Quite a bit of traditional medicine herbs actually can be shown to have positive effects in some circumstances. However, as it stands I don’t think ashwagandha falls into that category. AIUI there is some evidence that if people already have pre-existing liver disease ashwagandha makes it worse.
I have taken it myself a good few years ago. I took it again perhaps about a year ago and it made me a bit ill. Having read up on it and given my personal experiences I am leaving it in the “no” box.
To all Minoxidil users, have you ever heard of pseudoacromegaly? In high doses, Minoxidil might cause overgrowth of parts of the face.
I’m currently using topical rapa for first grey hairs. I don’t use Minoxidil. AFAIK, Minoxidil increases blood flow to the follicles. This can also be achieved by red light therapy.
NOW sells an affordable liquid Ashwagandha extract (tincture) with cane alcohol (ethanol). And ethanol has been shown to promote skin penetration:
“topically applied ethanol acts as a skin penetration enhancer and may facilitate the transdermal absorption of xenobiotics.” Source
It would be too concentrated as is. So it would need to be added to another product or otherwise diluted.
I have the opposite opinion. If I had to pick one herb out of all them that I think is likely to positively impact overall general health in aging individuals, it would be Ashwagandha. It doesn’t surprise me that your own experience with it wasn’t positive. I expect such reports from any herbal extract due to individual sensitivities.
I felt terrible after taking ashwagandha. Many taking Ashwaghanda have simliar long term side effects to SSRI’s , especially anhedonia, as it desensitizes serotonin receptors. Personally, I don’t see any benefit to it. It’s on my “no” list as well. There are way more effective adaptogens out there.
Ashwagandha can mess up someone’s liver, it is not uncommon. Very high risk vs. reward IMO.
Seems like very low incidence of injury… just a few case reports
Though, if someone has a history of liver issues, probably something to avoid.
When I read up on this I came to the conclusion that if you have liver issues you should definitely avoid it. I am not persuaded it is worth taking based upon personal experience and not having read anything reliable enough to argue I should. There is an indian medic on twitter who campaigns against it. If people want me to try to find a link to his account I will.
It is the liver doc.
https://twitter.com/theliverdr
I am just getting flashbacks to people messing up their liver with green tea extract. I have no reason to take ashwagandha so I am not going to risk it. There are other substances without this side effect. Supplements are less studied than drugs.
LiverDoc is the Twitter anti-Ayurveda guy. I think he is more against failing to use real medicine when needed.
Yes and @AnUser you are both right this is the person. I am not sure it is fair to say he is anti-Ayurveda, merely focussed on molecules with good evidence. It does not appear in the wider sense that Ashwaghanda is one of these.
Finding evidence about bempedoic acid (EMA assessment reports) made me convinced that supplements in general have so little evidence compared to drugs about safety. If there is even a tiny signal like this for a supplement then that is dangerous. I have seen anecdotes on reddit about doctors who say ashwaganda injuries are something they see even for people taking it as said on the package.
Did not yet have the time to listen to the podcast. However, anecdotally, I work at a large hospital as a general medical doctor. If there has ever been a reason for a young individual to be hospitalized for an acute liver injury in the absence of alcohol abuse, it is Ashwagandha use. I’ve seen a few young men use this as instructed on the product label. They then develop yellowing of the skin and eyes (jaundice), abdominal discomfort, and then present to the hospital with acute liver injury. The degree of liver injury measured by liver enzymes can be quite dramatic, however. Fortunately, the liver injury is usually reversible and they walk away fine after a couple days of hospitalization. Hard to say how common this is, but it’s a memorable clinical interaction to care for a young health person who experiences this.
Although there may not be formal (blinded RCT) studies very often with herbs that have been in traditional medicine you can find at least some anecdotal reporting. My view is that if I stick to commonly used herbs that don’t have negative reporting then that is reasonably safe.
Ashwagandha has quite a bit of negative reporting in terms of liver damage.
EMA assesement reports doesn’t only use RCT’s afaik, but also mice studies looking at single dose toxicity, repeat dose toxicity, genotoxicity, carcinogenicity, reproduction toxicity, ecotoxicity, etc. Of course there are some herbs that have quite a clean mechanism of action, large scale use, and no young health people flooding into ICU’s with liver damage.
Dose. Frequency. Brand. Source. Oral/topical. These things are relevant to any assessment of potential toxicity.
Talking about ashwaganda as if there were one manufacturer, as if all products had the same quality and toxicity profile, as if everyone were taking the very same dose at the very same frequency, makes all these conclusions and warnings… weak.
For some people, no amount is safe. For others, high doses are probably fine.
But am I talking about ashwaganda or coffee or aspirin? Acetaminophen? Maybe chocolate?
Dose. Frequency. Brand. Source. It matters.
