Ashwaghanda for Stress

Here it comes again. The moment when you feel stressed, tense, and overwhelmed. Your shoulders get tight, you feel like you're about to lose your mind and your cool, your gut wrenches. 

Whether its another tiff with a loved one or an impossible list of must-do's, stressors activate well known paths within the body.

Managing stress may take many forms.  A good deep breathe and counting to 10, blasting your favorite song and singing along, or a regular meditation practice are all great strategies.  You have likely found yourself here though because the usual measures are not holding up to stress' effects.  You may have already tried to reduce stressors where possible and adopted mindfulness practices and apps and yet still find yourself feeling overwhelmed and not like yourself.  

It's not your fault.  There are many out there that need additional support to manage the physical impact of stress whether it be supporting digestion, hormones, or mood. 

There are many herbs, botanicals, and supplements out there that may help support the body's stress response.  I've had a few people asking me questions recently about Ashwagandha so I thought I'd highlight some of the benefits, indications, and reasons why some may need to be cautious.

Benefits of Ashwagandha

Ashwagandha, an evergreen shrub from Asia and Africa used in Ayurvedic traditions for centuries, is commonly used for stress (MedlinePlus, 2022). It contains biologically active chemicals that may help soothe the brain, reduce swelling, support the immune system, and lower blood pressure. 

Indications for Ashwagandha

Ashwagandha is most commonly used for conditions such as

• Insomnia (MedlinePlus, 2022; Kelgane, Salve, Sampara & Debnath, 2020)
• Anxiety (MedlinePlus, 2022)
• Stress (MedlinePlus, 2022; Salve, Pate, Debnath & Langade, 2019)
• Stress related weight gain (MedlinePlus, 2022)

Additional sources suggest Ashwagandha may be helpful for

• Improving exercise performance (Tiwari, Gupta & Pathak, 2021)
• Improving quality of life (Kelgane, Salve, Sampara & Debnath, 2020)
• Subclinical hypothyroidism (Sharma, Basu & Singh, 2018)
• Reduction in circulating cortisol levels (Salve, Pate, Debnath & Langade, 2019)
• Increasing testosterone (by reducing testosterone suppression from cortisol) (Zielinski, 2021)
• Lowering blood sugar and triglycerides (Andallu & Radhika, 2000)
• Improving mental clarity and memory (Choudhary, Bhattacharyya, & Bose, 2017)

How to Take Ashwagandha

Typically Ashwagandha can be found in capsules, tablets, powder, tinctures, or tea as a single compound or in a blend with other herbs. Starting with an herbal tea may be a way to introduce the herb into your diet while also improving hydration. You may also consider adding raw ashwagandha or a powder form to food.  However, if you choose to do the later, do not expose it to high heat as this could degrade the herb and cause it to lose its benefits (Silva, 2022). 

Side Effects

Ashwagandha is considered generally safe for most people at doses of 300mg by mouth twice daily (Verma, Gupta, Tiwari, & Mishra, 2020).  Some studies do indicate that individuals may experience mild, temporary side effects (Sharma, Basu & Singh, 2018). Reported side effects include nasal congestion, cough, cold, constipation, changes in appetite, increased libido, gastrointestinal upset, diarrhea, nausea, vomiting, liver injury or drowsiness (LiverTox, 2019; Chandrasekhar, Kapoor & Anishetty, 2012). Unfortunately, herbs and supplements are often contaminated with other unknown substances. Thus, it is advisable to always get supplements from well reputed sources that participate in third party testing for quality.

