Tongkat ali is a traditional Malaysian tonic, sometimes called “Malaysian ginseng” because of its energy-boosting effects.
Its traditional use is as medicine for older men suffering from tiredness, fatigue, and low libido. Like ginseng, it’s a root, and in a traditional preparation is boiled into tea or a soup.
Dr. Shawn Talbott joins Jesse this week to talk about harnessing this traditional medicine for modern use.
The Benefits of Tongkat Ali
Like ginseng, tongkat ali boosts energy, vigor, and mental focus. It also increases libido.
How is it doing this? Well, there are two phases of action.
Within 30 – 60 minutes of dosing, you’ll feel more mentally energetic. That speed means that it’s affecting your neurotransmitters, not hormones or your endocrine system.
How Tongkat Ali Works
But there’s a second mechanism of action. After about two weeks of dosing, tongkat ali begins to have an effect on the endocrine system by increasing testosterone and decreasing the stress hormone cortisol.
However, it’s not causing an increase in synthesis or secretion of testosterone. It’s just making more testosterone bioavailable.
But more than that, if you have healthy levels of testosterone, it won’t boost your levels higher. If you’re at suboptimal levels of testosterone, however, tongkat ali will take you back to a healthy baseline.
This is because tongkat ali is an adaptogen, a class of plants and fungus that normalize physiology regardless of the direction of change. So they can bring you up when you’re down, and down when you’re up. Adaptogens help you maintain balance.
The Perfect Remedy For Stress
Both men and women can benefit from tongkat ali, as both need testosterone to function optimally, just in different amounts. Because women produce 10 times less testosterone than men, it’s even more important for women to keep their levels healthy.
The daily stresses of our modern lives can make this difficult however. When we’re under chronic, moderate stress, our levels of cortisol increase and testosterone is suppressed. Testosterone is just what you need to help you feel calmer.
Taking tongkat ali reverses this, making more testosterone bioavailable, and restoring your cortisol rhythm.
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Taking Tongkat Ali
Dr. Talbott’s research has used 200mg per day as a dosage and found effects. Higher doses are also effective, but not necessary.
He recommends looking for a hot water extract, as using water extracts different bioactive compounds than an alcohol extract, and the traditional usage has always relied on water.
Who Should Take Tongkat Ali?
Dr. Talbott recommends tongkat ali for a range of people, but especially:
- Older people
- Women, particularly if considering taking bioidentical hormones
- Athletes who train hard
- Anyone suffering from low libido
- Anyone suffering from chronic, moderate stress
Tongkat ali is generally very safe. Dr. Talbott hasn’t seen any major side effects and hasn’t heard of any allergic reactions. There’s low addiction potential.
The most common negative side effect is heartburn if taken on an empty stomach.
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Shawn Talbott: Tongkat ali was used traditionally as a tonic, probably the stereotypical use of Tongkat Ali. Back in the day, and even to this day, when it's used by the people of Malaysia is as a tonic for an older man. Older man is a little bit tired, a little bit fatigued, a little bit low in the libido department. You get some Tongkat Ali root and you either shave it to your tea, or you boil it, or you put in to a soup as a traditional way to do it.
So, you're doing an extraction, so to speak. You're doing the hot water extraction if you're making it into a tea, and what you get from that is libido comes back, energy comes back, mental focus and acuity comes back. In my research, I measure something called vigor. Psychological vigor is part energy, part mental focus, part well-being, and that's what you get from a traditional usage of Malaysian ginseng or Tongkat Ali, or what we call Eurycoma. Its Latin name is Eurycoma Longifolia.
Jesse Lawler: Are the results the people seek from Tongkat Ali something that comes on in an acute spike a few minutes or hours after they take it or is it something that builds in your system over a period of time as a nutrient?
Shawn: That's a great question actually, because it's kind of a two-phase effect. You can get more of a mental energy effect from Tongkat Ali within 30 to 60 minutes of taking it, right? So that tells us that there's something going on, maybe, neurotransmitter-wise in the brain. Maybe, something is happening with the gut microbiome. That sort of acute effect that you're feeling within an hour or so, it's unlikely that it’s hormonal. It's unlikely that it’s doing anything through sort of the endocrine system.
But, there's a secondary effect that does come on after several weeks of usage and that is more of an endocrinological effect where you're getting a change in cortisol, stress hormone is coming down, testosterones are coming up, and I'll put a big asterisk on that as soon as people hear me say that I'm raising their testosterone. If you're a guy, you're getting all excited, especially if you're an athlete, and if you're a woman, you're getting all worried, right?
