Published July 16 2018
I commonly recommend adaptogenic herbs to my patients. And while I have written about some of the individual adaptogens in past articles, I have decided to put together an article which discusses five specific adaptogenic herbs that can benefit those with thyroid and autoimmune thyroid conditions. The five adaptogenic herbs I’ll be discussing in this article include ashwagandha, eleuthero, holy basil, maca, and rhodiola. Although I realize that there are other adaptogenic herbs, including Schisandra chinensis and Panax ginseng, the five herbs discussed in this article are the ones I most commonly utilize in my practice.
Adaptogens are defined as a group of herbal preparations that increase tolerance to mental exhaustion and enhance attention and mental endurance (1) [1]. In simpler terms, adaptogens help you to better adapt to the stress by decreasing the sensitivity to stressors. As for how they accomplish this, adaptogens influence the hypothalamic-pituitary-adrenal (HPA) axis, although they also affect other molecular targets and signaling pathways associated with the stress response, including heat shock proteins and nitric oxide.
Let’s go ahead and take a look at each of these five adaptogenic herbs:
Adaptogenic Herb #1: Ashwaghanda (Withania somnifera). I listed ashwagandha first because it is one of the most well known adaptogenic herbs, and perhaps THE most well known one. One of the concerns with ashwagandha is that it’s part of the nightshade family, and I spoke about this in a blog post entitled “Should Ashwagandha Be Avoided in Those With Graves’ Disease? [2]”. Although I do recommend ashwagandha to some of my Graves’ disease and Hashimoto’s patients, because it’s a nightshade, those who are following a strict autoimmune Paleo (AIP) diet should avoid it. In addition, those who have a negative reaction to nightshades should also be cautious about taking this herb, even if they’re not following an AIP diet.
That being said, many people do fine supplementing with ashwagandha, and as you’ll soon find out, besides supporting the adrenals and the HPA axis, it also has many other health benefits. So if you’re taking ashwagandha as part of an adrenal formulation, or individually, just know that it’s also benefiting your health in other ways.
What Does The Research Show? Just as is the case with all of these adaptogenic herbs, the primary reason why ashwagandha is commonly recommended by healthcare professionals is to help support the adrenals/HPA axis. But by diving into the research you’ll see some of the other health benefits of this herb. What I like about these studies involving ashwagandha is that many of them are human studies. While there is also value with animal studies, some of which I’ve included in this article, human studies are of course more valuable since not all studies conducted on animals translate to humans.
Subclinical hypothyroidism. A pilot study looked at the efficacy and safety of ashwagandha root in subclinical hypothyroid patients (2) [3]. This involved 50 subjects with elevated TSH levels, and they took 600 mg per day of ashwagandha for 8 weeks. After the 8 weeks those who took ashwagandha showed an improved TSH, and the T3 and T4 levels improved significantly as well compared to placebo.
Memory and cognition. One study looked to evaluate the efficacy and safety of ashwagandha in improving memory and cognitive functioning in adults with mild cognitive impairment (3) [4]. The subjects took 300 mg of ashwagandha twice per day, and after eight weeks of study the ashwagandha treatment group showed significant improvements in both immediate and general memory, along with greater improvement in executive function, sustained attention, and information-processing speed.
Cardiorespiratory endurance. A study looked at the effect of ashwagandha on the cardiorespiratory endurance capacity (aerobic capacity) of elite Indian cyclists (4) [5]. This involved 40 elite cyclists, and the experimental group took 500 mg of ashwagandha twice per day for eight weeks. The results showed a significant improvement in the experimental group in all parameters, while the placebo group didn’t show any positive change.
Muscle strength and recovery. One study examined the effects of ashwagandha on muscle mass and strength in healthy young men engaged in resistance training (5) [6]. This was an 8-week, randomized, double-blind, placebo-controlled study involving 57 subjects, and they took 300 mg of ashwagandha root twice per day. Compared to the placebo subjects, the group treated with ashwagandha had significantly greater increases in muscle strength and significantly greater muscle size increase at the arms. Those who took ashwagandha also had significantly greater reduction of exercise-induced muscle damage, significantly greater increase in testosterone levels, and a significantly greater decrease in body fat percentage.
Other conditions. Some of the other health conditions ashwagandha may help with include skin inflammation (6) [7], anxiety (7) [8], obsessive-compulsive disorder (8) [9], and neurological disorders (9) [10].
