Phytotherapy: Considerations for athletes and athletic trainers

G. Baydas; M. Uca; V. S. Nedzvetsky

doi:10.15421/0225006

G. Baydas Istanbul Medeniyet University
M. Uca Istanbul Esenyurt University
V. S. Nedzvetsky Dnipro State Agrarian and Economic University

Keywords: herbal medicines, exercise, alternative medicine, adverse effects, medicinal plants.

Abstract

Recently, the increased availability and popularity of herbal supplements have created an environment of misinformation for both patients and healthcare providers. The rich bioactive compounds found in plants, such as polyphenols, flavonoids, alkaloids, terpenes, and glycosides, have been shown to exhibit anti-inflammatory, antioxidant, antimicrobial, and immune-boosting effects. Each plant possesses a unique chemical structure and therapeutic properties. Notably, many plants contain antioxidant components that prevent cell damage and slow down the aging process. Research has demonstrated that these properties play a significant role in preventing chronic diseases and contributing to a healthy lifestyle. Taraxacum officinale exhibits antidiabetic effects, while Panax ginseng enhances physical and mental performance. Studies indicate that these plants have a wide range of potential effects due to the diverse and numerous bioactive compounds they contain. Zingiber officinale and Taraxacum officinale are effective in addressing digestive issues. Additionally, Curcuma longa stands out for its anti-inflammatory properties, Hypericum perforatum for its antidepressant effects, Achillea millefolium for promoting vitality, Tribulus terrestris for improving sexual health and performance, Urtica dioica for its anti-inflammatory and detoxifying e f fects, Rhodiola rosea for stress reduction, and Echinacea purpurea for boosting immunity. Of course, the effects of these he r bal products on human health are not limited to the benefits mentioned above. All individuals using these products, particularly athletes and athletic trainers, must be able to identify their effectiveness and potential risks, as well as select the appropriate products and dosages. It's important to recognize that, despite their many benefits, these products can have adverse effects ranging from mild to life-threatening when used irresponsibly. Athletes tend to use herbal supplements more than non-athletes. Therefore, professional athletes, particularly those who are involved in sports competitions and have to exercise healthily, must pay attention to the warnings of their doctors and athletic trainers when using herbal supplements in order not to negatively affect their performance. This review aims to assess the health benefits and potential adverse effects of commonly used herbal products and offer relevant recommendations.

References

Adnan, M., Gul, S., Batool, S., Fatıma, B., Rahman, A., Yaqoob, S., Shabir, H., Yousuf, T., Mussarat, S., Ali, N., Khan, S.N., Rahman, H., & Abdul Aziz, M. (2017). A review on the ethnobotany, phytochemistry, pharmacology and nutritional composition of Cucurbita pepo L. Journal of Phytopharmacology, 6(2), 133–139.

Ali, B. H., Blunden, G., Tanira, M. O., & Nemmar, A. (2008). Some phytochemical, pharmacological, and toxicological properties of ginger (Zingiber officinale Roscoe): A review of recent research. Food and Chemical Toxicology, 46(2), 409–420.

Ali, S. I., Gopalakrishnan, B., & Venkatesalu, V. (2017). Pharmacognosy, phytochemistry and pharmacological properties of Achillea millefolium L.: A review. Phytotherapy Research, 31(8), 1140–1161.

Altun, M. L. (2022). Fitoterapide yer alan bazi bitkisel kaynaklar ve gelecekte tibbi bitkiler [Some herbal resources in phytotherapy and medicinal plants in the future]. In: Tekin, A., Çankaya, İ. T., & Zeybek, A. U. (Eds.). Fitoterapi Uygulaması Kitabı [Phytotherapy Practice Book]. T. C. Sağlik Bakanliği, Sağlık Hizmetleri Genel Müdürlüğü. Republic of Turkey Ministry of Health, General Directorate of Health Services, Ankara. Pp: 88–95.

Amalraj, A., Divya, C., & Gopi, S. (2020). The effects of bioavailable curcumin (Cureit) on delayed onset muscle soreness induced by eccentric continuous exercise: A randomized, placebo-controlled, double-blind clinical study. Journal of Medicinal Food, 23(5), 545–553.

