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All Things Adaptogens: Lessons from Russia with Dr. Adrian Lopresti and Sophia Gerontakos

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All Things Adaptogens: Lessons from Russia with Dr. Adrian Lopresti and Sophia Gerontako

How do we choose the right adaptogens for our patients?

Dr. Adrian Lopresti and Naturopath and Herbalist Sophia Gerontakos discuss all things adaptogens - what they are, mechanisms of action and how they affect the HPA axis, and best practices on prescribing them. Sophia also talks her findings from translating and studying Russian research on adaptogens, how we can apply that research to our own clinical practice, as use it to formulate new questions we need to be asking for future research.

Covered in This Episode

[00:39] Welcoming Sophia Gerontakos
[01:12] Defining adaptogens and some commonly used ones
[02:11] Traditional uses around the world
[03:32] Discussing Sophia’s research 
[06:28] Sophia’s research into the use of adaptogens in Russia
[15:23] Adaptogens for physical and mental endurance 
[20:36] Adaptogens’ mechanism of action
[22:00] Adaptogens effects on the HPA axis
[26:26] How to choose the right adaptogen for the patient
[29:31] Stimulatory and calming adaptogens
[31:43] Best practices for prescribing adaptogens 
[34:34] Using adaptogens in children
[37:24] Thanking Sophia and closing remarks

Resources Discussed in this Episode

Sophia Gerontakos
Research: Findings of Russian literature on the clinical application of Eleutherococcus senticosus (Rupr. & Maxim.): A narrative review (Gerontakos, et al., 2021)
ResearchA Critical Review to Identify the Domains Used to Measure the Effect and Outcome of Adaptogenic Herbal Medicines (Gerontakos, et al., 2020)
Research: Clinician perspectives and understanding of the adaptogenic concept: A focus group study with Naturopaths and Western Herbalists (Gerontakos, Casteleijn, & Wardle, 2021)
Research: Understanding adaptogens: The action that evades us (Gerontakos, Wardle, & Casteleijn, 2019)
Article: Hidden studies from the Soviet Union: PhD student uncovers body of evidence
Book: The Rhodiola Revolution by Richard P. Brown

Adrian: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr. Adrian Lopresti and with us on the line today is Sophia Gerontakos, a naturopath and researcher, who completed her honours postgraduate degree by research in the field of adaptogens.

She will be taking us through some of her research in this area and help improve our understanding of these herbs, and how we can use them to improve the health of our patients. 

Welcome to FX Medicine, Sophia, thanks for joining us today.

Sophia: Thanks, Adrian. It's great to be here.

Adrian: Terrific. Before we get started talking about adaptogens, can you tell us what are adaptogens, and what are some of the commonly used ones?

Sophia: Yeah, certainly. So adaptogens are quite wonderful medicinal plants that have a normalising effect on various different body systems, specifically where stress or chronic stress is involved. So they have a nonspecific effect of increasing resistance to stressors, whether they be physical, chemical, or biological. So they essentially reduce the negative impact of chronic stress by having a normalising intersystems effect within the body.

So some of the most commonly used adaptogens amongst Australian herbalists would be probably Eleutherococcus, that's definitely my most frequently used adaptogen. And Withania, Schisandra, and Rhodiola. But there's also quite a few others, that's not an exhaustive list.

Adrian: Terrific. Yeah, I know there's a whole range of adaptogens and the ones you've mentioned there are certainly quite popular amongst practitioners. And in terms of countries that have traditionally used adaptogens, what countries have used them, and what are they typically being used for?

Sophia: Many of the adaptogens that we tend to be familiar with here in our herbal medicine practice come from countries such as Russia, India, and parts of East Asia. I know from my research adaptogens do have a long tradition of use in Russia for things like improving physical performance and stamina, for stress adaptation, and also for influenza prophylaxis, amongst other things. But I think they would be the main things that they've traditionally been used for.

