Firstly, breathe....


Understanding stress


Everyone experiences stress at times in their lives, though how it is defined and the impact it has differ from person to person.

However, to better understand the phenomenon more precisely it is more helpful to separate stressors—stress­ful events and circumstances-from stress, the automatic physical response to the latter challenges, or indeed to any situation that requires adaptation to change.

Here, confrontation of each potential or actual stressor or threat trig­gers a cascade of stress hormones that produce well-orchestrated physiological changes and sensations: a pounding heart, tensing muscles, and quickening of breath, known simply the fight-or-flight response, or the stress response.

 The response to a threat begins in the thalamus, a part of the brain that receives and processes informa­tion from the senses. Instantly, the thalamus alerts the brain’s fear centre, the amygdala, and other emotional centres of the brain, which then send signals to the motor cortex. From there, the message to respond speeds down nerve pathways to muscles, which tense and tighten, bracing for trouble.  Another signal from the amygdala goes to the hypothalamus, a portion of the brain situated above the brainstem. The hypothalamus in turn relays the warning to the nearby pituitary gland, which sends a chemical messenger via the bloodstream to the adre­nal glands, located above the kidneys. In response, the adrenal glands secrete a series of stress hormones, including epinephrine, commonly known as adrenaline. The adrenal glands also release a second stress hor­mone called norepinephrine, or noradrenaline as well as a third one-cortisol, so that all three begin circulating in bloodstream, producing a broad range of physiological responses.


Simultaneously, the hypothalamus activates the auto­nomic nervous system. This network of nerves relays the warning down through the spinal cord and from there to nerves throughout the body. In response, nerve endings in organs, blood vessels, the skin, and even sweat glands release epinephrine and norepinephrine. This combination of stress hormones primes the body to react to the imminent threat by either preparing to stand and fight, or else fleeing to safety.  The breath quickens as the body takes in extra oxygen to help fuel muscles. Likewise, energy-boosting glucose and fats are released from storage sites into the bloodstream. Sharpened senses, such as sight and hearing, heighten alertness. The heart pounds—beating up to two to three times as quickly as normal—and blood pres­sure rises. Certain blood vessels constrict, which helps direct blood flow to the muscles and brain.


Blood cells called platelets become stickier, so clots can form more easily to minimize bleeding from potential injuries. Immune system activity picks up to combat infection from anticipated wounds. Muscles, even tiny, hair-raising muscles beneath the skin tighten, preparing for action. Body systems not needed for the immediate emer­gency are suppressed in order to focus energy where it’s needed. The stomach and intestines minimise function, sexual arousal lessens and repair and growth of body tissues slows.


The autonomic nervous system, which governs these responses, is actually divided into two parts with opposite effects. The sympathetic nervous system stimulates the body in response to perceived dangers, as described above. Its counterpart, the parasympathetic nervous system, calms the body after the danger has passed. But in today’s world, stressors often add up one after another in a combination and continuum of challenges. As a result, the sympathetic system often remains engaged long after it should have yielded to the soothing influ­ence of the parasympathetic system. Similarly, immune activity may not abate as it should, leading to persistent low-grade inflammation.


The stress response can be enormously helpful in times of physical danger or when there is an urgent task to fulfil. The stress response is appropriate and essential in such situa­tions and helps one rise to many challenges. But the stressors in life are not always physi­cal dangers. Physiologist Hans Selye advanced the idea that psychosocial stressors like a pressing work dead­line or a heated family argument can trigger the same physiological response as a bodily threat. In the short term, this might be beneficial. Selye explored the differ­ence between short-term stress that stimulates people to overcome obstacles (“good” stress, or eustress) and ongoing or excessive stress, which wears down people’s ability to adapt and cope (“bad” stress, or distress).


Many people find short-term challenges exhilarating. Here, the satisfaction of ris­ing to and overcoming a challenge is much greater than the pleasure of doing something that requires no effort. What makes these experiences rewarding is the creativ­ity involved, the physical effort, the sense of accom­plishment, and possibly the feeling of being part of a team. This type of stress delivers performance at a higher level, even if there are moments of anxiety or doubt along the way.


In fact, as stress or anx­iety levels rise, so too can performance and efficiency—but only up to a point. Once this optimal point is reached, further stress and anxiety lead to significant declines in performance and ability. Where the turning point lies seems to differ from person to person, for while the stress response is innate in humans and other animals, the events and perceptions that set it off vary widely. What one person per­ceives as intimidating, their neighbour may easily brush aside or even relish.  People who handle stress well also seem to have certain things in common. They seem to feel a sense of control over their circumstances or the ability to influ­ence events. They embrace the challenge in situations others might find stressful and describe themselves as committed to something meaningful. Exercise and strong social support are also often key  factors in their resil­ience.

Chronic stress


Intuitively, the classic stress response makes sense. It enables one to rise to occasions that reward height­ened awareness and abilities. But experience shows obvious dangers are not the only scenarios that evoke the stress response. Any sit­uation perceived as bothersome or a threat to well-being may trigger it, too, especially if a lightning-quick assessment suggests that the resources to cope with it are lacking. However, often the body does a poor job of distinguishing between life-threatening events and day-to-day stress­ful situations. Anger or anxiety triggered by less momentous sources of stress, often don’t find a quick physical release and tends to build up over time. When the body repeatedly experiences the stress response, or when arousal following a terrible trauma is never fully switched off, the body’s stress response can be described as maladaptive, or unhealthy. In this situation, the stress response starts sooner or more frequently than normal, increasing the burden the body must handle. This can lead to worrisome health problems. Certain factors seem to make stress especially harmful. A sense of lack control over a sit­uation can make it harder to cope with. Similarly, if there appears no time limit on the stress, it is more difficult to handle. And without social support, distress level can rise even higher.


