The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Stress And Supplements

Episode Date: October 3, 2023

Hey podcast community, Dr. Mark here. My team and I are so excited to offer you a 7 Day Free trial of the Dr. Hyman+ subscription for Apple Podcast. For 7 days, you get access to all this and more entirely for free! It's so easy to sign up. Just go click the Try Free button on the Doctor’s Farmacy Podcast page in Apple Podcast.  In this episode, you’ll hear our latest Dr. Hyman+ Functional Medicine Deep Dive on stress and supplements with Dr. Melinda Ring.  Dr. Ring takes us on a journey to show us how our body responds to stress, what it can do naturally, and the circumstances where it may need additional support while responding to stress. She shares the environmental and lifestyle factors that can disrupt our internal stress monitor and the symptoms that can result from stress overload. Access Dr. Ring's Deep Dive Slides here.  View Dr. Ring's Ted Talk here.  Follow Dr. Ring on Instagram @drmelindaring.  To learn more about the Institute of Functional Medicine, sign up for IFM’s newsletter: https://www.ifm.org/about/free-newsletter/. With your 7 day free trial to Apple Podcast, you’ll gain access to audio versions of: - Ad-Free Doctor’s Farmacy Podcast episodes - Exclusive monthly Functional Medicine Deep Dives - Monthly Ask Mark Anything Episodes  - Bonus audio content exclusive to Dr. Hyman+ Trying to decide if the Dr. Hyman+ subscription for Apple Podcast is right for you? Email my team at [e-mail] with any questions you have.   Please note, Dr. Hyman+ subscription for Apple Podcast only includes Dr. Hyman+ in audio content.

I'm Dr. Melinda Ring. Today we're going to talk about something that is a hot topic and very important these days since there's so much stress. That's HPA access dysfunction and the role of natural products in managing our stress. We're going to go through a few different areas today. So the first is a journey through this intricate world of stress and how our bodies respond to it. We'll explore our amazing network inside our bodies called the hypothalamic pituitary adrenal access. We'll call that the HPA access for short.

And that's our internal stress control system. And if that gets out of balance, things can start to feel pretty haywire. But don't worry, nature has some good tricks up her sleeve. And there's this wave of interest in natural products to help manage stress. Think herbs and roots and other plant-based goodies. So we'll journey into that green world, but also take into consideration how can we do that safely and effectively. So we need some of these tools to sift out some of the fiction claims, these big claims out there about adaptogenic herbs versus the fact, because we need to be discerning readers, discerning healthcare users, and really understand what we're consuming, both in terms

of information and supplements. So buckle up, let's dive into this fascinating world of stress physiology, nature's potential solutions, and the art of information discernment. Just a quick note, I'm only sharing this for educational purposes. Of course, you should talk to your own health provider before starting any dietary supplements or herbs. And also, you'll see some pictures of some supplements in here. I'm not recommending these particular supplements. They're just shown here, for example. Let's take a moment now to explore recent data that sheds light on the state of mental health this particular study was in the u.s by the american psychological association and they did

this monthly survey called healthy minds monthly that tracks mental health issues among a sample of american adults and i want to share a few key highlights from the survey that happened when 2022 is drawing to a close because it really contextualizes the importance of addressing stress and mental health. First of all, it was observed that 37% of Americans rated their mental health as only fair to poor, and that was a significant decrease from 31% just a year prior. Additionally, 26% of respondents anticipated feeling more stress in 2023, which is up from 20% the previous year. So this is concerning because we know chronic stress contributes to HPA axis dysfunction, which we'll discuss shortly. You can see here some of the specific areas that were highlighted as being anxious,

personal finances, uncertainty, concerns about physical health, mental health, and relationships, all those increased from the previous year. There was a little highlight here in that people did feel a little better about traveling. But other than that, lots of areas showed a decline from just one year prior. And the story of stress and its effects on our health can be traced back to the origins of experimental medicine. In the 19th century, French physiologist Claude Bernard proposed an idea that's fundamental to our understanding of biology, and that's that to survive, our bodies have to have a stable internal environment. If we fast forward then to the 20th century, Walter Cannon, who's a real luminary in the field,

refined the idea by introducing this concept of homeostasis. Now homeostasis is derived from a Greek word homeo, which means similar, and stasis, which means standing still. So together, homeostasis literally means staying the same. And that term just beautifully encapsulates how our bodies work to maintain a steady, balanced internal state, adjusting and readjusting as needed to keep everything in harmony, no matter what life throws at it. And to understand homeostasis a little deeper, imagine that you're a master conductor and you're leading a world-class symphony orchestra. Every musician and every instrument has a vital role to play. The harmony that fills a concert hall, it's the result of precise tuning and timing and team effort. And if even one instrument is off, the entire performance could be affected. Now imagine your body as that orchestra. Billions of cells are the musicians. Each is playing a crucial role. And homeostasis is the conductor, ensuring that everything is

working in harmony, maintaining balance and stability. Let's take an example. Think about when you're exercising, maybe running a race, jumping on a bike, your body temperature starts to rise. The violin section's getting heated. Your body, or should we say the conductor, recognizes the change and triggers sweat production to cool you down, just as if the conductor of the orchestra lowered the tempo. When your body temperature gets back to normal, you stop sweating. That's homeostasis in action. Now let's imagine we got an unexpected guest conductor named Stress. They take the stage. They have a very different style. He wants more energy, more intensity from our orchestra. So under the guidance of stress, some sections of the orchestra, like the adrenal glands,

