Common name: Ashwagandha
Other names: Indian ginseng, winter cherry, dunal
Latin name: Withania somnifera
Affinities: Nervous system, immune system, musculoskeletal system, endocrine system, reproductive system
Actions: Rasayana, adaptogen, nervine tonic, immunomodulator, nootropic, nervine trophorestorative, reproductive tonic, immune tonic, antirheumatic, aphrodisiac
Specific indications: Joint or muscle pains and aches, fatigue, red hot inflamed joints or skin, sexual debility, sharp shooting pains, mental stress, cognitive problems, nerve damage
Diseases: Anxiety(1*), osteoarthritis(1), mild thyroid failure(1), depression(3), ADD(3), ADHD(3), Alzheimer’s(2), dementia(2), rheumatoid arthritis(2), neuralgia(2), fibromyalgia(3)
Parts used: Roots
Energetics: Warming, drying
Characteristics: Ashwagandha is a small shrub native to India, parts of the Middle East and East Africa (Castleman, 2001). It is a member of the nightshade family. The name, ashwagandha, means smells like a stallion, and relates both to the smell of the root and that the belief was it gave you the strength of a stallion (Gardner et al., 2015). It produces a round fruit that turns reddish orange when ripe, hence the other name Indian cherry (Castleman, 2001). Ashwagandha is also nicknamed Indian ginseng because its effects are similar to the revered Asian herb, Asian ginseng, as they are so diverse.
History: It has been used in Ayurveda (Indian traditional medicine) for at least 3000 years (Castleman, 2001). It has been mentioned in ancient Indian medical texts, including the Charak that recommends it as a whole body tonic, particularly for emancipation, reproductive ability, and longevity. It was typically applied usually to emancipated children and the elderly. It is classified as a ‘rasayana’ herb in Ayurvedic medicine, or rejuvenator herb, a special class of herbs reserved for those that restore health in the long term. It has been long used as a traditional home remedy in India for a wide range of reasons, it is one of Ayurveda’s most versatile and powerful herbs (Gardner et al., 2015).
Current applications: Ashwagandha is considered a calmer adaptogen (Groves, 2016), and therefore potentially useful for CFS, hypertension associated with anxiety, and a variety of stress linked health disorders (Kuhn and Winston, 2000). It is less stimulating than most other adaptogens and may help in some cases of insomnia (Groves, 2016). However, it may actually disrupt sleep in some individuals with its energising effect. It may be useful in treating fibromyalgia alongside reishi, black cohosh, and kava (Kuhn and Winston, 2000). Because of it’s anti-inflammatory activity it may be useful in treating chronic inflammatory diseases (e.g. sero negative arthritis, osteoarthritis, rheumatoid arthritis, multiple sclerosis) especially when combined with other anti-inflammatory herbs such as boswellia, ginger, and turmeric (Kuhn and Winston, 2000; Kulkarni et al., 1991).
Ashwagandha is recommended for depleted, exhausted, and underweight patients, especially the elderly with cognitive problems (Kuhn and Winston, 2000; Castleman, 2001), but also people who have been ill for quite a long time. It is useful in improving sexual performance as tends to increase sex drive with it’s affinity for the reproductive system (Kuhn and Winston, 2000). It is stimulates the thyroid gland, making it useful in cases of hypothyroidism (Winston and Maimes, 2007). With ashwagandha’s affinity for the nervous system and restorative action it has a role to play in cases of nerve damage and anxiety. To target the nerves, it may be applied alongside other nervine tonic herbs such as St. John’s wort, holy basil, gotu kola, and bacopa (Groves, 2016). Ashwagandha is one of the most valuable healing herbs we have in our materia medica.
