(Nothing in the following article should be considered medical advice.  Always consult with your provider.)

In the course of my clinical practice, I sometimes recommend supplements and am also asked about various others.  Supplements would not work if they did not have properties similar to medications–which then means they could interact with medications and other supplements.  Therefore, I try to read up on supplements and look at what are the risks and benefits of using them.

With stress being high in our society most of us could use help with it. This has made Ashwagandha a popular supplement right now.  Many people are taking it and promoting it to others to combat the effects of stress on the body.

The Benefits

There have been some studies proving effectiveness in combatting stress.  Here is what one has to say:  240mg of ashwagandha and placebo given daily were compared.  No adverse events reported. Ashwagandha supplementation was associated with a significant decrease in anxiety levels.  There was also a reduction in morning cortisol (a hormone we need but is often too high in people under stress).  These changes were not shown in the placebo group.  “These findings suggest that ashwagandha’s stress-relieving effects may occur via its moderating effect on the hypothalamus-pituitary-adrenal axis. However, further investigation utilizing larger sample sizes, diverse clinical and cultural populations, and varying treatment dosages are needed to substantiate these findings.”  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750292/)

The Risks
However, there are some surprising interactions and contraindications with ashwagandha.  It should never be taken with benzodiazepines as it will enhance effects.  While I was not able to find the same warning about alcohol, benzodiazepines and alcohol work similarly so one should likely avoid alcohol too. Can interact with other medications too.  Additionally, ashwagandha should not by taken by anyone with Hashimoto’s thyroiditis, Type 1 diabetes, lupus, rheumatoid arthritis, and hypertension.  It may be not be recommended for anyone with autoimmune disease.  It is also not recommended to take in pregnancy.
Conclusion
Ashwagandha supplements may have benefits, but some people should not to take them.  If you want to take it and your healthcare provider thinks it is ok for you, look for a supplement brand that is having a third party test their supplements to see if they have in them what they are claiming is in them.  Many supplements have no testing and contaminants have been found in many.  These contaminants may be harmless, but in some cases have been found to be harmful substances and even medications.  Also follow the directions on the bottle.  More is not necessarily better.  Good things in excess are bad things.
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