Anxiety and depression


Stress feeds negative emotions like anxiety and depres­sion. And, in turn, anxiety and depression may boost feelings of stress. Broadly speaking, anxiety is typically tied to a real or imagined threat that leads to the fear of loss, while depression may be sparked by the response to loss itself. Even when a clear threat to well-being forms the springboard, anxious or depressive thoughts often spiral into a series of perceived threats, spinning off into increasingly distorted worries. If anxiety is severe enough to interfere with daily life, talk to a doctor or seek counsell­ing. Symptoms may include any of the following:

extreme worry or fear much of the time, or repeated panicky feelings; irrational feelings of fear, dread, or danger; frequent physical symptoms—such as agitation, shakiness and trembling, nausea, hot and cold flashes, dizziness, headaches, shortness of breath, or frequent urination—in the absence of a rational threat; recurring distressing thoughts and uncontrollable repetitive behaviours intended to reduce the anxiety triggered by those thoughts.  Likewise, it’s important to seek help from a doctor or a professional for symptoms of depression, such as prolonged feelings of sadness or irritability; loss of interest in activities that were once enjoyed; sleeping or eating markedly more or less than usual; feelings of guilt, worthlessness, or hopelessness; feeling anxious and unable to sit still and trouble concentrating and making decisions.

Healthy vs. unhealthy responses to stress


People have their own ways of dealing with stressful times. Some may be healthy, such as a massage treat, or curling up in bed earlier than usual, or simply calling a friend. Others may not be as help­ful. All too often, people self-medicate or turn to other unhealthy behaviours in an attempt to relieve pressure. They may do so in a variety of ways. These are some examples of less healthy responses to stress: watching endless hours of TV; withdrawing from friends or partners or, con­versely, jumping into a frenzied social life to avoid facing problems; overeating or weight gain; undereating or weight loss; sleeping too much; drinking too much alcohol; lashing out at others in emotionally or physically violent outbursts; taking up smoking, or smoking more than usual;  taking illegal or unsafe drugs; taking prescription or over-the-counter drugs that promise some form of relief, such as sleeping pills, muscle relaxants, or anti-anxiety pills. Becoming aware of how one typically handles stress can help in making healthy choices.


The relaxation response is a term used to describe the deep physiological shift in the body that counters the stress response. Learning how to evoke this health-enhanc­ing response is a core feature of managing stress and one of the tools to help foster resilience.  A number of physiological changes occur dur­ing the relaxation response. Heartbeat and breath­ing slow down. The body uses less oxygen, and blood lactate levels, which some researchers believe are linked with anxiety attacks, decline markedly. Some methods will work better for some people than others. Rather than choosing just one technique to elicit the relaxation response, try sampling many to find the most appropriate one/s to suit individual needs. Then, if a favourite fails to engage at times, an alternative will be available. And many people get the best results from combining several techniques.


Creating a routine for relaxation response sessions will help make the new behaviour stick. Therefore, it’s best to practice regularly, once or twice a day. Choosing a particular time of day can enhance the sense of ritual, which will enable practice come more easily. Many people choose to use relaxation techniques in the morning before breakfast, since it can be hard to schedule time later in the day. Aim for at least 10 to 20 minutes daily, either in one sitting, or try several five-minute seg­ments spaced throughout the day. Remember that any time spent eliciting the relaxation response is better for the mind and body than none.  Common techniques include Breath focus; Body scan; Guided imagery; Mindfulness meditation; Yoga, tai chi, pilates and qigong; as well as repetitive prayer. However, this list is not comprehensive, and there are many variants to examine and test to find the one/s most suited to the individual.

 The importance of stress management

It’s impossible to sidestep all sources of stress and probably undesirable too as life is full of physi­cal and psychological challenges that can add zest and sometimes deliver satisfying rewards. But while all sources of unwelcome stress cannot be erased, they can be perceived and handled differently. This approach to managing stress helps build resilience—the ability to bounce back from stress.


There’s little doubt that chronic stress has harmful effects on the body, and that it acts in multiple ways. To begin with, the ripple effects of stress undermine healthy behaviour. Abundant evidence shows that chronic stress erodes physical health and high levels may even speed up the aging process.  By contrast, people exhibiting less stress tend to be in better health, suggesting stress management can benefit the entire body, right down to gene expression. Results from several studies show that the simple act of eliciting the relaxation response changes the activity of certain genes in ways that may benefit health and reduce, for example, the activity of genes associated with chronic inflammation. At the same time, the relaxation response boosts the activity of genes linked with a variety of benefi­cial functions: the cells’ use of energy in the body and insulin sensitivity (which helps regulate blood sugar), the maintenance of telomeres (protective end-caps on chromosomes that erode with age), and the func­tions of tiny cellular powerhouses called mitochon­dria that also help the body counter the damage caused by highly reactive molecules called free radicals which initiate oxidative stress.


Boosting resilience


Wellness depends on both the total amount of stress in life (over which there may be little or no control) and the ability to deal with it—that is, resilience. Learning to elicit the relaxation response helps enormously in controlling stress. But it works best when combined with resilience training. Simply put, resilience is the ability to bounce back from difficult or stressful experiences. How one responds to stress is determined by many dynamic, interacting fac­tors, including genes and the family environment, both current and historical. These factors are embedded within a larger social realm, which is shaped by culture, eco­nomics, and politics, among other things. Growing up in an environment surrounded by people who are loving, emotionally responsive, con­sistent, and reliable can help build resilience. In these secure situations, children are more likely to learn resilience skills (like regulating their emotions, calm­ing themselves down, and sustaining close relation­ships with other people) compared with children who grow up in chaotic, unpredictable environments that create insecure, unstable relationships.  But even people who find challenging situations overwhelming and are prone to overreact to stress (by virtue of their genes, a difficult childhood, or a combi­nation of factors) can still learn to be resilient adults.


  • Changing mindset


Most of the time, people speak of stress as a bad thing. Some people thrive on stress, and find it energizing and exciting. In people with a more stress-hardy mindset, the stress response is often tempered by the challenge response, which accounts for the so-called excite-and-delight experience that some people have in stressful situations. Like the typical stress response, the challenge response also affects the car­diovascular system, but instead of constricting blood vessels andheightening inflammatory processes in anticipation of wounds, it allows for maximum blood flow, much like exercise. The balance of hormones is different, too, including more of the compound DHEA which enhances recovery from the effects of cortisol.