Adrian: And so I know that obviously, those countries are using them and now, certainly in Australia they're becoming a lot more popular, aren't they?

Sophia: Yes, definitely. And I think amongst herbalists they've always been very popular. But now they're probably starting to become more widely known outside of the herbalist community as well.

Adrian: Yeah, absolutely you see a lot of supplement companies and online companies selling different adaptogens. And the virtues of the different adaptogens, so they're certainly increasing in popularity. 

Sophia: Oh, definitely.

Adrian: You've done some really interesting work in the area of adaptogens. So how did you become interested in adaptogens? And you've obviously done some research in the area. So why did you choose to do further studies in this area?

Sophia: Yeah, I did. So as a naturopath and herbalist in clinical practice, I was using adaptogens a lot, obviously. And there are not many people out there who are not under some kind of stress, whether it be physical, mental, or emotional. So it's quite hard not to prescribe adaptogens really when you've got these fabulous...

Adrian: Absolutely.

Sophia: ...medicines that help with a wide range of stress effects. And adaptogens actually help in many and various clinical presentations indirectly, by helping the body adapt to stress. For example, you might have someone come in who's ready to become pregnant and start a family, but they haven't had a regular menstrual cycle for over 12 months. And you give them adaptogens and things start to regulate again and the cycle is restored. That can be without even doing anything directly with hormones. Or another example is people struggling with mental health, who also respond really well with improved mood, and energy, and things like that.

So that's how my curiosity piqued into adaptogens because I was prescribing them with all these different people with different issues and watching their health turn around. And I thought “How are these actually working and why are these medicines not more widely understood and used?” So that's when I came up with the idea of doing some research on them and trying to develop our understanding of them and ultimately try and help more people with them.

Because there's plenty of research out there now showing how stress impacts multiple body systems and has really negative impacts on health. We know that. So we do need more healthcare support in the area of stress, especially with modern-day lifestyles where it's just not always possible to live a stress-free life or lifestyle. So I guess that's where my interest piqued in my clinical practice just by watching them work.

Adrian: And so then you ended up going back and doing more studies in the area after working as a naturopath for a few years?

Sophia: Yes, that's right. So I actually ended up doing an honours degree by research in adaptogens, where I actually looked at...I did a review of clinical trials to try and work out how they've actually been measured in studies in humans.

And then I also went out and spoke to different groups of naturopaths to understand their experience and perceptions of adaptogens about how they work and where they've acquired their knowledge from, and their understandings. And then I sort of pulled that together into a more comprehensive body of work, I suppose.

Adrian: I've got a couple of your papers here that you've published. So well done. Congratulations on that. And looks like they were quite recently published, so brilliant.

Sophia: Yeah. Thank you.

Adrian: And you did...well, let's go to one of the papers which you wrote on. One of them was that you did a review of adaptogens, particularly their use in Russia. So can you tell us a bit about what you found from your work in this area with the research that was done in Russia?

Sophia: Yes, that was really interesting. So yeah, it was actually Russian researchers who coined the term adaptogen in the 1940s. And that was while they were looking for substances that would improve physical and mental stamina and endurance in harsh working environments, basically.

And then, during the time of the Soviet Union, the USSR, they undertook a targeted research directive on adaptogens. And one of the herbs I focused on was Eleutherococcus, otherwise known as Siberian Ginseng in common terms. And there was quite a lot of work there on its effects on physical and mental performance, on seasonal illnesses like colds and flus, both treatment and prevention. And on things like hypertension, cancer, and pregnancy.

Adrian: So as I was reading your paper I was thinking, or one of the things I was thinking was, how did you translate it? Can you speak and read Russian?

Sophia: No, I definitely can't, so it was quite an adventure. I went to Russia and actually, I have a colleague, a professor and mentor, if you will, from St. Petersburg. He's a professor at one of the pharmaceutical universities there. So he invited me over to work with some masters students over there.

