Ashwagandha — Evidence Review for Stress, Sleep, and Immunity
Source: editorial
Ashwagandha (Withania somnifera) is among the most-studied Ayurvedic adaptogens. The published evidence is substantial — both supportive and cautionary.
## What the Evidence Supports
**Stress + cortisol reduction:** Chandrasekhar K et al. (Indian J Psychol Med 2012) — RCT, 64 chronic stress patients, 60-day intervention with 300 mg standardised KSM-66 extract twice daily showed **27.9% serum cortisol reduction** vs placebo. PSS scale and DASS-21 scores significantly improved.
**Sleep onset + quality:** Langade D et al. (Cureus 2019) — RCT, 60 insomnia patients, 8 weeks of 300 mg twice daily showed significant PSQI (Pittsburgh Sleep Quality Index) improvement vs placebo. Sleep onset latency reduced; sleep efficiency improved.
**Anxiety:** Lopresti AL et al. (Medicine, Baltimore 2019) — RCT, 60 patients, 60 days of 240 mg standardised extract showed significant DASS-21 anxiety subscale + HAM-A score improvements.
**Strength + sports recovery:** Multiple smaller RCTs document modest improvements in upper-body strength + VO2 max in athletes.
**Hypothyroidism (subclinical):** Sharma AK et al. (J Altern Complement Med 2018) — 8-week pilot showed TSH normalisation + T3/T4 modest improvements in subclinical cases. CAUTION: this is the source of the major interaction warning below.
## Safety + Side Effects
In published RCTs, Ashwagandha is generally well tolerated. Reported side effects (rare): - Mild GI upset - Drowsiness (occasionally) - Mild diarrhoea - Rare hepatotoxicity case reports (LiverTox database)
## Important Drug Interactions
**Thyroid medication (levothyroxine):** Ashwagandha can stimulate thyroid output. Combining with thyroxine without medical supervision risks iatrogenic hyperthyroidism. AyurConnect's interaction checker flags this combination as MODERATE — confirm TSH every 6–8 weeks if combined.
**Immunosuppressants (transplant patients, autoimmune on cyclosporine/tacrolimus/mycophenolate):** Ashwagandha's immunostimulant effect may antagonise immunosuppression. AVOID in transplant recipients.
**Sedatives (benzodiazepines):** Additive CNS depression possible. Reduce one or both doses; avoid combination during the day.
**Pregnancy:** Classical Ayurveda permits low-dose Ashwagandha in pregnancy under supervision; many modern integrative guidelines recommend avoidance. Don't self-prescribe in pregnancy.
## Dosage in Studies
The clinically studied range is **300–600 mg standardised extract daily** (KSM-66 or Sensoril extracts). Classical powdered root: 3–5 g daily, with warm milk + ghee. Higher does not equal better.
## What Studies DON'T Show
- Cure of any specific disease - Anti-cancer effect (preliminary lab work only — no human evidence) - Erectile dysfunction cure (modest improvements in stress-related cases; not vascular ED) - Long-term safety beyond 12 months (most studies are 8 weeks)
## Practical Use
For someone with chronic stress + mild insomnia + low energy: 600 mg KSM-66 or 5 g classical powder with warm milk + ½ tsp ghee at bedtime, daily for 60–90 days, then reassess. Confirm thyroid status before starting.
--- **Disclaimer.** This article is for educational purposes only. Consult a qualified Ayurveda practitioner for personalised advice. _AI-generated content — pending medical review._
_Author: AyurConnect Editorial._