Hi Reader,

A wonderfully good morning / day / evening :-)

Today, we're once again putting the spotlight on a dietary supplement that's currently all the rage:

Ashwagandha

Supplement manufacturers are actively promoting it again, while at the same time, the Federal Institute for Risk Assessment (BfR) is warning against its consumption.

Enough reason for us to delve into the topic and explore it in depth.

Enjoy the read, and don't hesitate to share any questions, suggestions, or criticisms

Supplement Spotlight:
Ashwagandha Hype or Danger?

The current buzz about Ashwagandha isn't dying down—you've surely heard about it. On one side, there are the skeptics warning primarily about liver damage. On the other, enthusiasts see Ashwagandha as a miracle cure for stress and testosterone deficiency. But what's the real deal? Let's take a closer look.

What Is Ashwagandha?

Ashwagandha is a plant-based product, an extract from the root of the "sleep berry" (also known as winter cherry), scientifically named Withania somnifera. The roots have a horse-like smell, which explains the name: in Sanskrit, "Ashva" means horse and "gandha" means smell.

This plant is found across the African continent, the Arabian Peninsula, Asia, and even in Spain and Italy.

Traditionally, Ashwagandha is used in Ayurvedic medicine, often in combination with other herbs. In this traditional practice, it's considered a "rasayana," a remedy for general health, wellness, and vitality. It's also known as "bhalya" (strengthening) and "vajikara" (aphrodisiac).

Ashwagandha belongs to the group of adaptogens, substances that are believed to help the body resist stress. Some studies also indicate it may affect cortisol levels and improve sleep quality.

How Does Ashwagandha Work?

The active compounds in Ashwagandha's root belong to several groups, including alkaloids, flavonoids, glycosides, steroids, and steroidal lactones. The primary active ingredients are steroidal lactones called withanolides.

It's suspected that Ashwagandha enhances certain gamma-aminobutyric acid (GABA)-dependent pathways in the brain, influencing the release of specific pituitary hormones. This indirectly reduces cortisol production in the adrenal glands.

There are initial (though not yet convincing) studies suggesting it can normalize testosterone production in men suffering from hypogonadism. This testosterone boost likely results from reduced stress levels (due to lowered cortisol), removing an obstacle to testosterone production.

In some cases, it may also affect thyroid function, though the exact mechanism remains unclear. Consequently, Ashwagandha can sometimes increase serum concentrations of T3 and T4 thyroid hormones.

Side Effects

No effect comes without side effects. Naturally, Ashwagandha has its downsides too. Case reports have mentioned instances of hyperthyroidism (overactive thyroid), especially when combined with a low-carbohydrate diet.

Taking Ashwagandha can lead to lethargy and drowsiness.

It has the potential to raise serotonin levels in the brain and reduce dopamine. There are individual case reports of anhedonia occurring—a state where one feels "empty," experiencing neither positive nor negative emotions—which aligns with the changes in brain neurotransmitters mentioned earlier.

In a 2024 report, the Federal Institute for Risk Assessment (BfR) warned about potential liver damage associated with Ashwagandha consumption, following a 2023 warning from the European Food Safety Authority (EFSA) about liver injuries. Multiple case reports support these concerns. For instance, a 2020 case report in the Journal of Clinical and Experimental Hepatology detailed a 32-year-old man who developed gout and acute liver failure after taking Ashwagandha.

In 2022, the American Journal of Case Reports described a case where a 74-year-old woman also developed liver failure following Ashwagandha intake.

Additional cases of liver failure linked to Ashwagandha were reported in another American journal in 2021.

Usage:

Still considering taking Ashwagandha to potentially improve your stress management?

Then you should keep a few things in mind:

• Consult Your Trusted Doctor: Before starting any new supplement—especially specialized ones—discuss it with your physician. They'll consider your existing conditions and any other medications you're taking. Some supplements can alter the effects of certain drugs.
• Exercise Caution with Certain Conditions: Be particularly careful if you have known thyroid disorders (especially hyperthyroidism or thyroid autonomy) or mental health issues. The risk of liver damage increases if you're also taking other medications or supplements that strain the liver (like ibuprofen or turmeric with piperine).
• Regular Blood Tests: It's best to get a blood test before starting supplementation (checking liver enzymes, thyroid levels, etc.). Repeat these tests regularly (every 3 or 6 months).
• Dosage Matters: Most studies use a dosage of 600 mg per day, divided into two doses of 300 mg. There's currently insufficient data to support increased efficacy at higher doses. Similarly, comprehensive safety studies for Ashwagandha are lacking.

