If you’re taking ashwagandha gummies or you’re thinking about taking it, you need to read this guide. Because while ashwagandha is marketed as a natural stress reliever and a sleep booster, there are recent studies that you need to know about that raised important safety questions.
So in this guide, we’ll walk you through the latest data that we have, not just on the benefits. Because yes, ashwagandha does have some impressive therapeutic benefits. But we also want to go over potential toxicities. And we’ll explain who should, and more importantly, who should not take the supplement.
We’ll also talk about hidden interactions with common medications that you need to watch out for. And at the end of the guide, we’ll go over the best dose to take. And we’ll go over how to pick the best brand of ashwagandha if you and your doctor decide it’s the right supplement for you.
Ashwagandha Benefits
So first of all, ashwagandha is an adaptogen that has been used in Ayurvedic medicine for centuries and has gained a lot of attention in recent years for its potential benefits, especially for stress and for sleep and possibly brain health and neuroprotection.
There are small studies that show that ashwagandha can help with exercise recovery and muscle growth, and it can help with hormonal balance.
But we’ll highlight a need for caution in certain populations due to rare but very serious risks, and we’ll cover that in just a bit.
But first, we got to talk about the latest evidence we have on the benefits of ashwagandha, because it’s pretty promising, especially when it comes to sleep.
And we have a systematic review and meta-analysis that included five randomized control trials that included 400 participants.
And it showed a clinically beneficial effect of ashwagandha extract compared to placebo in improving sleep. And the effects were noted in areas like total sleep time, and wake time after sleep onset, and sleep efficiency, with the most prominent effects seen in adults diagnosed with insomnia who took doses of at least 600 milligrams per day for at least eight weeks. But there were some notable limitations to this meta-analysis.
Use of Actigraphy
Three of the five trials included in this meta-analysis used actigraphy to objectively measure the quality of participants’ sleep. And actigraphy is basically a method where participants wear a wearable device on their wrist or their ankles.
And even though actigraphy is widely used in sleep studies, it does not actually directly measure your quality of sleep. But it measures movement, which is then used to estimate your sleep and wake cycles.
Whereas ideally, the gold standard assessment for sleep would be done with a test called polysomnography, which is more expensive and is done in a laboratory setting.
And another limitation is the sample size in all of those studies was pretty small, and the duration of the studies was limited to only eight weeks.
Now, a lot of people take ashwagandha for anxiety. And we have this systematic review and meta-analysis of nine randomized control trials involving over 500 patients that found that ashwagandha formulations had a significant beneficial effect on the measures of anxiety and serum cortisol when compared to the placebo group.
There was a study that looked specifically at the safety parameters of ashwagandha, and it found that taking ashwagandha up to 300 milligrams twice a day for up to eight weeks did not show any adverse effects on hematologic and biochemical parameters.
That said, most trials that looked at the effects of ashwagandha, they were fairly small with a very small sample size, and they only lasted six to eight weeks. And this is where there are concerns.
Safty Concerns
Liver Toxicity
First, let’s talk about one major safety concern that you should know about, and it’s liver toxicity. And this is the most serious and well documented complication, and it’s known as herb-induced liver injury.
And this liver injury was first mentioned in literature in 2017 with a case report of a 20-year-old man in Japan that developed severe intrahepatic cholestasis, basically a condition where the bile couldn’t flow out of the liver properly.
And this type of blockage leads to a buildup of bile acids in the liver and in the bloodstream, which can then cause severe itching of the palms and itching of the soles of the feet. And it may cause dark urine, and it can also cause pale stools, and in severe cases, it will cause jaundice or yellowing of the skin or the eyes.
Since then, there were multiple case reports from the US and Europe and Asia that have linked ashwagandha to liver injury.
And in most of these cases, they were able to analyze the chemical composition of the supplement that was consumed, and they ruled out any contamination of toxic compounds.
So it was the ashwagandha supplement itself and not an outside toxin that had caused the damage. So when you take a deep dive into those cases, the reported minimal time from the first dose taken to the onset of symptoms was only two weeks. And there was another case in Iceland where the first symptom did not appear until after 12 weeks.
So what causes this damage? Well, the specific substance that is suspected to be responsible for these liver damaging effects is one of ashwagandha’s metabolites called withenone. And a recent study revealed that withenone can cause DNA damage in liver cells, especially when the body’s natural detox systems are overwhelmed.
Normally, we have a natural chemical called glutathione that neutralizes or removes these harmful substances like withenone. But when overwhelmed, this is where the damage can build up fast.
This is why taking ashwagandha can be especially risky for people with poor liver function or for those taking other hepatotoxic drugs, even something as mild as Tylenol.
