Rhodiola for fatigue: what is claimed, what is known and the risks

Rhodiola rosea is a plant whose root and underground stem are used in traditional medicine in Eastern and Northern Europe and parts of Asia. It is known by many names, including golden root, arctic root and rose root. Extracts of the root and rhizome are dried and dissolved in alcohol to prepare medicinal compounds, according to the MSD Manual.

It is often described as an adaptogen, a herbal medicine term meaning a substance thought to help the body respond to stress and restore normal function. That term comes from herbal medicine rather than from a recognised medical category. Traditional claims include improving learning and memory, increasing energy, reducing fatigue and depressive symptoms and treating altitude illness.

The MSD Manual (UK consumer edition, written by a US pharmacist) is blunt about the claims. It says any single compound is highly unlikely to have such a broad range of benefits, that studies in cells and animals have important weaknesses, and that evidence from studies in people is limited because most studies are small and of poor quality, and some are contradictory.

It does say that studies in people, although not conclusive, have shown that rhodiola could possibly improve endurance including athletic, work and cognitive performance, reduce fatigue in stressful situations, and relieve anxiety and depression, though it provides less benefit than a traditional antidepressant would. One finding concerned reducing heart damage caused by the chemotherapy drug epirubicin.

Put simply, rhodiola may do something modest for some people in short trials, but the evidence is not strong enough to recommend it for fatigue.

The MSD Manual says taking rhodiola twice a day for 6 to 12 weeks seems to be safe for most people. Side effects can include dizziness, dry mouth and excessive saliva. Because it might stimulate the immune system, it could worsen autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. Safety in pregnancy, breastfeeding and children has not been studied.

On interactions, the manual states that combining rhodiola with prescription antidepressants could cause a very rapid heart rate, that it could lower blood sugar and blood pressure, that it may increase levels of warfarin and some anti-inflammatory medicines and that it may counteract immunosuppressants.

The NHS says herbal medicines are not available on the NHS and are not tested in the same way as standard medicines. They are not recommended for children, and should not be taken if you are pregnant or breastfeeding, have kidney or liver problems or are taking certain medicines. It advises checking for a traditional herbal registration (THR) mark and a product code from the MHRA, and not buying unlicensed products online.

Fatigue is a symptom, not a diagnosis. The NHS lists common causes as not enough sleep or insomnia, an unhealthy lifestyle, stress and depression, hormonal changes, some illnesses and some medicines, and conditions such as sleep apnoea, iron deficiency anaemia, diabetes, an overactive thyroid and ME/CFS. It advises seeing a GP if you have been tired for a few weeks and are not sure why, if it affects daily life, or if you also have other symptoms such as weight loss or mood changes, and says not to self-diagnose.

The NHS says treatment depends on the cause, and a GP may arrange blood tests to check for anaemia, diabetes or hyperthyroidism. Before trying a supplement, it is worth looking at sleep, alcohol, diet and activity.