Adaptogens · Herbs & Botanicals · Ayurvedic root herb

Ashwagandha

Q: What is ashwagandha good for?

It is mainly studied for stress, anxiety and sleep. Small trials often find lower scores than placebo, but most reviews rate the evidence as low certainty. Some small trials also report higher testosterone in men and more strength with weight training. Evidence for other uses, such as blood sugar, immunity or anti-aging, is weak or missing.

Q: Is ashwagandha safe?

It may be safe for many healthy adults in the short term, but it is not risk-free. Cases of liver injury, including severe ones in people with existing liver disease, have been reported. It can affect thyroid hormone and add to sedatives. NIH advises against it in pregnancy and breastfeeding. Long-term safety is unknown.

Q: Can ashwagandha damage the liver?

Yes, liver injury linked to ashwagandha has been described in published case series, with jaundice, itching and nausea usually starting 2 to 12 weeks after starting. Most people recovered after stopping, but some people with liver disease died. No study gives how often it happens, so we do not call it common or rare. Stop it and get care if you notice yellow skin or eyes, dark urine or severe itching.

Q: Does ashwagandha lower cortisol?

Several trials measured lower cortisol than placebo. Cortisol is a lab marker. A lower number does not by itself mean you feel or function better, and one case report describes adrenal insufficiency in a woman taking it for over a year.

Q: Does ashwagandha raise testosterone?

Several small trials in men found higher testosterone than with placebo, and a 2026 pooled analysis found an average rise. Researchers do not know whether this improves health. NIH advises that people with hormone-sensitive prostate cancer avoid it.

Q: Is ashwagandha good for sleep?

A pooled analysis of trials found a small to moderate improvement in sleep quality, larger in people with insomnia, mostly with root extract at 600 mg/day or more for 8 weeks or longer. Certainty is low and most trials used questionnaires.

Q: Can ashwagandha affect the thyroid?

It may raise thyroid hormone (T4) and there are case reports of an overactive thyroid after use. Talk to your prescriber before using it if you have a thyroid condition or take thyroid medicine.

Q: How much ashwagandha is used in studies?

Trials used from 30 to 1,000 mg a day of extract, typically 125 to 600 mg a day for 8 to 12 weeks. That is what researchers tested, not a recommendation. Products differ in strength, so the same dose of two products is not equal. See the Dosage tab.

Q: What are the side effects?

Reported effects include drowsiness, stomach upset, diarrhea and nausea. Serious effects reported in case reports include liver injury and an overactive thyroid. See the Safety tab for how often each was reported and the type of evidence.

Q: Who should not take ashwagandha?

NIH says to avoid it in pregnancy and breastfeeding. It is also not recommended before surgery, with autoimmune or thyroid disorders, in people with liver disease, or in hormone-sensitive prostate cancer, unless a clinician agrees.

Withania somnifera (L.) Dunal · also called Indian ginseng, winter cherry

Ashwagandha is an evergreen shrub of the nightshade family. Its root, and sometimes its leaf, is taken as a powder, capsule or extract. It has been used in Ayurveda for thousands of years, according to NIH and is now studied for stress, sleep and hormones. Most human trials are small and short, and some people have had serious liver injury.

General information, not medical advice. Last substantive update October 24, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Ashwagandha

Ashwagandha (Withania somnifera) is a shrub whose root has been used in Ayurveda for thousands of years, according to NIH. Today it is sold as a supplement, mainly for stress and sleep. The best human evidence is a set of small, short, placebo-controlled trials. Most reviews call that evidence low certainty. It is not risk-free: liver injury, thyroid effects and pregnancy are the main concerns.

What it is

Ashwagandha is Withania somnifera, a woody shrub in the nightshade family (Solanaceae). It grows in dry parts of India, Africa and the Middle East. The name comes from Sanskrit and is often explained as the smell of a horse. It is sometimes called "Indian ginseng", but it is not related to true ginseng (Panax).

Supplements are made from the root, the leaf, or both. NIH notes that these are different products and results from one do not carry over to another.

National Center for Complementary and Integrative Health (NCCIH) 2023

What makes it distinctive

Its characteristic compounds are withanolides, a family of steroid-like molecules. Different parts of the plant and different extracts contain different amounts, so two products labelled "ashwagandha" can differ a lot.

It is classed as an "adaptogen", a term used for herbs said to help the body handle stress. That word is a marketing and traditional category, not a medical one, and no regulator defines it. See what adaptogens are.

Historical and current uses

In Ayurveda it is a rasayana, a rejuvenating tonic, used for weakness, thinness and sexual vigour. Today people mostly take it for stress, sleep and energy, and some athletes use it for strength. Traditional use shows how a plant was used; it does not show that a supplement works.

What the research shows

For perceived stress and sleep, several meta-analyses of placebo-controlled trials find lower scores with ashwagandha, but the trials are small, mostly from a few research groups, and many tested a branded extract. One 2025 meta-analysis found no clear effect on perceived stress. For testosterone, strength, menopause symptoms and sexual function, small trials point toward a benefit with low certainty. For blood sugar, immune function, heart health and aging, there is not enough human evidence.

Many lab and animal studies describe how withanolides act on cells. Those findings are leads for research and are not proof of an effect in people.

Chandrasekhar 2012 Pratte 2014 Choudhary 2017 Kaushik 2017 Lopresti 2019 Langade 2019 Salve 2019 Kelgane 2020 Deshpande 2020 Langade 2021 Speers 2021 Cheah 2021 Remenapp 2022 Baker 2022 O'Connor 2022 Akhgarjand 2022 Park 2023 Smith 2023 Majeed 2023 Pandit 2024 Fatima 2024 Pérez-Piñero 2024 Mishra 2024 Arumugam 2024 Albalawi 2025 Mahadevan 2025 Marchi 2025 Coope 2026 Alsanie 2026 McKinney 2026 Honnutagi 2026 West 2026 Thanawala 2026 Saxena 2026 Łuszczak 2026 Pakhale 2026 Movva 2026 Pattojoshi 2026 Baune 2026 Lopresti 2026 Kulkarni 2026 Obhrai 2026 Mastrofini 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Root, leaf, powder, extract: what is the difference?

Root extract

Concentrated extract of the root, often standardized to a percentage of withanolides.

The form used in most trials. Results do not automatically apply to other extracts.

Root powder

Dried, ground root in capsules or mixed into drinks.

Withanolide content is rarely stated and varies from batch to batch.

Leaf or root-and-leaf extract

Made from the leaf, or a mix of root and leaf.

Chemistry differs from root-only products (for example, more withaferin A in leaf in some reports). Safety and effects cannot be assumed to match root extracts.

Gummies, teas and tinctures

Convenience formats.

Amounts and plant part are often unclear. Few were studied.

At a glance

Traditional uses history, not proof

A rasayana: a tonic for strength and general resilience in Ayurveda
Used for weakness, thinness and tiredness, and for sexual vigour and fertility
Taken as root powder with milk or ghee in Ayurvedic practice

Studied for research

Perceived stress and anxiety
Sleep quality and insomnia
Testosterone and semen quality in men
Muscle strength with resistance training
Sexual function and menopause symptoms
Thyroid hormones (also a safety signal)

Main compounds

Withanolides (steroidal lactones), including withaferin A and withanolide A
Withanosides and other withanolide glycosides
Alkaloids and sitoindosides (less studied)

Common forms

Root extract (the form most trials used)
Root powder
Root-and-leaf or leaf extract (different chemistry)
Capsules and tablets, gummies, teas, tinctures

Research links: NIH NCCIH: Ashwagandha · LiverTox (NIH): Ashwagandha · PubMed: ashwagandha randomized trials · Research Library · Genes & Biomarkers Library

The plant and its history

Accepted scientific name: Withania somnifera (L.) Dunal
Naming authority: (L.) Dunal; basionym Physalis somnifera L.
Synonyms: Physalis somnifera L.; Physaloides somnifera (L.) Moench; Hypnoticum somniferum (L.) Rodati; Alicabon somniferum (L.) Raf.; Withania somnifera var. flexuosa (L.) Dunal; Withania somnifera var. communis (Nees) Dunal; Withania somnifera var. macrocalyx Chiov.; Withania kansuensis Kuang & A.M.Lu; Withania obtusifolia Tackh.; Withania sicula Lojac.; Physalis flexuosa L.; Physalis alpini J.Jacq.; Physalis arborescens Thunb.; Physalis tomentosa Thunb.; Physalis villosa Moench
Common names: Ashwagandha (Hindi / Sanskrit (transliterated)); Indian ginseng (English); Winter cherry (English); Poison gooseberry (English); Ginseng indien; Withania somnifere (French); Schlafbeere; Winterkirsche (German); Hierba del sueno (sleep herb); bufera (Spanish); Ginseng-indiano; jimsem-indiano (Portuguese); Witania ospala (Polish); Vitania opojna (Slovak); Geneesbossie; stuipbossie (Afrikaans); Ubuvimbha; ubuvuma (Zulu / Xhosa)
Botanical family: Solanaceae (nightshade family, which also holds tomato, potato, tobacco and belladonna)
Classification: Plantae > Tracheophyta > Magnoliopsida > Solanales > Solanaceae > Withania > Withania somnifera
Native range: Wide dry-region distribution from the Mediterranean and North Africa through tropical and southern Africa, the Middle East and Afghanistan to Pakistan, India, Nepal, Sri Lanka and China (Wikipedia, plus the open Bashir 2023 review). Treated as naturalised or a weed in parts of Australia. Kew POWO native-range data could not be retrieved (site blocked automated access).
Habitat: Dry, stony or sandy soils in sun to partial shade, in arid and semi-arid zones; also gardens and disturbed ground (Wikipedia, secondary).
What the plant looks like: Roots: Fleshy, tuberous taproot, the part used medicinally; has a strong, horse-like smell when fresh (secondary sources). Not detailed in the primary sources I could read.; Stems: Erect, much-branched, densely covered in fine hairs (tomentose); an evergreen woody shrub about 35-75 cm tall (Wikipedia).; Leaves: Dull green, elliptic, up to about 10-12 cm long (Wikipedia).; Flowers: Small, greenish, bell-shaped (Wikipedia).; Fruit: Round berry that ripens orange-red, enclosed in a papery inflated calyx like a Chinese lantern (the lantern detail is general knowledge for the genus, not verified from the sources read).
Cultivation: Grown commercially for the roots mainly in drier regions of India (Madhya Pradesh, Rajasthan, Gujarat, Maharashtra and others per Bashir 2023 and Wikipedia); propagated from seed in spring or by cuttings (Wikipedia). Detailed agronomy (sowing dates, spacing, yields) was not verified.
Harvest and processing: Not verified from the sources I could read. General practice (unverified here): roots are dug when the plant matures, washed, cut and dried, then powdered or extracted. Extraction method and plant part (root, leaf or both) strongly change chemistry (see compounds).
Look-alikes and adulterants: Name: Withania coagulans (Indian cheesemaker); Note: A related species that is sometimes used or sold alongside; has different chemistry (coagulins). Cited as a related species in the Bashir 2023 reference list and GBIF genus; quantitative adulteration rates not verified.; Name: Leaf and stem material mixed into 'root' products; Note: Analytical survey p41386716 found only 2 of 25 commercial products confirmed root-derived; the rest contained varying proportions of aerial parts. This is the best-documented adulteration issue.; Name: Other Solanaceae shrubs with orange berries (e.g. Physalis species); Note: Visual resemblance only; the plant was historically named Physalis somnifera (GBIF synonyms). Identification should be by a botanist or DNA/chemical test.
Sustainability and conservation: IUCN Red List: Least Concern, per Wikipedia (secondary); the IUCN page itself could not be retrieved. Wild harvest pressure is discussed in the literature but I did not verify any regional threatened status.

The plant and the parts used

Ashwagandha shrub growing in a field with orange-red berries — The whole shrub.

Ashwagandha leaves and small greenish bell-shaped flowers — Leaves and flowers.

Orange-red ashwagandha berries inside papery husks — Berries inside their husks.

Pale ashwagandha roots and root powder — The root, the part most used.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Ayurveda - classical texts (Charaka Samhita, Susruta Samhita, Astanga Hridaya, nighantus)	Described as balya (strength-giving), brimhana/pustida (nourishing, weight-building), vajikarana (used for sexual vigour and fertility) and as a rasayana (rejuvenative tonic); used in emaciation and weakness, internally and externally.	p32783987; p38122911 (introduction)
Ayurveda - dosha theory	Traditionally described as balancing Vata (calming, grounding) and Kapha; warming. This is classical doctrine rather than measured physiology. Not found in the abstracts I read; stated from general Ayurvedic knowledge.	general Ayurvedic reference (not verified in a retrieved source)
Ayurveda - age of use	Reviews state use in Ayurvedic and Unani medicine for about 3,000 years.	p32783987; p37063285; s-pmc-bashir-2023
Unani (Indian subcontinent)	Root regarded as a tonic, aphrodisiac and emmenagogue.	p38122911 (introduction)
Broader Indian traditional use	Listed uses include anti-stress, diuretic, anti-anaemia, aphrodisiac, constipation, worms, liver disease, inflammation, joint pain, nervous disorders and arthritis; also relief of abdominal swelling, mild purgative, treatment of swollen glands.	s-pmc-bashir-2023; p38122911
African indigenous medicine	Used in traditional African medicine for various diseases including HIV/AIDS and tuberculosis (stated as the reason for a drug-interaction study); local names (Zulu ubuvimbha, Afrikaans geneesbossie) exist.	p33395575; s-gbif-withania-somnifera
Modern pharmacopoeial status	Described in the Ayurvedic Pharmacopoeia of India; also in British and US pharmacopoeial standards for supplements. Contents of WHO, EMA or Health Canada monographs were not retrieved in this pass.	p38122911; p41386716
Important note	All items above describe tradition, not proof. Clinical benefit is judged only by trials (see the benefits section of the master profile).	n/a

Traditional use shows how a plant was used. It does not show that a supplement works or is safe today.

What is inside, and how it may work

What the plant contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Withaferin A PubChem 265237	withanolide (steroidal lactone, ergostane type; reactive enone and epoxide)	Leaf richer; also present at lower level in root; quantity varies strongly by chemotype In Shoden (root+leaf) powder about 0.09 umol per mg (p42353009). In AgeVel root extract at 500 mg dose, plasma Cmax 2.8 ng/mL (p38122911). No reliable general percentage verified.	Binds protein cysteines (IKK beta Cys179, Keap1/Nrf2 pathway, vimentin and others); anti-inflammatory and cytotoxic in cells and animals; oral bioavailability 1.8% in mice; the focus of leaf-safety concern. Heyninck 2014 Bailly 2024 Logie 2020 Palliyaguru 2016 Gupta 2022 Speers 2026 Vaidya 2024 Dutta 2026	Laboratory research
Withanolide A PubChem 11294368	withanolide (steroidal lactone)	Root Plasma Cmax 2.9 ng/mL after 500 mg root extract (p38122911); content in extract not quantified in sources read.	Promoted axon outgrowth in cultured neurons; no direct glucocorticoid-receptor effect shown; docking-only AChE suggestions. Kuboyama 2002 Crane 2019 Vaidya 2024	Laboratory research
Withanolide D PubChem 161671	withanolide (steroidal lactone)	Root and leaf (sources differ) Not quantified in sources read.	Frequently named as a key active along with withaferin A in reviews; most evidence is cell-based. Bashir 2023 Dutta 2026	Laboratory research
Withanoside IV PubChem 71312551	withanolide glycoside (sugar-bound)	Root (withanosides reported exclusively in roots) In Shoden about 0.03 umol/mg (p42353009); plasma Cmax 0.64 ng/mL after 500 mg root extract (p38122911).	Dendrite outgrowth in cultured neurons; converted to sominone (aglycone) found in human urine; glycoside content linked to much higher bioavailability of the whole extract. Kuboyama 2002 Speers 2026 Kim 2023 Rathi 2025 Kumar 2023	Laboratory research
Withanoside V PubChem 10700345	withanolide glycoside	Root Detected in plasma but below quantification limit (p38122911).	Little activity data in sources read. Vaidya 2024	Laboratory research
Withanoside VI PubChem 91827019	withanolide glycoside	Root Not quantified in sources read.	Dendrite outgrowth in cultured neurons. Kuboyama 2002	Laboratory research
Withanone PubChem 21679027	withanolide (steroidal lactone)	Leaf (and fruit per one review table) Not quantified in sources read.	Metabolised by CYP3A4 and CYP1A2 in liver microsomes, highly protein bound (82-88%), no CYP inhibition in vitro. Singh 2021 Kumar 2023	Laboratory research
12-Deoxywithastramonolide PubChem 44576309	withanolide (steroidal lactone)	Root Highest plasma Cmax of the four measured (5.5 ng/mL, p38122911).	Little pharmacology in sources read. Vaidya 2024 Sharma 2025	Laboratory research
Withanolide B PubChem 14236711	withanolide	Root Not quantified.	Measured in rodent pharmacokinetic work. Speers 2024	Animal research
Withanolide E PubChem 301751	withanolide	Leaf Not quantified.	Named in reviews; no data read. Bashir 2023	Theory
Withastramonolide PubChem 21607602	withanolide	Not stated Not quantified.	Parent name of 12-deoxy analogue; no data read. Bashir 2023	Theory
2,3-Dihydrowithaferin A PubChem 15411208	withanolide (reduced withaferin A)	Not stated Tentatively identified by mass spectrometry in root extracts (p33395575).	Possible contributor to CYP2B6 inhibition (inferred by authors). Kumar 2021	Laboratory research
Dihydrowithaferin A sulfate	withanolide sulfate	Leaf Not quantified; its co-elution caused underestimation of withanolide A in leaf samples (p41386716).	Used as a marker of leaf material in product testing. Avula 2026	Laboratory research
Sitoindoside IX (sitoindosides VII-X) PubChem 189586	acylsteryl glucoside / withanolide glycoside	Root Not quantified.	Reviews attribute antioxidant and 'adaptogenic' effects to sitoindosides; I found no human data. Bashir 2023	Theory
Docosanyl ferulate (long-chain ferulic acid esters)	phenolic acid ester	Root Not quantified.	Potentiated GABA-A inhibitory currents (IC50 7.9 uM) in cells; the GABA-active principle found in a root extract was an ester, not a withanolide. Sonar 2019	Laboratory research
Somniferine and other alkaloids (anaferine, isopelletierine) PubChem 14106342	alkaloids	Root Not quantified. Anaferine PubChem CID 443143, isopelletierine CID 92987.	Isopelletierine tentatively detected by LC-MS in root extracts; no pharmacology read. Kumar 2021 Paul 2021	Theory
Flavonoids and phenolic acids (e.g. salvigenin)	flavonoid / phenolic	Root and leaf Not quantified.	Tentatively identified by LC-MS; present among minor constituents. Kumar 2021 Mukherjee 2021	Laboratory research

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
GABA-A receptor	GABRA/GABRR1 subunits	A long-chain ferulic acid ester from root extract enhanced GABA-A currents in cells (IC50 7.9 uM). In rodents, root extracts raised brain GABA and GABA-A receptor expression and lengthened sleep. Not shown in humans. Sonar 2019 Park 2023 Murthy 2022	Animal research
NF-kB signalling	IKK beta (IKBKB), Cys179	Withaferin A covalently binds cysteine 179 and inhibits IKK beta activity in test-tube and cell assays; many other proposed sites. Heyninck 2014 Logie 2020 Bailly 2024	Laboratory research
Nrf2 antioxidant response	NFE2L2 (Nrf2), KEAP1, PTEN/PI3K/AKT	Withaferin A induced Nrf2-dependent cytoprotective genes and protected mice from acetaminophen liver injury only when Nrf2 was intact; partly Keap1-independent. Effects depend on dose and context. Palliyaguru 2016 Logie 2020	Animal research
Glucocorticoid receptor / cortisol axis	NR3C1	Withanolide A pulled out glucocorticoid receptor as a possible target but did not interfere directly with receptor binding or activation. Human cortisol lowering is a trial finding handled in the biomarkers section; the molecular route (HPA axis) is a proposal from reviews, not demonstrated. Crane 2019 Such 2026 Wiciński 2023	Laboratory research
Acetylcholinesterase and butyrylcholinesterase	ACHE, BCHE	Withanolides inhibited both enzymes in test tubes (IC50 20.5-49.2 uM AChE). Concentrations are far above human plasma levels (ng/mL range). Docking papers add more speculation. Choudhary 2005 Bashir 2023	Laboratory research
GSK-3 beta and tau kinases	GSK3B, TTBK1	Only computer simulation of binding (free energies -9 to -13 kcal/mol); no laboratory or human test read. J 2026	Theory
Neurite outgrowth	neuronal structural proteins (NF-H, MAP2)	Withanolide A extended axons and withanosides IV/VI extended dendrites in cultured human and rat neurons. Kuboyama 2002 Crane 2019	Laboratory research
Phosphodiesterase 4D	PDE4D	A 2026 narrative review states withanolides inhibit PDE4D; primary evidence not checked. Such 2026	Laboratory research
Covalent cysteine modification (general)	multiple proteins (IKK beta, vimentin, Hsp90, tubulin, etc.)	Withanolides with a reactive enone bind protein thiols; explains many cell effects and also possible toxicity at high local concentration. Bailly 2024	Laboratory research
Drug-metabolising enzymes (CYP)	CYP2B6, CYP3A4, CYP1A2, CYP2C9	Root extracts inhibited CYP2B6 and moderately induced CYP3A4 in cells; another study found no CYP1A2/2C9 inhibition; withanone is itself metabolised by CYP3A4/1A2. No human interaction trial found. Kumar 2021 Savai 2015 Singh 2021	Laboratory research
Thyroid axis (T3/T4/TSH)	TSHR axis (proposed)	A review reports changes in T3, T4 and TSH in some studies and proposes an HPT-axis route; mechanism not shown. Wiciński 2023	Human data

Absorption, metabolism and elimination

Absorption: Withanolides appear in human blood quickly: Tmax about 0.9-1.6 h for withaferin A, withanolide A, withanoside IV and 12-deoxywithastramonolide after 500 mg of a root extract (p38122911); 1.0-1.4 h after 400 mg of a 2.5% extract (p39963957). Blood levels are tiny (Cmax roughly 0.5-5.5 ng/mL at these doses; range 0.1-49.5 ng/mL across human studies in the p39599622 review). Pure withaferin A orally had 1.8% bioavailability in mice (p36518386) and was undetectable in blood in cancer patients on 72-216 mg per day (p30904387).
Distribution: Withanone is 82-88% bound to plasma protein in vitro (p33460762). Human tissue distribution of withanolides has not been measured in the sources I read.
Metabolism: Withanone is extensively metabolised by CYP3A4 and CYP1A2 in human liver microsomes (p33460762). In humans, withanoside IV is converted to its aglycone sominone, and an unidentified metabolite isomeric with 4-oxo-withaferin A appears in urine (p42353009). Glycosides probably lose their sugar before absorption, but this step is not directly shown in the abstracts read.
Elimination: Half-lives 1.7-4.4 h across four withanolides at 400 mg (p39963957). Only low amounts (<3% of dose) of withaferin A, sominone and viscosalactone B were recovered in 12-h urine after 240 or 480 mg Shoden (p42353009).
Bioavailability: Product-dependent. Extracts rich in withanolide glycosides (35%) gave far higher blood exposure per mg than 2.5-10% extracts (p38144272, p40792075, 118-280 times per gram in the manufacturers' analyses); a 1.5% low-dose formula beat 5% and 10% extracts (p40748423). Most trials come from extract makers. Blood level is not proof of clinical effect, and extract-to-extract results do not transfer.

Vaidya 2024 Kim 2023 Sharma 2025 Rathi 2025 Ramapalaniappan 2025 Speers 2024 Speers 2026 Gupta 2022 Pires 2020 Singh 2021

Isolated compounds versus whole extracts

Whole extracts and isolated compounds behave differently. Pure withaferin A is poorly absorbed (1.8% in mice) and was not detectable in blood in patients given up to 216 mg daily, yet withaferin A is measurable at about 2-3 ng/mL after a 500 mg root extract. Extract composition (glycoside share, plant part) changes blood exposure by orders of magnitude. Leaf-heavy extracts carry more withaferin A and related electrophilic withanolides; root extracts are dominated by withanolide A, D and glycosides. Because of this, results from one product (e.g. KSM-66 root, Sensoril root+leaf, Shoden root+leaf, Witholytin root) cannot be assumed for another. Cell-culture findings with pure withaferin A used concentrations well above what humans reach from supplements.

Nutritional composition

A nutritional composition table is not meaningfully applicable: ashwagandha is taken as a small-dose extract or a few grams of root powder, so it supplies negligible calories, vitamins or minerals; its relevance is phytochemical (withanolides), not nutrient content.

Products, quality and comparisons

Independent evidence comes first. Nothing in this section is a paid ranking. If a product link is added later, it will be marked clearly as an affiliate link and will never change what the research says.

Quality indicators

Plant part stated (root, leaf or both) and extract or powder
Marker compound named with percentage and test method (for example HPLC)
Same extract and daily mg as a published trial, if you want to match research
No proprietary blend hiding the ashwagandha amount
Lot number and a certificate of analysis available on request
Independent seal checked on the certifier's own website

Identity and authenticity

A 2026 HPLC study of 25 commercial products found only 10 met both British and US pharmacopoeia standards and only 2 were confirmed as root-derived; the remainder had varying amounts of undisclosed aerial parts (the authors blame co-eluting dihydrowithaferin sulfate found mainly in leaf).
A 2026 review says analytical surveys have documented root material adulterated with leaf and stem.
These findings describe the products tested and cannot be applied to any single brand.

Standardization and extract strength

Standardization states how much of a marker compound the extract contains, for example total withanolides (2.5%, 5%, 10%) or withanolide glycosides (10%, 35%).
Percent depends on method: one trial reports 2.5% 'as per USP protocol'; another extract is described as at least 5% (site page).
A single-dose crossover in 16 volunteers found an extract with 35% withanolide glycosides gave much higher plasma exposure than 10%, 5% and 2.5% extracts dosed to the same 185 mg total withanolides, and a 125 mg 1.5% product gave 2.1x the exposure of a 600 mg 5% product. These suggest the percentage on the bottle does not predict absorption; plasma levels are not proof of benefit.
Serving size is NOT the same as withanolide content: mg of withanolides = serving mg x percent.

Third-party testing

US supplements are not reviewed by FDA before sale; makers must follow GMP (identity, purity, strength, contaminant limits).
Third-party programmes (USP, NSF, ConsumerLab and others) differ in what they test, and a seal is a statement about that programme, not a guarantee of effect.
ConsumerLab-type reports are mostly behind paid access, so we cite none. We found no publicly readable independent test of ashwagandha products besides the 2026 academic study.

Contaminants and adulterants

Heavy metals: surveys of Ayurvedic medicines in lead-poisoning investigations found lead in 65% of 252 samples (mercury 38%, arsenic 32%); in New York City investigations the highest levels were in metal-based rasa shastra preparations. These are not studies of ashwagandha root capsules, and we found no ashwagandha-specific contamination rate.
The UK FSA asked industry for heavy metal and pesticide testing information in 2024 and has not published numbers.
Microbial, pesticide and solvent residues were not covered by the sources we read.

Reading a product label

Find the botanical name Withania somnifera and the plant part.
Is it 'extract' or 'powder'? Note mg per serving and servings per day.
Look for a named marker and percentage and the test method.
Compare mg per day and extract type with a trial, not with another bottle.
Check for proprietary blends and other herbs (for example black pepper/piperine, which one trial used).
Check cautions (pregnancy, thyroid, autoimmune, medicines).
Find the lot number and ask for a certificate of analysis.
Check any seal on the certifier's own site.

Certifications and what they actually mean

Certification	What it means	What it does not tell you
USP Verified	Run by US Pharmacopeia; NCCIH names it as an independent group whose label can help judge quality.	USP pages returned an error to our tools so we could not read the test list; verify the exact product on USP's site.
NSF Certified for Sport / NSF Contents Certified	NSF says it checks absence of banned substances, label match, contaminant limits and GMP audit.	Programme built around athlete banned-substance risk; description is the organisation's own.
ConsumerLab seal	ConsumerLab says its Quality Certification Program tests products and does not accept samples directly from the manufacturer.	Manufacturer pays a fee; for-profit; reports are membership-based so not verifiable here.
GMP statement (cGMP)	Maker says it follows good manufacturing practice, which US law requires.	Not a quality seal on its own and not an independent test of the product.
Organic	Farming and processing standard.	Says nothing about withanolide content, plant part or heavy metals unless tested.
Vegan, non-GMO, gluten-free	Ingredient and process claims.	Not quality or potency claims.

Comparing price and servings

Do not compare bottle prices. Step 1: cost per serving = bottle price / servings per bottle. Step 2: servings per day needed to reach the studied extract daily mg (studied mg/day / mg of extract per serving). Step 3: cost per day = cost per serving x servings per day. If a withanolide percentage is stated, cost per 10 mg of withanolides = bottle price / (servings x mg per serving x percent / 10); use only products with the same extract type. Leave prices blank until a real current product is entered; no prices are included here.

Extract types compared

Extract	Plant part	Standardization	Trials	Evidence note	Safety note	Limitations	Studies
KSM-66 (as described on the site's extract-types page)	root	Water-based, root only, at least 5% withanolides (site page, from the paper and maker supply statements)	Chandrasekhar 2012 (600 mg/day 60 days); Wankhede 2015 (600 mg/day 8 weeks); many more per the 2026 safety review	Abstracts we read do not name the brand; brand identification comes from the site's own page.	Root-only safety review: biomarkers normal in healthy adults	Maker-supplied extract; no head-to-head with other extracts.	Chandrasekhar 2012 Wankhede 2015 Coope 2026 alternativemed.com (internal) 2026
Sensoril	root+leaf	Aqueous extract; one trial's label 'not less than 10% withanolide glycosides, not more than 0.5% withaferin A' (site page)	Ziegenfuss 2018 (500 mg/day 12 weeks); others per site page	Leaf contains withaferin A; toxicology report of the extract is maker-funded.	Rat 90-day NOAEL 4,000 mg/kg/day; in 3 bipolar patients thyroxine rose	Animal safety data; small human trials.	Ziegenfuss 2018 Summan 2026 Gannon 2014
Shoden	root+leaf (per the 2026 urine study abstract)	21 mg withanolide glycosides/day from beads in one trial; 120 to 480 mg doses elsewhere	Lopresti 2019 (240 mg); Deshpande 2020 (120 mg); Lopresti 2019 men (21 mg withanolide glycosides)	Several authors linked to the product's maker.	Not specifically assessed in the abstracts we read	Mixed results: hormones changed but fatigue and vigor did not differ from placebo in men.	Lopresti 2019 Deshpande 2020 Lopresti 2019 Speers 2026
Witholytin	root	Not in abstract	Smith 2023 (400 mg/day 12 weeks)	Primary stress outcome did NOT beat placebo; fatigue and HRV did.	Not in abstract	One trial.	Smith 2023
Full-spectrum or generic standardized root extracts (unbranded in abstracts)	root	Varies	Many 125-600 mg/day trials	Cannot be assumed equal to KSM-66 or Sensoril.	Healthy-adult review: no serious attributable events	Heterogeneity.	Coope 2026 Salve 2019
Newer high-bioavailability or low-dose products (Zenroot 1.5%, LDA 30 mg, AshwaSR)	root or unspecified	1.5% withanolides; >15% withanolides; sustained-release	Mahadevan 2025 (125 mg); Prajapati 2026 (30 mg); Thanawala 2026 (150/300 mg)	Each is a single maker-linked trial; absorption claims come from single-dose crossovers in 16-20 people.	Well tolerated in the short trials	Plasma exposure is not clinical benefit; no independent replication found.	Mahadevan 2025 Prajapati 2026 Thanawala 2026 Rathi 2025 Ramapalaniappan 2025
Whole root powder	root	None	Mahdi 2011 (5 g/day); Mamidi 2011 (null)	Few, small, partly unblinded.	Little data	Not comparable with extracts.	Mahdi 2011 Mamidi 2011
Leaf extract	leaf	Richer in withaferin A	None standalone found	Human data sparse and confounded.	Product-specific data needed	Not studied alone.	Dutta 2026

Compare Ashwagandha with another ingredient

Compare with

Ashwagandha vs Rhodiola rosea

Both are called adaptogens, but no study compares them directly. Ashwagandha has more trials on stress and sleep; Rhodiola is studied more for fatigue. Evidence for each is weak to moderate at best, and results belong to the specific extract.