or we'll say the brass section in our analogy, they start to play more loudly. They release stress hormones like cortisol and adrenaline. And these hormones increase our heart rate, our blood pressure. They do that to send more blood to the muscle and critical organs. It's like a whole orchestra shifts to play a fast-paced, powerful symphony. And the analogy is that our body is on high alert. We often call this the fight-or-flight response. Now, initially, this is not a problem. In fact, it's helpful if you're in a dangerous situation. Just like an orchestra can indeed play a fast, intense symphony, your body can handle short periods of stress.

But problems arise if our guest conductor, stress, doesn't leave the stage and that fast paced symphony continues for too long. The orchestra, or in our case, our body's organs and cells start to wear out. They cannot keep up the intensity. They're playing too hard for too long. So that's homeostasis. What about stress? So stress, as we understand it, was popularized by Hans Selye in this landmark 1936 study, A Syndrome Produced by Diverse Noxious Agents. And he used stress to represent just all these responses our bodies have to any big demands on it. He also described what happens in our bodies. So it's called this general adaptation syndrome. And this is like our body's sympathetic nervous system jumps into action,

releasing stress hormones like cortisol and adrenaline. Again, our body's prepared for fight or flight, ready to face whatever's thrown its way. That's good. We need that. Then we move into the resistance stage. Our body, like a steadfast warrior, tries to adapt and combat the stressor. And during this phase, it's all hands on deck. Our body's resources are mobilized and our functions, they seem to normalize, but stress

hormones are still high. They're still playing their loud tune. Lastly, if this continues, we reach the exhaustion stage. If we have an extended battle against stress, our body's resources, like a tired army, starts to deplete. And how does this manifest? It manifests as fatigue, lowered resistance to stressors, and in some cases, a heightened vulnerability to illnesses. This is when the music begins to fade, the conductor takes a bow, and it leaves us with an orchestra that is in need of rest and recuperation. This general adaptation syndrome model highlights the importance of stress management so we can avoid reaching that exhaustion stage and maintain our well-being. Now remember, stress is not all bad. This Yerkes-Dodson law describes a relationship

between stress and performance, or you could think of it as stress and health, as an inverted U-shaped curve. So performance tends to improve as our stress levels increase up to a point. Low to moderate levels of stress are associated with heightened alertness and focus, which can actually positively impact performance. The arousal can enhance motivation and concentration, and that helps us complete our tasks. However, there is that tipping point that's shown as the dotted line here. When stress levels surpass an optimal threshold, our performance starts to deteriorate. Excess stress can lead to cognitive overload, anxiety, impaired decision-making, and the body can struggle to keep out, resulting in fatigue and ultimately burnout.

It is important to note that this optimal stress line, shown as the dotted line again, is not one size fits all. It can vary on individual factors like personality or experience or stress tolerance, and it can vary by the complexity of task. So what's stressful for one person may be a breeze for somebody else and vice versa. It is also important to realize that our body's ability to respond to stress is cumulative. We might be okay reacting to an acute stress, and then we come back to our baseline quickly, but chronic stress can wear us down. Acute stress, being a response to a specific event, can sometimes fall into that optimal

zone. This is a stress that's usually minutes to hours. So again, we can have heightened alertness and focus and think about if you have a tight deadline or you're giving a speech, you can become hyper-focused. And that's a good thing in that time. And physiologically, our immune system actually increases mobilization to sites that are more likely to be wounded.

Our heart, our cardiovascular system becomes more efficient because it thinks we might need to have more physical exertion during acute stress. And there's actually in this short period, more brain synapse turnover and neuroplasticity. So again, acute stress, not a bad thing. On the other hand, chronic stress days to years long has much different effects. It often psychologically correlates with feeling just a lack of control over our circumstances, like a feeling of being stuck or just like not seeing a way out of this situation.

Our immune system can get suppressed and increase the risk of autoimmune or inflammatory disorders. From a heart perspective, we can develop an increased risk of high blood pressure, heart attack, and stroke. And in the brain, chronic stress can result in decreased hippocampal volume, which correlates to decreased memory and cognitive decline. So chronic stress, again, if we go back to that Yerkes-Dodson curve, it pushes us past that optimal line. And so when we have this chronic stress like chronic caregiving or recurrent stress like somebody that you have negative interpersonal interactions with again and again, it's more likely to lead to overload and burnout, reflecting that declining curve. So let's turn now to the workings of that hypothalamic pituitary adrenal access,

the cornerstone of our body's stress response mechanism, and it is shared across vertebrates. So another analogy here, imagine you're a superhero and your body is the state-of-the-art super secret headquarters. One of the headquarters key features is a system called the HPA access. It's like that internal alarm system. Its main job is to keep you safe when you're in danger or under stress. So picture it like this. When something stressful happens, like you're in a tight spot with a villain, a part of your brain called the hypothalamus, the brain here is shown in light blue at the top, it starts ringing the alarm bells. And then the brain pumps out alert signals. These are scientifically known as CRH or cortisol releasing hormone and AVP.