And together, we went into the library archives, we searched and we found these books that contain the articles, the studies. And between the two of us, so they were speaking Russian and English, and I was speaking English. And with the help of a couple of different applications, we translated all articles together, over about three weeks of intense study, I guess.

Adrian: Wow, that must have been an amazing effort. 

Sophia: Yeah, it was pretty amazing. And some stunning, stunning libraries as well, we were really lucky to have access to the archives and to be able to just be in that space as well.

Adrian: And I remember reading a book several years ago, it was called The Rhodiola Revolution and they were talking about the same thing. In terms of some of the research that was done on Rhodiola. Is that what they've done? They've done research on Eleutherococcus plus other adaptogens too?

Sophia: Yes, they were interested in several adaptogens. Rhodiola is another one that there's a lot of research on. Because as I said, they were examining substances that would improve physical performance.

And so Eleutherococcus is one that they focused on because it's an adaptogen that was recognised in the Pharmacopoeia of the Union of Soviet Socialist Republics, the USSR. And so they ordered a research directive into herbs that were recognised in the Pharmacopoeia and one of those herbs was Eleutherococcus. So there's a high volume of studies looking at that particular herb.

Adrian: And when were they conducting this research? What years were they doing this research?

Sophia: This was between 1960 and 1980, or just after 1980 it concluded.

Adrian: And so from reading your paper, it seems as though there's been a huge range of different conditions that were investigating Eleutherococcus for. So can you tell us a bit about some of the areas that some of the research was in?

Sophia: Yeah. A lot of the studies were done with healthy volunteers, so people without any specific conditions to examine physical and mental stamina under different conditions. And also looking at incidents or prophylaxis of colds, and flus, and seasonal illnesses. Immune reactivity, looking at work capacity and cognitive function in some of them. And also some smaller studies looking at things like the effects of Eleutherococcus on vision and hearing.

Adrian: Wow.

Sophia: And then there was a few other ones looking at it in various different types of cancer, so given in conjunction to chemotherapy and radiation. And it did seem to really improve quality of life and tolerance to chemo and radiation, and just offset some of the side effects. And then there was a very large study of over four and a half thousand pregnant women looking at birth outcomes. And just a few on the cardiovascular system as well, and hypertension.

Adrian: And so was the research kind of then indicating... What did it say, that there was generally positive for a lot of those conditions, was it?

Sophia: Yeah, definitely. For physical performance, it was definitely positive. Cognition was a little bit different, it was quite variable and looks like it's really quite dose-dependent with cognition. Especially where potentially a smaller acute dosing regimen might be more effective than larger doses. 

But with influenza prophylaxis, it looked very positive. And also with regulating things like cardiovascular system and nervous system. So that's also tying back into physical performance again and improving work capacity.

Adrian: Okay. And so how were they administering it? Was it through a liquid, or was it through capsules? Or how did they do it?

Sophia: It was actually often taken in juice, or tea, or with the addition of sugar. So I haven't been able to completely determine whether that was to mask the flavour, or if it actually was because...there was one or two studies alluding that it might have an effect on blood sugar.

So it opened up a bit of another question there regarding how or why they were administering in that way which I'm sort of still digging into a little bit. But the dosage really varied across the studies between 0.5 ml and 8 ml a day of a liquid extract. And it was pretty much always a liquid extract.

Adrian: Wow and you're saying with the cognition, the lower doses were often better than the high doses was it?

Sophia: Yeah, it looks that way. It's not conclusive. But definitely in some studies, a lower dose...there were some studies that gave 2 ml twice a day where it had no effect. And then other studies where a lower dose like 0.5 ml was actually more effective. But I think yeah, definitely more research is needed in that area to determine the best dosage.

Adrian: And would they administer it once a day, twice a day? How would they administer it?

Sophia: Mostly twice a day. So most of the studies would do 1 to 2 mls, or actually between 1 and 4 mls twice daily, for between 10 and 30 days often. And there was actually some other studies that spanned over a number of years, up to six years, and those were the ones looking at morbidity rates in influenza. And so they would generally take a course of Eleutherococcus every year for say, two months per year of a twice-daily dose.

