Cortisol plays a crucial role in maintaining health. A feedback loop involving the brain and adrenal glands balances the 24-hour cycle in which cortisol is delicately secreted to preserve homeostasis according to the body's total stress load and physiological needs. However, under the pressures of chronic stress – as many of us are (55% of Americans are stressed, according to The American Institute of Stress) – this feedback loop and the body's chemical response to stress response become dysregulated. The adrenals reach a point where they cannot keep up with the body's demands, manifesting as adrenal fatigue. The good news? This is reversible, and functional medicine offers supportive tools for the adrenals. Adaptogens are often key players in helping offset the symptoms of adrenal fatigue and reset cortisol's natural rhythm. Rhodiola rosea is one herb widely studied as an adaptogen for adrenal fatigue. 

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What Is Adrenal Fatigue? 

Adrenal fatigue is a term used in functional medicine to describe a cluster of symptoms believed to result from chronic stress and an overworked adrenal gland. The adrenal glands, situated atop the kidneys, play a crucial role in the body's stress response system. When an individual encounters stress, the adrenal glands release cortisol, a hormone that helps the body respond to the stressor. Over time, chronic stress may lead to an excessive demand for cortisol production, potentially resulting in adrenal fatigue. Common causes include chronic stress, inadequate nutrition, and insufficient sleep. 

The physiological response of the adrenal glands to stress involves the activation of the hypothalamus-pituitary-adrenal (HPA) axis. Initially, the hypothalamus releases corticotropin-releasing hormone (CRH), signaling the pituitary gland to release adrenocorticotropic hormone (ACTH). This, in turn, prompts the adrenal glands to produce cortisol. Chronic exposure to physical, mental, and emotional stressors; subsufficient nutrient status; and inflammation can lead to HPA axis dysfunction, resulting in maladaptive changes to the cortisol's typical secretion pattern and subsequent symptoms of adrenal fatigue. (7)  

Controversy surrounds the recognition of adrenal fatigue as a medical diagnosis within mainstream medicine. Critics argue that the term lacks scientific validity and that the symptoms attributed to adrenal fatigue are nonspecific and overlap with other medical conditions. As a result, there is a divide between the perspectives of functional medicine practitioners and mainstream medical professionals regarding the acceptance and diagnosis of adrenal fatigue. (10)

The Role of Adaptogens in Stress Management

Adaptogens are natural substances, often plant-derived, that are believed to assist the body in adapting to stress and maintaining physiological balance. These compounds are thought to modulate the stress response, supporting the adrenal glands and promoting overall resilience to stressors. In managing stress and supporting adrenal health, adaptogens, such as Rhodiola rosea, have gained attention for their potential therapeutic effects. Other well-known adaptogenic herbs include ashwagandha, ginseng, holy basil, licorice, and schisandra.  

Adaptogens enhance the body's resilience to stress and support adrenal gland function through various proposed mechanisms. One key aspect is their interaction with the HPA axis, the central regulator of the body's stress response. Adaptogens are thought to modulate the release of stress hormones such as cortisol. This modulation is theorized to prevent excessive cortisol production during chronic stress, contributing to the maintenance of a more balanced stress response and improved subjective perception of stress in those who experience mental stress. (28) 

It is also proposed that adaptogens act on the adrenal glands themselves. Adrenal glands may struggle to meet the demand for cortisol during chronic, prolonged stress. Adaptogens, through their purported effects on adrenal function, are believed to support the glands in adapting to stressors and optimizing cortisol output. This adaptogenic support is thought to contribute to overall adrenal health and resilience. (19)

Additionally, adaptogens are suggested to have a role in cellular protection and energy metabolism. They may enhance the body's ability to cope with oxidative stress, a common consequence of chronic stress. By promoting antioxidant defenses and mitigating oxidative damage, adaptogens are thought to protect cells from the harmful effects of stress. (21) 

Furthermore, some adaptogens are believed to influence neurotransmitter levels in the brain, particularly those related to mood and stress. Rhodiola, for example, modulates the activity of serotonin, dopamine, and norepinephrine by inhibiting the enzymes responsible for their degradation. In this way, adaptogens may contribute to a more balanced emotional response to stress. 

Rhodiola Rosea: Profile and Properties

Rhodiola rosea, commonly known as rhodiola, arctic root, golden root, rose root, and king's crown, is an herbaceous plant native to high-altitude, cold regions in Europe and Asia. Rhodiola has a long history of medicinal use throughout Europe, dating back to the Vikings, who used the plant to improve physical strength, work performance, and endurance (29).

Rhodiola's root contains over 30 bioactive compounds, including phenylethanoids, phenylpropanoids, flavonoids, cyanoglycosides, monoterpenes, and triterpenes (20). The constituent rosavin is specific to Rhodiola rosea, distinguishing it from other plant species in the Rhodiola genus. Salidroside and tyrosol are two of rhodiola's major therapeutic constituents, which have been shown to have adaptogenic, antioxidant, anti-inflammatory, anti-cancer, and immunomodulatory properties (29). Rhodiola has been used for treating symptoms of fatigue, depression, and pain. Research models show promise for its use in preventing cancer, cardiovascular, neurodegenerative, liver, and skin conditions. (3)  

Scientific Evidence Supporting Rhodiola Rosea's Efficacy 

Preliminary clinical research shows that oral rhodiola extract reduces fatigue and feelings of stress in stressful situations. Most preliminary clinical trials have evaluated a standardized rhodiola root extract called SHR-5 in various doses and populations.

