Rhodiola rosea, also known as “golden root” or “roseroot” grows primarily in dry sandy ground at high altitudes in the arctic areas of Europe and Asia (1). The plant reaches a height of 12 to 30 inches (70cm) and produces yellow blossoms. It is a perennial with a thick rhizome, which has the fragrance of roses when cutt. The Greek physician, Dioscorides, first recorded medicinal applications of rodia riza in 77 C.E. in De Materia Medica (2) and later Linnaeus renamed it Rhodiola rosea (3). For centuries, R. rosea was used in the traditional medicine of Russia, Scandinavia, and other countries. Traditional folk medicine used R. rosea to increase physical endurance, work productivity, longevity, resistance to high altitude sickness, and to treat fatigue, depression, anaemia, impotence, gastrointestinal ailments, infections, and nervous system disorders. In Middle Asia, R. rosea tea was the most effective treatment for cold and flu during severe winters (4). Whilst Chinese emperors sent expeditions to Siberia to bring back the “golden root” for medicinal preparations, the Vikings used the herb to enhance their physical strength and endurance (5).
There are over 200 species of Rhodiola (6), and each species has a distinctive pharmacology, although the compound salidroside is common throughout the genus. However, R. rosea is distinguished from other species of Rhodiola by the presence of three water-soluble glycosides: rosavin, rosin, and rosarian, commonly known as rosavins (7). It is, however, still unclear which specific compound(s) in R. rosea are active constituents. According to the revised 1989 Soviet Pharmacopeia, (8) the extracts of R. rosea are now standardized for both rosavin, rosarin and salidroside. Hence rosavins are now the accepted marker for genetically pure R. rosea (and its extracts), even though they may not necessarily be the only pharmacologically active ingredients responsible for the efficacy observed in clinical studies.
Pharmacological and Clinical Studies
Between 1748 and 1961 various medicinal applications of R. rosea appeared in the scientific literature of Sweden, Norway, France, Germany, the Soviet Union, and Iceland (1,3,9-16). Whilst in 1755 R. rosea was included in the first Swedish Pharmacopoeia, the herb was not recognized there as an Herbal Medicinal Product until 1985 and appeared as an antifatigue agent in the Textbook of Phytomedicine for Pharmacists (13).
Since 1961, more than 200 pharmacological, phytochemical and clinical studies have been published, but its properties still remained largely unknown in the West possibly due to the fact that the bulk of the original research was published in Slavic and Scandinavian languages. Subsequently, the traditional use of R. rosea as a tonic in Siberian and Russian medicine stimulated extensive research leading to identification of the herb as an adaptogen, a substance that nonspecifically increases the resistance of an organism and does not disturb normal biological parameters. Studies have since revealed antifatigue, anti-stress, antihypoxic (protection against damaging effects of oxygen deprivation), antioxidant, immune enhancing and sexual stimulating effects (1,17-21). Currently almost 400 studies relating to Rhodiola rosea appear in the Russian Scientific literature with around an additional 300 publications referenced on Medline.
Results of the many hundred pharmacological studies of Rhodiola rosea appear in several review articles and books (6,8,22-26)Some of the pharmacological effects of Rhodiola rosea extracts described in these studies include: Adaptogenic and stress-protective (neuro-cardio and hepato-protective) effects; Antioxidant effect; Stimulating effect on the central nervous system including effects on cognitive functions such as attention, memory and learning; Anti-fatigue effects; Antidepressive and anxiolytic effects; Normalizing Endocrine activity.
The role of Rhodiola rosea in stress regulation
Possibly because rhodiola rosea grows under such extremely stressful conditions in the northern hemisphere it seems predestined to become one of our most widely used sources of compounds known as adaptogens-substances of natural plant origin that increases the human body's resistance to stress with a high level of safety.
