HerbalEGram: Volume 7, Number 1, January 2010

Adaptogen Conference in Stockholm
Highlights Recent Research
About 10 years ago, an editorial that I had submitted to a major medical journal was returned to me with an objection from a peer reviewer that my characterization of Asian ginseng (Panax ginseng) as an adaptogen (or an herb having adaptogenic properties) employed a term that was not recognized in pharmacology (or perhaps not recognized in “Western pharmacology”). I recall being surprised, and disappointed, that this reviewer was obviously not familiar with the growing body of pharmacological and clinical trial data on Asian ginseng and other so-called adaptogens—so termed in Russia and Eastern Europe. I am not certain that things have changed all that much in US medical and pharmacology professions in the past decade, but I suspect that they may soon.

Adaptogens are a group of medicinal plants that have been traditionally used for their general strengthening and stress-modulating effects. Early Soviet work in this area classified adaptogens as natural products with a high level of safety that assist an organism’s ability to adapt to various forms of stress (e.g., heat, cold, fatigue, etc.).

I had the opportunity to attend a conference focused on the emerging science on adaptogens in Stockholm, Sweden in October 2009. The conference was sponsored by the Swedish Herbal Institute (SHI), a privately-held company that manufactures a small line of pharmacologically and clinically studied phytomedicines—most of which are in the adaptogenic and immunomodulatory area. SHI also functions much like a research institute, writing review articles and sponsoring basic and clinical research on its various adaptogenic phytomedicines.

My old friend Georg Wikman, founder of SHI, is an avid collector and writer of research papers and books on the subject of how herbs and other natural products can positively affect the metabolism of mammals, particularly humans. He and his colleagues have reportedly translated over 2000 pages from original Russian pharmacological literature on adaptogens. He and his collaborator Alexander Panossian, PhD, have recently completed several comprehensive reviews of some of the key adapatogenic herbs, including rhodiola (Rhodiola rosea) root and schisandra (Schisandra sinensis) fruit.

The one-day conference in Stockholm highlighted both recent basic pharmacological and clinical research on several of SHI’s adaptogenic phytomedicines, particularly its standardized R. rosea extract (known as SHR-5®) and its combination of standardized extracts of andrographis (Andrographis paniculata) herb, schisandra (Schisandra chinensis) fruit, and eleuthero (Eleutherococcus senticosus) root (called ADAPT 232®). To date, it seems fair to say that SHI has probably conducted more research on both R. rosea and andrographis than any commercial, government, or nonprofit group in the world.

According to a Swedish government report, between 10-15% of all Swedes suffer from mental illness, and about 25% of physician visits deal with fatigue.1 Since the year 2000, the number of Swedes diagnosed with some type of mental disorder has reportedly increased by 200%. The problem increases during the winter, when almost 1 million Swedes are said to experience problems like depression, anxiety and fatigue. Government statistics state that about half of these people are treated with conventional pharmaceutical drugs.2 However, about 50% of people on these conventional medications are known to experience adverse effects (e.g., as sexual dysfunction3), which can result in discontinuation of drug therapy. Thus, there is an opportunity for safer, gently acting, clinically effective nutritional and/or phytomedicinal alternatives (as well as perhaps spending the winter in sunnier climates).

There were several presenters at the conference from Sweden, as well as 2 researchers from the United States involved in researching SHI phytomedicines.

Physician and stress researcher Clas Malmström, MD, manager of the private research company PBM Halsokompetens, reported results from a randomized, double-blind, placebo-controlled phase III clinical trial on mild-to-moderately depressed subjects, published in the Nordic Journal of Psychiatry in 2007.4 (The ABC HerbClip summary of this trial is available here.)

This trial, conducted on 90 patients, concluded that the mood-enhancing effect of the SHR-5 R. rosea extract had a positive effect, leading Dr. Malmström to consider SHR-5 comparable in efficacy as conventional serotonin reuptake inhibitor (SSRI) drugs. Dr. Malmström stated that a significant difference between the SHR-5 and SSRIs is that subjects on SHR-5 appear to experience a noticeable effect sooner with the herbal extract (although no clinical trial directly comparing SHR-5 to SSRIs has yet been conducted). Also, he noted that those receiving SHR-5 were more active and focused, and there were no serious adverse effects. Dr. Malmström said that he believes that adaptogens can help depressed patients muster more energy and courage to live more robust lives.

Psychologist Erik Olsson, PhD, of the Department of Psychology at Uppsala University, discussed his new randomized, double-blind, placebo-controlled clinical trial, which is scheduled to be published in Planta Medica and has been published online.5

In this trial, SHR-5 was shown to reduce fatigue, increase mental performance, and reduce stress levels in individuals diagnosed with chronic fatigue syndrome (n = 60 men and women, 20-55 years) after 28 days of continuous use. Patients with chronic fatigue syndrome have higher levels of the stress hormone cortisol than healthy people, particularly in the morning, as measured in saliva. This can be a marker for the diagnosis of severe stress and anxiety. This trial demonstrated that the patients who received SHR-5 had lower cortisol levels equal to the level of healthy subjects.
 