Reasons to be Cautious or Avoid Use

• Individuals who are pregnant or currently breastfeeding: Anyone who is pregnant, trying to become pregnant or breastfeeding should always ask their health care provider before starting any new herbs or supplements.  There is some evidence to suggest that use of Ashwagandha during pregnancy can increase miscarriage (MedlinePlus, 2022).
• Individuals with autoimmunity such as Lupus, Multiple Sclerosis or Rheumatoid Arthritis: Ashwagandha helps to activate the immune system, thus could worsen autoimmune conditions (MedlinePlus, 2022).
• Recent or upcoming surgery: Ashwagandha may slow the nervous system, a response that could interact with drugs often given with surgical procedures.  It is recommended to stop taking Ashwagandha 2 weeks before a scheduled surgery and for a week or two after(MedlinePlus, 2022). 
• Thyroid conditions: Ashwagandha interacts with thyroid hormone.  It is recommended to use cautiously in you have a known thyroid condition or take thyroid hormone medications (MedlinePlus, 2022).
• Medication interactions: Ashwagandha may interact with a variety of medications such as drugs for diabetes, high blood pressure, immunosuppressants, sedatives (such as benzodiazepines or anti-seizure medications) or thyroid hormone (MedlinePlus, 2022).
• Interactions with herbs and supplements: Ashwagandha may lower blood pressure, blood sugar, and cause sleepiness or slowed breathing.  Other herbs or supplements that may cause similar effects could interact.  Examples include L-arginine, niacin, stinging nettle, berberine, andrographis, hops, kava, L-tryptophan, melatonin, and valerian(MedlinePlus, 2022). 

What To Do Before Adding Ashwagandha 

Ashwagandha has some incredible benefits with a very low side effect profile. Before adding it in to your supplement regimen, here are some things to consider doing

• Get specialty testing: Most traditional doctors order the same battery of conventional tests.  Specialty Functional Medicine testing goes deeper and will help illuminate if Ashwaganda is or isn't a good fit for you.  Be sure to check out testing such as hormone levels (such as a full thyroid panel, diurnal cortisol, and sex hormones), blood glucose, fasting insulin, markers for inflammation and autoimmunity.
• Work with a specialized Functional or Integrative clinician to review what other supplements and medications you are taking to ensure Ashwagandha would not interact negatively
• Monitor your blood pressure regularly as Ashwagandha may impact it.
• Utilize lifestyle techniques to support stress, anxiety, insomnia as well so that Ashwagandha can work synergistically with the other ways you are promoting your health.

References

Andallu B, Radhika B. Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Indian J Exp Biol. 2000 Jun;38(6):607-9. PMID: 11116534.

Chandrasekhar K, Kapoor J, Anishetty S. A 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;34(3):255-62. doi: 10.4103/0253-7176.106022. PMID: 23439798; PMCID: PMC3573577.

Choudhary D, Bhattacharyya S, Bose S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl. 2017 Nov 2;14(6):599-612. doi: 10.1080/19390211.2017.1284970. Epub 2017 Feb 21. PMID: 28471731.

MedlinePlus (2022). Ashwagandha. Retrieved from https://medlineplus.gov/druginfo/natural/953.html#Safety on November 28th, 2022.

Kelgane SB, Salve J, Sampara P, Debnath K. Efficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Randomized, Double-blind, Placebo-controlled Study. Cureus. 2020 Feb 23;12(2):e7083. doi: 10.7759/cureus.7083. PMID: 32226684; PMCID: PMC7096075.

Salve J, Pate S, Debnath K, Langade D. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019 Dec 25;11(12):e6466. doi: 10.7759/cureus.6466. PMID: 32021735; PMCID: PMC6979308.

Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med. 2018 Mar;24(3):243-248. doi: 10.1089/acm.2017.0183. Epub 2017 Aug 22. PMID: 28829155.

Silva, L. (2022). 7 Science-backed health benefits of ashwagandha. Retrieved from https://www.forbes.com/health/body/ashwagandha-benefits/#footnote_5 on November 28, 2022. 

Tiwari S, Gupta SK, Pathak AK. A double-blind, randomized, placebo-controlled trial on the effect of Ashwagandha (Withania somnifera dunal.) root extract in improving cardiorespiratory endurance and recovery in healthy athletic adults. J Ethnopharmacol. 2021 May 23;272:113929. doi: 10.1016/j.jep.2021.113929. Epub 2021 Feb 15. PMID: 33600918.

Verma N, Gupta SK, Tiwari S, Mishra AK. Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers. Complement Ther Med. 2021 Mar;57:102642. doi: 10.1016/j.ctim.2020.102642. Epub 2020 Dec 15. PMID: 33338583.

Zielinksi, L. (2021). Ashwagandha and testosterone: the science behind the link. Retrieved from https://ro.co/health-guide/ashwagandha-testosterone/ on November 28, 2022.