Adrian: Oh, okay, and so would they use it just for short periods or certain periods throughout the year rather than ongoingly use it?

Sophia: Yeah, it did vary across studies and depended on what were the outcomes they were looking for. So if they were looking at reducing rates of influenza and seasonal illnesses, then that would be a course for, say, one to two months per year for a number of years. And then the rest of the year, they didn't take anything. But then in other studies, it was just looking at one to two months of twice-daily dose in say, things like physical performance.

Adrian: Wow. And did they use it at all acutely? Was there any benefits associated with just acute use, a single-use?

Sophia: Yes. Most of the studies that used single-use were in cognition and it does look to be quite positive used in an acute once or twice-off dose for improving cognition, or cognitive function.

Adrian: So it's really then...obviously, it's great that you were able to put all this information together and, really summarise some of the findings for us, because that's quite amazing. And I suppose what it indicates is that there's a whole range of conditions that it could be used for, but we still don't know optimally how to use it, and how often. But potentially, lower doses could be better than high doses. So more is not necessarily better for certain conditions then?

Sophia: That's right, yeah. And I think that's a really interesting thing about it is, it does appear to be quite dose-specific or dose-dependent, especially in various different areas like cognition. And I think from a herbalist perspective that does align with herbal medicine practice, where you really have to get the dose right for the individual as well. So there's always a few different things that you need to look at when you're thinking about dosing herbal medicines with different individuals.

Adrian: The other area you wrote a couple of papers on, I was reading. So you did a critical review I think was...was it last year? Published last year on research on adaptogens. And as you mentioned earlier, some of the perceptions from practitioners about adaptogens. Can you tell us a bit about your research and what you found in that area?

Sophia: Yeah. The review that was published last year was looking at clinical trials reporting on herbal medicines with an adaptogenic action examining physical and mental endurance or physiological stress adaptation in healthy individuals.

So with that criteria, we found 24 studies that were looking at 12 different herbs. And some of those herbs weren't actually herbs that we might commonly think of as adaptogens in our practice. But others were quite popular ones like Panax ginseng, Rhodiola, Bacopa, Eleutherococcus, and Schisandra, and also I think Withania.

So the purpose of the review was to identify domains which have been used in clinical trials to measure the effects of adaptogens. So to try and work out how people are actually measuring what adaptogens do. What we found overall, is that articles reported three broad categories of outcome measures, and that was cognitive tests, mood measures, and biological measures, things like blood pressure, heart rate, and cortisol. And most of those studies used a combination of those measures, or all three of them together.

So I think there was actually relative consistency in outcome measures in terms of those three broad categories. But within the categories, there was great difference in heterogeneity because they used different tests. With cognitive tests, they'd used...all the studies had used a wide range of different CDR batteries, and variations and adaptations of those tests. So it did make it really hard to draw conclusions as to what is...if anything's being consistently used, or what might need to be consistently measured when measuring adaptogenic activity.

Adrian: Yeah. I'm doing some research at the moment on a couple of different herbs. And one of them is Withania with regards to its impact on cognitive performance. And we're doing a whole range of computer-based tests that we're using. And they're great as an outcome measure, but the thing I'm really struggling with is going, “okay, well, all right, you say you can press a button quicker.” And so your reaction time is faster when you see some figure on the screen, an arrow on a screen. 

But what we also need to really look at is, well, what's the real-world applicability of that? How much does it actually translate into better cognitive performance, better memory in the real world? And that's just something I'm just kind of struggling with and trying to find a really good measure for cognitive performance.

And, yeah, and that's just...hopefully, as we expand the area and we'll be able to understand more about adaptogens and specific adaptogens. Because obviously, some of them could work on improving verbal memory, and others could be better from a visual memory perspective.

