Ashwagandha

Scientific Name: Withania somnifera, synonym Physalis somnifera.

History

Ashwagandha has been used for thousands of years in traditional Indian medicine practices called Ayurveda. The root is said to smell like a horse and is named after the Sanskrit words for horse “ashva” and smell “gandha”.

Ashwagandha roots were commonly available as a powder that could be mixed with water, ghee, milk, or honey. A paste for external use can be made by crushing the roots with water. The leaves and flowers are also sometimes used in additional treatments.¹

Background

Ashwagandha is an evergreen green shrub that is native to dry areas of India, the Middle East, and parts of Africa. It is identified as an “adaptogen”. Adaptogens are theorized to help the body to resist various stressors. Of note, “adaptogen” is not a scientific term and is not accepted in pharmacological or physiological clinical practice. More studies of adaptogens need to be completed. Whether or not ashwagandha is an adaptogen doesn’t matter, what matters is if it helps with various conditions.

Mechanism of action: The roots and berries are used for medicinal purposes. Several active components have been identified including alkaloids, steroidal lactones, and saponins. The mechanism of the antioxidant and anti-inflammatory effects is not known. The anxiolytic and anti-stress effects may be related to enhanced serotonergic transmission, GABA mimetic effects, dopamine receptor effects, or corticosterone suppression.

Ashwagandha does not contain nicotine, contrary to some reports.

Dosing

Ashwagandha has been used at up to 1000 mg daily for 12 weeks

Effectiveness

Ashwagandha may have benefits in mental health, physical health, and sexual health.

Mental Health:

Anxiety

A 60-day, randomized, double-blind, placebo-controlled trial compared ashwagandha 240 mg with placebo. Ashwagandha supplementation had a statistically significant reduction in an anxiety scale called the HAM-A scale. Ashwagandha decreased cortisol levels and increased testosterone levels in males.²

An eight-week trial of 60 participants compared twice-daily ashwagandha 125 mg, ashwagandha 300 mg, and placebo. A significant reduction in anxiety scores was seen in both ashwagandha groups as compared to placebo. Additionally, cortisol levels were decreased in both ashwagandha groups.³

A study of 64 patients with chronic stress compared a standardized product of Ashwagandha 300 mg twice daily with placebo. The ashwagandha used in this study was a root extract called KSM-66 from a company called Ixoreal Biomed. The treatment group had significant decreases in stress scores, serum cortisol levels, and no serious adverse effects were reported in either group.⁴

Memory:

A study was conducted on 50 adults age 35 and older to evaluate the efficacy of ashwagandha in improving memory and cognitive function in adults with mild cognitive impairment. Treatment included KSM-66 ashwagandha 300 mg twice daily or placebo for eight weeks. The treatment group demonstrated greater improvement in executive function, sustained attention,
and information-processing speed. At eight weeks, memory scores were significantly better in the ashwagandha group as shown by the Wechsler Memory Scale-III scores.⁵

Physical Health:

An eight-week randomized, double-blind study was conducted in 57 male patients aged 18-50. Participants had little experience in resistance training and were provided with a workout program, one year of a free gym membership, and three months of professional trainer support. The participants received either KSM-66 ashwagandha 300 mg twice daily or placebo.

Results:

Bench-press increases: ashwagandha 46.0 kg, placebo 26.4 kg
Leg-extension increases: ashwagandha 14.5 kg, placebo 9.8 kg
Arm size increases: ashwagandha 8.6 cm squared, placebo 5.3 cm squared
Testosterone increases: ashwagandha 96.2 ng/dL, placebo 18.0 ng/dL
Body fat level decreases: ashwagandha 3.5%, placebo 1.5%⁶

Another trial of 50 healthy male or female athletic adults assessed KSM-66 ashwagandha 300 mg twice daily vs. placebo in improving cardiorespiratory endurance. Cardiorespiratory endurance was assessed by measuring the oxygen consumption at peak exertion (VO₂ max) during a 20-meter shuttle run test. There was a greater VO₂ max increase in the ashwagandha group at eight and 12 weeks as compared to placebo.⁷

Sexual Health:

46 male patients with low sperm counts were randomized to receive either KSM-66 ashwagandha 675 mg/day in three divided doses or placebo. Parameters were gathered at baseline, 60-days, and 90-days. The ashwagandha group had significant improvements. At 90-days there was a 167% increase in sperm count, a 53% increase in sperm volume, and a 57% increase in sperm motility as compared to minimal change in the placebo group. Additionally, testosterone levels were higher in the ashwagandha group.⁸

50 female patients were randomized to receive KSM-66 ashwagandha 300 mg twice daily or placebo for eight weeks. Sexual function was assessed with the Female Sexual Function Index (FSFI) Questionnaire and the Female Sexual Distress Scale (FSDS). The ashwagandha group significantly outperformed the placebo group in total scores and domains such as arousal, lubrication, orgasm, and satisfaction.⁹

Safety

Natural Medicines Database deems ashwagandha to be possibly safe when used orally and appropriately for short-term use. It has been been used in doses of 1250 mg daily for up to six months.

Pregnancy: LIKELY UNSAFE, has abortifacient effects

Side effects

Generally, ashwagandha is well tolerated but side effects are possible.

Dermatologic: dermatitis (inflammation of the skin) has been reported
Gastrointestinal: nausea, vomiting and diarrhea have been reported
Hepatic: there are at least five reports of liver injury with symptoms of jaundice, nausea, abdomnial pain and lethargy. Liver enzymes returned to normal within a few months after discontinuation

Drug interactions

Diabetes medications: may increase the risk of hypogylcemia
Blood pressure medications: may increase the risk of hypotension
CNS depressants: may increase the risk of oversedation
Immunosuppressants: may decrease the effects of immunosuppressants. Ashwagandha has immunostimulant effects and may exacerbate autoimmune diseases
Thyroid medications: may increase the effects of thyroid hormones

References:

Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-213. doi:10.4314/ajtcam.v8i5S.9.
Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019 Sep;98(37):e17186. doi: 10.1097/MD.0000000000017186. PMID: 31517876; PMCID: PMC6750292.
Salve J, Pate S, Debnath K, Langade D. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019;11(12):e6466. Published 2019 Dec 25. doi:10.7759/cureus.6466.
Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-262. doi:10.4103/0253-7176.106022.
Choudhary D, Bhattacharyya S, Bose S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl. 2017 Nov 2;14(6):599-612. doi: 10.1080/19390211.2017.1284970. Epub 2017 Feb 21. PMID: 28471731.
Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Int Soc Sports Nutr. 2015;12:43. Published 2015 Nov 25. doi:10.1186/s12970-015-0104-9.
Choudhary B, Shetty A, Langade DG. Efficacy of Ashwagandha (Withania somnifera [L.] Dunal) in improving cardiorespiratory endurance in healthy athletic adults. Ayu. 2015;36(1):63-68. doi:10.4103/0974-8520.169002.
Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre A. Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot Study. Evid Based Complement Alternat Med. 2013;2013:571420. doi:10.1155/2013/571420.
Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154. doi:10.1155/2015/284154.