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Withania somnifera, commonly referred to as ashwagandha, is a superfood herb that grows in North Africa, Southeast Asia, and the Mediterranean. The Sanskrit word “Ashwa” (horse) and “Gandha” (bad odor) translates to the “smell of a sweaty horse,” which is due to the plant’s distinct aroma. The word also subtly hints at its ability to help enhance strength and induce calm, two traits that are also associated with horses.
In addition, the Latin name of this shrub species, “somnifera,” means sleep-inducing, which is one of the other beneficial properties of the plant. Ashwagandha is also referred to as “Indian ginseng” or “Winter cherry.”
Ashwagandha is an Ayurvedic herb that has been used in the Indian sub-continent for centuries. Ayurveda is a natural system of medicine that originated in India more than 3,000 years ago. The term Ayurveda was derived from the Sanskrit words ayur (life) and veda (science or knowledge). Thus, Ayurveda translates to knowledge of life.
In addition to medical techniques and herbal remedies, Ayurveda delved into lifestyle practices, such as meditation for mental health and yoga for physical health, among other concepts. In the system of traditional medicine called “Ayurveda”, ashwagandha is respected for its many therapeutic properties including stress relief, nerve growth, hormone balance, performance enhancement, memory support, sleep support, and sexual desire enhancement.
There are various documented uses of ashwagandha in scientific literature, books, and ancient texts predating 3000 years from today. Botanicals like ashwagandha that have multiple beneficial roles in the human body are known as adaptogens.
Adaptogens are defined as a class of non-toxic metabolic regulators of plant origins that are claimed to increase “non-specific” resistance to a broad spectrum of adverse biological, chemical, and physical stress (27). Ashwagandha is revered for its adaptogenic ability to cope with stress in the body. For ingredients to be classified as adaptogens, they should also follow the following guidelines (8, 27):
Ashwagandha’s multi-faceted healing nature will be explored in this article so that readers can gain a deeper understanding about ashwagandha:
Ashwagandha is an evergreen shrub that originated in India and thrives in hot dry climates. It has been extensively documented in historical Ayurvedic texts, including Kasyapa-samhita (600 A.D.), Susruta-samhita (100 BC to 400 AD), and Charaka-samhita (1000 BC to 100 BC).
Charaka-samhita, attributed to Charaka, a medieval Ayurvedic physician, builds upon Agnivesha-samhita, an earlier text based on Punarvasu Atreya’s teachings (1, 16). Susruta-samhita, authored by Susruta, an Ayurvedic surgeon, contains significant surgical and anatomical information, including techniques for nose reconstruction and cataract surgeries (2).
These texts underscore the traditional significance and therapeutic potential of ashwagandha in Ayurvedic medicine. In these historical texts, ashwagandha has been mentioned in therapeutic preparations including Kusthadilepa, Bilva Taila, Lepa among many others for its beneficial properties as a Rasayani (elixir), Vranaan hanti (wound healing), Vishahara (detoxifying), Vrushya (aphrodisiac), Balya (strength) etc. (1, 2, 16, 36).
Phytochemicals are active compounds found in plants that provide potential health benefits. For example, curcumin is an active compound in turmeric root that supports anti-inflammation. Similarly, ashwagandha contains about >35 phytochemical compounds including Withaferin A Withanolide A, and Withanoside IV, as its major constituents, among other alkaloids and steroidal lactones (3).
Withanolides are believed to be the primary active compounds in ashwagandha responsible for its adaptogenic properties that help the body cope with stress and promote overall well-being (9, 26).
In addition, the main alkaloids consist of somniferine, somnine, somniferinine, withananine, among others, and the main steroidal lactones are withanolides A-Y, withaferin A, withanone, etc. (3). These additional phytochemicals may help provide synergistic health benefits, when used in combination with full-spectrum ashwagandha extracts containing withanolides for anti-inflammatory, immune-modulation, and neuroprotection.
Pharmacological studies in the exploration of this medical plant have provided us with diverse information to rely on for taking care of our health today.
Free radicals are highly reactive molecules that contain one or more unpaired electrons which make them unstable and prone to starting chemical reactions within our cells. They are commonly generated by normal metabolism, inflammation, cellular toxins, and exposure to environmental pollution.