Science: It is the roots of ashwaganda which contain the withanoloids thought to be pharamacologically highly active compounds (Gardner et al., 2015), and ashwagandha extracts have been studied extensively using various model systems. The glycowithanolides have been found to exhibit anti-oxidant effects in vivo models (Bhattacharya et al., 2001). A study has been conducted that suggested the alkaloid and withanolide content of the herb was responsible for anti-inflammatory activity ex vivo (Chandra et al., 2012). Leaf extract of ashwagandha has been found to kill cancer cells ex vivo and in vivo models (Widodo et al., 2007), this paper was published in a higher impact American journal. Another study, found an extract of ashwagandha effective in reducing amyloid induced cytotoxic effects in a human neuronal cell line, implying it may be important in treating Alzheimer’s disease (Kurapati et al., 2013). Another in vivo model study found ashwagandha extracts have neuroregenerative effects in spinal chord injury (Nakayama et al., 2007).
Double blind placebo controlled human studies on ashwagandha are still few in number, but steadily growing. One study found a highly significant difference of ashwagandha treatment for anxiety over 60 days versus placebo (Chandrasekhar et al., 2012). An additional interesting study found a significant effect against chronic stress in adults, confirming this effect (Abedon et al., 2008). Another very intriguing study that examined ashwagandha as part of a formula (with boswellia, curcumin, and ginger) to treat osteoarthritis, did find a significant reduction versus placebo both in pain and disability (Kulkarni et al., 1991). A further study confirmed that ashwagandha works against osteoarthritis knee pain even as a standalone therapy (Ramakanth et al., 2016). A very recent study in India identified a significant improvement of thyroid parameters with treatment with ashwagandha in patients with subclinical hypothyroidism (Sharma et al., 2017), confirming more of its traditional use. These studies imply the traditional use of ashwagandha is at least partially justified. I expect further human clinical studies to further expand on this.
Overall Safety: Ashwagandha is safe to use and may be taken by the young or old, whilst pregnant or during breastfeeding with confidence. However, it is probably best to avoid use if the individual has hyperthyroidism because ashwagandha stimulates the thyroid.
Dosage: If a tincture is used between 5-60 drops may be taken 3-4 times daily. Between 1 and 4 capsules per day may be used.
Form: A patented extract called KSM-66 has become popular, which is very enriched in withanolides. KSM-66 is popular in scientific studies (Ambiye et al., 2013; Dongre et al., 2015; Choudhary et al., 2015). KSM-66 is extracted with a unique processing technology to produce a broad-spectrum extract enriched with withanolides (Ambiye et al., 2013), but the withanolides are maintained at the same naturally occuring ratio. This extraction seems to potentiate the action of ashwagandha (Ambiye et al., 2013). I remain a little skeptical that KSM-66 is preferable to traditional root powders and tinctures as I suspect that the extraction process for KSM-66 may change some of its pharmacological properties. It is certainly stronger, but the problem is this may cause over stimulation and insomnia in some people.
Research on models
Anti-oxidant: One study investigated the ability of ashwagandha extracted glycowithanolides to reduce oxidative stress response in an in vivo model (Bhattacharya et al., 2001). They found a dose dependent reversal of the stress response by application of the glycowithanolides that appears to involve normalization of the activity of anti-oxidant enzymes.
Anti-inflammatory: Another study found anti-inflammatory effects similar to diclofenac sodium in an in vitro model (Chandra et al., 2012).
Anti-tumour: A study investigated whether extracts from the leaf of ashwagandha could kill tumour cells in an ex vivo and in an in vivo model (Widodo et al., 2007). They found the extract inhibited tumour cell growth via a p53 dependent pathway.
Neuroregenerative: One study found that an ashwagandha withanoside could help regenerate axons in an in vivo model of spinal chord injury (Nakayama et al., 2007).
Neuroprotective: A study observed that ashwagandha extract reversed β-amyloid induced cytotoxic effects in SK-N-MC cells (a human neuronal cell line), implying the extract may be beneficial against Alzheimer’s disease in humans (Kurapati et al., 2013).
Research on humans
Stress/ anxiety: One study (n = 64, double blind placebo controlled) found that with treatment of 300 mg high-concentration full-spectrum extract of ashwagandha root twice daily reduced stress significantly versus a placebo (Chandrasekhar et al., 2012). Adverse events were mild in nature and similar between both placebo and treatment groups.