Appell, C. R., Jiwan, N. C., Wang, R., Shen, C. L., & Luk, H. Y. (2024). Ginger supplementation attenuated mitochondrial fusion and improved skeletal muscle size in type 2 diabetic rats. In vivo, 38(1), 73–81.

Aslani, M. R., Movassaghi, A. R., Mohri, M., Pedram, M., & Abavisani, A. (2004). Experimental Tribulus terrestris poisoning in goats. Small Ruminant Research, 51, 261–267.

Badr, S. E., Shaaban, M., Elkholy, Y. M., Helal, M. H., Hamza, A. S., Masoud, M. S., & El Safty, M. M. (2011). Chemical composition and biological activity of ripe pumpkin fruits (Cucurbita pepo L.) cultivated in Egyptian habitats. Natural Product Research, 25(16), 1524–1539.

Bakhshaei, S. (2017). Phyto-pharmacological effect of nine medicinal plants as a traditional treatment on depression. Journal of Applied Pharmacy, 9(3), 2–5.

Balaji, S., & Chempakam, B. (2010). Toxicity prediction of compounds from turmeric (Curcuma longa L). Food and Chemical Toxicology, 48(10), 2951–2959.

Barrett, B., Brown, R., Rakel, D., Mundt, M., Bone, K., Barlow, S., & Ewers, T. (2010). Echinacea for treating the common cold: a randomized trial. Annals of Internal Medicine, 153(12), 769–777.

Baumgardner, D. J. (2016). Stinging nettle: The bad, the good, the unknown. Journal of Patient-Centered Research and Reviews, 3(1), 48–53.

Bayir, E., Cebe, G. E., & Öztürk, B. (2023). Naturally sourced ergogenic supports used by athletes. Journal of the Faculty of Pharmacy of Ankara, 47(3), 1155–1169.

Bellar, D., Moody, K. M., Richard, N. S., & Judge, L. W. (2014). Efficacy of a botanical supplement with concentrated Echinacea purpurea for increasing aerobic capacity. International Scholarly Research Notices Nutrition, 2014, 49549.

Bent, S., & Ko, R. (2004). Commonly used herbal medicines in the United States: A review. The American Journal of Medicine, 116(7), 478–485.

Borchardt, J. K. (2002). “The beginnings of drug therapy”: Ancient Mesopotamian medicine. Drug News and Perspectives, 5(3), 187–192.

Borrelli, F., & Izzo, A. A. (2009). Herb–drug interactions with St John's wort (Hypericum perforatum): An update on clinical observations. The American Association of Pharmaceutical Scientists Journal, 11(4), 710–727.

Brinkeborn, R. M., Shah, D. V., & Degenring, F. H. (1999). Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold: A randomized, placebo-controlled, double-blind clinical trial. Phytomedicine, 6(1), 1–6.

Bucci, L. R. (2000). Selected herbals and human exercise performance. American Journal of Clinical Nutrition, 72(S2), 624S–636S.

Burgos-Morón, E., Calderón-Montaño, J. M., Salvador, J., Robles, A., & López-Lázaro, M. (2010). The dark side of curcumin. International Journal of Cancer, 126(7), 1771–1775.

Çankaya, İ. T. (2022). Bitkiden ilaca tarihi yolculuk ve fitoterapide temel kavramlar [Historical journey from plants to medicine and basic concepts in phytotherapy]. In: Tekin, A., Çankaya, İ. T., & Zeybek, A. U. (Eds.). Fitoterapi Uygulaması Kitabı [Phytotherapy Practice Book]. Republic of Turkey Ministry of Health, General Directorate of Health Services, Ankara. Pp. 3–20.

Chan, S. W. (2012). Panax ginseng, Rhodiola rosea, and Schisandra chinensis. International Journal of Food Sciences and Nutrition, 63(S1), S75–S81.

Cheetham, P. J. (2013). Role of complementary therapy for male LUTS. Current Urology Reports, 14(6), 606–613.

