Ashwagandha

The name Ashwagandha comes from the Sanskrit words ashwa, meaning horse, and gandha, meaning smell. Traditional sources explain the name in two ways: the fresh root has a strong smell that resembles a horse, and the herb is believed to provide the strength and stamina of a horse. Ashwagandha is described in the classical Ayurvedic tradition, and the plant grows in the drier regions of India, the Middle East and Africa (Singh et al., 2011).

In Ayurveda, Ashwagandha is classified as a Rasayana, a group of substances traditionally used to support long-term health and resilience, and as a Balya, a substance traditionally used to support physical strength (Singh et al., 2011). Its root is described as having a bitter (Tikta) and astringent (Kashaya) taste (Rasa), a heating potency (Virya) and a sweet post-digestive effect (Vipaka). Traditional texts describe it as balancing the Vata and Kapha doshas.

Ashwagandha is known by a botanical name, several English names and regional Indian names, which are listed below.

• Botanical name: Withania somnifera (L.) Dunal
• Sanskrit: Ashwagandha, Vajigandha
• Hindi: Ashgandh, Punir
• English: Indian ginseng, winter cherry, Indian winter cherry, poison gooseberry
• Kannada: Hiremuddina gida
• Tamil: Karappaan thazhai, Amukkila chedi
• Telugu: Pennerugadda, Pulivendrum, Panneru Vajigandha
• Malayalam: Amukkuram
• Urdu: Asgand

Indian ginseng is not botanically related to Panax ginseng, which belongs to a different plant family.

The activity of Ashwagandha is attributed mainly to steroidal compounds and alkaloids found in the root and leaf. The main groups of constituents are listed below.

• Withanolides: Ashwagandha contains numerous withanolides, including withaferin A and withanolide A. Their types, and concentrations vary between roots, leaves and extracts.
• Withanosides and sitoindosides: withanolide glycosides, including withanosides IV and V and sitoindosides IX and X.
• Alkaloids: including anaferine, anahygrine, cuscohygrine, isopelletierine, tropine and pseudotropine.
• Flavonoids and polyphenols: present in the root, leaf and fruit.
• Withanamides: reported mainly in the fruit.
• Other root constituents: starch, reducing sugars and iron).

The content of these compounds varies with the plant part, growing region and type of extract, so the composition and strength of Ashwagandha products can vary.

Laboratory, animal and clinical studies have described the following properties of Ashwagandha.

• Adaptogenic: may help the body adapt to physical and emotional stress.
• Anxiolytic: is associated with lower anxiety scores in some clinical trials.
• Antioxidant: may reduce oxidative stress in laboratory models.
• Anti-inflammatory: may lower inflammatory markers in laboratory and animal studies.
• Immunomodulatory: may alter immune cell activity in laboratory studies and small human studies.
• Mild sedative: may cause drowsiness, particularly at higher doses.

Most of these properties have been demonstrated in laboratory and animal research, which cannot confirm that the same effect occurs in people. Evidence in humans comes mainly from small, short clinical trials in adults who used standardised root extracts (Mikulska et al., 2023). These findings cannot be applied to every product, dose or individual, and Ashwagandha is not a substitute for medical treatment or prescribed medicines. Seek medical advice before use if you have a health condition.

The benefits of Ashwagandha have been studied for stress, sleep quality and fatigue, although evidence in humans remains limited. Some studies suggest that Ashwagandha may help reduce perceived stress and serum cortisol levels, but it should not be presented as a proven treatment for stress or anxiety.

1. Diabetes Support

Ashwagandha has been traditionally used to help maintain healthy blood glucose levels. Some preliminary studies have explored its potential effects on blood glucose and insulin sensitivity, but clinical evidence remains limited. It should not replace prescribed diabetes medication.

2. Nervousness and Stress Reduction

Ashwagandha is traditionally used as an adaptogen and may help the body respond to stress. Some studies suggest it may reduce perceived stress and cortisol levels, but the evidence remains limited in humans.

3. Fertility and Sexual Wellbeing

In men, limited clinical studies suggest that Ashwagandha may support testosterone levels and some sperm parameters, including sperm count and motility. Similarly, for women, evidence on hormonal balance, menstrual discomfort and fertility remains limited, and more research is needed.

