What are the potential harms of taking ashwagandha?
While often well-tolerated in the short-term by healthy adults, ashwagandha can pose risks for certain individuals and in specific circumstances. The potential for harm ranges from mild, temporary discomfort to serious, long-term health issues.
Mild Side Effects
For many, the adverse effects of ashwagandha are minor and typically linked to high doses. These can include:
- Gastrointestinal issues: Stomach upset, diarrhea, and vomiting are some of the most commonly reported side effects, especially with larger doses. To minimize this, it is often recommended to take ashwagandha with food.
- Drowsiness: The name Withania somnifera literally means "sleep-inducing," and while this can be a desired effect for some, it can interfere with daily activities for others.
- Headache: Some users have reported experiencing headaches after taking ashwagandha supplements.
- Skin rash: Allergic reactions, including skin rashes, are possible in rare cases.
Rare but Serious Side Effects
Beyond the minor and more common side effects, more serious risks have been linked to ashwagandha use, warranting significant caution.
- Liver Injury: Although rare, numerous case reports have linked ashwagandha supplements to liver injury, including acute hepatitis. While liver function typically recovers after stopping the supplement, severe and even fatal cases have been documented, particularly in individuals with pre-existing liver conditions. Experts suggest compounds called withanolides may be responsible by disrupting the liver's detoxification system.
- Thyroid Dysfunction: Ashwagandha can increase thyroid hormone levels, which can cause problems for people with thyroid disorders. In individuals with hyperthyroidism or borderline thyroid function, it could aggravate the condition. Cases of thyrotoxicosis have been reported in individuals taking ashwagandha.
- Hormonal Effects: Ashwagandha may increase testosterone levels, which could be problematic for men with hormone-sensitive prostate cancer.
- Autoimmune Flare-ups: Since ashwagandha can stimulate the immune system, people with autoimmune diseases such as lupus, rheumatoid arthritis, or multiple sclerosis are advised to avoid it, as it could worsen symptoms.
Interaction with Medications
Combining ashwagandha with other medications can produce dangerous interactions. You should always consult a healthcare professional before combining supplements and medications.
- Immunosuppressants: By increasing immune system activity, ashwagandha can decrease the effectiveness of medications used to suppress the immune system, such as those taken after an organ transplant. There are documented cases of kidney transplant rejection associated with ashwagandha use.
- Sedatives: Ashwagandha's sedative properties can be amplified when combined with other central nervous system depressants, leading to excessive sleepiness and slowed breathing.
- Diabetes Medications: The herb's potential to lower blood sugar levels means that taking it with diabetes medications could cause blood sugar to drop too low.
- Blood Pressure Medications: Similarly, ashwagandha may lower blood pressure, and combining it with antihypertensive drugs could cause a dangerously low blood pressure.
- Thyroid Hormones: Combining ashwagandha with thyroid medication can result in an overproduction of thyroid hormones.
Who should not take ashwagandha?
Certain populations are strongly advised to avoid ashwagandha due to heightened risks:
- Pregnant and breastfeeding women
- Individuals with autoimmune disorders
- People with thyroid conditions
- Those with pre-existing liver disease
- Men with hormone-sensitive prostate cancer
- Anyone scheduled for surgery within two weeks, as it can slow the central nervous system
Long-term use and safety
Most clinical studies examining ashwagandha's effects have been short-term, typically lasting up to three months. The long-term safety of ashwagandha, particularly concerning potential effects on the liver and thyroid, remains largely unknown. Due to this lack of long-term data, caution is advised for anyone considering prolonged use.
Risks and Safety Profile: A Comparison
To summarize the safety profile of ashwagandha, consider the following comparison table. It's important to remember that 'safe for most' does not mean risk-free for everyone.
| Feature | Short-Term Use (Up to 3 months) | Long-Term Use (Beyond 3 months) |
|---|---|---|
| Mild Side Effects | Generally low risk and well-tolerated, but can cause stomach upset, nausea, or drowsiness. | Potential for persistent or more frequent mild side effects. |
| Serious Side Effects | Rare but documented cases of liver injury and thyroid issues, especially at high doses. | Long-term safety is unknown; potential for cumulative effects on liver and thyroid is a concern. |
| Drug Interactions | Significant risk of interaction with immunosuppressants, sedatives, diabetes medication, and blood pressure medication. | Ongoing risk of interaction; monitoring by a healthcare professional is crucial. |
| Specific Health Conditions | Risks include worsening autoimmune disease, thyroid conditions, and liver issues. Should be avoided by pregnant women and those with certain cancers. | Same contraindications apply, with the added unknown of prolonged exposure risks. |
| Professional Guidance | Always recommended to consult a doctor before starting. | Absolutely essential, especially with limited data on long-term effects. |
Conclusion
While ashwagandha offers some potential benefits, especially for stress and sleep, its status as a widely available supplement does not equate to absolute safety for all individuals. Concerns regarding liver injury, thyroid function, and interactions with common medications highlight significant risks that should not be overlooked. Vulnerable populations, including pregnant women and individuals with autoimmune or liver diseases, must avoid it entirely. The limited research on its long-term effects further emphasizes the need for caution. Before taking ashwagandha, it is imperative to consult a healthcare professional to weigh the potential benefits against the personalized risks. For further information on the safety of various supplements, consult reliable health authorities like the National Center for Complementary and Integrative Health (NCCIH).
