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Ashwagandha

Ashwagandha (Withania somnifera) is a leading rasayana, or rejuvenating tonic, in Ayurveda, traditionally used to build strength and resilience to stress. Meta-analyses of small randomised trials suggest standardised extracts may modestly improve sleep and lower self-reported stress and anxiety over several weeks, but no claim reaches moderate certainty because the trials are few, small, use different extracts and disagree in effect size. Rare cases of liver injury have been reported, several European authorities and the Australian TGA have reviewed its safety, and it is advised against in pregnancy and breastfeeding.

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Evidence retrieved up to

What the research shows

Ashwagandha supplements have been linked to rare cases of liver injury in adults, usually cholestatic jaundice with itching that resolved within months after stopping.

Very low certaintyThis is uncertain; treat it as a lead, not a finding.
Caution: see the safety noteRisk

Who this is about

adults taking ashwagandha supplements

Practical note

Evidence comes from case reports and case series, so how often this happens is unknown; the published cases appeared 2-12 weeks after starting a supplement.

Safety note

Rare cases of liver injury, usually cholestatic jaundice with itching appearing 2-12 weeks after starting, have been linked to ashwagandha supplements; the German BfR also notes reports of acute liver failure. NCCIH advises avoiding ashwagandha in pregnancy and breastfeeding and does not recommend it before surgery or for people with autoimmune or thyroid disorders; it may interact with medicines for diabetes, blood pressure, immunosuppressants, sedatives, anticonvulsants and thyroid hormone. Reported short-term effects include drowsiness, stomach upset, diarrhoea and vomiting. Long-term safety (beyond about 3 months) is not established. European authorities including DTU (Denmark), RIVM, ANSES and BfR, and the Australian TGA, have reviewed its safety; BfR found no safe intake level could be derived and advises against food supplements containing it.

Sources

Standardised ashwagandha extracts taken for several weeks may modestly improve sleep quality and quantity compared with placebo, with larger effects reported in adults living with insomnia.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults, including adults living with insomnia

Practical note

The pooled trials were small (five trials, 400 participants) and used different extracts; effects were larger in trials using 600 mg a day or more for 8 weeks or longer. Certainty is low because of inconsistency between trials (I2 62%) and imprecision from few small trials.

Vegan note

Ayurvedic texts describe giving ashwagandha powder with milk or ghee; the same sources also describe mixing it with water, so a plant-based preparation fits the tradition. Supplement capsules may use gelatin shells.

Safety note

Rare cases of liver injury, usually cholestatic jaundice with itching appearing 2-12 weeks after starting, have been linked to ashwagandha supplements; the German BfR also notes reports of acute liver failure. NCCIH advises avoiding ashwagandha in pregnancy and breastfeeding and does not recommend it before surgery or for people with autoimmune or thyroid disorders; it may interact with medicines for diabetes, blood pressure, immunosuppressants, sedatives, anticonvulsants and thyroid hormone. Reported short-term effects include drowsiness, stomach upset, diarrhoea and vomiting. Long-term safety (beyond about 3 months) is not established. European authorities including DTU (Denmark), RIVM, ANSES and BfR, and the Australian TGA, have reviewed its safety; BfR found no safe intake level could be derived and advises against food supplements containing it.

Sources

Ashwagandha extracts may reduce self-reported stress and anxiety scores compared with placebo in adults, as part of a healthy lifestyle.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults experiencing stress

Practical note

The meta-analysis pooled 12 small trials (1,002 participants aged 25-48) using varied extracts; the stress benefit was seen at doses of about 300-600 mg a day. Results varied widely between trials, and the review authors rated certainty low.

Vegan note

Ayurvedic texts describe giving ashwagandha powder with milk or ghee; the same sources also describe mixing it with water, so a plant-based preparation fits the tradition. Supplement capsules may use gelatin shells.

Safety note

Rare cases of liver injury, usually cholestatic jaundice with itching appearing 2-12 weeks after starting, have been linked to ashwagandha supplements; the German BfR also notes reports of acute liver failure. NCCIH advises avoiding ashwagandha in pregnancy and breastfeeding and does not recommend it before surgery or for people with autoimmune or thyroid disorders; it may interact with medicines for diabetes, blood pressure, immunosuppressants, sedatives, anticonvulsants and thyroid hormone. Reported short-term effects include drowsiness, stomach upset, diarrhoea and vomiting. Long-term safety (beyond about 3 months) is not established. European authorities including DTU (Denmark), RIVM, ANSES and BfR, and the Australian TGA, have reviewed its safety; BfR found no safe intake level could be derived and advises against food supplements containing it.

Sources

What the tradition holds

Ayurveda classifies ashwagandha root as a rasayana (rejuvenating tonic) and uses it as a nervine tonic, held to restore vitality and steady the nervous system under stress in adults.

Take care: see the safety noteBenefit

Who this is about

adults

The tradition's frame

Ayurveda

Ayurveda counts ashwagandha among the most important rasayana (rejuvenating) herbs, a 'sattvic kapha rasayana' that restores strength in debility and old age, classically taken as a root powder in milk or ghee.

Vegan note

Ayurvedic texts describe giving ashwagandha powder with milk or ghee; the same sources also describe mixing it with water, so a plant-based preparation fits the tradition. Supplement capsules may use gelatin shells.

Safety note

Rare cases of liver injury, usually cholestatic jaundice with itching appearing 2-12 weeks after starting, have been linked to ashwagandha supplements; the German BfR also notes reports of acute liver failure. NCCIH advises avoiding ashwagandha in pregnancy and breastfeeding and does not recommend it before surgery or for people with autoimmune or thyroid disorders; it may interact with medicines for diabetes, blood pressure, immunosuppressants, sedatives, anticonvulsants and thyroid hormone. Reported short-term effects include drowsiness, stomach upset, diarrhoea and vomiting. Long-term safety (beyond about 3 months) is not established. European authorities including DTU (Denmark), RIVM, ANSES and BfR, and the Australian TGA, have reviewed its safety; BfR found no safe intake level could be derived and advises against food supplements containing it.

Sources