So I'm interested by obviously, what you've mentioned with the Eleutherococcus, some of the work that I've done on vision and hearing. So that potentially could have an impact in terms of cognitive performance, too by just improving your vision and hearing.

Sophia: Yeah, that's right. It's certainly something to look deeper into. And with the vision, they often looked at colour perception as well. So that was something that was quite interesting. And then hearing, the studies looking at hearing suggested that it might improve hearing where people have been under working conditions where there's been a lot of loud noise, so it might prevent damage to hearing. But not so useful in acute conditions of the inner ear. So more of a prevention I think than treating hearing conditions.

Adrian: Now, with the paper that you wrote on the review, when you critically evaluated all the different adaptogens, what was the overall quality of the research like?

Sophia: It was a little bit variable. We used the Jadad scale to assess the quality and quite a lot of them had a moderate score on that because they had omitted details in reporting, some essential details in reporting. So it wasn't always excellent. I think there was about 3 out of the 24 studies that had a superior quality of reporting, so that's not a lot. So there was definitely some limitations, additional limitations to the review from that sense because the quality of reporting wasn't excellent in some of them.

Adrian: In which countries were they conducting most of the studies?

Sophia: If I recall correctly it was mostly USA and some from Australia, I think.

Adrian: Terrific. Okay. So we've got then these adaptogens that potentially have far-reaching effects, potentially could be beneficial for a whole range of different conditions. How do they work? I know it's not a simple question, but how do you think they work?

Sophia: It's definitely not a simple question, Adrian. But I guess the most basic and simplified understanding of adaptogens is that they have a regulatory effect on the hypothalamus-pituitary-adrenal axis, otherwise known as the HPA axis. But that really is only the tip of the iceberg pharmacologically speaking on how they work.

Naturopathically speaking, I think...and from what I've heard from the naturopaths in my research, that they have a regulatory effect on various different body systems that perhaps works via the HPA axis. But also different adaptogens will work in different ways and have an affinity for different body systems.

For example, some might have more beneficial effects on the digestive system, others have a real affinity with the immune system or the liver area. So you can really match the adaptogen to the patient and the ways in body systems which stress impacts that individual. But in terms of how they work, that's a lot more complicated.

Adrian: Okay. All right. So we probably think that it impacts on the HPA axis. So does that mean for people with a hyperactive HPA response and potentially too much cortisol circulating, it can kind of lower cortisol? And then for people with a hypoactive system, it would potentially increase cortisol to kind of lead to a normalising effect?

Sophia: Yeah. I think it depends on the adaptogen. They don't all work the same way. And also, you have to take into account the circumstances. I know that there is some research where it shows that adaptogens decrease cortisol but you also have to take into account the circumstances in which cortisol is being decreased.

For example, if you're looking at people working under stressful conditions, which a lot of the Russian research was doing, then, yes, it would make sense for the effect to be cortisol reduction because it would make sense for cortisol to be elevated in those conditions. But perhaps in other circumstances, that might not be the case.

So potentially, they can have a regulatory effect. I do know from my clinical experience that you do need to be a bit careful about your choice of adaptogen, depending on where the person is at on the spectrum of fatigue, adrenal function, or hyperarousal.

So if a person is at a severe state of exhaustion or burnout, you might not actually immediately prescribe an adaptogen. You might first need to more gently build them back up with things like nervines and nutritives, and then bring adaptogens in a little bit further down the track when they're starting to get a little bit of energy and vitality back.

So I think adaptogens are actually best utilised before a person reaches extreme burnout or exhaustion to actually prevent that from happening which is generally when and why you'd want to be decreasing cortisol. 

Adrian: Okay.

Sophia: But yeah, there might be exceptions to the rule where the right dose at the right time, in combination perhaps with other herbs like nervines could have a regulatory effect, certainly.

Adrian: Okay. All right. So typically, when people are experiencing that high stress when they're probably having elevated cortisol, that's where then adaptogens could really kind of...and obviously, you need to choose the type of adaptogen. But that's potentially where they can really have a positive effect then?