These alerts travel down to another part of our headquarters, the pituitary gland, just like a control center. It picks up the signal and it calls for backup by releasing signal called ACTH. This backup signal then reaches our body's defense factory, the adrenal cortex. These adrenal glands sit right on top of our kidneys and they start churning out a substance that's like your body's very own superpower, cortisol. This stuff is super useful and it helps different parts of your body, like your immune system and your heart, deal with a stressful situation. Now, one of the really cool things about this system, this HPA access, is that it has a built-in off switch. When the body's defense factory has produced enough cortisol, it sends a message back up the line saying, hey, okay, we have enough backup now. You can turn off the alarms.

This stops the release of that alert and backup signals, the CRH and the ACTH, and that means that everything calms down and goes back to normal. It is interesting to note that this alarm system works differently in different people. Some people's systems are really good at turning off quickly when there's danger, turning on when there's danger, and turning off when the danger is over. And they tend to be pretty resilient when faced with stress. But sometimes that alarm system doesn't work right. Maybe it doesn't turn on as it should, or it takes a while to ramp up, or what we're seeing more often, does not turn

off when it should. And that can lead to problems. That's what we're going to talk about next. Now, our body has its own natural internal rhythm. It's oftentimes called a biological clock. And this clock operates on a 24-hour cycle, and it influences the production of a lot of different hormones. In this case, we're talking about cortisol. The cortisol ebbs and flows with the cycle of the day. So our cortisol levels typically are at their lowest around midnight, assuming we're on a regular 24-hour schedule sleeping at night, and then it steadily rises upon waking. It peaks shortly after you wake up and then gradually decreases over the day, reaching again their lowest point when we should be sleeping. However, various factors like changes

in our diet, changes in light, shift work, increased physical activity, and particularly stress can disrupt this rhythm. Chronic stress conditions, for example, in the chart shown here on the right, PTSD, post-traumatic stress disorder, can significantly alter the typical rise and fall of our cortisol levels, leading in this example to a relatively flat cortisol level throughout the day, as shown in the chart on the right in yellow, compared to the gray line, which is somebody who is not under stress. And the impact of these irregular cortisol patterns on our health is a topic of important and active research. Here are some of the things that have been shown to be correlated with this HPA access dysfunction.

And a quick note that these issues used to be called adrenal stress or adrenal fatigue, but that's really not an appropriate name. And it's led to some confusion and also some recommendations by more conventional endocrinologists and others that the term is being used inappropriately. There is not something wrong technically with the adrenals. We're not talking about autoimmune adrenal issues like Cushing's or Addison's disease. Here we're talking about dysfunction that's a result of chronic stress. correlated with many different things. And so for example, people are more likely to have mood disorders, anxiety, and other stress-related problems. There is an increased risk of heart disease and high blood pressure, rheumatoid arthritis, which is a type of autoimmune joint

disease, decreased immunity, weakened immune system. And then also people who have different conditions like chronic lung disease or cancer or HIV and have HPA axis dysfunction seem to go to the hospital more often and they have a higher risk of dying. In addition, when that cortisol level doesn't change much throughout the day, like we saw in the previous slide, people are more likely to get type 2 diabetes and to die early if they have cancer. So on the other hand, people who have just lower cortisol levels throughout the day and a more balanced normal HPA access cortisol response tend to live longer. So this shows that our stress systems is vital not only for dealing with stress, but also with keeping us just healthy overall in all different ways. The other thing to look at to know is that when these stress hormones the catecholamines which

are like the adrenaline and noradrenaline and the cortisol are high for a long time that those have been linked to several problems so again the catecholamines that adrenaline noradrenaline mainly affect our mind and heart and higher levels of those cortisol. We already talked about some of the correlations of the different diseases, but what are some of the other things? The well-known, the very dreaded belly fat, it stimulates production of these fat deposits. It can also, from a body composition perspective, because it increases protein breakdown as it's trying to get more energy for stress can cause lower muscle mass. So the combination of increased fat, lower muscle mass is not a good body composition. It also can lead to demineralization of the bones, which means osteopenia, osteoporosis risk, and of course, decreased memory loss because it affects the hippocampus, the memory center of the brain, like we talked about, and increase in blood sugar levels, which raise the risk for things like insulin resistance, prediabetes, and diabetes. So again, when we're

looking at this chronic elevation, chronic stimulation, high levels of catecholamines and cortisol can have a negative effect on both your mental and your physical health. Now a moment to just pause and talk about salivary cortisol testing. It is increasingly popular in research and in functional medicine practices because it's non-invasive, meaning you don't have to get stuck for it. It's easy, and they tend to be pretty reliable. So when we're doing salivary cortisol, it reflects the active free fraction of cortisol. And again, that makes it a useful measure of the cortisol in our body that's available to bind receptors

and exert their biologic effects. And when we think then about looking for this diurnal rhythm, the circadian rhythm of cortisol, where it's peaking in the early morning and coming down throughout the night, doing saliva collections versus getting your blood drawn allows it for somebody to do multiple collections over the course of the day. Usually you will do a level on waking, maybe another one 30 45 minutes after, that's called the cortisol awakening response. And then usually there's a couple of additional collections throughout the day. Now, what do I think about this? For one, salivary cortisol as a mean of measuring cortisol levels is well-validated.

