Ashwagandha: Could it be the miracle supplement we’ve all been looking for? What does science say?

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Illustration photo by Getty Images

We spoke to Professor Carine Smith - Division Clinical Pharmacology, Dept Medicine, Faculty of Medicine and Health Sciences at Stellenbosch University.

Where did ashwagandha come from?

"Ashwagandha… has been used in Ayurvedic medicine for the longest time," says Smith, who adds that she is not a "non-believer" but that she wants to look at the facts.

"When strong anecdotal evidence exists for a particular benefit for any natural product, it should not be ignored as it may have potential to be developed into a medicine, safely and effectively, for all of us," says Smith.

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Why is it being punted as this miracle supplement?

Smith believes that two possible reasons for the reported "miracle" effects could be: "Ayurvedic medicine has a significant religious component – therefore, the possibility of a placebo effect (i.e. the 'patient' believes it to work before it was prescribed in the Ayurvedic context) cannot be excluded, and two, ashwagandha may have the effects as claimed."

Smith continues that it seems ashwagandha is beneficial within a specific context, so one cannot assume that everyone will experience the same effects.  

"Although some scientific studies exist on ashwagandha, they are mostly pre-clinical," says Smith. This means it has not been thoroughly tested in humans. "A very recent review paper (Ng et al., published in Phytotherapy Research in 2020) reported that only five studies on humans are available. All of these studies had significant flaws though, so no definitely proof of efficacy currently exists to support a claim for health benefits in humans. On the more positive side, there are no significant reports of intolerance or toxicity."

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Should I approach with caution?

Smith advises people to approach with caution because a lack of human data means it's premature to claim that it works for everyone and is beneficial to one's health. "Even when health benefits are demonstrated, it would only apply to the population in which it was tested," says Smith. "This is also the reason why we comprehensively test any new pharmaceutical drug though complex clinical trials process – there is no reason why natural products would be safer. Natural products are basically 'chemical cocktails', so if used without caution – and especially when combined with others – the consumer could be putting him/herself at risk of adverse effects."

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If ashwagandha is so great, why is it only becoming popular now?

"This is not a phenomenon unique to ashwagandha – it may be due to aggressive advertising by a particular supplier, or anecdotal testimonies by Ayurvedic medicine users. I think with the current Covid-19 situation, more people are thinking about their health, with many grasping at anything which may promise to extend health or life," says Smith.

What should I know before I start taking ashwagandha or any other supplement?

"Natural medicines, by nature, are very complex and have many different constituents. While it is not realistic to ignore many decades of anecdotal evidence, it is important to understand that this evidence is very context specific. Potential users of ashwagandha, or any other natural medicine – should exercise caution and do their homework – at least in terms of long-term safety of the product, but preferably also to see if any positive effects have been scientifically proven in humans – before they start using a supplement. In particular, patients on chronic medication should never take natural supplements without consulting their prescribing physician," says Smith.

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What are the side effects?

Nootropicsexpert.com says ashwagandha stimulates your thyroid, so you should proceed with caution if you are hypothyroid. It's non-toxic at moderate doses, but is an adaptogen with powerful effects and could cause miscarriage in pregnant women.

It should not be taken with alcohol and can enhance the effect of sedatives, antidepressant and anti-anxiety medications, including St John's Wort, as well as other drugs used to control blood pressure.

Other possible side effects include diarrhoea, nausea, abdominal pain, drowsiness and a slowed pulse.

This article on Ergogenic Health has anecdotal accounts of how ashwagandha had a negative effect on many people, including dissociation, emotional numbness and apathy.

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How do I know if it's good for me?

If you're on any other kind of medication or have any conditions, speak to your doctor first about the effects of ashwagandha and how much you should be taking. All supplements should be taken with caution and are not always needed for long periods of time.

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