	Ashwagandha	Rhodiola rosea
Benefits studied	Stress, anxiety, sleep, strength, cognition, thyroid and hormone markers	Physical and mental fatigue, exercise performance, stress (per reviews)
Evidence certainty	low (meta-analyses rated low certainty; very high heterogeneity)	low: a systematic review found contradictory results and every trial at high or unclear risk of bias
Typical studied dose	125-600 mg/day extract for 8-12 weeks (range 30-1,000)	290-1,500 mg/day in the trials reviewed
Head-to-head trial	None found	None found; one 2026 trial tested a Rhodiola, holy basil and schisandra blend and a full-spectrum ashwagandha, each against placebo only
Safety and interactions	See the site's safety pages (liver, thyroid, pregnancy, medicines)	See the site's Rhodiola page; not re-verified here
Forms	Capsule, extract, powder, tincture, tea, gummy	Capsule or tablet extracts mostly
Cost note	Use the price-per-day formula; no prices stored	Use the same formula

Łuszczak 2026 Ishaque 2012 McKinney 2026 Read the full comparison

Ashwagandha vs Panax (Asian) ginseng

The two are often paired as 'stimulating' and 'calming' adaptogens in popular writing, but we found no trial comparing them and the reviews of ginseng for fatigue report small effects and poor methods.

	Ashwagandha	Panax (Asian) ginseng
Benefits studied	Stress, anxiety, sleep, strength	Fatigue, sexual function, menopausal symptoms, metabolic markers (umbrella review)
Evidence certainty	low	low: meta-analysis found no significant overall fatigue reduction (SMD -0.36, CI -0.82 to 0.11) although subgroups did; umbrella review found 14 of 19 reviews critically low quality
Typical studied dose	125-600 mg/day extract	Varies; not tabulated here
Head-to-head trial	None found	None found
Safety and interactions	See site pages	Umbrella review: gastrointestinal symptoms and potential bleeding; no serious adverse events reported
Forms	As above	Root powder, extracts, teas
Cost note	Formula only	Formula only

Li 2023 Li 2023 Akhgarjand 2022 Read the full comparison

Ashwagandha vs Holy basil (tulsi)

Holy basil has mainly small studies; ashwagandha has more randomized trials for stress. They have not been tested against each other.

	Ashwagandha	Holy basil (tulsi)
Benefits studied	Stress, anxiety, sleep	Metabolic, cardiovascular, immune and neurocognitive outcomes; stress
Evidence certainty	low	low: 24 mostly small, varied human studies; authors say dosage and form need clarifying
Typical studied dose	125-600 mg/day extract	300 mg/day ethanolic leaf extract for 30 days in one small trial
Head-to-head trial	None found (2026 trial tested a blend containing holy basil versus placebo)	None found
Safety and interactions	See site pages	No significant adverse events in the review; interaction data not verified here
Forms	Capsule, powder, extract	Leaf extract, tea, capsules
Cost note	Formula	Formula

Jamshidi 2017 Sampath 2015 McKinney 2026 Read the full comparison

Ashwagandha vs Magnesium

Magnesium is a mineral that can correct low intake; ashwagandha is a herbal extract. Evidence for both for sleep and anxiety is low certainty. No head-to-head trial was found.

	Ashwagandha	Magnesium
Benefits studied	Stress, anxiety, sleep	Anxiety (in anxiety-prone groups), sleep, especially older adults
Evidence certainty	low	low to very low: meta-analysis in older adults with insomnia (3 RCTs, 151 people) found 17.36 minutes shorter sleep onset latency but low to very low certainty; a 2026 review rated certainty low to very low and findings inconsistent
Typical studied dose	125-600 mg/day extract	Varied between trials; elemental dose differs by form
Head-to-head trial	None found	None found
Safety and interactions	See site pages	See the site's magnesium page; not re-verified here
Forms	Extract, powder	Citrate, glycinate, oxide and others, varying absorption (not compared here)
Cost note	Formula	Formula

Mah 2021 Lopresti 2026 Boyle 2017 Rawji 2024 Akhgarjand 2022 Read the full comparison

Ashwagandha vs Melatonin

The only direct comparison we found is a single 2026 trial in 200 adults where each alone helped about equally and together helped most. It is one trial with abstract-only data.

	Ashwagandha	Melatonin
Benefits studied	Sleep onset latency, sleep quality, anxiety	Sleep onset latency
Evidence certainty	low (sleep meta-analysis of 5 RCTs, 400 people; SMD -0.59)	low overall (umbrella review rated studies low quality); a meta-analysis found no significant effect in adults with non-comorbid chronic insomnia but possible effect in children and adolescents
Typical studied dose	300 mg twice a day in the sleep trials	3 mg/day in the one head-to-head trial
Head-to-head trial	Yes: Movva 2026, 200 adults, 8 weeks: ashwagandha 600 mg/day and melatonin 3 mg/day each reduced sleep onset latency with moderate, comparable benefit; combination best	Same trial
Safety and interactions	See site pages	Mild adverse events similar across groups in the trial
Forms	Capsule, extract	Tablet, gummy, liquid
Cost note	Formula	Formula

Movva 2026 Cheah 2021 Choi 2022 Ell 2023 Read the full comparison

Ashwagandha vs L-theanine

L-theanine is a single amino acid studied for acute effects within an hour; ashwagandha is a multi-compound extract studied over weeks. They suit different questions and have not been compared directly.

	Ashwagandha	L-theanine
Benefits studied	Stress, anxiety, sleep	Attention (single 200 mg dose), modest acute stress effect, sleep and anxiety scores in a small trial
Evidence certainty	low	low: the 31-RCT meta-analysis found the acute stress benefit modest (SMD 0.31) and driven by high-risk-of-bias studies, with inconsistent anxiety effects
Typical studied dose	125-600 mg/day extract for weeks	200 mg single dose or 200-400 mg/day
Head-to-head trial	None found	None found
Safety and interactions	See site pages	No serious adverse events in the meta-analysis
Forms	Capsule, extract	Capsule, tablet, tea (natural source)
Cost note	Formula	Formula

Gerolymos 2026 Williams 2020 Hidese 2019 Zhang 2022 Read the full comparison

Other supplements people compare it with

Rhodiola rosea (Fatigue, stress): Reviews call results contradictory with high risk of bias Evidence: low. Ishaque 2012
Panax ginseng (Fatigue): Small effects in meta-analysis Evidence: low. Li 2023 Li 2023
Holy basil (tulsi) (Stress, metabolic support): Small, varied trials Evidence: low. Jamshidi 2017
Magnesium (Sleep, anxiety): Low to very low certainty; useful if intake is low Evidence: very-low. Mah 2021 Lopresti 2026
Melatonin (Sleep onset): Direct comparison trial exists Evidence: low. Movva 2026 Ell 2023
L-theanine (Calm, attention): Acute effects; modest Evidence: low. Gerolymos 2026
Kava, Silexan (lavender oil), ginkgo (Anxiety): Appeared in a network meta-analysis of herbs for anxiety; kava has its own liver warnings per NCCIH (not re-read here) Evidence: low. Zhang 2022

Product links

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40benefits and uses looked at

232studies and sources checked

Low certaintybest evidence rating found

38lab markers tracked in trials

3 mixed findings16 low certainty16 very low certainty5 not enough evidence

What is Ashwagandha good for?

The main proposed benefits and how strong the human evidence is for each. "Low certainty" means small or inconsistent trials and a result that could change. Open any benefit for the studies, doses and limits.

StressLow certaintyMost small trials found lower stress scores than placebo, but two large reviews disagree on whether the average effect is real. Sleep qualityLow certaintyA small to moderate improvement in pooled trials, larger in people with insomnia. Everyday anxietyLow certaintyLower anxiety scores in most trials; results vary a lot between trials. Testosterone in menLow certaintySeveral small trials found higher testosterone. This is a lab marker, not proof of better health. Semen qualityLow certaintySmall trials found more and better-moving sperm; no trial measured pregnancies. Muscle strengthLow certaintyBigger strength gains in several 8 to 12 week trials in people doing weight training. Menopause symptomsLow certaintyFour small recent trials found lower symptom scores; larger studies are needed. Memory and attentionLow certaintyModest gains in meta-analysis; individual trials are small and inconsistent. Thyroid (a caution)Mixed findingsMay raise thyroid hormone; case reports of an overactive thyroid. See Safety. Blood sugarVery low certaintyA small drop in fasting glucose in one pooled analysis, with very low certainty and no clear HbA1c change. COVID-19Not enough evidenceNIH says there is not enough high-quality evidence to support its use. Healthy agingNot enough evidenceNo human trial shows it slows aging. Evidence is laboratory and animal only.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Perceived stress

Low certainty

Many small trials in stressed adults found lower stress scores than placebo after 4 to 12 weeks, but the two largest recent meta-analyses disagree on whether the average effect is real, and the quality of the evidence is low.

31 studiesRoot extracts at 120-1000 mg/day for 4-12 weeks were used. Akhgarjand…

Studies, doses and limits

What the trials found

Eleven or more placebo-controlled trials in stressed but otherwise healthy adults (mostly in India, mostly 8 weeks, 60 to 150 people) report lower scores on the Perceived Stress Scale (PSS) or similar scales. Meta-analyses: Akhgarjand 2022 (12 RCTs, n=1,002) pooled SMD -1.75 for stress and rated certainty LOW; Arumugam 2024 (9 RCTs, n=558) PSS mean difference -4.72; Marchi 2025 (people with mental disorders) stress SMD -0.95. In contrast Albalawi 2025 (6 RCTs, n=488) found NO significant effect on PSS (SMD -0.355, CI -1.188 to 0.47) even though cortisol fell. Individual null or partial results: Smith 2023 (Witholytin, 12 weeks, overweight adults aged 40-75) did not beat placebo on PSS (p=0.867); Remenapp 2022 saw all groups, including placebo, improve on stress scales; Lopresti 2026 (30 mg/day, 28 days) only reached significance in the full analysis set (p=0.046) and not in the per-protocol set; the O'Connor 2022 student trial found no stress difference at 30 days; Lopresti 2019 DASS-21 was near-significant only (p=0.096).

Results

Positive in most single trials and in three of four meta-analyses; null on perceived stress in one meta-analysis and in several individual trials.

Effect sizes as reported

SMD -1.75 (CI -2.29 to -1.22; I2 83%) Akhgarjand 2022; PSS MD -4.72 (CI -8.45 to -0.99) Arumugam 2024; SMD -0.355 (CI -1.188 to 0.47) Albalawi 2025 (null); stress SMD -0.95 (CI -1.46 to -0.43) Marchi 2025; SMD -5.88 (CI -8.15 to -3.60) Alsanie 2026 (implausibly large, see limitations).

Why this rating

The only meta-analysis that graded the evidence (Akhgarjand 2022) rated it low. Results are inconsistent between meta-analyses, heterogeneity is very high (I2 up to 98%), trials are small and short, and several outcomes were self-reported.

Form and dose studied

Root extracts at 120-1000 mg/day for 4-12 weeks were used. Akhgarjand's dose-response analysis suggested stress benefit at 300-600 mg/day. Low-dose branded extracts (30, 60, 120, 125 mg/day) were each tested in single small trials.

Who was studied

Mostly healthy adults aged 18-65 reporting mild-to-moderate stress; also hypertension patients (Pattojoshi 2026), athletes, students, and older adults. Few data in people over 65 or in those with clinical burnout; one 2026 review states no RCTs exist for burnout or PTSD.

Limits

High heterogeneity; mostly short (8 weeks); many extract brands; self-reported scales; unclear blinding quality in older trials; several meta-analyses mix stress and anxiety scales; possible publication bias not assessed in all reviews.

Why researchers looked

Ashwagandha is classed as an adaptogen, so stress is the main reason it is studied in people.

Traditional use

In Ayurveda the root is a rasayana (a tonic for general vitality and resilience) used for debility and exhaustion.

Proposed mechanism Preliminary mechanism

Ashwagandha is thought to dampen the body's stress-hormone (HPA) axis and to act on calming brain chemistry (GABA and serotonin pathways). Human trials measuring morning cortisol are consistent with the HPA idea, but the pathway itself is not proven in people.

A proposed mechanism does not show that the effect happens in people.

Mild adverse events (nausea, drowsiness) reported in 4 of 9 trials in Arumugam 2024. In a 1,002-person safety trial (Pakhale 2026) adverse events were 5.6% on ashwagandha vs 9.2% on placebo. Liver injury is a separate safety topic covered elsewhere.

Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023

Anxiety symptoms (healthy and subclinical)

Low certainty

Trials in adults with everyday or moderate anxiety usually found lower anxiety scores than placebo. Pooled results are large but come from small, varied trials with very high heterogeneity.

19 studiesRoot extracts 240-1000 mg/day for 6-12 weeks; Shoden 60-240 mg/day; s…

Studies, doses and limits

What the trials found

Ten RCTs for anxiety were included in Alyami 2026. Akhgarjand 2022 (12 RCTs, n=1,002) found SMD -1.55; Arumugam 2024 found Hamilton Anxiety (HAM-A) mean difference -2.19; Fatima 2024 (5 RCTs, n=254) HAM-A MD -5.96 but I2 98%; Marchi 2025 anxiety outlier-corrected SMD -1.13. A network meta-analysis of anxiety herbs (Zhang 2022, 29 trials) ranked Withania somnifera as efficacious (HAM-A MD -4.90) but with a very wide interval and small trials. NCCIH (2023) says evidence for anxiety is unclear. Individual trials: Mishra 2024 HAM-A fell 59% vs 0.83% rise on placebo in GAD-criteria adults (60 and 120 mg Shoden), Lopresti 2019 HAM-A p=0.040, Langade 2019 and 2021 improved HAM-A within insomnia samples, and Majeed 2023 improved GAD-7. In the Zenroot trial, BAI improved but serum cortisol did not. The 2000 Andrade trial in ICD-10 anxiety disorders showed only trends at 2 and 6 weeks, with 88.2% vs 50% responders at 6 weeks.

Results

Mostly positive; pooled effect sizes very large and very heterogeneous; NCCIH calls evidence unclear.

Effect sizes as reported

SMD -1.55 (CI -2.37 to -0.74; I2 93.8%) Akhgarjand 2022; HAM-A MD -2.19 (CI -3.83 to -0.55) Arumugam 2024; HAM-A MD -5.96 (CI -10.34 to -1.59; I2 98%) Fatima 2024; HAM-A MD -4.90 (95% CrI -9.70 to -0.17) Zhang 2022.

Why this rating

Akhgarjand 2022 rated certainty low. Results come from small trials with extreme heterogeneity; NCCIH describes the evidence as unclear.

Form and dose studied

Root extracts 240-1000 mg/day for 6-12 weeks; Shoden 60-240 mg/day; standard 600 mg/day common.

Who was studied

Adults with mild-to-moderate anxiety or stress, a few with DSM-IV GAD; not enough data on severe anxiety disorders or on use instead of standard treatment.

Limits

I2 over 90% in several pooled analyses; small trials; anxiety scales often secondary outcomes; severe anxiety disorders not studied as stand-alone therapy.

Why researchers looked

Traditional use for nervousness and a long history of rodent studies showing calming effects.

Traditional use

Used in Ayurveda for restlessness and 'Vata' imbalance.

Proposed mechanism Animal research

Animal and test-tube work suggests withanolides and other constituents act on the GABA system (the brain's main calming signal) and the stress axis. This has not been confirmed in people.

A proposed mechanism does not show that the effect happens in people.

Reported adverse effects were mild. Ashwagandha should not replace prescribed treatment for an anxiety disorder; interaction with sedatives and thyroid medicines are covered in the safety sections.

Pages-García 2024 Akhgarjand 2022 Arumugam 2024 Fatima 2024 Marchi 2025 Alsanie 2026 Zhang 2022 Pratte 2014 Lopresti 2019 Majeed 2023 Mishra 2024 Langade 2019 Langade 2021 Andrade 2000 Mahadevan 2025 Baker 2022 McKinney 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Generalized anxiety disorder and OCD as add-on to standard drugs

Very low certainty

Two small Iranian trials added ashwagandha to SSRIs in people with a diagnosed anxiety disorder or OCD and saw larger symptom drops than placebo. They are tiny and unreplicated.

5 studiesRoot extract 120 mg/day (OCD) and 1 g/day (GAD) as add-on for 6 weeks.

Studies, doses and limits

What the trials found

Fuladi 2021: 40 people with GAD already on SSRIs took 1 g/day or placebo for 6 weeks; HAM-A fell 14 vs 8 units (P<0.05). Jahanbakhsh 2016: 30 people with OCD on SSRIs took 120 mg/day or placebo for 6 weeks; Y-BOCS median change -8 vs -2 (P<0.001). Andrade 2000: 39 people with anxiety disorders took an ethanolic extract; statistical trends at 2 and 6 weeks, and 88.2% vs 50% responders at 6 weeks. The Cooley 2009 naturopathic-care trial (n=81) is not an ashwagandha-only test. Marchi 2025 meta-analysis of people with mental disorders (14 RCTs) found anxiety improvement.

Results

Positive in three very small trials; all needed replication.

Effect sizes as reported

HAM-A -14 vs -8 units (Fuladi); Y-BOCS median -8 vs -2 (Jahanbakhsh); responders 88.2% vs 50% (Andrade). No confidence intervals reported in the abstracts.

Why this rating

Three small trials (30-40 people each), short duration, no replication, risk of bias unclear.

Form and dose studied

Root extract 120 mg/day (OCD) and 1 g/day (GAD) as add-on for 6 weeks.

Who was studied

Adults on stable SSRI therapy with a DSM-IV diagnosis.

Limits

Tiny samples, single country, adjunct design, short follow-up, no long-term data.

Why researchers looked

Whether an add-on herb could strengthen an SSRI response, since SSRIs often give only partial relief.

Traditional use

No specific traditional use for OCD.

Proposed mechanism Pharmacological theory

Proposed to work through the GABA system and the stress axis; for OCD the authors suggest a serotonin link. This is theory, not shown in these trials.

A proposed mechanism does not show that the effect happens in people.

No adverse events were reported in either Iranian trial. Combining a herb with SSRIs needs a doctor's supervision because interactions are poorly studied.

Fuladi 2021 Jahanbakhsh 2016 Andrade 2000 Cooley 2009 Marchi 2025

Sleep quality

Low certainty

Pooled trials show a small-to-moderate improvement in sleep quality, larger in people with insomnia, at 600 mg/day or more and for 8 weeks or longer. Most trials are small and several share investigators.

21 studiesRoot extract 120-600 mg/day, commonly 300 mg twice daily for 6-12 wee…

Studies, doses and limits

What the trials found

Cheah 2021 (5 RCTs, n=400): overall sleep SMD -0.59 (CI -0.75 to -0.42), more marked with insomnia, doses 600 mg/day or more and 8 weeks or longer; no effect on quality of life. Fatima 2024 (5 RCTs, n=254): PSQI and several actigraphy measures improved. Marchi 2025: sleep quality SMD -1.35. A node-resolved 2026 review pooled perceived stress and sleep quality but numbers are not in the abstract. NCCIH (2023) says some preparations may be effective for insomnia. Individual trials: Deshpande 2020 (Shoden 120 mg, 6 weeks, n=150, non-restorative sleep) 72% vs 29% self-reported sleep improvement; Kelgane 2020 (600 mg, 65-80 year olds) improved sleep quality; Obhrai 2026 (postmenopausal women) PSQI -5.2 vs -0.8; Zenroot (125 mg) improved PSQI; AshwaSR improved sleep; the enriched-milk trial found a visual sleep-quality gain but no significant PSQI difference. The 30-day student trial reported better final sleep only after covariate adjustment.

Results

Mostly positive; subjective sleep scales improve more consistently than objective measures; some null or conditional findings.

Effect sizes as reported

SMD -0.59 (CI -0.75 to -0.42; I2 62%) Cheah 2021; sleep quality SMD -1.35 (CI -1.79 to -0.91) Marchi 2025; PSQI change -5.2 vs -0.8 (P<0.001) Obhrai 2026.

Why this rating

Small number of trials, short duration, heterogeneous populations and extracts, mostly self-reported outcomes; no GRADE rating in the sleep meta-analysis abstract; consistent direction across trials supports 'low' rather than 'very low'.

Form and dose studied

Root extract 120-600 mg/day, commonly 300 mg twice daily for 6-12 weeks.

Who was studied

Healthy adults, adults with non-restorative sleep, adults with insomnia, older adults, postmenopausal women; children in one trial (parent-reported).

Limits

Several trials share investigators; subjective questionnaires; short follow-up; placebo groups often also improved.

Why researchers looked

The species name somnifera means 'sleep-inducing', and rodent studies point to sleep-promoting components.

Traditional use

Ashwagandha is used traditionally to promote sleep and to calm the nervous system.

Proposed mechanism Animal research

In rodents an amylase-treated root extract increased deep (NREM) sleep and raised GABA and GABA-A receptor expression; a leaf water extract rich in triethylene glycol (not the withanolides) also induced sleep. These are animal findings only.

A proposed mechanism does not show that the effect happens in people.

Drowsiness was reported by a few participants; additive sedation with sleep medicines is theoretical and not studied.

Cheah 2021 Fatima 2024 Marchi 2025 Baune 2026 Deshpande 2020 Kelgane 2020 Obhrai 2026 Mahadevan 2025 Thanawala 2026 Pérez-Piñero 2024 O'Connor 2022 McKinney 2026 Langade 2021 Langade 2019 Movva 2026 Saxena 2026 Kulkarni 2026 Park 2023 Kaushik 2017 National Center for Complementary and Integrative Health (NCCIH) 2023 Honnutagi 2026

Insomnia (diagnosed)

Low certainty

Two trials in people diagnosed with insomnia showed faster sleep onset and better sleep efficiency than placebo with root extract. Evidence is limited to a few small trials.

7 studiesRoot extract 600 mg/day for 8-10 weeks.

Studies, doses and limits

What the trials found

Langade 2019 (n=60, 2:1 randomisation, 300 mg twice daily for 10 weeks) used actigraphy: sleep onset latency 29.00 vs 33.94 minutes (p=0.019), sleep efficiency 83.48 vs 79.68, sleep quality p=0.002. Langade 2021 (80 people: 40 healthy, 40 insomnia; 8 weeks) found larger gains in the insomnia arm for sleep onset latency (p=0.013), sleep efficiency, total sleep time and WASO. Movva 2026 (n=200, 8 weeks, actigraphy primary) found sleep onset latency fell with ashwagandha and melatonin separately and most with the combination. An open-label study in elderly men with primary insomnia (Atul 2020) is not placebo-controlled. A 2026 review of Ayurvedic insomnia treatments in older adults found only two elderly-targeted studies.

Results

Positive in 3 placebo-controlled trials; placebo groups also improved in the Langade trials.

Effect sizes as reported

SOL 29.00 vs 33.94 min (p=0.019) and sleep efficiency 83.48 vs 79.68 in Langade 2019; reported p-values only for Langade 2021 and Movva 2026.

Why this rating

Few small trials, several sharing investigators, partly unblinded or without effect sizes in abstracts; objective actigraphy results support it, but replication by independent groups is lacking.

Form and dose studied

Root extract 600 mg/day for 8-10 weeks.

Who was studied

Adults with clinically assessed insomnia; sparse data in the elderly.

Limits

Small samples, short term, actigraphy is a proxy for sleep (not polysomnography), few independent replications.

Why researchers looked

People with insomnia often seek herbal options because standard sleep drugs have side effects.

Traditional use

Used in Ayurvedic practice for insomnia, especially in older adults.

Proposed mechanism Animal research

Suggested GABA-related sedation and lower arousal from stress hormones; shown in animals, not confirmed in people.

A proposed mechanism does not show that the effect happens in people.

Mild adverse events only; interactions with sedatives are not studied.

Langade 2019 Langade 2021 Movva 2026 Atul 2020 Kulkarni 2026 Cheah 2021 Fatima 2024

Objective sleep measures (actigraphy)

Low certainty

Wrist-worn actigraphy in four trials showed shorter time to fall asleep and better sleep efficiency with ashwagandha. No trial used full sleep-lab recordings, so changes in sleep stages are unknown in humans.

7 studies120 mg/day (Shoden) to 600 mg/day.

Studies, doses and limits

What the trials found

Deshpande 2020 (n=150): sleep efficiency p<0.01, total sleep time p<0.001, sleep latency p<0.01, WASO p<0.05 vs placebo at 6 weeks. Langade 2019: SOL 29.00 vs 33.94 min and sleep efficiency 83.48 vs 79.68 at 10 weeks. Langade 2021: SOL, SE, TST and WASO improved in healthy and insomnia groups. Movva 2026 used actigraphy SOL as primary outcome. Fatima 2024 pooled SOL, TST, SE and PSQI as improved but not WASO or time in bed. Mastrofini 2026 (multi-compound) used a wearable monitor; the abstract does not give the objective results.

Results

Positive for sleep latency, efficiency and total sleep time; WASO inconsistent.

Effect sizes as reported

Not reported as pooled SMDs for actigraphy alone in the abstracts; individual p-values as above.

Why this rating

Four small trials, several sharing investigators; actigraphy overestimates sleep; no polysomnography.

Form and dose studied

120 mg/day (Shoden) to 600 mg/day.

Who was studied

Healthy adults with poor sleep, insomnia patients.

Limits

No polysomnography, no sleep stage data, short duration, unclear actigraphy scoring settings.

Why researchers looked

Actigraphy gives a measure that is not just self-report.

Traditional use

Not applicable.

Proposed mechanism Animal research

Rodent EEG recordings with an amylase-treated root extract showed more delta waves and NREM sleep; there is no human sleep-staging data.

A proposed mechanism does not show that the effect happens in people.

No safety signal specific to sleep outcomes.

Deshpande 2020 Langade 2019 Langade 2021 Movva 2026 Fatima 2024 Mastrofini 2026 Park 2023

Memory, attention and executive function in healthy adults

Low certainty

Meta-analysis suggests modest gains in memory, attention and processing speed, but individual trials use many tests and small groups, and some stress-related improvements may reflect lower stress rather than a direct brain effect.

11 studiesRoot or root-and-leaf extracts, 225-600 mg/day; acute single doses of…

Studies, doses and limits

What the trials found

Zhu 2026 (20 RCTs, n=1,249) found memory SMD 0.52, attention and processing speed SMD 0.29, executive function SMD -0.42 (lower scores better), visuospatial ability SMD 0.39 only after excluding one heterogeneous study; only one study assessed global cognition. Trials: Gopukumar 2021 (n=130, 90 days) improved CANTAB recall memory; Majeed 2023 improved CANTAB multitasking, concentration and decision time; Kale 2026 (n=120, 600 mg, 8 weeks) improved episodic memory, working memory and attention accuracy; Remenapp 2022 saw group differences in cognitive flexibility, visual memory and reaction time; Leonard 2024 and Xing 2022 (acute dose, n=13) found improvements in some tasks but many outcomes were tested; Pingali 2014 (n=20 men) improved reaction times. NCCIH (2023) lists cognitive function among conditions with insufficient evidence. A 2020 systematic review (Ng) included only 5 trials in mixed populations.

Results

Positive for memory and attention in several trials and one meta-analysis; high number of outcomes per trial.

Effect sizes as reported

Memory SMD 0.52 (CI 0.27-0.78; I2 29.7%); attention/processing speed SMD 0.29 (CI 0.07-0.51; I2 0%); executive SMD -0.42 (CI -0.70 to -0.13; I2 37.5%).

Why this rating

Meta-analysis applied GRADE but certainty per outcome is not shown in the abstract; most individual trials are small, many outcomes, short follow-up. NCCIH (2023) considers evidence insufficient.

Form and dose studied

Root or root-and-leaf extracts, 225-600 mg/day; acute single doses of 225-400 mg tested.

Who was studied

Healthy and stressed adults aged 18-55; people with self-reported cognitive and energy complaints; healthy young adults.

Limits

Many cognitive outcomes tested per trial; short follow-up; different test batteries; healthy adults rarely show large cognitive gain; stress reduction may mediate effects.

Why researchers looked

Ashwagandha is a traditional 'medhya rasayana' (memory tonic).

Traditional use

Used in Ayurveda for memory, concentration and mental vitality.

Proposed mechanism Animal research

Rodent studies suggest effects on acetylcholine signalling, brain inflammation and nerve growth; none confirmed in human brain imaging.

A proposed mechanism does not show that the effect happens in people.

No cognition-specific safety signals.

Zhu 2026 Gopukumar 2021 Majeed 2023 Kale 2026 Remenapp 2022 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 National Center for Complementary and Integrative Health (NCCIH) 2023

Mild cognitive impairment

Very low certainty

Two small trials in adults with mild cognitive impairment reported better memory and attention scores. They are pilot studies and need larger confirmation.

3 studiesRoot extract 600 mg/day; Sominone-standardised extract 250 mg/day.

Studies, doses and limits

What the trials found

Choudhary 2017 (n=50, 300 mg twice daily, 8 weeks): improved immediate and general memory on Wechsler Memory Scale III (e.g. logical memory I p=0.007) and executive function and attention (Flanker p=0.002). Rai 2025 (n=40, Somin-On 250 mg/day, 60 days): improved immediate, general, working memory and visuospatial processing; MoCA +14.77% and MMSE +19.21% from baseline at day 60. Ng 2020 systematic review found 5 trials in heterogeneous groups. No trial has tested progression to dementia.

Results

Positive in two pilot trials.

Effect sizes as reported

Mostly p-values and percentages; no effect sizes with CIs in abstracts.

Why this rating

Two pilot trials (40-50 people each), short duration, no confirmatory trial and no dementia outcomes.

Form and dose studied

Root extract 600 mg/day; Sominone-standardised extract 250 mg/day.

Who was studied

Adults with mild cognitive impairment.