Disclaimer: This text is not (and does not replace) medical advice and is intended solely for informational purposes. All medical topics should be individually discussed with your doctor to address your specific situation.

Literature:

1. Monograph. Withania somnifera. Altern Med Rev. 2004 Jun;9(2):211-4. PMID: 15253680.

2. Pratte MA, Nanavati KB, Young V, Morley CPAn alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera)J Altern Complement Med.(2014 Dec)

3. Sara Fuladi, Seyed Ahmad Emami, Amir Hooshang Mohammadpour, Asieh Karimani, Ali Akhondpour Manteghi, Amirhossein SahebkarAssessment of Withania Somnifera Root Extract Efficacy in Patients With Generalized Anxiety Disorder: A Randomized Double-Blind Placebo-Controlled TrialCurr Clin Pharmacol.(2020 Apr 13)

4. Lopresti AL, Smith SJ, Malvi H, Kodgule RAn investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled studyMedicine (Baltimore).(2019 Sep)

5. Kumarpillai Gopukumar, Shefali Thanawala, Venkateswarlu Somepalli, T S Sathyanaryana Rao, Vijaya Bhaskar Thamatam, Sanjaya ChauhanEfficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled StudyEvid Based Complement Alternat Med.(2021 Nov 30)

6. Salve J, Pate S, Debnath K, Langade DAdaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical StudyCureus.(2019 Dec 25)

7. Diego A Bonilla, Yurany Moreno, Camila Gho, Jorge L Petro, Adrián Odriozola-Martínez, Richard B KreiderEffects of Ashwagandha ( Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-AnalysisJ Funct Morphol Kinesiol.(2021 Feb 11)

8. Chauhan S, Srivastava MK, Pathak AKEffect of standardized root extract of ashwagandha () on well-being and sexual performance in adult males: A randomized controlled trial.Health Sci Rep.(2022-Jul)

9. K Chandrasekhar, Jyoti Kapoor, Sridhar AnishettyA 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 Jul)

10. Deepa S Mandlik Ingawale, Ajay G NamdeoPharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspectsJ Diet Suppl.(2021)

11. https://en.wikipedia.org/wiki/Withania_somnifera

12. Yokota, Yasuno et al. “Development of withaferin A analogs as probes of angiogenesis.” Bioorganic & medicinal chemistry letters (2006)

13. Grover, Abhinav et al. “Inhibition of the NEMO/IKKβ association complex formation, a novel mechanism associated with the NF-κB activation suppression by Withania somnifera's key metabolite withaferin A.” BMC genomics,2010

14. Yang, Huanjie et al. “The tumor proteasome is a primary target for the natural anticancer compound Withaferin A isolated from "Indian winter cherry".” Molecular pharmacology (2007)

15. Lopresti, Adrian L et al. “Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials.” Nutritional neuroscience (2022)

16. Nasimi Doost Azgomi, Ramin et al. “Corrigendum to "Effects of Withania somnifera on Reproductive System: A Systematic Review of the Available Evidence".” BioMed research international. 21 Nov. 2019,

17. Sharma, Ashok Kumar et al. “Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial.” Journal of alternative and complementary medicine (New York, N.Y.)

18. Salve, Jaysing et al. “Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study.” Cureus vol. Dec. 2019

19. Cheah, Kae Ling et al. “Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis.” PloS one, 24 Sep. 2021,

20. Jilani, Kashif et al. “Withaferin A-stimulated Ca2+ entry, ceramide formation and suicidal death of erythrocytes.” Toxicology in vitro (2013):

21. Tóth M, Benedek AE, Longerich T, Seitz HK. Ashwagandha-induced acute liver injury: A case report. Clin Case Rep. 2023 Mar 14;11(3)

22. Philips CA, Valsan A, Theruvath AH, Ravindran R, Oommen TT, Rajesh S, Bishnu S, Augustine P; Liver Research Club India. Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol Commun. 2023

23. Vazirani S, Kothari A, Fujimoto J, Gomez M. Supplements Are Not a Synonym for Safe: Suspected Liver Injury From Ashwagandha. Fed Pract. 2023

24. Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020 Apr;

That's all for now. Until next time! Feel free to send me your topic requests if there's something you're curious about and want to learn more.

Do you have questions, wishes, criticisms, or just comments?

Then feel free to write to me:

karsten@konzept-health.de

All the best, we'll be in touch,

Karsten