Ashwagandha

Ashwagandha suits a lot of people, but it isn't for everyone. These are the questions our naturopaths ask in store every day.

A good fit if

• You're an adult looking for traditional herbal support through a stressful patch
• You want a standardised extract with the withanolide content on the label, so you know what you're taking
• Your health history is straightforward: no liver, thyroid or autoimmune concerns, and no prescription medicines
• You'd rather stir a traditional whole-root powder into food or a drink than swallow a capsule
• You're happy to give it a fair trial and check in with a practitioner, rather than expecting an overnight change

Check with us first if

• You have a thyroid condition or take thyroid hormone such as levothyroxine. Ashwagandha may change thyroid hormone levels, and there are reports of an overactive thyroid settling after people stopped it.
• You take immunosuppressant medicines. This is a known possible interaction, so don't combine them without medical advice.
• You take sedatives, anticonvulsants or anything else that makes you drowsy. Ashwagandha can cause drowsiness too, and the effects may add up.
• You take diabetes or blood pressure medicines. The effects may add up, so monitoring is advised.
• You take any prescription medicine. A quick check with your doctor, pharmacist or our naturopaths first is the sensible step.
• You're buying from an overseas website. Those products aren't regulated by the TGA for quality and safety, and some reported liver injury cases involved products bought overseas.

• Standardised root extract (generic). Best known for: The standard form on Australian listed medicine labels. Absorption: Concentrated, with the withanolide content on the label, so you can see the active dose. Typical use: Capsules or tablets, often split into two doses.
• KSM-66 (branded root extract). Best known for: A root-only, water-based extract. It was used in 16 of 23 trials in one systematic review. Absorption: A water-based root extract, standardised to total withanolides. Typical use: Capsules and sports powders, most often 600 mg a day, which is the most studied dose.
• Sensoril (branded root-and-leaf extract). Best known for: A root-and-leaf extract standardised to withanolide glycosides rather than total withanolides. Absorption: Leaf has a different mix of plant compounds from root, so doses cannot be swapped with root-only extracts. Typical use: Used at the lower end of the dose range. Not common on Australian labels.
• Whole root powder. Best known for: The traditional Ayurvedic preparation, closest to how it was historically used, stirred into milk, water or food. Absorption: Not concentrated. You need far more to match the withanolide dose of an extract. Typical use: 1–2 teaspoons a day, measured by the spoon rather than by withanolide content.
• Whole-herb or leaf-containing preparations. Best known for: Uses leaf and other above-ground parts rather than the root used in trials. Absorption: Leaf contains much more withaferin A and withanone than root. Typical use: Not common on Australian labels. Leaf material is one suggested factor in reported liver injury cases.

Reference values. None. Ashwagandha is a herb, not an essential nutrient, so there's no NHMRC recommended intake for it.

Typical supplemental range. Australian labels usually provide 150–600 mg of standardised root extract a day. Combination tablets often contain 150 mg of extract, equivalent to about 1.5 g of dried root. The extract amount and the dried-root equivalent on a label are two different numbers, so don't confuse them.

Upper level. There's no NHMRC upper limit. The 12 g dried-root figure in Australia's ingredient rules is a labelling threshold, not a safety limit.

Worth knowing. Ashwagandha isn't part of everyday Australian food, so there's no dietary intake to compare against. How long you take it matters as much as how much: safety beyond about three months hasn't been established. What you need depends on your age, diet and health, so talk to one of our naturopaths.

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Pregnancy. Don't take it without professional advice. NCCIH advises avoiding ashwagandha in pregnancy.
• Breastfeeding. Don't take it, because safety has not been established (NCCIH).
• You have, or have had, liver problems. Don't take it, as a precaution.
• Yellowing skin or eyes (jaundice), dark urine, nausea, vomiting, unusual tiredness, stomach pain or loss of appetite. Stop taking it and get medical advice promptly.
• Sudden nausea, vomiting or diarrhoea after only one or two doses. Stop and get advice. These reactions have been reported to the TGA.
• You have a thyroid condition or take thyroid hormone such as levothyroxine. It may change thyroid hormone levels, and there are case reports of an overactive thyroid (thyrotoxicosis).
• You have an autoimmune condition. NCCIH advises against using it.
• You take immunosuppressant medicines. This is a recognised potential interaction.
• You take sedatives, anticonvulsants or other medicines that make you drowsy. The drowsiness adds up.
• You take diabetes or blood pressure medicines. The effects may add up, so monitoring is advised.
• You have surgery planned. NCCIH advises against using it beforehand.
• You have hormone-sensitive prostate cancer. NCCIH advises avoiding it.
• Children and teenagers. Australian labels often state it is not suitable under 15.
• Products bought from overseas websites. They are not regulated by the TGA for quality and safety, and some reported liver injury cases involved products bought overseas.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.