Adaptogens

Adaptogens are herbs proposed to help the body resist physiological and psychological stress. The category is dominated by ashwagandha (Withania somnifera), which has the strongest RCT base of any adaptogen for stress, anxiety, and sleep. Rhodiola has weaker but defensible evidence for fatigue; eleuthero has weaker modern evidence than its Soviet-era reputation suggests. The 3 entries in this section cover what the published research shows about ashwagandha specifically, the comparative evidence across adaptogens, and the medication interactions and safety contraindications that matter.

The adaptogen category is unusually mixed in evidence quality. Ashwagandha (Withania somnifera) has accumulated multiple modern RCTs at standardised KSM-66 or Shoden extract doses of 240-600 mg/day, with reproducible effects on perceived stress (Lopresti 2019, Med Baltimore 98(37):e17186), anxiety (Chandrasekhar 2012, Indian J Psychol Med 34(3):255-262), and sleep quality (Salve 2019, Langade 2019, Cureus). Rhodiola rosea has fewer RCTs but defensible evidence for mental fatigue at 200-400 mg/day standardised extract. Eleuthero (Siberian ginseng) carries a long Soviet-era research tradition but the modern English-language RCT base is thin.

This is also a category where safety detail matters more than is widely communicated in consumer marketing. Ashwagandha is contraindicated in pregnancy per the UK BNF and traditional herbal literature, and contraindicated in hyperthyroidism because of its thyroid-stimulating activity. It can elevate free T4 in patients on stable levothyroxine, requiring TFT recheck at 6-8 weeks if started. Rare hepatotoxicity has been reported. Sedative interaction with benzodiazepines, alcohol, and other GABA-active agents is plausible at higher doses.

The published evidence on adaptogens does not support the wellness-marketing framing of universal stress-resilience enhancement. It supports specific clinical effects at specific doses of specific standardised extracts in specific populations, with material safety considerations that recreational supplement use tends to overlook. The entries in this section prioritise what the modern RCT literature actually shows and where the safety picture sits, not the historical claims that drive consumer marketing.

This is a summary of published research, not personal health advice. Discuss any health or supplement decisions with a qualified healthcare professional, particularly during ongoing care, pregnancy, or with chronic conditions.