Limits

Small samples, short duration, no biomarkers or conversion-to-dementia outcome.

Why researchers looked

Rodent models of Alzheimer's disease suggest protective effects.

Traditional use

Used traditionally for age-related forgetfulness.

Proposed mechanism Animal research

Animal studies suggest reduced amyloid and inflammation; no human biomarker data.

A proposed mechanism does not show that the effect happens in people.

No notable adverse events reported.

Choudhary 2017 Rai 2025 Ng 2020

Cognition in bipolar disorder (adjunct)

Very low certainty

One 8-week trial found small gains in working memory, reaction time and social cognition when ashwagandha was added to bipolar maintenance treatment.

3 studiesStandardised extract 500 mg/day added to maintenance medication.

Studies, doses and limits

What the trials found

Chengappa 2013 (n=60 euthymic patients, 500 mg/day, 8 weeks): better digit span backward (P=.035, d=0.51), Flanker neutral response time (P=.033) and social cognition (Penn Emotional Acuity, P=.045); other tasks not different; mood and anxiety stable. Yalin 2026 systematic review (16 studies, 13 agents) lists ashwagandha as showing cognitive benefit in a single study.

Results

Positive on 3 of many tasks in one trial.

Effect sizes as reported

Cohen d 0.51 (CI 0.25-0.77) for digit span backward.

Why this rating

One small trial; only three tasks differed; no replication.

Form and dose studied

Standardised extract 500 mg/day added to maintenance medication.

Who was studied

Euthymic adults with bipolar disorder.

Limits

n=60 (53 completed), multiple tests, no replication.

Why researchers looked

Cognitive problems persist between mood episodes and are poorly treated.

Traditional use

No specific traditional use.

Proposed mechanism Pharmacological theory

Suggested anti-inflammatory and stress-axis effects; not tested in this trial.

A proposed mechanism does not show that the effect happens in people.

Adverse events minor; interactions with lithium or other maintenance drugs not studied.

Chengappa 2013 Yalin 2026 Ng 2020

Schizophrenia symptoms, stress and mood (adjunct)

Very low certainty

One 12-week trial added ashwagandha to antipsychotic medication during symptom flare-ups and found lower negative and general symptoms and lower stress. Larger meta-analyses of supplements in schizophrenia do not single ashwagandha out.

3 studiesStandardised extract 1,000 mg/day as adjunct for 12 weeks.

Studies, doses and limits

What the trials found

Chengappa 2018 (n=66, 1,000 mg/day, 12 weeks): PANSS negative, general and total symptoms fell (d 0.83, 0.76, 0.83) but not positive symptoms; PSS improved (d 0.58); CRP and S100B declined more but not significantly; somnolence, epigastric discomfort and loose stools were more common with the extract. Gannon 2019 secondary analysis: depression and anxiety-depression cluster d 0.68 (CI 0.16-1.21). The Fornaro 2025 network meta-analysis (50 studies) listed other nutraceuticals as outperforming placebo in its abstract; ashwagandha is not named there (full text not read). Agnihotri 2013 pilot letter exists but has no abstract.

Results

Positive for negative symptoms and stress in a single trial; inflammatory markers not significantly different.

Effect sizes as reported

PANSS total d=0.83; PSS d=0.58; depression item d=0.683 (CI 0.16-1.21).

Why this rating

One randomised trial of 66; no replication; network meta-analysis abstract does not highlight ashwagandha.

Form and dose studied

Standardised extract 1,000 mg/day as adjunct for 12 weeks.

Who was studied

Adults with schizophrenia/schizoaffective disorder in symptom exacerbation.

Limits

Small sample, single centre, adjunct design, only one trial.

Why researchers looked

Inflammation and stress are thought to worsen schizophrenia symptoms.

Traditional use

No specific traditional use.

Proposed mechanism Pharmacological theory

Authors point to anti-inflammatory and immune-modulating effects; CRP and S100B fell but not significantly more than placebo.

A proposed mechanism does not show that the effect happens in people.

Somnolence and GI discomfort more common with the extract. Interactions with antipsychotics are not well studied; use only under psychiatric supervision.

Chengappa 2018 Gannon 2019 Fornaro 2025

Mood and depressive symptoms

Very low certainty

Pooled analyses suggest lower depression scores, but the effect disappeared in one Bayesian analysis and most trials were not designed for depression. Evidence is weak.

7 studiesRoot extract 500-600 mg/day, 60-90 days; with piperine in one trial.

Studies, doses and limits

What the trials found

Marchi 2025 (14 RCTs in people with mental disorders): depression SMD -1.28 (CI -2.40 to -0.16), but Bayesian analysis did not confirm it. Alsanie 2026 (22 studies) reported depression SMD -5.68 (CI -8.43 to -2.94), an implausibly large figure. Majeed 2024 (n=70, 500 mg + piperine, 90 days, mild-to-moderate depression and anxiety): HDRS, HARS, GSQS and QOL improved vs placebo (p<0.001) with a rise in serum serotonin. Gannon 2019 found medium effects in schizophrenia. Smith 2023 found no benefit on most self-report mood items.

Results

Mixed to weakly positive; no large trial in clinical depression.

Effect sizes as reported

Depression SMD -1.28 (CI -2.40 to -0.16) Marchi 2025; SMD -5.68 (CI -8.43 to -2.94) Alsanie 2026 (implausible).

Why this rating

Few trials with depression as primary outcome; Bayesian analysis not confirmatory; pooled effects too large to be credible.

Form and dose studied

Root extract 500-600 mg/day, 60-90 days; with piperine in one trial.

Who was studied

Adults with mild-to-moderate depression/anxiety; stressed adults; schizophrenia.

Limits

Depression often a secondary outcome; no trial in major depressive disorder; short term.

Why researchers looked

Stress and anxiety trials often also measured mood, and animal studies show antidepressant-like behaviour.

Traditional use

Used for low vitality and 'melancholy' in classical texts.

Proposed mechanism Preliminary mechanism

Animal studies propose monoamine, BDNF and anti-inflammatory pathways; one human trial reported higher serum serotonin with the extract.

A proposed mechanism does not show that the effect happens in people.

Not a replacement for antidepressants; do not stop prescribed medicines.

Marchi 2025 Alsanie 2026 Majeed 2024 Gannon 2019 Smith 2023 Łuszczak 2026 Speers 2021

Fatigue and energy

Very low certainty

A few trials report less fatigue and more vigour, including a 28-day low-dose trial and a 12-week trial in overweight adults, but results depend on the scale and many trials are small.

7 studiesRoot extract 30-600 mg/day, 4-12 weeks.

Studies, doses and limits

What the trials found

Smith 2023 (12 weeks, 400 mg/day): Chalder Fatigue Scale improved vs placebo (p=0.016) and HRV rose (p=0.003) although the primary stress outcome was null. Lopresti 2026 (30 mg, 28 days) measured Chalder fatigue; no significant secondary effect. Kale 2026 improved mental fatigue and mood in adults with energy complaints. Leonard 2024 lowered POMS fatigue and tension. Coope 2026: fatigue perception improved in female athletes. Biswal 2013 (non-randomised, breast cancer chemotherapy) found less fatigue.

Results

Mixed but trending positive on secondary scales.

Effect sizes as reported

Chalder p=0.016 (Smith 2023); Piper fatigue P<.001 (Biswal 2013, non-randomised).

Why this rating

Fatigue mostly a secondary outcome, several null secondaries, one non-randomised study.

Form and dose studied

Root extract 30-600 mg/day, 4-12 weeks.

Who was studied

Stressed, overweight, athletic and cancer patients.

Limits

Subjective scales; multi-outcome trials; non-randomised cancer study.

Why researchers looked

Fatigue is a common stress-related complaint and a traditional use.

Traditional use

Used as a tonic for exhaustion and weakness.

Proposed mechanism Preliminary mechanism

Proposed effects on autonomic balance (heart rate variability) and stress hormones; not proven.

A proposed mechanism does not show that the effect happens in people.

No fatigue-specific safety issues; high dose (2 g every 8 h) was used in the cancer study.

Smith 2023 Lopresti 2026 Kale 2026 Leonard 2024 Coope 2026 Biswal 2013 Saxena 2026

Quality of life and general well-being

Low certainty

Several small trials, mostly in older adults and stressed adults, found better quality-of-life scores with ashwagandha, though one meta-analysis found no pooled quality-of-life effect.

8 studiesRoot extract 600 mg/day.

Studies, doses and limits

What the trials found

Kelgane 2020 (65-80 years, 600 mg, 12 weeks): WHOQOL-BREF 140.53 to 161.84. Honnutagi 2026 (60-85 years, 8 weeks): OPQOL p<0.0001 at week 8. Obhrai 2026: quality of life improved in postmenopausal women. Majeed 2023 and 2024: QOL scores improved. Cheah 2021 meta-analysis (5 RCTs) found no significant effect on quality of life. Salve 2026 (12-month uncontrolled): SF-12 improved.

Results

Positive in small trials; no pooled benefit.

Effect sizes as reported

Not pooled; WHOQOL-BREF mean change +21 points.

Why this rating

Consistent direction in small trials, several sharing investigators; pooled analysis null; self-reported.

Form and dose studied

Root extract 600 mg/day.

Who was studied

Older adults, stressed adults.

Limits

Subjective, short, mostly small single-site trials.

Why researchers looked

Quality of life summarises how people feel overall.

Traditional use

Rasayana tonic for vitality in older age.

Proposed mechanism Preliminary mechanism

No specific mechanism; likely follows improvements in stress, sleep and energy.

A proposed mechanism does not show that the effect happens in people.

Well tolerated in these trials.

Movva 2026 Kelgane 2020 Honnutagi 2026 Obhrai 2026 Majeed 2023 Majeed 2024 Cheah 2021 Salve 2026

Attention and sleep in children (ADHD concerns)

Very low certainty

Two 2026 trials of ashwagandha gummies in children reported better attention and sleep, but they are small and new and need independent replication. Safety in children is not established.

2 studiesRoot extract gummies 300 mg/day for 8 weeks.

Studies, doses and limits

What the trials found

Saxena 2026 (n=85, ages 6-12, 150 mg twice daily gummies, 8 weeks): improved information processing speed (p=0.040) and Stroop, Corsi and choice RT accuracy (d 0.61-0.75); parent-reported sleep disturbance improved (p=0.035). Naik 2026 (n=58, mild ADHD, 8 weeks): lower ADHD-RS-IV total (P<0.001), better executive function and PROMIS sleep and anxiety.

Results

Positive in two small, recent trials.

Effect sizes as reported

d 0.59-0.75 on selected tasks (Saxena 2026).

Why this rating

Two small recent pediatric trials, parent-reported outcomes, no replication.

Form and dose studied

Root extract gummies 300 mg/day for 8 weeks.

Who was studied

Children 6-12 (Saxena) and children/adolescents with mild ADHD (Naik).

Limits

Small, short, no long-term safety data in children.

Why researchers looked

Parents seek non-drug options for attention problems.

Traditional use

Ashwagandha is traditionally given to children as a tonic in some Ayurvedic practices.

Proposed mechanism Pharmacological theory

No proposed mechanism in the abstracts.

A proposed mechanism does not show that the effect happens in people.

No significant adverse events were reported in the trials; paediatric safety is not established.

Saxena 2026 Naik 2026

Stress-related eating and food cravings

Very low certainty

Trials in chronically stressed adults found lower food cravings with ashwagandha. This is a stress-behaviour outcome and weight loss findings need caution.

4 studiesRoot extract 300 mg twice daily.

Studies, doses and limits

What the trials found

Choudhary 2017 (n=52, 8 weeks): improved Food Cravings Questionnaire and body weight. Pakhale 2025 (n=100, 24 weeks): weight -8.46 kg vs -2.41 kg and lower craving scores. O'Connor 2022 students: lower food cravings at 30 days. A systematic review (Quinones 2025) concluded clinical studies indicate weight loss through reduced stress, cortisol and cravings.

Results

Positive in three small trials.

Effect sizes as reported

Weight -8.46 vs -2.41 kg (Pakhale 2025).

Why this rating

Three small trials; unusual size of weight change; weight is covered by another topic.

Form and dose studied

Root extract 300 mg twice daily.

Who was studied

Chronically stressed or overweight adults.

Limits

Small, short, few independent replications.

Why researchers looked

Stress raises cortisol and appetite.

Traditional use

Not applicable.

Proposed mechanism Preliminary mechanism

Linked in review to cortisol, dopamine and appetite hormones; mostly preclinical.

A proposed mechanism does not show that the effect happens in people.

No unique safety signals.

Choudhary 2017 Pakhale 2025 O'Connor 2022 Quinones 2025

Acute (single-dose) cognitive effects

Very low certainty

Single-dose crossover studies in healthy volunteers suggest small short-term gains in attention and reaction time. They are tiny.

3 studies225-400 mg single dose.

Studies, doses and limits

What the trials found

Xing 2022 (n=13, 400 mg single dose, crossover): improved Sternberg working memory and sustained attention but not accuracy. Leonard 2024 (n=59, 225 mg, 60 min after dose): improved word recall, choice reaction time. Pingali 2014 (n=20, 14 days): faster reaction times.

Results

Small positive signals.

Effect sizes as reported

Not reported in abstracts.

Why this rating

Very small crossover studies, many outcomes tested.

Form and dose studied

225-400 mg single dose.

Who was studied

Healthy young adults.

Limits

Tiny samples; multiple testing; unclear real-world relevance.

Why researchers looked

Tests whether an effect appears quickly rather than needing weeks.

Traditional use

Not applicable.

Proposed mechanism Pharmacological theory

Unknown; possibly cholinergic or via reduced stress arousal.

A proposed mechanism does not show that the effect happens in people.

No adverse events reported.

Xing 2022 Leonard 2024 Pingali 2014

Fatigue during cancer chemotherapy

Very low certainty

One non-randomised study found less fatigue in breast cancer patients taking high-dose ashwagandha during chemotherapy. It needs randomised confirmation and interaction checks.

1 studies2 g root extract every 8 hours during chemotherapy.

Studies, doses and limits

What the trials found

Biswal 2013 (open-label, non-randomised, n=100): lower Piper Fatigue Scale and Schwartz fatigue scores (P<.001 and P<.003) and better EORTC QLQ-C30 symptom scales; 24-month survival 72% vs 56% not significant.

Results

Positive in one non-randomised study.

Effect sizes as reported

Fatigue scores P<.001; no CIs in abstract.

Why this rating

Non-randomised, open-label, one study.

Form and dose studied

2 g root extract every 8 hours during chemotherapy.

Who was studied

Breast cancer patients on chemotherapy.

Limits

Non-randomised, open-label; high dose; possible interactions with chemotherapy not assessed.

Why researchers looked

Chemotherapy-related fatigue is common and hard to treat.

Traditional use

Used as a tonic for weakness.

Proposed mechanism Pharmacological theory

Not tested.

A proposed mechanism does not show that the effect happens in people.

Interactions with chemotherapy and effects on blood counts are not established; consult oncologist.

Biswal 2013

Testosterone in men

Low certainty

In several small trials, men taking ashwagandha root extract had higher testosterone than men taking placebo, and a 2026 pooled analysis found an average rise of about 57 ng/dl. The rise stayed inside normal ranges in the safety review, it is not seen in women, and a few trials found no difference from placebo. It is a lab change; higher testosterone has not been shown to make men healthier by itself.

12 studiesMostly root extracts 300 mg twice daily for 8 weeks (e.g. 600 mg per …

Studies, doses and limits

What the trials found

A 2026 meta-analysis of 23 placebo-controlled trials (1,706 adults) found testosterone higher in men (MD 57.43 ng/dl) but not in women (MD 5.09 ng/dl). A 2026 meta-analysis of 20 trials found a pooled SMD of 0.33. Individual trials: Shoden extract 8 weeks in overweight men aged 40-70 (14.7% greater rise than placebo, p=.010); 8 weeks of 300 mg twice daily in men with low desire (higher than placebo); 8 weeks in beginners doing resistance training (+96.2 vs +18.0 ng/dL). Null or mixed: the 60-day Shoden stress trial (male rise not significant versus placebo, p=.158) and the 90-day sustained-release trial (rise similar to placebo, p>0.05). The 2021 systematic review of herbs and testosterone found 9 of 32 studies significant overall and named ashwagandha among two herbs with positive effects. A 12-month observational study found testosterone rose (p<0.05) but had no control group. NCCIH says there is limited evidence that 2 to 4 months of use may increase testosterone.

Results

Higher testosterone than placebo in most but not all trials, mainly in men and mainly within normal ranges.

Effect sizes as reported

Men: MD 57.43 ng/dl (2026 MA); all-adults SMD 0.33 (95% CI 0.13-0.54); women MD 5.09 ng/dl; single trials +14.7% (Shoden salivary), +96.2 vs +18.0 ng/dL (strength trial).

Why this rating

Consistent direction across meta-analyses, but trials are small, many from single centres in India using different extracts, several found no difference from placebo, and no reviewer gave a high certainty rating. This rating is the compiler's, based on the reviewers' own statements of heterogeneity and limited data.

Form and dose studied

Mostly root extracts 300 mg twice daily for 8 weeks (e.g. 600 mg per day); Shoden 21 mg withanolide glycosides per day; Sensoril 500 mg per day (root and leaf).

Who was studied

Healthy and overweight men, men with low desire, men with infertility; effect not seen in women.

Limits

Hormone numbers vary by lab method (saliva versus blood); changes mostly small; no trial showed the rise improved health outcomes; free testosterone and SHBG results were not reported in most abstracts read.

Why researchers looked

Ashwagandha is marketed to men for vitality, strength and fertility; testosterone is the hormone people expect to move.

Traditional use

In Ayurveda ashwagandha is classed as a rasayana (rejuvenating tonic) and vajikarana (a herb for sexual vitality and fertility) (traditional use; Ayurvedic texts as summarised in the reviews cited).

Proposed mechanism Preliminary mechanism

A 2026 review of hormonal activities concludes the effects most likely come from changes in central (brain and pituitary) regulation rather than from ashwagandha binding to hormone receptors. This is a review-level interpretation, not proven in humans.

A proposed mechanism does not show that the effect happens in people.

NCCIH advises people with hormone-sensitive prostate cancer to avoid ashwagandha because it may raise testosterone (authoritative guidance; not a trial finding).

Fornalik 2026 Zhu 2026 Smith 2021 Lopresti 2019 Lopresti 2019 Chauhan 2022 Wankhede 2015 Thanawala 2026 Vaidya 2026 Salve 2026 Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Semen quality and male infertility

Low certainty

Small trials in men with low sperm counts found more sperm, more semen and better movement after about 90 days, and two 2025-2026 trials in healthy men reported similar gains over 8 weeks. Very few studies were properly controlled, none measured babies born, and the authors of the main review call the data promising but too limited.

9 studiesRoot extract or root powder 675 mg per day to 5 g per day for 90 days…

Studies, doses and limits

What the trials found

A 2018 systematic review and meta-analysis found only one RCT among four trials; pooling before-and-after data gave sperm concentration +13.57 million/mL and motility +8.50 percentage points. In the one RCT (46 oligospermic men, 675 mg per day for 90 days), sperm count rose 167% from baseline while placebo changed little. Two studies without a placebo group by the same Lucknow research group (2010, 2013) also improved semen and hormones. 2025 and 2026 RCTs in healthy men (300 mg twice daily, 8 weeks; 76 and 100 men) reported better semen volume and sperm numbers and motility versus placebo. NCCIH says there is limited evidence that 2 to 4 months may increase sperm quality. No trial reported pregnancy or live birth as a controlled outcome; the meta-analysis reported a 14% pregnancy success rate in normozoospermic men in uncontrolled data.

Results

More sperm, volume and motility in small trials; clinical fertility outcomes not shown.

Effect sizes as reported

Pooled observational before-after: concentration MD 13.57 million/mL (11.12-16.01), motility MD 8.50% (7.36-9.63), volume MD 0.28 mL (0.12-0.43); RCT: sperm count +167%, volume +53%, motility +57% from baseline.

Why this rating

One small RCT in infertile men plus mostly uncontrolled work; the reviewers say data are too limited for robust conclusions. Compiler rating.

Form and dose studied

Root extract or root powder 675 mg per day to 5 g per day for 90 days; 600 mg per day for 8 weeks in healthy men.

Who was studied

Men with oligospermia or infertility; healthy men.

Limits

Few controlled trials, no live-birth data, several by the same research groups or sponsors; some animal studies reported reversible spermicidal effects at other doses (systematic review).

Why researchers looked

Male infertility is one of the main reasons ashwagandha is sold to men; oxidative damage to sperm and stress hormones are suspected contributors.

Traditional use

In Ayurveda ashwagandha is classed as a rasayana (rejuvenating tonic) and vajikarana (a herb for sexual vitality and fertility) (traditional use; Ayurvedic texts as summarised in the reviews cited).

Proposed mechanism Preliminary mechanism

Seminal fluid studies suggest lower oxidative stress and higher antioxidant vitamins after treatment; effects on LH, FSH and testosterone may also help sperm production. These are measurements in the same men, not proof of mechanism.

A proposed mechanism does not show that the effect happens in people.

Authoritative sources advise avoiding ashwagandha in pregnancy; see the safety records elsewhere in the master profile.

Durg 2018 Ambiye 2013 Ahmad 2010 Gupta 2013 Khanna 2026 Mutha 2025 Roy 2026 Nasimi Doost Azgomi 2018 National Center for Complementary and Integrative Health (NCCIH) 2023

Sexual function in men

Low certainty

Two recent 8-week trials in healthy men and one in men with low desire reported better sexual desire and satisfaction than placebo, but one older trial in men with erectile dysfunction found no difference from placebo (both groups improved).

5 studies300 mg twice daily root extract for 8 weeks.

Studies, doses and limits

What the trials found

8-week RCT in 50 men with low sexual desire (300 mg twice daily): higher DISF-M and testosterone than placebo. 8-week RCTs in 76 and 100 healthy men aged 30-50: better desire, orgasm, satisfaction scores (p<0.05 to <=0.001). Null: 60-day RCT in 86 men with psychogenic erectile dysfunction, with similar improvement in ashwagandha (12.6%) and placebo (19.11%) groups. A 16-week crossover trial in overweight older men found sexual well-being scores did not differ from placebo.

Results

Improved desire and satisfaction scores in healthy men; no benefit shown for erectile dysfunction.

Effect sizes as reported

DISF-M mean difference -9.8 (as reported, CI -10.73 to -8.87); IIEF/SDI-2 improvements p<=0.001 in one 8-week trial; ED trial: no difference between groups.

Why this rating

Positive trials are small, short and mostly from the same region; the one trial in diagnosed erectile dysfunction was null.

Form and dose studied

300 mg twice daily root extract for 8 weeks.

Who was studied

Healthy men aged 30-50, men with low desire, men with psychogenic erectile dysfunction.

Limits

Self-reported scales; strong placebo response in the ED trial; not compared with approved drugs.

Why researchers looked

Ashwagandha is traditionally an aphrodisiac; stress and low desire are common complaints.

Traditional use

In Ayurveda ashwagandha is classed as a rasayana (rejuvenating tonic) and vajikarana (a herb for sexual vitality and fertility) (traditional use; Ayurvedic texts as summarised in the reviews cited).

Proposed mechanism Pharmacological theory

Lower stress hormones and higher testosterone may play a part. This is a theory; it has not been shown in men.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events in these trials.

Chauhan 2022 Khanna 2026 Mutha 2025 Mamidi 2011 Lopresti 2019

Sexual function in women

Low certainty

Two small 8-week trials in healthy women, one in women with low desire, found better sexual function scores and less distress than placebo.

2 studies300 mg twice daily root extract for 8 weeks.

Studies, doses and limits

What the trials found

2015 pilot RCT in 50 healthy women (300 mg twice daily, 8 weeks): higher FSFI total and every domain, less distress, more successful encounters (p<0.001 to 0.004). 2022 RCT in 80 women with hypoactive sexual desire: FSFI 22.62 vs 19.25 at week 8 (p<0.0001). Adverse events comparable.

Results

Higher female sexual function scores than placebo.

Effect sizes as reported

FSFI total 22.62 vs 19.25 (p<0.0001) at week 8 in the 2022 RCT; 2015 pilot FSFI total p<0.001.

Why this rating

Two small, short trials from related teams; self-report scales.

Form and dose studied

300 mg twice daily root extract for 8 weeks.

Who was studied

Healthy women aged 18-50, some with low desire.

Limits

Small; premenopausal women only; no follow-up after stopping.

Why researchers looked

Low desire and sexual distress are common; ashwagandha has a traditional reputation for female vitality.

Traditional use

Used in Ayurveda as a rasayana for both sexes (traditional use).

Proposed mechanism Pharmacological theory

Possible effects on stress hormones and mood; no established mechanism in women.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events reported.

Dongre 2015 Ajgaonkar 2022

Menopause and perimenopause symptoms

Low certainty

Four recent small trials in perimenopausal and postmenopausal women found lower menopause symptom scores than placebo and shifts in female hormones, but NCCIH says there is not enough evidence to conclude ashwagandha helps menopause.

5 studies300 mg twice daily root extract (8 weeks); 600 mg per day (12 weeks);…

Studies, doses and limits

What the trials found

8-week RCT in 100 perimenopausal women (300 mg twice daily): Menopause Rating Scale fell more than placebo (p<0.0001), estradiol rose, FSH and LH fell, testosterone unchanged. 56-day RCT in 60 women aged 45-55: MRS, hot flashes and perceived stress improved; estradiol and progesterone rose; FSH and LH fell. 24-week six-arm RCT in postmenopausal women (ashwagandha, shatavari or both, aqueous extracts): dose-dependent improvements in MENQoL, vascular index and bone turnover markers. 12-week RCT in 66 postmenopausal women (600 mg per day): sleep, symptom score and body fat improved; bone density unchanged.

Results

Lower symptom scores than placebo in four small trials.

Effect sizes as reported

MRS total p<0.0001 in two RCTs; MRS change -8.1 vs -1.2 and PSQI -5.2 vs -0.8 in the 2026 RCT; no between-group bone density difference.

Why this rating

Consistent across four trials but all small, short and mostly from related Indian sites; NCCIH considers evidence insufficient for menopause.

Form and dose studied

300 mg twice daily root extract (8 weeks); 600 mg per day (12 weeks); aqueous extracts 250-500 mg (24 weeks).

Who was studied

Peri- and postmenopausal women aged 40-65.

Limits

Symptom scales are self-reported; hormone numbers not given in the abstracts; no long-term safety data in this group.

Why researchers looked

Hot flashes, mood and sleep changes are common; people look for alternatives to hormone therapy.

Traditional use

Ashwagandha is used in Ayurveda for women's vitality; formulas pair it with shatavari (traditional use).

Proposed mechanism Pharmacological theory

Authors suggest effects on the stress axis and possible effects on gonadotrophins; unproven.

A proposed mechanism does not show that the effect happens in people.

Avoid in pregnancy (authoritative guidance, covered elsewhere).

Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Female hormones and PCOS

Not enough evidence

No human trial of ashwagandha in polycystic ovary syndrome was found. The idea rests on animal work and narrative reviews. In women the pooled analysis found no change in testosterone or estradiol, though menopause trials reported estradiol, FSH and LH shifts.

3 studiesNot established.

Studies, doses and limits

What the trials found

A 2026 narrative review of women's hormonal modulation covers PCOS and premenstrual symptoms and a 2026 systematic review covers sex-specific outcomes, but both rely largely on animal and non-PCOS human data. The 2026 meta-analysis found testosterone MD 5.09 ng/dl in women (no significant effect) and no estradiol change in either sex. NCCIH lists menopause and female infertility as areas without enough evidence.

Results

No PCOS trial identified.

Effect sizes as reported

None for PCOS.

Why this rating

No controlled human study in PCOS found in PubMed searches done for this profile.

Form and dose studied

Not established.

Who was studied

Not studied in PCOS.

Limits

Absence of trials; animal-to-human gap.

Why researchers looked

PCOS involves stress hormones, insulin and androgens, so reviewers have suggested ashwagandha might help.

Traditional use

Used traditionally for women's reproductive health (traditional use).

Proposed mechanism Pharmacological theory

Preclinical studies and narrative reviews propose effects on stress hormones and insulin resistance; none proved in PCOS patients.

A proposed mechanism does not show that the effect happens in people.

Avoid in pregnancy; relevant to women trying to conceive (authoritative guidance).

Fornalik 2026 Roy 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Thyroid hormones in low thyroid function (benefit signal)

Very low certainty

One small 8-week trial in 50 people with mildly raised TSH reported improved TSH, T3 and T4 on ashwagandha. This is a pilot result, not a treatment, and it needs the matching safety caution in the next record.

5 studies600 mg per day root extract for 8 weeks.

Studies, doses and limits

What the trials found

2018 RCT of 50 adults with TSH 4.5-10 uIU/L (600 mg per day, 8 weeks): TSH, T3 and T4 improved versus placebo (p<0.001, 0.0031, 0.0096). A bipolar-trial secondary analysis saw T4 rise in 3 treated patients. The 2026 meta-analysis of 23 trials found no effect on TSH or T3 and a modest T4 rise (0.61 ug/dL, p=0.02) in mostly people with normal thyroid function. The 2026 review of hormonal activities said ashwagandha appears to raise thyroid hormones in hypothyroid contexts.

Results

TSH, T3 and T4 improved in one pilot trial in subclinical hypothyroidism.

Effect sizes as reported

p<0.001 (TSH), p=0.0031 (T3), p=0.0096 (T4) vs placebo; values not in abstract.

Why this rating

Single 50-person trial; the meta-analysis of mostly euthyroid people found no TSH or T3 effect.

Form and dose studied

600 mg per day root extract for 8 weeks.

Who was studied

Adults 18-50 with subclinical hypothyroidism.

Limits

Tiny trial, lab values only, no symptoms; thyroid disease should be managed by a doctor.

Why researchers looked

Animal studies showed ashwagandha raised thyroid hormones, so researchers tested it in subclinical hypothyroidism.

Traditional use

Ashwagandha is used in Ayurveda for general weakness and sometimes for thyroid complaints (traditional use).

Proposed mechanism Animal research

Rodent studies show higher thyroxine; the mechanism in humans is not established.

A proposed mechanism does not show that the effect happens in people.

NCCIH advises against use in thyroid disorders and says it may interact with thyroid hormone medicines.

Sharma 2018 Gannon 2014 Fornalik 2026 Vollmer 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Thyroid: overactive thyroid signal and thyroid-medicine interaction

Mixed findings

Three case reports describe overactive thyroid (thyrotoxicosis) after taking ashwagandha, which went away after stopping. Trials in healthy people mostly found no change in TSH or T3, but T4 edged up in a pooled analysis. No source gives how often this happens.

10 studiesDoses in cases not stated or about 600 mg per day; trials 300-2000 mg…

Studies, doses and limits

What the trials found

Case reports: a 73-year-old woman with supraventricular tachycardia and low TSH after 2 years (2022); a 47-year-old man with painless thyroiditis after 2 months (2024); a 32-year-old woman with thyrotoxicosis after raising the dose (2005, Dutch report). All resolved after stopping. 8-week RCT in 80 healthy adults: no change in thyroid profile. 2024 and 2026 safety studies: no thyroid harm or small within-range changes. 2026 meta-analysis: T4 up 0.61 ug/dL, TSH and T3 unchanged. The 2026 food-additive review concluded people with thyroid disorders are a risk group.