But, what we found that I think is interesting, because I think it supports how the herb is used traditionally, but it doesn't necessarily support the modern usage of it in some of the modern supplements in that what we found is that, if you had low testosterone, or sub-optimal testosterone levels, we were able to raise those back up into what we might consider a more normal, more optimal range, but we weren't increasing it above that, and that, I think, is an important distinction for people who are maybe looking at something like Tongkat Ali and saying, "Oh, maybe that'll increase my performance." Maybe yes, maybe no, depending on where you're starting from.
Jesse: Got you. So, there is sort of a natural ceiling to it?
Shawn: Yeah, and I think it goes back to why people should consider adaptogens in the first place in that they really are these herbs that help to either maintain down balance, or rebalance you if you're out of balance versus taking something to take you from your normal baseline to a higher baseline, and this might not be that. Like a Tongkat Ali might not take you normal to super normal like some other nootropics might do. But, if you're below normal or you're sub-optimal, this might be just the thing you need to get back up to that strong baseline where you should've been in the first place.
Jesse: Yeah, that's one of those continuing themes that we try to keep coming back to is getting yourself to your physiological baseline the natural way, if possible, before layering in the exotic new pharmaceuticals technologies kind of icing on the cake stuff.
Shawn: I'm sure you run into this all the time is that you get people who are not eating right, not sleeping enough, they're under a lot of stress, they're putting all these things on top of themselves so that, in effect, they're going through life at this sub-optimal balance point. They're suppressed in a lot of ways, and if they would just do the things that we know they're supposed to do: control their stress, get more sleep, exercise more regularly, eat a better diet, they're going to be at a better level anyway, and then from there, maybe the sky's the limit but let's at least get you back to where you’re supposed to be before you start doing all kinds of self-prescribing.
Jesse: What are some of the things we know about the mechanism of action for Tongkat Ali?
Shawn: We think the way it works -- in the clinical trial that we did, we did it because of some of my clients, nutraceutical companies that want to formulate with this were looking at it as a testosterone booster. Could we put this in a sports product and market it to young athletic males as something that's going to increase their testosterone? Because, sometimes companies will market it as an herbal Viagra or an herbal sexual enhancement kind of a thing, and so the other side of that is to come into sports and say, "Well if it boosts your testosterone that's going to be good for your muscles."
We came at this in a very skeptical way to say, "Look it probably isn't going to increase testosterone." The way it's structured, it just doesn't seem like it should have that sort of a mechanism in the body. So, we did a trial, and what we found was what I explained before. It didn't increase testosterone from normal to above normal, but it did take it from low normal back up to mid-range normal, and we think that's what happening there is not that it's increasing total testosterone - we actually did not find that. There was no increase in overall testosterone synthesis or secretion, but there was a higher level of free testosterone.
One of the things that can happen in certain kinds of stress is your body still has testosterone, but it's not a bio-available form. So, Tongkat Ali, its main effectiveness might be that it takes that testosterone that's there and makes it more bio-available so that you're able to use a higher percentage of what you already have on board.
Jesse: Where is the testosterone bound up on the body when it's not freely available? I mean, the fact that there is free testosterone implies that there must be non-free testosterone somewhere? What's going on there exactly?
Shawn: Yeah, so it has to be free testosterone for your body to use it. In total testosterone, it's not a bio-available source. The way we get to that is that we measure, in our studies, salivary testosterone. Salivary testosterone is free testosterone, so you're not getting into, "Well, am I measuring total? Am I measuring free? What percentages are those?" What we're measuring in our studies is 100% free testosterone because we're measuring salivary testosterone.
Jesse: Did the changes that you saw bringing people up towards that baseline, was that age-dependent in any way? Did you test both older men for whom a lower level testosterone might be normal, and also younger men who are running at a conspicuously low level of testosterone for their age?
Shawn: No, and that'd be interesting to do because we wanted to not only look at the potential hormonal change, but we also want to look at mood state changes. So, we looked at subjects that were moderately stressed, and we split it between men and women. So, we had males and females here. When we talk about testosterone, I think people default automatically think that testosterone is a man's hormone and that's the only ones who should be concerned about it.
But, women have plenty of testosterone. Ten times less than a male's body will, but it's even more important for a female to keep her testosterone in that normal range because when her testosterone drops below normal, there's so little of it, it's much more noticeable that she'll get some to the common side effects like fatigue, and depression, and brain fog, and abdominal fat, and those sort of things. So, we wanted to look at both men and women, and what we found was there wasn't the same magnitude of change, but there was the same percentage change, which again points to, "Hey, this isn't something that's changing synthesis; it's probably changing the bio-availability of this hormone that's already been manufactured in the body."
