When to Avoid Ashwagandha
Although widely used, there are significant health concerns and contraindications that mean ashwagandha is not suitable for everyone. It is a potent herb that can have powerful effects on the body, both beneficial and harmful. Individuals with pre-existing conditions or those on medication should be particularly cautious and consult a healthcare professional.
Pregnancy and Breastfeeding
Pregnant women are strongly advised to avoid ashwagandha. In traditional practice and early research, high doses of the herb have been suggested to potentially cause uterine contractions, which could increase the risk of miscarriage. Similarly, due to a lack of sufficient data, the safety of ashwagandha during breastfeeding is unknown, and it should be avoided. The German Federal Institute for Risk Assessment (BfR) issued a statement in 2024 recommending against its use in pregnant and breastfeeding women.
Autoimmune Disorders
Ashwagandha is known to increase the activity of the immune system. For individuals with autoimmune diseases such as lupus, rheumatoid arthritis, or multiple sclerosis, this effect can be problematic. By stimulating the immune system, ashwagandha can potentially exacerbate the symptoms of these conditions, which are often managed with medications designed to suppress the immune response.
Thyroid Conditions
Ashwagandha has been shown to increase thyroid hormone levels. While this may be beneficial for some, it is a serious risk for those with thyroid disorders. Individuals with hyperthyroidism (overactive thyroid) or those taking thyroid hormone medication could experience an increase in thyroid hormone levels that disrupts their treatment and causes complications. Anyone with a thyroid condition should only use ashwagandha under strict medical supervision.
Before Surgery
Because ashwagandha can slow down the central nervous system, it may have an additive effect with anesthesia and other medications used during and after surgery. For safety, healthcare providers recommend discontinuing ashwagandha use at least two weeks before a scheduled surgical procedure.
Liver Problems
Although rare, there have been case reports linking ashwagandha supplements to liver injury. These reports indicate the potential for mild to moderate liver damage, and in extremely rare cases, severe liver failure requiring transplantation. The risk appears to be higher for those with pre-existing liver disease. People with known liver issues should avoid this supplement.
Side Effects and Considerations
Beyond contraindications for specific populations, there are general side effects and risks to consider before use.
- Gastrointestinal Distress: High doses of ashwagandha are known to cause digestive upset, including nausea, diarrhea, and vomiting. Taking the supplement with food can help mitigate these symptoms.
- Drowsiness: The calming, sedative effect of ashwagandha can be desirable for sleep, but it can also cause excessive drowsiness during the day. This is particularly dangerous for individuals operating machinery or driving.
- Contaminants: As a dietary supplement, ashwagandha is not strictly regulated by the FDA. This increases the risk of contamination with heavy metals like lead and mercury, which have been found in some Ayurvedic products. It is crucial to choose supplements from reputable, third-party tested manufacturers.
Ashwagandha vs. Common Medications
| Medication Type | Ashwagandha Interaction | Reason for Caution |
|---|---|---|
| Sedatives / Anti-Anxiety | Increases sedative effects, potential for excessive drowsiness | Additive effect of central nervous system depressants |
| Immunosuppressants | May interfere with medication effectiveness | Ashwagandha can increase immune system activity |
| Diabetes Medications | Can cause dangerously low blood sugar levels | Ashwagandha may lower blood glucose, causing hypoglycemia |
| Thyroid Hormones | Can disrupt hormone levels | Ashwagandha may increase thyroid hormone production |
| High Blood Pressure Meds | Potential for blood pressure to drop too low | Ashwagandha can have a blood pressure-lowering effect |
| Antidepressants (SSRI) | Potential for serotonin syndrome (theoretical) | Ashwagandha may affect serotonin levels, caution advised |
Conclusion: The Importance of Professional Guidance
While ashwagandha offers a range of potential benefits, including stress reduction and improved sleep, it is not a universally safe supplement. The reasons not to take ashwagandha are numerous and include specific medical contraindications, potential drug interactions, and common side effects. The lack of comprehensive long-term safety data also warrants caution. Anyone considering adding this supplement to their routine, especially if they have pre-existing health conditions or take other medications, must consult a healthcare provider first. Proper medical guidance can help determine if ashwagandha is appropriate and safe for individual use, minimizing risks and avoiding potential complications. For further information on general supplement safety, the National Institutes of Health provides a helpful overview on their website.