Results

Case reports of thyrotoxicosis; healthy-adult trials mostly show no thyroid harm.

Effect sizes as reported

T4 MD 0.61 ug/dL (p=0.02) in the 2026 meta-analysis; no TSH or T3 effect.

Why this rating

Case reports are a signal, not a rate; controlled trials in healthy people are reassuring but did not enrol thyroid patients and are short.

Form and dose studied

Doses in cases not stated or about 600 mg per day; trials 300-2000 mg per day.

Who was studied

Adults with or without thyroid disease; highest concern for people with thyroid conditions or on levothyroxine.

Limits

No incidence figures; case reports may involve other ingredients; thyroid-medicine interaction not tested in trials.

Why researchers looked

Because ashwagandha can raise thyroid hormones in animals and in some trials, clinicians worry about people with thyroid disease or on thyroid medicine.

Traditional use

Not part of traditional safety teaching in the sources reviewed.

Proposed mechanism Animal research

Animal studies reported higher thyroxine; one case report suggests thyroiditis; the mechanism in people is unknown.

A proposed mechanism does not show that the effect happens in people.

NCCIH recommends against use in people with thyroid disorders and warns of interaction with thyroid hormone medicines. Anyone with a thyroid condition should talk to their clinician first.

Kamal 2022 Hayashi 2024 van der Hooft 2005 Verma 2021 Vaidya 2024 Movva 2026 Fornalik 2026 Gannon 2014 Li 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Muscle strength and size with resistance training

Low certainty

Several 8 to 12 week trials in young, mostly untrained people doing weight training found bigger strength gains with ashwagandha. A 2026 analysis of these trials said the effect was statistically fragile and of low certainty, and two other trials in trained athletes found no extra benefit.

12 studies300 mg twice daily or 500-600 mg per day of root extract; Sensoril 50…

Studies, doses and limits

What the trials found

2026 meta-analysis of 3 pooled trials (n=161): bench SMD 0.60, lower body 0.52, chest 0.86 but strength effects lost significance under a conservative statistical adjustment; GRADE low. 2026 three-level meta-analysis of 13 trials (599 people): overall g=0.47 with prediction interval crossing zero. 2026 meta-analysis of 20 trials: strength SMD 0.58, mainly in active people. Individual trials: bench press +46.0 vs +26.4 kg (8 weeks, beginners); squat +19.1 vs +10.0 kg (Sensoril, 12 weeks); 8-week trial in men and women showing greater strength and girth. Null: 8-week HIIT trials in healthy men and elite wrestlers found no extra benefit; female footballers improved recovery perception but not strength.

Results

Larger strength gains than placebo in beginners; no extra benefit in some athletes.

Effect sizes as reported

Resistance-training MA: bench SMD 0.60 (0.20-1.01), lower body 0.52 (0.19-0.86), chest 0.86 (0.41-1.31); overall exercise MA g=0.47 (0.25-0.69), PI -0.40 to 1.33; active-adult strength SMD 1.03.

Why this rating

Reviewers' own GRADE for resistance-training outcomes: Low (strength) and Very Low (chest size); results depend on one influential trial; null trials in athletes.

Form and dose studied

300 mg twice daily or 500-600 mg per day of root extract; Sensoril 500 mg per day (root and leaf); 8-12 weeks.

Who was studied

Healthy untrained or recreational men and women; trained athletes show less benefit.

Limits

Small trials, short duration, mostly the same few research groups; hypertrophy measured by girth rather than imaging.

Why researchers looked

Ashwagandha is widely sold as a sports supplement; early trials from the supplement makers reported large gains.

Traditional use

Traditionally taken for general strength and vitality (balavardhan, mamsavardhan) (traditional use).

Proposed mechanism Laboratory research

Possible effects through lower stress hormones, higher testosterone or muscle-cell signalling; lab studies on muscle cells exist. Not proven in humans.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events reported in these trials.

Wankhede 2015 Ziegenfuss 2018 Verma 2023 Lee 2026 Li 2026 Zhu 2026 Bonilla 2021 Coope 2025 Ewa 2025 Charmas 2025 Gierczuk 2025 Thanawala 2026

Muscle recovery and exercise stress markers

Low certainty

Some trials reported lower muscle-damage markers (creatine kinase) and better recovery scores with ashwagandha, but many recovery outcomes are self-rated and trials in athletes gave mixed results.

5 studies300-600 mg per day for 4-8 weeks; Ashwa.30 30 mg per day.

Studies, doses and limits

What the trials found

Beginners' 8-week trial: creatine kinase differed from placebo (p=0.03, wording unclear in abstract). 28-day trial in female footballers: perceived recovery (p=0.026) and sleep quality (p=0.038) better. 42-day trial in team athletes: salivary cortisol rose in placebo but not ashwagandha; soreness improved in women. Low-dose Ashwa.30 trial: lower CPK and lactate. Elite wrestlers: no benefit beyond training.

Results

Better perceived recovery in some athlete trials; marker changes inconsistent.

Effect sizes as reported

TQR interaction p=0.026; CK difference p=0.03; wrestler trial no difference.

Why this rating

Subjective scales dominate; several null or mixed trials.

Form and dose studied

300-600 mg per day for 4-8 weeks; Ashwa.30 30 mg per day.

Who was studied

Athletes and active adults.

Limits

Small subgroups; many outcomes tested.

Why researchers looked

Hard training raises muscle damage markers and stress hormones; supplements for recovery are popular.

Traditional use

Traditional use for restoring strength and vitality.

Proposed mechanism Pharmacological theory

Lower cortisol and antioxidant effects have been proposed; unproven.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events reported.

Wankhede 2015 Coope 2025 Coope 2026 Prajapati 2026 Gierczuk 2025

Aerobic fitness and VO2max

Low certainty

A 2020 meta-analysis of four small trials found VO2max about 3 units higher with ashwagandha, with wide uncertainty; 2023 and 2026 reviews found stronger signals for aerobic endurance than for strength, while two HIIT trials found no extra benefit.

10 studies300 mg twice daily or 600 mg per day for 8-12 weeks.

Studies, doses and limits

What the trials found

2020 meta-analysis (4 RCTs, 142 people): VO2max MD 3.00 (0.18-5.82), high heterogeneity. Trials: KSM-66 in 50 athletic adults (+5.67 vs +1.86 at 12 weeks, shuttle-run estimate); 300 mg twice daily in 50 athletic adults (p=0.0074); 8-week resistance-training trial; sustained-release trial (reported VO2max change unusually large). 2026 three-level meta-analysis: aerobic endurance g=0.54 (0.22-0.85). Null: 8-week HIIT trial in healthy men, and elite wrestlers.

Results

Higher VO2max in several small trials; no extra benefit in two HIIT trials.

Effect sizes as reported

VO2max MD 3.00 (0.18-5.82) (unit not stated in abstract); aerobic endurance g=0.54 (0.22-0.85).

Why this rating

Reviewers flag few studies and high heterogeneity; field-test estimates of VO2max; null trials exist.

Form and dose studied

300 mg twice daily or 600 mg per day for 8-12 weeks.

Who was studied

Healthy adults and athletes.

Limits

Indirect VO2max methods; small trials; same research groups.

Why researchers looked

VO2max is a standard measure of fitness; athletes use ashwagandha to improve endurance.

Traditional use

Traditional use for stamina.

Proposed mechanism Pharmacological theory

Unknown; may relate to lower stress or effects on oxygen use.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events reported.

Pérez-Gómez 2020 Li 2026 Choudhary 2015 Tiwari 2021 Verma 2023 Prajapati 2026 Thanawala 2026 Ewa 2025 Gierczuk 2025 Sandhu 2010

Body weight and body composition

Mixed findings

Two trials in stressed or heavier adults reported weight loss with ashwagandha, one very large (about 8 kg over 24 weeks), but a 2026 meta-analysis of 20 trials and other trials found no effect on body weight or body fat.

6 studies300 mg twice daily root extract for 8-24 weeks.

Studies, doses and limits

What the trials found

24-week RCT (n=100): weight -8.46 kg vs -2.41 kg, BMI -3.31 vs -0.93 (P<0.0001). 8-week RCT in 52 stressed adults: weight and BMI improved (numbers not in abstract). Pilot RCT in adults with overweight (40 days): no change in weight, BMI or waist. Postmenopausal RCT: body fat -0.6% vs +0.03%. 8-week HIIT trial: no effect on body composition. 2026 meta-analysis: no effect on body weight or body fat percentage.

Results

Mixed: large loss in one trial, none in the pooled analysis.

Effect sizes as reported

Weight -8.46 vs -2.41 kg (single trial); meta-analysis: no significant effect on body weight or fat.

Why this rating

Pooled analysis null; positive trials small and from stressed groups; one outlier effect size.

Form and dose studied

300 mg twice daily root extract for 8-24 weeks.

Who was studied

Stressed adults, overweight adults, postmenopausal women.

Limits

Weight effects not replicated; diet not controlled in most.

Why researchers looked

Chronic stress is linked with weight gain and cravings; ashwagandha lowers stress scores.

Traditional use

Not a traditional weight-loss herb in the sources reviewed.

Proposed mechanism Pharmacological theory

Proposed via lower cortisol and fewer food cravings; unproven.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events reported.

Pakhale 2025 Choudhary 2017 Ballesteros-Torres 2025 Obhrai 2026 Charmas 2025 Zhu 2026

Blood sugar and HbA1c

Very low certainty

A 2026 meta-analysis of 11 trials found fasting glucose about 3 mg/dL lower and no clear change in HbA1c, with very low certainty. Larger effects seen in diabetic animals do not carry over.

5 studiesVaried; no dose-response found.

Studies, doses and limits

What the trials found

2026 dose-response meta-analysis (11 trials, 667 people): FBG WMD -3.09 mg/dL (-5.61 to -0.58), HbA1c WMD -0.05% (-0.47 to 0.36); certainty very low. 2020 meta-analysis: strong glucose effects in animal data, clinical data limited. A 12-person trial in 2000 reported lower glucose. A 12-month observational study found glucose unchanged.

Results

Small fasting glucose effect, HbA1c inconclusive.

Effect sizes as reported

FBG -3.09 mg/dL; HbA1c -0.05%.

Why this rating

Reviewers' own GRADE: very low for both outcomes.

Form and dose studied

Varied; no dose-response found.

Who was studied

Mostly adults without diabetes in modern trials.

Limits

Not shown in people with diabetes; NCCIH warns of interaction with diabetes drugs.

Why researchers looked

Animal and small human studies suggested ashwagandha lowers glucose.

Traditional use

Used in traditional medicine for diabetes-like conditions (traditional use).

Proposed mechanism Animal research

Animal studies show lower glucose and better insulin signalling.

A proposed mechanism does not show that the effect happens in people.

Could add to glucose-lowering drugs (NCCIH lists diabetes medicines among possible interactions).

Farrin 2026 Durg 2020 Andallu 2000 Salve 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Blood fats: triglycerides and cholesterol

Very low certainty

Small trials reported lower triglycerides and in older studies lower cholesterol, but others found no lipid change; no pooled analysis exists.

6 studies500 mg per day to 1.25 g per day.

Studies, doses and limits

What the trials found

Pilot RCT in adults with overweight (500 mg for 40 days): triglycerides (p=0.0082) and VLDL (p=0.0321) fell. Hypertensive stress trial: triglycerides -13.00%, LDL favourable trend. Dose-escalation study in 18 volunteers: total and LDL cholesterol fell. 12-person older trial: cholesterol, TG, LDL fell. Null: 8-week HIIT trial lipids unchanged; 12-month observational study lipids unaffected.

Results

Mixed; small triglyceride signals.

Effect sizes as reported

TG p=0.0082 and VLDL p=0.0321 in a pilot trial; TG -13.00% in a hypertension trial.

Why this rating

Small uncontrolled or pilot studies, conflicting results.

Form and dose studied

500 mg per day to 1.25 g per day.

Who was studied

Adults with overweight, hypertension; healthy adults.

Limits

No meta-analysis of lipids; follow-up short.

Why researchers looked

Lipids are a key cardiovascular risk factor.

Traditional use

Used traditionally as a general tonic.

Proposed mechanism Animal research

Computer modelling and animal work suggest effects on lipid metabolism; not proven.

A proposed mechanism does not show that the effect happens in people.

No lipid harm reported.

Ballesteros-Torres 2025 Pattojoshi 2026 Raut 2012 Andallu 2000 Charmas 2025 Salve 2026

Inflammation: CRP, IL-6 and TNF-alpha

Very low certainty

A few trials reported lower CRP, IL-6 or TNF-alpha with ashwagandha, but results are mostly trends or secondary findings in small studies, and a lab study of the same markers was in cells, not people.

6 studies250-600 mg per day for 8-24 weeks.

Studies, doses and limits

What the trials found

60-day RCT in healthy volunteers: hs-CRP, IL-6, TNF-alpha showed a decreasing trend. 180-day pilot RCT: CRP fell 51.1% in the ashwagandha group. 24-week postmenopausal RCT: hs-CRP and MDA lower, glutathione and nitric oxide higher (P<0.0001). COVID trials of herbal combinations reported lower hs-CRP, IL-6 and TNF-alpha, but ashwagandha was only one ingredient.

Results

Lower CRP and cytokines in small trials, often as trends.

Effect sizes as reported

CRP -51.1% (group change, 40-person safety trial); postmenopausal trial p<0.0001; others trend only.

Why this rating

Small samples, inflammation not the primary outcome, mixed products.

Form and dose studied

250-600 mg per day for 8-24 weeks.

Who was studied

Healthy adults, postmenopausal women.

Limits

Lowering a blood marker is not proof of clinical benefit.

Why researchers looked

Withanolides have anti-inflammatory activity in lab studies; blood inflammation markers are easy to measure.

Traditional use

Used traditionally for inflammatory joint complaints.

Proposed mechanism Laboratory research

Cell studies show ashwagandha extract lowers TNF-alpha and IL-1 beta release.

A proposed mechanism does not show that the effect happens in people.

No safety signal in these trials.

Raut 2024 Vaidya 2026 Pingali 2025 Devpura 2021 Chitre 2023 KrishnaRaju 2023

Immune markers and immune function

Not enough evidence

Immune cell markers rose in tiny studies, and a 1,200-person vaccine trial found no clear boost to antibody levels or fewer infections. NCCIH advises avoiding ashwagandha with autoimmune disease and immune-suppressing medicines.

5 studies500 mg per day aqueous root extract in the large trial.

Studies, doses and limits

What the trials found

5-person study: CD4 on T cells and NK-cell activation increased at 96 hours. 180-day pilot RCT: slight CD3/CD4/CD8 improvements. TB add-on RCT: CD4 and CD8 counts rose. 1,200-person post-vaccine RCT (24 weeks): IgG higher but not significant; breakthrough infection 3.9% in both arms.

Results

Cell marker changes in small studies; no clinical benefit shown.

Effect sizes as reported

Breakthrough infection 3.9% (3.0-5.2%), no difference between arms.

Why this rating

Immune marker changes do not equal better protection; the one large trial showed no effect.

Form and dose studied

500 mg per day aqueous root extract in the large trial.

Who was studied

Healthy adults, TB patients.

Limits

No consistent immune endpoint; short or tiny trials.

Why researchers looked

Ashwagandha is promoted for immunity; its effect on immune cells is poorly characterised.

Traditional use

Used in Ayurveda as a general rejuvenating tonic.

Proposed mechanism Preliminary mechanism

Lab and animal data suggest immune cell activation.

A proposed mechanism does not show that the effect happens in people.

NCCIH: avoid with autoimmune disorders and immunosuppressant medicines.

Mikolai 2009 Chopra 2026 Vaidya 2026 Kumar 2018 National Center for Complementary and Integrative Health (NCCIH) 2023

COVID-19

Not enough evidence

NIH's NCCIH says there is not enough high-quality evidence to support using ashwagandha for COVID-19. Small trials combined it with other herbs, and a large vaccine trial showed it was safe but did not clearly boost immunity.

5 studies500 mg per day extracts in combos.

Studies, doses and limits

What the trials found

Open-label RCT in mild-moderate COVID-19 (48 analysed): ashwagandha plus ginger gave recovery in 6.9 vs 13.0 days (p<0.001) without a significant difference in viral clearance. Pilot RCT of a four-herb regime and a four-herb phase III trial reported faster recovery; ashwagandha cannot be separated from the other herbs. The 1,200-person post-vaccine RCT found breakthrough infection did not differ.

Results

Faster recovery in small herb-combination trials; no ashwagandha-alone evidence.

Effect sizes as reported

Recovery 6.9 vs 13.0 days (open-label, combined with ginger).

Why this rating

NCCIH: not enough high-quality evidence; trials open label, combined products.

Form and dose studied

500 mg per day extracts in combos.

Who was studied

COVID-19 patients, vaccinated adults.

Limits

Open label, multi-herb, small.

Why researchers looked

Ashwagandha was widely used in India during the pandemic.

Traditional use

Used in Ayurveda protocols for infectious illness.

Proposed mechanism Pharmacological theory

Computer-modelling (in-silico) papers have proposed antiviral binding; they were not reviewed here and are not clinical proof.

A proposed mechanism does not show that the effect happens in people.

Do not use as a substitute for medical care.

Singh 2023 Devpura 2021 Chitre 2023 Chopra 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Blood pressure and heart markers

Not enough evidence

No trial in people with high blood pressure has clearly shown a blood-pressure lowering effect; most trials in healthy adults report no change, and NCCIH warns of interactions with blood-pressure drugs.

5 studies300 mg twice daily.

Studies, doses and limits

What the trials found

Hypertensive stress RCT (60 people, 60 days): blood pressure showed favourable trends, not stated as significant; cortisol -28.99%. Healthy adult safety trials: vital signs unchanged. A 180-day pilot trial: NT-proBNP fell 28.70% in the ashwagandha group. A small 8-week trial found arjuna, not ashwagandha, lowered systolic pressure.

Results

No confirmed blood-pressure effect.

Effect sizes as reported

BP trend only; NT-proBNP -28.7% (group change).

Why this rating

No adequately powered trial with blood pressure as the primary outcome.

Form and dose studied

300 mg twice daily.

Who was studied

Hypertensive adults (one trial), healthy adults.

Limits

Tiny samples.

Why researchers looked

Stress affects blood pressure; ashwagandha lowers stress scores.

Traditional use

Used traditionally as a heart tonic in some formulas.

Proposed mechanism Animal research

Some animal work has been described as heart-protective; not reviewed here and not shown in people.

A proposed mechanism does not show that the effect happens in people.

NCCIH lists blood-pressure medicines among possible interactions.

Pattojoshi 2026 Verma 2021 Vaidya 2026 Sandhu 2010 National Center for Complementary and Integrative Health (NCCIH) 2023

Joint pain, knee osteoarthritis and rheumatoid arthritis

Low certainty

One 12-week trial of a root-and-leaf extract in 60 people with knee pain found less pain and swelling; a network analysis suggested lower stiffness. Rheumatoid arthritis data come from an uncontrolled study combined with a mercury-containing preparation. NCCIH does not list arthritis as supported.

4 studies125-250 mg twice daily root-and-leaf extract.

Studies, doses and limits

What the trials found

Knee RCT (60 people, root plus leaf, 125 or 250 mg twice daily, 12 weeks): WOMAC and swelling better than placebo (250 mg p<0.001). Network meta-analysis of 36 botanical RCTs: ashwagandha stiffness MD 4.16 (2.43-5.90) while other plants ranked higher for pain. Triple-blind knee OA RCT of a three-herb product (70 people): better pain and function. RA pilot (78 completed): ACR20 in 56.4% but used a mercury-containing preparation.

Results

Possible pain and stiffness benefit in knee osteoarthritis.

Effect sizes as reported

Stiffness MD 4.16 (2.43-5.90) in network meta-analysis.

Why this rating

One small RCT for ashwagandha alone plus a network analysis; remaining evidence mixes products.

Form and dose studied

125-250 mg twice daily root-and-leaf extract.

Who was studied

Adults with knee pain; RA patients in the pilot.

Limits

Combination products; no uncontrolled RA data can be attributed to ashwagandha.

Why researchers looked

Withanolides show anti-inflammatory and cartilage-protective effects in cells.

Traditional use

Traditionally used for joint complaints.

Proposed mechanism Laboratory research

Lab studies show anti-inflammatory and chondroprotective effects.

A proposed mechanism does not show that the effect happens in people.

The RA regime raised urinary mercury; ashwagandha alone not implicated.

Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026 Kumar 2015

Skin and hair

Very low certainty

Two small trials reported better skin barrier and photoaged skin with an 8% ashwagandha lotion and better hair density with a 75-day oral extract, but both are small and cosmetic.

2 studies8% topical lotion twice daily or 300 mg twice daily oral.

Studies, doses and limits

What the trials found

60-day lotion RCT (53 analysed): physician score -74.69% vs -48.68%; hydration, TEWL and elasticity better; melanin unchanged. 75-day oral RCT in adults with hair loss or skin conditions: better TEWL, hair density, anagen/telogen ratio and quality of life (p<0.05).

Results

Small cosmetic benefits.

Effect sizes as reported

Physician score -74.69% vs -48.68%.

Why this rating

Two small trials, cosmetic outcomes, sample size not in one abstract.

Form and dose studied

8% topical lotion twice daily or 300 mg twice daily oral.

Who was studied

Healthy adults.

Limits

Short; small; lotion trial is topical.

Why researchers looked

Stress affects skin and hair; ashwagandha is added to cosmetics.

Traditional use

Traditional topical and oral use.

Proposed mechanism Laboratory research

Laboratory work on skin and hair cells has been reported but was not reviewed here; the mechanism in people is unknown.

A proposed mechanism does not show that the effect happens in people.

No adverse events reported.

Narra 2023 Jillella 2026

Aging and biological-age markers

Not enough evidence

Rasayana herbs are traditionally linked to longevity.

Traditional use

Classified as a rasayana.

Proposed mechanism Animal research

Reviews describe laboratory and animal work only (not reviewed in detail here).

A proposed mechanism does not show that the effect happens in people.

None specific.

Vaidya 2026 Salve 2026

Oxidative stress markers

Very low certainty

Some trials reported better antioxidant markers; others found no difference.

4 studies300 mg twice daily.

Studies, doses and limits

What the trials found

Athlete RCT: antioxidant level higher (P<0.0001). Postmenopausal RCT: MDA lower, glutathione and nitric oxide higher. Stress trial: NO, glutathione and MDA not different. Infertile men: seminal oxidative markers fell in uncontrolled studies.

Results

Mixed.

Effect sizes as reported

P<0.0001 in two trials; null in one.

Why this rating

Mixed results, surrogate markers.

Form and dose studied

300 mg twice daily.

Who was studied

Athletes, postmenopausal women, infertile men.

Limits

Marker choice varies.

Why researchers looked

Withanolides act as antioxidants in the lab.

Traditional use

Rasayana.

Proposed mechanism Laboratory research

Lab antioxidant activity.

A proposed mechanism does not show that the effect happens in people.

None.

Tiwari 2021 Pingali 2025 Majeed 2023 Ahmad 2010

Cortisol lowering and a single adrenal suppression case report

Mixed findings

Ashwagandha consistently lowers cortisol. One case report describes a woman taking about 950 mg per day for over a year who developed adrenal insufficiency. Systematic reviews note none of the trials tested adrenal function.

3 studiesAbout 950 mg per day in the case.

Studies, doses and limits

What the trials found

2026 meta-analysis: cortisol SMD -1.18. 2023 systematic review of 9 trials: cortisol decreased, adrenal function not evaluated. 2026 case report: low basal cortisol and weak ACTH response in a woman using about 950 mg for more than a year, unresolved at 3 months.

Results

Reliable lowering of cortisol; one adrenal insufficiency case.

Effect sizes as reported

SMD -1.18.

Why this rating

Cortisol drop is a lab change; the safety case is single.

Form and dose studied

About 950 mg per day in the case.

Who was studied

Stressed adults.

Limits

Adrenal function not measured in trials.

Why researchers looked

Cortisol lowering is the leading proposed mechanism for the stress benefit.

Traditional use

Adaptogen.

Proposed mechanism Preliminary mechanism

Lower HPA-axis activity.

A proposed mechanism does not show that the effect happens in people.

Clinicians should ask about ashwagandha when adrenal insufficiency is unexplained.

