Ashwagandha: Nature's Laxative?

Ashwagandha is a popular herb used in traditional Indian medicine (Ayurveda) for stress relief and to improve general health. It is also known as Indian ginseng or winter cherry. The name “ashwagandha” describes the smell of its root, meaning “like a horse.”.

Ashwagandha is used to reduce anxiety, fatigue and joint pain. It is generally safe to use in food and tea. However, supplements are stronger than the herbs used in cooking, so it is recommended to talk to a healthcare professional before taking them. Side effects of using ashwagandha may include nausea and diarrhoea.

Ashwagandha's impact on thyroid function

Ashwagandha, or *Withania somnifera*, is a herb used in traditional Indian medicine (Ayurveda) for hundreds of years. It is used to treat a variety of conditions, including thyroid disorders.

Impact on Thyroid Function

Ashwagandha is often prescribed for thyroid dysfunctions and may help manage an underactive thyroid. It is thought to increase levels of thyroid hormones, which can be beneficial for people with hypothyroidism.

A 2018 double-blind, randomized, placebo-controlled trial found that ashwagandha treatment effectively normalized the serum thyroid indices in subclinical hypothyroid patients during an 8-week treatment period. However, another study reported a case of a 73-year-old female with hypothyroidism who presented with supraventricular tachycardia and symptoms of hyperthyroidism after two years of using ashwagandha as a self-administered treatment.

While ashwagandha may be beneficial for people with hypothyroidism, it is important to note that it may worsen the symptoms of hyperthyroidism and can lead to thyrotoxicosis. Thyrotoxicosis refers to excess circulating thyroid hormones in the body, which can result in palpitations, weight loss, heat intolerance, fine tremors, anxiety, and more severe complications like cardiac arrhythmias and heart failure.

Therefore, ashwagandha should be used cautiously or avoided by individuals with thyroid conditions or those taking thyroid hormone medications. It is always advisable to consult a healthcare professional before taking any herbal supplements, especially when dealing with thyroid disorders.

Ashwagandha's benefits for rheumatoid arthritis

Ashwagandha is a herb used in Ayurvedic medicine, the traditional medicine of India. It is commonly used to reduce stress and anxiety and manage several chronic conditions. However, there is limited evidence supporting its potential benefits in humans.

Ashwagandha has been used in Ayurvedic medicine to treat rheumatoid arthritis (RA) for many decades. It is believed to have anti-inflammatory, analgesic, and immunomodulating effects, which can help reduce joint pain and swelling associated with RA.

A 2020 review of the use of herbal medications for treating osteoarthritis and RA noted that ashwagandha has anti-inflammatory and analgesic effects. The review found a significant decrease in self-reported pain scores in a study on people with knee osteoarthritis. There was also a significant reduction in scores for pain, stiffness, and disability.

In a 2015 pilot study, 86 patients with RA were given 5g of ashwagandha powder twice a day for three weeks, followed by 100mg of Sidh Makardhwaj (another Ayurvedic medicine) daily for four weeks. The treatment decreased RA factor and showed significant improvements in tender joint counts, swollen joint counts, physician global assessment score, patient global assessment score, pain assessment score, patient self-assessed disability index score, and erythrocyte sedimentation rate (ESR) level compared to baseline scores. ACR20 response (a 20% improvement in tender joint counts, swollen joint counts, and 20% improvement in 3 of 5 areas) was observed in 56.4% of patients. However, ACR50 and ACR70 responses were not observed.

Another study found that ashwagandha formulations may benefit patients with RA, exerting analgesic, anti-inflammatory, and chondro-protective effects in those with knee joint pain.

Precautions and Interactions

It is important to note that ashwagandha may not be suitable for everyone. It may increase testosterone levels and should be avoided by patients with hormone-sensitive prostate cancer. Pregnant women should also avoid ashwagandha as it may induce abortion. Additionally, ashwagandha may interact with certain medications, including benzodiazepines, anticonvulsants, thyroid hormone drugs, and medications for diabetes and hypertension.

While ashwagandha is generally considered safe for short-term use, there is limited research on its long-term safety. It is always best to speak with a healthcare professional before taking any new herbal supplements to ensure they are safe and do not interact with any medications you are currently taking.

Ashwagandha's ability to improve sleep quality

Ashwagandha, also known as Indian ginseng or winter cherry, is an evergreen shrub that grows in Asia and Africa. It is commonly used for stress relief and to improve general health and has been used for medicinal purposes for hundreds of years.