Sophia: Yes, that's really where they come into their own. That's the key time to get in there with adaptogens.

Adrian: And obviously, they also have anti-inflammatory effects, and they're potent antioxidants. And many of them target different neurotransmitters. And so you have a whole range of different mechanisms of action, then?

Sophia: Yes, definitely. So animal and laboratory studies have identified a wide range of key molecular targets and regulatory targets. The obvious ones being stress hormones, and cortisol, neuropeptide Y, and mediators of that stress response. But there were over 3,000 genes identified as being regulated by adaptogens. And numerous different pathways relating to neuroinflammation, melatonin, opioids, and enteroendocrine cells, and many others.

So that's what I say when regulation of the HPA access is really only the tip of the iceberg with what they do pharmacologically speaking, they really have multi-target effects.

Adrian: Absolutely. I can see why the research is so difficult because you've got all these...if you're looking at just one area, is really a whole range of different physiological systems that adaptogens can really target. And yeah, it might reduce cortisol, but it also might be via a whole bunch of other mechanisms that it might be impacting on.

Sophia: That's right, yeah.

Adrian: Good luck. Good luck to the researcher. Are you going to do more research in that area?

Sophia: Look, my adaptogen research is always bubbling away in the background, but my more primary focus has shifted a little bit in the field of naturopathy and public health, actually with people with endometriosis. So I've shifted a little bit, but I am keeping the adaptogen work bubbling in the background, yes.

Adrian: All right. As a clinical psychologist, my interest is in the mental health side of things. And I'm interested in how adaptogens could potentially be used for different conditions. So you mentioned that you've got somebody…. So if somebody is experiencing significantly high stress, whether it be work-related stress or study-related stress, you got all these different adaptogens that you can choose from. Where do practitioners start? How do they kind of choose one over the other?

Sophia: Okay, I think there are three main ways to start with using adaptogens for practitioners. And that's obviously always, firstly, by studying the herbs from different contexts and with different teachers and mentors. But also, its clinical experience. Once you've been prescribing herbs for a very long time, you get to know who they work for, and what situations, what constitutions, and which herbs are best avoided in which types of people as well. So that's really just clinical experience and practice.

And I heard that from the naturopaths in my research as well, they said that it is practice and there is an element of trial and error with not just adaptogens but herbal medicine practice in general, I suppose. And it's also personal experience, the only way to really get to know herbs is through using them and getting to know them personally as well. So those are the ways I would say.

Adrian: Okay, all right. And so when you say clinical experience is it like if somebody is coming in with specific symptoms, that will then lead you to a particular adaptogen over another? Is that how it kind of works for you, or are you doing other assessments too?

Sophia: Yeah, definitely. So because stress affects different people in different ways and different body systems. So I guess if someone who's, for example, they've come in and they're hyper-vigilant, hyper-aroused, jittery, easily stressed type of person, I'd be very cautious about giving them a very stimulating adaptogen. I wouldn't be going straight in with something like Panax ginseng. But on the other hand, if you've got someone who's come in and they're quite lethargic, they're slow-moving, lacking lustre, that's when I'd be thinking about giving them an adaptogen with a little bit more oomph.

But you also assess other things like which areas of their body are their weak spots, for example, like, do they need liver support, or do they need digestive support? Because no adaptogen is purely just an adaptogen, all adaptogens will do other things. So some of them are very good in the liver area. Others are really nice for repairing the intestines and things like that. So it just really depends on what type of support you feel this person needs.

Adrian: And then more stimulating adaptogens, you mentioned Panax ginseng. Are there others that are kind of a bit more stimulatory?

Sophia: I would consider Rhodiola to be a bit more stimulating than others. And I always have felt that Rhodiola needs quite a low dose. I've always felt like the recommended therapeutic dose is a little bit high oftentimes. So I find that to be a stimulating herb. And also, from a liver perspective, Schisandra could be a little bit stimulating as well, I would find. It's more regulatory, so not the most stimulating, but yeah, there's an element of caution there as well.