It's used in research. And so it's a valid test. And I will use this with my patients. It can be very affirming to them to see that indeed the symptoms that they're having may be related to how stress is showing up for them and impacting their hormones. However, they're like any measurement. These testing kits for salivary cortisol are not without limitations. It is a circadian rhythm. And so timing of the collection is just crucial. Being off by an hour can make a

difference in the measurement in this cortisol awakening response. It can also be impacted by stress, which varies from day to day. And even behaviors like eating and medical conditions and all kinds of things can impact. So I tell people, I think it's a great measure. It's available direct to patients. You might be able to order on your own. It's available through a lot of integrative functional medicine practitioners, and it can help provide insight into the functioning of your HPA access, but realize, again, that those results reflect only that single day that the test is done.

So you, your provider, need to look not just at this one test, but really at all of your symptoms and all of the factors involved instead of just making recommendations based only on the results. Now, to effectively deal with long-term stress, you need a well-rounded approach that touches on different parts of your life. I think we all need a mind-body practice like meditation or yoga or going for a mindful walk or whatever it is for you to help relax and clear our minds. Regular exercise lifts our mood and helps fight stress by releasing those feel good hormones called endorphins. Helping strong relationships with family and friends can also help. They can provide emotional support and give us a sense of belonging, which makes stress easier to handle. It's now considered one of the top factors in terms of having a happy life based on long-term studies. Eating a healthy diet full of foods that

can help reduce stress and making sure to get good quality sleep also are so critical. And certainly when I'm helping somebody with stress, I'm not just jumping to, hey, take these supplements. Really, we need to start with all of these different factors and address mind, body, and spirit as a whole. But for the rest of the talk, let's focus on natural products. An increasing number of individuals are turning to these natural products as allies in managing stress. And there's a few major categories.

There's vitamins and minerals. We're not going to focus so much on those, but the biggies there are your B vitamins, C and magnesium. Those are oftentimes considered adrenal nourishing. But today let's focus on adaptogens. And adaptogens are these herbs that are purported to have a rejuvenating power to help our body cope with stresses. Now, adaptogens are plants that have been used for hundreds of years, especially in Chinese traditional medicine and Indian traditional medicine like Ayurveda, because people believed that they could help them live longer and feel

more energetic. The modern study of adaptogens began during World War II in a slightly nefarious situation when a Russian scientist named Nikolai Lazarev was being asked to study performance-enhancing drugs used by soldiers to keep them alert and going. And he was pushed to study these sort of stimulating things. And he noticed that while these drugs did boost performance in the short term, they had a harmful effect over the long term. So after the war, he decided to study substances that could improve health and performance in a sustainable way without having those negative side effects. So in 1947, he came up with this term adaptogen to describe substances that could strengthen the body's ability to handle different stress, whether it's physical stress, chemical stress,

biologic stress, without causing addiction or harmful effects. Then in the 1960s, a scientist named Dr. Israel Breckman came around. He took a closer look at these special plants, these adaptogens, and he pointed out three important features of these herbs. Number one, adaptogens are generally safe to use and they usually don't cause side effects or problems when used with other substances or treatment. Number two, they can boost the body's resistance to different kinds of stress. Physical stress like illness or injury, chemical stress like exposure to toxins, and psychological stress like anxiety or depression. Lastly, adaptogens can help bring the body back to a balanced state no matter which way it's been thrown off. So if the cortisol

is too high, it helps balance it down. If it's too low, it helps bring it up. And that ability to be balancing like a seesaw coming into equilibrium is due to their effect on what we already talked about, the body stress response system. So now this definition that you see here was formed over 50 years and it's evolved since then, but these basic three tenets still stay true. There are, since then, some additional factors that come into play as to classifying a plant as an adaptogen, because there are still a lot of plants that fit into those, check the list, the three check marks, but they're not considered adaptogens. And that's because they need to be shown to work at two different levels. The first is that extracellular level, the HPA axis that we already discussed. And then in 2009, and since then, we found that true adaptogens also work at the smallest level, the level of individual cells.

So they work through whole organs and through the neuroendocrine system. But also they increase the activity of proteins in cells called heat shock proteins. And through these, the adaptogens work a little bit like a stress vaccine that says to the body, stress is coming, get ready. Now, if we look at this, we can see that adaptogenic substances have a wide range of possible benefits. If we're looking at this picture that we've got stress coming in, affecting the brain, trying to stimulate that neuroendocrine complex, but adaptogens can come in and block that effect. And so you can see

that there can be a decrease in symptoms like fatigue, exhaustion, low energy, difficulty concentrating, irritability, anxiety, depression, and improvements in some physical things like our work capacity, our ability to recover, sexual function, other kinds of things. And these benefits are not just hearsay. They're backed up by a large amount of research that we'll talk about when we get to some of the individual adaptogens. Now, given the remarkable benefits of adaptogens and the high load of stress worldwide, it is not surprising that an interest in adaptogens has skyrocketed. If we look, first of all, just overall use of dietary supplements, that's pretty steady. There's a big study called the