Fornalik 2026 Della Porta 2023 Javid 2026

Connections to the rest of health

How Ashwagandha connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Stress Reduction	Potential benefit	Low certainty	Perceived stress: Many small trials in stressed adults found lower stress scores than placebo after 4 to 12 weeks, but the two largest recent meta-analyses disagree on whether the average effect is real, and the quality of the evidence is low. Schizophrenia symptoms, stress and mood (adjunct): One 12-week trial added ashwagandha to antipsychotic medication during symptom flare-ups and found lower negative and general symptoms and lower stress. Larger meta-analyses of supplements in schizophrenia do not single ashwagandha out.	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023 Chengappa 2018 Gannon 2019 Fornaro 2025 Pakhale 2025 Quinones 2025
Resilience Support	Potential benefit	Low certainty	Perceived stress: Many small trials in stressed adults found lower stress scores than placebo after 4 to 12 weeks, but the two largest recent meta-analyses disagree on whether the average effect is real, and the quality of the evidence is low. Quality of life and general well-being: Several small trials, mostly in older adults and stressed adults, found better quality-of-life scores with ashwagandha, though one meta-analysis found no pooled quality-of-life effect.	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023 Movva 2026 Kelgane 2020 Honnutagi 2026 Obhrai 2026 Majeed 2024 Cheah 2021 Salve 2026
Burnout Recovery	Potential benefit	Low certainty	Perceived stress: Many small trials in stressed adults found lower stress scores than placebo after 4 to 12 weeks, but the two largest recent meta-analyses disagree on whether the average effect is real, and the quality of the evidence is low.	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023
Anxiety Support	Potential benefit	Low certainty	Anxiety symptoms (healthy and subclinical): Trials in adults with everyday or moderate anxiety usually found lower anxiety scores than placebo. Pooled results are large but come from small, varied trials with very high heterogeneity. Generalized anxiety disorder and OCD as add-on to standard drugs: Two small Iranian trials added ashwagandha to SSRIs in people with a diagnosed anxiety disorder or OCD and saw larger symptom drops than placebo. They are tiny and unreplicated.	Pages-García 2024 Akhgarjand 2022 Arumugam 2024 Fatima 2024 Marchi 2025 Alsanie 2026 Zhang 2022 Pratte 2014 Lopresti 2019 Majeed 2023 Mishra 2024 Langade 2019 Langade 2021 Andrade 2000 Mahadevan 2025 Baker 2022 McKinney 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Fuladi 2021 Jahanbakhsh 2016 Cooley 2009
Calm Relaxation	Potential benefit	Low certainty	Anxiety symptoms (healthy and subclinical): Trials in adults with everyday or moderate anxiety usually found lower anxiety scores than placebo. Pooled results are large but come from small, varied trials with very high heterogeneity.	Pages-García 2024 Akhgarjand 2022 Arumugam 2024 Fatima 2024 Marchi 2025 Alsanie 2026 Zhang 2022 Pratte 2014 Lopresti 2019 Majeed 2023 Mishra 2024 Langade 2019 Langade 2021 Andrade 2000 Mahadevan 2025 Baker 2022 McKinney 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Mood Balance	Potential benefit	Very low certainty	Generalized anxiety disorder and OCD as add-on to standard drugs: Two small Iranian trials added ashwagandha to SSRIs in people with a diagnosed anxiety disorder or OCD and saw larger symptom drops than placebo. They are tiny and unreplicated. Schizophrenia symptoms, stress and mood (adjunct): One 12-week trial added ashwagandha to antipsychotic medication during symptom flare-ups and found lower negative and general symptoms and lower stress. Larger meta-analyses of supplements in schizophrenia do not single ashwagandha out.	Fuladi 2021 Jahanbakhsh 2016 Andrade 2000 Cooley 2009 Marchi 2025 Chengappa 2018 Gannon 2019 Fornaro 2025 Alsanie 2026 Majeed 2024 Smith 2023 Łuszczak 2026 Speers 2021
Better Sleep	Potential benefit	Low certainty	Sleep quality: Pooled trials show a small-to-moderate improvement in sleep quality, larger in people with insomnia, at 600 mg/day or more and for 8 weeks or longer. Most trials are small and several share investigators. Insomnia (diagnosed): Two trials in people diagnosed with insomnia showed faster sleep onset and better sleep efficiency than placebo with root extract. Evidence is limited to a few small trials.	Cheah 2021 Fatima 2024 Marchi 2025 Baune 2026 Deshpande 2020 Kelgane 2020 Obhrai 2026 Mahadevan 2025 Thanawala 2026 Pérez-Piñero 2024 O'Connor 2022 McKinney 2026 Langade 2021 Langade 2019 Movva 2026 Saxena 2026 Kulkarni 2026 Park 2023 Kaushik 2017 National Center for Complementary and Integrative Health (NCCIH) 2023 Honnutagi 2026 Atul 2020 Mastrofini 2026
Sleep Quality	Potential benefit	Low certainty	Sleep quality: Pooled trials show a small-to-moderate improvement in sleep quality, larger in people with insomnia, at 600 mg/day or more and for 8 weeks or longer. Most trials are small and several share investigators. Insomnia (diagnosed): Two trials in people diagnosed with insomnia showed faster sleep onset and better sleep efficiency than placebo with root extract. Evidence is limited to a few small trials.	Cheah 2021 Fatima 2024 Marchi 2025 Baune 2026 Deshpande 2020 Kelgane 2020 Obhrai 2026 Mahadevan 2025 Thanawala 2026 Pérez-Piñero 2024 O'Connor 2022 McKinney 2026 Langade 2021 Langade 2019 Movva 2026 Saxena 2026 Kulkarni 2026 Park 2023 Kaushik 2017 National Center for Complementary and Integrative Health (NCCIH) 2023 Honnutagi 2026 Atul 2020 Mastrofini 2026 Naik 2026
Memory Support	Potential benefit	Low certainty	Memory, attention and executive function in healthy adults: Meta-analysis suggests modest gains in memory, attention and processing speed, but individual trials use many tests and small groups, and some stress-related improvements may reflect lower stress rather than a direct brain effect. Mild cognitive impairment: Two small trials in adults with mild cognitive impairment reported better memory and attention scores. They are pilot studies and need larger confirmation.	Zhu 2026 Gopukumar 2021 Majeed 2023 Kale 2026 Remenapp 2022 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 National Center for Complementary and Integrative Health (NCCIH) 2023 Choudhary 2017 Rai 2025 Chengappa 2013 Yalin 2026
Cognitive Performance	Potential benefit	Low certainty	Memory, attention and executive function in healthy adults: Meta-analysis suggests modest gains in memory, attention and processing speed, but individual trials use many tests and small groups, and some stress-related improvements may reflect lower stress rather than a direct brain effect. Cognition in bipolar disorder (adjunct): One 8-week trial found small gains in working memory, reaction time and social cognition when ashwagandha was added to bipolar maintenance treatment.	Zhu 2026 Gopukumar 2021 Majeed 2023 Kale 2026 Remenapp 2022 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 National Center for Complementary and Integrative Health (NCCIH) 2023 Chengappa 2013 Yalin 2026 Saxena 2026 Naik 2026
Mental Clarity	Potential benefit	Low certainty	Memory, attention and executive function in healthy adults: Meta-analysis suggests modest gains in memory, attention and processing speed, but individual trials use many tests and small groups, and some stress-related improvements may reflect lower stress rather than a direct brain effect. Acute (single-dose) cognitive effects: Single-dose crossover studies in healthy volunteers suggest small short-term gains in attention and reaction time. They are tiny.	Zhu 2026 Gopukumar 2021 Majeed 2023 Kale 2026 Remenapp 2022 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 National Center for Complementary and Integrative Health (NCCIH) 2023
Better Focus	Potential benefit	Low certainty	Memory, attention and executive function in healthy adults: Meta-analysis suggests modest gains in memory, attention and processing speed, but individual trials use many tests and small groups, and some stress-related improvements may reflect lower stress rather than a direct brain effect. Attention and sleep in children (ADHD concerns): Two 2026 trials of ashwagandha gummies in children reported better attention and sleep, but they are small and new and need independent replication. Safety in children is not established.	Zhu 2026 Gopukumar 2021 Majeed 2023 Kale 2026 Remenapp 2022 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 National Center for Complementary and Integrative Health (NCCIH) 2023 Saxena 2026 Naik 2026
Brain Health	Potential benefit	Very low certainty	Mild cognitive impairment: Two small trials in adults with mild cognitive impairment reported better memory and attention scores. They are pilot studies and need larger confirmation.	Choudhary 2017 Rai 2025 Ng 2020
Healthy Aging	Potential benefit	Very low certainty	Mild cognitive impairment: Two small trials in adults with mild cognitive impairment reported better memory and attention scores. They are pilot studies and need larger confirmation. Quality of life and general well-being: Several small trials, mostly in older adults and stressed adults, found better quality-of-life scores with ashwagandha, though one meta-analysis found no pooled quality-of-life effect.	Choudhary 2017 Rai 2025 Ng 2020 Movva 2026 Kelgane 2020 Honnutagi 2026 Obhrai 2026 Majeed 2023 Majeed 2024 Cheah 2021 Salve 2026
Reduce Fatigue	Potential benefit	Very low certainty	Fatigue and energy: A few trials report less fatigue and more vigour, including a 28-day low-dose trial and a 12-week trial in overweight adults, but results depend on the scale and many trials are small. Fatigue during cancer chemotherapy: One non-randomised study found less fatigue in breast cancer patients taking high-dose ashwagandha during chemotherapy. It needs randomised confirmation and interaction checks.	Smith 2023 Lopresti 2026 Kale 2026 Leonard 2024 Coope 2026 Biswal 2013 Saxena 2026
Energy Boost	Potential benefit	Very low certainty	Fatigue and energy: A few trials report less fatigue and more vigour, including a 28-day low-dose trial and a 12-week trial in overweight adults, but results depend on the scale and many trials are small.	Smith 2023 Lopresti 2026 Kale 2026 Leonard 2024 Coope 2026 Biswal 2013 Saxena 2026
Weight Management	Potential benefit	Very low certainty	Stress-related eating and food cravings: Trials in chronically stressed adults found lower food cravings with ashwagandha. This is a stress-behaviour outcome and weight loss findings need caution. Body weight and body composition: Two trials in stressed or heavier adults reported weight loss with ashwagandha, one very large (about 8 kg over 24 weeks), but a 2026 meta-analysis of 20 trials and other trials found no effect on body weight or body fat.	Choudhary 2017 Pakhale 2025 O'Connor 2022 Quinones 2025 Ballesteros-Torres 2025 Obhrai 2026 Charmas 2025 Zhu 2026
Mens Vitality	Demonstrated clinical effect	Low certainty	Testosterone in men: In several small trials, men taking ashwagandha root extract had higher testosterone than men taking placebo, and a 2026 pooled analysis found an average rise of about 57 ng/dl. The rise stayed inside normal ranges in the safety review, it is not seen in women, and a few trials found no difference from placebo. It is a lab change; higher testosterone has not been shown to make men healthier by itself.	Fornalik 2026 Zhu 2026 Smith 2021 Lopresti 2019 Lopresti 2019 Chauhan 2022 Wankhede 2015 Thanawala 2026 Vaidya 2026 Salve 2026 Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Hormone Balance	Demonstrated clinical effect	Low certainty	Testosterone in men: In several small trials, men taking ashwagandha root extract had higher testosterone than men taking placebo, and a 2026 pooled analysis found an average rise of about 57 ng/dl. The rise stayed inside normal ranges in the safety review, it is not seen in women, and a few trials found no difference from placebo. It is a lab change; higher testosterone has not been shown to make men healthier by itself.	Fornalik 2026 Zhu 2026 Smith 2021 Lopresti 2019 Lopresti 2019 Chauhan 2022 Wankhede 2015 Thanawala 2026 Vaidya 2026 Salve 2026 Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Fertility Support	Potential benefit	Low certainty	Semen quality and male infertility: Small trials in men with low sperm counts found more sperm, more semen and better movement after about 90 days, and two 2025-2026 trials in healthy men reported similar gains over 8 weeks. Very few studies were properly controlled, none measured babies born, and the authors of the main review call the data promising but too limited.	Durg 2018 Ambiye 2013 Ahmad 2010 Gupta 2013 Khanna 2026 Mutha 2025 Roy 2026 Nasimi Doost Azgomi 2018 National Center for Complementary and Integrative Health (NCCIH) 2023
Mens Vitality	Potential benefit	Low certainty	Semen quality and male infertility: Small trials in men with low sperm counts found more sperm, more semen and better movement after about 90 days, and two 2025-2026 trials in healthy men reported similar gains over 8 weeks. Very few studies were properly controlled, none measured babies born, and the authors of the main review call the data promising but too limited. Sexual function in men: Two recent 8-week trials in healthy men and one in men with low desire reported better sexual desire and satisfaction than placebo, but one older trial in men with erectile dysfunction found no difference from placebo (both groups improved).	Durg 2018 Ambiye 2013 Ahmad 2010 Gupta 2013 Khanna 2026 Mutha 2025 Roy 2026 Nasimi Doost Azgomi 2018 National Center for Complementary and Integrative Health (NCCIH) 2023 Chauhan 2022 Mamidi 2011 Lopresti 2019
Libido Support	Potential benefit	Low certainty	Sexual function in men: Two recent 8-week trials in healthy men and one in men with low desire reported better sexual desire and satisfaction than placebo, but one older trial in men with erectile dysfunction found no difference from placebo (both groups improved). Sexual function in women: Two small 8-week trials in healthy women, one in women with low desire, found better sexual function scores and less distress than placebo.	Chauhan 2022 Khanna 2026 Mutha 2025 Mamidi 2011 Lopresti 2019 Dongre 2015 Ajgaonkar 2022
Womens Wellness	Potential benefit	Low certainty	Sexual function in women: Two small 8-week trials in healthy women, one in women with low desire, found better sexual function scores and less distress than placebo. Menopause and perimenopause symptoms: Four recent small trials in perimenopausal and postmenopausal women found lower menopause symptom scores than placebo and shifts in female hormones, but NCCIH says there is not enough evidence to conclude ashwagandha helps menopause.	Dongre 2015 Ajgaonkar 2022 Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Menopause Support	Potential benefit	Low certainty	Menopause and perimenopause symptoms: Four recent small trials in perimenopausal and postmenopausal women found lower menopause symptom scores than placebo and shifts in female hormones, but NCCIH says there is not enough evidence to conclude ashwagandha helps menopause.	Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Hormone Balance	Potential benefit	Low certainty	Menopause and perimenopause symptoms: Four recent small trials in perimenopausal and postmenopausal women found lower menopause symptom scores than placebo and shifts in female hormones, but NCCIH says there is not enough evidence to conclude ashwagandha helps menopause. Thyroid hormones in low thyroid function (benefit signal): One small 8-week trial in 50 people with mildly raised TSH reported improved TSH, T3 and T4 on ashwagandha. This is a pilot result, not a treatment, and it needs the matching safety caution in the next record.	Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Sharma 2018 Gannon 2014 Fornalik 2026 Vollmer 2026
Hormone Balance	Preliminary mechanism	Not enough evidence	Female hormones and PCOS: No human trial of ashwagandha in polycystic ovary syndrome was found. The idea rests on animal work and narrative reviews. In women the pooled analysis found no change in testosterone or estradiol, though menopause trials reported estradiol, FSH and LH shifts.	Fornalik 2026 Roy 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Womens Wellness	Preliminary mechanism	Not enough evidence	Female hormones and PCOS: No human trial of ashwagandha in polycystic ovary syndrome was found. The idea rests on animal work and narrative reviews. In women the pooled analysis found no change in testosterone or estradiol, though menopause trials reported estradiol, FSH and LH shifts.	Fornalik 2026 Roy 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Fertility Support	Preliminary mechanism	Not enough evidence	Female hormones and PCOS: No human trial of ashwagandha in polycystic ovary syndrome was found. The idea rests on animal work and narrative reviews. In women the pooled analysis found no change in testosterone or estradiol, though menopause trials reported estradiol, FSH and LH shifts.	Fornalik 2026 Roy 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Thyroid Support	Potential benefit	Very low certainty	Thyroid hormones in low thyroid function (benefit signal): One small 8-week trial in 50 people with mildly raised TSH reported improved TSH, T3 and T4 on ashwagandha. This is a pilot result, not a treatment, and it needs the matching safety caution in the next record.	Sharma 2018 Gannon 2014 Fornalik 2026 Vollmer 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Thyroid Support	Adverse effect or risk	Mixed findings	Thyroid: overactive thyroid signal and thyroid-medicine interaction: Three case reports describe overactive thyroid (thyrotoxicosis) after taking ashwagandha, which went away after stopping. Trials in healthy people mostly found no change in TSH or T3, but T4 edged up in a pooled analysis. No source gives how often this happens.	Kamal 2022 Hayashi 2024 van der Hooft 2005 Verma 2021 Vaidya 2024 Movva 2026 Fornalik 2026 Gannon 2014 Li 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Peak Performance	Potential benefit	Low certainty	Muscle strength and size with resistance training: Several 8 to 12 week trials in young, mostly untrained people doing weight training found bigger strength gains with ashwagandha. A 2026 analysis of these trials said the effect was statistically fragile and of low certainty, and two other trials in trained athletes found no extra benefit. Muscle recovery and exercise stress markers: Some trials reported lower muscle-damage markers (creatine kinase) and better recovery scores with ashwagandha, but many recovery outcomes are self-rated and trials in athletes gave mixed results.	Wankhede 2015 Ziegenfuss 2018 Verma 2023 Lee 2026 Li 2026 Zhu 2026 Bonilla 2021 Coope 2025 Ewa 2025 Charmas 2025 Gierczuk 2025 Thanawala 2026 Coope 2026 Prajapati 2026 Pérez-Gómez 2020 Choudhary 2015 Tiwari 2021 Sandhu 2010
Muscle Recovery	Potential benefit	Low certainty	Muscle strength and size with resistance training: Several 8 to 12 week trials in young, mostly untrained people doing weight training found bigger strength gains with ashwagandha. A 2026 analysis of these trials said the effect was statistically fragile and of low certainty, and two other trials in trained athletes found no extra benefit. Muscle recovery and exercise stress markers: Some trials reported lower muscle-damage markers (creatine kinase) and better recovery scores with ashwagandha, but many recovery outcomes are self-rated and trials in athletes gave mixed results.	Wankhede 2015 Ziegenfuss 2018 Verma 2023 Lee 2026 Li 2026 Zhu 2026 Bonilla 2021 Coope 2025 Ewa 2025 Charmas 2025 Gierczuk 2025 Thanawala 2026 Coope 2026 Prajapati 2026
Physical Stamina	Potential benefit	Low certainty	Muscle strength and size with resistance training: Several 8 to 12 week trials in young, mostly untrained people doing weight training found bigger strength gains with ashwagandha. A 2026 analysis of these trials said the effect was statistically fragile and of low certainty, and two other trials in trained athletes found no extra benefit. Aerobic fitness and VO2max: A 2020 meta-analysis of four small trials found VO2max about 3 units higher with ashwagandha, with wide uncertainty; 2023 and 2026 reviews found stronger signals for aerobic endurance than for strength, while two HIIT trials found no extra benefit.	Wankhede 2015 Ziegenfuss 2018 Verma 2023 Lee 2026 Li 2026 Zhu 2026 Bonilla 2021 Coope 2025 Ewa 2025 Charmas 2025 Gierczuk 2025 Thanawala 2026 Pérez-Gómez 2020 Choudhary 2015 Tiwari 2021 Prajapati 2026 Sandhu 2010
Endurance Support	Potential benefit	Low certainty	Aerobic fitness and VO2max: A 2020 meta-analysis of four small trials found VO2max about 3 units higher with ashwagandha, with wide uncertainty; 2023 and 2026 reviews found stronger signals for aerobic endurance than for strength, while two HIIT trials found no extra benefit.	Pérez-Gómez 2020 Li 2026 Choudhary 2015 Tiwari 2021 Verma 2023 Prajapati 2026 Thanawala 2026 Ewa 2025 Gierczuk 2025 Sandhu 2010
Metabolic Health	Potential benefit	Mixed findings	Body weight and body composition: Two trials in stressed or heavier adults reported weight loss with ashwagandha, one very large (about 8 kg over 24 weeks), but a 2026 meta-analysis of 20 trials and other trials found no effect on body weight or body fat. Blood sugar and HbA1c: A 2026 meta-analysis of 11 trials found fasting glucose about 3 mg/dL lower and no clear change in HbA1c, with very low certainty. Larger effects seen in diabetic animals do not carry over.	Pakhale 2025 Choudhary 2017 Ballesteros-Torres 2025 Obhrai 2026 Charmas 2025 Zhu 2026 Farrin 2026 Durg 2020 Andallu 2000 Salve 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Pattojoshi 2026 Raut 2012
Blood Sugar Balance	Potential benefit	Very low certainty	Blood sugar and HbA1c: A 2026 meta-analysis of 11 trials found fasting glucose about 3 mg/dL lower and no clear change in HbA1c, with very low certainty. Larger effects seen in diabetic animals do not carry over.	Farrin 2026 Durg 2020 Andallu 2000 Salve 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Cholesterol Balance	Potential benefit	Very low certainty	Blood fats: triglycerides and cholesterol: Small trials reported lower triglycerides and in older studies lower cholesterol, but others found no lipid change; no pooled analysis exists.	Ballesteros-Torres 2025 Pattojoshi 2026 Raut 2012 Andallu 2000 Charmas 2025 Salve 2026
Heart Health	Potential benefit	Very low certainty	Blood fats: triglycerides and cholesterol: Small trials reported lower triglycerides and in older studies lower cholesterol, but others found no lipid change; no pooled analysis exists.	Ballesteros-Torres 2025 Pattojoshi 2026 Raut 2012 Andallu 2000 Charmas 2025 Salve 2026
Inflammation Balance	Preliminary mechanism	Very low certainty	Inflammation: CRP, IL-6 and TNF-alpha: A few trials reported lower CRP, IL-6 or TNF-alpha with ashwagandha, but results are mostly trends or secondary findings in small studies, and a lab study of the same markers was in cells, not people.	Raut 2024 Vaidya 2026 Pingali 2025 Devpura 2021 Chitre 2023 KrishnaRaju 2023
Immune Support	Biological association	Not enough evidence	Immune markers and immune function: Immune cell markers rose in tiny studies, and a 1,200-person vaccine trial found no clear boost to antibody levels or fewer infections. NCCIH advises avoiding ashwagandha with autoimmune disease and immune-suppressing medicines.	Mikolai 2009 Chopra 2026 Vaidya 2026 Kumar 2018 National Center for Complementary and Integrative Health (NCCIH) 2023
Immune Support	Potential benefit	Not enough evidence	COVID-19: NIH's NCCIH says there is not enough high-quality evidence to support using ashwagandha for COVID-19. Small trials combined it with other herbs, and a large vaccine trial showed it was safe but did not clearly boost immunity.	Singh 2023 Devpura 2021 Chitre 2023 Chopra 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Blood Pressure Support	Biological association	Not enough evidence	Blood pressure and heart markers: No trial in people with high blood pressure has clearly shown a blood-pressure lowering effect; most trials in healthy adults report no change, and NCCIH warns of interactions with blood-pressure drugs.	Pattojoshi 2026 Verma 2021 Vaidya 2026 Sandhu 2010 National Center for Complementary and Integrative Health (NCCIH) 2023
Heart Health	Biological association	Not enough evidence	Blood pressure and heart markers: No trial in people with high blood pressure has clearly shown a blood-pressure lowering effect; most trials in healthy adults report no change, and NCCIH warns of interactions with blood-pressure drugs.	Pattojoshi 2026 Verma 2021 Vaidya 2026 Sandhu 2010 National Center for Complementary and Integrative Health (NCCIH) 2023
Joint Support	Potential benefit	Low certainty	Joint pain, knee osteoarthritis and rheumatoid arthritis: One 12-week trial of a root-and-leaf extract in 60 people with knee pain found less pain and swelling; a network analysis suggested lower stiffness. Rheumatoid arthritis data come from an uncontrolled study combined with a mercury-containing preparation. NCCIH does not list arthritis as supported.	Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026 Kumar 2015
Inflammation Balance	Potential benefit	Low certainty	Joint pain, knee osteoarthritis and rheumatoid arthritis: One 12-week trial of a root-and-leaf extract in 60 people with knee pain found less pain and swelling; a network analysis suggested lower stiffness. Rheumatoid arthritis data come from an uncontrolled study combined with a mercury-containing preparation. NCCIH does not list arthritis as supported.	Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026 Kumar 2015
Healthy Skin	Potential benefit	Very low certainty	Skin and hair: Two small trials reported better skin barrier and photoaged skin with an 8% ashwagandha lotion and better hair density with a 75-day oral extract, but both are small and cosmetic.	Narra 2023 Jillella 2026
Hair Support	Potential benefit	Very low certainty	Skin and hair: Two small trials reported better skin barrier and photoaged skin with an 8% ashwagandha lotion and better hair density with a 75-day oral extract, but both are small and cosmetic.	Narra 2023 Jillella 2026
Healthy Aging	Traditional use	Not enough evidence	Aging and biological-age markers: No human trial has shown ashwagandha slows aging or changes biological-age markers. Reviews describe laboratory and animal evidence only, plus small trials of related markers.	Vaidya 2026 Salve 2026
Longevity	Traditional use	Not enough evidence	Aging and biological-age markers: No human trial has shown ashwagandha slows aging or changes biological-age markers. Reviews describe laboratory and animal evidence only, plus small trials of related markers.	Vaidya 2026 Salve 2026
Healthy Aging	Biological association	Very low certainty	Oxidative stress markers: Some trials reported better antioxidant markers; others found no difference.	Tiwari 2021 Pingali 2025 Majeed 2023 Ahmad 2010
Inflammation Balance	Biological association	Very low certainty	Oxidative stress markers: Some trials reported better antioxidant markers; others found no difference.	Tiwari 2021 Pingali 2025 Majeed 2023 Ahmad 2010
Adrenal Support	Adverse effect or risk	Mixed findings	Cortisol lowering and a single adrenal suppression case report: Ashwagandha consistently lowers cortisol. One case report describes a woman taking about 950 mg per day for over a year who developed adrenal insufficiency. Systematic reviews note none of the trials tested adrenal function.	Fornalik 2026 Della Porta 2023 Javid 2026
Stress Reduction	Adverse effect or risk	Mixed findings	Cortisol lowering and a single adrenal suppression case report: Ashwagandha consistently lowers cortisol. One case report describes a woman taking about 950 mg per day for over a year who developed adrenal insufficiency. Systematic reviews note none of the trials tested adrenal function.	Fornalik 2026 Della Porta 2023 Javid 2026

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Hepatic system	Adverse effect or risk	Low certainty	Herb-induced liver injury; LiverTox lists it as recently implicated. Preparation or compound: Unspecified	LiverTox (NIDDK) 2012 McIntyre 2026
Endocrine system	Adverse effect or risk	Low certainty	Effects on T4, cortisol and testosterone; adrenal suppression in one case. Preparation or compound: Unspecified	Fornalik 2026 Javid 2026
Immune system	Drug or supplement interaction	Very low certainty	Named by NCCIH with immunosuppressants; one kidney transplant rejection reported. Preparation or compound: Unspecified	National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Sriperumbuduri 2020
Immune system	Contraindication	Very low certainty	Not recommended with autoimmune disorders or after organ transplant. Preparation or compound: Unspecified	National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Reproductive system	Contraindication	Not enough evidence	Avoid in pregnancy and breastfeeding (precaution). Evidence of harm is inconclusive. Preparation or compound: Root; traditional use	National Center for Complementary and Integrative Health (NCCIH) 2023 RIVM (Netherlands National Institute for Public Health and the Environment) 2024 Tallon 2026
Stress Mood	Biological association	Low certainty	Studied for: Perceived stress Studied for: Anxiety symptoms (healthy and subclinical)	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023 Pages-García 2024 Fatima 2024 Zhang 2022 Langade 2019 Langade 2021 Andrade 2000 Fuladi 2021 Jahanbakhsh 2016 Cooley 2009 Chengappa 2013 Yalin 2026 Ng 2020 Chengappa 2018 Gannon 2019 Fornaro 2025 Majeed 2024 Kale 2026 Leonard 2024 Biswal 2013 Saxena 2026 Movva 2026 Kelgane 2020 Honnutagi 2026 Obhrai 2026 Cheah 2021 Salve 2026 Pakhale 2025 Quinones 2025 Chauhan 2022 Khanna 2026 Mutha 2025 Mamidi 2011 Lopresti 2019 Dongre 2015 Ajgaonkar 2022
Nervous System	Biological association	Low certainty	Studied for: Perceived stress Studied for: Anxiety symptoms (healthy and subclinical)	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023 Pages-García 2024 Fatima 2024 Zhang 2022 Langade 2019 Langade 2021 Andrade 2000 Fuladi 2021 Jahanbakhsh 2016 Cooley 2009 Cheah 2021 Deshpande 2020 Kelgane 2020 Obhrai 2026 Pérez-Piñero 2024 Movva 2026 Saxena 2026 Kulkarni 2026 Park 2023 Kaushik 2017 Honnutagi 2026 Atul 2020 Zhu 2026 Gopukumar 2021 Kale 2026 Leonard 2024 Xing 2022 Pingali 2014 Ng 2020 Lorca 2023 Choudhary 2017 Rai 2025 Chengappa 2013 Yalin 2026 Chengappa 2018 Gannon 2019 Fornaro 2025 Majeed 2024 Naik 2026
Endocrine System	Biological association	Low certainty	Studied for: Perceived stress Studied for: Fatigue and energy	Akhgarjand 2022 Arumugam 2024 Albalawi 2025 Marchi 2025 Alsanie 2026 Alyami 2026 Baune 2026 Łuszczak 2026 Pratte 2014 Chandrasekhar 2012 Salve 2019 Lopresti 2019 Majeed 2023 Smith 2023 Pandit 2024 Mishra 2024 Mahadevan 2025 Lopresti 2026 McKinney 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Choudhary 2017 Remenapp 2022 O'Connor 2022 Baker 2022 Mastrofini 2026 Coope 2026 Pakhale 2026 Speers 2021 National Center for Complementary and Integrative Health (NCCIH) 2023 Kale 2026 Leonard 2024 Biswal 2013 Saxena 2026 Fornalik 2026 Zhu 2026 Smith 2021 Lopresti 2019 Chauhan 2022 Wankhede 2015 Thanawala 2026 Vaidya 2026 Salve 2026 Coope 2026 Durg 2018 Ambiye 2013 Ahmad 2010 Gupta 2013 Khanna 2026 Mutha 2025 Roy 2026 Nasimi Doost Azgomi 2018 Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026 Sharma 2018 Gannon 2014 Vollmer 2026 Kamal 2022 Hayashi 2024 van der Hooft 2005 Verma 2021 Vaidya 2024 Movva 2026 Li 2026 Farrin 2026 Durg 2020 Andallu 2000 Della Porta 2023 Javid 2026
Sleep Recovery	Biological association	Low certainty	Studied for: Sleep quality Studied for: Insomnia (diagnosed)	Cheah 2021 Fatima 2024 Marchi 2025 Baune 2026 Deshpande 2020 Kelgane 2020 Obhrai 2026 Mahadevan 2025 Thanawala 2026 Pérez-Piñero 2024 O'Connor 2022 McKinney 2026 Langade 2021 Langade 2019 Movva 2026 Saxena 2026 Kulkarni 2026 Park 2023 Kaushik 2017 National Center for Complementary and Integrative Health (NCCIH) 2023 Honnutagi 2026 Atul 2020 Mastrofini 2026 Gopal 2021 Vani 2025 Pingali 2025 Wankhede 2015 Coope 2025 Coope 2026 Prajapati 2026 Gierczuk 2025
Metabolism Weight	Biological association	Very low certainty	Studied for: Stress-related eating and food cravings Studied for: Body weight and body composition	Choudhary 2017 Pakhale 2025 O'Connor 2022 Quinones 2025 Ballesteros-Torres 2025 Obhrai 2026 Charmas 2025 Zhu 2026 Farrin 2026 Durg 2020 Andallu 2000 Salve 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Pattojoshi 2026 Raut 2012
Reproductive System	Biological association	Low certainty	Studied for: Testosterone in men Studied for: Semen quality and male infertility	Fornalik 2026 Zhu 2026 Smith 2021 Lopresti 2019 Lopresti 2019 Chauhan 2022 Wankhede 2015 Thanawala 2026 Vaidya 2026 Salve 2026 Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Durg 2018 Ambiye 2013 Ahmad 2010 Gupta 2013 Khanna 2026 Mutha 2025 Roy 2026 Nasimi Doost Azgomi 2018 Mamidi 2011 Dongre 2015 Ajgaonkar 2022 Gopal 2021 Vani 2025 Pingali 2025 Obhrai 2026
Musculoskeletal System	Biological association	Low certainty	Studied for: Muscle strength and size with resistance training Studied for: Muscle recovery and exercise stress markers	Wankhede 2015 Ziegenfuss 2018 Verma 2023 Lee 2026 Li 2026 Zhu 2026 Bonilla 2021 Coope 2025 Ewa 2025 Charmas 2025 Gierczuk 2025 Thanawala 2026 Coope 2026 Prajapati 2026 Pérez-Gómez 2020 Choudhary 2015 Tiwari 2021 Sandhu 2010 Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026 Kumar 2015 Vaidya 2026 Salve 2026
Cardiovascular System	Biological association	Low certainty	Studied for: Aerobic fitness and VO2max Studied for: Blood fats: triglycerides and cholesterol	Pérez-Gómez 2020 Li 2026 Choudhary 2015 Tiwari 2021 Verma 2023 Prajapati 2026 Thanawala 2026 Ewa 2025 Gierczuk 2025 Sandhu 2010 Ballesteros-Torres 2025 Pattojoshi 2026 Raut 2012 Andallu 2000 Charmas 2025 Salve 2026 Raut 2024 Vaidya 2026 Pingali 2025 Devpura 2021 Chitre 2023 KrishnaRaju 2023 Verma 2021 National Center for Complementary and Integrative Health (NCCIH) 2023
Immune System	Biological association	Very low certainty	Studied for: Inflammation: CRP, IL-6 and TNF-alpha Studied for: Immune markers and immune function	Raut 2024 Vaidya 2026 Pingali 2025 Devpura 2021 Chitre 2023 KrishnaRaju 2023 Mikolai 2009 Chopra 2026 Kumar 2018 National Center for Complementary and Integrative Health (NCCIH) 2023 Singh 2023 Tiwari 2021 Majeed 2023 Ahmad 2010
Respiratory System	Biological association	Not enough evidence	Studied for: COVID-19	Singh 2023 Devpura 2021 Chitre 2023 Chopra 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Integumentary System	Biological association	Very low certainty	Studied for: Skin and hair	Narra 2023 Jillella 2026

C. Body parts and organs

Connected to	Kind of connection	Evidence status	Context	Studies
Liver	Adverse effect or risk	Low certainty	Idiosyncratic cholestatic or mixed liver injury, jaundice and itching 2-12 weeks after starting; deaths in people with cirrhosis. Safety relationship, not a benefit. No frequency known. Preparation or compound: Root and unspecified extracts; mostly products where plant part was not stated	Björnsson 2020 Philips 2023 McIntyre 2026 TGA (Australia) 2026
Liver	Contraindication	Low certainty	People with existing liver disease should avoid it (TGA, scoping review). Preparation or compound: All forms	Philips 2023 McIntyre 2026 TGA (Australia) 2026
Thyroid	Adverse effect or risk	Low certainty	Raised T4 in a 23-trial meta-analysis; case reports of thyrotoxicosis and painless thyroiditis that resolved on stopping. Preparation or compound: Root extracts and unspecified	Fornalik 2026 Hayashi 2024 van der Hooft 2005 Gannon 2014
Thyroid	Drug or supplement interaction	Very low certainty	Possible additive effect with thyroid hormone medicines; no direct trial. Preparation or compound: Unspecified	National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Thyroid	Contraindication	Low certainty	NCCIH does not recommend it with thyroid disorders. Preparation or compound: All forms	National Center for Complementary and Integrative Health (NCCIH) 2023
Adrenal glands	Adverse effect or risk	Very low certainty	One case of HPA-axis suppression needing hydrocortisone. Preparation or compound: About 950 mg/day for over a year	Javid 2026
Nervous system	Adverse effect or risk	Low certainty	Drowsiness; single reports of dystonia and neurotoxicity; possible withdrawal-type symptoms. Preparation or compound: Unspecified	National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Holzman 2025
Nervous system	Drug or supplement interaction	Very low certainty	Possible additive sedation with benzodiazepines, barbiturates and anticonvulsants (lab and animal evidence). Preparation or compound: Unspecified	Memorial Sloan Kettering Cancer Center 2026
Gut	Adverse effect or risk	Moderate certainty	Nausea, stomach upset, diarrhea; rates similar to placebo in trials (nausea 2.0% vs 3.2%). Preparation or compound: Standardised root extract 125-600 mg/day	Pakhale 2026 Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Kidneys	Contraindication	Very low certainty	Kidney dysfunction listed as a higher-risk group by a review; transplant rejection case. No kidney-disease trials. Preparation or compound: Unspecified	Li 2026 Sriperumbuduri 2020
Reproductive organs	Adverse effect or risk	Not enough evidence	Danish agency cites effects on sex hormones and reproduction; human trials in the reviews found none; animal studies show no reproductive toxicity at human-relevant doses. Preparation or compound: Root	Patwardhan 2024 Tallon 2026 Kalaiselvan 2025
Blood vessels	Drug or supplement interaction	Not enough evidence	NCCIH names blood pressure medicines; no data found. Preparation or compound: Unspecified	National Center for Complementary and Integrative Health (NCCIH) 2023

D. Symptoms

Connected to	Kind of connection	Evidence status	Context	Studies
Difficulty sleeping	Potential benefit	Low certainty	Sleep questionnaires and actigraphy improved in several trials.	Kaushik 2017 Langade 2019 Kelgane 2020 Deshpande 2020 Langade 2021 Cheah 2021 Atul 2020 O'Connor 2022 Park 2023 Fatima 2024 Pérez-Piñero 2024 Mahadevan 2025 Marchi 2025 McKinney 2026 Honnutagi 2026 Thanawala 2026 Saxena 2026 Movva 2026 Baune 2026 Kulkarni 2026 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Fatigue	Potential benefit	Very low certainty	Less fatigue in a few small trials.	Biswal 2013 Smith 2023 Leonard 2024 Kale 2026 Coope 2026 Saxena 2026 Lopresti 2026
Anxious feelings	Potential benefit	Low certainty	Lower anxiety scores in most trials; high variation.	Andrade 2000 Pratte 2014 Lopresti 2019 Langade 2019 Langade 2021 Zhang 2022 Baker 2022 Akhgarjand 2022 Majeed 2023 Fatima 2024 Mishra 2024 Arumugam 2024 Pages-García 2024 Mahadevan 2025 Marchi 2025 Alsanie 2026 McKinney 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Low sexual desire	Potential benefit	Low certainty	Small trials in men and women reported better desire scores.	Mamidi 2011 Dongre 2015 Lopresti 2019 Chauhan 2022 Ajgaonkar 2022 Mutha 2025 Khanna 2026
Menopause symptoms	Potential benefit	Low certainty	Lower symptom scores in four small trials.	Gopal 2021 Pingali 2025 Vani 2025 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Joint pain and stiffness	Potential benefit	Low certainty	One 12-week trial of a root-and-leaf extract in knee pain.	Kumar 2015 Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026

E. Health conditions

Connected to	Kind of connection	Evidence status	Context	Studies
Insomnia	Potential benefit	Low certainty	Two trials in people diagnosed with insomnia. A symptom study, not a proven treatment.	Langade 2019 Langade 2021 Cheah 2021 Atul 2020 Fatima 2024 Movva 2026 Kulkarni 2026
Generalized anxiety disorder and OCD (add-on)	Potential benefit	Very low certainty	Two small trials added it to SSRIs. Not a substitute for treatment.	Cooley 2009 Andrade 2000 Jahanbakhsh 2016 Fuladi 2021 Marchi 2025
Mild cognitive impairment	Potential benefit	Very low certainty	Two small pilot trials.	Choudhary 2017 Ng 2020 Rai 2025
Male infertility (low sperm count)	Potential benefit	Low certainty	Small trials measured sperm count and movement, not pregnancies.	Ahmad 2010 Gupta 2013 Ambiye 2013 Nasimi Doost Azgomi 2018 Durg 2018 Mutha 2025 Roy 2026 Khanna 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Subclinical hypothyroidism	Potential benefit	Very low certainty	One 50-person pilot trial. See thyroid safety.	Gannon 2014 Sharma 2018 Vollmer 2026 Fornalik 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Hyperthyroidism (thyrotoxicosis)	Adverse effect or risk	Low certainty	Case reports of an overactive thyroid after use. A safety relationship.	van der Hooft 2005 Gannon 2014 Verma 2021 Kamal 2022 Vaidya 2024 Hayashi 2024 Li 2026 Fornalik 2026 Movva 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Knee osteoarthritis and rheumatoid arthritis	Potential benefit	Low certainty	Small studies; not a replacement for treatment.	Kumar 2015 Ramakanth 2016 Yan 2025 Yousefi-Mohammadabad 2026

F. Functional actions

Connected to	Kind of connection	Evidence status	Context	Studies
Adaptogenic (traditional and marketing term)	Traditional use	Not enough evidence	"Adaptogen" is not a regulated or clinical category.
Sleep regulation	Preliminary mechanism	Very low certainty	Proposed via GABA pathways in animal and lab work. Not proven in people.

