or whatever. So
if you are going to buy supplements, there are
labs out there that actually do verify the substances
that they sell if they are supplement companies.
I think Thorne, T -H -O -R -N -E, is a great
company that actually verifies the substances
and the quality of ingredients they put in their...
My generous call on the medicines. Supplements.
If you are going to buy supplements, make sure
you're buying from a company that at least has
been vetted and verified to produce things. And
it's going to be a little bit more expensive
because it does take effort to actually. validate
what you're what you're making yeah for example
there there was an ashwagandha with 60 capsules
for 24 and some of the combination products could
cost up to 50 a bottle and stuff for 60 capsules
and stuff so yeah the price was all over the
board but yet it wasn't like you know you think
of some of the prescription drugs that are really
expensive but but again usually those it's a
it's for a targeted patient population and it's
going to be something that is you know covered
by insurance yeah this is even true of generics
too like not all generics are created equally
like some people some generics skate by on quality
like they're not all created equally so i'm not
sure i agree with that but no it's true i mean
i mean just think about think about what it means
to be a generic drug and like they're still regulated
though The companies are still regulated. But
they do have, even with a brand name product,
you have a 10 % margin either overage or underage
in each capsule or tablet and stuff. And so that's
considered still bioavailable. I know this is
going to be a future episode for us. of talking
about how drugs are made, especially on the pharmaceutical
side. And I think it's going to be an interesting
episode to discover about that. Oh, boy. It's
going to break the purity bubble, probably with
both of us. But anyways, let's keep moving on.
Anyway, we'll keep going with adaptogens. So
we always like to try to find, are there myths?
or misunderstandings about the particular agent
that we're talking about. And so I only really
found two that I could see targeted for adaptogens.
And the first is something that we've definitely
kind of driven home and that people feel like
there's been scientific evidence that supports
adaptogen use. And there may be a little, some,
but a lot of the results are ambivalent. And
so I think that some of the deals are that the...
Sample sizes are usually small. The trial could
have been supported or paid for by a manufacturer
of a product. And whenever you have a manufacturer
paying for the study and analyzing the trial
data, you're always concerned with some bias
there. So you want to be careful about that.
And like I also mentioned too, a lot of the trials
are older. So, and then this is the last thing,
the second thing as far as scientific evidence.
A lot of, there is some concern or some thought
that using adaptogens may actually be a placebo
effect. And a placebo effect is basically you
take something and you think it's going to have
this effect and it does. But it's not really.
Again, without a randomized controlled trial
to measure that, you don't know whether or not
you're really having an actual effect from that
particular supplement or not. I was sharing with
Josh earlier years ago when we taught a biostatistics
class in our pharmacy school, and there was this
old study where back in maybe the 1930s, 1940s,
the treatment for angina pectoris, which is a,
it's, it's, oxygen deficiency to your heart.
So you'll get chest pain and stuff. The treatment
for angina or angina, if people say it that way,
was that you would do this surgery and they would
go inside the person's body and clip and tie
off what they called an internal mammary artery.
So some sort of a vessel that was going to the
mammary gland in the body and stuff. And that
was what they thought caused it. and so they
clipped it off and stuff. Well, several years
later, they actually did a randomized control
trial where half the people got this, this, this.
and then the other half got a sham surgery. There
was an incision made, but no mammary artery cut,
and they found no difference between those two
patient populations. So again, there's that placebo
effect. So we'd have to have more clinical trials
to determine whether or not these adaptogens
have more than just a placebo effect. So it's
just a thought to put out there. Yeah, I wonder
if that's a hangover from our bloodletting days,
you know, because we forget that medicine, especially
evidence -based medicine, is relatively young
to the world. And even like little techniques
from the 1930s might have had a hangover, you
know, from the earlier days of like, well, this
is just what we've done. And it seems to have
worked, but you really only count the people
who have lived. And that's why you need to study
things to really confirm. whether something is
actually working or not. Like you can't just,
it's like when you ever go to like a court trial
and you look at somebody, that guy looks guilty.
It's like, well, looking guilty is very different
than being guilty. And I wouldn't want somebody
to look at me and just based on how I look to
determine if I'm guilty, I would like for them
to have some evidence. So we want to apply that
same rigor to what we put in our bodies. Yeah,
I agree. So the second misunderstanding is that
adaptogens are safe to use. And, you know, again...