National Health and Nutrition Examination Survey. It's called the NHANES. And it repeatedly collects data from adults in the United States. And what that showed was that basically, you know, roughly 52% of adults in the US said that they were using dietary supplements, and that's how it helped study over the past several decades. When we look at how people around the world are buying and using adaptogens, that is growing rapidly. In 2021, the total value of the global market for adaptogens was about $.3 billion US dollars. And according to this report by an allied market research on the market, this number is expected to double to around $20.3

billion by 2031. During the pandemic, it had a noticeable effect on the adaptogen market. More people were buying them because they were just looking for ways to stay healthy and well, and the buzz is continuing. While the list of substances that are classified as adaptogens is extensive if you look online, really, if we go back to that group of herbs that are substantially researched, providing solid evidence, the onesajit, rapanticum, cordyceps, which is a mushroom, licorice, shatavari, reishi, and holy basil, or what's sometimes called Tulsi. These are really some of the most classic and common adaptogens, and you'll see them in stress supplements all the time. For the purposes of time and just to give you some a

little more depth in some of these, I want to focus on the top three ones. So let's start with Asian ginseng. It's a well-known remedy in China. It's used for over 5,000 years. It's scientifically known as Panex ginseng. And this one has historical significance because it's really considered the model of adaptogen. So it was one of the first ones studied back after World War II. So it has stimulating effects at higher doses, but with the added benefit of promoting health. Now, traditionally, people use it to boost energy, to recover from illness, and to strengthen the elderly or those who are weak. And also, athletes oftentimes use it to build strength.

And if you go to Chinese hospitals, it may even be used in serious conditions like shock and chronic illness. Something to note is that Asian ginseng, if we think about it from a more traditional medicine perspective, herbs are often described as cooling or warming, stimulating or calming. Asian ginseng is stimulating and warming. And so that means it's best for people who have a lack of energy and may feel cold a lot. It's also used more often than for chronic issues rather than an acute illness. If you have a cold or a flu and are feverish, having a warming herb is probably not the right choice. When it comes to safety,

Asian ginseng is usually, it's been shown to be well tolerated for use up to six months. There is some caution about using it long-term, and that's because it can have some hormone-like effects that might be potentially harmful. The most common side effects are insomnia. There's been some rare instances of rash, liver damage, and more severe allergies being reported. It is not recommended in pregnancy or for infants and children. And another common issue that comes up with adaptogenic herbs is that if they have an effect on stimulating the immune system, if they are immune stimulants,

they may not be a good choice for somebody with autoimmune disease. Another thing to know about Asian ginseng is that it may increase bleeding risk because of its effect on the bleeding and the platelet pathway. And also people on certain medications should be cautious in using it. Now, as I mentioned, there are two main types of ginseng root. There's Asian ginseng that we're focused on here. There's also American ginseng, which is called Panax quincofolius, and that has a different profile and it's generally less energizing. So we're not talking about that one. And again, we are not talking about Siberian or Russian ginseng. That's not a true ginseng. And while it's also an adaptogen, it doesn't have the same active compounds as real ginseng.

One other thing you may note when you're choosing products is that sometimes it'll be called different types. So the most common type we'll see is white ginseng versus the red or the black ginseng. What these are referring to is just how it's been processed. So white ginseng, it's simply been dried, like the root you see here. The other forms, and the most common one you'll see is red ginseng, are steamed, cured, and then dried. The white ginseng is a little less stimulating, but overall right now,

there's not enough data to talk about you should use white ginseng or red ginseng for different conditions. So I'm just mentioning this for you to be aware of that. When we look at the research into the benefits of Panax ginseng, here's a simple breakdown of what they found. So brain function, taking Panax ginseng may improve memory, problem solving skills, and reaction times in middle-aged people. Doesn't seem to have the same effect in younger adults. And there was a study where it was combined with ginkgo leaf. And in that case, it may help improve memory in people who are middle-aged and older. Erectile dysfunction have shown that taking Panax ginseng orally may help improve sexual function. It also may boost sexual response,

improving sexual arousal and satisfaction in postmenopausal women and desire in women who have sexual issues. So it can help on both sides of the equation here. Cold and few prevention. It seems that taking some extracts reduce the chance of catching a colder flu. But once you have the flu, it doesn't seem to really help with the symptoms or shortening the length of illness. So it's really more of a preventive during the cold and flu season. Fatigue, one of the big things people are interested in, it's been shown really to help improve energy and life quality in people who have chronic disease, possibly in cancer, in people who have multiple sclerosis, not so much for, I'm not sleeping well, and I'm a little tired, so let me take it as a pick-me-up. It's really

been shown more in chronic disease. And one of the common things athletes might use this, but so far studies don't really show that there's any enhancement of athletic performance even after taking it for over eight weeks. Now ginseng can contain many active chemicals. The most important ones are called ginsenicides, or sometimes you'll see it called panaxicides. And a lot of times that just ginsenoside is used as a marker compound. So you know how much you're getting. Now you'll find ginseng as both a standardized extract, which is most often taken around a hundred milligrams twice daily, or you can get just a root powder. And that's usually a thousand to 2000 milligrams daily. It's important to note that if you do take ginseng, that it can take a few days or a few weeks to really start to see those benefits. So for example, if you're taking it for enhancing

your sex drive, don't expect it to work in a night. It might take longer than that for you to actually see the benefit. Now, I am big into culinary medicine, trying to get food, get our nutrients through what we eat. So ginseng, it's a little bitter, but it can pair well with other things like astragalus or shaga. Historically, it's a good herb because it's a good herb for feeling weak. A lot of times we'll see it added to nutritious broths and soups. And usually you don't see ginseng eaten on its own. Sometimes you'll see that root sweetened with sugar, soaked in honey, and you can get it as a sweet snack. You may want to make your own ginseng infused honey.