The researchers concluded that repeated treatment with SHR-5 appears to have a positive effect on fatigue level, attention, and levels of cortisol. Although previous research has documented the anti-fatigue effects of SHR-5, this trial is the first to demonstrate such effects in patients with stress-induced fatigue.  

One of the most interesting presentations was from Gusatvo Kinrys, MD, director of the Depression and Anxiety Disorders Research Program at Harvard Medical School. Dr. Kinrys is currently involved in a clinical trial using SHI products. He noted that only about 50-60% of conventional pharmaceutical drugs are effective in the treatment of anxiety and depression, and many of these produce a significant level of adverse effects.

Patients in his recent pilot observational trials had previously found no effect from conventional anti-depression drugs. According to Dr. Kinrys, the Harvard studies show reduced symptoms of both anxiety and depression. He claimed that on average the “depression index” was reduced by more than 50%, demonstrating that patients had returned to a state of normalcy after 10-12 weeks with the use of either the SHR-5 R. rosea extract or the adaptogenic combination ADAPT-232. Dr. Kinrys and his colleagues believe that these observational results were significantly positive to warrant a double-blind, placebo-controlled trial at Harvard, which they have initiated. He stated that they hope to complete this trial by summer 2010. He also stated that, so far, there is no evidence that the adaptogenic products interact with conventional anti-depression medicines, and he added that the rate of adverse reactions is negligible.

One of the areas of concern about adaptogens, and phytomedicines in general, is determining how they work on a molecular level, i.e., what is/are their mechanism(s) of action? In what is easily considered some of the most ground-breaking research presented at the conference, Alexander Asea, PhD, of Texas A&M University System Health Science Center and the chief of the Division of Investigative Pathology, Scott & White Memorial Hospital and Clinic in Temple, Texas presented his research on the effect of ADAPT-232 on the activity of heat-shock proteins (HSPs). In effect, Dr. Asea has uncovered a new mechanism of action for this phytomedicinal combination.

HSPs are proteins that protect human cells and increase the immune system efficiency, helping to detect and eliminate viruses, bacteria, and even cancer cells. Research has indicated that increased levels of HSPs improve health by enhancing activity of the immune system.

He initially investigated ADAPT-232’s claimed adaptogenic properties in a standard pharmacological model called the forced swimming test, in which mice are forced to swim as long as possible. Normally, depending on the study medication, mice swim between 2-4 minutes in water. However, when given ADAPT-232, they reportedly swam an average of 23 minutes! Upon analysis, mice that swam more than 20 minutes were shown to have high levels of HSP-72 in their blood serum, suggesting that the adaptogen product increased energy and the immune response. Through this and other research on HSPs, Dr. Asea stated that he believes that he has discovered a mechanism that may portend a use for adaptogens in future cancer therapies. He also noted a significant correlation of low levels of HSPs and depression, which suggests a possible molecular mechanism for how the adaptogenic herbs in ADAPT-232 may exhibit their documented anti-depressive effect.

Summing up much of the adaptogenic research, Alexander Panossian, PhD, head of research and development at SHI, provided a summary of the history of adaptogens and an overview of the extensive scientific literature on many adaptogenic herbs. He noted that since 1970, at least 6 plants classed as adaptogens are utilized in official medicine in Russia: Asian ginseng root, eleuthero root and rhizome, R. rosea root, schisandra fruit, Aralia mandshurica root, and maral root (Rhoponticum carthamoides).

I wish many medical experts and editors of medical journals in the United States could have attended this conference. I suspect it may have had a positive impact on the current bias against herbs, herbal dietary supplements, and phytomedicines, particularly the entire concept of adpatogens. In addition, the research and concepts presented at this conference may possibly enhance the medical community’s and public’s awareness that there is a growing and impressive body of scientific and clinical literature supporting the rational use of some of these adaptogenic botanicals in selfcare and healthcare.


—Mark Blumenthal


References

1. Halford C. Specialistläkare, CEOS, Akademiska Sjukhuset, Uppsala, Sweden.

2. Sobocki P, Lekander I, Borgström F, Ström O, Runeson B. The economic burden of depression in Sweden from 1997 to 2005. European Psychiatry. 2007;22(3):146-152.

3. Backlund S, Nordström J, Bodlund O. Sexuella problem är vanliga vid antidepressiv behandling. Vad vet allmänläkarna om denna biverkan, och hur hanteras den? [Sexual problems are common in antidepressant treatment. What do the general practitioners know about the side effect, and how is it handled?] Läkartidningen 2005;102:650-653.

4. Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmstrom C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psyc. 2007;61:343-348.

5. Olsson EM, von Schéele B, Panossian AG. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 2009;75(2):105-12. E-pub November 18, 2008.