Ashwagandha is believed to help with sleep issues and insomnia by regulating the body's stress response through its adaptogenic properties, helping to balance stress hormone levels and reduce anxiety. It may also modulate neurotransmitters, such as serotonin and GABA, contributing to improved mood and relaxation. Additionally, its anti-inflammatory, antioxidant, and immune-modulating effects might contribute to overall well-being.

Several studies have found that ashwagandha can help people fall asleep faster, improve sleep quality, increase total time spent asleep, and lead to less time spent awake in bed. For example, an 8-week study with 80 participants found that ashwagandha led to significant improvements in sleep, especially for people with insomnia. Similarly, a 2020 study of 150 healthy individuals with poor sleep quality found that after 6 weeks, the group taking ashwagandha reported a 72% improvement in sleep quality, compared with 29% in the placebo group.

The appropriate dosage of ashwagandha for sleep can vary based on factors such as individual response, the form of ashwagandha, and the concentration of active compounds in the product. As a general guideline, powder doses typically range from 1-2 grams per day, divided into two doses. Capsules or tablets usually range from 225-600 milligrams per day, taken in divided doses. Liquid extract doses are typically about 1-2 milliliters, taken two to three times a day, corresponding to around 600-1200 milligrams of ashwagandha per day. Tea doses are generally 1-2 cups per day.

It is important to note that ashwagandha should not be viewed as a long-term solution for sleep issues and should not be taken by those who are pregnant, breastfeeding, have certain medical conditions, or are taking certain medications.

Ashwagandha's side effects

Ashwagandha is generally considered safe for short-term use, but its long-term effects are unknown. It is always best to discuss taking ashwagandha with a healthcare provider, especially if you have a pre-existing health condition.

Some people may experience mild side effects, including:

• Gastrointestinal upset
• Vomiting
• Nausea
• Diarrhea
• Loose stools
• Upper GI discomfort
• Constipation
• Drowsiness
• Giddiness
• Hallucinogenic effects
• Vertigo
• Nasal congestion (rhinitis)
• Cough
• Cold
• Decreased appetite
• Dry mouth
• Hyperactivity
• Nocturnal cramps
• Blurring of vision
• Hyperacidity
• Skin rash
• Weight gain

Although rare, taking ashwagandha supplements may cause liver issues that manifest as itchy skin or jaundice.

Ashwagandha's potential to cause liver issues

Ashwagandha is an evergreen shrub that grows in Asia and Africa. It is commonly used for stress relief and to improve general health. It is considered generally safe for consumption without significant side effects. However, there have been rare cases of ashwagandha causing clinically apparent liver injury.

Ashwagandha has been associated with a rare but serious adverse effect of liver damage. Although the exact mechanism is not fully understood, several cases of liver injury and even liver failure have been reported with the use of ashwagandha supplements. The liver injury typically presents 2 to 12 weeks after starting ashwagandha, with symptoms such as jaundice, pruritus, and elevated liver enzymes. In most cases, the liver injury subsides within 1 to 3 months of discontinuing the herbal product.

The potential liver toxicity of ashwagandha was first reported in a case study published in 2017, where a 20-year-old man developed jaundice after increasing his dose of ashwagandha. His liver function tests showed elevated bilirubin, alanine transaminase (ALT), and alkaline phosphatase (Alk P) levels. The jaundice persisted for more than two months but eventually resolved after discontinuing the supplement.

Since then, several other case reports and case series have been published, indicating the hepatotoxic potential of ashwagandha. In 2020, a case series from Iceland and the US Drug-Induced Liver Injury Network described five patients who developed jaundice and elevated liver enzymes after using ashwagandha. Their liver injury was classified as hepatocellular or mixed liver injury, and it resolved after discontinuing the supplement.

Another case report described a 40-year-old man who experienced acute liver injury after consuming ashwagandha extract for more than a year. He presented with jaundice, pruritus, and elevated transaminases. His symptoms resolved after discontinuing the supplement and receiving supportive treatment.

The exact mechanism of ashwagandha-induced liver injury is not fully understood. One hypothesis suggests that ashwagandha may cause a reduction in glutathione levels in cells, leading to cytotoxicity and liver damage. Glutathione is a crucial antioxidant that protects cells from oxidative stress. However, further research is needed to confirm this mechanism.

It is important to note that the risk of liver injury with ashwagandha use is rare, and the majority of people can tolerate it without any adverse effects. However, due to the potential for rare but serious liver injury, it is recommended to exercise caution when using ashwagandha supplements, especially in individuals with pre-existing liver disease.

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