Mickie Cathers
Ashwagandha (Withania somnifera), a small perennial shrub with yellow flowers, is a key component of Ayurveda, the traditional practice of medicine developed more than 3,000 years ago in India. In Ayurvedic medicine, ashwagandha is promoted for its effects on fatigue, mood, sleep, and libido. Current research shows that ashwagandha’s therapeutic potential resides in its cortisol-lowering and testosterone-enhancing effects.
Function
Native to Southern Asia and North Africa, the herb—also known as Indian ginseng and winter cherry—is a member of the nightshade family, related to potatoes and tomatoes. Many of the health benefits of ashwagandha are attributed to its anti-inflammatory properties and ability to regulate cortisol. Ashwaganha’s bioactive compounds include amino acids, alkaloids (withanine, withasomnin), lactones (withanolides), and glycosides (sitoindosides). High concentrations of withanolides present antiangiogenic properties and have been shown to inhibit inflammation and tumor growth.
Ashwagandha has been recognized as an adaptogen, much like turmeric, holy basil, and licorice root. Although their effectiveness is controversial, adaptogens have been demonstrated to produce antifatigue, neuroprotective, antidepressive, and CNS stimulating activity. The stress-protective activity of adaptogens has been linked to the hypothalamic–pituitary–adrenal axis and the regulation of key mediators of stress response, such as molecular chaperons (e.g., HSP70), stress-activated c-Jun N-terminal protein kinase 1 (JNK1), Forkhead box O (FOXO) transcription factor DAF-16, cortisol, and nitric oxide.
Is there a benefit?
Two recent double-blind, randomized, placebo-controlled trials showed similar results illustrating ashwagandha’s effect on stress, anxiety, and insomnia.
In a study published in 2012 in the Indian Journal of Psychological Medicine, Chandrasekhar and colleagues evaluated the effectiveness of 300 mg of ashwagandha-root extract in patients with a history of chronic stress and anxiety. Results showed a significant reduction in stress-assessment scores and serum cortisol levels in the ashwagandha group compared with placebo, and adverse effects were mild.
A trial published in Cureas in 2019 evaluated outcomes of ashwagandha supplementation in study participants who were randomized to receive 125 mg or 300 mg of ashwagandha extract or placebo twice daily for 8 weeks. Anxiety, cortisol levels, and sleep quality were measured at baseline and at 8 weeks. The researchers found a significant decrease in serum cortisol levels and improvement in sleep quality in both ashwagandha groups compared with the placebo group.
Muscle mass and strength
Ashwagandha is translated from Sanskrit as “smell of the horse,” which hints at the aroma of this herb and the documented stamina- and strength-building benefits.
A 2018 randomized double-blind, placebo-controlled trial published in Nutrients examined the effect of ashwagandha supplementation on muscle strength and recovery in male study participants engaged in resistance training. In their assessment of study participants after 12 weeks of 500 mg supplementation of ashwagandha extract, the researchers found significantly greater improvements in maximal strength in participants taking ashwagandha compared with those taking placebo. In addition, only the ashwagandha group experienced statistically significant improvements in average squat power, peak bench-press power, 7.5-km time trial performance, and perceived recovery scores.
Daily requirements and dietary sources
Ashwagandha is available as gummies, powders, tablets, and teas and is often paired with black pepper, which aids absorption and digestion. Dosages of 125 mg to 5 g ashwagandha extract have been shown to reduce cortisol levels by 11% to 32%. For muscle mass and strength increases in men, daily doses of 500 mg of ashwagandha have been shown to be effective.
What to tell your patients
Inform patients who are interested in taking ashwagandha that this supplement is considered safe for most people, with limited reports of adverse effects at dosages of one to two 500-mg tablets per day. Extremely high dosages can cause upset stomach, diarrhea, and vomiting.
Caution pregnant or breastfeeding patients as well as those with lupus, rheumatoid arthritis, type 1 diabetes, and Hashimoto’s disease to avoid using ashwagandha. Ashwagandha may interact with thyroid, blood glucose, and blood pressure medication.