Chen, X. W., Sneed, K. B., Pan, S. Y., Cao, C., Kanwar, J. R., Chew, H., & Zhou, S. F. (2012). Herb–drug interactions and mechanistic and clinical considerations. Current Drug Metabolism, 13(5), 640–651.

Clare, B. A., Conroy, R. S., & Spelman, K. (2009). The diuretic effect in human subjects of an extract of Taraxacum officinale folium over a single day. The Journal of Alternative and Complementary Medicine, 15(8), 929–934.

Clayton, D. J., Burbeary, R., Parker, C., James, R. M., Saward, C., Procter, E. L., Mode, W. J. A., Baker, C., Hough, J., Williams, N. C., Rossington, H., & Varley, I. (2024). Combined turmeric, vitamin C, and vitamin D ready-to-drink supplements reduce upper respiratory illness symptoms and gastrointestinal discomfort in elite male football players. Nutrients, 16(2), 243.

Coors, A., Brosch, M., Kahl, E., Khalil, R., Michels, B., Laub, A., Franke, K., Gerber, B., & Fendt, M. (2019). Rhodiola rosea root extract has antipsychotic-like effects in rodent models of sensorimotor gating. Journal of Ethnopharmacology, 235, 320–328.

Dias, K. A., da Conceição, A. R., Oliveira, L. A., Pereira, S. M. S., Paes, S. D. S., Monte, L. F., Sarandy, M. M., Novaes, R. D., Gonçalves, R. V., & Della Lucia, C. M. (2021). Effects of curcumin supplementation on inflammatory markers, muscle damage, and sports performance during acute physical exercise in sedentary individuals. Oxidative Medicine and Cellular Longevity, 2021, 9264639.

Dias, K. A., da Conceição, A. R., Pereira, S. M. S., Oliveira, L. A., da Silva Rodrigues, J. V., Dias, R. S., de Paula, S. O., Natali, A. J., da Matta, S. L. P., Gonçalves, R. V., Tako, E., Martino, H. S. D., & Lucia, C. M. D. (2022). Curcumin-added whey protein positively modulates skeletal muscle inflammation and oxidative damage after exhaustive exercise. Nutrients, 14(22), 4905.

Dias, M. I., Barros, L., Dueñas, M., Pereira, E., Carvalho, A. M., Alves, R. C., Oliveira, M. B. P. P., Santos-Buelga, C., & Ferreira, I. C. F. R. (2013). Chemical composition of wild and commercial Achillea millefolium L. and bioactivity of the methanolic extract, infusion and decoction. Food Chemistry, 141(4), 4152–4160.

Diker, N. Y., & Çankaya, İ. T. (2022). Gebelik, doğum sonrası ve emzirme döneminde fitoterapi ve homeopati uygulamalarında kullanılan bitkisel kaynaklar [Herbal resources used in phytotherapy and homeopathy practices during pregnancy, postpartum and breastfeeding]. In: Tekin, A., Çankaya, İ. T., & Zeybek, A. U. (Eds.). Fitoterapi uygulaması kitabı [Phytotherapy Practice Book]. Republic of Turkey Ministry of Health, General Directorate of Health Services, Ankara. Pp. 182–187.

Ding, A., & Wen, X. (2018). Dandelion root extract protects NCM460 colonic cells and relieves experimental mouse colitis. Journal of Natural Medicines, 72(4), 857–866.

Domínguez-Balmaseda, D., Bressa, C., Fernández-Romero, A., de Lucas, B., Pérez-Ruiz, M., San Juan, A. F., Roller, M., Issaly, N., & Larrosa, M. (2022). Evaluation of a Zingiber officinale and Bixa orellana supplement on the gut microbiota of male athletes: A randomized placebo-controlled trial. Planta Medica, 88(13), 1245–1255.

Elendu, C. (2024). The evolution of ancient healing practices: From shamanism to Hippocratic medicine. A review. Medicine, 103(28), e39005.

