Calming Cortisol with Botanicals

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Cortisol is our body’s predominant stress hormone.[1] Think of it as our built-in alarm system that lets our body know when potential dangers arise and then equips us to deal with them. Under stress, cortisol puts us on high alert in case of impending danger. It increases our blood pressure, elevates our blood sugar, and slows down our metabolic processes that are lower on the priority list so that we can escape our stressor safely and efficiently.[2]

When we’re stressed for long periods, this alarm continues to ring. Our blood pressure and heart rate remain elevated, blood sugar levels become distorted, and those non-priority metabolic processes like digestion, reproduction, and sleep remain suppressed.[3] Because of this, chronic stress and the subsequent cortisol dysfunction can lead to anxiety, headaches, heart disease, memory issues, digestive struggles, insomnia, and weight gain.[4]

When we’re stressed for long periods…non-priority metabolic processes like digestion, reproduction, and sleep remain suppressed.

Herbal Remedies for Cortisol Dysfunction

One of my favorite ways to address cortisol dysfunction is by utilizing the power of adaptogens. These herbs improve our ability to cope with stress and protect against stress-related damage, including cortisol dysfunction.[5]^,[6] Below are some of my favorites to use clinically.

Ashwagandha (Withania somnifera)

The root of Withania somnifera, commonly referred to as ashwagandha, has a longstanding history of use in Ayurvedic medicine, dating back to at least 6000 BCE. It is considered one of the most essential Ayurvedic herbs, with ancient documents touting its use for “rejuvenating the system” and “improving lifespan.”[7]

Today ashwagandha is known as a nervine tonic with adaptogenic, anti-stress properties. These adaptogenic effects are due to the withanolides found in the herb’s root that possess steroidal properties.[8] These withanolides are structurally similar to ginsenosides from ginseng.[9] Additionally, ashwagandha root contains sitoindosides, which have been shown to protect against oxidative damage and exhibit anti-stress activity.[10]

Over the course of eight weeks, researchers observed significant reductions in cortisol levels, perceived stress via the Perceived Stress Scale (PSS), and improved sleep quality in the ashwagandha group compared to the placebo group.

One study of 64 subjects with a history of chronic stress evaluated the effects of ashwagandha administration over 60 days on serum cortisol and levels of perceived stress through questionnaires. The treatment group exhibited a significant reduction in scores on every stress-assessment scale relative to the placebo group. The same study also observed that serum cortisol levels were substantially reduced in the ashwagandha group relative to the placebo group.²¹

Another prospective, randomized, double-blind, placebo-controlled study by Salve et al. saw similar results. Over the course of eight weeks, researchers observed significant reductions in cortisol levels, perceived stress via the Perceived Stress Scale (PSS), and improved sleep quality in the ashwagandha group compared to the placebo group.[11]

Lemon Balm (Melissa officinalis)

Melissa officinalis or lemon balm, as it is more commonly known, is a plant native to Iran and used in Iranian folk medicine. It was traditionally used for its digestive, carminative, antispasmodic, sedative, and antioxidant properties, as well as its anxiolytic properties.[12] Lemon balm has been observed in prescriptions dating back to the early 1500s, some by Paracelsus, a pioneer of the “medical revolution” and one of the first to introduce chemistry to medicine. He would use lemon balm to address “all complaints supposed to proceed from a disordered state of the nervous system.”[13]

Paracelsus might be proud to see that modern science has substantiated many of the traditional beliefs and uses surrounding lemon balm, particularly around its anxiolytic effects.¹³ One study observed lemon balm’s effect on healthy volunteers exposed to the Defined Intensity Stressor Simulation (DISS) battery. Researchers found that a 600 mg dose of lemon balm ameliorated the DISS’s adverse mood effects and significantly increased ratings of calmness compared to the placebo group, suggesting that lemon balm could mitigate the adverse effects of stress.[14] Another study involving subjects with mild to moderate anxiety disorders found that the same 600 mg per day of lemon balm significantly reduced anxiety levels following just 15 days of supplementation.[15]

Rosmarinic acid, a constituent of lemon balm, inhibits the enzyme acetylcholinesterase, which degrades acetylcholine. This inhibition allows for higher levels of acetylcholine, the chief neurotransmitter of the parasympathetic nervous system.³⁸ Lemon balm has also demonstrated the ability to bind both nicotinic and muscarinic acetylcholine receptors.[16]^,[17] These effects are valuable not only in promoting the parasympathetic state but also in improving cognition and memory in times of stress.[18] Quite remarkably, given such a long history of usage, no adverse side effects have been reported thus far with the administration of lemon balm.[19]

