Maggie McKay (Host): If you've been hearing a lot in the news or social media or from your friends about supplements called ashwagandha and lion's mane and wondering what the real story is, we're going to find out today with Dr. Ciara Kazakis, Internal Medicine doctor at St. Joseph Hospital Primary Care and Specialty Services in Nashua, New Hampshire.

Welcome to Wellness First, a St. Joseph Hospital podcast, where we hear and learn directly from the experts on all things health and wellness. I'm your host, Maggie McKay. Welcome, Dr. Kazakis. It's so great to have you here.

Ciara Kazakis, MD: Thank you so much, Maggie. It's an honor. I appreciate you having me today.

Host: Could you please tell us what you do at St. Joseph?

Ciara Kazakis, MD: Yeah. So, I practice at 460 Amherst Street. I'm an Internal Medicine physician, so I treat outpatient, and I see patients in the office.

Host: So, it seems like more and more we're hearing about lion's mane and ashwagandha, that's a hard one to say, I will admit, a lot on TikTok. It's quite the trend there. So, what are they? Are they natural? And, you know, we'll get into it later specifically what they do and one versus the other. But in general, what's the story?

Ciara Kazakis, MD: You know, there's a lot of new, we'll call them supplements for all intent and purposes. We'll get into a little bit better description of what they are. But, you know, I'm certainly seeing them a lot more in my own clinical practice. You had mentioned social media. Definitely seeing them come up on Instagram and in TikTok.

I was actually talking to some colleagues of mine and they kind of have an understanding. There's a little bit of, you know, information. You know, but even some of my colleagues still have questions about what they do, what the research is behind them, the side effects. So, I thought it would be good for medical providers out there who are having these questions about these supplements come from their patients, but also for the public too, to just get some more information, because they are becoming a quick staple in the medicine cabinet these days.

Host: So, I've heard that they've been used in Chinese medicine for centuries. Why are we just hearing about them?

Ciara Kazakis, MD: So, they have been used in traditional Chinese medicine, especially lion's mane. So, lion's mane, again, is supplement for all intents and purposes, but it's actually an edible fungus. So, it grows at the base of dead hardwood trees, like oak trees. They have been around for a long time. The reason we're starting to see them a little bit more is because more research is being done on them, albeit there's lacking human clinical studies and we'll get into that. But the main reason is because we are starting to see at least, you know, more test tube animal model studies being done on them, which just naturally is going to start trickling out into the scientific community and then the community, the population at large.

Host: So, they're basically mushrooms. Is that right? Or the mushroom family?

Ciara Kazakis, MD: Yeah. So, lion's mane is. And then ashwagandha, itself, again, has been used for thousands of years in traditional Chinese medicine, and it's a medicinal herb. So, that is actually a supplement, again, for all intent and purposes. But they've been around for thousands of years.

Host: Do we know what they do to our brains, if we take them in some form?

Ciara Kazakis, MD: So, mice brains, we have an idea. Again, human brain is where we're lacking the clinical studies, and that really is kind of where some of the ambiguity comes in with these, again, supplements, because we are starting to see some more studies come out, but we're not seeing human models just yet. A lot of the clinical trials are small. So if we are seeing them in the human population, it's very, very small. I mean, we're talking like 50 to 60 patients, which if you're familiar with scientific studies, is a very small sample size. Like I said, really until we start to have a larger sample size for human studies, we kind of just have a general idea of what these supplements do.

Host: So, what do they do to mice brains?

Ciara Kazakis, MD: So, let's talk about lion's mane. The thing with these supplements is when you hear about them in the community or, you know, you hear about them from your sister-in-law who's taking them, you know, there's actually really five to eight different health benefits that they're used for. So, I'll get into a little bit of that right now.

So, lion's mane, like I had said, so traditional Chinese medicine has been using lion's mane for a very long time. Cognitive impairment. So, there was actually a small study in that was done in 2009, with mice. And it actually showed that it improved brain function in mice. And the reason how it did this is that it actually helped to slow the progression of what we called amyloid beta, which is a protein that is intimately involved with the plaques that cause Alzheimer's dementia, so kind of going with that. It was a corollary that lion's mane can actually prevent neuronal damage. Again, direct evidence is lacking, but that was something that that small study did see in 2009. So, that was one kind of improvement in cognitive impairment that was tacked on for lion's mane.

Host: Are either of them regulated by the FDA?

Ciara Kazakis, MD: They are not currently regulated by the FDA. Again, direct evidence is lacking. There's really not even a set dosage recommendation on either one of them, which is why I said there's still a lot of things to be learned, which is why when I have the conversation with my patients, because there's a lot of questions around them. They have definitely demonstrated some benefits health-wise. But we're just not fully there yet to be able to make a full recommendation to prescribe them, if you will.