Erdem, S., & Eren, P. A. (2009). Tedavi amacıyla kullanılan bitkiler ve bitkisel ürünlerin yan etkileri [Adverse effects of herbal medicines and products]. Türk Hijyen ve Deneysel Biyoloji Dergisi, 66(3), 133–141.

Figueredo, E., Cuesta-Herranz, J., Minguez, A., Vidarte, L., Pastor, C., de las Heras, M., Vivanco, F., & Lahoz, C. (2000). Allergy to pumpkin and cross-reactivity to other Cucurbitaceae fruits. Journal of Allergy and Clinical Immunology, 106(2), 402–403.

Gertsch, J., Schoop, R., Kuenzle, U., & Suter, A. (2004). Echinacea alkylamides modulate TNF-α gene expression via cannabinoid receptor CB2 and multiple signal transduction pathways. FEBS Letters, 577(3), 563–569.

Göktaş, Ö., & Gıdık, B. (2019). Tıbbi ve aromatik bitkilerin kullanım alanları [Areas of use of medicinal and aromatic plants]. Bayburt Üniversitesi Fen Bilimleri Dergisi, 2(1), 145–151.

González-Gross, M., Quesada-González, C., Rueda, J., Sillero-Quintana, M., Issaly, N., Díaz, A. E., Gesteiro, E., Escobar-Toledo, D., Torres-Peralta, R., Roller, M., & Guadalupe-Grau, A. (2021). Analysis of effectiveness of a supplement combining Harpagophytum procumbens, Zingiber officinale and Bixa orellana in healthy recreational runners with self-reported knee pain: A pilot, randomized, triple-blind, placebo-controlled trial. International Journal of Environmental Research and Public Health, 18(11), 5538.

Greeson, J. M., Sanford, B., & Monti, D. A. (2001). St. John's wort (Hypericum perforatum): A review of the current pharmacological, toxicological, and clinical literature. Psychopharmacology, 153(4), 402–414.

Grimm, W., & Müller, H. H. (1999). A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. American Journal of Medicine, 106(2), 138–143.

Gupta, S. K., & Sharma, A. (2014). Medicinal properties of Zingiber officinale Roscoe – A review. IOSR – Journal of Pharmacy and Biological Sciences, 9(5), 124–129.

Hammerness, P., Basch, E., Ulbricht, C., Barrette, E. P., Foppa, I., Basch, S., Bent, S., Boon, H., & Ernst, E. (2003). St John's wort: A systematic review of adverse effects and drug interactions for the consultation psychiatrist. Psychosomatics, 44(4), 271–282.

Iddrisu, I., Oduro, I. N., Tandoh, A. M., & Annan, R. A. (2015). Anti-diabetic effect of dandelion leaves and roots in type two diabetic patients: A systematic review. Nutrition and Food Science, 45(3), 479–492.

Ivanova, S., Ivanov, K., Mladenov, R., Papanov, S., Ivanova, S., Obreshkova, D., & Atanasov, P. P. (2016). Food supplements with anabolic and androgenic activity – UHPLC analysis of food additives containing Tribulus terrestris extract. World Journal of Pharmaceutical Research, 5(3), 6–13.

Ivanova Stojcheva, E., & Quintela, J. C. (2022). The effectiveness of Rhodiola rosea L. preparations in alleviating various aspects of life-stress symptoms and stress-induced conditions – Encouraging clinical evidence. Molecules, 27(12), 3902.

Izzo, A. A., Hoon-Kim, S., Radhakrishnan, R., & Williamson, E. M. (2016). A critical approach to evaluating clinical efficacy, adverse events, and drug interactions of herbal remedies. Phytotherapy Research, 30(5), 691–700.

Jacobsson, I., Jönsson, A. K., Gerdén, B., & Hägg, S. (2009). Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. Pharmacoepidemiology and Drug Safety, 18(11), 1039–1047.

Jakubczyk, K., Koprowska, K., Gottschling, A., & Janda-Milczarek, K. (2022). Edible flowers as a source of dietary fibre (total, insoluble and soluble) as a potential athlete's dietary supplement. Nutrients, 14(12), 2470.