Another modification to the stress response is called “tend-and-befriend”. It explains why, after significantly stressful events, people feel the need to reach out to friends and relatives in the com­munity—to assure themselves that loved ones are all right, to comfort the distressed or bereaved, and to shore up social networks. Connecting in this way actually helps reduce stress because it also involves different balances of hormones—in particular, increased levels of oxytocin, which typically enhances the bonding between a mother and child or between sexual partners, for example. It makes the brain’s reward centres more responsive to social con­tact, and is an important part of resilience.


Stepping back from full-on fight-or-flight can be simply a matter of changing mindset. Experiencing a racing heart—for example, before about to give a presentation or initiate a tough conver­sation—can be turned to an advantage by understanding that the body is trying to energise itself, so try and capitalize on that thought. Pause and reflect upon feelings of nervousness to consider why, and remember it’s because the task is something that matters personally and therefore reinforces values and gives meaning to life. Don’t deny the stress, but redirect energy away from it and toward the task at hand. Try to focus on the larger purpose of whatever is being done.


Don’t pretend that stress doesn’t exist. People who do so tend to isolate them­selves and reinforce their fears. Instead, ask why this stress is being experienced and look for any positive aspects to it. Is something being learned from it? Is it providing strength? Is connection being made with people on a more fundamental level? Does the situation create a feeling of being more intensely alive? 


  • Exercise regularly


Accumulating 30 min­utes a day of moderate-intensity activity—a brisk walk, for example—delivers a wealth of health-enhancing benefits. Exercise lowers blood pressure, helps keep bones strong and healthy, and enhances the immune system, while dampening low-level, chronic inflammation. It can boost metabolism and mood. Many studies have linked physical activity with reduced symptoms of depression and anxiety.  What’s more, exercise defuses stress. Engaging in physical activity after the stress response is encountered allows stress hormones to be removed just as nature intended. Exercise also increases the production of feel-good chemicals known as endorphins. In addition, certain activities (such as yoga, tai chi, and qigong) and rhythmic, repetitive exercise (such as walking, running, swimming, cycling, and rowing) elicit the relaxation response. Regularly engaging in these kinds of activities can help counteract everyday stress. To boost the stress-relief rewards even more, try shifting attention to an awareness of self— what is being felt and what effect it is having—and the surroundings during exercise. This should generate a greater feeling of calm and being more centred. Coordinate breathing with movement, focusing attention mindfully on the sensations in the body. When dis­ruptive thoughts intrude, gently turn the mind away from them and focus on moving and breathing.


  • Eat well


Stress can have a significant effect on appetite and eating habits. In an emergency, stress shuts down the desire to eat. The hypothalamus produces corticotropin-releasing hormone, which suppresses appetite, and the brain tells the adrenal glands to produce epinephrine. These hormonal cues signal the body to divert energy to other, more pressing matters than eating.

But persistent stress induces a different response. The adre­nal glands also release cortisol, which increases appe­tite and may also elevate motivation, including the urge to eat. If the stress doesn’t go away—or if a per­son’s stress response gets stuck in the “on” position— cortisol may stay elevated.


Fat- and sugar-laden foods seem to dampen stress-related responses and emotions. These foods really are “comfort” foods in that they seem to counteract stress in the immediate moment, contributing to peo­ple’s stress-induced craving for those foods. But over the long term, stress-related eating can cause weight gain. Stressed people also sleep less, exercise less, and drink more alcohol, all of which can also contrib­ute to weight gain.

  • Heathy eating advice includes such ideas as-eating whole foods and avoid packaged or processed foods; Instead of vegetable or fruit juice, consider increas­ing the intake of fresh fruits and vegetables.
  • Frozen fruits without added sugars are a good choice, too.
  • Include fibre-rich whole grains and legumes in the diet.
  • Include probiotic-rich foods such as plain yogurt without added sugars.
  • Add fermented foods such as kefir (unsweetened), sauerkraut, or kimchi.
  • Eat a balance of seafood and lean poultry, and less red meat each week.
  • Add a range of colourful fresh fruits and vegetables to the diet. Consider choosing organic produce.

Food offers comfort and pleasure as well as nourish­ment, but often its’s easy to be distracted by working, read­ing, or watching TV whilst eating that the actual food is barely noticed, much less the time taken to savour each bite. However, significant pleasure can be derived from meals by taking the time to eat mindfully.  To practice mindful eating, start by eliminating distractions like the background drone of the TV or even a propped-up book. Clear the table of clutter and set a proper place setting/s before sitting down to eat. Then, close the eyes for several seconds, and inhale and exhale deeply to help focus. Bring full attention to the moment. Now, look at the food. Breathe in its aromas before tasting it. Chew slowly to delight in textures and flavours. Try not to rush through one mouthful to get to the next, but con­centrate instead on the mouthful actually being eat­en at that moment. Bringing all the senses into play can sharpen the taste for fresher, healthier foods and help break the cycle of stress-related eating. Pay attention to feelings not only while eating, but before and after as well. Are these feelings at the start actual physical signs of hunger, or is it simply “time” for din­ner? Is eating happening to quell stress? Becoming more aware of these feelings, may help to lead other stress control techniques becoming just as satisfying as eating.


  • Social support


Strong evidence suggests that social iso­lation is a very powerful force in predisposing mam­mals to stress-related illnesses. For everyone based on our evolution as social organisms, stress emerges when social attachments are insecure. Strength­ening social support can do much to lessen the innate fear of separation, thereby reducing stress. A host of epidemiological studies in human populations show that social ties—at least those that represent pos­itive relationships—significantly protect health and well-being and lengthen life.  Confidants, friends, acquaintances, co-work­ers, relatives, and spouses or companions weave a life-enhancing social net. Their support may involve outright assistance or may be largely emotional. Not surprisingly, the quality of relationships counts. Research suggests that negative ones can be more harmful than helpful.