When free radicals accumulate in our cells and tissues, they can react with cellular components such as DNA, cell proteins, and cell lipids, resulting in oxidative stress. Oxidative stress over long periods of time can contribute to various diseases.
As a defense mechanism, our body regularly employs various essential antioxidant enzymes including superoxide dismutase (SOD), catalase, and glutathione, that neutralize the free radicals produced in our body. Additionally, vitamin A, C, and E present in our body support the reduction of free radicals by donating electrons to stabilize them. Ashwagandha has been shown to increase antioxidants enzymes and antioxidant vitamins in our body.
During a study conducted in 2010, 150 male (25-40 years) participants were divided into four groups, 75 healthy fertile men (control), and 75 infertile men, who were further divided into 25 normozoospermic, 25 oligospermic, and 25 asthenozoospermic men. The infertile men received 5g of raw ashwagandha powder for 3 months (13).
Post-treatment, oxidative biomarkers such as lipid peroxide and protein carbonyls significantly improved in the infertile group. Moreover, oxidative enzymes such as superoxide dismutase, catalase, and glutathione essential for metabolic functions that were suppressed pre-treatment demonstrated significant reversal in all three groups of infertile men (13). Additionally, the infertile group also showed substantial increases in antioxidant vitamins (vitamins A, E, and C) with a p<0.01 (13). Therefore, this study demonstrated the benefits of ashwagandha consumption as a safe and effective treatment for improving the body’s antioxidants.
Stress, depression, and anxiety are interconnected yet distinct health conditions that can impact well-being and quality of life.
Stress is our body’s natural response triggered by various factors like work, relationships, finances, and traumatic events, activating the “fight or flight” mechanism. Acute stress resolves when the stressor is gone, while chronic stress persists and adversely affects physical and mental health, leading to symptoms like headaches, digestive issues, anxiety, and unhealthy coping mechanisms.
Depression, a mood disorder, brings persistent feelings of sadness, hopelessness, and loss of interest, impacting daily functioning. Symptoms include persistent sadness, loss of interest in activities, changes in appetite or sleep patterns, and fatigue. Anxiety, a response to stress, manifests as feelings of fear and unease, with symptoms including anxious thoughts, physical reactions like increased heartbeat, and changes in behavior.
Research suggests that ashwagandha may help with stress, depression, and anxiety. As an adaptogen, it helps our body cope with stressors by supporting the adrenal gland and regulating physiological processes.
It is believed that ashwagandha modulates neurotransmitter levels such as serotonin, thus alleviating symptoms of depression and promoting a positive mood. Moreover, it helps mitigate anxiety symptoms by reducing cortisol/stress hormone levels in the body, promoting a sense of calm. Now, let’s delve into the scientific literature that supports ashwagandha’s benefit claims of relieving stress, depression, and anxiety.
In a clinical study, 64 individuals between 18-54 years were given a dosage of 300 mg of full-spectrum extract, twice a day after food with a glass of water. The results of this study were statically significant with a p<0.0001 on a stress test (Perceived Stress Scale) (9).
The placebo group showed a 5.5% reduction from baseline, while the ashwagandha group showed a 44% reduction from baseline in the perceived stress scale test, after 60 days of intervention (9). There was also a remarkable reduction in the serum cortisol levels between the control and experimental groups, with a 27.9% reduction from baseline for the ashwagandha group, and a 7.9% reduction from baseline for the placebo group (9).
In another clinical randomized, double-blind, placebo-controlled study, 60 male and female participants with a baseline stress score >20 were randomized into three groups. The individuals were asked to consume a placebo or 125 mg or 300 mg ashwagandha root extract twice a day for 8 weeks (26).
The outcomes of the study were measured using the Perceived Stress Scale (PSS), serum cortisol levels, Hamilton Anxiety Rating Scale (HAM-A), and sleep quality. Individuals consuming 600 mg ashwagandha extract per day showed the greatest significant improvement from baseline for all outcomes measured with a 38.34% reduction in perceived stress (PSS), 32.63% reduction in serum cortisol levels, 16.39% improvement in HAM-A stress scale, and a 46.01% improvement in sleep quality (26).