Kanter, M., Coskun, O., & Budancamanak, M. (2005). Hepatoprotective effects of Nigella sativa L. and Urtica dioica L. on lipid peroxidation, antioxidant enzyme systems, and liver enzymes in carbon tetrachloride-treated rats. World Journal of Gastroenterology, 11(42), 6684–6688.

Karakus, A., Deger, Y., & Yildirim, S. (2017). Protective effect of Silybum marianum and Taraxacum officinale extracts against oxidative kidney injuries induced by carbon tetrachloride in rats. Renal Failure, 39(1), 1–6.

Kim, S. H., Park, K. S., Chang, M. J., & Sung, J. H. (2005). Effects of Panax ginseng extract on exercise-induced oxidative stress. Journal of Sports Medicine and Physical Fitness, 45, 178–182.

Klemow, K. M., Bartlow, A., Crawford, J., Kocher, N., Shah, J., & Ritsick, M. (2011). Medical attributes of St. John’s Wort (Hypericum perforatum). In: Benzie, I. F. F., & Wachtel-Galor, S. (Eds.). Herbal medicine: Biomolecular and clinical aspects. 2nd ed. CRC Press/Taylor & Francis, Boca Raton.

Laasonen, M., Wennberg, T., Harmia-Pulkkinen, T., & Vuorela, H. (2002). Simultaneous analysis of alkamides and caffeic acid derivatives for the identification of Echinacea purpurea, Echinacea angustifolia, Echinacea pallida, and Parthenium integrifolium roots. Planta Medica, 68(6), 572–574.

Lee, W. J., Chung, H. H., Cheng, Y. Z., Lin, H. J., & Cheng, J. T. (2013). Rhodiola water extract induces β-endorphin secretion to lower blood pressure in spontaneously hypertensive rats. Phytotherapy Research, 27(7), 1543–1547.

Li, H., Liu, Y., Luo, D., Ma, Y., Zhang, J., Li, M., Yao, L., Shi, X., Liu, X., Yang, K. (2019). Ginger for health care: An overview of systematic reviews. Complementary Therapies in Medicine, 45, 114–123.

Lis, B., Jedrejek, D., Rywaniak, J., Soluch, A., Stochmal, A., & Olas, B. (2020). Flavonoid preparations from Taraxacum officinale L. fruits – A phytochemical, antioxidant and hemostasis studies. Molecules, 25(22), 5402.

Liu, Q., Zhao, H., Gao, Y., Meng, Y., Zhao, X. X., & Pan S. N. (2018). Effects of dandelion extract on the proliferation of rat skeletal muscle cells and the inhibition of a lipopolysaccharide-induced inflammatory reaction. Chinese Medical Journal, 131(14), 1651–1658.

Liu, S., Liu, J., He, L., Liu, L., Cheng, B., Zhou, F., Cao, D., & He, Y. (2022). A comprehensive review on the benefits and problems of curcumin with respect to human health. Molecules, 27(14), 4400.

Lovell, C. R., & Rowan, M. (1991). Dandelion dermatitis. Contact Dermatitis, 25(3), 185–188.

Lowe, F. C., & Fagelman, E. (2002). Phytotherapy in the treatment of benign prostatic hyperplasia. Current Opinion in Urology, 12, 15–18.

Lu, Y., Deng, B., Xu, L., Liu, H., Song, Y., & Lin, F. (2022). Effects of Rhodiola rosea supplementation on exercise and sport: A systematic review. Frontiers in Nutrition, 9, 856287.

Majid, A. K., Ahmed, Z., & Khan, R. (2020). Effect of pumpkin seed oil on cholesterol fractions and systolic/diastolic blood pressure. Food Science and Technology, 40(3), 769–777.

Mashhadi, N. S., Ghiasvand, R., Askari, G., Hariri, M., Darvishi, L., & Mofid, M. R. (2013). Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: Review of current evidence. International Journal of Preventive Medicine, 4(S1), S36–S42.