So, we looked at men and women, we looked across a wide age range - you would say middle-age people - and we look at people with moderate stress, which is known to increase cortisol and suppress testosterone.
Jesse: And it’s also just about everybody in the world these days.
Shawn: You know, and that's one of the other things is that it makes it more representative of the people want to look at a supplement like this. Going into study, what we thought was if this is going to work, and we see any of this hormonal changes, and we look at how people feel when they take this traditionally, we expected we would see changes in things like vigor. Vigor would go up and burnout would go down, we thought we would see changes in fatigue levels, we thought we'd see changes in depression levels, and we actually didn't see any significant change in depression, we didn't we didn't see any significant change in vigor or fatigue, but we did see changes in other mood states. So, in the Tongkat Ali group, tension went down, so people were calmer, which was interesting to see, and that could have been to the cortisol suppression.
Anger went down, which was really interesting, and a lot of people have asked me questions about saying, "Well, wait a minute, if testosterone is going up even though it was free that was going up, shouldn't people be more angry. Isn't that like an anger thing?" and they're thinking like 'roid rage kinds of questions, but it didn't, anger went down. Irritability would be another way of describing what anger is in the mood state parameters that we look at. Confusion went down, which makes perfect sense, because if your cortisol's up and your testosterone is down, you generally have more brain fog when you're stressed out, and so people seem to be clearer-headed with this, which kind of a neat story overall.
You're chronically stressed, your cortisol goes up, your testosterone goes down. We can give you Tongkat Ali, and I can't remember if we did four weeks or eight weeks in this particular trial. So, we see that cortisol's come down to normal, from high down to normal. Testosterone's come from low back up to normal. So, hormones are normalizing, and then we see a very nice correlation between those hormones and the mood state parameter. So, you can’t necessarily sit there and say, "Oh, my cortisol feels lower today." But, you can say to yourself, "Do I feel calm? Do I feel stressed? Do I feel clear headed or foggy or those sorts of things?" So, the mood state parameters and the hormone parameters tracked really nicely with each other.
Jesse: Something like cortisol varies day in, day out based on diurnal rhythms, among other things so that the changes that you're seeing is your tracking of cortisol levels over the course of eight weeks. How is that being measured? Are you measuring it multiple times per day or the same time of day for a given person each day?
Shawn: Yeah, so generally in the kinds of studies that we do, we'll measure it two ways. If we're doing circadian rhythms and we're looking for a pattern of cortisol, we'll measure it four times a day: immediately on waking, 10 o'clock in the morning, 2 o'clock in the afternoon, 8 o'clock at night. Usually four time points so that you can get a curve, and what we see there with something like Tongkat Ali is we'll see that that cortisol rhythm can get restored similar to how several adaptogens will do that.
What a lot of people will get when they're under chronic stress isn't so much that their cortisol is high, but that their cortisol rhythm is flattened. What you end up seeing is that their morning cortisol, when it should be high, is low, and so that person feels fatigue. They feel like they can't get out of bed. Then, that same person, when you look at their nighttime cortisol, their nighttime cortisol is high when it should be low, and that person feels restless, and tense, and they can't relax. So, it's not high when it's supposed to be high and it's not low when it's supposed to be low. It's flat. I mean, literally, the line is flat across those four time points and that person just feels terrible. Something like Tongkat Ali, or cordyceps, or rhodiola, or some of the ginseng can restore that rhythm so that you're not really changing overall cortisol exposure, but you're changing when the cortisol exposure hits.
We also can sometimes measure it depending on the design of the study. If we don't have the opportunity to measure it four times throughout the day, we can just do once, and that one time is a morning, first wakening cortisol. So, we basically have the subjects take a little saliva tube, put it on their bathroom counter or on their nightstand, and as soon as they wake up in the morning, they're spitting into that tube. That morning cortisol is very representative of what their cortisol reactivity is going to look like through the rest of the day.
Jesse: Do the parameters that you're tracking, things like mood over the course of these eight weeks, is that a self-reported test that people are doing or is there something more numerical or analytical? I'm also wondering about things like brain fog, if this is just based on a self-report or doing time tests or something like that?
