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Overview of Ashwagandha

What is Ashwagandha? 

Ashwagandha is an herb obtained from the plant Withania somnifera, which is a commonly used herbal remedy to promote sleep, reduce chronic stress and anxiety symptoms, and improve cognitive functions. Ashwagandha root extract shows promise for various health benefits, though more research is needed to confirm these potential effects. 

Ashwagandha is an adaptogen, meaning it helps the body adapt to stress. It contains natural compounds called withanolides, specifically withanone and withaferin A, which are believed to be responsible for its health benefits. Other active compounds in ashwagandha with pharmacological actions include alkaloids, saponins, and steroidal lactones.

Ashwagandha is also known as Indian ginseng and winter cherry, and you can take it as a dietary supplement. Ashwagandha supplements contain leaf and root extracts from the plant.

Historical and Cultural Context

Ashwagandha is used in Ayurveda and Unani traditional systems of medicine that have been practiced in India for thousands of years. “Ashwa” is the Sanskrit word for horse (it can be said that ashwagandha root smells like horses). 

Traditional uses of ashwagandha root include many ailments, such as joint inflammation, skin conditions, fatigue, insomnia, constipation, anxiety, diabetes, and goiter. However, it is important to note that there is insufficient scientific evidence to support most of the health claims for this popular herb.

Current Popularity and Uses

Ashwagandha is one of the most popular supplements in the United States, and its popularity is growing, with sales rising by over 225% in 2021. The most common uses of ashwagandha in the US are reducing stress and anxiety, promoting better sleep, and enhancing overall well-being. 

Is Ashwagandha Safe: Yes or No?

Ashwagandha has been evaluated in clinical trials and is generally considered safe for up to three months of use. Commonly reported side effects include nausea, diarrhea, and drowsiness. There are case reports of individuals experiencing more serious side effects, such as liver damage and changes in thyroid levels. Additionally, there are no long-term studies, and it is unclear if ashwagandha is safe to use for longer than three months. It may also interact with other medications, so it is important to talk with your doctor before taking ashwagandha.

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Potential Health Benefits of Ashwagandha

Stress and Anxiety Relief

Clinical trials suggest that taking ashwagandha root extract may reduce chronic stress and anxiety symptoms. As such, this Ayurvedic medicine may benefit individuals with generalized anxiety disorder, depression, and other mood disorders.

A systematic review of studies found that at doses ranging between 240 and 1,250 mg daily for 6 to 8 weeks, ashwagandha root extract significantly reduced stress and anxiety levels, depression symptoms, insomnia, fatigue, and food cravings. A randomized placebo-controlled trial also found that doses in the range of 500 mg to 600 mg per day were more beneficial than lower doses.

People who took ashwagandha during placebo-controlled clinical trials reported improved well-being, sense of calm, mental clarity, higher energy levels, and better sleep quality.  

A placebo-controlled study found that people in the ashwagandha group had lower serum cortisol levels (stress hormone levels) compared to those in the placebo (inactive substance) group. 

Improved Sleep

Limited research suggests ashwagandha extracts help to improve sleep quality. 

A double-blind, placebo-controlled trial found that adults with self-reported sleep problems (insomnia or lack of restful sleep) who took ashwagandha root and leaf extract for six weeks experienced improvements in sleep quality. About 72% of those in the ashwagandha group reported improved sleep compared to 29% in the placebo group. Those in the ashwagandha extract group had improved sleep efficiency, including the amount of time spent in bed, total sleep time, time taken to fall asleep (sleep latency), and the number of awakenings after sleep onset, as measured by a wearable wrist monitor that used actigraphy to measure body movements. 

Other randomized, double-blind, placebo-controlled trials have shown similar results. Compared to placebo, people who took ashwagandha supplements reported improved sleep quality, faster sleep onset, improved mental alertness during the day, and decreased anxiety symptoms.

The doses of an ashwagandha supplement used in studies on sleep effects have ranged from 250 mg to 600 mg per day in the form of a root extract. The benefits are more prominent at 600 mg/day doses with a treatment duration of at least eight weeks. 

Enhanced Athletic Performance 

Research suggests ashwagandha supplementation at doses ranging between 120 mg and 1,250 mg per day can potentially enhance performance in athletes. One placebo-controlled clinical study found that people who took ashwagandha had improved muscle strength, bench-press power, squats, and recovery rates.

Studies suggest that professional athletes might benefit from higher doses, 300 mg to 500 mg twice daily while undergoing strenuous training. Individuals who are not physically active should take lower doses (less than 300 mg daily while engaging in routine exercise programs to improve physical performance.

Neuroprotective Properties and Cognitive Functions

There is limited evidence that the herbal supplement ashwagandha has neuroprotective effects. This herbal medicine could potentially improve cognitive function and lower the risk of neurological disorders such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. Studies have also found that taking ashwagandha may prevent cognitive impairment in older adults. 

Cancer Risk and Treatment

There is no evidence to support that ashwagandha can treat cancer or lower the risk of cancer. However, evidence suggests cancer patients may benefit from ashwagandha supplementation because of its beneficial effects on stress, anxiety, and fatigue, which are common symptoms related to cancer and cancer treatments.