I didn't see a lot of really serious adverse
effects associated with them, but they have some,
and especially that concern about liver injury
with ashwagandha. So you want to not put something
into your body without realizing that it could
have some sort of an effect. And we also mentioned,
too, that potentially it could have a drug interaction
as well, too. And again, with the lack of FDA
regulation, what you are taking is not going
to be the same in each. bottle that you get and
stuff so that's there's just something it's just
some food for thought so to wrap this up um i
you know a couple of the the concluding comments
that i have about adaptions and says is that
they have been utilized to help the body adapt
to stress and promote it for other health benefits
um the research is lacking but they're but they're
But there is some evidence for use for ashwagandha
for short -term use. And then a lot of the other
health claims for adaptogens, there just isn't
a lot of validation for, you know, why you should
be using that to begin with and stuff. So, but
again, you know, again. And you've got to balance
that in with the placebo effect and all that
good stuff. So they're not regulated by the FDA,
so they can vary in quality and purity. Adverse
events and drug interactions are possible. And
I think it's really important. This is the last
point that I'll leave you with, and then I'm
sure Josh has a couple of things to say. You
really do want to consult your health care provider
before you start one of these because... Herbs
and supplements should not replace standard of
care therapies or sustainable lifestyle changes.
They're not a substitute. I mean, maybe you can
add something on and it's okay with your physician
or your nurse practitioner to do this, but keep
them in the loop when you're doing this. I think
that's so well said. We've actually, the NIH
recently changed their definition of alternative
medicine to complementary medicine. Because,
yeah, this shouldn't be a substitute for, let's
say you're a diabetic and you need to take insulin
in order to cope with that. And you find this
new route that's going to do the quote unquote
same thing. And also it's going to cure your
stress and, you know, make you taller. You want
to take this stuff because it will complement
the lifestyle that you already have, which you
should probably be using evidence -based care.
I tend, I'm... We've covered a couple of these
topics so far with supplements, and it seems
that this space is growing. And I think this
space is growing because I think there's this
kind of yearning for wholeness in people. I think
people are feeling stressed, and I think they're
feeling overwhelmed or whatever. And I think
a lot of times when that happens, people will
just grab onto something that kind of gives you
this kind of panacea effect. I think that can
be a really comforting thing. I think taking
a ritual, whether it be a cup of coffee or prayer
or going for a run, I think some of these things
can have benefit, but I really think it's your
relation to these things that can have the benefit.
I think belief and having a story that you tell
yourself can really help you feel like a healthier
person. But I think the unfortunate— Thing in
this space is that we've kind of pitted these
two things against one another. There's evidence
-based medicine versus complimentary medicine
and like their enemies, which I really think
they can, they just need to recognize their own
role. Um, and I think one is more of this spiritual
or holistic side where you're kind of just actively
engaging in the world. And then this other side
is like, Hey, these things have. actual specific
uses and i still think that i can be grateful
for my tylenol the same way i'm grateful for
my ashwagandha because it's still amazing that
i'm putting these things in my body it has an
effect i'm i'm i'm caring about my health i think
sometimes the people who criticize evidence -based
medicine think oh these are people who just pop
pills and just don't care about themselves they
just are just using a pill to try to get better
and i think they discount the fact that people
like you and I, mom, we still want to have an
active relationship with the world. And we take
drugs because we think that they work because
they have evidence behind them. And we still
want to be healthy people. And I think if we
both recognize that both camps want to be healthy,
I think that's the benefit. And I think what
I would encourage from the people on the adaptogen
side is like, just show us that you have evidence
that it works. And we'll believe you. But even
if you don't want to show that you have evidence,
that's fine. Just don't make claims that it works.
Just make claims that you're doing this because
it just makes you feel better. Just internally,
psychologically. And I still think that has a
benefit as well. So that's the last thing I'll
say. All righty. That's all I have. Well, wonderful.
Well, y 'all, thank you so much for kind of joining
us on this space. If you like what we do, please
subscribe to us on any podcast service that you
have, whether it be Apple Podcasts or Spotify
or whatever. If you ever have a question, feel
free to reach out to us. We'd love to chat with
you. But until next time, I'm Josh Klaus. And
I'm Jenny Seltzer. And this has been another
episode of Your Mom on Drugs. Talk to you soon.
Bye.