G. Root causes and contributing factors

Connected to	Kind of connection	Evidence status	Context	Studies
Chronic stress	Potential benefit	Low certainty	Studied in adults with self-reported stress.	Chandrasekhar 2012 Pratte 2014 Choudhary 2017 Lopresti 2019 Salve 2019 Speers 2021 Remenapp 2022 Baker 2022 O'Connor 2022 Akhgarjand 2022 Smith 2023 Majeed 2023 Pandit 2024 Mishra 2024 Arumugam 2024 Albalawi 2025 Mahadevan 2025 Marchi 2025 Coope 2026 Alsanie 2026 McKinney 2026 West 2026 Thanawala 2026 Łuszczak 2026 Pakhale 2026 Pattojoshi 2026 Baune 2026 Lopresti 2026 Mastrofini 2026 Alyami 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Poor sleep	Potential benefit	Low certainty	Studied for sleep quality.	Kaushik 2017 Langade 2019 Kelgane 2020 Deshpande 2020 Langade 2021 Cheah 2021 O'Connor 2022 Park 2023 Fatima 2024 Pérez-Piñero 2024 Mahadevan 2025 Marchi 2025 McKinney 2026 Honnutagi 2026 Thanawala 2026 Saxena 2026 Movva 2026 Baune 2026 Kulkarni 2026 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Oxidative stress	Biological association	Very low certainty	Some trials reported better antioxidant markers; others no difference. Speculative as a cause.	Ahmad 2010 Tiwari 2021 Majeed 2023 Pingali 2025
Inflammation	Preliminary mechanism	Very low certainty	Lower CRP or cytokines in some small trials. Not shown to improve health.	Devpura 2021 Chitre 2023 KrishnaRaju 2023 Raut 2024 Pingali 2025 Vaidya 2026

H. Lifestyle and habits

Connected to	Kind of connection	Evidence status	Context	Studies
Resistance training	Potential benefit	Low certainty	Trials added ashwagandha to a weight-training programme.	Wankhede 2015 Ziegenfuss 2018 Bonilla 2021 Verma 2023 Coope 2025 Ewa 2025 Gierczuk 2025 Charmas 2025 Coope 2026 Prajapati 2026 Zhu 2026 Li 2026 Lee 2026 Thanawala 2026

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
ALT	Adverse effect or risk	Low certainty	Raised ALT and bilirubin in injury cases (for example ALT peak 315 IU/L in one report); no differences vs placebo in an 8-week trial of 1,002 people. Preparation or compound: Unspecified	Almuzghi 2024 Pakhale 2026
AST	Adverse effect or risk	Low certainty	Raised in liver injury cases; stable in short trials. Preparation or compound: Unspecified	Lubarska 2023 Pakhale 2026
Cortisol	Adverse effect or risk	Very low certainty	Lowering is a measured trial effect; the safety concern is lasting suppression with long high-dose use (one case). Preparation or compound: Unspecified	Javid 2026 Fornalik 2026
TSH	Biological association	Mixed findings	No overall effect on TSH in a meta-analysis; improved in a small subclinical hypothyroidism trial; not a safety finding on its own. Preparation or compound: Unspecified	Fornalik 2026 Sharma 2018
Testosterone	Contraindication	Low certainty	Raised in men; reason to avoid with hormone-sensitive prostate cancer. Preparation or compound: Unspecified	Fornalik 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Blood glucose	Drug or supplement interaction	Very low certainty	Modest average fall in fasting glucose; possible additive effect with diabetes medicines. Preparation or compound: Unspecified	Farrin 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Cortisol	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Chandrasekhar 2012 Lopresti 2019 Salve 2019 Lopresti 2022 Remenapp 2022 Gopukumar 2021 Majeed 2023 Della Porta 2023 Mishra 2024 Arumugam 2024 Albalawi 2025 Mahadevan 2025 Coope 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Lopresti 2026 Alyami 2026 Fornalik 2026 Javid 2026 Lopresti 2019
DHEA-sulphate (DHEA-S)	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Lopresti 2019
Heart rate variability (HRV)	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Smith 2023 Mahadevan 2025
Serotonin	Biological association	Very low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Majeed 2023 Majeed 2024
Brain-derived neurotrophic factor (BDNF)	Biological association	Not enough evidence	Measured in trials: no-change. A lab change is not the same as a health benefit.	Gopukumar 2021
C-reactive protein (CRP) and S100B	Biological association	Very low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Chengappa 2018
Salivary alpha-amylase and chromogranin A	Biological association	Low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Mahadevan 2025 Lopresti 2026
Nitric oxide, glutathione and malondialdehyde	Biological association	Very low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Majeed 2023
Testosterone (total, free, salivary)	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Fornalik 2026 Lopresti 2019 Chauhan 2022 Wankhede 2015 Lopresti 2019 Thanawala 2026 Vaidya 2026 Gopal 2021 Coope 2026
Luteinizing hormone (LH)	Biological association	Low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Ahmad 2010 Durg 2018 Gopal 2021 Vani 2025
Follicle-stimulating hormone (FSH)	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Ahmad 2010 Gopal 2021 Vani 2025
DHEA-S (dehydroepiandrosterone sulfate)	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Lopresti 2019 Lopresti 2019
Prolactin	Biological association	Very low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Chauhan 2022 Ahmad 2010
Estradiol	Biological association	Low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Gopal 2021 Vani 2025 Fornalik 2026 Lopresti 2019
Progesterone	Biological association	Very low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Vani 2025
Sperm concentration / count	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Ambiye 2013 Durg 2018 Khanna 2026 Mutha 2025
Semen volume	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Ambiye 2013 Khanna 2026 Mutha 2025
Sperm motility	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Ambiye 2013 Durg 2018 Khanna 2026
TSH (thyroid-stimulating hormone)	Biological association	Mixed findings	Measured in trials: mixed. A lab change is not the same as a health benefit.	Sharma 2018 Fornalik 2026 Verma 2021 Kamal 2022 Gannon 2014
T3 (triiodothyronine)	Biological association	Low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Fornalik 2026 Sharma 2018
T4 (thyroxine)	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Fornalik 2026 Sharma 2018 Gannon 2014 Movva 2026
Creatine kinase (CK/CPK)	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Wankhede 2015 Prajapati 2026
Maximal strength (1-RM bench and leg press)	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Wankhede 2015 Ziegenfuss 2018 Lee 2026 Ewa 2025
VO2max	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	Pérez-Gómez 2020 Choudhary 2015 Tiwari 2021 Ewa 2025
Body weight and BMI	Biological association	Mixed findings	Measured in trials: mixed. A lab change is not the same as a health benefit.	Pakhale 2025 Ballesteros-Torres 2025 Zhu 2026
Body fat percentage	Biological association	Mixed findings	Measured in trials: mixed. A lab change is not the same as a health benefit.	Wankhede 2015 Obhrai 2026 Lee 2026 Zhu 2026
Fasting blood glucose	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Farrin 2026 Andallu 2000 Salve 2026
HbA1c	Biological association	Very low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	Farrin 2026
Triglycerides (and VLDL)	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Ballesteros-Torres 2025 Pattojoshi 2026 Charmas 2025
Total and LDL cholesterol	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Raut 2012 Andallu 2000 Charmas 2025 Pattojoshi 2026
High-sensitivity C-reactive protein (hs-CRP)	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Vaidya 2026 Pingali 2025 Raut 2024 Devpura 2021
Interleukin-6 (IL-6)	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Raut 2024 Chitre 2023 Devpura 2021
TNF-alpha	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Raut 2024 Devpura 2021 KrishnaRaju 2023
Lymphocyte markers (CD3, CD4, CD8, NK/CD56)	Biological association	Not enough evidence	Measured in trials: raised. A lab change is not the same as a health benefit.	Mikolai 2009 Vaidya 2026 Kumar 2018
NT-proBNP and blood pressure	Biological association	Not enough evidence	Measured in trials: mixed. A lab change is not the same as a health benefit.	Vaidya 2026 Pattojoshi 2026 Verma 2021
Bone turnover markers (CTX, bone ALP, RANKL, osteoprotegerin)	Biological association	Very low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	Pingali 2025 Obhrai 2026
Oxidative stress markers (MDA, glutathione, nitric oxide, antioxidant level)	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	Pingali 2025 Tiwari 2021 Majeed 2023 Ahmad 2010

J. Genes, receptors and enzymes

Connected to	Kind of connection	Evidence status	Context	Studies
IKBKB (IKK beta)	Preliminary mechanism	In vitro	Withaferin A binds Cys179 and inhibits NF-kB activation	Heyninck 2014
GABA-A receptor	Preliminary mechanism	Animal	Potentiated by root-derived ferulate ester; receptor expression raised in rodents	Sonar 2019 Park 2023 Murthy 2022
Histamine H3 receptor	Preliminary mechanism	In vitro	Expression raised by extract in rat glioma cells	Murthy 2022
Glucocorticoid receptor (NR3C1)	Preliminary mechanism	In vitro	Identified as possible target of withanolide A, no direct binding shown	Crane 2019
Acetylcholinesterase / butyrylcholinesterase	Preliminary mechanism	In vitro	Inhibited by withanolides in test tubes at micromolar levels	Choudhary 2005
GSK-3 beta and TTBK1	Preliminary mechanism	Theory	Computer-predicted binding only	J 2026
CYP3A4 (metabolism; induction by extract in cells)	Preliminary mechanism	In vitro	Affects potential drug interactions	Singh 2021 Kumar 2021
CYP2B6 (inhibition by extracts)	Preliminary mechanism	In vitro	Potential drug interaction signal	Kumar 2021
CYP1A2	Preliminary mechanism	In vitro	Metabolises withanone; no inhibition by Withania in one study	Singh 2021 Savai 2015
PDE4D	Preliminary mechanism	In vitro	Reported inhibition by withanolides (review statement)	Such 2026

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
NF-kB signalling	Preliminary mechanism	In vitro	Anti-inflammatory effects of withaferin A in cells and animal models	Logie 2020 Heyninck 2014
Nrf2 / KEAP1 antioxidant response	Preliminary mechanism	Animal	Induction by withaferin A; protection against acetaminophen liver injury in mice	Palliyaguru 2016 Logie 2020
PTEN/PI3K/AKT	Preliminary mechanism	Animal	Part of the Keap1-independent route to Nrf2 activation	Palliyaguru 2016
HPA axis (cortisol)	Preliminary mechanism	Human	Proposed route for stress effects; cortisol outcomes come from human trials covered elsewhere	Such 2026 Wiciński 2023
HPT axis (thyroid)	Preliminary mechanism	Human	T3/T4/TSH changes reported; mechanism proposed	Wiciński 2023
Withanolide biosynthesis (sterol pathway; WsDWF5)	Preliminary mechanism	In vitro	Plant-side genes; silencing of sterol delta7-reductase affects the withanolide backbone	Gupta 2015 Narayanan 2024

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Withaferin A	Biological association	In vitro	Binds protein cysteines (IKK beta Cys179, Keap1/Nrf2 pathway, vimentin and others); anti-inflammatory and cytotoxic in cells and animals; oral bioavailability 1.8% in mice; the focus of leaf-safety concern. Preparation or compound: Leaf richer; also present at lower level in root; quantity varies strongly by chemotype	Heyninck 2014 Bailly 2024 Logie 2020 Palliyaguru 2016 Gupta 2022 Speers 2026 Vaidya 2024 Dutta 2026
Withanolide A	Biological association	In vitro	Promoted axon outgrowth in cultured neurons; no direct glucocorticoid-receptor effect shown; docking-only AChE suggestions. Preparation or compound: Root	Kuboyama 2002 Crane 2019 Vaidya 2024
Withanolide D	Biological association	In vitro	Frequently named as a key active along with withaferin A in reviews; most evidence is cell-based. Preparation or compound: Root and leaf (sources differ)	Bashir 2023 Dutta 2026
Withanoside IV	Biological association	In vitro	Dendrite outgrowth in cultured neurons; converted to sominone (aglycone) found in human urine; glycoside content linked to much higher bioavailability of the whole extract. Preparation or compound: Root (withanosides reported exclusively in roots)	Kuboyama 2002 Speers 2026 Kim 2023 Rathi 2025 Kumar 2023
Withanoside V	Biological association	In vitro	Little activity data in sources read. Preparation or compound: Root	Vaidya 2024
Withanoside VI	Biological association	In vitro	Dendrite outgrowth in cultured neurons. Preparation or compound: Root	Kuboyama 2002
Withanone	Biological association	In vitro	Metabolised by CYP3A4 and CYP1A2 in liver microsomes, highly protein bound (82-88%), no CYP inhibition in vitro. Preparation or compound: Leaf (and fruit per one review table)	Singh 2021 Kumar 2023
12-Deoxywithastramonolide	Biological association	In vitro	Little pharmacology in sources read. Preparation or compound: Root	Vaidya 2024 Sharma 2025
Withanolide B	Biological association	Animal	Measured in rodent pharmacokinetic work. Preparation or compound: Root	Speers 2024
Withanolide E	Biological association	Theory	Named in reviews; no data read. Preparation or compound: Leaf	Bashir 2023
Withastramonolide	Biological association	Theory	Parent name of 12-deoxy analogue; no data read. Preparation or compound: Not stated	Bashir 2023
2,3-Dihydrowithaferin A	Biological association	In vitro	Possible contributor to CYP2B6 inhibition (inferred by authors). Preparation or compound: Not stated	Kumar 2021
Dihydrowithaferin A sulfate	Biological association	In vitro	Used as a marker of leaf material in product testing. Preparation or compound: Leaf	Avula 2026
Sitoindoside IX (sitoindosides VII-X)	Biological association	Theory	Reviews attribute antioxidant and 'adaptogenic' effects to sitoindosides; I found no human data. Preparation or compound: Root	Bashir 2023
Docosanyl ferulate (long-chain ferulic acid esters)	Biological association	In vitro	Potentiated GABA-A inhibitory currents (IC50 7.9 uM) in cells; the GABA-active principle found in a root extract was an ester, not a withanolide. Preparation or compound: Root	Sonar 2019
Somniferine and other alkaloids (anaferine, isopelletierine)	Biological association	Theory	Isopelletierine tentatively detected by LC-MS in root extracts; no pharmacology read. Preparation or compound: Root	Kumar 2021 Paul 2021
Flavonoids and phenolic acids (e.g. salvigenin)	Biological association	In vitro	Tentatively identified by LC-MS; present among minor constituents. Preparation or compound: Root and leaf	Kumar 2021 Mukherjee 2021

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 24, 2026).

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Hormonal 13

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Cortisol

Lowered in trials

The body's main stress hormone, made by the adrenal glands, highest in the morning. It can be measured in blood (serum), saliva, urine or hair.

Low certainty

Results and what it means

Why it was measured

Used as an objective marker of stress-axis (HPA) activity in stress trials.

Statistical vs. clinical meaning

Cortisol lowering is the most consistent biological finding, seen in multiple trials and meta-analyses. It is statistically clear but only about 1 to 3 ug/dL on average; whether that matters clinically is unknown, and several trials with lower cortisol found no change in perceived stress (Albalawi 2025). A few trials found no cortisol effect or lowering in placebo too. Reference ranges depend on lab and time of day and are not given here.

Safety implication

Lowering cortisol could matter for people with adrenal insufficiency or on steroid medicines; no study measured adrenal function (Della Porta 2023).

Study	Result	People	Product
Chandrasekhar 2012	Serum cortisol lower than placebo (P=0.0006) at day 60	64 adults with chronic stress	300 mg root extract twice daily
Lopresti 2019	Morning cortisol reduced vs placebo (P<0.001)	60 stressed adults	Shoden 240 mg/day
Salve 2019	Serum cortisol reduced vs placebo at both doses (P<0.05 and P<0.0001)	60 stressed adults	Root extract 250 and 600 mg/day (as stated)
Majeed 2023	Greater reduction in morning salivary cortisol vs placebo (value not in abstract)	54 adults with mild-moderate stress	500 mg with piperine
Mishra 2024	Morning serum cortisol -66% (60 mg) and -67% (120 mg) vs -2.22% on placebo	60 adults with GAD criteria and high cortisol	Shoden 60 or 120 mg/day
Gopukumar 2021	Serum cortisol lower vs placebo (p=0.0443)	130 stressed adults	Sustained-release root extract 300 mg/day
Pattojoshi 2026	Cortisol fell 28.99% in the active group	60 patients with stress, anxiety and hypertension	Ashwagen 600 mg/day
Lopresti 2026	Salivary cortisol stable on ashwagandha vs rise on placebo during stress test (p=0.047)	60 stressed adults	Ashwa.30 30 mg/day
Coope 2026	Salivary cortisol rose significantly on placebo in females; stabilised on ashwagandha	56 team-sport athletes	600 mg/day
Thanawala 2026	Serum cortisol significantly reduced at day 60 with 300 mg (P<.05); abstract does not say vs placebo	135 stressed adults	AshwaSR 150 or 300 mg
Mahadevan 2025	NO significant difference in serum cortisol or salivary alpha-amylase vs placebo	90 adults with mild-moderate stress	Zenroot 125 mg/day
West 2026	Serum cortisol fell significantly in all groups including placebo	141 adults with moderate stress/anxiety	Root extract 600 mg/day or proprietary extract
Remenapp 2022	Salivary cortisol fell over time in ashwagandha groups, significant only for 225 mg/day; no group effect	60 stressed adults	NooGandha 225 or 400 mg/day
Arumugam 2024	Pooled serum cortisol MD -2.58 (CI -4.99 to -0.16), units not stated in abstract	9 RCTs	Various
Albalawi 2025	Pooled cortisol -1.16 ug/dL (CI -1.64 to -0.69)	7 RCTs	Various
Alyami 2026	Pooled cortisol -3.27 ug/dL	Ashwagandha RCTs in review	30-600 mg/day
Lopresti 2022	Most consistent HPA finding across plants was a morning cortisol-lowering effect of ashwagandha	52 RCTs of plants	Various
Della Porta 2023	Reviewers: WS supplementation decreases cortisol; adrenal function not studied	9 studies	Various

Chandrasekhar 2012 Lopresti 2019 Salve 2019 Lopresti 2022 Remenapp 2022 Gopukumar 2021 Majeed 2023 Della Porta 2023 Mishra 2024 Arumugam 2024 Albalawi 2025 Mahadevan 2025 Coope 2026 West 2026 Thanawala 2026 Pattojoshi 2026 Lopresti 2026 Alyami 2026

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DHEA-sulphate (DHEA-S)

Lowered in trials

A hormone made by the adrenal glands that is converted into sex hormones; levels fall with age and some stress states.

Very low certainty

Results and what it means

Why it was measured

Measured alongside cortisol to see how the adrenal stress response changes.

Statistical vs. clinical meaning

Only one placebo-controlled trial reports DHEA-S. DHEA-S fell with ashwagandha, the opposite of what some would expect from an 'anti-aging' supplement; its meaning is unknown.

Safety implication

Unknown; one trial only.

Study	Result	People	Product
Lopresti 2019	DHEA-S fell more than placebo (P=0.004) in 60 stressed adults; direction was a reduction	60 stressed adults	Shoden 240 mg/day for 60 days

Lopresti 2019

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Testosterone (total, free, salivary)

Raised in trials

The main male sex hormone; also present in lower amounts in women. Measured in blood or saliva.

Low certainty

Results and what it means

Why it was measured

Ashwagandha is marketed for male vitality and fertility.

Statistical vs. clinical meaning

Statistically significant rises in several trials and pooled analyses, but several trials show no difference from placebo; an increase within the normal range is a lab change, not a proven health benefit.

Safety implication

NCCIH advises people with hormone-sensitive prostate cancer to avoid ashwagandha because it may raise testosterone.

Study	Result	People	Product
Fornalik 2026	Men: MD 57.43 ng/dl higher than placebo; women MD 5.09 ng/dl, with a significant sex difference	Adults, 23 RCTs (1,706)	Oral ashwagandha vs placebo
Lopresti 2019	Salivary testosterone 14.7% greater increase than placebo (p=.010)	Overweight men 40-70	Shoden 21 mg withanolide glycosides/day, 8 weeks
Chauhan 2022	Serum testosterone higher than placebo; difference -66.52 (CI -80.70 to -52.34) as reported	Men with low desire	300 mg twice daily, 8 weeks
Wankhede 2015	+96.2 vs +18.0 ng/dL (p=0.004)	Beginner weight-trainers, men	300 mg twice daily, 8 weeks
Lopresti 2019	Rose in males (p=.038) but not significantly different from placebo (p=.158); no change in females	Stressed adults	Shoden 240 mg/day, 60 days
Thanawala 2026	Increased within ashwagandha group in men (+121.43 ng/dL, p=0.024) but similar to placebo (p>0.05)	Recreationally active adults	AshwaSR 300 mg/day, 90 days
Vaidya 2026	+15.7% in men in the ashwagandha group	Healthy adults 50-70	200 mg twice daily, 180 days
Gopal 2021	No between-group difference	Perimenopausal women	300 mg twice daily, 8 weeks
Coope 2026	Increases stayed within physiological ranges	Healthy adults, 23 studies	Standardised root extracts

Fornalik 2026 Lopresti 2019 Chauhan 2022 Wankhede 2015 Lopresti 2019 Thanawala 2026 Vaidya 2026 Gopal 2021 Coope 2026

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Luteinizing hormone (LH)

Mixed results in trials

A pituitary hormone that signals the testes to make testosterone and the ovaries to ovulate.

Low certainty

Results and what it means

Why it was measured

Used to understand whether hormone changes come from brain signals.

Statistical vs. clinical meaning

Direction differs by sex and state (raised in infertile men, lowered in menopausal women); small trials.

Safety implication

None identified.

Study	Result	People	Product
Ahmad 2010	LH increased after treatment	Infertile men	Withania somnifera root (no placebo group)
Durg 2018	Serum LH +34% in the one RCT	Oligospermic men	675 mg/day, 90 days
Gopal 2021	LH lower than placebo (p<0.05)	Perimenopausal women	300 mg twice daily, 8 weeks
Vani 2025	LH lower than placebo (p<0.001)	Women 45-55	8 weeks

Ahmad 2010 Durg 2018 Gopal 2021 Vani 2025

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Follicle-stimulating hormone (FSH)

Lowered in trials

A pituitary hormone that drives sperm production in men and egg follicle growth in women; rises after menopause.

Low certainty

Results and what it means

Why it was measured

A marker in menopause and male fertility.

Statistical vs. clinical meaning

Consistent direction in small trials.

Safety implication

None identified.

Study	Result	People	Product
Ahmad 2010	FSH reduced after treatment	Infertile men	Root (no placebo group)
Gopal 2021	FSH lower than placebo (p<0.0001)	Perimenopausal women	300 mg twice daily, 8 weeks
Vani 2025	FSH lower than placebo (p<0.001)	Women 45-55	8 weeks

Ahmad 2010 Gopal 2021 Vani 2025

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DHEA-S (dehydroepiandrosterone sulfate)

Mixed results in trials

An adrenal hormone that is a building block for sex hormones.

Very low certainty

Results and what it means

Why it was measured

Linked to stress response and aging.

Statistical vs. clinical meaning

Opposite directions in two trials; unclear what drives it.

Safety implication

None identified.

Study	Result	People	Product
Lopresti 2019	DHEA-S rose 18% more than placebo (p=.005)	Overweight men 40-70	Shoden, 8 weeks
Lopresti 2019	DHEA-S fell more than placebo (p=.004)	Stressed adults	Shoden 240 mg/day, 60 days

Lopresti 2019 Lopresti 2019

●

Prolactin

No clear change in trials

A pituitary hormone; high levels can lower sex drive and fertility.

Very low certainty

Results and what it means

Why it was measured

Related to male sexual function.

Statistical vs. clinical meaning

One null controlled trial, one uncontrolled decrease.

Safety implication

None identified.

Study	Result	People	Product
Chauhan 2022	No change in either group (difference -1.06, CI -2.78 to 0.66)	Men with low desire	300 mg twice daily, 8 weeks
Ahmad 2010	Prolactin reduced after treatment	Infertile men	Root (no placebo group)

Chauhan 2022 Ahmad 2010

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Estradiol

Mixed results in trials

The main estrogen.

Low certainty

Results and what it means

Why it was measured

Menopause and hormone balance.

Statistical vs. clinical meaning

Rose in two menopause trials but not in the pooled analysis across all trials.

Safety implication

Not assessed in hormone-sensitive cancers.

Study	Result	People	Product
Gopal 2021	Serum estradiol higher than placebo (p<0.0001)	Perimenopausal women	300 mg twice daily, 8 weeks
Vani 2025	Estradiol higher than placebo (p<0.001)	Women 45-55	8 weeks
Fornalik 2026	No effect in either sex	Adults, 23 RCTs	Oral ashwagandha
Lopresti 2019	No between-group difference	Overweight men	Shoden, 8 weeks

Gopal 2021 Vani 2025 Fornalik 2026 Lopresti 2019

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Progesterone

Raised in trials

A female sex hormone, important after ovulation.

Very low certainty

Results and what it means

Why it was measured

Menopause trial endpoint.

Statistical vs. clinical meaning

One trial.

Safety implication

None identified.

Study	Result	People	Product
Vani 2025	Higher than placebo (p<0.001)	Women 45-55	8 weeks

Vani 2025

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TSH (thyroid-stimulating hormone)

Mixed results in trials

A pituitary hormone that tells the thyroid to work; high TSH suggests an underactive thyroid, very low TSH an overactive one.

Mixed findings

Results and what it means

Why it was measured

Used to screen for thyroid effects of ashwagandha.

Statistical vs. clinical meaning

No effect in healthy people; improvement in one pilot in subclinical hypothyroidism; low TSH in case reports.

Safety implication

People with thyroid disease or on thyroid medicine should consult a clinician (NCCIH).

Study	Result	People	Product
Sharma 2018	Improved vs placebo (p<0.001)	Subclinical hypothyroid adults (TSH 4.5-10)	600 mg/day, 8 weeks
Fornalik 2026	No effect	Adults, 23 RCTs	Oral ashwagandha
Verma 2021	No significant change	Healthy adults	300 mg twice daily, 8 weeks
Kamal 2022	Significantly low TSH with thyrotoxicosis	73-year-old woman	About 2 years of use
Gannon 2014	One treated patient with subclinical hypothyroidism normalised; one placebo patient moved to subclinical hypothyroid	Bipolar trial subgroup	8 weeks

Sharma 2018 Fornalik 2026 Verma 2021 Kamal 2022 Gannon 2014

●

T3 (triiodothyronine)

No clear change in trials

The active thyroid hormone.

Low certainty

Results and what it means

Why it was measured

Thyroid safety screening.

Statistical vs. clinical meaning

Pooled no effect; single pilot positive.

Safety implication

See thyroid safety.

Study	Result	People	Product
Fornalik 2026	No effect	Adults, 23 RCTs	Oral ashwagandha
Sharma 2018	Improved vs placebo (p=0.0031)	Subclinical hypothyroid adults	600 mg/day, 8 weeks

Fornalik 2026 Sharma 2018

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T4 (thyroxine)

Raised in trials

The main hormone made by the thyroid; converted to T3.

Low certainty

Results and what it means

Why it was measured

Thyroid safety screening.

Statistical vs. clinical meaning

Modest rise across analyses; clinical meaning unclear.

