Pilot clinical trials support anti-stress reputations of ashwagandha and rhodiola
Nowadays, it’s common for busy people to say they feel “burnt out”.
And the demands of today’s fast-paced workplaces seem to be making matters worse.
Burnout is typically associated with office jobs, but research shows that job stress takes a harder health toll on people in blue-collar, service-industry, and pink collar (nursing) jobs.
The term burnout was coined by American psychologist Herbert Freudenberger in a 1974 paper titled “Staff Burn-Out”, about a growing loss of job interest and empathy among doctors and nurses.
In that paper, Freudenberger addressed growing evidence that more doctors, nurses, and residential care workers reported feeling exhausted, listless, and unable to cope with the ongoing demands of their jobs.
Four years later, University of California psychologist Christina Maslach found that burnout also affected people in jobs that focus on other people’s needs, often under time pressure.
As she wrote, “The intense involvement with clients required of professional staff in various human service institutions … can result in the emotional exhaustion syndrome of burn-out, in which staff lose all feeling and concern for their clients and treat them in detached or even dehumanized ways.”
Surprisingly, there's still no agreed definition of burnout — a deficiency that makes it hard to diagnose or to pinpoint the percentage of Americans affected.
Emotional stress seems key, since people in medical and other caring professions often combine long, unpredictable hours with constant attention to the needs of others.
Burnout may be most prevalent among people in health care and social work, but the term applies to anyone who feels overwhelmed and under-supported at work.
It also applies to many among the fast-growing legions of family caregivers — mostly women — at a time when Alzheimer’s disease is growing fast.
Punishing hours and pressures
Some Japanese office workers — notably men — succumb to karoshi, or “overwork death” with alarming frequency.
The same phenomenon is called gwarosa in South Korea and guolaosi in China, and heart attack or stroke is usually the immediate cause.
Fewer American office workers work such insanely long hours — but growing numbers of Americans work more than one job, and growing numbers say they suffer from burnout.
The burnout epidemic afflicting Americans may be due in part to the two-week annual vacations typical of this country, versus the four to six weeks common in European nations.
However, burnout affects nearly one in four employees in the European Union's 27 member states, with many citing high workload and lack of support.
European studies suggest that stress is a factor in about half of all lost working days, and long-term, work-related stress accounts for an estimated 16% of male and 22% of female cardiovascular disease in the EU.
And European research shows that long-term job strain is worse for your heart than gaining 40 lbs. or aging 30 years.
Today, burnout affects overstretched employees, working parents, family caregivers, and others — which would explain why the term burnout has become more broadly used.
Psychologists typically advise a break from work, but that’s often easier said than done.
There’s probably no miracle cure for burnout, but recent studies suggest that two traditional medicines — ashwagandha root and rhodiola root — hold potential for easing the strain.
Scientists classify both medicinal roots as “adaptogens” — a term coined to describe herbs that help maintain balance in key bodily processes, thereby enhancing resistance to physical and mental stress.
We’ll quickly review what’s known about these medicinal roots, and then summarize recent clinical findings about their effects on stress, anxiety, and mood.
All the clinical studies described here are considered "pilot" trials, due to their small size and short duration.
They simply provide evidence for or against the wisdom of proceeding with larger, costlier, more complex trials — the kind needed to prove or disprove a proposed remedy's efficacy.
However, ashwagandha and rhodiola enjoy substantial bodies of published, peer-reviewed laboratory, animal, and clinical evidence.
Much of that evidence supports (and sometimes expands) these roots' reputations as balancing "tonics" — and their similar modern image as "adaptogenic" agents that help maintain balance within and between major body systems.
Ashwagandha: Overview and recent clinical trials
Ashwagandha (Withania somnifera) — a small, woody shrub — is the most popular herb in India and prized in Ayurveda, that nation’s ancient system of medicine.
The second half of its Latin name — somnifera — means “sleep-inducing”. But, rather than make users drowsy, rodent studies show that ashwagandha simply helped the animals resist anxiety-induced sleep disturbances, and reduced the ill effects of sleep deprivation on memory and thinking.
Beyond sleep, the results of several recent preliminary or pilot clinical studies lend support to ashwagandha's ancient reputation as a tonic, "adaptogenic" ally.