And that gives a little spicy, sweet taste to your winter teas. And you can add it to other things. You can add ginseng powder to a chai, to an energy snack, to smoothies. The important thing is just to know to use caution when you do buy powdered ginseng, look for organic, make sure it's high quality and it's fresh. And again, if you're making a broth, you're making chicken soup or a vegetarian broth with a lot of vegetables, you can throw a little bit of ginger root in there to, cook it low and slow, and that will allow extraction of its flavor and all those beneficial compounds. Moving on to ashwagandha, this is one of my

favorite herbs. It's a highly valued herb in Ayurvedic medicine, used for over 3,000 years because of its many healing properties. The name ashwagandha in Sanskrit literally means smell of a horse. And the name isn't about its aroma, but more because it signifies it can give you the power and endurance of a horse. Plus it has a nourishing effect on the reproductive systems of both men and women, as well as the nervous system. And then if you look at the scientific name with ania somnifera, that also gives us a little bit of a hint of its property. Somnifera means sleep inducing. So that points to its calming abilities. By promoting a restful sleep, it helps us recharge, giving us energy to tackle the day. Traditionally, this plant that's grown in Asia and Africa,

it's historically used to help people handle stress, improve energy stamina, help with recovery from illness, help with nervous exhaustion. When it comes to the safety, it's possibly safe to take for up to three months. I have plenty of people who take it for longer than that, but there's not that much data on long-term safety. It is important to note that if you take large doses, it can be associated with some GI issues, diarrhea, vomiting, and other sorts of things. Like Jin saying, it should be avoided in pregnancy and use caution with autoimmune disease and other interactions. Looking at the data again, scientific reviews indicate that its most promising effects are

in treating and addressing insomnia and stress. And it seems to help with just overall sleep and sleep quality. And furthermore, taking the herbs seems to help reduce stress in some people. And for those people who gain weight when they're stressed or associated with stress, it may help curb that effect. Now, when we're looking at ashwagandha supplements, they are often standard to what's called withanolides. Those are a key marker compound, again, that can play a role in its activity. And like ginseng, you'll see it available as a powder or as an extract. The extract, usually most of my patients will take this in a capsulated form. It's usually 500 to 1500 milligrams standardized to at least 1.5% of the

withanolides. So you can see here a typical good dose for ashwagandha. Now looking at it from a culinary perspective, it's a versatile herb. You can put it in a lot of different foods and drinks. The flavor is a little bit bitter and earthy for some people, but when you combine it with the right ingredients, it offers a great touch to your meals. In Ayurveda, the herbs are commonly taken with honey or milk or some other carrier substance. And you can buy the organic ashwagandha powder and use it in recipes like energy balls, like shown here. The chocolate does a nice, and the chocolate and the dates combined with the ashwagandha

really give it a nice balance of flavors. Some of the other ways that you can consume this, instead of just taking it as a capsule, there's ashwagandha tea. You can just take one to two teaspoons of the root, put it in hot water, steep it for 10 to 15 minutes and drink. You can put the ashwagandha powder into a smoothie with different berries and fruits. Golden milk is a traditional Indian drink that's made with turmeric and milk. Add a teaspoon of ashwagandha to your golden milk recipe for an extra health boost. You can even add it to soups and stews, all kinds of things. So all kinds of different

ways that you can use ashwagandha as a nourishing, balancing ingredient in a lot of different things that you're probably already consuming. And lastly, in terms of highlights, let's talk about Rhodiola rosea. It's a plant that thrives in the cold regions of Europe and Asia, and its roots have been used for centuries. Safety, it's possibly safe when used for six to 12 weeks. Again, not a lot known about long-term use, but I have plenty of people who use it longer term. Some of the more common side effects, unlike the GI effects that we saw with ashwagandha, here, some dry mouth or excess saliva, some dizziness. Again, I haven't seen this too much, but it is the most common reported side effects. And again, caution in pregnancy, those with autoimmune disease

and other medications and conditions. When we look at the data, rhodiola rosea has promising effects in alleviating fatigue and enhancing mental performance under stressful conditions. There was reviews looking at a mild to moderate depression for six weeks, and it improved most symptoms of depression, including insomnia, just feeling more emotionally stable. And on the other side, the flip side of depression, we've got anxiety. Patients with mild anxiety after just two weeks of use reported lower anxiety. So a nice herb for people who have some of that, who need some more energy, but also are struggling a little bit with mood issues. In terms of rhodiola supplements, a lot out there, typical