Adaptogenic Herb #2: Siberian ginseng (Eleutherococcus senticosus). While some people take an adrenal formulation with numerous adaptogenic herbs, when I was dealing with Graves’ disease the only one I took was Eleutherococcus senticosus, also known as eleuthero. This isn’t to suggest that I couldn’t have benefited from taking other adaptogenic herbs, but I must admit that there will always be a special place in my heart for eleuthero.
For those with hyperthyroidism and Graves’ disease, some people have claimed that taking eleuthero increased their hyperthyroid symptoms. I can’t say that patients commonly experience this side effect, and I just mentioned that I personally took this herb when I was trying to reverse my Graves’ disease condition. Just keep in mind that sometimes a temporary increase in cortisol can mimic hyperthyroid symptoms, and it’s very possible that eleuthero can have this effect. This is why some healthcare practitioners will mainly recommend eleuthero if someone has depressed cortisol levels (which is what I had when I was dealing with Graves’ disease).
What Does The Research Show? Just as is the case with ashwagandha, and the other adaptogenic herbs I’ll be discussing in this article, eleuthero does more than just support the adrenals and HPA axis.
Endurance capacity. One study looked at the effects of eleuthero supplementation on endurance capacity, cardiovascular functions, and metabolism over an 8-week period (10) [11]. This was a small study involving nine males who consumed 800 mg of eleuthero or a starch placebo. The results of the study showed that eleuthero enhanced endurance capacity, elevated cardiovascular functions, and alters the metabolism.
Antiedema activity. One study evaluated the antiedema effects of eleuthero (11) [12]. This involved ingestion of eleuthero (dosage wasn’t specified) in 50 females. Edema of the lower limbs significantly decreased in those who took eleuthero, and thus the authors concluded that eleuthero has potent antiedema activity by promoting lymphatic function.
Neuroprotective properties. One study demonstrated that eleuthero, along with Panax ginseng and Rhodiola rosea, can protect brain cells from various injuries (12) [13]. The authors discussed how these adaptogenic herbs might benefit people with neurodegenerative conditions such as Parkinson’s disease.
Decreases insulin resistance. A study on mice looked at the effect of eleuthero on hyperglycemia and insulin resistance (13) [14]. This was a 5-week study, and it showed that eleuthero improved serum lipid profiles and significantly decreased blood glucose and insulin levels.
Other conditions. Some of the other health conditions eleuthero may help with include enhanced learning and memory (14) [15], vascular relaxation (15) [16], and it also might have anti-cancer properties (16) [17].
Adaptogenic Herb #3: Holy Basil (Ocimum tenuiflorum). This herb is also known as tulsi, and is yet another potent adaptogenic herb that can help people to better adapt to stress (17) [18] (18) [19]. The leaves contain numerous constituents, including ursolic acid, which is known to possess analgesic, anti-inflammatory, anti-atherosclerotic, anti-cancer, anti-diabetic, anti-epileptic, hepato-protective, anti-hyperlipidemic, anti-fertility, anti-platelet aggregation, anti-tuberculosis and anti-HIV activities (18) [19].
One of my favorite tea brands is Organic India, which includes holy basil in all of their teas. Since I’ve been drinking herbal tea on a regular basis I’ve noticed a decrease in getting colds, as over the years I usually get one or two mild head colds. I have no idea if it’s due to drinking Organic India herbal tea on a daily basis, but as you’ll see below, holy basal has both immunomodulatory and antimicrobial properties. I do drink other brands of herbal tea as well, and so perhaps the lack of annual head colds can be attributed to other factors, but either way, having some holy basil in your cupboard might be a good idea.
What Does The Research Show? Besides helping to support the adrenals and HPA axis, below I’ll also share research studies which demonstrate the antimicrobial properties of holy basil. And you’ll see that there are other health benefits of this herb as well.
Antimicrobial properties. A couple of studies show that tulsi/holy basal has antimicrobial properties against the bacteria involved in periodontal diseases (19) [20] (20) [21]. Another study showed that holy basil has antimicrobial properties against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, and Salmonella species (21) [22]. Another study showed that tulsi essential oil has antimicrobial activity against Staphylococcus aureus (including MRSA) and Escherichia coli, but only partly inhibited the growth of Pseudomonas aeruginosa (22) [23].