Shawn: We use a lot of validated, psychological mood state questionnaires. The one that we use is called a profile of mood states, or POMS. That one's been used in 3 or 4 thousand different clinical trials to really get a quantitative, and a qualitative, validated view on what somebody is feeling like. I see all kinds of studies that will do exactly what you just described asking people, "Do you have more energy? How do you feel?" That's interesting. Every piece of information is good information, but using something like the POMS, it's validated, it's quantifiable, it's trackable over time.
The one thing that it does suffer from is that the intervals that you can take something like that has to be two weeks or longer. So, you couldn't give somebody a profile of mood states today and then give it two hours later or tomorrow. It just doesn't work that way. It really is more of a long term index of what their mood is doing in several different parameters. There are other ones too: their quality of life indices that are more four weeks to eight weeks in duration. We can quantify how somebody is feeling overtime pretty reproducibly.
Jesse: What were the population sizes like that you're putting in through these studies?
Shawn: There's one that we've been talking about, there were probably 60 or so subjects that we went through, so not a huge study, but the fact that we're seeing pretty good statistical significance on most of this parameters tells us that the magnitude changes that we're seeing are pretty substantial. The consistency that we're seeing of the 30 subjects who got Tongkat Ali, it's not like we’re getting a huge effect and then rest are getting no effect. There seems to be a pretty good consistency, given that let me qualify it by saying, in a certain sense, our subjects were tailor-recruited to have an effect. They were moderately stressed. These would be the kinds of people who would get a traditional preparation of Tongkat Ali if they were living in Malaysia and went to a traditional therapist.
So, from that standpoint, you look at that. Can you now take those data and transfer it to a 25-year-old weightlifter who's trying to get ripped. I wouldn't necessarily think that that would be right use of the data.
Jesse: So, in the traditional uses, it sounds like there's probably a lot of different potential preparations. Sometimes this might be a drink, it might be topical treatment. There's types of studies that have been shown to have efficacy. What are some of the commonalities? Like, if somebody's looking for Tongkat Ali preparation, what might that look like?
Shawn: What I tell people is to look for a water extract. Even though we come at it from the perspective of science and say, "Okay, what mechanism do you think we're seeing here? What do the rodent studies say? What can we standardize this extract to?"
I do always like to go back to traditional usage, and the easiest way to look at traditional preparations is to say, "Alright, is this root traditionally a water extract? Are they making tea out of it? Or is this an alcohol extract? Are they putting it in a jar with ethanol, rum, or something like to extract those bioactives?" because that's a really important distinction because the water's going to extract different bioactive compounds that the alcohol is. Traditionally, Tongkat Ali is a tea, so it's a water extract.
There have been some studies, and I'm not an analytical chemist. I've read these studies before to show you that if you extract that Tongkat Ali root with alcohol versus water, you get a vastly different profile of bioactives, and I'm not sure that doing an alcohol extract is the way to go, because we've got hundreds or thousands of years of usage in Malaysian traditional medicine using hot water extracts. So, what I'll tell people is if they're going to look for Tongkat Ali supplement, the supplement is probably going to say on it, "Hot water extract," and then I think that's probably the way to go because we know the most about it. That's what we used in our study, and so I can't speak to an alcohol extract of is that better or worse. I know it's different.
Jesse: What should people be looking at dosage-wise with Tongkat Ali? I know one of the nice things with adaptogens is that they're sort of self-regulating and there's not necessarily a hard and dangerous ceiling like there are with some other compounds. But, nevertheless, what's a target dose that would be good to aim for?
Shawn: We use 200 milligrams a day for four weeks of a hot water extract, and I know there's a couple of companies that make a hot water extract, three that I know of, at least, that supply it to a lot of different finished product manufactures. I would say to somebody, "If you're interested in this, look for 200 milligrams, look for a hot water extract." I don't know if you're going to find Tongkat Ali by itself out there. Maybe you will, but I would suspect that most formulators are going to say, "Alright, so we can get these effect with Tongkat Ali, what else am I going to combine it with? Am I going to combine it with XYZ ingredients so I have my proprietary blend or something like that?" That's where I would expect to see at most often.
Jesse: For somebody that's looking to put a stack together and Tongkat Ali is something that they're interested in, does that get rid of the need for something else that might be in their medicine cabinet already, something that might then be duplicative and they just don't need anymore?
Shawn: I'll tell you who I recommend Tongkat Ali to most often this days is athletes. Even like me, I'm turning 50 later on this year, I still exercise pretty hard, I do ultra-running and long-distance triathlons and things like that. When I'm training my hardest, my cortisol-testosterone balance is definitely at risk, so I'll take Tongkat Ali in that sort of situation to try to keep my testosterone in the normal range, keep it from dropping.