Other Potential Health Benefits of Ashwagandha

There is limited scientific evidence supporting the potential clinical effectiveness of ashwagandha for:

• Improved growth, hemoglobin levels, and red blood cell counts in children

• Anti-aging effects and longevity

• Reduction in chronic inflammation

• Prevention of cognitive dysfunction

• Beneficial effects on the immune system and improvement in immune function

• Chronic fatigue syndrome

• Chronic pain

• Constipation

• Skin diseases

• Diabetes (high blood glucose or hyperglycemia)

• Gastrointestinal diseases

• Degenerative joint diseases such as osteoarthritis

• Autoimmune disorders such as rheumatoid arthritis

• Epilepsy (seizure disorders)

• Mood disorders, such as bipolar disorder

• Sexual health

• Male infertility

• Menopausal symptoms

• Body weight management

Safety and Side Effects

Common Side Effects

Most people tolerate the Ayurvedic drug ashwagandha well. Common side effects include mild fatigue, headache, stomach upset, nausea, diarrhea, and drowsiness. 

Rare But Serious Side Effects

There are reports of acute liver injury and hyperbilirubinemia (high bilirubin levels) in a small number of people who took ashwagandha supplements. 

Contraindications for Specific Populations

Ashwagandha may not be safe for people with certain medical conditions. For example, studies have found that taking ashwagandha may affect thyroid function and circulating thyroid hormone concentrations. Therefore, it may not be safe for people with thyroid disorders (high or low thyroid hormones). 

There is also evidence suggesting that ashwagandha can increase testosterone levels, and it may not be safe for men with hormone-sensitive prostate cancer.

Ashwagandha is not advised for pregnant women due to the potential risk of spontaneous abortion. Women who are breastfeeding should also not take this dietary supplement. 

Interactions with Other Medications

People on certain medications such as thyroid hormone medications, diabetes medications, antihypertensives for high blood pressure, immunosuppressants, and sedatives should check with their healthcare professional before taking ashwagandha dietary supplements. 

Scientific and Regulatory Perspectives

Clinical Research Summary

Most of the research on ashwagandha has focused on its stress-relieving and anxiety-reducing effects. Several small randomized, placebo-controlled clinical trials have shown that ashwagandha can reduce stress and anxiety and improve sleep quality and duration in healthy volunteers. 

However, due to a wide variety of ashwagandha preparations being used in various studies and the lack of standardization of manufacturing processes, experts cannot make recommendations on the best ashwagandha products or the most effective doses. 

In addition, it is worth noting that many studies on the hormonal and vitality effects of ashwagandha were done by practitioners of traditional medicine, which is outside the purview of modern medical practitioners. 

Ashwagandha Regulatory Status in the US

In the United States, the Food and Drug Administration (FDA) regulates dietary supplements under different regulations than those for conventional drugs and foods. This means that a herbal medicine such as ashwagandha does not have the same manufacturing, testing, and labeling standards as prescription and over-the-counter medications. 

The FDA doesn't approve dietary supplements to treat, prevent, diagnose, or cure medical conditions. Products that make these claims are regulated as drugs. 

Additionally, the FDA does not usually review dietary supplements before they are put on the market. Manufacturers can, therefore, produce and sell ashwagandha supplements without notifying the FDA. The FDA does require manufacturers of dietary supplements to ensure the products are safe and accurately labeled. 

You can report a bad side effect or reaction from the herbal supplement ashwagandha to the FDA.

Ashwagandha Regulatory Status Worldwide

In 2023, Denmark banned ashwagandha dietary supplements, stating these products can harm thyroid function and sex hormones. Denmark also recalled and seized all ashwagandha products sold to Danish consumers.

Ashwagandha is considered a food supplement in most of the European Union. Some countries, such as Sweden, have left it to individual municipalities to decide on the safety profile of this herb.

In the United Kingdom, ashwagandha is considered an unauthorized novel food. Businesses that want to use ashwagandha in food products need special authorization.

In Australia, ashwagandha is considered an unauthorized novel food and is not permitted in foods or beverages. The Australian government also recommends that people with liver problems avoid all ashwagandha-containing medicines and herbal supplements. 

Questions and Answers

Is It OK To Take Ashwagandha Everyday? Is Ashwagandha Safe for Daily Use?

Ashwagandha is likely safe for daily use for up to 3 months by most healthy adults. However, safety data for longer-term use and use in people with underlying health conditions is not available.

Are There Any Dangers To Ashwagandha?

Possible dangers of ashwagandha use:

• Drug-induced hepatocellular injury (Ashwagandha-induced liver injury).

• Drug interactions with other medications and dietary supplements.

• May not be safe for people with thyroid disorders (high or low thyroid hormone levels) or hormone-sensitive prostate cancer.

• Common side effects such as upset stomach, nausea, and vomiting.

• Possible adverse effects in pregnant and breast-feeding women.

What Supplements Should Not Be Taken With Ashwagandha?

No randomized controlled trial has been done on the interactions between the Ayurvedic medicine ashwagandha and other dietary supplements. Therefore, we do not know if other supplements can cause problems if you take them with ashwagandha. 

However, you should check with your doctor before taking ashwagandha supplementation if you are on diabetes medications, blood pressure medicines, thyroid drugs, sedatives, or immunosuppressants.

Weighing the Benefits and Risks

Ashwagandha is a herb that has many potential health benefits but can also cause side effects, especially in people with certain medical conditions. Taking ashwagandha for up to three months is likely safe for most healthy people. It is worth noting that any single compound is highly unlikely to have such a broad range of health benefits. In fact, there is insufficient scientific evidence to support most of the health claims for this popular herb.