In recognising Rhodiola rosea as an adaptagen, The European Medicines Agency has determined that it meets the following criteria-produces a non-specific response and increases the resistance to adverse physical, chemical and biological influences, possesses a normalising influence irrespective of the direction of the foregoing pathological changes, be non-toxic and should disrupt body functions as little as possible; and have a more pronounced effect with increased pathological changes in the organism (27).
Rhodiola appears to work at a cellular level by inducing the increased expression of stress regulatory molecules like Heat shock protein 70 (Hsp70), neuropeptide Y (NPY) and heat shock factor 1 (HSF-1) that inhibit SAPK expression. In turn the inhibition of SAPK prevents the formation of nitric oxide and the associated decline in ATP synthesis (28).
Hence rhodiola rosea has a dual mode of action. It boosts energy with relief of fatigue, exhaustion, and burnout through increased ATP levels and enhanced energy metabolism. Equally importantly it facilitates composure by relieving unrest, irritability, and tension by reducing dysregulation of the stress hormones noradrenaline, cortisol (29-31)
Rhodiola has been demonstrated to be effective in all stages of stress
Stage one - Reduction Of Stress
In 2012, Edwards conducted an open label multicentre single arm explorative study in 101 outpatients experiencing distinct stress symptoms as assessed on numerical analogue scales and according to the multi-dimensional fatigue inventory 20 diagnostic tool (32). The trial took place over 28 days and patients took two Rhodiola tablets each day. Statistically significant improvements were observed both in physical symptoms (exhaustion and somatic symptoms) and mental symptoms (impairment of concentration, irritability, feeling of heteronomy, anxiety and loss of zest for life) within three days and the improvements continued throughout the duration of the trial. Significant improvements in general fatigue, physical fatigue, mental fatigue, activity and motivation were similarly observed by the end of the trial. Following on from original research by Spasov in 2000 and Shevtsov in 2003 in stress reduction (33,34). Heldman, Cropley and Lekomsteva all reported similar outcomes as a result of using Rhodiola (35-37).
Spasov, and Darbinyan (33,38) first reported improvement in mood and well-being, later confirmed by Edwards and Cropley with Rhodiola (32,36). Meanwhile, improvement in concentration was observed in the studies of shevtsov and, spasov (33,34), and again confirmed by Heldman, Edwards and Darbinyan (32,35,38).
These investigators- Abidov, Parisi, Evdokimov, and Noreen (28,39-41)-also assessed endurance and identified significant improvements in this parameter of stress related symptoms as a result of Rhodiola rosea supplementation.
A recent single centre, open label pilot study was undertaken in 50 healthy male and female participants over 12 weeks investigating parameters such as attention, concentration, reaction time, mood and safety of Rhodiola (35). Event-related brain potentials were measured and results suggest that the intervention led to an increase of attention and resources under a simulated multi-tasking exercise which required a strong attention burden. Treatment with Rhodiola led to an increase in both working speed and working quality.
Stage two - Reduction in fatigue and exhaustion
Olsson initially conducted a randomised, placebo-controlled, double-blind, parallel group study in 60 adults aged between 20 and 55 suffering from stress-related fatigue (29). At the end of the 28 day trial, individuals taking Rhodiola rosea reported significant improvement in the symptoms of fatigue as assessed by the Pines’ burnout scale compared to those consuming placebo. Similarly patients taking Rhodiola rosea were observed to have a statistically significant decreased cortisol response to awakening stress after 28 days compared the placebo group.
Subsequently, Lekomtseva and colleagues investigated the benefits of Rhodiola in 101 male and female outpatients aged between 18 and 60 with symptoms of chronic fatigue over a period of eight weeks (37). They identified statistically significant improvements in general fatigue, physical fatigue, mental fatigue, activity and motivation throughout the trial, with improved concentration becoming statistically significant by week four. Goyvaerts and Spasov both also reported improvements in fatigue and exhaustion in their research on Rhodiola rosea (33,42). This was confirmed with Rhodiola by Edwards and Darbinyan (32,43).