4. Joint Pain Support

Ashwagandha has been studied for its potential anti-inflammatory and pain-relieving effects. Some research suggests it may help with joint discomfort and inflammation, but evidence in humans is limited and it should not be considered a treatment for autoimmune joint diseases or osteoarthritis.

5. Heart Health

Ashwagandha has been studied for its potential effects on cholesterol, blood lipids, stress and blood pressure. However, evidence is limited, and it should not be used as a substitute for treatment prescribed for cardiovascular conditions.

6. Blood Pressure Support

Some studies have explored whether Ashwagandha may help support healthy blood pressure, possibly through effects on stress and vascular function. However, there is not enough evidence to recommend it for treating high blood pressure.

7. Cancer Research

Some investigations suggest that compounds within Ashwagandha, such as Withaferin A (WA) and withanolides, may possess properties that inhibit cancer cell proliferation and induce cancer cell death in laboratory settings. While these findings are promising, laboratory findings do not establish effectiveness or safety as a cancer treatment in humans. Ashwagandha should not replace standard cancer treatment or be used as part of cancer therapy without medical advice.

8. Support for Brain & Nerve Health

Ashwagandha’s potential neuroprotective effects have mainly been studied in laboratory and preclinical research. It may have a supportive role in brain and nerve health, but evidence in humans is limited, including for age-related memory decline. Its antioxidant activity has been investigated as one possible mechanism.

Disclaimer: These effects have been observed mainly in short clinical studies of adults who used standardised extracts. Ashwagandha does not treat, prevent or cure any disease, and it must not replace prescribed medicines or medical advice.

Ashwagandha is commonly used in Ayurvedic rejuvenation routines and as a traditional tonic during weakness or recovery. Some adults also take standardised Ashwagandha extracts during periods of mental or physical strain or as part of a bedtime routine. The appropriate form, dose and duration can vary, so longer-term or condition-specific use should be discussed with a qualified healthcare professional.

General Tonic in Long-Term Rejuvenation Therapy

In Ayurveda, Ashwagandha root powder is included in Rasayana regimens, which are followed over weeks to months to support general health and resilience. These regimens are individualised, and a qualified Ayurvedic practitioner usually decides the form and duration (Singh et al., 2011).

Traditional Use During Weakness and Convalescence

Ashwagandha is traditionally taken as a nourishing tonic by people who feel physically weak or are recovering from a prolonged illness. It is usually given as a powder with warm milk. A person who is recovering should first discuss its use with the treating doctor.

Use During Periods of Mental or Physical Strain

Adults commonly take standardised Ashwagandha extract during sustained work, study or physical training to support stamina and the response to stress. Studies in healthy adults and athletes have generally used daily doses over several weeks (Bonilla et al., 2021).

Use as Part of a Bedtime Routine

Some adults take Ashwagandha in the evening to support relaxation before sleep, often with warm milk. In sleep studies, the extract was taken daily for several weeks, and the effect is generally gradual rather than immediate (Cheah et al., 2021).

Ashwagandha is not suitable for everyone. The groups and situations below need particular care or medical advice before use.

Pregnancy

Avoid Ashwagandha during pregnancy. Traditional use includes inducing abortion, and no adequate studies have examined its safety in early pregnancy (NCCIH, n.d.). A woman who is planning a pregnancy should consult her doctor before use.

Breastfeeding

Safety information is insufficient to support the use of Ashwagandha while breastfeeding, so use during this time is not recommended (NCCIH, n.d.). A breastfeeding mother should consult her doctor before taking any herbal supplement.

Children and Adolescents

The safety of Ashwagandha in children and adolescents has not been established. Give it only if a paediatrician or a qualified Ayurvedic physician prescribes it.

Liver Disease

Rare cases of liver injury have been reported with Ashwagandha supplements (NIDDK, 2012; Björnsson et al., 2020). Those who have liver disease, or who take other medicines that can affect the liver, should consult a doctor before use. Warning symptoms are described under Side Effects.

Thyroid Conditions

Thyroid hormone levels may rise with Ashwagandha, and excess thyroid activity has been reported in a few individuals. Anyone with a thyroid disorder, or who takes thyroid medicine, should use it only under medical supervision, with regular thyroid testing.

Autoimmune Conditions and Organ Transplantation

Immune stimulation by Ashwagandha could interfere with immunosuppressant treatment. People with an autoimmune condition, and transplant recipients, should use it only if their specialist advises.