doses range anywhere from 200 to 680 milligrams of the extract. It's oftentimes standardized to these Rosa bins. And I recommend that if you're taking doses over 400 milligrams in a day, that you divide it up into twice daily of a dose. I'll oftentimes start people at 200 milligrams a day or 200 milligrams twice a day if they're sensitive, maybe at 100 milligrams, and then work them up to a more therapeutic dose. And while it's not typically known for its culinary use, you can use rhodiola and incorporate into foods and drinks. The simplest way to use it is to brew it as a tea, make an infusion by taking that dried rhodiola root, steeping it for 10 minutes before drinking. You can also make it into more of a latte like is shown here with Rubio's tea. Rhodiola can come as a powder or as a liquid extract. And so those can make it

easy to blend it into smoothies or juices. And like some of the others, Rhodiola on its own has a somewhat bitter flavor. So oftentimes it's good to pair it with sweet things like bananas or berries to mask the taste. If you use rhodiola, again, you want to steep it long enough, but add it in so that it retains its nutritional value. So those three are great options for a lot of people, as are many of the other adaptogens, each of which also have their own nature and each have their own benefits and characters. What about some of the other things? What about combination products and glandulars? I want to talk about this for a minute. So combination adaptogen products,

sometimes these are called like adrenal boost or stress formula, they will oftentimes contain a mix of a lot of different adaptogens. And their aim is to provide a range of benefits to support the body's stress response in different ways. And I like these, I use them. I use them when I know what all of them are, because the combination products sometimes feel like they're just throwing everything at the wall. And the problem with some of them is that they may say that it's a proprietary formula, and then we don't know how much of each of them is in there. And that makes it harder to pinpoint if there's enough to actually be effective. Secondly, it is possible for some of these herbs to interact with each other,

potentially leading to unexpected outcomes. So while those adrenal support general supplements can be helpful for some people, for others, they may not be effective or the right fit. As for the labels I showed on the right here, these adrenal glandular extracts, these are derived from the adrenal glands of animals, usually cows or pigs. And there's really limited scientific evidence of any supporting the benefits of using adrenal extracts. And in my opinion, they pose potential health risks. There have been studies that have shown that these extracts can

be adulterated with steroids. We don't want to take too many steroids. They lead to overstimulation. They lead to problems with blood sugar, weight gain, all kinds of things. So we do not want adulteration with steroids. There have also been reports of infection and exposure to disease from the source animal. So for that reason, I personally prefer adaptogenic herbs over these glandular extracts. If somebody really needs steroids, I prefer to just give them it as a drug like hydrocortisone or prednisone. So I know how much is in there per dose instead of it being adulterated and somebody getting something that's potentially harmful and not even knowing they're taking it. And for the last part, let's talk about if you are ready or if you are adding dietary supplements to

your routine, what do you need to know? So these are my three questions. Is it safe? Could it work for me? Is it a quality product? And if we check the box on these three things, you can make an informed decision about whether it's the right choice for you. So let's look at these in a little more detail. Let's start with, is it safe? So how do we judge if supplements are safe and effective? We need good research and evidence-based medicine. They are the building blocks of our work. But here's a burning question that often comes across. Are dietary supplements even regulated? I hear this all the time. Dietary supplements aren't regulated. It's not safe to take them. So let's dive in and see if that's actually true. The short answer is yes, they are regulated. Both federal and state laws provide guidelines for the dietary supplement industry in the U.S. with the Food and Drug

Administration, the FDA, and the Federal Trade Commission, the FTC, leading the charge at the federal level. State government bodies also play a part in this regulatory dance. Now, the rulebook for these regulations stems from the Federal Food, Drug, and Cosmetic Act, and that's been supplemented with additional regulations like the Dietary Supplement Health and Education Act that came out in 1994 and the subsequent Dietary Supplement and Non-Prescription Drug Consumer Protection Act in 2006. According to these laws, the FDA has the power to keep tabs on dietary supplement products and ingredients that make it to the market. So you can see this as the second line in my comparison chart here. So here's where it gets

a little interesting. Unlike the medications, the drugs, which need to prove their safety and effectiveness before they can get sold, dietary supplements do not need that pre-market approval. They can hit the shelves without pre-market tests. Instead, their safety is monitored after they are released to the public. Now, this doesn't mean anything goes. There is some strict rules about how the products are made, labeled, and marketed, And a supplement can be found to be unsafe or misleading or poor quality. If it is, it will be pulled from the shelves by the FDA. And in a nutshell, yes, there is a system in place to regulate dietary supplements. They just play by a slightly different set of rules than medications. And before you start to take any dietary

supplements, it's crucial to be aware of potential risks. So here are the five major categories I think about. The first one is hidden ingredients. So this is like I was mentioning with the glandulars. It's when something is added into the mix that's not on the label or when a listed ingredient is replaced with something else. We definitely don't want that. The second is contamination. So sometimes supplements accidentally contain things we don't want like bacteria, heavy metals, pesticides.

