ashwagandha

Ashwagandha (Withania somnifera) is an evergreen shrub that grows in parts of India, Africa, and the Middle East and has a long history of use in traditional Ayurvedic medicine. Its roots and leaves contain plant compounds known as withanolides. It is commonly described as an "adaptogen" — a loosely defined marketing term for substances claimed to help the body cope with stress, though the concept is not well established scientifically. Supplements are typically prepared from extracts of the root, or the root and leaf.

NCCIH states that some ashwagandha preparations may be helpful for insomnia and for stress, but that the evidence about its effects on anxiety is unclear. The NIH Office of Dietary Supplements notes that several short, randomized, placebo-controlled trials have reported reductions in perceived stress and improvements in sleep, with some trials also reporting benefits for anxiety; however, the studies were generally brief and used different products and doses, so the findings are not considered definitive. There is only limited evidence that taking ashwagandha for roughly 2 to 4 months may increase testosterone and sperm quality. According to NCCIH, there is not enough evidence to determine whether it helps other conditions such as athletic performance, cognitive function, diabetes, menopause symptoms, or female infertility, and it is not supported as a treatment for COVID-19. It should not be used to treat, cure, or prevent any disease.

There is no officially established dose. In clinical trials, ashwagandha extract has been studied across a wide range of doses, with the NIH Office of Dietary Supplements noting that benefits for stress and sleep were more often seen at doses of about 500 to 600 mg per day, typically over roughly 6 to 8 weeks and for periods of up to about 3 months. Because products, extracts, and standardization differ widely and long-term safety has not been established, talk with a qualified health care provider before starting ashwagandha — especially if you take any medications, are pregnant or breastfeeding, or have a health condition.

NCCIH indicates that ashwagandha may be safe when used short term (up to about 3 months), but the NIH Office of Dietary Supplements notes there is not enough information to draw conclusions about its safety when used for longer periods of months or years. Importantly, there have been case reports linking ashwagandha supplements to liver injury, and the supplements may also affect thyroid function. Ashwagandha should be avoided during pregnancy and is not recommended while breastfeeding, and NIH notes it may not be safe for people with prostate cancer.

Reported side effects are generally mild and can include drowsiness, gastrointestinal upset, diarrhea, and vomiting. More seriously, ashwagandha supplements have been linked in case reports to liver injury. Stop use and seek medical care promptly if you notice possible signs of liver problems such as unusual tiredness, abdominal pain, dark urine, loss of appetite, or yellowing of the skin or eyes.

According to NCCIH, ashwagandha might interact with several types of medication, including sedatives, anti-seizure (anticonvulsant) medications, thyroid hormone medications, drugs for diabetes, drugs for high blood pressure, and medicines that suppress the immune system (immunosuppressants). Because of its possible sedative effect, it could add to the effects of sedating medications. Tell your health care provider that you take or are considering ashwagandha if you use any prescription medication, or if you have a thyroid, liver, or autoimmune condition.