Kidney Disease

Information on the safety of Ashwagandha in kidney disease is limited. A person with kidney disease should use it only if the treating doctor or nephrologist agrees.

Diabetes

Blood glucose may fall with Ashwagandha use. People with diabetes should check blood glucose regularly and consult their doctor before use, particularly if they take diabetes medicines.

Low Blood Pressure

Blood pressure may fall in some individuals who take Ashwagandha. Anyone with low blood pressure, or who feels dizzy or faint, should seek medical advice before use.

Planned Surgery

Drowsiness may occur, and the effect of sedative medicines may increase. The surgeon and anaesthetist should be told about its use before any planned procedure, and their advice on when to stop should be followed.

Hormone-Sensitive Conditions

Sex hormone levels, including testosterone, may change with Ashwagandha use. People with a hormone-sensitive condition should consult their doctor before use.

Disclaimer: This list is not exhaustive. Consult a doctor or a qualified Ayurvedic practitioner before using Ashwagandha, particularly if you have a medical condition or take regular medicines.

Ashwagandha is available in several forms, and the method of use depends on the form. The dose should be the one advised by a doctor or Ayurvedic practitioner, or the one printed on the product label.

Root Powder With Warm Milk

Measure the quantity of root powder advised by the practitioner. The usual daily quantity is given under Recommended Dosage.

• Warm one cup of milk until it is comfortably warm to drink.
• Stir in the measured powder until it is evenly mixed.
• Drink the mixture after a light meal if the powder causes stomach discomfort on an empty stomach.

Decoction Prepared From Root Powder

Add one-quarter to one-half teaspoon of root powder and a small pinch of dried ginger powder to two cups of water.

• Boil on a low flame until the liquid reduces to about half its original volume.
• Allow the decoction to cool to a comfortable temperature.
• Add honey if desired, then drink the decoction while it is still warm.

No scientific studies have evaluated the effect or safety of Ashwagandha tea or decoction, so the quantity should not exceed the amount advised by the practitioner.

Capsules

• Check the label for the amount of extract in each capsule and the number of capsules to be taken.
• Swallow the capsule whole with a glass of water, preferably after a meal.
• Take the product at about the same time each day, and do not exceed the labelled number.

Tablets

• Check the label to see whether the tablet is standardised to a stated amount of withanolides.
• Swallow the tablet whole with water. Do not crush or chew it unless the label permits.
• Keep to the labelled number of tablets per day, and stop use if any warning symptom described under Side Effects occurs.

Oil for External Use

• Apply a small amount of oil to a patch of skin and wait 24 hours to check for irritation or an allergic reaction.
• If there is no reaction, massage a small quantity gently into the intact skin of the affected area.
• Do not apply to broken skin or near the eyes, and do not swallow the oil.

Herbs Traditionally Used With Ashwagandha

Ashwagandha is traditionally combined with certain other herbs in Ayurvedic preparations. Three examples are listed below.

Disclaimer: Combining herbs may change both the effects and the risks. Do not start a combination product without advice from a doctor or a qualified Ayurvedic practitioner.

The dose of Ashwagandha depends on the age, general health and form of the product. Guidance for each age group is given below.

Children

No safe or effective dose has been established for children. Ashwagandha should not be given to a child unless a paediatrician or a qualified Ayurvedic physician prescribes it and states the dose.

Teenagers

A dose has not been established for teenagers. Clinical studies have been conducted in adults aged 18 years and above (Cheah et al., 2021). Ashwagandha should be used by a teenager only under the supervision of a doctor or Ayurvedic physician.

Adults

For root powder, the dose given in the WHO monograph is 3 to 6 g daily, equal to about one to two teaspoons. For standardised root extract, clinical studies used 250 to 600 mg daily, for example 300 mg twice daily, for 8 to 12 weeks (Chandrasekhar et al., 2012). Product strength varies, so the label should be followed. Long-term safety has not been established, and continuous use beyond the period advised by a doctor is not recommended (NCCIH, n.d.).

Elderly People

No specific dose has been established for older adults. Some studies in adults aged 60 years and above used standardised extract or root powder under supervision. Because older adults are more likely to take other medicines and to have liver, thyroid or blood pressure conditions, a doctor may recommend an appropriate dose based on the individual's health and medicines.

Disclaimer: These doses are for general information only and may vary with individual health conditions, age and the product used. Consult a qualified healthcare professional or Ayurvedic practitioner before starting Ashwagandha, and do not exceed the recommended amount without medical supervision.