Anti-stress properties. A few different studies have shown that some of the compounds of holy basil have anti-stress properties (23) [24] (24) [25]. These compounds are Ocimarin, Ocimumoside A and Ocimumoside B.
Immunomodulatory effects. I came across a study which looked at the immunomodulatory effects of tulsi leaves through a double-blinded randomized controlled trial (25) [26]. This was a small study, involving 24 people (22 completed the study), and the experimental group took 300 mg of tulsi leaves. The results showed a statistically significant increase in the levels of IFN-γ, IL-4 and percentages of T-helper cells and natural killer cells.
Anti-cancer and anti-inflammatory properties. One study looked at the anti-cancer and anti-inflammatory properties of Ocimum sanctum (holy basil) essential oil (26) [27]. The results of the study showed that the Ocimum sanctum essential oil showed strong anti-inflammatory activity, which in turn prevented cancer cell migration, and thus can be useful as a therapy for inflammation associated cancer.
Diabetes mellitus. A randomized placebo-controlled, single blind study looked at the effects of holy basil leaves on fasting and postprandial glucose levels in patients with noninsulin-dependent diabetes mellitus (27) [28]. The results of the study showed a significant decrease in fasting and postprandial blood glucose levels, and urine glucose levels showed a similar trend. The authors concluded that holy basil leaves may be an alternative treatment for those with mild to moderate noninsulin-dependent diabetes mellitus.
Lipid markers. One study looked at the effectiveness of holy basil on metabolic and biochemical parameters in thirty individuals who were overweight and obese (28) [29]. The experimental group took one 250 mg capsule of holy basil twice per day on an empty stomach for 8 weeks, and there were significant improvements in the serum triglycerides, LDL, HDL, VLDL, BMI, and plasma insulin.
Enhance cognitive ability. A rat study looked to see if holy basil can enhance cognitive ability (29) [30]. The results of the study showed that the rats treated with holy basil had an increase in cognitive ability.
Should Holy Basil Be Avoided In Those With Hypothyroidism?
I came across a study which showed that a holy basil extract resulted in decreased T4 levels (30) [31], which might suggest that this herb should be avoided in those with hypothyroidism and Hashimoto’s. However, besides this being a mouse study that was conducted 20 years ago, it also was the only study I was able to find related to holy basil and thyroid health. I haven’t read any other sources which demonstrated that holy basil decreases T4 levels, and haven’t heard of anyone with hypothyroidism having problems with holy basil, but I figured I’d still mention it since it’s in the literature.
Adaptogenic Herb #4: Maca (Lepidium meyenii). Although maca is an adpatogenic herb that can support the adrenals and HPA axis, it is more known for supporting the sex hormones and hypothalamic-pituitary-gonadal (HPG) axis. In fact, when you read some of the research listed below, you’ll notice that there are quite a few studies showing that maca can influence the hormones in one way or another. But of course there are some other health benefits of maca as well, which you’ll learn shortly.
What Does The Research Show? As I just mentioned, there are a number of studies showing the influence that maca has on the hormones. But I’ll add that more research is needed, although this probably is true of all other herbs as well.
Antidepressant-induced sexual dysfunction. This involved a 12-week, double-blind, placebo-controlled trial of maca root in 45 females (31) [32] with sexual dysfunction caused by antidepressants (SSRI/SNRI). At the end of the study, remission rates of sexual dysfunction were higher for the maca group.
Improving sexual function. A systematic review looked to see the effectiveness of maca as a treatment for sexual dysfunction (32) [33]. Although this study provides some evidence that maca can improve sexual function, further research is needed.
Improve semen quality. Another systematic review looked to assess the effectiveness of maca in improving semen quality (33) [34]. The results provided some evidence that maca can improve semen quality, although because the small amount of studies and small sample sizes the authors added that more rigorous studies are warranted.
Reduces blood pressure. One study looked at the effects of maca on hormones, lipids, glucose, serum cytokines, blood pressure, menopausal symptoms, and general well-being (34) [35]. This was a randomized, double-blind, placebo-controlled study involving 29 postmenopausal women. The experimental group took 3.3 grams of maca per day over 12 weeks. The study showed that there were no differences in estradiol, FSH, TSH, SHBG, glucose, lipid profiles, and serum cytokines, although there were significant decreases in diastolic blood pressure and depression.