Safety implication

Rise may matter in people with hyperthyroid tendency or on levothyroxine.

Study	Result	People	Product
Fornalik 2026	MD 0.61 ug/dL higher (p=0.02)	Adults, 23 RCTs	Oral ashwagandha
Sharma 2018	Improved vs placebo (p=0.0096)	Subclinical hypothyroid adults	600 mg/day, 8 weeks
Gannon 2014	T4 rose 7%, 12%, 24% in 3 treated patients; fell 4-23% in 6 of 7 on placebo	Bipolar trial subgroup	8 weeks
Movva 2026	Small changes in thyroid parameters within reference ranges	Healthy adults	2000 mg/day, 12 weeks

Fornalik 2026 Sharma 2018 Gannon 2014 Movva 2026

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Cortisol

Lowered in trials

The main stress hormone made by the adrenal glands.

Low certainty

Results and what it means

Why it was measured

Cross-cutting marker for the stress mechanism and adrenal safety.

Statistical vs. clinical meaning

Reductions are consistent in stress trials but not all measures; clinical meaning of a lab drop is unclear.

Safety implication

Reports of adrenal suppression with prolonged use at high dose.

Study	Result	People	Product
Fornalik 2026	SMD -1.18 (p<0.04 as reported)	Adults, 23 RCTs	Oral ashwagandha
Della Porta 2023	Decreased in 9 studies; adrenal function not evaluated	Stressed adults	Various
Javid 2026	Low basal cortisol and weak ACTH response	Woman, ~950 mg/day for over 1 year	Case report
Lopresti 2019	No difference vs placebo (salivary)	Overweight men	Shoden, 8 weeks

Fornalik 2026 Della Porta 2023 Javid 2026 Lopresti 2019

Metabolic 5

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Body weight and BMI

Mixed results in trials

Weight and weight relative to height.

Mixed findings

Results and what it means

Why it was measured

Weight management outcome.

Statistical vs. clinical meaning

Large effect in one trial not seen in meta-analysis.

Safety implication

None.

Study	Result	People	Product
Pakhale 2025	Weight -8.46 vs -2.41 kg; BMI -3.31 vs -0.93	Adults, 24 weeks	300 mg twice daily
Ballesteros-Torres 2025	No significant change in weight, BMI or waist	Adults with overweight	500 mg/day, 40 days
Zhu 2026	No effect on body weight	20 RCTs	Oral ashwagandha

Pakhale 2025 Ballesteros-Torres 2025 Zhu 2026

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Fasting blood glucose

Lowered in trials

Blood sugar after fasting.

Very low certainty

Results and what it means

Why it was measured

Diabetes risk marker.

Statistical vs. clinical meaning

Reviewers' GRADE very low; small average change.

Safety implication

May add to diabetes medicines (NCCIH).

Study	Result	People	Product
Farrin 2026	WMD -3.09 mg/dL (-5.61 to -0.58); very low certainty	11 RCTs (667)	Ashwagandha
Andallu 2000	Reduced in 6 mild type 2 diabetic subjects (no placebo)	Mild diabetics	Root powder, 30 days
Salve 2026	Plasma glucose unaffected	Healthy adults, 12 months	Standardised root extract

Farrin 2026 Andallu 2000 Salve 2026

●

HbA1c

No clear change in trials

Average blood sugar over about 3 months.

Very low certainty

Results and what it means

Why it was measured

Diabetes control marker.

Statistical vs. clinical meaning

Inconclusive.

Safety implication

None.

Study	Result	People	Product
Farrin 2026	WMD -0.05% (-0.47 to 0.36); imprecise	3 trials	Ashwagandha

Farrin 2026

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Triglycerides (and VLDL)

Lowered in trials

A type of blood fat.

Very low certainty

Results and what it means

Why it was measured

Cardiometabolic risk marker.

Statistical vs. clinical meaning

Small, inconsistent.

Safety implication

None.

Study	Result	People	Product
Ballesteros-Torres 2025	TG p=0.0082; VLDL p=0.0321 reduced	Adults with overweight	500 mg/day, 40 days
Pattojoshi 2026	TG -13.00%	Stress and hypertension	300 mg twice daily, 60 days
Charmas 2025	No lipid change	Healthy men doing HIIT	600 mg/day, 8 weeks

Ballesteros-Torres 2025 Pattojoshi 2026 Charmas 2025

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Total and LDL cholesterol

Mixed results in trials

Blood cholesterol; LDL is the fraction linked to cardiovascular risk.

Very low certainty

Results and what it means

Why it was measured

Heart-risk marker.

Statistical vs. clinical meaning

Uncontrolled positives, controlled null.

Safety implication

None.

Study	Result	People	Product
Raut 2012	Total and LDL cholesterol fell	Healthy volunteers	750-1250 mg/day, 30 days (no control)
Andallu 2000	Cholesterol, TG, LDL, VLDL fell	6 hypercholesterolemic	Root powder (no placebo)
Charmas 2025	No lipid change	Healthy men doing HIIT	600 mg/day, 8 weeks
Pattojoshi 2026	LDL favourable trend	Stress and hypertension	60 days

Raut 2012 Andallu 2000 Charmas 2025 Pattojoshi 2026

Inflammatory 4

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C-reactive protein (CRP) and S100B

No clear change in trials

CRP is a blood marker of general inflammation; S100B is a brain-injury and inflammation marker.

Very low certainty

Results and what it means

Why it was measured

Tested in schizophrenia as a marker of inflammation.

Statistical vs. clinical meaning

Not statistically different from placebo; no support yet for an anti-inflammatory mechanism in stress trials.

Safety implication

None.

Study	Result	People	Product
Chengappa 2018	CRP and S100B declined more with the extract but not significantly vs placebo	66 patients with schizophrenia exacerbation	1,000 mg/day, 12 weeks

Chengappa 2018

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High-sensitivity C-reactive protein (hs-CRP)

Lowered in trials

A blood marker of inflammation.

Very low certainty

Results and what it means

Why it was measured

Inflammation marker.

Statistical vs. clinical meaning

Small trials, mixed products.

Safety implication

None.

Study	Result	People	Product
Vaidya 2026	CRP decreased 51.1% in ashwagandha group	Adults 50-70	200 mg twice daily, 180 days
Pingali 2025	hs-CRP lower than placebo (P<0.0001)	Postmenopausal women	24 weeks
Raut 2024	Decreasing trend	Healthy volunteers	250 mg twice daily, 60 days
Devpura 2021	hs-CRP 12.4-fold lower than placebo at day 7	COVID-19 patients	Four-herb regime

Vaidya 2026 Pingali 2025 Raut 2024 Devpura 2021

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Interleukin-6 (IL-6)

Lowered in trials

An inflammatory signalling protein.

Very low certainty

Results and what it means

Why it was measured

Inflammation marker.

Statistical vs. clinical meaning

Combination products, trends.

Safety implication

None.

Study	Result	People	Product
Raut 2024	Decreasing trend	Healthy volunteers	60 days
Chitre 2023	Significant only without remdesivir (p=0.042)	Moderate COVID-19	BV-4051, 14 days
Devpura 2021	2.5-fold lower than placebo at day 7	COVID-19	Four-herb regime

Raut 2024 Chitre 2023 Devpura 2021

▼

TNF-alpha

Lowered in trials

An inflammatory signalling protein.

Very low certainty

Results and what it means

Why it was measured

Inflammation marker.

Statistical vs. clinical meaning

Mostly trends and combinations; cell data separate.

Safety implication

None.

Study	Result	People	Product
Raut 2024	Decreasing trend	Healthy volunteers	60 days
Devpura 2021	20-fold lower than placebo at day 7	COVID-19	Four-herb regime
KrishnaRaju 2023	Ashwagandha sustained-release lowered TNF-alpha and IL-1 beta in cells (in vitro)	Human cell lines	AshwaSR in vitro

Raut 2024 Devpura 2021 KrishnaRaju 2023

Other 16

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Heart rate variability (HRV)

Mixed results in trials

Beat-to-beat variation in heart rate, a marker of how the autonomic nervous system balances rest and stress.

Very low certainty

Results and what it means

Why it was measured

Lower HRV is linked to stress; used as an objective stress-physiology marker.

Statistical vs. clinical meaning

Two trials only; effects were small, early or secondary. The direction is encouraging but not established.

Safety implication

None reported.

Study	Result	People	Product
Smith 2023	HRV increased on ashwagandha (p=0.003)	Overweight adults 40-75 with stress and fatigue	Witholytin 400 mg/day, 12 weeks
Mahadevan 2025	HRV RMSSD and SDNN improved vs placebo at day 14 only	90 stressed adults	Zenroot 125 mg/day

Smith 2023 Mahadevan 2025

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Serotonin

Raised in trials

A brain and body signalling chemical involved in mood and sleep; measured in blood or urine in these trials.

Very low certainty

Results and what it means

Why it was measured

Tested as a possible mechanism for mood and anxiety effects.

Statistical vs. clinical meaning

Both trials are from the same group of investigators, used a piperine combination, and peripheral serotonin does not reliably reflect brain serotonin.

Safety implication

Interaction with SSRIs or other serotonergic drugs is untested.

Study	Result	People	Product
Majeed 2023	Urinary serotonin increased vs placebo	54 stressed adults	500 mg with piperine, 60 days
Majeed 2024	Serum serotonin rose with extract and fell on placebo (p<0.001)	70 adults with mild-moderate depression/anxiety	500 mg with piperine, 90 days

Majeed 2023 Majeed 2024

●

Brain-derived neurotrophic factor (BDNF)

No clear change in trials

A protein that supports nerve cell growth and connections; blood levels are sometimes used as a marker of brain health.

Not enough evidence

Results and what it means

Why it was measured

Measured as a secondary outcome in one cognition trial.

Statistical vs. clinical meaning

No usable BDNF result can be verified from the abstract; direction recorded as 'no-change' only as a placeholder for not reported.

Safety implication

None.

Study	Result	People	Product
Gopukumar 2021	Serum BDNF was a secondary outcome; the abstract does not report the result	130 stressed adults	Sustained-release root extract 300 mg/day, 90 days

Gopukumar 2021

●

Salivary alpha-amylase and chromogranin A

No clear change in trials

Saliva markers of the sympathetic (fight-or-flight) nervous system.

Low certainty

Results and what it means

Why it was measured

Objective markers of acute stress reactivity.

Statistical vs. clinical meaning

Null results in two trials suggest effects are not on the sympathetic markers.

Safety implication

None.

Study	Result	People	Product
Mahadevan 2025	No significant difference in salivary alpha-amylase	90 stressed adults	Zenroot 125 mg/day
Lopresti 2026	Chromogranin A and other physiological measures: no significant between-group differences	60 stressed adults	30 mg/day

Mahadevan 2025 Lopresti 2026

●

Nitric oxide, glutathione and malondialdehyde

No clear change in trials

Blood markers of oxidative stress and antioxidant defences.

Very low certainty

Results and what it means

Why it was measured

Tested as part of an antioxidant mechanism hypothesis.

Statistical vs. clinical meaning

Null result in one small trial; does not support an antioxidant effect in this setting.

Safety implication

None.

Study	Result	People	Product
Majeed 2023	Serum NO, GSH and MDA not significantly different from placebo	54 stressed adults	500 mg with piperine, 60 days

Majeed 2023

▲

Sperm concentration / count

Raised in trials

Number of sperm per mL of semen (or total). Standard semen analysis.

Low certainty

Results and what it means

Why it was measured

The primary fertility lab measure.

Statistical vs. clinical meaning

Improvement in small trials; only one placebo-controlled trial in infertile men.

Safety implication

Some animal studies reported reversible spermicidal effects at other doses (systematic review).

Study	Result	People	Product
Ambiye 2013	9.59 to 25.61 million/mL (+167%) vs minimal placebo change	Oligospermic men	675 mg/day, 90 days
Durg 2018	Observational pooling: MD 13.57 million/mL (11.12-16.01)	Infertile men	W. somnifera
Khanna 2026	Total sperm count +38% (as reported)	Healthy men	300 mg twice daily, 8 weeks
Mutha 2025	Sperm number p=0.006 and concentration p=0.007 vs placebo	Healthy men	300 mg twice daily, 8 weeks

Ambiye 2013 Durg 2018 Khanna 2026 Mutha 2025

▲

Semen volume

Raised in trials

The amount of fluid ejaculated.

Low certainty

Results and what it means

Why it was measured

Part of the semen analysis.

Statistical vs. clinical meaning

Consistent direction.

Safety implication

None identified.

Study	Result	People	Product
Ambiye 2013	1.74 to 2.76 mL (+53%)	Oligospermic men	675 mg/day, 90 days
Khanna 2026	+36% (as reported)	Healthy men	300 mg twice daily, 8 weeks
Mutha 2025	p=0.005 vs placebo	Healthy men	300 mg twice daily, 8 weeks

Ambiye 2013 Khanna 2026 Mutha 2025

▲

Sperm motility

Raised in trials

Share of sperm that move; important for fertilisation.

Low certainty

Results and what it means

Why it was measured

Part of the semen analysis.

Statistical vs. clinical meaning

Improved in small trials.

Safety implication

None identified.

Study	Result	People	Product
Ambiye 2013	18.62% to 29.19% (+57%) from baseline	Oligospermic men	675 mg/day, 90 days
Durg 2018	Observational pooling: MD 8.50 percentage points (7.36-9.63)	Infertile men	W. somnifera
Khanna 2026	Total motility +87% (as reported)	Healthy men	300 mg twice daily, 8 weeks

Ambiye 2013 Durg 2018 Khanna 2026

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Creatine kinase (CK/CPK)

Mixed results in trials

An enzyme released from muscle after hard exercise; higher levels indicate muscle damage.

Very low certainty

Results and what it means

Why it was measured

Recovery marker.

Statistical vs. clinical meaning

Two small trials.

Safety implication

None.

Study	Result	People	Product
Wankhede 2015	Difference vs placebo p=0.03 (wording hard to interpret)	Beginner weight-trainers	300 mg twice daily, 8 weeks
Prajapati 2026	CPK significantly reduced	Healthy adults	Ashwa.30 30 mg/day, 8 weeks

Wankhede 2015 Prajapati 2026

▲

Maximal strength (1-RM bench and leg press)

Raised in trials

The heaviest weight a person can lift once. A performance test, not a lab biomarker.

Low certainty

Results and what it means

Why it was measured

Strength outcome.

Statistical vs. clinical meaning

Positive in beginners; fragile in pooled analysis; null in athletes.

Safety implication

None.

Study	Result	People	Product
Wankhede 2015	Bench +46.0 vs +26.4 kg (p=0.001); leg extension +14.5 vs +9.8 kg (p=0.04)	Beginner men	300 mg twice daily, 8 weeks
Ziegenfuss 2018	Squat +19.1 vs +10.0 kg (p=0.009); bench +12.8 vs +8.0 (p=0.048)	Recreational men	Sensoril 500 mg/day, 12 weeks
Lee 2026	Bench SMD 0.60; lower body 0.52; lost significance under HKSJ; GRADE low	3 pooled RCTs	Standardised extract + resistance training
Ewa 2025	No added benefit (HIIT)	Healthy men	600 mg/day, 8 weeks

Wankhede 2015 Ziegenfuss 2018 Lee 2026 Ewa 2025

▲

VO2max

Raised in trials

The highest rate the body can use oxygen during exercise; measures aerobic fitness.

Low certainty

Results and what it means

Why it was measured

Endurance outcome.

Statistical vs. clinical meaning

Positive in small trials; null in HIIT trials.

Safety implication

None.

Study	Result	People	Product
Pérez-Gómez 2020	MD 3.00 (0.18-5.82), high heterogeneity	Healthy adults and athletes	Ashwagandha
Choudhary 2015	+5.67 vs +1.86 at 12 weeks (unit not stated)	Athletic adults	KSM-66
Tiwari 2021	Greater than placebo (p=0.0074)	Athletic adults	300 mg twice daily, 8 weeks
Ewa 2025	No group difference	Healthy men doing HIIT	600 mg/day, 8 weeks

Pérez-Gómez 2020 Choudhary 2015 Tiwari 2021 Ewa 2025

↕

Body fat percentage

Mixed results in trials

Share of body weight that is fat.

Mixed findings

Results and what it means

Why it was measured

Body composition outcome.

Statistical vs. clinical meaning

Mixed.

Safety implication

None.

Study	Result	People	Product
Wankhede 2015	-3.5% vs -1.5% (p=0.03)	Beginner men	8 weeks
Obhrai 2026	-0.6% vs +0.03% (P<0.01)	Postmenopausal women	600 mg/day, 12 weeks
Lee 2026	Body fat SMD -0.32 (-0.72 to 0.08), not significant	3 RCTs	Standardised extract
Zhu 2026	No effect on body fat	20 RCTs	Oral ashwagandha

Wankhede 2015 Obhrai 2026 Lee 2026 Zhu 2026

▲

Lymphocyte markers (CD3, CD4, CD8, NK/CD56)

Raised in trials

Surface markers on immune cells counted by flow cytometry.

Not enough evidence

Results and what it means

Why it was measured

Immune activity marker.

Statistical vs. clinical meaning

Tiny or add-on studies; unclear meaning.

Safety implication

NCCIH advises caution with autoimmune disease and immunosuppressants.

Study	Result	People	Product
Mikolai 2009	CD4 on T cells and NK-cell CD69 increased at 96 hours	5 participants	6 mL root extract twice daily
Vaidya 2026	Slight improvement in CD3, CD4, CD8	Adults 50-70	180 days
Kumar 2018	CD4 and CD8 rose	TB patients	12 weeks

Mikolai 2009 Vaidya 2026 Kumar 2018

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NT-proBNP and blood pressure

Mixed results in trials

NT-proBNP is a blood marker of heart strain; blood pressure is measured in the arm.

Not enough evidence

Results and what it means

Why it was measured

Heart safety/benefit.

Statistical vs. clinical meaning

No confirmed effect.

Safety implication

NCCIH: possible interaction with blood-pressure medicines.

Study	Result	People	Product
Vaidya 2026	NT-proBNP decreased 28.70% in ashwagandha group	Adults 50-70	180 days
Pattojoshi 2026	Blood pressure favourable trend	Hypertension with stress	60 days
Verma 2021	Vital signs unchanged	Healthy adults	8 weeks

Vaidya 2026 Pattojoshi 2026 Verma 2021

▼

Bone turnover markers (CTX, bone ALP, RANKL, osteoprotegerin)

Lowered in trials

Blood markers of bone breakdown and formation.

Very low certainty

Results and what it means

Why it was measured

Menopause bone health.

Statistical vs. clinical meaning

Marker change in one trial; no density change in another.

Safety implication

None.

Study	Result	People	Product
Pingali 2025	Lower CTX, bone ALP, RANKL and higher osteoprotegerin vs placebo (P<0.0001)	Postmenopausal women	Aqueous extracts, 24 weeks
Obhrai 2026	No bone mineral density difference	Postmenopausal women	600 mg/day, 12 weeks

Pingali 2025 Obhrai 2026

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Oxidative stress markers (MDA, glutathione, nitric oxide, antioxidant level)

Mixed results in trials

Chemicals showing oxidative damage or antioxidant capacity.

Very low certainty

Results and what it means

Why it was measured

Oxidative stress.

Statistical vs. clinical meaning

Mixed.

Safety implication

None.

Study	Result	People	Product
Pingali 2025	MDA lower; GSH and NO higher (P<0.0001)	Postmenopausal women	24 weeks
Tiwari 2021	Antioxidant level higher (P<0.0001)	Athletes	8 weeks
Majeed 2023	NO, GSH, MDA not significantly different	Stressed adults	Standardised root extract, 60 days
Ahmad 2010	Seminal oxidative markers fell	Infertile men	Root (no placebo)

Pingali 2025 Tiwari 2021 Majeed 2023 Ahmad 2010

The evidence

The research centre for Ashwagandha. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, NIH NCCIH, LiverTox and regulators' pages, opened each source and recorded the study design, people, product, dose and result as reported. Abstracts only for most studies; full texts for a few guidance pages. No study is cited that we could not verify.

