Why Ashwagandha isn’t for everyone: Benefits, risks, and who should avoid it

Ashwagandha offers proven benefits for stress, sleep, and athletic performance, with standardized extracts demonstrating effectiveness. However, potential risks such as liver injury and endocrine disruptions require careful evaluation. Informed use involves weighing the benefits against individual health conditions and possible interactions. Known scientifically as Withania somnifera, Ashwagandha is a popular adaptogenic herb in Ayurvedic tradition, known for its stress-relieving, sleep-enhancing, and vitality-boosting properties. Despite clinical evidence supporting its benefits, safety concerns limit its suitability for everyone. While systematic reviews show its efficacy in cortisol control and anxiety reduction, case reports have linked it to liver damage and hormonal imbalances. To use it safely, individuals must carefully consider their own health profiles. Standardized root extracts of 300-600 mg daily, containing 5% withanolides, have been shown to significantly reduce stress levels. Meta-analyses confirm its effectiveness in reducing anxiety and cortisol levels. Studies have also demonstrated improvements in physical performance, including increased strength, VO2 max, and quicker recovery times. Trials focusing on insomnia have shown positive results in improving sleep patterns. Individuals with subclinical hypothyroidism have experienced favorable outcomes with the herb. However, caution is advised due to the potential side effects that may arise. Recommended short-term use is generally safe, with common side effects including gastrointestinal discomfort and sedation. Long-term use has also been deemed safe in studies, with only transient gastrointestinal effects reported. Acute liver injury is a major concern with Ashwagandha, as evidenced by cases of cholestatic hepatitis and the need for liver transplants in severe cases. The herb can also exacerbate autoimmune conditions like rheumatoid arthritis and multiple sclerosis. Hyperthyroid patients should be cautious due to its effects on thyroid hormones. Pharmacokinetic interactions can occur with medications metabolized by the CYP3A4 enzyme, such as sedatives and anticonvulsants. It can also potentiate the effects of thyroid replacement therapy. Pregnant women should avoid Ashwagandha due to its potential abortifacient properties, while there is insufficient data on its safety during lactation. Children under 18 years, individuals with active autoimmune diseases, untreated hyperthyroidism, and preexisting liver issues are advised to avoid it. Patients with hormone-sensitive cancers should consult with an oncologist before use. Starting with a low dose of 300 mg per day with food is recommended, with cycling of 8 weeks on and 2 weeks off. It is important to choose extracts verified by reputable organizations like USP or NSF. Monitoring liver and thyroid function for at-risk individuals is also suggested. While Ashwagandha can provide significant benefits for certain populations, the risks must be carefully weighed. Professional guidance is essential for vulnerable groups, underscoring the importance of ongoing monitoring to optimize its use.