Stress is very simply something either physically, chemically or emotionally that causes our bodies to have to adapt, or respond in a way that requires it to be brought back into balance (homeostasis). The system that regulates stress is our nervous system, and this is also where stress starts - in the brain (HPA axis). The brain takes in and processes everything and is closely tied to our adrenal glands through a complex system.
Our brains release hormones and neurotransmitters that then cause the release of hormones involved in the stress response (adrenaline and cortisol). It's important to explain the stress response as completely normal, because it is, but also because many experiencing symptoms of short-term and probably to a higher degree long-term symptoms don't "feel" normal. Many feel like they're losing their minds or going crazy. Part of this is due to the effects stress (activation of the HPA axis) can have on mood and psychological status when our emergency alarms are constantly ringing.
This same system once activated can have detrimental effects on other organs and systems in the body because emergencies require immediate attention to survive now, as opposed to being able to reserve resources for the long-term. It's difficult to ignore the immediate symptoms but by doing so some root cause triggers of the HPA axis get overlooked. Identifying and avoiding key individual triggers can help most significantly improve stress, thyroid function, and boost the immune system and there's an amazing adaptogenic herb that can help.
The adaptogenic herb that has a long history (over 3,000 years) of helping balance the stress response is ashwagandha (Withania somnifera). Ashwagandha is a small evergreen shrub that grows to about 4-5 feet tall and is found in dry areas of India and the Middle East, as well as parts of Africa and is very similar to ginseng (1). The term "adaptogen" means to increase the body's ability to resist the damaging effects of stress and promote or restore normal physiological functioning. While this may seem somewhat ambiguous, essentially adaptogens are a class of nutrients or phytonutrients that help the body adapt to a stressor.
Whether that stressor is physical (exercise, cold temperatures), chemical (enhancing immune response), and emotional (improving depression and anxiety) adaptogens have been shown effectiveness. Ashwagandha has been used for a variety of psychological conditions (bipolar, ADHD, OCD), liver disease, infections, arthritis and joint pain, low white blood cell count, fatigue, diabetes and high cholesterol and triglycerides, and hypothyroidism (Ref). We're going to focus on how ashwagandha helps balance the stress system and how this benefits other important organs and systems in the body.
Starting with the stress system (HPA axis) and cortisol, there is good evidence supporting it's benefits in clinical studies to match it's reported ability to reduce cortisol output and suppresses stress-induced increases of dopamine receptors in the corpus striatum of the brain. One study showed that taking ashwagandha root extract at 300 mg twice daily for 60 days reduced perceived stress levels by 33% to 44% and decreased cortisol levels by 22% to 28% in adults with chronic stress. The improvements were all significant compared to placebo (2,3). Interestingly, ashwagandha also seems to prevent stress-related weight gain for some (3). Many have argued that excessive cortisol may make weight loss much more difficult. In another human double-blinded study, chronically stressed patients had significant reductions in an anxiety scale, serum cortisol, C-reactive protein, pulse rate, and blood pressure and significant increases of serum DHEA-S and hemoglobin compared with the placebo group. In addition, there were dose-dependent responses in lowering fasting blood glucose and improving the serum lipid levels. Dosage was 125 to 250 mg one to two times daily (4).
The same stress system (HPA axis) that when activated can be a major contributor to anxiety because it constantly triggers our brain to go into "survival mode". Reducing this alarm, or underlying triggering of the HPA axis can help with anxiety. Ashwagandha may mimic gamma-aminobutyric acid (GABA), the primary calming neurotransmitter in the brain. Animal research also shows that it may boost serotonin receptors, which can also increase the benefits of available serotonin and make us feel happy instead of scared. In a 12-week clinical trial, ashwagandha given to subjects at 300 mg twice daily reduced anxiety scores compared to a control group (5). In another clinical study, taking ashwagandha three times daily for 60 days improved anxious mood in 58% of patients (6).
Ashwagandha has also shown immune system benefits. Anything that can reduce cortisol, potentially can boost immune function. Cortisol is a potent anti-inflammatory hormone and powerful enough to decrease our ability to fight infections if it is chronically elevated. The bioactives in the root also have been show to boost specific immune function in cell and animal studies. Ashwagandha can cause our first line of defense immune cells, our macrophages (big eaters) to mobilize, eat more efficiently and release lysosomal enzymes that can kill bacterial cells and cells infected with viruses by breaking open their cell membranes. Emerging research also points to ashwagandha's ability to enhance white blood cell function and boost WBC production in bone marrow (7).
The thyroid gland controls the body's metabolism and energy production and a decrease in function can lead to weight gain and very low energy. Stress causes our body to produce more of the stress hormone cortisol, which directly impacts the thyroid gland. Elevated cortisol can suppress the hormone called thyroid stimulating hormone (TSH). The body uses TSH to boost thyroid hormone production in an effort to maintain proper metabolism. Low TSH reduces the thyroid hormone thyroxine (T4) and triiodothyronine (T3) production. Chronically elevated cortisol can reduce the conversion of T4 to T3 and increase the conversion of T4 to rT3, which moves someone closer to a state of hypothyroidism.
In clinical and animal research, ashwagandha has been shown to stimulate thyroid function, increasing serum T3 and T4 levels and reducing serum thyroid stimulating hormone (TSH) levels (9,10). An 8-week study in 50 people with hypothyroidism found that taking 600 mg of ashwagandha improved thyroid levels, compared to those taking a placebo. Those in the ashwagandha group boosted T3 41.5% and T4 levels 19.6%. Also worth noting was that TSH levels decreased by 17.5%, indicating that the body no longer needed to boost thyroid hormones T3 and T4 (10). Ashwagandha's cortisol-lowering effects may play a big role.
The benefits and research goes on and on. If you've tested your cortisol levels via your diurnal pattern or cortisol awakening response and have found the pattern and cortisol levels to be dysfunctional ashwagandha is one of the best adaptogenic herbs available. I've linked a few top products below to consider:
1. Ven Murthy, M. R., Ranjekar, P. K., Ramassamy, C., and Deshpande, M. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: ashwagandha. Cent.Nerv.Syst.Agents Med.Chem. 9-1-2010;10(3):238-246.
2. Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-62.
3. Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with ashwagandha root extract: a double-blind, randomized, placebo-controlled trial. J Evid Based Complementary Altern Med. 2017 Jan;22(1):96-106
4. B. Auddy, J. Hazra, A. Mitra, et al.: A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: a double-blind, randomized, placebo-controlled study. JANA. 11:50-56 2008
5. Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial ISRC TN78958974. PLoS One 2009;4:e6628.
6. Sud Khyati S, Thaker B. A randomized double blind placebo controlled study of ashwagandha on generalized anxiety disorder. Int Ayurvedic Med J 2013;1(5):1-7.
7. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev 2000;5:334-46.
8. Chang Y S, et al. The Relationship Between Thyroid Status, Cortisol Level, Cognition And Neuropsychiatric Symptoms In Patients With Alzheimer Disease. Neurpsychiatry (2018) Volume 8, Issue 3
9. Panda S, Kar A. Withania somnifera and Bauhinia purpurea in the regulation of circulating thyroid hormone concentrations in female mice. J Ethnopharmacol 1999;67:233-39.
10. Sharma AK, Basu I, Singh S. Efficacy and safety of Ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018 Mar;24(3):243-248.