Do adaptogens like ashwagandha actually balance your stress hormones?

Aviva RommMD · family physician (NPPES taxonomy 207Q00000X, MA licence 253326 and NY licence 9040902; Yale MD awarded 1 Sep 2009, verified in Yale's own thesis repository; stated board certification not confirmed against ABFM) · midwife, apprenticeship-trained, approx. 25 years, current standing not established · herbalist, past president of the American Herbalists Guild and former Medical Director of the American Herbal Pharmacopoeia, both confirmed by the organisations themselves

Take a combination of about three adaptogens daily for at least three months; they normalise adrenal function in either direction, whether you are over-stimulated or depleted.

What it rests onTraditional use in Ayurvedic and Chinese medicine over centuries, where these herbs are the 'Kings' and 'Queens' of the materia medica, plus a stated pharmacological property: 'the chemicals they contain actually help to normalize adrenal function ... they work whether you are experiencing adrenal over-stimulation, or adrenal fatigue.' She also states the category is non-toxic even with long-term use, and gives individual cautions per herb.

Jennifer GunterMD · OB/GYN and pain medicine physician

The adaptogen concept does not match the pharmacology, and she would not take ashwagandha.

What it rests onHer argument is specifically against bidirectionality: every trial shows ashwagandha lowers cortisol rather than adapting to need, so it is a unidirectional cortisol suppressant. Since chronic stress raises cortisol early and blunts it later, suppressing cortisol in the late phase could worsen the fatigue and brain fog it is taken for. She adds cholestatic hepatitis inherent to the herb, possible thyroid effects, and that proprietary blends hide the amounts. She grades her own evidence as poor twice in the same passage and concedes the early-phase case as an untested hypothesis.