  • Positive psychological tools


Many experts who design stress management programs now draw on the lessons of positive psychology to help people learn to reframe their outlook and mimic the mindset of those who are naturally more stress-hardy. Gratitude helps people feel more positive, relish positive experiences, enjoy bet­ter health, build stronger relationships, and deal bet­ter with adversity and stress. Researchers have found that laugh­ter boosts immune system activity and lowers the amount of circulating stress hormones, such as epi­nephrine and cortisol. Many mind-body practitioners even prescribe laughter, often urging their patients to rent funny movies, read amusing books, and embrace the absurd in daily life. Savour pleasure by placing attention on pleasure as it occurs, consciously enjoying the expe­rience as it unfolds. It’s like mindful eating, but carried over into other aspects of life. Often people let everyday pleasures slip by without much notice, while placing a great deal of emphasis on stressors. Savouring can help reverse that trend, especially when pleasurable experiences are shared with friends and family.

Strengths are built-in capacities and capabilities. When people play from their strengths, they are likely to feel more energetic and to perform better. Knowing ones strengths is helpful only they are used correctly Try to identify key strengths and use one in a new way each week. Finally, it’s good to be good. Research demonstrates that people who help others often have happier, healthier lives.


One safe way to decant any emotions—even the most hurt­ful, terrifying, or sad feelings—is journal writing. A blank sheet of paper and a pen, or a blank document, can offer enormous release and, possibly, insight into hidden conflicts that are often a source of stress. Write for oneself, not others. Don’t worry about grammar or sentence structure. Do this exercise for 15 to 20 minutes a day for three to four days, or as long as a week if the writ­ing continues to be helpful and don’t worry about repeating things.  Another approach is to write about a positive event to identify ways to bring more joy and meaning to life. For this exercise, set aside 10 minutes to write about any positive event that’s taken place in life. Focus on the details of the event as well the feelings at the time.  Afterwards, take a few minutes to think about these feelings. Then look for ways to experience those feelings again. Are there oppor­tunities in the present that might bring those same feelings?


Often, negative thoughts are riddled with irra­tional distortions. Negative automatic thinking can engage the stress response very easily. In people who get caught in a rut of negative thinking, there is a tendency to cat­astrophize—that is, to blow things out of proportion, which in turn leads to a physiological stress response. Some people have a greater tendency to do this than others. Worse, research shows that what starts out as a habit of thinking negatively can provoke a long-term stress response, mak­ing a person vulnerable to a variety of chronic illnesses, including depression.  A type of therapy called cognitive behavioural therapy is built on the premise that thoughts and perceptions shape moods and emotions—and that distorted thinking can be changed with practice. This helps to deflate negative thoughts through cognitive restructuring, a technique that helps change the way of thinking. That, in turn, can help change feeling.


Communicating effectively is a powerful tool. It helps ward off the stress experienced from behaving either too passively or too aggressively. This is espe­cially true in the workplace, where miscommunica­tion can result in much undue stress. Learning to listen actively and communicate assertively can improve the ability to manage con­flicts, prevent situations from escalating, and lessen the likelihood of stressful misunderstandings.  To listen actively, appreciate other people’s realities without making judgments or interrupting. This kind of empathetic listening takes practice, but it can make a difference in the tone discussions take.  


Learning to nurture oneself is another key tool for managing stress. Reducing stress and developing resilience can be achieved through self-nur­turing, which includes coping adaptively through fol­lowing a healthy lifestyle, reaching out to family and friends, accepting their limitations, and being com­passionate towards oneself and others.  Try nurturing oneself in other ways, too. The nerve-jangling pressure of lengthy daily “to do” lists can leach away energy. The thought of adding more items to the list may lead to more dismay than delight, even if the addition is relaxation, creativ­ity, or time with a loved one. Refreshing oneself in meaningful ways, can add to the stock of energy and joy.


Adaptogens and stress


The concept of adaptogen is now more than 60 years old, and has been thoroughly reviewed in relation to physiology, pharmacology, toxicology, and potential uses in medicine. Originally defined as substances “that increase

resistance to a broad spectrum of harmful factors (stressors) of different physical, chemical, and biological natures,”. Adaptogens are considered “metabolic regulators, which increase the ability of an organism to adapt to environmental factors and to avoid damage from such factors.” Some adaptogens have been used in traditional Chinese medicine and Ayurveda for centuries to promote physical and mental health, improve the body’s defence mechanisms, and enhance longevity.


  • The historical background of the adaptogen concept


Resistance to stress and survival depends on adaptability and the thresholds that determine an organism’s innate tolerance to a given level of stress. The stress-induced responses of the innate and adaptive defence systems involve numerous mediators of stress signalling. Repeated mild exposure or low doses of stress result in the increased resistance of cells and organisms to subsequent stress exposure, resulting in an adaptation that favours survival. This phenomenon of adaptation to repetitive low-level stress was first described by Hans Selye in 1936 (1) who observed several nonspecific reactions were evoked which he termed the general adaptation syndrome (GAS) (1,2). GAS necessitates three stages. The first is the initial stress recognition or “alarm reaction” when symptoms emerge. The second stage involves the acquisition of nonspecific resistance, following which symptoms disappear. Stage 3 signals exhaustion, when the same symptoms reappear.


Through the 1950s and 1960s, Lazarev and Brekhman suggested that certain compounds and herbal extracts, termed adaptogens, could prolong the duration of nonspecific resistance to stress and diminish the magnitude of the alarm phase (3,4). The adaptogens were defined as nontoxic compounds with multiple mechanisms of action and

pharmacological effects related to adaptability and survival (3,4). The adaptive stress response occurs in a variety of regulatory systems from the cellular level to the whole organism. A characteristic feature of adaptogens is that they act as eustressors (i.e., “good stressors”) and as mild stress mimetics or “stress vaccines” that induce stress-protective responses (5,6).