Decreases IL-6 levels. Although the study I just mentioned showed that maca didn’t have an effect on cytokines, another study involving 50 subjects (27 took maca) showed that consumption of maca was associated with low serum interleukin 6 (IL-6) levels (35) [36]. IL-6 acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine. Since many people take maca to help balance the sex hormones, it’s worth mentioning that serum estradiol levels were higher in subjects who took maca.
Other health conditions. Other studies show that maca can help with memory impairment (36) [37], fatigue (37) [38], and has antioxidant and neuroprotective effects (38) [39] (39) [40].
Adaptogenic Herb #5: Rhodiola rosea. Although Rhodiola rosea is listed last in this article, this herb is commonly found in adrenal formulations. It truly is a wonderful herb for helping people to better adapt to the stress in their life. And of course I’ll discuss other health benefits in the research associated with Rhodiola rosea .
What Does The Research Show?
Reduces anxiety and stress. A few studies show that Rhodiola rosea can help with anxiety and stress. One of these studies involved 80 anxious participants, with the experimental group taking 200 mg of Rhodiola rosea twice per day for 14 days (40) [41]. Those who took Rhodiola rosea demonstrated a significant reduction in anxiety, stress, anger, confusion, and depression. The authors did mention that further studies are needed to demonstrate that Rhodiola rosea can help with stress related symptoms.
An earlier study also looked to see if Rhodiola rosea can help with anxiety (41) [42]. This was a very small study involving ten participants with generalized anxiety disorder. They took 340 mg of Rhodiola rosea each day for 10 weeks, and significant improvement in generalized anxiety was found when taking Rhodiola rosea.
Depression. A randomized placebo controlled clinical trial involving 57 subjects looked to see if Rhodiola rosea had similar therapeutic effects as the antidepressant sertraline (42) [43]. The subjects took Rhodiola rosea over 12 weeks, and the results of the study showed that while Rhodiola rosea produced less antidepressant effects when compared to sertraline, it also resulted in significantly less side effects and was better tolerated. A review of the literature looked at the antidepressant mechanisms of action of Rhodiola rosea (43) [44], and the authors concluded that Rhodiola rosea affects various components of the neuroendocrine, neurotransmitter receptor and molecular networks associated with possible beneficial effects on mood.
Chronic fatigue syndrome. One study involved 100 subjects with prolonged or chronic fatigue symptoms (44) [45]. They took 200 mg of Rhodiola rosea twice per day for 8 weeks. The fatigue symptoms decreased, with statistically significant improvement at week 8.
Antiviral activity. One study looked to measure the antiviral and antibacterial properties of the bioactive metabolites of Rhodiola rosea in experienced marathon runners (45) [46]. The marathon runners consumed 600 mg/day of Rhodiola rosea , and it resulted in a delay of an exercise-dependent increase in virus replication. However, while Rhodiola rosea demonstrated antiviral activity, it did not demonstrate antibacterial properties.
Improve endurance exercise performance. A double blind placebo-controlled randomized study looked at the effects Rhodiola rosea had on physical capacity, muscle strength, speed of limb movement, reaction time, and attention (46) [47]. This involved 24 participants, and there were two separate phases, one phase which investigated the effect of “acute” Rhodiola intake, while in the second phase the experimental group took 200 mg of Rhodiola rosea over a 4 week period. The results showed that acute intake of Rhodiola rosea can improve endurance exercise capacity.
Which of These Adaptogenic Herbs Should You Take?
Earlier I mentioned that when I was dealing with Graves’ disease I took eleuthero. As a practitioner I recommend all of these herbs at times, although probably the top three adaptogenic herbs I recommend include 1) ashwagandha, 2) maca root, and 3) eleuthero. It doesn’t mean that these are superior to Rhodiola rosea and holy basil, as it’s just a preference on my part. There are natural healthcare practitioners who recommend Rhodiola rosea to most of their patients with adrenal and HPA axis problems. The point is that different practitioners will make different recommendations. In addition, since ashwagandha is part of the nightshade family, some will hesitate to recommend this herb to their autoimmune patients, which of course would include people with Graves’ disease and Hashimoto’s thyroiditis.