These studies strongly suggests that ashwagandha is a safe and effective alternative solution for individuals exploring solutions to manage stress, anxiety, and depression.
Testosterone is an essential hormone that helps promote sex drive, muscle gain, and fertility. With increasing age, it is estimated that males experience testosterone declines of 1%-2% per annum after the age of 40 (12).
Even though testosterone is considered a male hormone, everyone needs it for bodily functions. Ashwagandha has been reported to enhance testosterone levels in several studies, along with improving the chances of fertility and sex drive.
Wankhede et al. (2015) conducted a randomized, double-blind, placebo-controlled study with 57 male participants (18-50 years) with 29 subjects receiving 300 mg of ashwagandha root extract, while 28 received a placebo for 8 weeks. The study’s objective was to determine the use of ashwagandha root extract on muscle mass and strength (21).
Post-treatment, the experimental group exhibited significant increases in arm size (p<0.01) and chest size (p<0.0002). In addition, the serum testosterone levels for the ashwagandha group increased by 96.19 ng/dL from 630.45 ng/dL (baseline, pre-treatment) to 726.64 ng/dL (post-treatment), compared to the placebo group with an increase of 18 ng/Dl only from baseline to 693.12 ng/dL (21).
Another pilot study conducted in 2013 evaluated the spermatogenic activity of ashwagandha root extract on 46 male patients with oligospermia. This study looked at a total dose of 675 mg/day in three smaller doses with n=21 for a full-spectrum ashwagandha extract, and n=25 for a placebo, with “n” representing the number of participants (6).
The results of the study demonstrated a 167% reduction in sperm count, a 53% increase in semen volume, and a 57% increase in sperm motility on day 90 from the baseline against the placebo group (6).
Stress-induced male infertility has been documented in the literature. In 2011, Mahadi et al documented its use in combating stress-induced infertility in normozoospermic men. Three groups of normozoospermic men (NS) were observed in this study with a raw ashwagandha dose of 5g/day in a single dose for 3 months with milk (7).
Semen samples collected pre-dosage and post-3-month treatment demonstrated a 14% increase in pregnancy outcomes, with a 15% increase for men under psychological stress, a 15% increase for the normozoospermic men group, and 10% for cigarette smokers (7).
Ashwagandha has demonstrated hormone-balancing properties. This makes it especially useful for women’s health since they go through periods of hormonal changes due to menstrual cycles, pregnancy, and menopause.
Ashwagandha can also have a positive effect on the endocrine system, which serves as our body’s signaling system. This system regulates various functions in the body such as mood, sleep, reproduction, sexual function, physical growth, and metabolism, among many others.
In 2019, Lopresti and colleagues conducted a randomized, double-blind, placebo-controlled study measuring the hormonal content after consumption of 240 mg of ashwagandha extract in females. Among 23 females, 11 were in the treatment group and 12 were in the placebo group (24).
Post 60 days of intervention, cortisol levels in the treatment group showed a statistically significant reduction of 25.23% from day 0, while the placebo group showed a trivial decrease. Moreover, DHEA-S and testosterone were also measured during this study. A near-significant DHEA-S reduction of 8.67% and a non-significant 0.2% reduction in testosterone were observed in the treatment group (24). By reducing stress levels through the reduction of cortisol in the body, ashwagandha may be able to soothe cramps, reduce fatigue, and enhance sleep quality during pre-menstrual syndrome.
Another randomized, double-blind, placebo-controlled 8-week study investigated the beneficial effects of 300 mg ashwagandha extract consumed twice a day (25). 46 female participants who showed climacteric symptoms before the final menopause period were assigned to the ashwagandha group. Outcomes of the study were measured using the menopause rating scale (MRS) and menopause-specific quality of life questionnaire (MENQoL), hot flash score, and hormonal changes in estradiol, follicle-stimulating hormone, luteinizing hormone, and testosterone.