Maslova, L. V., Kondratev, B., Maslov, L. N., & Lishmanov, I. B. (1994). O kardioprotektornoĭ i antiadrenergicheskoĭ aktivnosti ékstrakta rodioly rozovoĭ pri stresse [The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress]. Eksperimental'naya i Klinicheskaya Farmakologiya, 57, 61–63.

Mullins, R. J., & Heddle, R. (2002). Adverse reactions associated with Echinacea: The Australian experience. Annals of Allergy, Asthma and Immunology, 88(1), 42–51.

Nathan, P. J. (2001). Hypericum perforatum (St John's wort): A non-selective reuptake inhibitor? A review of the recent advances in its pharmacology. Journal of Psychopharmacology, 15(1), 47–54.

Nedzvetsky, V. S., Gasso, V. Y., Agca, C. A., & Sukharenko, E. V. (2021). Soluble curcumin ameliorates motility, adhesiveness and abrogate parthanatos in cadmium-exposed retinal pigment epithelial cells. Biosystems Diversity, 29(3), 235–243.

Neychev, V. K., & Mitev, V. I. (2005). The aphrodisiac herb Tribulus terrestris does not influence androgen production in young men. Journal of Ethnopharmacology, 101, 319–323.

Nishiyama, T., Mae, T., Kishida, H., Tsukagawa, M., Mimaki, Y., Kuroda, M., Sashida, Y., Takahashi, K., Kawada, T., Nakagawa, K., & Kitahara, M. (2005). Curcuminoids and sesquiterpenoids in turmeric (Curcuma longa L.) suppress an increase in blood glucose level in type 2 diabetic KK-Ay mice. Journal of Agricultural and Food Chemistry, 53(4), 959–963.

Nocerino, E., Amato, M., & Izzo, A. A. (2000). The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia, 71(S1), S1–S5.

Ojulari, L. S., Olatubosun, O. T., Okesina, K. B., & Owoyele, B. V. (2014). The effect of Zingiber officinale (ginger) extract on blood pressure and heart rate in healthy humans. IOSR Journal of Dental and Medical Sciences, 13(10), 76–78. http://doi.org/10.9790/0853-131037678

Orhan, I. E. (2022). Plant/herbal medicine–drug/medicinal product interactions, abuse of medicinal plants, phytovigilance. In: Tekin, A., Çankaya, İ. T., & Zeybek, A. U. (Eds.). Phytotherapy practice book. Republic of Turkey Ministry of Health, General Directorate of Health Services, Ankara. Pp. 182–187.

Pareek, A., Purohit, S. G., Khatik, N., & Neha, N. (2020). Selected traditional Indian plants and sports performance: A review. Journal of Phytological Research, 33(1), 115–126.

Park, C. M., Youn, H. J., Chang, H. K., & Song, Y. S. (2010). TOP1 and 2, polysaccharides from Taraxacum officinale, attenuate CCl₄-induced hepatic damage through the modulation of NF-κB and its regulatory mediators. Food and Chemical Toxicology, 48(5), 1255–1261.

Parlakpınar, H. (2022). Medicinal plants used in respiratory diseases. In: Tekin, A., Çankaya, İ. T., & Zeybek, A. U. (Eds.). Phytotherapy practice book. Republic of Turkey Ministry of Health, General Directorate of Health Services, Ankara. Pp. 138–145.

Pokrywka, A., Obmiński, Z., Malczewska-Lenczowska, J., Fijałek, Z., Turek-Lepa, E., & Grucza, R. (2014). Insights into supplements with Tribulus terrestris used by athletes. Journal of Human Kinetics, 41(8), 99–105.

Popov, I. M., & Goldwag, W. J. (1973). A review of the properties and clinical effects of ginseng. American Journal of Chinese Medicine, 1, 263–270.

Prasad, S., & Aggarwal, B. B. (2011). Turmeric, the golden spice: From traditional medicine to modern medicine. In: Benzie, I. F. F., & Wachtel-Galor, S. (Eds). Herbal medicine: Biomolecular and clinical aspects. 2nd ed. CRC Press. Pp. 263–288.