What I like about ashwagandha is that it seems to be beneficial to take regardless if someone has elevated or depressed cortisol levels. And while the term “adaptogenic” may imply that all of these herbs can be taken in a person who has elevated cortisol levels, some practitioners find that eleuthero and Rhodiola rosea are best taken by those who have depressed cortisol levels. I can’t say that I always follow this “rule”, and of course you have to listen to your own body. For example, if you have elevated cortisol levels and have been taking eleuthero or Rhodiola rosea , and if it seems to be helping you, then continue taking it. Perhaps you’re not taking these herbs individually, but as part of an herbal formulation that also includes ashwagandha and other adaptogenic herbs.
Regarding maca root, I’ll commonly recommend this for someone who has sex hormone imbalances. However, keep in mind that you need to have healthy adrenals in order to have healthy hormones, which I discussed in a blog post entitled “The Negative Impact of the Pregnenolone Steal [48]”. The good news is that maca can also help support the adrenals, although I usually will support the adrenals in other ways.
Warning: These Herbs Aren’t A Substitute For Living A Healthy Lifestyle
Although you probably understand that these herbs should be taken to provide additional support, I know there are some people who take these herbs who eat poorly, don’t get sufficient sleep, and/or don’t do a good job of managing their stress. And while I realize that some people will take one or more of these herbs to help them better adapt to the stress (hence the name adaptogenic herbs), for optimal benefits you also need to work on improving your stress handling skills. Similarly, while some people take herbs such as ashwagandha to help with sleep by lowering nighttime cortisol levels, you really need to try to live a healthy lifestyle while doing this.
And so if you eat a lot of refined foods and sugars, intentionally go to bed late, and/or don’t block out time for stress management on a daily basis, then these herbs are less likely to help. On the other hand, if you eat a diet consisting of whole, healthy foods, try to go to bed at a decent time, and block out at least five to ten minutes per day to work on stress handling, then you are more likely to reap the benefits of these herbs. In fact, you very well might not need to take these herbs if you incorporate these lifestyle factors I just mentioned, as while I’m writing this article because these herbs have helped many people, we of course don’t have a deficiency in ashwagandha, Rhodiola rosea , or other adaptogenic herbs. In other words, these herbs probably aren’t critical to restoring your health, but without question they can provide additional support to help speed up the recovery time of some people.
Are There Risks Associated With Taking These Adaptogenic Herbs?
Overall these herbs are safe, although keep in mind that anyone can have a negative reaction to any herb. And of course you want to be cautious about taking too high of a dosage of any herb as well. For example, toxicity studies regarding ashwagandha show that the no-observed-effect-level is 2,000 mg/kg body weight (in rats), which is a very high dosage. I also mentioned how ashwagandha is a member of the nightshade family, and as a result, some people with Graves’ disease and Hashimoto’s shouldn’t take it.
Right around the time I was getting ready to publish this article I was conducting a webinar, and one of the participants read online that maca could potentially stimulate the immune system, and thus should be avoided in those with autoimmune conditions. I couldn’t find anything in the research confirming this. Maca is a cruciferous plant, and some people are concerned about the goitrogenic properties of crucifers. But as I’ve mentioned in other articles and blog posts, most people with thyroid and autoimmune thyroid conditions do fine consuming crucifers.
I did come across a drug-induced liver injury case study involving maca from December 2017 (47) [49]. It involved a 30-year old man who drank 300 mL of maca, which also contained 50% alcohol. This was followed by jaundice that lasted for one week. Of course this is just a single case study, and I’ve had many patients take maca over the years without any adverse effects. As I’m sure you know, there are many more people who experience a liver injury due to prescription medications. In fact, I see this frequently with my hyperthyroid patients who take antithyroid medication.
Finally, there is some evidence that both eleuthero and Rhodiola rosea can slightly inhibit the CYP2C9 enzyme (48) [50] (49) [51], which can affect the metabolism of certain drugs, including phenytoin and warfarin.
In summary, many people with thyroid and autoimmune thyroid conditions can benefit from taking adaptogenic herbs. This article focused on the following five adaptogenic herbs: ashwagandha, eleuthero, holy basil, maca, and Rhodiola rosea . These can all help people to better adapt to stress by influencing the HPA axis, although they have numerous other benefits. Although not everyone needs to take adaptogenic herbs, if you decide to take one or more of them you might want to read some of the other health benefits I discussed in this article. And of course I always recommend working with a competent natural healthcare practitioner.