Rhodiola Evidence Discussion Hypoxia • Summary: Rhodiola has been hypothesized to protect against hypoxic-induced injury (12; 23; 197; 200) by increasing intracellular oxygen diffusion and efficiency of oxygen utilization, as well as to reduce hypoxia-induced oxidative damage via antioxidant activities (197). In available clinical trials, Rhodiola rosea had a lack of beneficial effects for hypoxia. Well-designed clinical trials are required before a conclusion may be made. • Systematic review: Hung et al. conducted a systematic review to evaluate the randomized controlled trials evaluating Rhodiola rosea (115). AMED (1985-July 2009), CINAHL (1982-July 2009), the Cochrane Library (search in July 2009), Embase (1974-July 2009), MEDLINE (1950-July 2009) and the Web of Science (searched in July 2009) were searched. Studies using Rhodiola rosea monotherapy for any condition or in healthy volunteers were included. Twelve randomized controlled trials were included in the review, all of which were placebo controlled trials. Six trials evaluated rhodiola for exercise performance (14; 97; 104; 107; 109; 234), four for mental performance (60; 78; 97; 104; 107), and two for mental health conditions (98; 103). Significant benefit was noted in eight studies. Adverse effects were mild and infrequent. Five of the studies had a Jadad score of 3 or higher, indicating good quality. • Evidence: Wing et al. conducted a randomized, double-blind, placebo controlled trial to investigate the effect of Rhodiola rosea on hypoxia and oxidative stress at a simulated altitude of 4,600m in healthy individuals (109). Fifteen healthy men and women, aged 20-33 years, were included in the study. Subjects were nonsmoking, moderately active, and generally healthy, based on questionnaire results. At baseline, subjects received three separate 60-minute hypoxic exposures (breathing 13.6% oxygen at an ambient barometric pressure of 633mmHg, which simulates the partial pressure of oxygen at 4,600m of elevation). Then in random order, each subject received placebo, Rhodiola rosea, or an acute dose of stabilized oxygen dissolved in water for seven days. Endpoints included arterialized capillary blood oxygen samples (PcO2), pulse oximeter oxyhemoglobin saturation (SaO2), and oxidative stress markers (serum lipid peroxides and urine malondialdehyde). PcO2 decreased by approximately 38% from baseline to the 60-minute hypoxic exposure, and SaO2 decreased from 97% to 81% in all groups. There was a lack of effect of Rhodiola rosea treatment on oxidative stress markers. Side effects were not indicated. Randomization and blinding were inadequately described in this study. • Ha et al. conducted a randomized equivalence trial in 24 male subjects residing at high altitudes to assess the effects of rhodiola on improving sleep quality (110). Included subjects were all healthy males, aged between 18 and 21 years, and had migrated to an altitude of 5,380 meters above sea level for at least one year. Subjects were randomly divided into three groups: group A was given two rhodiola capsules twice daily; group B was given acetazolamide 0.25g twice daily; and group C was given two rhodiola capsules and acetazolamide 0.25g twice daily. All medications were taken by mouth for 24 days. Standardization of rhodiola capsules and acetazolamide was not specified. Rhodiola capsules were manufactured by Sanpu Pharmaceuticals in Qinghai, China. Acetazolamide was manufactured by Xinyi Pharmaceuticals in Shanghai, China. Sleep structures and blood oxygen saturation (SaO2)were recorded at the initiation of the study and after 24 days of treatment. All three groups had improved sleep structures and SaO2 compared to before treatment (p
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