Stress/ anxiety(II): Another study (n = 98, double blind placebo controlled) found an extract of ashwagandha taken one or two times daily reduced stress significantly compared with placebo (Auddy et al., 2008). Dose was either 125mg per capsule or 250mg per capsule, depending on the group.
Osteoarthritis: A study (n = 42, double blind placebo controlled) examined a formula containing the roots of Withania somnifera, the stem of Boswellia serrata, and the rhizomes of Curcuma longa in patients with osteoarthritis compared with a placebo (Kulkarni et al., 1991). They observed statistically significant decreases in both pain and disability in the treatment group.
Osteoarthritis(II): One study (n=60, double blind placebo controlled) on patients with osteoarthritis knee pain found that either 250mg or 125mg of ashwagandha per day over 12 weeks found a significant reduction in pain in either group, with the 250mg treatment resulting in a stronger effect and earlier (4 weeks) (Ramakanth et al., 2016).
Hypertension: One study (n = 51, open label, not controlled) found a decrease in blood pressure in hypertensive patients with ashwagandha treatment, although the trend was not significant (Kushwaha et al., 2012). A properly controlled study is now required.
Fatigue: A study (n = 100, open label, placebo controlled) observed significant improvements in fatigue and quality of life in breast cancer patients taking ashwagandha (Biswal et al., 2013). A higher quality study is required.
Mild thyroid failure: One study (n=50, double blind placebo controlled) found patients who took 600mg ashwagandha daily for mild thyroid failure (subclinical hypothyroidism) significantly normalised their thyroid indices (Sharma et al., 2017).
Ambiye, Vijay R., et al. “Clinical evaluation of the spermatogenic activity of the root extract of Ashwagandha (Withania somnifera) in oligospermic males: a pilot study.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. J Am Nutraceutical Assoc. 2008;11:50–6.
Biswal, Biswa Mohan, et al. “Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients.” Integrative cancer therapies 12.4 (2013): 312-322.
Bhattacharya, A., S. Ghosal, and S. K. Bhattacharya. “Anti-oxidant effect of Withania somnifera glycowithanolides in chronic footshock stress-induced perturbations of oxidative free radical scavenging enzymes and lipid peroxidation in rat frontal cortex and striatum.” Journal of Ethnopharmacology 74.1 (2001): 1-6.
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Chandra, Sangita, et al. “Evaluation of anti-inflammatory effect of ashwagandha: a preliminary study in vitro.” Pharmacognosy Journal 4.29 (2012): 47-49.
Chandrasekhar, K., Jyoti Kapoor, and Sridhar Anishetty. “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 Journal of Psychological Medicine 34.3 (2012): 255.
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Kulkarni, R. R., et al. “Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study.” Journal of ethnopharmacology 33.1-2 (1991): 91-95.
Kurapati, Kesava Rao Venkata, et al. “Ashwagandha (Withania somnifera) reverses β-amyloid 1-42 induced toxicity in human neuronal cells: implications in HIV-associated neurocognitive disorders (HAND).” PLoS One 8.10 (2013): e77624.
Nakayama, Natsuki, and Chihiro Tohda. “Withanoside IV improves hindlimb function by facilitating axonal growth and increase in peripheral nervous system myelin level after spinal cord injury.” Neuroscience research 58.2 (2007): 176-182.
Ramakanth, G. S. H., et al. “A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain.” Journal of Ayurveda and integrative medicine 7.3 (2016): 151-157.
Raut, Ashwinikumar, et al. “Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania Somnifera) in healthy volunteers.” Journal of Ayurveda and Integrative Medicine 3.3 (2012): 111.
Sharma, Ashok Kumar, Indraneel Basu, and Siddarth Singh. “Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial.” The Journal of Alternative and Complementary Medicine (2017).
Widodo, Nashi, et al. “Selective killing of cancer cells by leaf extract of Ashwagandha: identification of a tumor-inhibitory factor and the first molecular insights to its effect.” Clinical Cancer Research 13.7 (2007): 2298-2306.
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