Magnolia (Magnolia officinalis)

Magnolia is one of the oldest species of tree, having evolved before even the bees. In ancient China, where magnolia trees are native, the flowers of the magnolia developed to encourage pollination by beetles. To avoid damage from pollinating beetles, the carpels of the flowers are extremely tough. Interestingly, traditional uses of the bark of the magnolia have also been to improve resilience or toughness for those who consume them. In traditional Chinese medicine, magnolia bark is often used as an anxiolytic, sleep aid, mood stabilizer, and for “stagnation of qi,” or what those of us in Western medicine might refer to as reduced psychological aptitude or “burnout.” Each of these benefits can likely be attributed, at least in part, to magnolia’s cortisol-modulating effects.[20]^,[21]

supplementation with magnolia extract coupled with Phellodendron bark extract reduced salivary cortisol levels by 18% after four weeks of supplementation compared to placebo.

Many of the clinical trials involving Magnolia also involve Phellodendron (Phellodendron amurense), as these two adaptogenic herbs are a common pairing in proprietary herbal blends. One study of 56 subjects (35 men and 21 women) with moderate stress levels revealed that supplementation with magnolia extract coupled with Phellodendron bark extract reduced salivary cortisol levels by 18% after four weeks of supplementation compared to placebo.[22] The same study found global stress markers decreased by 11%, depression by 20%, fatigue by 31%, and anger by a whopping 42% compared to placebo.

A 2008 double-blind, placebo-controlled study used the same proprietary blend of magnolia and Phellodendron bark to evaluate the effects on anxiety, stress, and weight in 26 healthy, overweight premenopausal women with higher-than-average levels of anxiety. The researchers found that the magnolia and Phellodendron group saw a significant reduction in anxiety levels compared to the placebo group after six weeks of supplementation.[23] The treatment group noticed no significant change in weight after six weeks, while the placebo group saw a weight increase over the six-week period, suggesting that the anxiolytic effects of magnolia could have an effect on stress-based eating or cortisol-related weight gain.

German Chamomile (Matricaria recutita)

Matricaria recutita or chamomile, as most of us commonly know it, is one of the most widely used medicinal herbs. The benefits of this herb are vast and range from gastrointestinal support to wound healing.[24] It is included in the pharmacopoeia of 26 countries.[25] With more than 120 known active constituents, the literature on this herb is substantial. Chamomile may best be known as a gentle sedative, perfect for an evening cup of tea, though its success in the realm of sleep may be partially due to chamomile’s anxiolytic and calming effects.[26]

The chamomile group observed a clinically meaningful reduction in GAD symptoms by week 2 of the eight-week study. Researchers saw a response rate comparable to conventional anxiolytic drug therapies with a much more favorable rate of adverse events.

In clinical trials, chamomile therapy has been shown to reduce symptoms of anxiety. In one double-blind, placebo-controlled study, chamomile significantly reduced symptoms of anxiety, and there was a notable change in total Hamilton Anxiety Rating Scale scores over placebo following eight weeks of supplementation.[27] Another randomized controlled trial by Keefe et al. with individuals with moderate to severe generalized anxiety disorder (GAD) found that the chamomile group observed a clinically meaningful reduction in GAD symptoms by week 2 of the eight-week study. Researchers saw a response rate comparable to conventional anxiolytic drug therapies with a much more favorable rate of adverse events.[28]

One trial by Mao et al. looked at the long-term effects of chamomile supplementation and its continued effects and relapse rates after ending the therapy. Participants with moderate to severe GAD were supplemented with chamomile over the course of 12 weeks. During this time, researchers observed a significant improvement in GAD symptoms for the chamomile subjects. For phase 2 of this randomized control trial, half of the participants were given a placebo while the remaining participants continued with chamomile therapy for an additional 26 weeks to observe relapse rates with GAD. Chamomile participants maintained significantly lower GAD symptoms than the placebo group throughout phase 2. Relapse rates were lower for the chamomile group but did not reach statistically significant values, though the researchers reported a clinically significant change in relapse rates following chamomile therapy. Mean time to relapse was 11.4 ± 8.4 weeks for the chamomile group and 6.3 ± 3.9 weeks for placebo, suggesting that chamomile therapy could have lasting effects on GAD, but additional research is indicated.[29]

In sum

Whether they’re decreasing anxiety, modulating cortisol, improving mental stamina, combatting fatigue, or all of these, adaptogens offer a stress-protective effect by encouraging homeostasis via multiple mechanisms of action. Magnolia, Phellodendron, ashwagandha, lemon balm, and chamomile are valuable tools in cases of cortisol dysfunction, with each having distinctive valuable impacts to the system. These herbs, used either individually or synergistically, can offer adaptogenic benefits to an individual experiencing the consequences of excess stress and cortisol dysfunction.