These have included trials designed to test the effects of ashwagandha on muscle strength and recovery, cardio-respiratory fitness, obsessive-compulsive disorder (in conjunction with SSRI drugs such as Prozac), female libido, and cancer patients undergoing chemotherapy.
In every case, the results indicated that ashwagandha was helpful, and the authors called for further study in larger trials.
Let’s examine three recent trials, which focused on concerns shared by many people: stress, memory, weight control, and mental function.
Clinical trial #1: Ashwagandha versus stress
Indian neuropsychiatrists recruited 64 people with a history of chronic stress for their double-blind, randomized, placebo-controlled trial, which lasted 60 days (Chandrasekhar K et al. 2012).
The volunteers’ health status was measured using clinical exams, blood tests for cortisol levels, and standard stress-assessment questionnaires.
The participants were divided into two groups:
- Placebo capsules
- Ashwagandha capsules— 300mg of a high-concentration, full-spectrum root extract (KSM-66)
After 60 days, stress and blood cortisol levels were significantly lower in the Rhodiola group versus the placebo group.
The adverse effects — none serious — reported by the volunteers were mild, and comparable in both the groups.
Accordingly, the researchers came to a positive conclusion: “The findings of this study suggest that a high-concentration full-spectrum Ashwagandha root extract safely and effectively improves an individual's resistance towards stress and thereby improves self-assessed quality of life.”
Clinical trial #2 — Effects of ashwagandha on memory and cognition
Last year, Indian scientists published the results of a pilot clinical trial designed to evaluate the effects and safety of ashwagandha in adults with mild cognitive impairment (MCI).
This randomized, double-blind, placebo-controlled trial lasted eight weeks and involved 50 adults with MCI, who were divided into two groups:
- Placebo capsules, twice-daily
- Ashwagandha capsules— 300mg of a high-concentration, full-spectrum root extract (KSM-66) — twice daily
Before and after the trial, the participants were subjected to standard tests designed to measure key aspects of memory and cognition (Choudhary D et al. 2017).
Compared with the placebo group, the ashwagandha group showed significant improvements in short-term and general memory, as well as greater improvements in executive function, sustained attention, and information-processing speed.
Clinical trial #3 — Effects of ashwagandha on stress and weight control
Scientists from three Indian medical institutions recruited 52 people aged between 18 and 60 years for a double-blind, randomized, placebo-controlled trial (Choudhary D et al. 2017).
To qualify, the participants had to show symptoms of chronic, routine work stress, score high on standard stress-assessment questionnaires, and be overweight (body mass index between 25 and 39.9 kg/m2).
People were excluded if they had any of these disqualifying characteristics:
- An eating disorder.
- A major-organ disorder.
- Taking drugs that affect weight.
- History of alcohol abuse or smoking.
- Recently participated in a weight-loss program.
- A genetic or hormonal predisposition to weight gain.
- Health conditions known to influence stress and weight.
The participants were divided into two groups:
- Placebo capsules, twice-daily
- Ashwagandha capsules — 300mg of a high-concentration, full-spectrum root extract (KSM-66) — twice daily
Before, during, and after the study, the participants answered standard stress-assessment and happiness/well-being questionnaires, and the researchers measured the volunteers’ weight, body mass index, vital signs, and blood cortisol levels.
Compared with the placebo group, the ashwagandha group showed significant improvements in every measured outcome:
- Less weight-gain.
- Lower cortisol levels.
- Fewer food cravings.
- Less “reactive” eating.
- Lower scores on stress tests.
- Higher scores on tests of self-perceived well-being and happiness.
As in the 2012 stress trial, people in the ashwagandha group reported no more or stronger adverse effects than people in the placebo group.
And, as the researchers wrote, “The outcome of this study suggests that Ashwagandha root extract can be used for body weight management in adults under chronic stress."
Rhodiola: Overview and burnout trial results
Rhodiola (Rhodiola rosea) is a shrub that grows from Scandinavia to Siberia, where its root has long been a traditional remedy for mental or physical stress and depressed mood.
Rhodiola's efficacy and safety enjoy substantial, growing support from many cell and animal studies … as well as dozens of clinical studies, mostly from Scandinavia, Russia, China, and Eastern Europe.
In 2002, psychiatrists Richard Brown, M.D. of Columbia University and Patricia Gerbarg, M.D. of New York Medical College co-authored a summary of 92 Rhodiola studies, many of which had been translated into English for the first time (Brown RP et al. 2002).
