What is Ashwagandha?
Ashwagandha, also known as Withania Somnifera or Ayurvedic ginseng, is a powerful herb that has been used for thousands of years in traditional Ayurvedic medicine. Ashwagandha is a type of adaptogen herb, which are herbal pharmaceuticals that help balance the body and mind, boost energy, and enhance physical and mental performance.
Ashwagandha is an evergreen, straight, branching shrub that originates in Western India and Mediterranean regions [Mukherjee et al 2020]. The roots contain the main bioactive molecule, withanolides, which possess potential medicinal properties, including anti-inflammatory, antioxidant, antitumor, stress hormone lowering (e.g., cortisol), blood pressure lowering, blood glucose lowering, and anti-anxiety properties [Srivastava et al 2018]. Other parts of the plant, such as its stem and leaves, also contain other bioactive molecules such as triethylene glycol (TEG) [Kaushik et al 2017].
What uses of ashwagandha have the most scientific evidence?
Stress
Ashwagandha may be helpful in the management of stress due to its ability to enhance the levels of the brain chemical GABA and its ability to reduce levels of the stress hormone cortisol. A meta-analysis of 12 randomized clinical trials including a total of 1,002 adults that ashwagandha reduced levels of stress and anxiety. The doses used ranged from 240mg to 1000mg per day. However, the authors of the study rated the certainty of the evidence as low to support the use of ashwagandha for stress and anxiety and that larger studies are needed to confirm these findings (Akhgarjand et al. 2022)
Insomnia
Ashwagandha may be helpful for the management of insomnia as well due to withanolides’ ability to increase levels of GABA and triethylene glycol’s (TEG) ability to enhance sleep as shown in mice. A meta-analysis of 5 randomized clinical trials, including a total of 400 adults, suggested that ashwagandha doses in the range of 120mg to 600mg per day improved overall sleep compared to placebo (Cheah et al. 2021). This study suggests that ashwagandha may be helpful for sleep, but larger studies are needed to confirm these findings. A healthcare professional should be consulted to make sure your sleep hygiene is optimized before using ashwagandha to improve sleep quality.
Other potential uses of ashwagandha with less evidence
Smaller studies have suggested benefit of ashwagandha for the following uses:
- Improved alertness in elderly people
- Improved athletic performance
- Improved cognitive performance in bipolar disorder
- Improved balance in patients with cerebellar ataxia
- Decreased chemotherapy related fatigue
- Decreased blood glucose in patients with diabetes
- Reduced anxiety in patients with generalized anxiety disorder
- Reduced cholesterol levels
- Improved male fertility
- Reduced symptoms of obsessive compulsive disorder
- Improved psychological well being in college students
- Enhanced sexual function
What is the most common dose of ashwagandha?
It has been most often used in doses up to 1200mg per day for up to 12 weeks in randomized clinical trials.
What are the adverse effects?
Ashwagandha is generally considered safe when taken in recommended doses. However, some individuals may experience adverse effects, including:
Upset stomach: Ashwagandha may cause nausea, diarrhea, and other digestive symptoms in some individuals.
Allergic reactions: Some people may be allergic to Ashwagandha, resulting in skin rashes, itching, and difficulty breathing.
Hormonal changes: Ashwagandha may affect hormone levels in some individuals, particularly in women. This can result in menstrual irregularities, changes in libido, and other related symptoms. It has also been shown to increase the level of thyroid hormones so caution should be taken in people with underlying thyroid issues.
Liver: There have been several case reports of liver injury with ashwagandha. If you experience yellowing of skin or eyes, pain in upper abdomen, a swollen belly, or disorientation or confusion while taking ashwagandha, stop taking it immediately and seek medical attention.
Anhedonia: People experiencing this have a reduce ability to experience pleasure. We have heard anecdotal reports of this in people taking ashwagandha. We recommend to stop taking ashwagandha.
Are there important interactions with prescription medications?
Ashwagandha may interact with certain medications: such as blood thinners, thyroid hormones, digoxin, and anti-anxiety drugs.
Limited evidence suggests ashwagandha may decrease blood sugar levels; therefore, it may have an additive effect when used with prescription medications for diabetes.
Limited evidence suggests ashwagandha may decreased blood pressure; therefore, it may have an additive effect when used with prescription medications for high blood pressure.
Ashwagandha has been shown to increase levels of GABA; therefore, it may have an additive effect when used with benzodiazepines such as Xanax, Ativan, and Valium, which also increase GABA, and may result in over sedation.
Ashwagandha has been shown to increase levels of thyroid hormones; therefore, it may have additive effects with prescription thyroid medications such as Synthroid or generic levothyroxine.
Finally, ashwagandha may falsely elevate levels of the prescription medication digoxin
Pharmacist Suggestions
Ashwagandha is most likely safe to take at doses of up to 1200mg per day and it may have benefits in managing stress and improving sleep, but further studies are needed to confirm safety and efficacy. It is important to note that the exact mechanisms by which Ashwagandha works are not fully understood and require further research.
Additionally, the effects of Ashwagandha may vary based on individual factors such as age, health status, and dosage. If you have any medical conditions or take prescription medications, you should consult with a healthcare professional before trying ashwagandha. They will be able to determine if it is compatible with your underlying medical conditions and prescription medications and monitor you for adverse effects.
We also suggest exploring non-medication-based ways to manage stress and anxiety, such as tai-chi, yoga, meditation, and professional counseling.
If you are pregnant or breast-feeding, do not take ashwagandha. Children should not take ashwagandha.
References
- Natural medicines comprehensive database. Ashwagandha professional monograph. Accessed February 2023.
- Akhgarjand et al. Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials Phytother Res. 2022 Nov;36(11):4115-4124.
- Mukherjee PK, Banerjee S, Biswas S, Das B, Kar A, Katiyar C. Withania somnifera (L.) Dunal-Modern perspectives of an ancient Rasayana from Ayurveda. J Ethnopharmacol. 2020; 264:113157. https://doi. org/10.1016/j.jep.2020.113157 PMID: 32783987
- Srivastava A, Gupta AK, Shanker K, Gupta MM, Mishra R, Lal RK. Genetic variability, associations, and path analysis of chemical and morphological traits in Indian ginseng [Withania somnifera (L.) Dunal] for selection of higher yielding genotypes. Journal of ginseng research. 2018; 42(2):158–64. https://doi. org/10.1016/j.jgr.2017.01.014 PMID: 29719462.
- Kaushik MK, Kaul SC, Wadhwa R, Yanagisawa M, Urade Y. Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction. PLoS One. 2017; 12(2): e0172508. https://doi.org/10.1371/journal.pone.0172508 PMID: 28207892.
Disclaimer: The information provided in this blog post is for educational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. As a clinical pharmacist, I strive to provide accurate and up-to-date information, but the field of herbal supplements is constantly evolving. Individual responses to herbal supplements may vary, and it is important to consult with a qualified healthcare professional before starting any new herbal supplement regimen. Additionally, it is crucial to carefully read and follow the instructions, warnings, and precautions provided by the manufacturers of herbal supplements. The author and the website disclaim any liability for any adverse effects or consequences resulting from the use or misuse of the information contained in this blog post.