That's why I recommend it in that sort of a situation as kind of a first step. I'll also recommend it to people who are thinking, "I need my testosterone levels up." Somebody might think that their testosterone is low for whatever reason, so I'll say to them, "Try Tongkat Ali first. See if your problem is actually that you need more free testosterone. See if that's going to get where you need to be. Then if not, if that doesn't do it for you, then there's others options, like you can go to DHEA, that's going to actually be the building block for you to make more testosterone. You'll see if that is kind of the issue." You may differ with this. Do you stack automatically or do you stack sequentially? I'm more of a sequential stacker. You know, you try product A, see what you get with that, then add product B, then add product C, instead of starting with a blended ABC.
Jesse: It seems like there's so much individual variability as far as what a given person is going to respond to that if you add everything in the kitchen sink all at once, even if you do get a result, you're not going to know what the result's actually coming from.
Shawn: Right, exactly.
Jesse: Are there any real "got you" things that people should know or that just might catch people by surprise that you wouldn't suspect?
Shawn: Maybe one that we touched on that I think is maybe important to emphasize is the female angle. Whether it's women who are training hard, women who are under stress, or if it's women who have low libido, low sex drive, or are considering bioidentical hormones or something like that, this might chance for them to say, "Alright, I'm going to take this traditional herb. I don't have to be afraid of it boosting my testosterone level like I'm taking a steroid or something like that, and it might get me up to that level where I feel like my young self again." If there's one label I could put on this, it really has some "anti-aging effects" in terms of hormones normalized a little bit and you feel younger in certain ways. I would maybe say that women should look at it even though it's "testosterone herb".
Jesse: Have you seen any negative effects from it, anybody that has an adverse reaction?
Shawn: I haven't. People will sometimes say that it gives them heartburn if they take it on an empty stomach. My solution there, as a nutritionist, is to tell them to take it with a meal. But, I've never heard of any allergic reactions, or haven't seen anything with liver enzymes, or renal functions, or anything like that that have changed even at pretty high doses. We only use 200 milligrams in ours, but I know that sometimes there's recommendations for 600 or 800 milligrams, but I haven't really seen any problems with that either.
Jesse: Is there any addictive potential for Tongkat Ali? Is that something that's been seen or talked about?
Shawn: I don't think it has does that sort of an effect at all. I think you'll feel better on it if it’s rebalancing you in the ways that we've just discussed, but I don't think there's an addictive or a stimulant or any of that kind of an effect going on here.
Jesse: Do people seem to build up a tolerance? Is this something where you need to cycle on or off every now and then to make sure that it kind of maintains its oomph?
Shawn: That's a great question. It's always really hard to answer whether it's Tongkat Ali, or whether it's any adaptogen in general. Because, in a certain sense, you should only be taking adaptogens when you need them, when your stress is high, or when your fatigue is high, or when your energy is low, or whatever.
There's one school of thought that adaptogens are temporary usage. You take them during the time of the high stress, and then when the stress goes away or the stress normalizes, you taper off of them. I kind of look at that as someone who studies stress, and I agree with that, but I also look the kind of stress that most people are under: the stress of sleep deprivation, the stress of families, and the stress modern living, and the stress of poor diets, and I look at it and say, "When is that stress going to come down a level where you want to give off of this adaptogen." So, I'm more of a chronic-usage adaptogen kind of a person than a cycling on and off, but I think that's open for debate.
In psychology research, vigor is the opposite of burnout. We have a lot of people who have high burnout, or low vigor, they don't feel very good. They're fatigued, and so they reach for a Red Bull. They can't concentrate, and so they think they need Ritalin or Adderall. They're depressed, their doctor tells them Prozac or Zoloft, or something like that. I'm not an anti-pharmaceutical kind of person by any stretch, but I'm trained as a nutritionist, and so what I'd rather do is say to people, "Alright, what can we do with nutrition, or herbals, or lifestyle where we can get you out of that state of burnout and back to a state of vigor?" You cover all aspects of this with nootropics, and there's a zillion ways to skin that cat, but adaptogens is one of the areas that I come back to. So, I've done studies on cordyceps, and rhodiola, eleuthero, ashwagandha, etcetera.
I like to throw a lot of things into the adaptogen basket because they're helping you become more stress-resilient through the immune system typically, but still the outcome is that you're more able to withstand whatever stressors you're under.