Mild (survivable) stress induces a resistance or “immunity” to subsequent, more severe stress exposure (5,6). However, this stress-induced resistance carries no memory function, and repeated exposure to the adaptogen is required to maintain

the plastic adaptive state. Another comparison could be made with repetitive physical exercise, which increases endurance and performance (7). A state of nonspecific resistance (SNSR) could be achieved either by the gradual “training” of an

organism to withstand the effects of the stress or by adaptogens that mimic the stress. The repeated administration of adaptogens and the consequent adaptogenic or stress-protective response arise in a manner analogous to repeated physical exercise that leads to prolonged SNSR and increased endurance and stamina (7,8). The phenomenon of adaptation to stress also underpins the what is known as a hormetic response, which is defined as an adaptive response characterized by a biphasic dose–response, with a low dose that is stimulatory (i.e., has a beneficial effect) and a high dose that is inhibitory (i.e., has a negative effect) (9,10).


Numerous systematic reviews, meta‐analyses of preclinical and clinical studies, and comprehensive assessment

reports (11-27) on the efficacy and safety of adaptogenic plants have been published in the last several decades. The

common concept relating to adaptogenic plants is used as a basis for officinal medical preparations in the USSR/Russian and in traditional Chinese medicine (TCM), Ayurveda, Kampo, and other traditional medical systems (TMS) and alternative medical systems. Adaptogens must be innocuous and cause minimal disorder in the physiological functions of an organism, and have nonspecific actions, that is, increase resistance to adverse influences of a wide range of factors with physical,

chemical, and biological properties. In addition, they typically possess normalizing actions irrespective of the

direction of the foregoing pathologic changes.


Similar to antioxidants and vitamins, adaptogens constitute a category of nutritional and herbal medicinal

products essential for good health, adaptability, resilience, survival, and healthy aging. Regardless of the nature of

the stimulus (stressor), an adaptogen increases adaptability, resilience, and survival by activating adaptive signaling

pathways of cellular and organismal defence systems (stress system e.g., neuroendocrine‐immune complex). Furthermore,

adaptogens trigger the generation of hormones (cortisol, corticotropin‐releasing hormone [CRH] and

gonadotropin‐releasing hormones, urocortin, neuropeptide Y), playing key roles in metabolic regulation and homeostasis. Meanwhile, multitarget mechanisms of action and a wide range of pharmacological effects indicate their nonspecific pharmacological activity.


Therefore, adaptogens are most likely effective for the prevention and treatment of stress‐induced and adult onset

disorders. This can be achieved due to their ability to activate the innate defence system, increase resistance to stress, adapt organisms to stress, increase recovery of stress‐induced damage, provide energy to fight fatigue, and reduce aging‐associated decline of the neuroendocrine‐immune system.


  • Background to The Adaptogenic Concept


The term adaptogen was introduced in 1958 by the Soviet toxicologist Lazarev, who used the results of intensive studies of Schisandra chinensis in the USSR during World War II,64–66 with the goal of finding an alternative to stimulants used by the German and U.K. army to increase the attention and endurance of pilots.67  During the 1960s and 1970s, other Soviet scientists extended the research of adaptogens to “rejuvenating and invigorating” medicinal plants traditionally used in China, Korea, Japan, Siberia, and the far east of the USSR for a variety of conditions and their symptoms.70–72 The authors screened many plants assuming that “adaptogens must be safe and normalize body functions irrespective of the nature of stressors” and in 1967, some were incorporated into official medical practice in the USSR as central nervous system (CNS)‐stimulating medicinal products and as tonics to fight fatigue and general weakness.  Rhodiola rosea extract is an example of an adaptogenic medicinal product used since 1975 in officinal medicine in the USSR/Russia. It is indicated for “decreased mental and physical capacities such as weakness, exhaustion, tiredness and loss of concentration, as well as during convalescence.” The extent of adaptogen research conducted in the USSR was enormous with more than 1000 pharmacological and clinical studies published in Russia.


Most common extracts or compounds isolated from Siberian Ginseng (Eleutherococcus senticosus), Schisandra

(S. chinensis), Ginseng (Panax ginseng), and Golden Root (R. rosea) have been studied. All adaptogenic plants and

preparations from them have been clinically tested and approved before incorporation into official medical practice.


Regardless of the formal indication for use in officinal medicine as tonics, adaptogens were widely used in:


  • sports medicine to promote quicker recovery after heavy exercise and overstraining,
  • occupational medicine for protection against negative environmental factors, and
  • geriatric medicine with the aim of promoting health by preventing and treating diseases and disabilities in older



Key points of the adaptogenic concept defined by Brekhman and Dardymov in 1969 are in line with basic principles

of TMS of China, Korea, Japan, India (Ayurveda), and Middle Asia (Yunani). For instance, an assumption is that some adaptogens used in TCM, Kampo, and Ayurveda medicine (e.g., Ginseng, Ashwagandha, Andrographis, Bryony) must have normalizing effects, irrespective of the nature of the disease. Herbalists refer to adaptogens as restoratives, qi‐tonics, rasayanas, or rejuvenating herbs. Tonic herbs are classified as the highest and most sought‐after herbal remedies in many traditional systems of healing such as TCM and Ayurveda.


  • Use of Adaptogens In Stress Induced And AgingRelated Diseases


The effects of adaptogens on cognitive functions and physical endurance in stress are summarized in several reviews (28-30). The main difference between adaptogens and conventional stimulants such as caffeine and amphetamine is that after prolonged use, the latter can cause the user to develop both tolerance and addiction (30). In a number of clinical studies, the beneficial effects of adaptogens have been demonstrated on healthy subjects in stress conditions (29,31,32) This is especially true of the mental and physical performance of fatigue and mental strain.


The prophylactic use of adaptogens seems to be justified in healthy subjects for preventing aging‐related

diseases, and to attenuate stress‐induced harmful effects (33-36). Several systematic reviews and assessment reports have been conducted on the clinical efficacy and safety of Korean ginseng (37-39), Eleutherococcus-siberian ginseng (40), Rhodiola (41-47) Withania-ashwagandha (38-53) and other adaptogens on several indications such as cognitive function. There is some evidence from randomized, placebo‐controlled, double‐blind trials regarding the benefits of W. somnifera on cognitive function, such as improved performance on cognitive tasks, attention, and reaction time (50).  In most of the clinical studies on Eleutherococcus preparations conducted in the USSR in the 1960s and 1970s, positive results were commonly reported.