As they wrote in that summary, "Studies in cell cultures, animals, and humans have revealed anti-fatigue, anti-stress, anticancer, antioxidant, immune enhancing, sexual stimulating, and anti-hypoxic (protection against oxygen deprivation) effects.”
According to the American Botanical Council, “Scientists have identified about 140 chemical compounds in the roots of Rhodiola, including phenols, rosavin, rosin, rosarin, organic acids, terpenoids, phenolcarbonic acids and derivatives thereof, and flavonoids.”
However, most of the clinical research has employed extracts that provide substantial, “standardized” (i.e., consistent) amounts of salidroside [a.k.a. rhodioloside] and rosavins, which appear responsible for the root’s beneficial effects on stress and fatigue.
Interestingly, the salidroside in rhodiola root is chemically related to tyrosol — an antioxidant shown to enhance human vascular function, which abounds primarily in extra-virgin olive oil.
Clinical study tested Rhodiola for burnout syndrome
Scientists from Austria and Germany recently reported the results of a clinical study designed to test the effects of Rhodiola extract in people with burnout syndrome.
The study was conducted by scientists from the Medical University of Vienna and Germany’s Schwabe GmbH & Co., which manufactures the Rhodiola extract used for this research (Kasper S, Dienel A 2017).
It wasn’t a “gold standard” clinical trial (randomized, double-blind, placebo-controlled) — but it’s positive results should prompt further clinical research of greater rigor.
The study was conducted by Drs. Siegfried Kasper and Angelika Dienel, who recruited 118 men and women aged between 30 and 60 who reported symptoms of burnout.
The participants were asked to take 400 mg of Rhodiola extract daily for 12 weeks, and compliance with the daily Rhodiola regimen was high.
After 12 weeks, the volunteers reported improvements in burnout symptoms such as emotional exhaustion, fatigue, exhaustion, lack of joy, loss of zest for life, and “depersonalization”.
Interestingly, many participants reported experiencing some improvements during the first week, and some reported feeling greater sexual desire and enjoying better sexual performance.
Unsurprisingly, given prior research on the safety of Rhodiola, the volunteers reported very few adverse side effects, which were minor in character.
This was the first clinical study designed to test the effects of Rhodiola in people reporting burnout, but the results fit with previously reported benefits regarding stress, mental and physical fatigue, depression, and energy.
The authors had this to say about the potential for Rhodiola to rapidly alleviate a condition that develops over time: “… the reduction of core values such as exhaustion, fatigue, and subjective stress perception during the treatment with R. rosea extract might be an important first step toward a continuous alleviation of burnout symptoms ...”.
And their conclusion seems warranted: “The results presented provide an encouraging basis for clinical trials further investigating the clinical outcomes of R. rosea extract in patients with the burnout syndrome,” concluded Kasper and Dienel.
- Biswal BM, Sulaiman SA, Ismail HC, Zakaria H, Musa KI. Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Integr Cancer Ther. 2013 Jul;12(4):312-22. doi: 10.1177/1534735412464551. Epub 2012 Nov 9.
- 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. doi: 10.4103/0253-7176.106022.
- Choudhary D, Bhattacharyya S, Bose S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl. 2017 Nov 2;14(6):599-612. doi: 10.1080/19390211.2017.1284970. Epub 2017 Feb 21.
- Choudhary D, Bhattacharyya S, Joshi K. Body Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled Trial. J Evid Based Complementary Altern Med. 2017 Jan;22(1):96-106. Epub 2016 Apr 6.
- 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. doi: 10.1155/2015/284154. Epub 2015 Oct 4.
- Jahanbakhsh SP, Manteghi AA, Emami SA, Mahyari S, Gholampour B, Mohammadpour AH, Sahebkar A. Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Complement Ther Med. 2016 Aug;27:25-9. doi: 10.1016/j.ctim.2016.03.018. Epub 2016 Apr 9.
- Kaur T, Singh H, Mishra R, Manchanda S, Gupta M, Saini V, Sharma A, Kaur G. Withania somnifera as a potential anxiolytic and immunomodulatory agent in acute sleep deprived female Wistar rats. Mol Cell Biochem. 2017 Mar;427(1-2):91-101. doi: 10.1007/s11010-016-2900-1. Epub 2016 Dec 21.