So contamination is an issue. The third thing, natural doesn't always mean safe. So remember, of course, that even if a supplement's from a plant or a natural source, it doesn't mean it can't be harmful, especially if you take too much. The third is mix and match woes there's a few different things here herbs and drugs some supplements interfere with medications and that can either make them higher quantity in your body or reduce their effectiveness example classic example is taking saint john's word and the oral contraceptive pill has led to unwanted pregnancies. So that's an example of an herb drug mix-up. The second is supplement condition clashes. So some supplements don't play well with other conditions. That's like immune stimulating adaptogens may not

play that well with Hashimoto's and rheumatoid arthritis. The third is too many cooks in the kitchen. I see a lot of people who are taking a lot of different supplements. And if you take too many at once, they can interact. Get some of those cooks out of the kitchen, make sure the right number is in there. And then the last thing are these oops moments. So taking the wrong amount, using the supplement the wrong way, being misled, something as simple as somebody mistaking DHA, which is a component of fish oil, with DHEA, which is an adrenal hormone. So lots of potential oops. So you just need to be careful. The second, is there evidence that it may work? Now, when thinking about dietary supplements, it is vital to check if there's solid scientific evidence to back up their benefits. And for this,

there's a lot of resources available. There's a growing amount of scientific literature. I look things up. I look up individual studies. And something that a lot of your providers may turn to is something called Natural Standard. It's a database that dives deep into the science evidence, including dietary supplements, and they sift through the studies and research and kind of compile it. So health professionals will oftentimes rely on natural medicines to provide trustworthy information and help you make a well-informed decision. Just to show you an example of how this might be used, if we look at g affect labs that you have? What's the risk of

overdose? All kinds of things and overviews of many studies. The other great tool that is available is an interaction checker. So for example, if I enter warfarin, which is a blood thinner and Panex ginseng in here, I can see that there is a moderate risk of interaction because of ginseng's antiplatelet effect and an increased risk of bleeding if they're used concurrently. So it might not be the right choice for my patient with a clotting issue that needs to be on warf in long-term. So again, probably not a tool that you will use, but one that is available for your providers to use to make sure that what you're using is safe.

And then lastly, is it a good quality product? Don't waste your money on the cheapest product that may not work. Sadly, there is some correlation between cost and quality, although not all the time. You can get plenty of good quality dietary supplements at a reasonable price. So how do you assess that? There are hundreds of choices on supplements. How do you know which one is the good quality and what you should take? One thing that you can do is look for one of these seals of approval, NSF International, the US Pharmacopoeia, and ConsumerLob.com. They all indicate that the

product has undergone third-party testing for quality and purity and potency. So they're like a layer of assurance that it's a reliable, credible supplement. It is important to note that these stamps do not mean that the supplement was shown to work. It's not the evidence, but rather than a past quality testing. So for example, Consumer Lab is here, and this is something that I've encouraged patients to get their own subscription for. ConsumerLab.com, it's an independent organization. It tests and reviews health and nutrition products, and they use these rigorous testing procedures.

For example, ConsumerLab.com is an independent organization. They test and review different health and nutrition products, and they use these rigorous testing procedures to evaluate the quality, purity, and potency and verify that they do contain what the label says they contain and that they're free of contaminants. For example, this most recent review of ginseng supplements showed that the ginsenoside content ranged tenfold across the tested products. So some of the supplements were given an approval rating, while a few were given a fail score. Now, consumerlab.com, I don't have any relationship with them. I just think it's a great tool. They provide subscription-based access,

and they'll give you these detailed test reports and guidance to help you make a decision. So if you have an integrative functional medicine provider who suggests certain supplements, that's great. But sometimes you need to find it on your own or you'll be given the okay to start a supplement, but you're not given an exact referral to which one. Consumerlab.com at least can make sure that you are getting a good quality supplement, which is extremely important. To close, thanks for coming on this fascinating journey into the world of stress and the ancient healing power of adaptogens.

We traced a path from age-old wisdom to modern science, discovering how adaptogens can fortify our body against stress, their pivotal role in helping support that HPA access, the crucial player in our stress response. We saw how worldwide interest in these natural health boosters is soaring, reflecting a growing desire for natural ways to enhance our well-being. And among the many numerous adaptogens out there, we talked about a few of my favorites, Asian ginseng, ashwagandha, and rhodiola. But again, as we explore the world of dietary supplements, we know we need to navigate wisely, use the, scrutinize the safety, the efficacy and quality of any products, realize that they can

carry risks, they can negatively interact with your medications, your supplements, or your health conditions. So make sure you arm yourself with reliable information, preferably under the guidance of a trained professional. But also thinking about some of these tools like consumerlab.com to help you make well-informed decisions. And remember also that while adaptogens, that's one of their three characteristics, they are generally safe, but they have unique characteristics. And so a trained professional can guide you to which is the right adaptogen for your need. you have more of a anxiety, sleep fatigue complex, or do you need something like rhodiola because you have some mood issues

and you're fatigued related to that? Or do you have chronic illness or PTSD or some chronic condition and you need something to help support energy, ginseng, that panics ginseng may be right for you. And wrapping up, remember, adaptogens have exciting potential for enhancing your health and being, but use them wisely to maximize their benefit and minimize their risk. And do not forget that they are part of a whole person picture. You can't skimp on sleep, eat junk food, be sedentary, all of that. You've got to do it

all together in order to really leave a full, rich life. Thank you for joining me today. I hope you learned something and I'll see you next time. Feel free to look me up at drmelindaring.com and you can have some free resources there on culinary medicine and health. Bye-bye. Hi, everyone. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine

practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.