Stage three - Burnout
A recent open label, multicentre, single arm, phase four trial of Rhodiola was recently conducted in 117 outpatients with burnout symptoms over a 12 week period (44). Here Kasper and Dienel assessed measures of impairment of concentration, irritability, feeling of heteronymity, anxiety, the loss of zest for life, exhaustion and somatic symptoms and reported statistically significant improvements within a week of treatment in all areas. This continued throughout the duration of the trial. Improvement was recorded in around 90% of patients with 57% reporting they were either very much better or much better. Previously in 2012 Goyvaets had also investigated burnout with a positive effect reported for treatment with Rhodiola rosea (42).
Secondary/Underlying Disease
Bystritsky first investigated the likely role of Rhodiola rosea in mild anxiety (45) and recently Cropley (36) published his findings with Rhodiola. This open, randomised, single centre study evaluated the impact on self-reported stress and anxiety and concomitant mood symptoms in 80 mildly anxious but otherwise healthy students over 14 days. Anxiety and stress were significantly lower in the treatment group than the control group at day 14 and self-reported anger, confusion and depression were rated significantly lower at the completion of the study with a significant improvement in total mood reported over the course of the study compared to baseline and control. Positive outcomes in the treatment of depression with Rhodiola rosea have also been observed by Goyvaerts and Darbinyan (38,42).
Energy boosting Effects of Rhodiola rosea
In 2006, Walker and Robergs (46) provided what was then the most comprehensive review of the evidence on the ergogenic properties of R. rosea. This was then followed up by a systematic review on the effects of R. rosea on physical and mental fatigue by Ishaque et al (47). These reviews provided much needed information on Russian studies, performed before and during the early 2000s. In one of these early 2000s studies, Spasov et al. (48) used a double-blind design to examine the effect of R. rosea ingestion on performance of the PWC170 (physical work capacity) cycle ergometer test. The authors reported (49) a 6.5% improvement in PWC170 performance in the R. rosea group. DeBock et al. (50) reported on both the acute and chronic effects of R. rosea ingestion on VO2 peak attained and time to exhaustion during cycle exercise and maximal isometric knee extension strength in a sample of 24 male and female students. They reported a 5% improvement in time to exhaustion in the R. rosea trial compared to the placebo as a consequence of an acute loading of extract before exercise. The acute performance changes were attributed to the stimulation of b-endorphin activity in the body.
Work by Noreen et al. (51) was one of the first studies to use a dose of R. rosea relative to body mass, and it examined the effect of R. rosea on 6-mile cycle time trial performance. In this study, in addition to time trial time, rating of perceived exertion (RPE) was measured every 5 min during the time trial, as was heart rate. In addition, a Profile of Mood States questionnaire was completed pre- and post-exercise by participants in both the R. rosea and placebo groups. The authors reported that participants completed the 6-mile time trial significantly faster after ingestion of R. rosea compared to a carbohydrate placebo and showed a more pronounced dampening of RPE in the R. rosea group compared to the placebo.
A similar approach was employed by Duncan and Clarke (52) in terms of dose of R. rosea utilized. They asked 10 male recreational exercisers to undertake a 30-min cycle test at an intensity of 70% VO2 max on two occasions and once at 60 min, following ingestion of R. rosea or a placebo (maltodextrin). RPE values were significantly lower in the R. rosea trial at the end of the 30-min exercise bout, as well as higher scores for vigour and significantly higher scores for lack of discomfort for active compared to placebo.
These findings led Perfumi and Mattioli (53) to speculate that, in addition to enhancing the catecholaminergic system, the ability of R. rosea to increase performance involves an improvement in cellular energy metabolism. Studies have speculated that the ingestion of R. rosea can improve exercise performance via altered energy metabolism (54), activated by the synthesis or resynthesis of ATP in mitochondria and stimulated restorative energy processes after intense exercise (55).
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