- Kumar A, Kalonia H. Effect of Withania somnifera on Sleep-Wake Cycle in Sleep-Disturbed Rats: Possible GABAergic Mechanism. Indian J Pharm Sci. 2008 Nov;70(6):806-10. doi: 10.4103/0250-474X.49130.
- Kumar A, Kalonia H. Protective effect of Withania somnifera Dunal on the behavioral and biochemical alterations in sleep-disturbed mice (Grid over water suspended method). Indian J Exp Biol. 2007 Jun;45(6):524-8.
- Manchanda S, Mishra R, Singh R, Kaur T, Kaur G. Aqueous Leaf Extract of Withania somnifera as a Potential Neuroprotective Agent in Sleep-deprived Rats: a Mechanistic Study. Mol Neurobiol. 2017 May;54(4):3050-3061. doi: 10.1007/s12035-016-9883-5. Epub 2016 Apr 1.
- 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. doi: 10.1089/acm.2017.0183. Epub 2017 Aug 22.
- Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Int Soc Sports Nutr. 2015 Nov 25;12:43. doi: 10.1186/s12970-015-0104-9. eCollection 2015.
- American Botanical Council. Jiaherb Supports ABC’s Adopt-an-Herb Program through Rhodiola Adoption. July 13, 2017. Accessed at http://cms.herbalgram.org/press/2017/JiaherbSupportsABCsAdoptanHerbProgramthroughRhodiolaAdoption.html
- Amsterdam JD, Panossian AG. Rhodiola rosea L. as a putative botanical antidepressant. Phytomedicine. 2016 Jun 15;23(7):770-83. doi: 10.1016/j.phymed.2016.02.009. Epub 2016 Feb 24. Review.
- Brown RP, Gerbarg PL, Ramazanov Z. Rhodiola rosea: A Phytomedicinal Overview. American Botanical Council, 2002. Accessed at http://cms.herbalgram.org/herbalgram/issue56/article2333.html
- Cropley M, Banks AP, Boyle J. The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. Phytother Res. 2015 Dec;29(12):1934-9. doi: 10.1002/ptr.5486. Epub 2015 Oct 27.
- Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psychiatry. 2007;61(5):343-8. Erratum in: Nord J Psychiatry. 2007;61(6):503.
- Eckleberry-Hunt J, Kirkpatrick H, Barbera T. The Problems With Burnout Research. Acad Med. 2017 Aug 16. doi: 10.1097/ACM.0000000000001890. [Epub ahead of print]
- Edwards D, Heufelder A, Zimmermann A. Therapeutic effects and safety of Rhodiola rosea extract WS® 1375 in subjects with life-stress symptoms--results of an open-label study. Phytother Res. 2012 Aug;26(8):1220-5. doi: 10.1002/ptr.3712. Epub 2012 Jan 6.
- European Agency for Safety and Health at Work. OSH in figures: stress at work — facts and figures, 2009.
- European Foundation for the Improvement of Living and Working Conditions. Work-related stress. 2007.
- Freudenberger HJ. Staff Burn-Out. J Soc Issues. Volume 30, Issue 1, Winter 1974
- Freudenberger HJ. The issues of staff burnout in therapeutic communities. J Psychoactive Drugs. 1986 Jul-Sep;18(3):247-51.
- Garner BR, Knight K, Simpson DD. Burnout among corrections-based drug treatment staff: impact of individual and organizational factors. Int J Offender Ther Comp Criminol. 2007 Oct;51(5):510-22. Epub 2007 Jul 5.
- Guan S, Xiaerfuding X, Ning L, Lian Y, Jiang Y, Liu J, Ng TB. Effect of Job Strain on Job Burnout, Mental Fatigue and Chronic Diseases among Civil Servants in the Xinjiang Uygur Autonomous Region of China. Int J Environ Res Public Health. 2017 Aug 3;14(8). pii: E872. doi: 10.3390/ijerph14080872.
- Ipsos. Omnibus polls 2003 and 2008. Referenced in OTC Bulletin, 11/2003, 07/2008
- Ishaque S, Shamseer L, Bukutu C, Vohra S. Rhodiola rosea for physical and mental fatigue: a systematic review. BMC Complement Altern Med. 2012 May 29;12:70. doi: 10.1186/1472-6882-12-70. Review.