Unfortunately, case reports and clinical trials come out years and even decades too late, after the damage has been done.
One lesson I learned from the cancer field, where there is no time for an abundance of case reports or clinical trials as patients don’t have much time nor options left before they pass, is that anectodal reports have a lot of value. So in the end, we are left experimenting on ourselves.
In terms of liver support, I would anyways recommend TUDCA and Artichoke Extract to mostly everyone. Milk thistle is ok unless you have hormonal issues or hormonal cancers.
If you loose an organ, you loose the fight, so it is important to keep organ function optimal.
There are occasional reports of liver damage from ashwagandha, and turmeric and green tea, too. But the reports are rare. We had discussion about turmeric and liver damage here in the past.
According to a report, ashwagandha is now the fifth most popular supplement. And on a global scale that suggests that millions of people are taking it daily.
There was a literature review published earlier this year titled, Effects of Withania somnifera (Ashwagandha) on Hematological and Biochemical Markers, Hormonal Behavior, and Oxidant Response in Healthy Adults: A Systematic Review. (*)
A couple excerpts:
“This is the first systematic to assess the potential health benefits of Ws supplementation in adults without chronic conditions. The evidence presented in this systematic review showed that Ws supplementation is safe. Given improvements in certain biomarkers, it may also benefit healthy individuals. Although Ws may act as an adaptogen to counterbalance and adjust some physiological markers outside the normal range, e.g., hematological and hormonal, it may exert a more potent anti-inflammatory and antioxidant effect, even in low inflammatory and oxidant status, that could further be utilized to prevent chronic inflammatory conditions.”
“Supplementation doses administered in interventions ranged from 240 mg to 1,250 mg from 2 weeks to 6 months without reports of any serious adverse events. We were not able to identify a clear duration pattern to ensure that long-term supplementation affects outcomes differently. Moreover, researchers reported no substantial changes in ALP, ALT, and AST levels, markers frequently used to assess drug-induced liver toxicity.”
Other published reviews have commented that ashwagandha is generally hepatoprotective:
From a review titled, Pharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspects:
" W. somnifera has demonstrated various biological actions such as anti-cancer, anti-inflammatory, anti-diabetic, anti-microbial, anti-arthritic, anti-stress/adaptogenic, neuro-protective, cardio-protective, hepato-protective, immunomodulatory properties." (**)
References:
(*) Gómez Afonso A, Fernandez-Lazaro D, Adams DP, Monserdà-Vilaró A, Fernandez-Lazaro CI. Effects of Withania somnifera (Ashwagandha) on Hematological and Biochemical Markers, Hormonal Behavior, and Oxidant Response in Healthy Adults: A Systematic Review. Curr Nutr Rep. 2023 Sep;12(3):465-477. doi: 10.1007/s13668-023-00481-0. Epub 2023 Jul 10. PMID: 37428341; PMCID: PMC10444651.
(**) Mandlik Ingawale DS, Namdeo AG. Pharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspects. J Diet Suppl. 2021;18(2):183-226. doi: 10.1080/19390211.2020.1741484. Epub 2020 Apr 3. PMID: 32242751.
Dihydrotestosterone (DHT) causes the regression of human hair follicles in the parietal scalp, leading to androgenic alopecia (AGA). Sulforaphane (SFN) increases the expression of DHT degrading enzymes, such as 3α-hydroxysteroid dehydrogenases (3α-HSDs), and, therefore, SFN treatment may improve AGA. To determine the effects of SFN on hair growth, we administered SFN (10 mg/kg BW, IP) or vehicle (DMSO) to ob/ob mice for six weeks and examined hair regeneration and the plasma levels of testosterone and DHT. We also tested the effects of SFN on the expression of two forms of 3α-HSD, aldo-keto reductase 1c21 and dehydrogenase/reductase (SDR family) member 9, both in vitro and in vivo . SNF significantly enhanced hair regeneration in ob/ob mice. The mice treated with SFN showed lower plasma levels of testosterone and DHT than those treated with vehicle. SFN increased the mRNA and protein levels of the two forms of 3α-HSD in the liver of the mice and in cultured murine hepatocyte Hepa1c1c7 cells. These results suggest that SFN treatment increases the amount of 3α-HSDs in the liver, accelerates the degradation of blood DHT, and subsequently blocks the suppression of hair growth by DHT.
Paywalled paper: https://www.sciencedirect.com/science/article/abs/pii/S0006291X16302881
Related: How to Increase Sulforaphane in your Diet, Cancer Prevention, etc
I asked my nephrologist if I could take ashwagangha and he said “no” bc it may cause acute kidney failure.
Out of curiosity @Agetron, when you fell off the tonic and noticed some regression did you also stop oral Minox? Or keep up with that?