Ramak, R., & Mahboubi, M. (2019). The beneficial effects of pumpkin (Cucurbita pepo L.) seed oil for health condition of men. Food Reviews International, 35(2), 166–176.

Rubió, L., Motilva, M. J., & Romero, M. P. (2013). Recent advances in biologically active compounds in herbs and spices: A review of the most effective antioxidant and anti-inflammatory active principles. Critical Reviews in Food Science and Nutrition, 53(9), 943–953.

Saraç, H., Durukan, H., & Demirbaş, A. (2021). Önemli tıbbi bitkilerden biri olan Achillea millefolium L. (Civanperçemi) bitkisinin besin elementi konsantrasyonları ve antioksidan aktivitesi [Nutrient concentrations and antioxidant activity of Achillea millefolium L. (Yarrow), one of the important medicinal Plants]. Türk Tarım – Gıda Bilim ve Teknoloji Dergisi, 9(3), 590–594.

Şarışen, Ö., & Çalışkan, D. (2005). Fitothrapy: Herbal medicine, attetion of in primary health care. Journal of Continuing Medical Education, 8(14), 182–187.

Sciberras, J. N., Galloway, S. D., Fenech, A., Grech, G., Farrugia, C., Duca, D., & Mifsud, J. (2015). The effect of turmeric (curcumin) supplementation on cytokine and inflammatory marker responses following 2 hours of endurance cycling. Journal of the International Society of Sports Nutrition, 12(1), 5.

Sellami, M., Slimeni, O., Pokrywka, A., Kuvačić, G., Hayes, L. D., Milic, M., & Padulo, J. (2018). Herbal medicine for sports: A review. Journal of the International Society of Sports Nutrition, 15, 14.

Senchina, D. S., Shah, N. B., Doty, D. M., Sanderson, C. R., & Hallam, J. E. (2009). Herbal supplements and athlete immune function – What's proven, disproven, and unproven? Exercise Immunology Review, 15, 66–106.

Şengül, F., Çakır, M., Öztürk, B., Çakmak, A. N., & Vatansev, H. (2021). Sarı Kantaron'a dair (Hypericum perforatum L.): Morfoloji, etki mekanizmaları, aktivite, yan etkileri ve ilaç etkileşimlerinin incelenmesi. Doğal Yaşam Tıbbı Dergisi, 3(1), 1–37.

Shakya, S. R. (2015). Medicinal uses of ginger (Zingiber officinale Roscoe) improves growth and enhances immunity in aquaculture. International Journal of Chemical Studies, 3(2), 83–87.

Sharma, R. (2021). Bioactive food components for managing cellular senescence in aging and disease: A critical appraisal and perspectives. Pharma Nutrition, 18, 100281.

Sidhu, K., Kaur, J., Kaur, G., & Pannu K. (2007). Prevention and cure of digestive disorders through the use of medicinal plants. Journal of Human Ecology, 21(2), 113–116.

Siegel, R. K. (1979). Ginseng abuse syndrome: Problems with the panacea. Journal of the American Medical Association, 241, 1614–1615.

Siegel, R. K. (1980). Ginseng and high blood pressure. Journal of the American Medical Association, 243(1), 32.

Soon, S. L., & Crawford, R. I. (2001). Recurrent erythema nodosum associated with Echinacea herbal therapy. Journal of the American Academy of Dermatology, 44(2), 298–299.

Sulieman, A. M. E., Ibrahim, S. M., Alshammari, M., Abdulaziz, F., Idriss, H., Alanazi, N. A. H., Abdallah, E. M., Siddiqui, A. J., Shommo, S. A. M., Jamal, A., & Badraoui, R. (2024). Zingiber officinale uncovered: Integrating experimental and computational approaches to antibacterial and phytochemical profiling. Pharmaceuticals, 17(11), 1551.

Surh, Y. J., Park, K. K., Chun, K. S., Lee, E., & Lee, S. S. (1999). Antitumor-promoting activities of selected pungent phenolic substances present in ginger. Journal of Environmental Pathology, Toxicology and Oncology, 18(2), 131–139.