Adrian: Yeah. And what about if you wanted something that's a little bit more calming, what would you go for in that area?

Sophia: I think Withania is always a favourite for calming. And I even find that Eleutherococcus can be, if given in the right combination. Because if someone really needs calming, I'm generally prescribing nervine herbs as well at the same time. So in herbal medicine practice, we're really capitalising on synergy. So we're using a combination of different herbs to have different effects and regulate things. But in terms of calming adaptogens, I think Withania is a really beautiful one.

Adrian: Is there anything that you found from a sleep perspective to help people to fall asleep or stay asleep?

Sophia: I do think adaptogens can help with sleep through their regulatory action, but I would also be giving the nervines as well to calm the nervous system down. But then when it comes to sleep, you're also generally doing other things like sleep hygiene and tweaking lifestyle to...

Adrian: Yeah, absolutely.

Sophia: ...sort of help them remove the barriers to getting a good night's sleep.

Adrian: Yeah, it's something we've always got to be careful about, just trying to use a pill to fix somebody's problem or a liquid just to fix somebody's problems. Obviously, we need to consider the whole context and what's going on for that individual.

Sophia: That's right, yes.

Adrian: Do you generally give it as a liquid or are you using it as capsules? How do you use it?

Sophia: Yeah, I do probably most often give it as a liquid. But if I'm more looking for something like longer-term immune support or something like that, I might use capsules. But probably most often I'm using liquids because I do like blending herbs.

Adrian: Okay. And what about how many times a day would you generally get people to take it, or the particular times in the day that are better for people to take it?

Sophia: For me, the most ideal way of taking a herbal medicine is three times a day. But it's not always doable for people. So probably the most common dosage regimen for me is twice daily morning and night. They often have a digestive aspect to them too so it's usually before meals.

Adrian: And duration of use? Do you expect changes in the first few days for people, or is it something that they need to continue to use ongoingly?

Sophia: You definitely can see changes very quickly with adaptogens, they're quite amazing like that. But also, I do use them longer term with some people as well and even with myself, actually. I think that you definitely can prescribe them longer term. If I'm doing something for many months, because if somebody's been in a chronic stress situation for years and years, they might need support for a little while.

So if I am doing something for many months, I do often have a little break. So I might give them a week off the medicine between each month of taking it, for example. And then they can take it for even up to six months that way, sometimes. The goal is always that they don't need to take something ongoing. But it also depends on the circumstances as well.

Adrian: And what about tolerability? Have you noticed any adverse effects that people may experience from different adaptogens?

Sophia: Occasionally, yeah, people can have idiosyncratic reactions to herbal medicine. So occasionally that does happen. I can't say it's happened very often to me, but it can definitely happen. And I think that's one rationale for using single ingredients.

And that's what one of my colleagues in Russia said to me actually, is that they only use single herbs because then they know what herb is having what effect. And if the person has an adverse reaction and you've given them a mix of herbs, you don't actually know which herbs caused that. So that's...

Adrian: Fair enough.

Sophia: ...their rationale for using single ingredients. And that's valid.

Adrian: What about ages? What are your thoughts on...do you see children?

Sophia: I haven't seen a lot of children in my practice, but certainly, you can prescribe herbs and adaptogens for children. And in some of the Russian studies, they were performing the studies on children. So yeah, we have different formulations for dosage with children, of course, so it won't be an adult dose.

Adrian: Yeah, we're doing a study at the moment on Withania. We're looking at its effects on their cognitive performance. So children who are exhibiting concentration problems, attention problems, they don't necessarily have ADHD. And we're looking at its effects on cognition in those kids, and also measuring outcomes, like mood-related outcomes and seeing what impact it also has on their sleep. So we're finding it's quite well-tolerated, and we're delivering it as gummies.

Sophia: Okay. Yeah, that's a good way to do it with children definitely.