References

[1] Stress Management. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037. Accessed Oct 1 2021.

[2] Hormone Health Network.”Cortisol | Hormone Health Network.” Hormone.org, Endocrine Society, 4 October 2021, https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/cortisol

[3]How stress affects your health. American Psychological Association. https://www.apa.org/topics/stress/health. Accessed Oct 1 2021.

[4] Lower stress: How does stress affect the body? American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/lower-stress-how-does-stress-affect-the-body. Accessed Oct 1 2021.

[5] Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel, Switzerland). 2010 Jan 19;3(1):188-224.

[6] Provino R. The role of adaptogens in stress management. Aust J Med Herbal. 2010;22:41-9.

[7] Singh N, et al. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. African Journal of Traditional, Complementary, and Alternative Medicines. 2011;8(5 Suppl):208-13.

[8] Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone; 2000.

[9] Dasgupta A, et al. Effect of Indian Ayurvedic medicine Ashwagandha on measurement of serum digoxin and 11 commonly monitored drugs using immunoassays: study of protein binding and interaction with Digibind. Arch Pathol Lab Med. 2007;131:1298-303.

[10] Ghosal S, et al. Chemistry and Bioactivity of Sitoindosides IX and X. Planta Medica. 1988;54(6):561.

[11] Salve J, et al. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019 Dec 25;11(12):e6466.

[12] Miraj S, et al. Melissa officinalis L: A Review Study With an Antioxidant Prospective. Journal of Evidence-Based Complementary & Alternative Medicine. 2017;22(3):385-94.

[13] Scholey A, et al. Anti-stress effects of lemon balm-containing foods. Nutrients. 2014 Oct 30;6(11):4805-21.

[14] Kennedy DO, et al. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosomatic Medicine. 2004;66(4):607-13.

[15] Cases J, et al. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Med J Nutrition Metab. 2011;4:211-8.

[16] Perry N, et al. European Herbs with cholinergic activities: potential in dementia therapy. Int J Geriatr Psychiatry. 1996;11:1063-9.

[17] Wake G, et al. CNS acetylcholine receptor activity in European medicinal plants traditionally used to improve failing memory. J Ethnopharmacol. 2000;69:105-14.

[18] Ferreira-Vieira TH, et al. Alzheimer’s disease: Targeting the Cholinergic System. Current Neuropharmacology. 2016;14(1):101-15.

[19] Wong AHC, et al. Herbal remedies in psychiatric practice. Arch Gen Psychiatry. 1998;55:1033-44.

[20] Sarrica, Andrea et al. “Safety and Toxicology of Magnolol and Honokiol.” Planta medica vol. 84,16 (2018): 1151-1164. doi:10.1055/a-0642-1966

[21] Luo, Hanyan et al. “A review of the phytochemistry and pharmacological activities of Magnoliae officinalis cortex.” Journal of ethnopharmacology vol. 236 (2019): 412-442. doi:10.1016/j.jep.2019.02.041

[22] Talbott SM, et al. Effect of Magnolia officinalis and Phellodendron amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. Journal of the International Society of Sports Nutrition. 2013 Aug 7;10(1):37.

[23] Kalman DS, et al. Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial. Nutrition Journal. 2008 Apr 21;7:11.

[24] McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea (Matricaria recutita L.). Phytotherapy Research. 2006;20(7):519-30.

[25] Salamon I. Chamomile, a medicinal plant. Herb Spice Med Plant Digest. 1992;10:1-4.

[26] Amsterdam, Jay D et al. Putative Antidepressant Effect of Chamomile (Matricaria chamomilla L.) Oral Extract in Subjects with Comorbid Generalized Anxiety Disorder and Depression. Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,9 (2020)

[27] Amsterdam JD, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of Clinical Psychopharmacology. 2009;29(4):378-82.

[28] Keefe JR, et al. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder. Phytomedicine. 2016;23(14):1699-705.

[29] Mao JJ, et al. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016;23(14):1735-42.

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