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Is There a Downside to Ashwagandha?

You could use herbal medicine to reduce anxiety and treat insomnia. Digestive upset is a downside to ashwagandha. So is withdrawal.
Is There a Downside to Ashwagandha?
Ashwagandha superfood powder and root on cutting board on wooden table.

Have you been looking for natural ways to get some sleep? That is certainly understandable. When you are worrying about family members and friends, you may not be able to sleep well. Some herbs could help you relax into sleep, including passionflower, valerian and one you might not have heard about, ashwagandha. Dr. Tieraona Low Dog has suggested this plant may help those who are feeling “tired but wired.” Is there a downside to ashwagandha?

A Downside to Ashwagandha:

Q. You have written about ashwagandha as a way to manage insomnia. People should be very cautious about trying this even though it’s been used for centuries.

My husband took it for insomnia and stress, but after only one capsule he became very ill: bloating, upset stomach and diarrhea. It lasted for almost 24 hours, and he was miserable. Obviously, some people can have an extreme reaction to it.

Ashwagandha Side Effects:

A. In these stressful times, ashwagandha’s reputation for helping people manage anxiety and insomnia may tempt many to try it. A clinical trial with 80 volunteers found that ashwagandha (along with deep breathing, caffeine limitation and a multivitamin) was more effective against chronic anxiety than psychotherapy (PLOS One, Aug. 31, 2009). A few volunteers in both groups had digestive upset or felt overstimulated. Clearly, your husband is not the only one to have trouble, but side effects seem to be uncommon.

In a randomized, placebo-controlled trial conducted in India, people taking ashwagandha fell asleep more quickly (Cureus, Sep. 28, 2019). In this study, none of the 40 volunteers taking the herb reported side effects. Another study in healthy elderly people with insomnia found similar results (Cureus, Feb. 23, 2020). 

Not surprisingly, some people using the herb have reported sleepiness. Others might not consider that a downside to ashwagandha. In some studies, volunteers reported headache, digestive distress, elevated liver enzymes and allergic reactions. One visitor to our website reported suddenly lower blood pressure

Ashwagandha and Withdrawal Symptoms:

Q. I took ashwagandha for insomnia for several years. It really improved my sleep issues.

I stopped taking it before a surgical procedure. For over a month, I had brain zaps like people do when discontinuing SSRI antidepressants. I take no medications so was surprised by this.

In online research I read that it works similarly to SSRIs. Apparently, some people do get brain zaps (which are very disconcerting) for months after stopping. Therefore, I’ve been reluctant to start taking it again though my sleep issues have come back. Have you heard of this effect?

A. Ashwagandha (Withania somnifera) is an ancient Ayurvedic herb from India. It is gaining popularity in the West as a sleeping aid and an anti-anxiety supplement (Current Clinical Pharmacology, April 13, 2020).

Ashwagandha Affects GABA Receptors:

Compounds in the plant act on neurotransmitters in the brain. In particular, they affect GABA (gamma aminobutyric acid). This is the same brain chemical affected by benzodiazepines such as diazepam (Valium). Although we could find no research reports of withdrawal symptoms like yours, this type of reaction deserves more attention. Thank you for telling us about your experience.

Ashwagandha and Thyroid Hormone:

Scientists have found that ashwagandha may normalize hormone levels in people with subclinical hypothyroidism (Journal of Alternative and Complementary Medicine, March 2018). To be prudent, people with overactive thyroid glands might want to avoid ashwagandha.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Cooley K et al, "Naturopathic care for anxiety: A randomized controlled trial ISRCTN78958974." PLOS One, Aug. 31, 2009. https://doi.org/10.1371/journal.pone.0006628
  • Langade D et al, "Efficacy and safety of Ashwagandha (Withania somnifera) root extract in insomnia and anxiety: A double-blind, randomized, placebo-controlled study." Cureus, Sep. 28, 2019. DOI: 10.7759/cureus.5797
  • Kelgane SB et al, "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, Feb. 23, 2020. DOI: 10.7759/cureus.7083
  • Fuladi S et al, "Assessment of Withania somnifera root extract efficacy in patients with generalized anxiety disorder: A randomized double-blind placebo-controlled trial." Current Clinical Pharmacology, April 13, 2020. DOI: 10.2174/1574884715666200413120413
  • Sharma AK et al, "Efficacy and safety of Ashwagandha root extract in subclinical hypothyroid patients: A double-blind, randomized placebo-controlled trial." Journal of Alternative and Complementary Medicine, March 2018. DOI: 10.1089/acm.2017.0183
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