Host: There was an article in Forbes I saw about the benefits of ashwaganda. It said It relieves stress and anxiety, lowers blood sugar and fat, increases muscle and strength, improves sexual function in women. It went on and on. It's like the miracle drug, you know? Are there any drawbacks?

Ciara Kazakis, MD: It has everything. So, yeah, you're right. It's funny, when I was kind of researching, you know, and doing my homework in preparation for the podcast, I thought these are really being touted as like a miracle drug, like Pfizer is in trouble. But let's get into that. So, ashwagandha, it's actually Sanskrit. So, it's actually means the smell of the horse. So just a little background, a medicinal herb that, like I said, it's been used for thousands of years. And it's ubiquitous in India and Southeast Asia. So, those kinds of areas have been using this for a long time. It's best known for its stress relieving properties, which is also why it's been so popular in society.

So, there was a very small study, 58 participants, and they looked at how ashwagandha, you know, helped us with our stress. What they actually found, long story short, was that these 58 participants took either 250 or 600 milligrams of ashwagandha for eight weeks, so about two months. And what they found at the end of that eight-week period was a decrease in perceived stress by the participants. So, they just overall felt better. They felt less stressed, but they also were able to measure the cortisol levels and they actually did see a decrease in cortisol levels, which cortisol is a stress hormone, and improved sleep quality as well versus placebo meaning versus participants that had not taken it for the eight weeks. So, that was good. Again, 58 participants, people will argue that's not a big number, but did show improvement in stress, both perceived and measured through hormone levels.

Host: I saw on TikTok quite a few times, kids, like I would say probably college age, talking about emotional blunting. In other words, they said like after they broke up with their girlfriend, they took one of these and they didn't feel the pain anymore. And then, another girl said, "Yeah, I didn't feel anything." So, what's that about?

Ciara Kazakis, MD: Yep. So, ashwagandha has also been studied. There was a study that looked at 66 patients. This particular study had 66 patients with diagnosed schizophrenia who were struggling with depression. And in the study, it a was 12-week long study, these patients had taken a thousand milligrams of ashwagandha daily. And then, at the end of that time period, the study period, there was a reduction in depression and anxiety, again, perceived versus placebo. So, a 2021 review actually indicated that ashwagandha can help depression, anxiety, and insomnia.

Host: Do you need a prescription for either or both or...?

Ciara Kazakis, MD: Nope, you do not. So, they are over-the-counter. The recommended dosages have not been set in stone because we do still have a lot more research that needs to be done. So, it's really an intimate conversation that needs to happen with your medical provider based upon who you are, based upon your medical problems, based upon medications that you may be taking already to kind of see, would this be a benefit?

When I have the conversation with my patients, we talk about, you know, some of these limited studies that have been done. And we also talk about, you know, more research is definitely needed. But you know, so far, there have been some pretty promising positive effects of taking these supplements.

Host: Well, it sounds like there aren't any drawbacks that they know of yet. Like you said, there needs to be a lot more research, but if it helps at all with dementia, can you imagine how wonderful that would be?

Ciara Kazakis, MD: Yeah, it would definitely be a game-changer for the medical community. You know, when we talk about, you know, kind of side effects, lion's mane, there have been some reported allergy and asthma side effects. Those have kind of been the two biggest side effects, people becoming allergic to the supplement.

The other thing I wanted to kind of hit upon too, at least with lion's mane, is they're actually seeing in animal studies, that it's actually able to block a very key enzyme dealing with blood sugar, regulatory blood sugar. Basically, it's able to block an enzyme, or enzyme activity, that breaks down carbohydrates in the small intestines. So, in essence, your body is not absorbing those carbs, which lowers your blood sugar. So, lion's mane is actually starting to show that maybe some beneficial use in diabetic patients as well would be great.

Host: That would be. So in closing, Dr. Kazakis, is there anything else you'd like to add that we didn't cover?

Ciara Kazakis, MD: No, like I said, you know, there's a lot of promising effects. It has to be a conversation with your doctor, with your medical provider based upon who you are. And I tell my patients, they're not technically regulated by the FDA. So, it really has to be a very intimate decision and conversation with your medical provider. But so far, there's been some promising insight, let's say, with these two supplements in particular. So, stay tuned.

Host: Well, that all sounds encouraging and hopeful. But again, the takeaway is don't do it until you ask your doctor about it, right?

Ciara Kazakis, MD: Yes, yes, a hundred percent.

Host: All right. Thank you so much for your time today. I know you are super busy, so we appreciate it.

Ciara Kazakis, MD: Thank you so much.

Host: Again, that's Dr. Ciara Kazakis. And for more information, please visit stjosephhospital.com or you can call 603-883-7970. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. This is Wellness First from St. Joseph Hospital. Thank you for listening.