Ashwagandha

Background

• Ashwagandha is an evergreen shrub found in parts of India, Africa, and the Middle East. It contains several bioactive compounds, including a group of substances known as withanolides. Withanolides have been associated with anti-inflammatory and antioxidant effects.
• Ashwagandha has been in use as a medicinal plant for thousands of years, especially in traditional Ayurvedic medicine.
• Currently, ashwagandha supplements are often promoted for stress and anxiety, sleep, male infertility, and athletic performance. These supplements typically contain ashwagandha root, leaf, or root/leaf extracts.
• Ashwagandha has also been promoted for COVID-19, but there is not sufficient high-quality evidence to support its use.

How Much Do We Know?

• Many clinical trials (studies in people) have looked at the use of ashwagandha for a variety of health conditions. However, many of the studies have had small sample sizes and have used a variety of ashwagandha preparations.

What Have We Learned?

• Research shows that some ashwagandha preparations may be effective for insomnia and stress. However, evidence is unclear about its effects on anxiety.
• There is some limited evidence that suggests that taking ashwagandha for 2 to 4 months may increase testosterone levels and sperm quality.
• There isn’t enough evidence to determine if ashwagandha is helpful for any other health conditions, such as asthma, athletic performance, cognitive function, diabetes, menopause, and female infertility.
• There is not enough high-quality evidence suggesting that ashwagandha is helpful in treating COVID-19.

What Do We Know About Safety?

• Ashwagandha may be safe when taken in the short term (up to 3 months). There is not enough information to allow conclusions about its long-term safety to be reached.
• In some individuals, ashwagandha preparations may cause drowsiness, stomach upset, diarrhea, and vomiting.
• Although it is rare, there have been a number of cases that link liver injury to ashwagandha supplements.
• Ashwagandha should be avoided during pregnancy and should not be used while breastfeeding.
• Ashwagandha is not recommended for people who are about to have surgery, or for those who have autoimmune or thyroid disorders.
• There is evidence that ashwagandha might interact with some medications, including those for diabetes and high blood pressure, medicines that decrease the immune system response (immunosuppressants), sedatives, anti-seizure medications (anticonvulsants), and thyroid hormone medications.
• Because ashwagandha may increase testosterone levels, people with hormone-sensitive prostate cancer should avoid its use. 

Keep In Mind

• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
• Federal Regulation of Herbal Products
  • Depending on what’s in them, how they’re intended to be used, and how they’re administered (orally or topically), herbal products are regulated in a variety of ways. Many herbal products intended for oral use are marketed as dietary supplements. The rules for making and distributing dietary supplements are less strict than those for drugs.
  • Unlike drugs, dietary supplements are not approved by the U.S. Food and Drug Administration (FDA) before they are sold to the public. When public health concerns arise about the safety of a dietary supplement or an ingredient including an herb, the FDA can take action to protect the public. Manufacturers and distributors of supplements are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all regulatory requirements. 

For More Information

• Using Dietary Supplements Wisely
• Know the Science: How Medications and Supplements Can Interact
• Know the Science: How To Make Sense of a Scientific Journal Article

Key References