Q: I’ve been struggling with sleep. My friends told me about ashwagandha, which seems like a natural solution. Should I try it?
A: Before trying ashwagandha, I’d recommend seeing your health-care provider to understand what’s causing your sleep issues. There are many reasons for insomnia, such as depression and sleep apnea, for which ashwagandha is not the first choice of treatment.
Ashwagandha has become popular among high-profile celebrities and TikTok scrollers for many reasons – they claim it improves sleep, anxiety, memory and even muscle mass.
Though it may be an unfamiliar term to many (the name is derived from Sanskrit), ashwagandha is far from a new therapy. It’s been used for a variety of ailments for thousands of years in countries like India, where Ayurvedic medicine – a traditional South Asian healing system – is practiced.
Those who use ashwagandha to help with sleep are probably availing themselves of its known sedating qualities. Studies in mice have identified that a chemical compound in ashwagandha, triethylene glycol, may be responsible for promoting sleep as well as its effect on GABA receptors – the same receptors targeted by many prescription sedatives and anti-seizure medications.
A meta-analysis of five randomized controlled trials in humans found ashwagandha led to a modest improvement in total sleep time – up to about 25 minutes – compared with a placebo. It also led to a notable improvement in sleep efficiency (the ratio of how long you were actually sleeping to lying in bed) and sleep quality, as assessed by participants.
The question for me remains: Is a sedative the best answer to your sleep troubles?
Prescription sedatives, which are known to have long-term risks, are not typically prescribed indefinitely. So while ashwagandha may adequately induce sleep, it shouldn’t be viewed as a long-term solution.
Here’s what else we do and don’t know about the ancient herb.
How has ashwagandha been used traditionally?
Ayurvedic medicine has a long history behind it – medicinal use of ashwagandha is described in an Ayurvedic textbook, the Charaka Samhita, that dates back to at least around 100 B.C.
There are certainly differences in how ashwagandha has been traditionally used versus in recent studies (or on TikTok, for that matter). For instance, in Ayurvedic medicine, herbs like ashwagandha are usually recommended in low doses for a short period of time, such as for two weeks. It’s also traditionally prepared into juices, teas or pastes along with other ingredients and recommendations – as opposed to taking it as a gummy or in a capsule.
“In Ayurvedic philosophies, it’s never like, ‘Oh, this is the one thing you need to take to be cured,’” said Darshan Mehta, medical and education director for the Osher Center for Integrative Health at Brigham and Women’s Hospital and Harvard Medical School. “It’s always part of a comprehensive plan which might include yoga and other healthy lifestyle changes”
Does ashwagandha help with stress and anxiety?
Some of the most popular reasons people are interested in ashwagandha are stress and anxiety. But studies looking at this tend to be small and have mixed results.
Does ashwagandha boost testosterone?
A few studies have found that ashwagandha increases testosterone levels. That alone isn’t exactly helpful – boosting testosterone in people who may have normal levels is associated with known risks, including acne, sleep apnea and prostate growth, with unclear benefit.
But many take ashwagandha to bulk up because a handful of small studies suggest it could be helpful. For instance, a randomized study analyzing 38 men found that ashwagandha supplementation improved strength-training performance after 12 weeks (the research was funded by the company selling the product being studied).
Can I take ashwagandha daily?
“My advice is to use the herb for a limited time and then check in again,” said Chiti Parikh, co-director of Integrative Health at Weill Cornell Medicine.
Patients on higher doses often report worse gastrointestinal side effects, like nausea or diarrhea, and cases of serious liver injury are associated with increased doses.
What I want my patients to know
There’s always tension in any discussion about complementary and alternative medical therapies: Is it appropriate – or even feasible – to hold ancient Eastern treatments to Western clinical standards?
Herbal supplements like ashwagandha are not regulated by the Food and Drug Administration the same way as medications. So they won’t go through the same set of experiments as a prescription drug. There’s simply no incentive or funding to take them through the same 10- to 15-year-long process of clinical trials that pharmaceuticals fund for their drugs.
The end result for patients is confusing. Marketing teams for supplements can tout a swath of benefits compared with the highly specific indications given for FDA-approved medications.
MORE DETAILS
Who should avoid ashwagandha?
The following groups should avoid ashwagandha:
-- Pregnant or nursing: There is concern that high doses of ashwagandha may induce an abortion.
-- On other sedatives: Don’t mix ashwagandha with medications that can be sedating. Check with your provider if you’re not sure about possible interactions.
-- Have nightshade intolerance: Ashwagandha belongs to the nightshade family.
The National Institutes of Health also recommends avoiding ashwagandha if you have autoimmune or thyroid disorders (it’s also thought to potentially interact with thyroid hormone medications) and if you have prostate cancer, given its potential effects on testosterone levels.
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