Adrian: Yeah. So it'd be interesting to see what results we get from that with regards to its performance, and cognition, and so forth. And I know...

Sophia: Yeah, definitely.

Adrian: ...there's a lot of research done on Withania, so that's quite a popular herb. Do you use that much in practice?

Sophia: Yes, I do. It's not my most commonly prescribed herb, but I do love Withania, it's hard not to love it. And especially, with certain thyroid situations as well it can be really nice. But for anxiety and stress, it is hard to go past.

Adrian: Yeah, everybody's got obviously their different ones and as you said. So basically, it seems as though unfortunately, there's no recipe book formula that people should go, "Okay, so someone is presenting with depression, I would give them this one." And someone is presenting with stress really needs to be individualised, isn't it?

Sophia: Yeah, that's right. There's an art and a science to herbal prescription. And there's definitely no formula that will work for every person. I think that's the beauty of herbal medicine as well.

Adrian: And obviously, that means really having...as you go out and practice and you start using more, it's really using the experience of your colleagues too and having good mentors who can guide you initially on applying that process.

Sophia: Definitely, yeah.

Adrian: Wow.

Sophia: I think that's how I grew as a herbalist was by being in clinical practice with other experienced herbalists and having that mentorship there. And I really recommend, especially new graduates to stay connected with your mentors.

Adrian: All right, well, I suppose then it sounds like the work you've done is great. It's really kind of preliminated some of the research, and I really loved the work on some of the Russian work and being able to translate that.

But unfortunately, it sounds or, fortunately, it sounds like we need to learn a lot more about these different adaptogens. There needs to be a lot more research to help us understand how they work, and who they would work for, and how you should dosage. And obviously, you've mentioned obviously clinical experience is really imperative, but obviously, research can help guide us in some of that decision-making process.

Sophia: Definitely, yeah. So I think my work is...it's very early work and I think it's brought up a lot more questions than it has answered, but I think that's a good thing as well. I think we need research to determine what questions we actually need to be asking in future research. So there's lots of avenues that are open now and every little contribution adds to the bigger picture. So, it's always good to be able to add something.
And it's been really nice to be able to bring that research from Russia out to the broader scientific community as well because although it's fraught with limitations, it's still a very valuable piece of evidence to show where we might want to direct our attention in future.

Adrian: Absolutely. Well, thanks for joining us today, Sophia, to help review our understanding of this important class of herbs, to help give us an overview of some really interesting history and how we can work with adaptogens to help offset stress and support both our mental and physical health. And thank you for all the work you've done and the research that you've done to help make herbs and naturopathic medicine more available to us. It's really quite an impressive accomplishment.

Sophia: Thank you very much, Adrian. And thanks for having me on the show to have a little chat about it. It's been really nice and it's always good to share the work and open discussions about these things.

Adrian: Thanks, everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode at the FX Medicine website. I'm Dr. Adrian Lopresti, and thanks for joining us. We'll see you next time.

About Sophia Gerontakos

Sophia Gerontakos is a Northern NSW-based naturopath, PhD candidate and research assistant for clinical trials with the National Centre for Naturopathic Medicine, Southern Cross University. Sophia holds an Honours degree by research in Naturopathy which focused on clinician and scientific understanding of the adaptogenic concept with the aim of identifying domains that could be used to measure adaptogenic effects in clinical trials. Following this, Sophia was invited to St Petersburg Russia to undertake research on Eleutherococcus senticosus – a well-known adaptogen, in collaboration with colleagues from the State Chemical Pharmaceutical University of St Petersburg. Sophia’s current PhD research is investigating a new model of delivering naturopathic consultations to women and gender-diverse people with endometriosis. She has authored several peer-reviewed articles on phytoadaptogens, herbal medicine and naturopathic practice and is passionate about naturopathy, herbal medicine and advancing the naturopathic profession by deepening understanding of traditional knowledge and contributing to continue building the modern evidence base.

Connect with her on Twitter: @NaturopathSofe


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