What are ashwagandha, rhodiola rosea, and tongkat ali used for?

Medicinal Uses of Ashwagandha, Rhodiola Rosea, and Tongkat Ali

Ashwagandha, rhodiola rosea, and tongkat ali are primarily used as adaptogens for stress reduction, hormonal support, and energy enhancement, though clinical evidence supporting their use varies in quality and quantity.

Ashwagandha (Withania somnifera)

Primary Uses:

• Stress and Anxiety Reduction
  • High-quality evidence shows significant reduction in perceived stress scale scores and serum cortisol levels with daily supplementation 1
  • Beneficial for improving sleep quality compared to placebo 1

Dosing:

• Effective doses range from 250-600 mg daily of root extract
• Higher doses (600 mg/day) show more pronounced effects on stress reduction 1

Safety Considerations:

• Should be held for 2 weeks before surgery due to sedative properties that may interact with anesthesia 2
• May potentiate γ-aminobutyric acid effects, potentially enhancing effects of sedatives 2

Rhodiola Rosea

Primary Uses:

• Stress Adaptation and Fatigue Reduction
• Cognitive Performance Enhancement
• Mood Improvement

Safety Considerations:

• Not specifically mentioned in perioperative guidelines, suggesting lower risk profile compared to other herbs 2
• Should be used with caution when combined with other medications due to potential interactions

Tongkat Ali (Eurycoma longifolia)

Primary Uses:

• Testosterone Enhancement

  • Shown to improve testosterone levels in men with late-onset hypogonadism 3
  • 90.8% of patients showed normal testosterone values after treatment compared to 35.5% before 3

• Stress Hormone Modulation

  • Reduces cortisol exposure (-16%) while increasing testosterone status (+37%) 4
  • Improves mood parameters including tension, anger, and confusion 4

• Sexual Function Support

  • Traditional use for enhancing libido and treating sexual dysfunction 5
  • Improves Aging Males' Symptoms (AMS) scores in men with hypogonadism 3

Other Traditional Uses:

• Treatment of malaria (traditional use) 6, 5
• High blood pressure management 5
• General health supplement for energy and strength 5

Dosing:

• Clinical studies have used 200 mg daily of standardized water-soluble extract 3

Safety Considerations:

• Acute toxicity studies show LD50 of alcoholic extract between 1500-2000 mg/kg in mice 5
• Aqueous extract shows LD50 of more than 3000 mg/kg 5
• Liver and renal function tests show no adverse changes at normal daily doses 5

Clinical Implications

When to Consider Use:

• For stress-related symptoms when conventional approaches are insufficient
• For hormonal support in men with symptoms of hypogonadism
• As adjunctive therapy for fatigue and reduced energy

When to Avoid:

• Prior to surgical procedures (hold for at least 2 weeks) 2
• In patients taking medications with sedative properties 2
• In patients with hormone-sensitive conditions (for tongkat ali)

Quality Concerns:

• Website information about these supplements often has low quality ratings despite low risk scores 6
• Standardization and product quality vary significantly between manufacturers
• Always recommend products from reputable sources with third-party testing

Monitoring Recommendations

For patients using these supplements, monitor for:

• Changes in stress levels and mood
• Hormonal effects (particularly with tongkat ali)
• Potential interactions with medications, especially sedatives and anesthetics
• Sleep quality changes (particularly with ashwagandha)

Remember that while these supplements show promise for specific conditions, they should not replace conventional medical treatment for serious medical conditions, and patients should always disclose supplement use to healthcare providers.