Most adults tolerate short-term use of Ashwagandha, but side effects can occur. Most are mild, although rare effects can be serious.

Digestive Discomfort

Upset stomach, nausea, vomiting and loose stools may occur, particularly at higher doses. These effects are generally mild. A doctor should be consulted if they persist.

Drowsiness

Drowsiness may occur after a dose. Driving and the use of machinery should be avoided until the individual response is known. The effect may be stronger when Ashwagandha is combined with alcohol or sedative medicines.

Liver Injury

Rare cases of liver injury have been reported, with symptoms starting between 1 and 12 weeks after the supplement was begun (Björnsson et al., 2020). In the cases that were followed up, liver tests returned to normal after the supplement was stopped. Warning symptoms include yellowing of the skin or eyes, dark urine, pale stools, itching, nausea and abdominal pain.

Thyroid Hormone Changes

Thyroid hormone levels can rise with Ashwagandha, and excess thyroid hormone (thyrotoxicosis) has been reported in a small number of people. Symptoms may include a fast heartbeat, tremor, anxiety, weight loss and intolerance to heat.

Allergic Reactions

Some individuals may develop an allergic reaction, which can cause skin rash, itching, swelling of the face or lips, or difficulty breathing. Any such reaction needs prompt medical attention.

When to Seek Medical Help

The product should be stopped and medical advice sought promptly if yellowing of the skin or eyes, dark urine, severe or persistent abdominal pain, persistent vomiting, a fast or irregular heartbeat or unusual weakness develops. Swelling of the face or lips, or difficulty breathing, requires emergency medical care.

Ashwagandha may interact with some medicines by enhancing their effects or affecting how they work. Main interactions are described below, and the doctor should be told about any herbal product in use.

Antidiabetic Medicines

Blood glucose may fall too low (hypoglycaemia) when Ashwagandha is used with insulin or tablets for diabetes. Blood glucose should be monitored closely, and the doctor may need to adjust the dose of the diabetes medicine.

Antihypertensive Medicines

Medicines that lower blood pressure may have a stronger effect when taken with Ashwagandha, which could cause dizziness or fainting. Regular blood pressure checks are advised, and the doctor should be informed before use.

Sedative and Sleep Medicines

The sedative effect of benzodiazepines, barbiturates, other sleep or anxiety medicines and alcohol may be increased by Ashwagandha. Excessive drowsiness and slowed reactions may result, so driving should be avoided until the response is known.

Thyroid Medicines

Thyroid hormone levels may rise further when Ashwagandha is combined with levothyroxine or other thyroid hormone medicines. Thyroid function should be checked, and the doctor informed before use.

Immunosuppressant Medicines

Immunosuppressant medicines, used after organ transplantation or for autoimmune conditions, may be affected when Ashwagandha, which can stimulate immune activity, is also taken. Use together only if the specialist advises.

Disclaimer: This list is not complete. Do not start or stop any prescribed medicine without medical advice, and inform the doctor and pharmacist before using Ashwagandha with other medicines.

Storage of Ashwagandha

Correct storage helps keep Ashwagandha products in good condition and safe to use. The following points apply to powder, capsules, tablets and oil.

• Store the product in a tightly closed container in a cool, dry place, away from direct sunlight and moisture.
• Heat and humidity can reduce the quality of the active compounds, particularly in extracts.
• Refrigeration is not usually necessary unless the product label states so.
• Keep the product out of the sight and reach of children.
• Do not use the product after its expiry date, or if the powder is damp, lumpy, discoloured or has an unusual odour.

• Ashwagandha is a traditional Ayurvedic root herb classified as a Rasayana. Short clinical studies in adults suggest it may help with everyday stress, sleep quality and physical performance.
• It has not been shown to treat or prevent any disease, and it must not replace prescribed treatment.
• Side effects are usually mild. Rare liver injury and thyroid hormone changes have been reported, and yellow skin or eyes, dark urine or severe abdominal pain need prompt medical advice.
• Ashwagandha should be avoided during pregnancy and breastfeeding, and in children unless prescribed.
• People with liver, thyroid, autoimmune or kidney conditions, and those who take medicines for diabetes, blood pressure, sleep or immunosuppression, need medical advice before use.
• The dose, form and duration should follow the product label or professional advice, as long-term safety has not been established.