Astragalus root (Astragalus membranaceus; Huang Qi in traditional Chinese medicine)

Astragalus is a flagship ingredient of the «telomere supplement» market. The concept: chromosome telomeres shorten with age, cells enter replicative senescence, and the cycloastragenol fraction TA-65 «activates telomerase» and «rebuilds telomeres», returning cells to a younger state. Clinical data do not confirm the hypothesis. Published TA-65 studies are small open-label manufacturer-sponsored series reporting immunological changes and modest telomere lengthening in some lymphocyte fractions, but no hard endpoints (lifespan, age-related disease incidence). NCCIH classifies astragalus among supplements with insufficient evidence for anti-ageing claims. Telomerase activation in humans carries an oncological risk – extending the life of cells carrying accumulated mutations – so most oncologists and geriatricians do not recommend TA-65. The real strategy for healthy longevity (data from Okinawa, Sardinia, Nicoya, Ikaria) is physical activity, a Mediterranean diet, calorie restriction without deficit, smoking and alcohol cessation, social ties, blood-pressure, diabetes, and lipid control. Astragalus root does not add anything magical to this picture.

Astragalus is often sold as an «adaptogen» for chronic fatigue, burnout, and post-viral syndrome. No high-quality RCTs with hard endpoints (validated fatigue scales, return-to-work rates, objective tests – ESR, thyroid hormones) exist for astragalus in chronic fatigue. The term «adaptogen» is a marketing construct from 1940s Soviet toxicology and is absent from the European Pharmacopoeia and Spanish AEMPS framework. NICE NG206 for myalgic encephalomyelitis/chronic fatigue syndrome recommends an individualised plan of energy management (pacing), psychological support, gradual return to activity, and treatment of comorbidities; neither astragalus nor «adaptogens» appear in the guideline. If fatigue lasts over 6 months and impairs function, consider seeking a second opinion – iron deficiency, hypothyroidism, depression, long COVID, sleep apnoea, untreated coeliac disease, and occult infection should be ruled out.

ICD-10: R53 · ICD-11: MG22

Astragalus is marketed as a «natural immune modulator» and a cold prevention agent. In animal models astragalus polysaccharides increase T- and B-cell proliferation. In humans, no high-quality RCTs with hard endpoints (lab-confirmed cold rates, symptom duration, hospitalisations) have been done. Cochrane has not published a systematic review on astragalus in cold or flu. NCCIH states that available data are too weak to recommend astragalus for immunity or infection prevention. Evidence-based seasonal measures are influenza and COVID-19 vaccination, hand hygiene, masking at peaks, control of chronic disease (diabetes, COPD), sleep, and adequate dietary protein. In patients on active immunosuppression (transplant, biological therapy for autoimmune disease), astragalus theoretically interferes with the immunosuppressive regimen and is not recommended.