Data also support the plausibility of the use of the traditional herbal medicinal products of R. rosea as adaptogens.1

In Sweden, Norway, and Denmark, Rhodiola traditional herbal medicinal product is indicated as an adaptogen

in situations of decreased performance such as fatigue and sensation of weakness. In a systematic review and meta‐analysis, Hung et al (46) concluded R. rosea may have beneficial effects on physical performance, mental performance, and certain mental health conditions. Only a few mild adverse events were reported.



Stress and B vitamins


Cross-sectional and prospective studies have revealed relationships between stress, cognitive performance and low B vitamin intake (54) coupled with high levels of plasma homocysteine (high in B vitamin deficiency) (54).  Folate, vitamin B12 and vitamin B6 are implicated in the metabolism of homocysteine (HCy), which is produced as a by-product of methionine metabolism. Normally, homocysteine is converted back to methionine or used to create cysteine and other substances in the body. Blocking of the conversion process (e.g. by deficiencies of folate or vitamins B12 and B6) leads to elevated levels of homocysteine.


When folate or vitamin B12 is insufficient, an accumulation of HCy occurs which is understood to be highly

toxic to neurons and believed to be the cause of neurological, sensory and motor symptoms (55). Folate, B6 and B12 vitamins are the key vitamins that have a direct effect on mood and neurotransmitter regulation. Therefore, deficiency may have a direct effect on mood and cognitive function by virtue of these vitamins in the production of neurotransmitters (56).


A clear association exists between stress and homocysteine levels. Kang and colleagues demonstrated a significant relationship in a cohort of 152 workers between perceived job-related stress, cardiovascular risk factors and plasma homocysteine levels (57). Similarly, Stoney demonstrated (58) that acute psychological stress, in terms of both mental arithmetic (serial subtractions) and speech stressors, induces rapid concomitant elevations in plasma homocysteine concentrations, blood pressure and heart rate. Stoney hypothesised both that the mechanism driving the homocysteine elevations may be the induction of a rapid decline in vitamin B6 levels by acute stressors. This certainly sits well with interpretations of data that suggest that chronic stress results in depletion of vitamin B6 (59) and that vitamin B6 supplementation may in itself be an effective anti-stress strategy (60).

 Vitamin supplementation interventions for work stress


One potential pharmacological intervention to assist our bodies to cope with increased levels of stress is vitamin B supplementation. Dietary deficiencies in micronutrients have been implicated in altered mood states (including work stress and psychiatric symptoms) in otherwise healthy individuals (61). Supplementation with micronutrients to overcome these dietary deficiencies has been observed to improve perceived stress, mild psychiatric symptoms, and some aspects of everyday mood in a recent meta-analysis of studies examining short-term multivitamin supplementation (62). These positive effects have been postulated to have occurred through alteration of biochemical processes affected by poorer dietary status through supplementation. Specifically, high doses of B vitamins have been suggested to be effective in improving mood states in both clinical and non-clinical populations.


One research centre has recently examined whether a multivitamin supplement containing a complex of mostly B group vitamins, improved work related stress (63). Sixty participants, recruited from the community, completed the 3-month, double-blind, randomized, placebo-controlled trial in which personality (64), work demands, mood, anxiety and strain were assessed. The primary analysis revealed that the Vitamin B group reported significant reduction in Personal Strain, while the placebo group showed a significant increase in levels of strain.


Several double-blind, placebo-controlled studies have assessed the effects of a multivitamin/mineral product, with a predominance of B vitamins (B1, B2, B3, B5, B6 and B12) plus vitamin C, calcium, magnesium and zinc on self-ratings of stress or psychological well-being. There was a significant benefit for B supplementation in terms of anxiety/stress ratings across all psychometrics assessed and participants also reported being less tired and having greater concentration compared to the placebo group. (65).


Another trial compared the efficacy of 30 days administration of supplement or placebo in 333 participants selected from 1000 screened volunteers on the basis of high levels of stress (66). Results showed significant advantages for supplementation across a range of measures including the Hamilton Anxiety Rating Scale and the Psychological General Well-being Schedule (a stress index).


Two more recent laboratory studies have focused on the effects of vitamin supplementation on cognitive performance and stress (67,68). The first found that 33-day supplementation to healthy men led to improvements in several measures including general psychological health and perceived Stress Scale (69). The second found that 9-week supplementation to women aged 25–50 years resulted in better performance on a standardised multi-tasking stressor task, coupled with reduced fatigue and improved mood responses to multi-tasking and lower levels of homocysteine (69). The results of these two studies suggest that multivitamin supplementation rich in B vitamins reduces fatigue and stress.



  1. Selye, H. 1976. Forty years of stress research: principal remaining problems and misconceptions. Can. Med. Assoc. J. 115: 53–56.
  2. Selye, H. 1938. Experimental evidence supporting the conception of “adaptation energy”. Am. J. Physiol. 123: 758–765.
  3. Lazarev, N.V. 1958. General and specific in action of pharmacological agents. Farmacol. Toxicol. 21: 81–86.
  4. Lazarev, N.V., E.I. Ljublina & M.A. Rozin. 1959. State of nonspecific resistance. Patol. Fiziol. Experim. Terapia 3: 16–21.
  5. Panossian, A., E. Gabrielian & H. Wagner. 1999. On the mechanism of action of plant adaptogens with particular

reference to Cucurbitacin R diglucoside. Phytomedicine 6: 147–155.

  1. Wiegant, F.A.C., G. Limandjaja, S.A.H. de Poot, et al. 2008. Plant adaptogens activate cellular adaptive mechanisms by causing mild damage. In Adaptation Biology and Medicine: Health Potentials. Vol. 5. L. Lukyanova, N. Takeda & P.K. Singal, Eds.: 319–332.
  2. Viru, A.A. 1981. Hormonal Mechanisms of Adaptation and Training. Leningrad: Nauka, 1–154.
  3. Hovhannisyan, A.S., M. Nylander, A.G. Panossian, et al. 2015. Efficacy of adaptogenic supplements on adapting to

stress: a randomized, controlled trial. J. Athl. Enhancement 4: 4.