Syed, Q. A., Akram, M., & Shukat, R. (2019). Nutritional and therapeutic importance of the pumpkin seeds. Biomedical Journal of Scientific and Technical Research, 21(2), 15798–15803.

Taj Eldin, I. M., Elmutalib, M. A., Hiba, A., Hiba, F., Thowiba, S., & Hamedelniel, E. I. (2016). An in vitro anticoagulant effect of aqueous extract of ginger (Zingiber officinale) rhizomes in blood samples of normal individuals. American Journal of Research Communication, 4(1), 113–121.

Talazas, A. H., Abbasi, M. R., Abkhiz, S., & Dashti-Khavidaki, S. (2010). Tribulus terrestris-induced severe nephrotoxicity in a young healthy male. Nephrology Dialysis Transplantation, 25, 3792–3793.

Taylor, J. A., Weber, W., Standish, L., Quinn, H., Goesling, J., McGann, M., & Calabrese, C. (2003). Efficacy and safety of Echinacea in treating upper respiratory tract infections in children. Journal of the American Medical Association, 290(21), 2824–2830.

Tinsley, G. M., Jagim, A. R., Potter, G. D. M., Garner, D., & Galpin, A. J. (2024). Rhodiola rosea as an adaptogen to enhance exercise performance: A review of the literature. British Journal of Nutrition, 131(3), 461–473.

Vogler, B. K., Pittler, M. H., & Ernst, E. (1999). The efficacy of ginseng. A systematic review of randomized clinical trials. European Journal of Clinical Pharmacology, 55, 567–575.

Wang, L., Meng, Q., & Su, C. H. (2024). From food supplements to functional foods: Emerging perspectives on post-exercise recovery nutrition. Nutrients, 16(23), 4081.

Whitehead, M., Martin, T., Scheett, T., & Webster, M. (2012). Running economy and maximal oxygen consumption after 4 weeks of oral Echinacea supplementation. Journal of Strength and Conditioning Research, 26(7), 1928–1933.

Wilson, P. B. (2015). Ginger (Zingiber officinale) as an analgesic and ergogenic aid in sport: A systemic review. Journal Strength Conditions Research, 29(10), 2980–2995.

Wirngo, F. E., Lambert, M. N., & Jeppesen, P. B. (2016). The physiological effects of dandelion (Taraxacum officinale) in type 2 diabetes. The review of Diabetic Studies, 13(2–3), 113–131.

Woelk, H., Burkard, G., & Grünwald, J. (1994). Benefits and risks of the hypericum extract LI 160: Drug monitoring study with 3250 patients. Journal of Geriatric Psychiatry and Neurology, 7(S1), S34–S38.

Yousefi Ghale-Salimi, M., Eidi, M., Ghaemi, N., & Khavari-Nejad, R. A. (2018). Inhibitory effects of taraxasterol and aqueous extract of Taraxacum officinale on calcium oxalate crystallization: In vitro study. Renal Failure, 40(1), 298–305.

Zaushintsena, A. V., Milentyeva, I. S., Babich, O. O., Noskova, S. Y., Kiseleva, T. F., Popova, D. G., Bakin, I. A., & Lukin, A. A. (2019). Quantitative and qualitative profile of biologically active substances extracted from purple echinacea (Echinacea purpurea L.) growing in the Kemerovo Region: Functional foods application. Foods and Raw Materials, 7(1), 84–92.

Zhang, Y., Liu, K., Zhan, Y., Zhao, Y., Chai, Y., Ning, J., Pan, H., Kong, L., & Yuan, W. (2024). Impact of Chinese herbal medicine on sarcopenia in enhancing muscle mass, strength, and function: A systematic review and meta-analysis of randomized controlled trials. Phytotherapy Research, 38, 2303–2322.

Zhou, S., Chan, E., Pan, S. Q., Huang, M., & Lee, E. J. D. (2004). Pharmacokinetic interactions of drugs with St John's wort. Journal of Psychopharmacology, 18(2), 262–276.