- Jaracz M, Rosiak I, Bertrand-Bucińska A, Jaskulski M, Nieżurawska J, Borkowska A. Affective temperament, job stress and professional burnout in nurses and civil servants. PLoS One. 2017 Jun 6;12(6):e0176698. doi: 10.1371/journal.pone.0176698. eCollection 2017.
- Kärkkäinen R, Saaranen T, Hiltunen S, Ryynänen OP, Räsänen K. Systematic review: Factors associated with return to work in burnout. Occup Med (Lond). 2017 Aug 1;67(6):461-468. doi: 10.1093/occmed/kqx093.
- Kasper S, Dienel A. Multicenter, open-label, exploratory clinical trial with Rhodiola rosea extract in patients suffering from burnout symptoms. Neuropsychiatr Dis Treat. 2017 Mar 22;13:889-898. doi: 10.2147/NDT.S120113. eCollection 2017.
- Landsbergis PA, Schnall PL, Pickering TG, Warren K, Schwartz JE. Life-course exposure to job strain and ambulatory blood pressure in men. Am J Epidemiol. 2003 Jun 1;157(11):998-1006..
- Landsbergis PA, Schnall PL, Pickering TG, Warren K, Schwartz JE. Lower socioeconomic status among men in relation to the association between job strain and blood pressure. Scand J Work Environ Health. 2003 Jun;29(3):206-15.
- Lekomtseva Y, Zhukova I, Wacker A. Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial. Complement Med Res. 2017;24(1):46-52. doi: 10.1159/000457918. Epub 2017 Feb 17.
- Mao JJ, Xie SX, Zee J, Soeller I, Li QS, Rockwell K, Amsterdam JD. Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial. Phytomedicine. 2015 Mar 15;22(3):394-9. doi: 10.1016/j.phymed.2015.01.010. Epub 2015 Feb 23.
- Mattioli L, Funari C, Perfumi M. Effects of Rhodiola rosea L. extract on behavioural and physiological alterations induced by chronic mild stress in female rats. J Psychopharmacol. 2009 Mar;23(2):130-42. doi: 10.1177/0269881108089872. Epub 2008 May 30.
- McCranie EW, Lambert VA, Lambert CE Jr. Work stress, hardiness, and burnout among hospital staff nurses. Nurs Res. 1987 Nov-Dec;36(6):374-8.
- Memorial Sloan-Kettering Cancer Center - Rhodiola Monograph. Accessed at http://www.mskcc.org/cancer-care/herb/rhodiola.
- Olsson EM, von Schéele B, Panossian AG. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 2009 Feb;75(2):105-12. doi: 10.1055/s-0028-1088346. Epub 2008 Nov 18.
- Palazzo Ldos S, Carlotto MS, Aerts DR. [Burnout Syndrome: population-based study on public servants]. Rev Saude Publica. 2012 Dec;46(6):1066-73. Epub 2013 Jan 28. Portuguese.
- Punja S, Shamseer L, Olson K, Vohra S. Rhodiola rosea for mental and physical fatigue in nursing students: a randomized controlled trial. PLoS One. 2014 Sep 30;9(9):e108416. doi: 10.1371/journal.pone.0108416. eCollection 2014.
- Ross SM. Rhodiola rosea (SHR-5), Part I: a proprietary root extract of Rhodiola rosea is found to be effective in the treatment of stress-related fatigue. Holist Nurs Pract. 2014 Mar-Apr;28(2):149-54. doi: 10.1097/HNP.0000000000000014
- Saijo Y, Chiba S, Yoshioka E, Nakagi Y, Ito T, Kitaoka-Higashiguchi K, Yoshida T. Synergistic interaction between job control and social support at work on depression, burnout, and insomnia among Japanese civil servants. Int Arch Occup Environ Health. 2015 Feb;88(2):143-52. doi: 10.1007/s00420-014-0945-6. Epub 2014 May 23.
- Squiers JJ, Lobdell KW, Fann JI, DiMaio JM. Physician Burnout: Are We Treating the Symptoms Instead of the Disease? Ann Thorac Surg. 2017 Oct;104(4):1117-1122. doi: 10.1016/j.athoracsur.2017.08.009.
- Wirtz PH, von Känel R. Psychological Stress, Inflammation, and Coronary Heart Disease. Curr Cardiol Rep. 2017 Sep 20;19(11):111. doi: 10.1007/s11886-017-0919-x. Review.