Post 8-week supplementation, significant reductions were observed in mean total MRS score (p<0.0001), mean total MENQoL score (p<0.0001), serum follicle-stimulating hormone (p<0.0001), and serum luteinizing hormone (<0.05) (25). Whereas, a significant increase was exhibited for serum estradiol (p<0.0001) and no change for serum testosterone level. In addition, hot flash symptoms were reduced from an average of 6.8 occurrences per day at baseline to 4.7 occurrences per day, following 8 weeks of treatment (25). This result was also statistically significant with p<0.0001, compared to the placebo group. These changes demonstrated that ashwagandha consumption is a safe and effective solution for climacteric symptoms during perimenopause in women.
Sleep is fundamental for human health and well-being. It serves as a restorative mechanism for the body and mind, supporting the body to undergo repair and rejuvenation, and allowing tissues to heal and muscles to recover from our daily lives. Moreover, sleep is crucial for cognitive function, including memory consolidation and learning.
Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both. This condition can be acute (short-term), chronic (long-term), or occasional. Insomnia can be caused by various elements in life, including stress, noise, genetics, and health issues from asthma to depression. Ashwagandha appears to improve sleep quality in adults and therefore is being explored as a potential sleep aid.
Kelgane et al. (2020) performed a 12-week randomized, double-blind, placebo-controlled study on elderly adults between 65 – 80 years of age. Among the participants, 25 received an ashwagandha root extract (600 mg/day), while the remaining 25 received a placebo. Each participant’s quality of life was assessed by having them complete a World Health Organization Quality of Life – Brief Version (WHOQOL-BREF) questionnaire with four questionnaire sections (physical health, psychological condition, social relationships, and environmental factors) with a total of 26 questions (15).
The results of the study demonstrated significant increases in the overall quality of life index on the questionnaire with p<0.0001 for all sections, excluding the social relationship section, when compared to the placebo group. In addition, the treatment group also showed large decreases in the sleep scale, with lower numbers corresponding to improvements in sleep quality. The sleep quality for the treatment group at baseline was measured at 5.76, and post-treatment measurement was 2.47 (15). This study provides evidence to the use of ashwagandha root extract as an effective sleep aid alternate.
In another study, 40 healthy subjects and 40 insomnia patients were recruited for an 8-week randomized, placebo-controlled, parallel-group comparative sleep quality study. Each participant in the treatment group was asked to consume 300 mg of ashwagandha root extract twice daily and was assessed for several sleep parameters (21).
Significant differences were observed in both groups; however, insomnia patients experienced the greatest benefits (21). Post-treatment, a significant reduction in sleep onset latency and wake after sleep onset were observed. Additionally, significant increases in total sleep time, total time in bed, and sleep efficiency were observed for both groups demonstrating the benefits of ashwagandha supplementation towards improved sleep quality (21).
Cognitive decline is commonly associated with aging. Studies have demonstrated that cognitive decline starts when adults are between 45-55 years and declines rapidly as we grow older (18). Some of our day-to-day processes that are dependent on a healthy cognitive system are communication, critical thinking, reasoning, comprehension, problem-solving, decision-making, and judgment.
Recent research has shown that ashwagandha may have beneficial effects on cognitive function and memory due to its cholinomimetic activity (19). Cholinomimetic activity refers to the ability of a substance to mimic or enhance the effects of acetylcholine, a neurotransmitter in the nervous system. Acetylcholine plays a crucial role in communicating between nerve-nerve cells, and nerve-muscle stimulation.
Compounds that possess cholinomimetic activity have been used for therapeutic purposes, such as in the treatment of certain neurological disorders like Alzheimer’s disease. Clinical intervention studies have demonstrated that ashwagandha supplementation improved cognition in patients who were diagnosed with mild cognitive impairment (MCI) (17).
In the randomized, double-blind, placebo-controlled study, 50 participants were either required to take 300 mg ashwagandha extract twice a day or a placebo for 8 weeks. After 8 weeks of supplementation, significant improvements in both immediate memory and general memory retention were observed on the Wechsler Memory Scale III, along with significant improvements in executive function, sustained attention, and information processing speed as observed during Wriksen Flanker task, Wisconsin Card Sort test, Trail-Making test part A, and Mackworth Clock test (17).
Another randomized, double-blind, placebo-controlled study demonstrated the efficacy of supplementing 1000 mg ashwagandha dosage per day in patients with schizophrenia, along with their antipsychotic medication. 66 participants were divided between the placebo group and the experimental treatment group. The study lasted for 12 weeks, and the efficacy was determined using PANSS and PSS scores (20).