  1. Mattson, M.P. 2008. Hormesis defined. Ageing Res. Rev. 7: 1–7.
  2. Calabrese, E.J., K.A. Bachmann, A.J. Bailer, et al. 2007. Biological stress response terminology: integrating the concepts of adaptive response and preconditioning stress within a hormetic dose–response framework. Toxicol. Appl. Pharmacol. 222: 122–128.
  3. EMA/HMPC/232100/2011. Assessment report on Rhodiola rosea L., rhizoma et radix. Based on Article 16d (1), Article 16f and Article 16h of Directive 2001/83/EC as amended traditional use). Final. 27 March 2012.
  4. EMA/HMPC/321232/2012. Assessment report on Panax ginseng C.A. Meyer, radix. Based on Article 16d (1), Article 16f and Article 16h of Directive 2001/83/EC as amended (traditional use). Final. 25 March 2014.
  5. EMA/HMPC/680615/2013. Assessment report on Eleutherococcus senticosus (Rupr. et Maxim.) Maxim., radix. Based on Article 16d (1), Article 16f and Article 16h of Directive 2001/83/EC as amended (traditional use). Final. 25 March 2014.
  6. EMA/HMPC/320433/2012. Assessment report on Andrographis paniculata Nees, folium. Based on Article 10a of Directive 2001/83/EC as amended (well‐established use). Based on Article 16d (1), Article 16f and Article 16h of Directive 2001/83/EC as amended (traditional use). Final. 27 August 2014.
  7. Samuelsson G, Bohlin L. Drugs of Natural Origin: A Treatise of Pharmacognosy. 6th ed. Stockholm: Swedish Academy of Pharmaceutical Sciences; 2009:776.
  8. Lazarev NV. General and specific in action of pharmacological agents. Farmacol Toxicol. 1958;21:81‐
  9. Lazarev NV, Ljublina EI, Ljublina MA. State of nonspecific resistance. Patol Fiziol Exp Terapia. 1959;3:16‐
  10. Brekhman II, Dardymov IV. New substances of plant origin which increase nonspecific resistance. Annu Rev Pharmacol. 1969;9:419‐
  11. Farnsworth NR, Waller D, Strelkova LM. Use of Eleutherococcus senticosus in United States: problems, prospects and literature update. Proceedings of the Second International Symposium on Eleutherococcus. Vladivostok: Far Eastern Scientific Center, USSR Academy of Sciences; 1986:47‐
  12. Wagner H, Nörr H, Winterhoff H. Plant adaptogens. Phytomedicine. 1994;1:63‐
  13. Panossian A, Wikman G, Wagner H. Plant adaptogens III. Earlier and more recent aspects and concepts on their mode of action. Phytomedicine. 1999;6:287‐
  14. Panossian A, Gabrielian E, Wagner H. On the mechanism of action of plant adaptogens with particular reference to cucurbitacin R diglucoside. Phytomedicine. 1999;6:147‐
  15. EMEA/HMPC/102655/2007. Reflection paper on the adaptogenic concept. London; 2008.…/WC500003646.pdf
  16. Panossian A, Wikman G. Evidence‐based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress‐protective activity. Curr Clin Pharmacol. 2009;4:198‐
  17. Panossian A, Amsterdam J. Chapter 8: Adaptogens in psychiatric practice. In: Gerbarg PL, Muskin PR, Brown RP, eds. Complementary and Integrative Treatments in Psychiatric Practice. Arlington, VA: American Psychiatric Publishing; 2017:155‐
  18. Panossian A. Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. Ann NY Acad Sci. 2017;1401:49‐
  19. Panossian A, Seo EJ, Efferth T. Novel molecular mechanisms for the adaptogenic effects of herbal extracts on isolated brain cells using systems biology. Phytomedicine. 2018;50:257‐
  20. Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress‐protective activity. Pharmaceuticals. 2010;3:188‐
  21. Panossian AG. Adaptogens: tonic herbs for fatigue and stress. Altern Complement Ther. 2003;9:327‐
  22. Panossian A, Wagner H. Adaptogens. A review of their history, biological activity, and clinical benefits. HerbalGram. 2011;90:52‐
  23. Darbinyan V, Kteyan A, Panossian A, Gabrielian E, Wikman G, Wagner H. Rhodiola rosea in stress induced fatigue—a double blind cross‐over study of a standardized extract SHR‐5 with a repeated low‐dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine. 2000;7:365‐
  24. Olsson EM, von Schéele B, Panossian AG. A randomized double‐blind placebo controlled parallel group study of SHR‐5 extract of Rhodiola rosea roots as treatment for patients with stress related fatigue. Planta Med. 2009;75: 105‐
  25. Panossian A, Gerbarg P. Potential use of plant adaptogens in age‐related disorders. In: Lavretsky H, Sajatovic M, Reynolds CF, III, eds. Complementary, Alternative, and Integrative Interventions in Mental Health and Aging. New York: Oxford University Press; 2016:197‐
  26. Panossian A, Wikman G. Evidence based efficacy and effectiveness of Rhodiola SHR‐5 extract in treating stress‐ andage‐associated disorders. In: Cuerrier A, Ampong‐Nyarko K, eds. Rhodiola rosea, Series: Traditional Herbal Medicines for Modern Times. Boca‐Raton London New‐York: CRC Press, Taylor & Francis Group; 2014:203‐
  27. Gospodaryov DV, Yurkevych IS, Jafari M, Lushchak VI, Lushchak OV. Lifespan extension and delay of age‐related functional decline caused by Rhodiola rosea depends on dietary macronutrient balance. Longev Health Span. 2013;2:5.
  28. Jafari M, Felgner JS, Bussel II, et al. Rhodiola: a promising anti‐aging Chinese herb. Rejuvenation Res. 2007;10: 587‐
  29. Lee NH, Son CG. Systematic review of randomized controlled trials evaluating the efficacy and safety of ginseng. J Acupunct Meridian Stud. 2011;4:85‐
  30. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol. 1999;55:567‐
  31. Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Saf. 2002;25: 323‐
  32. Li W, Liu M, Feng S, et al. Acanthopanax for acute ischaemic stroke. Cochrane Database Syst Rev. 2009;3:CD007032.
  33. Man C, Dai Z, Fan Y. Dazhu Hongjingtian preparation as adjuvant therapy for unstable Angina Pectoris: a metaanalysis of randomized controlled trials. Front Pharmacol. 2020;11:213.
  34. Ma GP, Zheng Q, Xu MB, et al. Rhodiola rosea L. improves learning and memory function: preclinical evidence and possible mechanisms. Front Pharmacol. 2018;9:1415.
  35. Yu L, Qin Y, Wang Q, et al. The efficacy and safety of Chinese herbal medicine, Rhodiola formulation in treating ischemic heart disease: a systematic review and meta‐analysis of randomized controlled trials. Complement Ther Med. 2014;22:814‐
  36. Korczak D, Wastian M, Schneider M. Therapy of the burnout syndrome. GMS Health Technol Assess. 2012;8:Doc05.
  37. Ishaque S, Shamseer L, Bukutu C, Vohra S. Rhodiola rosea for physical and mental fatigue: a systematic review. BMC Complement Altern Med. 2012;12:70.
  38. Hung SK, Perry R, Ernst E. The effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trials. Phytomedicine. 2011;18:235‐
  39. Sarris J. Herbal medicines in the treatment of psychiatric disorders: a systematic review. Phytother Res. 2007;21: 703‐
  40. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014;20: 901‐
  41. Nasimi Doost Azgomi R, Zomorrodi A, Nazemyieh H, et al. Effects of Withania somnifera on reproductive system: a systematic review of the available evidence. BioMed Res Int. 2018;2018:4076430.
  42. Ng QX, Loke W, Foo NX, et al. A systematic review of the clinical use of Withania somnifera (Ashwagandha) to ameliorate cognitive dysfunction. Phytother Res. 2020;34:583‐
  43. Durg S, Bavage S, Shivaram SB. Withania somnifera (Indian ginseng) in diabetes mellitus: a systematic review and meta‐analysis of scientific evidence from experimental research to clinical application. Phytother Res. 2020;34: 1041‐
  44. Ayati Z, Sarris J, Chang D, Emami SA, Rahimi R. Herbal medicines and phytochemicals for obsessive‐compulsive disorder. Phytother Res. 2020;2020(34):1889‐
  45. Pérez‐Gómez J, Villafaina S, Adsuar JC, Merellano‐Navarro E, Collado‐Mateo D. Effects of Ashwagandha (Withania somnifera) on VO2max: a systematic review and meta‐ Nutrients. 2020;12:1119.
  46. Durga J, Anteunis LJC, Schouten EG, Bots ML, Kok FJ, Verhoef P. 2006. Association of folate with hearing is dependent on the 5,10-methylenetetrahdyrofolate reductase 677C ! T mutation. Neurobiol Aging 27(3): 482–489.
  47. Obeid R, Herrmann W: Mechanisms of homocysteine neurotoxicity in neurodegenerative diseases with special reference to dementia. FEBS Lett 2006, 5801:2994–3005.
  48. Calvaresi E, Bryan J: B vitamins, cognition and aging: A review. J Gerontol Psychol Sci 2001, 56B:P327–P339.
  49. Kang MG, Koh SB, Cha BS, Park JK, Baik SK, Chang SJ. 2005. Job stress and cardiovascular risk factors in male workers. Preventive Medicine 40: 583–588
  50. Stoney CM. 1999. Plasma homocysteine levels increase in women during psychological stress. Life Sci 64(25): 2359–2365.
  51. Baldewicz T, Goodkin K, Feaster DJ, et al. 1998. Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men. Psychosom Med 60(3): 297–308.
  52. McCarty MF. 2000. High dose pyridoxine as an ‘anti-stress’ strategy. Med Hypotheses 54(5): 803–807.
  53. Benton D: To establish the parameters of optimal nutrition do we need to consider psychological in addition to physiological parameters? Mol Nutr Food Res 2013, 57:6–19.
  54. Long SJ, Benton D: Effects of vitamin and mineral supplementation on stress, mild psychiatric symptoms, and mood in nonclinical samples: A meta-analysis. Psychosom Med 2013, 75:144–153.
  55. Stough C, Scholey A, Lloyd J, Spong J, Myers S, Downey LA: The effect of 90 day