Now, these cases are scary, but they’re still very rare. But still, even rare side effects, they matter when the consequences are very serious and potentially preventable. So the way you should approach this is you will definitely stay away from ashwagandha if you have any pre-existing liver conditions like hepatitis or fatty liver, or if you take other medications that may have toxic effects on the liver.
So it would be drugs like Tylenol and many antibiotics and other supplements like green tea extracts. And if you were to start ashwagandha, make sure you have your liver labs checked four to eight weeks after starting the supplement. And monitor your liver labs periodically, probably at least every three to four months the first year.
Thyroid Function
This is another area where ashwagandha can cause unexpected changes. In some cases, ashwagandha may increase both T3 and T4 thyroid hormone levels. And that might sound helpful if you have low thyroid levels, but it can push healthy thyroid function into overdrive.
There’s case reports of people developing heart palpitations and anxiety and headaches and diarrhea and insomnia after using ashwagandha only to find their thyroid labs out of range.
Now for those folks, the average time for symptoms to appear is two months after starting ashwagandha. And that delayed onset is part of the danger. By the time symptoms show up, the damage is already happening.
So if you have any thyroid issues, you should definitely be careful with ashwagandha. And regardless of whether you have pre-existing thyroid conditions, then you should monitor your thyroid function very frequently, especially the first three to six months after starting the supplement.
Ashwagandha and Other Medications
Another important thing you have to consider is how ashwagandha interacts with your other medications. So if you’re on blood pressure medications, ashwagandha can actually amplify those medications effects, which can lead to dangerously low blood pressure.
Blood Pressure & Diabetes Meds
Ashwagandha can also lower your blood sugars. So this is especially important if you’re on diabetes medications and especially insulin, as that combination can cause an unsafe drop in blood sugars or hypoglycemia.
Sedative Meds
We also have to be careful with sedative medications and anti-anxiety medications, as ashwagandha may cause excessive sedation or respiratory depression. Some people report emotional blunting or emotional numbness.
Pregnancy/Breastfeeding
You should definitely not use ashwagandha if you’re pregnant or breastfeeding, as we just have no safety data in that population. All right, this is not meant to scare you off ashwagandha, as it’s an incredibly powerful supplement that has a lot of great benefits.
And the vast majority of people do very well with ashwagandha. But you do have to be careful when you take it.
What you Should Know
So if you are going to take ashwagandha, discuss it with your doctor first.
Daily Dose
And keep these things in mind. First, the dose matters. And most clinical trials use doses of 300 to 600 milligrams per day.
So be hesitant to take anything higher than that, as higher doses don’t mean more benefit, just more potential for side effects.
And since most studies we have on ashwagandha had a pretty short duration of no more than eight weeks, and we don’t have any long-term safety data, it is actually recommended taking breaks from ashwagandha and cycle on and off it every six to eight weeks.
This will give your body time to recalibrate, and it may reduce the risk of side effects and toxicity building up slowly in your body.
Don’t Take Ashwagandha with Liver Issues
And most importantly of all, do not take ashwagandha if you have any liver issues. And you should be extremely careful with it if you have an underlying thyroid issue. And even if you don’t have any of those conditions, get baseline set of labs to measure your liver function and thyroid function before starting ashwagandha.
While you’re on it, then monitore your labs at least every three to six months, depending on your other health conditions. And probably one of the most overlooked, but one of the most important decisions you have to make when you take ashwagandha is picking the right supplement. And unfortunately, the supplement industry, at least in the U.S., is not really regulated.
So the quality of the products you get can vary wildly between brands. So when you’re looking for a brand to get, look for labels that say NSF certified or USP verified, which indicates that the product is third-party tested, and it actually contains what it claims, and that it’s free from contaminants like heavy metals.
Also avoid proprietary blends that say ashwagandha complex without specifying how much of the actual extract is in it.
And that’s a big red flag, because the dose is very important when it comes to ashwagandha. And just like with many other medications or supplements, the dose is what makes the poison.
Avoid Ashwagandha Gummies
Also, you have to be careful with ashwagandha gummies, as there are way too many wellness brands that throw a sprinkle of ashwagandha into a gummy full of sugar, and they call it a stress solution. And with gummies, you often do not get any therapeutic levels of ashwagandha, and these gummies often lack any kind of standardization or third-party testing.
Now, that’s not all gummies, but most of them, so you have to be careful.
Conclusion
Ashwagandha has many amazing benefits, but there are some important safety questions that everyone should know about before taking it.
So please talk to your doctor before you make any changes to your health regimen, as the information in this guide is educational only and not medical advice.