A double-blind, placebo-controlled pilot investigation explored the adaptogenic effects of Rhodiola rosea SHR-5 extract on stress-induced fatigue in students during a 20-day examination period, utilizing a repeated low-dose regimen. The research revealed that participants receiving 50 mg of SHR-5 twice daily exhibited a reduction in fatigue levels and an improvement in subjective well-being compared to the placebo group. These findings suggest the potential of rhodiola as a natural intervention to alleviate stress-related exhaustion in students during challenging academic periods. (26) 

In a double-blind, cross-over investigation, researchers studied the impact of SHR-5 on the mental performance of 56 healthy night-shift physicians. Night-shift workers taking 170 mg daily for two weeks experienced reductions in fatigue and improvements in mental performance compared to those taking a placebo at the end of the study. The findings suggest rhodiola's potential as a natural intervention to counteract stress-induced fatigue and enhance cognitive function in demanding work environments. (12)

Other research using other specific dried rhodiola extracts shows similar findings. Clinical research in adults with general stress shows that taking a rhodiola extract called Vitango (Rhodiola rosea extract WS® 1375) 200 mg twice daily before breakfast and lunch for one month improves stress, disability, and functional impairment in stressful situations compared to baseline. Improvements were noted as soon as three days after initiating treatment and continued throughout the 4-week trial. (14)

In adults experiencing symptoms of burnout, comprising fatigue, cynicism, impaired sexual function, poor concentration, headaches, and digestive upset, taking 200 mg of Rhodiola rosea extract WS® 1375 twice daily for 12 weeks reduced perceived levels of stress, burnout, and fatigue when compared to baseline. (17) 

Dosage and Administration

Rhodiola is commonly prescribed to adults in oral doses of 100-600 mg daily for up to 12 weeks (25). Rhodiola extracts are often standardized to rosavin and salidroside content. SHR-5 is an ethanolic extract with a drug/extract ratio of 4:1, standardized to contain 3.07% rosavin and 1.95% salidroside. WS® 1375 is another ethanolic extract standardized to contain an extract ratio of 1.5–5:1. (15). 

Rhodiola has been used safely in studies up to 300 mg twice daily for up to 12 weeks. Possible side effects, which are rare and typically mild when they do occur, associated with oral rhodiola extract include dizziness, dry mouth, or excessive saliva production. (15, 23) 

Potential Interactions and Contraindications

While rhodiola is generally considered safe for many individuals, there are specific contraindications and situations where its use may not be advisable. Because of this, it is crucial to exercise caution and consult healthcare professionals before incorporating rhodiola into a supplemental regimen, especially for individuals with certain health conditions or those taking specific medications.

Insufficient evidence is available regarding the use of rhodiola during pregnancy or while breastfeeding; to ensure safety, it is recommended that pregnant and breastfeeding individuals avoid taking it (23).

Rhodiola may interact with certain medications, including anticoagulants and blood thinners, central nervous system stimulants, antihypertensives, antidiabetes drugs, antidepressants, and anti-seizure drugs, affecting the way they work, intensifying their effects, and increasing the risk for adverse reactions (24, 25). 

Integrating Rhodiola Rosea into a Holistic Approach

A holistic approach to adrenal fatigue involves addressing the root causes of stress and adrenal imbalance and recognizing the interconnectedness of various factors influencing overall well-being. Integrating Rhodiola rosea into the treatment plan can be one aspect of a comprehensive and integrative strategy for combating stress and adrenal fatigue. As outlined throughout this article, rhodiola can be valuable in managing adrenal fatigue due to its adaptogenic effects. However, in a broader context, a holistic approach to adrenal fatigue encompasses much more than just herbal supplements. It emphasizes lifestyle modifications, nutritional support, and stress management techniques. Identifying and addressing the root causes of stress, such as poor sleep, dietary imbalances, and chronic psychological stressors, is crucial for long-term success. Lifestyle changes, including a nutrient-dense diet, regular exercise, adequate amounts of quality sleep, and mindfulness practices, contribute to the body's overall resilience and help restore balance to the adrenal glands. (1, 4, 9) 

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Rhodiola for Adrenal Fatigue: Key Takeaways

Rhodiola rosea presents promising potential as a natural approach to managing adrenal fatigue, owing to its adaptogenic properties that support the body's resilience to stress. The herb's ability to modulate the stress response and alleviate fatigue makes it a valuable component in a holistic strategy for adrenal health. However, it is crucial to approach the use of rhodiola with a personalized and informed perspective, recognizing that individual responses may vary. Professional guidance is paramount, especially considering potential contraindications, medication interactions, and the necessity for a comprehensive understanding of an individual's health history. The collaboration between individuals and healthcare professionals ensures a safe, effective, and tailored integration of rhodiola into a holistic regimen for managing adrenal fatigue.