Significantly better outcomes were observed for the treatment group compared to placebo on PANSS negative, general, and total symptom scores. However, the positive symptom scores did not show significant differences between the placebo group (20).
Resistance training programs, also known as strength training or weightlifting, consist of workouts that result in skeletal muscles contracting due to external resistance. This form of workout enhances muscle strength, muscle mass, and endurance.
In addition to the physical benefits of resistance training, incorporating this form of workout also improves bone density, metabolism, cardiovascular health, and joint function. Several studies have reviewed the role of ashwagandha in expediting muscle recovery post-workouts.
A recent study reported the impact of 300 mg ashwagandha root extract supplement, twice a day on untrained male participants towards their muscle strength and recovery. 29 treatment subjects and 28 placebo subjects underwent an 8-week resistance training program. Serum creatine kinase level and 1-RM load for bench press and leg extension exercise were used to evaluate muscle recovery and muscle strength, respectively (21).
The treatment group demonstrated a 46.05%, and 14.50% increase in muscle strength, compared to only 26.42%, and 9.77% for the placebo group from baseline at the end of 8 weeks for bench press (1RM), leg extension (1RM), respectively. The significance values between the treatment group and placebo group were p=0.001 and p=0.04 for the bench press and leg extension, respectively (21). The level of serum creatine kinase exhibits the muscles’ ability to recover post-workout, with a smaller increase suggesting greater recovery and vice versa. In the same study, a significant reduction (p=0.03) in serum creatine kinase was observed for the treatment group at 16.2 U/L, compared to the placebo group at 99.04 U/L post 8 weeks (21).
Another randomized, double-blind, placebo-controlled study evaluated the efficacy of 500 mg per day of ashwagandha root and leaf extract for a period of 12 weeks on recreationally active men. The treatment group and placebo group comprised 19 individuals each, and were assessed for squat performance and bench press performance pre-intervention and post-intervention (22).
A mean difference of 9.1, and 4.78 were observed for the lower body and upper body strength with a significance of p=0.009, and p=0.048, respectively. This study corroborates the efficacy of the treatment group toward greater muscle strength and performance (22).
Ashwagandha is generally safe for consumption when taken according to recommended dosage instructions. However, it’s critical to understand how to safely consume it. Some factors to consider are product form, dosage, frequency, and drug interactions. In this section, we will also discuss some of the mild and temporary adverse reactions observed during clinical trials with ashwagandha.
Ashwagandha is available in several product formats, including raw root powder or whole root granules, powder extract, or liquid extract. The powder extract has been extensively used in many clinical trials and seems to be well-tolerated.
240 mg – 600 mg/day of ashwagandha root extract has been used most frequently for 8 – 12 weeks.
In many clinical articles (6, 9, 14, 15, 17, 20, 21, 24, 25 26), ashwagandha consumption was well-tolerated with no adverse events reported by the participants compared to the placebo. Some participants in the clinical studies reviewed in this article have described the below mild to temporary adverse reactions when consuming ashwagandha. If you have noticed this reaction, it could suggest that your body doesn’t prefer the supplement, and it is highly advisable to discontinue use immediately.
Ashwagandha has been documented to interact with the following drugs:
Consult a healthcare practitioner before starting or adding a new supplement to your diet. They may recommend trying small doses of 100 mg – 200 mg per day and observing any changes in your body before slowly increasing the amount to the product manufacturer’s recommended dose.
In conclusion, ashwagandha is a revered botanical in Ayurvedic medicine with a rich history spanning centuries. Its traditional uses and modern scientific investigations highlight its diverse benefits ranging from stress relief and hormone-balancing effects to cognitive enhancement and sports and sexual performance support.
Ashwagandha’s classification as an adaptogen underscores its ability to bolster the body’s resilience to stress while maintaining physiological balance. Through its phytochemical profile, including compounds like Withaferin A and Withanolide A, ashwagandha offers promise in addressing various health concerns, from stress-induced infertility to sleep disturbances and cognitive decline.
While generally regarded as safe, it’s important to consider dosage, potential drug interactions, and individual responses when incorporating ashwagandha into one’s health regimen.
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