administration of a high dose vitamin B-complex on work stress. Human

Psychopharmacol 2011, 26:470–476.

  1. Chamorro-Premuzic T, Ahmetoglu G, Furnham A: Little more than personality:

Dispositional determinants of test anxiety (the Big Five, core self-evaluations, and selfassessed intelligence). Learn Individ Differ 2008, 18:258–263.

  1. Willemsen G, Petchot-Bacque J, Alleaume B, Suter M, Ring C, Carroll DA. 1997. Double-blind placebo-controlled study of the effects of an oral multivitamin combination with calcium and magnesium on psychological well-being and cardiovascular reactions to stress in healthy young male volunteers. Eur J Clin Res 9: 175–184.
  2. Carroll D, Ring C, Suter M, Willemsen G. 2000. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology 150(2): 220–225.
  3. Schlebusch L, Bosch BA, Polglase G, Kleinschmidt I, Pillay BJ, Cassimjee MH. 2000. A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. S Afr Med J 90(12): 1216–1223.
  4. Kennedy DO, Veasey R, Watson A, Dodd F, Jones E, Maggini S, Haskell CF. 2010. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology 211: 55–68.
  5. Haskell CF, Robertson B, Jones E, et al. 2010. Effects of a multi-vitamin/ mineral supplement on cognitive function and fatigue during extended multi-tasking. Hum Psychopharmacol 25(6): 448–461.