Study library: every study we checked 232

Design Research type Plant part Year from Search

Study	Design	People	Product, dose, length	Result
Ahmad 2010 Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males Fertil Steril · PMID 19501822 · DOI	Controlled clinical trial	150 75 fertile men (controls) and 75 men undergoing infertility screening	Withania somnifera root (preparation and dose not stated in abstract) root · vs Healthy fertile controls (not a placebo group)	In treated infertile men, sperm count and motility improved, oxidative markers fell, antioxidant vitamins rose, and serum testosterone and LH rose while FSH and prolactin fell. Direction of change only; numbers not in abstract Methods, limits and funding Outcomes: Seminal oxidative markers and antioxidant vitamins, sperm count and motility, serum testosterone, LH, FSH, prolactin Limitations: No placebo group for the treated men (controls were healthy fertile men); dose and duration not stated in the abstract Read: abstract
Ajgaonkar 2022 Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract for Improvement of Sexual Health in Healthy Women: A Prospective, Randomized, Placebo-Controlled Study Cureus · PMID 36447681 · DOI	Controlled trial	80 Women aged 18-50 with hypoactive sexual desire (FSFI under 26 or FSDS over 11)	Standardised root extract root 300 mg twice daily 8 weeks · vs Identical placebo	FSFI total rose from 14.20 to 22.62 with ashwagandha versus 14.17 to 19.25 with placebo (p<0.0001), improved in all domains; distress improved more (p<0.0001). Quality of life trend not significant (p=0.078). Adverse events were comparable between groups. FSFI 22.62 vs 19.25 at week 8 (p<0.0001) Methods, limits and funding Outcomes: FSFI, FSDS, satisfying sexual encounters, GHQ-28, safety Limitations: Single trial; self-report scales; placebo group also improved by about 5 points Read: abstract
Ajgaonkar 2026 Efficacy and safety of Ashwagandha (Withania somnifera) root extract in pregnant women: a prospective, randomized, comparative, open-label, 12-week study. Front Glob Womens Health · PMID 41767760 · DOI	Controlled trial	70 Pregnant women in the second trimester (63 completed), India	Ashwagandha root extract + standard hematinic therapy root 300 mg twice daily 12 weeks · vs Standard hematinic therapy alone (open-label)	Haemoglobin rose 1.06 vs 0.78 g/dL (difference 0.28 g/dL, p=0.003). No adverse events or serious adverse events reported; no detrimental effect on liver, kidney or thyroid markers in the intention-to-treat safety analysis. Hb difference 0.28 g/dL Methods, limits and funding Outcomes: Haemoglobin and red cell indices; stress; sleep; safety markers Limitations: Open-label, small, second trimester only, 12 weeks; cannot rule out rare pregnancy outcomes; birth outcomes not in abstract. Funding and conflicts: Authors declare no commercial conflicts Registration: CTRI/2025/01/079238 Read: abstract
Akhgarjand 2022 Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. Phytotherapy research : PTR · PMID 36017529 · DOI	Meta-analysis	1002 Adults aged 25-48 in 12 RCTs	Ashwagandha extract (various) unspecified Dose-response modelled up to 12000 mg/day Varied · vs Placebo	Pooled reduction in anxiety and stress vs placebo; dose-response suggested stress benefit at 300-600 mg/day. Reviewers rated certainty of evidence LOW for both outcomes. Anxiety SMD -1.55 (I2 93.8%); stress SMD -1.75 (I2 83.1%) (Anxiety -2.37 to -0.74; stress -2.29 to -1.22) Methods, limits and funding Outcomes: Anxiety and stress scores Limitations: Very high heterogeneity; low certainty (reviewers' own rating); SMDs this large are unusual for a herbal supplement and likely reflect small, heterogeneous trials. Read: abstract
Albalawi 2025 Dual impact of Ashwagandha: Significant cortisol reduction but no effects on perceived stress - A systematic review and meta-analysis. Nutrition and health · PMID 40746175 · DOI	Meta-analysis	488 Adults in 7 cortisol and 6 perceived-stress RCTs (oral >=250 mg/day, >=2 weeks)	Ashwagandha (various) unspecified >=250 mg/day >=2 weeks · vs Placebo	Significant cortisol reduction but NO significant effect on perceived stress. Risk of bias generally moderate; no publication bias detected. Cortisol -1.16 ug/dL; PSS SMD -0.355 (I2 50.9%) (Cortisol -1.64 to -0.69; PSS -1.188 to 0.47) Methods, limits and funding Outcomes: Cortisol; Perceived Stress Scale Limitations: Small number of trials; authors note disconnect between cortisol and PSS. Read: abstract
Almuzghi 2024 Ashwagandha-Induced Hepatic Injury: A Case Report. Cureus · PMID 39553154 · DOI	Case report	1 22-year-old healthy woman, Libya	Ashwagandha capsules unspecified Symptoms after a latency of 30 hours · vs none	Severe itching, fatigue, nausea, jaundice. ALT peak 315 IU/L, total bilirubin peak 12.85 mg/dl, ALP peak 150 IU/L; R ratio 5.4; RUCAM 7 (probable). Washout 60 days; symptoms relieved with ursodeoxycholic acid. Viral and autoimmune hepatitis tests negative. Methods, limits and funding Outcomes: Liver tests, RUCAM, outcome Limitations: Single case; the 30-hour latency is unusual compared with the 2-12 weeks in the larger series. Funding and conflicts: No conflicts declared Read: abstract
Alsanie 2026 Effects of ashwagandha (Withania somnifera) on mental health in adults: A systematic review and dose-response meta-analysis of randomized controlled trials. Complementary therapies in medicine · PMID 41644067 · DOI	Meta-analysis	Adults in 22 RCTs	Ashwagandha (various) unspecified · vs Placebo	Pooled improvement in stress, depression and anxiety; significant dose-response for stress. Stress SMD -5.88; depression SMD -5.68; anxiety SMD -6.87 (Stress -8.15 to -3.60; depression -8.43 to -2.94; anxiety -8.77 to -4.97) Methods, limits and funding Outcomes: Stress, depression, anxiety (SMD); dose-response Limitations: SMDs of 5-7 are implausibly large (a very large effect is usually about 0.8-1.0), suggesting a calculation or heterogeneity problem; read from abstract only; treat magnitude with caution. Registration: PROSPERO CRD420251073134 Read: abstract
Alyami 2026 Efficacy and Safety of Saffron and Ashwagandha for Stress-Related Mental Health Outcomes: A Systematic Review of Randomized Controlled Trials. Journal of visualized experiments : JoVE · PMID 42858054 · DOI	Systematic review	Adults in 31 RCTs of saffron and ashwagandha (14 ashwagandha studies)	Ashwagandha, withanolide-standardised extracts unspecified 30-600 mg/day Varied · vs Placebo	Ashwagandha showed efficacy for anxiety (10 RCTs), stress (8 RCTs) and sleep (3 RCTs); pooled cortisol reduction -3.27 ug/dL. GRADE certainty moderate at best; no RCTs exist for burnout or PTSD. Pooled cortisol -3.27 ug/dL (not reported in abstract) Methods, limits and funding Outcomes: Anxiety, stress, sleep; cortisol Limitations: Abstract only; combined saffron and ashwagandha review; GRADE at best moderate; notes ashwagandha-associated hepatotoxicity needs liver enzyme monitoring. Registration: PROSPERO CRD420261385134 Read: abstract
Ambiye 2013 Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot Study Evid Based Complement Alternat Med · PMID 24371462 · DOI	Controlled trial	46 Men with oligospermia (sperm count under 20 million/mL)	Full-spectrum root extract root 675 mg per day in three doses 90 days · vs Placebo (n=25; treatment n=21)	Sperm count rose 167% (9.59 to 25.61 million/mL), volume 53% (1.74 to 2.76 mL), motility 57% (18.62% to 29.19%) from baseline (all P<0.0001). Improvement was minimal with placebo. Greater hormone improvement than placebo. Sperm count +167%, volume +53%, motility +57% from baseline Methods, limits and funding Outcomes: Semen volume, sperm count, motility, serum hormones Limitations: Pilot study; small groups; hormone values not given in the abstract; live births not measured Read: abstract
Andallu 2000 Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root Indian J Exp Biol · PMID 11116534	Controlled clinical trial	12 6 mild type 2 diabetics and 6 with mild hypercholesterolemia	Root powder root Dose not stated in abstract 30 days · vs None (before-and-after)	Blood glucose fell (authors say comparable to an oral hypoglycaemic drug); total cholesterol, triglycerides, LDL and VLDL fell; urine volume and sodium rose. Direction only Methods, limits and funding Outcomes: Blood glucose, urine sodium and volume, cholesterol, triglycerides, LDL, VLDL Limitations: Twelve people; no placebo; year 2000 Read: abstract
Andrade 2000 A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera. Indian journal of psychiatry · PMID 21407960	Controlled trial	39 Patients with ICD-10 anxiety disorders	Ethanolic Withania somnifera extract unspecified 6 weeks · vs Placebo	Statistical trends favoured drug at 2 and 6 weeks; at 6 weeks 88.2% responded vs 50% on placebo. Responders 88.2% vs 50% Methods, limits and funding Outcomes: Response criteria, anxiety scales Limitations: Small n=39; dose not stated in abstract. Read: abstract
Arumugam 2024 Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis. Explore (New York, N.Y.) · PMID 39348746 · DOI	Meta-analysis	558 Adults in 9 RCTs (stress/anxiety)	Ashwagandha formulations (various) unspecified · vs Placebo	Significant reductions vs placebo in PSS, HAM-A and serum cortisol; 4 of the included studies reported mild to moderate adverse events. PSS MD -4.72; HAM-A MD -2.19; serum cortisol MD -2.58 (units not stated in abstract) (PSS -8.45 to -0.99; HAM-A -3.83 to -0.55; cortisol -4.99 to -0.16) Methods, limits and funding Outcomes: Perceived Stress Scale, Hamilton Anxiety Scale, serum cortisol Limitations: Abstract only; search ended January 2022; certainty not graded in abstract; heterogeneity not given in abstract. Read: abstract
Atul 2020 Efficacy of Brimhana Nasya and Ashwagandha (Withania somnifera (L.) Dunal) root powder in primary insomnia in elderly male: A randomized open-label clinical study. Ayu · PMID 35370376 · DOI	Controlled trial	60 Elderly men with primary insomnia	Ashwagandha root powder alone vs with Brimhana Nasya (nasal oil) root Not stated in abstract 30 days · vs Open-label comparison of two active treatments (no placebo)	Combination gave larger improvements; ashwagandha powder alone gave ~37-40% improvement in sleep measures. Group B: 38.66% sleep efficiency, 37.05% subjective sleep quality Methods, limits and funding Outcomes: PSQI components Limitations: Open-label, no placebo, comparison of two active regimens; cannot isolate ashwagandha effect. Read: abstract
Avula 2026 A Comparison of British and US Pharmacopoeia Standards for Quality of Ashwagandha Dietary Supplements in Commerce. Phytother Res · PMID 41386716 · DOI	Chemical survey of commercial products in-vitro	ashwagandha raw material and 25 supplements	Commercial products root, leaf, aerial parts n/a n/a · vs British Pharmacopoeia and USP standards	Over 44% of products failed BP and 60% failed USP standards, attributed to co-eluting dihydrowithaferin sulfate (mainly in leaf samples); only 10 of 25 supplements met both, and only two were confirmed as root-derived. Methods, limits and funding Outcomes: Withaferin A, withanolide A, withanoside IV by HPLC-PDA Limitations: Abstract only; product list and exact numbers per compound not captured. Read: abstract
Bailly 2024 Covalent binding of withanolides to cysteines of protein targets. Biochem Pharmacol · PMID 38969301 · DOI	Narrative review in-vitro	literature	Withanolides (withaferin A etc.) isolated compounds n/a n/a · vs none	The alpha,beta-unsaturated carbonyl of withanolides reacts with protein cysteines, binding about 20 proteins including IKK beta, Nrf2 targets, vimentin and Hsp90. Methods, limits and funding Outcomes: Covalent binding to cysteines Limitations: Mostly cell and test-tube evidence. Read: abstract
Baker 2022 The Perceived Impact of Ashwagandha on Stress, Sleep Quality, Energy, and Mental Clarity for College Students: Qualitative Analysis of a Double-Blind Randomized Control Trial. Journal of medicinal food · PMID 35984870 · DOI	Controlled trial	60 College students (qualitative analysis of RCT)	Full-spectrum root extract root 700 mg/day 30 days · vs Placebo	Participants described greater sustained energy, mental clarity and sleep quality. Qualitative (not applicable) Methods, limits and funding Outcomes: Thematic analysis of energy, clarity, sleep, stress Limitations: Qualitative, self-perceived; not an efficacy measure. Registration: NCT05430685 Read: abstract
Ballesteros-Torres 2025 Impact of ashwagandha (Withania somnifera L.) supplementation on serum lipid concentrations and anthropometric parameters in adults with overweight and obesity: a double-blind, placebo-controlled pilot study Nutr Metab (Lond) · PMID 41204297 · DOI	Rct pilot	43 Mexican adults with overweight or obesity (17 control, 21 intervention as reported)	Ashwagandha (extract form not stated) unspecified 500 mg once daily 40 days · vs Placebo	No significant change in weight, BMI or waist; triglycerides (p=0.0082) and VLDL (p=0.0321) fell. In-silico modelling also reported. TG and VLDL reduced; anthropometrics unchanged Methods, limits and funding Outcomes: Weight, BMI, waist, lipid profile Limitations: Pilot, 40 days, group numbers do not add to 43 in the abstract; computer modelling is not clinical evidence Read: abstract
Bashir 2023 An updated review on phytochemistry and molecular targets of Withania somnifera (L.) Dunal (Ashwagandha). Front Pharmacol · PMID 37063285 · DOI	Narrative review in-vitro	literature	Withania somnifera constituents mixed n/a n/a · vs none	Describes about 300 withanolides; reports NF-kB inhibition, dopamine D2 activity, and computer-docking suggestions of AChE inhibition by withanolide A. Methods, limits and funding Outcomes: Phytochemistry and molecular targets Limitations: Narrative; mixes in-silico, cell and animal findings. Read: abstract
Baune 2026 Ayurvedic Dravya-Based Herbal Products for Cognition, Stress, Sleep, and Psychiatric Symptoms: A Node-Resolved Systematic Review and Meta-Analysis. Journal of integrative and complementary medicine · PMID 42359794 · DOI	Systematic review	Controlled human studies on Ayurvedic herbal products (49 reports, 20 herbs); Withania prominent for stress and sleep	Withania somnifera vs placebo (meta-analysis strata: perceived stress, sleep quality) unspecified · vs Placebo	Ashwagandha showed potentially beneficial signals for perceived stress and sleep quality; abstract states confidence in effect size is limited by heterogeneity, small-study effects and reporting quality. Numbers not given in the abstract. not reported in abstract (not reported in abstract) Methods, limits and funding Outcomes: Perceived stress, sleep quality Limitations: Numbers not available from abstract; study frozen 30 January 2026. Read: abstract
BfR (Germany) Ashwagandha food supplements with potential health risks BfR opinion PDF · Source	Authoritative guidance		unspecified	NOT READ (PDF text could not be extracted). A web-search summary says BfR advises children, pregnant women, breastfeeding mothers and people with liver disease to avoid such supplements. Treat as unverified. Methods, limits and funding Outcomes: Risk assessment advice Limitations: Unverified; date and opinion number unknown. Read: summary-only
Biswal 2013 Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Integrative cancer therapies · PMID 23142798 · DOI	Trial nonrandomized	100 Breast cancer patients on chemotherapy	Withania somnifera root extract root 2 g every 8 hours Throughout chemotherapy · vs Chemotherapy alone	Less fatigue (P<.001 PFS; P<.003 SCFS-6) and better QoL scales with Withania; 24-month survival 72% vs 56% not significant. Fatigue P<.001 Methods, limits and funding Outcomes: Piper Fatigue Scale, SCFS-6, EORTC QLQ-C30 Limitations: Open-label, non-randomized; very high dose; no placebo. Read: abstract
Björnsson 2020 Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int · PMID 31991029 · DOI	Case series	5 Adults with suspected ashwagandha liver injury: 3 from Iceland (2017-2018), 2 from the US DILIN (2016); 3 male; mean age 43 (range 21-62)	Ashwagandha-containing dietary supplements (chemically analysed; ashwagandha confirmed, no other toxic compounds found) unspecified Latency 2-12 weeks before jaundice · vs none (case series)	All five developed jaundice with nausea, lethargy, itching and abdominal discomfort after 2-12 weeks. Injury was cholestatic or mixed (R ratios 1.4-3.3). Itching and raised bilirubin were prolonged (5-20 weeks). No hepatic failure. Liver tests normalised within 1-5 months in four; one lost to follow-up. One biopsy: acute cholestatic hepatitis. Four were also using other supplements; in one, rhodiola was a possible co-cause. No hepatic failure in these five; self-limited course (R ratio 1.4-3.3 (cholestatic/mixed)) Methods, limits and funding Outcomes: Clinical phenotype, liver test pattern (R ratio), outcome Limitations: Five cases only; no denominator, so no frequency can be drawn. Four patients used other supplements. Causality by structured expert opinion, not proof. Funding and conflicts: Authors report no conflicts of interest Read: abstract
Bokan 2023 Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel) · PMID 37631044 · DOI	Case series	2 Two new cases from Bosnia and Herzegovina (36-year-old man; 30-year-old woman) plus a review of all published cases to 2023	Ashwagandha capsules 450 mg (man: three times daily for 6 months; woman: 450 mg for 45 days) unspecified 450 mg capsules; man 3x/day 6 months; 45 days · vs none	Man: nausea, itching, dark urine; hepatocellular pattern (R 11.1). Woman: itching; mixed pattern (R 2.6). RUCAM score 7 (probable) in both. Clinical and liver tests improved after stopping. The review notes one reported case ended in liver transplantation. Both improved after stopping Methods, limits and funding Outcomes: Causality by updated RUCAM, liver pattern, outcome Limitations: Two cases; no denominator; plant part not stated in abstract. Funding and conflicts: Authors declare no conflict of interest Read: abstract
Bonilla 2021 Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis J Funct Morphol Kinesiol · PMID 33670194 · DOI	Systematic review meta analysis	Healthy men and women in 13 trials (12 analysed) up to 2020	Ashwagandha (various) unspecified Varied Varied · vs Placebo	Bayesian models suggested benefit over placebo on physical performance variables; low-to-moderate risk of bias; authors call for more comparable trials in athletes. Qualitative (Bayesian credible intervals; numbers not in abstract) Methods, limits and funding Outcomes: Strength/power, cardiorespiratory fitness, fatigue/recovery Limitations: Numbers not in abstract; pre-2021 trials only Read: abstract
Boyle 2017 The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients · PMID 28445426 · DOI	Systematic review	18 studies in people vulnerable to anxiety	Magnesium not applicable Varied Varied · vs Varied	Suggestive benefit in anxiety-prone samples; evidence quality poor. Methods, limits and funding Outcomes: Subjective anxiety Limitations: Poor quality studies. Read: abstract
Brendler 2026 Ashwagandha: Is It Safe? Part 1: A Regulatory Review. Phytother Res · PMID 41420287 · DOI	Narrative review	Regulation of ashwagandha in major markets	Ashwagandha unspecified	Abstract states EU regulators have increasingly scrutinised ashwagandha safety in food supplements, culminating in a recent recommendation for an Article 8 procedure under Regulation (EC) 1925/2006 that, once executed, could lead to a ban on its use as an ingredient in food supplements. Only the abstract was read. Methods, limits and funding Outcomes: Regulatory status Limitations: Abstract only; country-by-country details not read. Funding and conflicts: No conflicts declared Read: abstract
Chandrasekhar 2012 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 · PMID 23439798 · DOI	Controlled trial	64 Adults with history of chronic stress	High-concentration full-spectrum root extract root 300 mg twice daily (600 mg/day) 60 days · vs Placebo	Significant reduction in all stress-assessment scales vs placebo (P<0.0001) and in serum cortisol (P=0.0006); adverse effects mild and comparable to placebo. P<0.0001 stress scales; P=0.0006 cortisol (effect sizes not in abstract) Methods, limits and funding Outcomes: Stress scales; serum cortisol Limitations: Single centre; telephone follow-up only at intermediate visits; abstract does not give effect sizes. Read: abstract
Charmas 2025 Ashwagandha Does Not Enhance the Effect of High-Intensity Interval Training on Selected Energy Metabolism Parameters in Young Healthy Men Nutrients · PMID 41156498 · DOI	Controlled trial	38 Healthy young men doing HIIT	Ashwagandha extract unspecified 600 mg per day 8 weeks · vs Placebo (20 placebo, 18 ashwagandha)	No effect of supplement or training on body composition or lipid profile; training changed adiponectin and irisin but ashwagandha did not affect any hormone measured. No effect of ashwagandha Methods, limits and funding Outcomes: Body composition, lipid profile, adiponectin, asprosin, irisin Limitations: Null result; small; healthy young men Read: abstract
Chauhan 2022 Effect of standardized root extract of ashwagandha (Withania somnifera) on well-being and sexual performance in adult males: A randomized controlled trial Health Sci Rep · PMID 35873404 · DOI	Controlled trial	50 Adult men with lower sexual desire	Standardised root extract (brand not stated in abstract) root 300 mg twice daily 8 weeks · vs Placebo capsules	Total DISF-M score and serum testosterone were higher than placebo; prolactin did not change. DISF-M mean difference -9.8 (as reported; sign reflects how difference was calculated); testosterone difference -66.52 (as reported) (DISF-M -10.73 to -8.87; testosterone -80.70 to -52.34) Methods, limits and funding Outcomes: Derogatis Interview for Sexual Functioning-Male (DISF-M), serum testosterone, serum prolactin, SF-36 Limitations: Small, single trial; registration not stated in abstract; very narrow confidence intervals for a n=50 trial are unusual and should be read with caution Read: abstract
Cheah 2021 Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PloS one · PMID 34559859 · DOI	Meta-analysis	400 Adults 18+ in 5 RCTs	Ashwagandha extract unspecified · vs Placebo	Small but significant overall sleep benefit, larger in adults diagnosed with insomnia, doses 600 mg/day or more, and 8 weeks or longer. Improved mental alertness on rising and anxiety; no significant effect on quality of life. Overall sleep SMD -0.59 (I2 62%) (-0.75 to -0.42) Methods, limits and funding Outcomes: Overall sleep (primary), mental alertness on rising, anxiety, quality of life Limitations: Only 5 RCTs; long-term safety data limited (reviewers' own statement). Read: abstract
Chengappa 2013 Randomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorder. The Journal of clinical psychiatry · PMID 24330893 · DOI	Controlled trial	60 Euthymic bipolar disorder on maintenance medication (53 completed)	Standardised Withania somnifera extract unspecified 500 mg/day 8 weeks · vs Placebo	Better digit span backward (P=.035; d=0.51), Flanker neutral response time (P=.033) and Penn emotional acuity social cognition (P=.045); no difference on other tasks; mood and anxiety stable. Digit span backward d=0.51 (95% CI 0.25-0.77) Methods, limits and funding Outcomes: Cognitive tasks Limitations: Small (n=60); only 3 tasks significant of many; adjunctive to medication. Registration: NCT00761761 Read: abstract
Chengappa 2018 Adjunctive Use of a Standardized Extract of Withania somnifera (Ashwagandha) to Treat Symptom Exacerbation in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study. The Journal of clinical psychiatry · PMID 29995356 · DOI	Controlled trial	66 Schizophrenia/schizoaffective disorder with symptom exacerbation	Standardised extract (adjunct to antipsychotics) unspecified 1000 mg/day 12 weeks · vs Placebo	Reduced PANSS negative, general and total symptoms (d 0.83, 0.76, 0.83) but not positive symptoms; PSS improved (d 0.58); CRP and S100B declined more but not significantly vs placebo; somnolence, epigastric discomfort, loose stools more common with extract. PANSS total d=0.83; PSS d=0.58 Methods, limits and funding Outcomes: PANSS (primary), PSS, S100B, CRP Limitations: Small; adjunct; CRP and S100B differences not significant. Registration: NCT01793935 Read: abstract
Chitre 2023 Phase III randomized clinical trial of BV-4051, an Ayurvedic polyherbal formulation in moderate SARS-CoV-2 infections and its impact on inflammatory biomarkers Phytother Res · PMID 36419388 · DOI	Controlled trial	208 Hospitalised moderate COVID-19 (175 completed)	BV-4051 polyherbal (ashwagandha, boswellia, ginger, turmeric) unspecified Not stated in abstract 14 days · vs Placebo plus standard care	Shorter illness (p=0.036); IL-6 difference significant only in patients not on remdesivir (p=0.042). Illness duration p=0.036 Methods, limits and funding Outcomes: Illness duration, symptoms, IL-6 Limitations: Four-herb product; ashwagandha effect cannot be isolated Read: abstract
Choi 2022 Efficacy of melatonin for chronic insomnia: Systematic reviews and meta-analyses. Sleep Med Rev · PMID 36179487 · DOI	Meta-analysis	Chronic insomnia; 24 RCTs	Melatonin not applicable Varied Varied · vs Placebo	Not significantly effective in adults with non-comorbid insomnia; possibly effective in children and adolescents. Methods, limits and funding Outcomes: Sleep onset latency, total sleep time Limitations: Heterogeneity. Read: abstract
Chopra 2026 Safe prolonged prophylactic use and tolerability of Ashwagandha following COVISHIELD™ vaccination over 24 weeks: a multicentre randomized double-blind placebo-controlled trial Front Med (Lausanne) · PMID 42694770 · DOI	Controlled trial	1200 Healthy adults aged 18-70 after COVISHIELD vaccination (1,032 completed)	Aqueous root extract root 500 mg per day 24 weeks · vs Placebo	Safety similar to placebo. IgG persistently higher with ashwagandha but not significant; breakthrough infection rate 3.9% overall with no difference between arms. Authors say an immune-boosting effect could not be shown. Breakthrough infection 3.9%, no difference (3.0 to 5.2 (overall rate)) Methods, limits and funding Outcomes: Safety, SARS-CoV-2 IgG, breakthrough infection Limitations: About 70% already had prior infection antibodies, masking any effect Registration: CTRI/2021/06/034496 Read: abstract
Choudhary 2005 Withanolides, a new class of natural cholinesterase inhibitors with calcium antagonistic properties. Biochem Biophys Res Commun · PMID 16108094 · DOI	In vitro and docking study in-vitro	enzyme assays; rabbit jejunum	Withanolides from Withania somnifera and Ajuga bracteosa isolated compounds n/a n/a · vs none	Withanolides inhibited AChE (IC50 20.5-49.2 uM) and BChE (29.0-85.2 uM) in a concentration-dependent way; also calcium-antagonistic effects. Methods, limits and funding Outcomes: Acetylcholinesterase and butyrylcholinesterase inhibition Limitations: Enzyme assay; compounds 1-3 are from Ajuga, 4-5 from Withania. Read: abstract
Choudhary 2015 Efficacy of Ashwagandha (Withania somnifera [L.] Dunal) in improving cardiorespiratory endurance in healthy athletic adults Ayu · PMID 26730141 · DOI	Controlled trial	50 Healthy athletic adults (49 analysed)	KSM-66 root extract root Dose not stated in abstract 12 weeks · vs Placebo	VO2max rose 4.91 vs 1.42 at 8 weeks and 5.67 vs 1.86 at 12 weeks (P<0.0001 for greater increase with ashwagandha); quality of life improved more at 12 weeks. VO2max +5.67 vs +1.86 at 12 weeks (unit not stated in abstract) Methods, limits and funding Outcomes: VO2max by 20 m shuttle run, WHO quality of life Limitations: Shuttle-run estimate of VO2max, not lab gas analysis; single trial Read: abstract
Choudhary 2017 Body Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled Trial. Journal of evidence-based complementary & alternative medicine · PMID 27055824 · DOI	Controlled trial	52 Adults under chronic stress	Standardised root extract root 300 mg twice daily 8 weeks · vs Placebo	Significant improvements in primary and secondary measures including serum cortisol. Numeric effects not in abstract Methods, limits and funding Outcomes: PSS, Food Cravings Questionnaire (primary), OHQ, TFEQ, cortisol, weight, BMI Limitations: Abstract has no effect sizes. Read: abstract
Choudhary 2017 Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. Journal of dietary supplements · PMID 28471731 · DOI	Controlled trial	50 Adults with mild cognitive impairment	Root extract root 300 mg twice daily 8 weeks · vs Placebo	Better immediate and general memory (e.g. logical memory I p=0.007) and executive function/attention/speed (Flanker p=0.002) vs placebo. WMS-III logical memory I p=0.007 Methods, limits and funding Outcomes: Wechsler Memory Scale III, Flanker, Wisconsin Card Sort, Trail-Making A, Mackworth Clock Limitations: Pilot trial n=50, 8 weeks; effect sizes not given in abstract. Read: abstract
Cooley 2009 Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PloS one · PMID 19718255 · DOI	Controlled trial	81 Employees with moderate-to-severe anxiety	Naturopathic care package: diet advice, breathing, multivitamin and ashwagandha root 300 mg b.i.d. (1.5% withanolides) root 300 mg twice daily 12 weeks · vs Psychotherapy plus placebo	BAI fell 56.5% vs 30.5% (p=0.003 between groups). BAI -56.5% vs -30.5% Methods, limits and funding Outcomes: Beck Anxiety Inventory (primary), SF-36, FSI Limitations: Multi-component package; ashwagandha effect cannot be isolated. Registration: ISRCTN78958974 Read: abstract
Coope 2025 Effects of Root Extract of Ashwagandha (Withania somnifera) on Perception of Recovery and Muscle Strength in Female Athletes Eur J Sport Sci · PMID 39954269 · DOI	Controlled trial	30 Professional female footballers	Root extract root 600 mg per day 28 days · vs Placebo	Perceived recovery (TQR, p=0.026 interaction; p=0.039 at day 28) and perceived sleep quality (p=0.038) improved versus placebo. The abstract reports no significant strength benefit; carbohydrate intake influenced strength results. TQR p=0.026; sleep item p=0.038 Methods, limits and funding Outcomes: Total Quality Recovery, Hooper Index, RPE, handgrip, medicine-ball throw, jump, power Limitations: Only 30 athletes; subjective recovery scales; strength not improved Registration: NCT06264986 Read: abstract
Coope 2026 Ashwagandha Root Extract Stabilises Physiological Stress Responses in Male and Female Team Sports Athletes During Pre-Season Training. Nutrients · PMID 41599843 · DOI	Controlled trial	56 Male and female team-sport athletes in pre-season training	Ashwagandha root extract root 600 mg/day 42 days · vs Placebo	Cortisol rose in placebo females but was stabilised in ashwagandha; recovery perception (Hooper, soreness, fatigue) improved in ashwagandha females; cortisone rose in placebo males. Females: placebo cortisol p=0.001; Hooper p=0.001; fatigue p=0.026 Methods, limits and funding Outcomes: Salivary cortisol and cortisone, Hooper Index recovery, muscle strength, aerobic capacity Limitations: Athletes, sex-split analysis, small subgroups of 14. Registration: NCT07041853 Read: abstract
Coope 2026 Back to the Roots: Safety and Tolerability of Standardised Ashwagandha (Withania somnifera) Root Extract in Healthy Adults-A Systematic Review of Biomarkers and Adverse Events Pharmaceuticals (Basel) · PMID 42198398 · DOI	Systematic review	2317 Healthy adults in 23 studies (2010 to April 2026)	Single-ingredient standardised root extracts root 125 to 600 mg per day Single dose to 180 days · vs Placebo or comparator	Liver, kidney, blood, hormone and cardiovascular markers stayed in normal ranges; cortisol fell consistently; testosterone rose within physiological ranges; no serious adverse events attributed; mild gut upset, headache, drowsiness occurred in both groups. Little data beyond 180 days. No clinically meaningful harm in biomarkers at studied doses Methods, limits and funding Outcomes: Safety biomarkers and adverse events Limitations: Healthy adults only; short durations; excludes multi-ingredient products where case reports concentrate Registration: PROSPERO CRD420261337116 Read: abstract
Crane 2019 Profiling withanolide A for therapeutic targets in neurodegenerative diseases. Bioorg Med Chem · PMID 30929949 · DOI	In vitro chemical biology study in-vitro	human neuroblastoma SH-SY5Y cells	Withanolide A isolated compound n/a n/a · vs dexamethasone	Glucocorticoid receptor found as a potential target; withanolide A reversed dexamethasone-inhibited neurite outgrowth, but binding and transactivation assays found no direct interference with the receptor. Methods, limits and funding Outcomes: Target identification Limitations: Cell work; no direct receptor effect shown. Read: abstract
Della Porta 2023 Effects of Withania somnifera on Cortisol Levels in Stressed Human Subjects: A Systematic Review. Nutrients · PMID 38140274 · DOI	Systematic review	Stressed human subjects in 9 studies	Withania somnifera (various) unspecified Varied 30-112 days · vs Placebo/various	Reviewers concluded WS supplementation decreases cortisol secretion with no significant adverse effects; none of the studies assessed adrenal function impact or long-term effects. Qualitative (not applicable) Methods, limits and funding Outcomes: Cortisol Limitations: Studies varied in design, formulation, dose; adrenal function and long-term effects not studied. Registration: PRISMA-guided (registration not stated in abstract) Read: abstract
Deshpande 2020 A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep medicine · PMID 32540634 · DOI	Controlled trial	150 Healthy adults with non-restorative sleep (144 completed)	Shoden standardised extract unspecified 120 mg once daily 6 weeks · vs Placebo	72% rise in self-reported sleep quality vs 29% on placebo (p<0.001); actigraphy improved SE (p<0.01), TST (p<0.001), sleep latency (p<0.01), WASO (p<0.05). RSQ +72% vs +29% Methods, limits and funding Outcomes: Restorative Sleep Questionnaire, WHOQOL-BREF, actigraphy SOL, SE, TST, WASO Limitations: Healthy adults selected for non-restorative sleep, not clinical insomnia. Registration: CTRI/2017/02/007801 Read: abstract
Devpura 2021 Randomized placebo-controlled pilot clinical trial on the efficacy of ayurvedic treatment regime on COVID-19 positive patients Phytomedicine · PMID 33596494 · DOI	Controlled trial	Asymptomatic COVID-19 patients	Four-herb regime including ashwagandha 0.5 g plus giloy, herbo-mineral and tulsi unspecified 0.5 g ashwagandha twice daily within the regime 7 days · vs Placebo	Faster recovery in treated group and lower hs-CRP, IL-6, TNF-alpha at day 7; ashwagandha is only one component. Marker fold changes reported by authors Methods, limits and funding Outcomes: Viral load, hs-CRP, IL-6, TNF-alpha, recovery Limitations: Multi-herb regime; ashwagandha effect cannot be isolated; pilot Registration: CTRI/2020/05/025273 Read: abstract
Dongre 2015 Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study Biomed Res Int · PMID 26504795 · DOI	Controlled trial	50 Healthy women	High-concentration root extract (HCARE) root 300 mg twice daily 8 weeks · vs Starch placebo	Greater improvement than placebo in FSFI total (p<0.001) and arousal, lubrication, satisfaction (p<0.001), orgasm (p=0.004), distress score (p<0.001) and successful encounters (p<0.001). FSFI total p<0.001 vs placebo Methods, limits and funding Outcomes: Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), number of successful encounters Limitations: Pilot; 50 women; healthy women rather than diagnosed disorder Registration: CTRI/2015/07/006045 Read: abstract
Durg 2018 Withania somnifera (Indian ginseng) in male infertility: An evidence-based systematic review and meta-analysis Phytomedicine · PMID 30466985 · DOI	Meta-analysis	Infertile men (4 clinical trials in 5 publications: 4 observational, 1 RCT)	Withania somnifera (various) unspecified Not pooled Up to 90 days in the RCT · vs Pre-treatment baseline (observational); placebo (1 RCT)	Only one RCT, so RCTs were not pooled. In the RCT, sperm concentration +167%, volume +59%, motility +57%, testosterone +17%, LH +34%. Pooling observational before-and-after studies: volume MD 0.28 mL, concentration MD 13.57 million/mL, motility MD 8.50 percentage points. Authors call the data promising but too limited for robust conclusions. Concentration MD 13.57 million/mL; motility MD 8.50%; volume MD 0.28 mL (observational before-after pooling) (Concentration 11.12 to 16.01; motility 7.36 to 9.63; volume 0.12 to 0.43) Methods, limits and funding Outcomes: Semen parameters, hormones, oxidative markers, pregnancy Limitations: Only one RCT; the pooled analysis compares before with after in uncontrolled studies Read: abstract
Durg 2020 Withania somnifera (Indian ginseng) in diabetes mellitus: A systematic review and meta-analysis of scientific evidence from experimental research to clinical application Phytother Res · PMID 31975514 · DOI	Meta-analysis	6 in-vitro, 13 preclinical and 5 clinical studies in diabetes	Withania somnifera (various) unspecified Varied Varied · vs Varied	Large effects in experimental (animal) data on blood glucose (MD -196.27, CI -220.96 to -171.58), but authors say clinical data (5 studies) are not robust enough. Animal glucose MD -196.27 Methods, limits and funding Outcomes: Blood glucose, HbA1c, insulin, lipids Limitations: Headline numbers are from animals; clinical data limited Read: abstract
Dutta 2026 Plant Part-Specific Differences in Ashwagandha (Withania somnifera): A Comparative Evaluation of Root and Leaf Evidence for Safety and Regulation. Food Sci Nutr · PMID 42835472 · DOI	Narrative review	Root vs leaf evidence, with regulatory focus (searches to 31 March 2026)	Ashwagandha root vs leaf vs whole plant root+leaf	Root and leaf differ chemically (leaf richer in withaferin A). Trials and a 12-month study of standardised root extracts show generally favourable safety with no reproducible serious organ toxicity. Human leaf data are sparse and confounded. European risk opinions and the Danish ban did not consistently distinguish plant parts; analytical surveys document adulteration of root material with leaves and stems. Methods, limits and funding Outcomes: Safety, quality and regulation by plant part Limitations: Narrative review; author affiliations include Indian government bodies (views stated as personal). Funding and conflicts: No conflicts declared Read: abstract
Eichner 2019 Essential Features of Third-Party Certification Programs for Dietary Supplements: A Consensus Statement. Curr Sports Med Rep · PMID 31082891 · DOI	Consensus statement	Third-party certification programmes	Programmes for dietary supplements not applicable Not applicable Not applicable · vs None	FDA has no premarket quality review; programmes differ in testing. Methods, limits and funding Outcomes: Programme features Limitations: Sport-focused authors. Read: abstract
Ell 2023 Complementary and alternative treatments for insomnia disorder: a systematic umbrella review. J Sleep Res · PMID 37527850 · DOI	Umbrella review	Insomnia disorder; 15 reviews	Alternative treatments including melatonin not applicable Varied Varied · vs Placebo or wait list	Melatonin reduced self-reported and objective sleep onset latency; overall study quality low. Methods, limits and funding Outcomes: Sleep Limitations: Umbrella review. Read: abstract
Ewa 2025 Effects of an 8-week high intensity interval training (HIIT) and ashwagandha supplementation on aerobic capacity, muscle oxygenation and haematological parameters in healthy men Biol Sport · PMID 40657001 · DOI	Controlled trial	33 Healthy male non-athletes doing HIIT	Ashwagandha extract unspecified 600 mg per day 8 weeks · vs Placebo (16 placebo, 17 ashwagandha)	No group or interaction effect on aerobic capacity or blood counts. Both groups improved greatly from training. Authors conclude no extra benefit over HIIT. No between-group difference Methods, limits and funding Outcomes: Aerobic capacity, muscle oxygenation, blood counts Limitations: Null result; small Read: abstract
Farrin 2026 The effects of Ashwagandha (Withania somnifera) supplementation on fasting blood glucose and HbA1c: a systematic review and dose-response meta-analysis of randomized controlled trials Diabetes Res Clin Pract · PMID 42641800 · DOI	Meta-analysis	667 Adults in 11 RCTs	Ashwagandha supplementation unspecified Varied; no dose-response found Varied · vs Placebo	FBG WMD -3.09 mg/dL; HbA1c WMD -0.05% (inconclusive, 3 trials). GRADE certainty very low for both outcomes; authors say no clinical recommendations can be made. FBG -3.09 mg/dL; HbA1c -0.05% (FBG -5.61 to -0.58; HbA1c -0.47 to 0.36) Methods, limits and funding Outcomes: Fasting blood glucose, HbA1c Limitations: Substantial heterogeneity; very low certainty Read: abstract
Fatima 2024 Safety and efficacy of Withania somnifera for anxiety and insomnia: Systematic review and meta-analysis. Human psychopharmacology · PMID 39083548 · DOI	Meta-analysis	254 Adults with anxiety and/or insomnia in 5 RCTs	Withania somnifera extracts unspecified · vs Placebo	Pooled HAM-A reduction; improved SOL, TST, PSQI and sleep efficiency; no significant effect on WASO or time in bed. HAM-A MD -5.96 (I2 98%) (-10.34 to -1.59) Methods, limits and funding Outcomes: HAM-A, sleep onset latency, total sleep time, WASO, time in bed, sleep efficiency, PSQI Limitations: Only 5 RCTs; I2 98% for anxiety; Cochrane RoB 2 used but results not detailed in abstract. Read: abstract
Food Standards Agency (UK) 2026 Summary of responses to call for evidence on Ashwagandha GOV.UK (published 25 June 2026) · Source	Authoritative guidance		unspecified	Call for evidence ran 8 July to 2 September 2024 to gather information on ashwagandha food supplements (including use by pregnant women and children). 19 responses (8 food businesses, 7 industry bodies, 3 public, 1 university team). Responses go to the independent Committee on Toxicity; a risk assessment will be conducted and published. The page contains no current consumer advice or ban. Methods, limits and funding Outcomes: Regulatory process Limitations: Process document, not a safety conclusion. Read: full-text
Food Standards Agency (UK) 2026 Summary of responses to call for evidence on Ashwagandha · Source	Authoritative guidance		unspecified	Call asked about product types, plant sourcing, specifications, and contaminant levels such as heavy metals; 19 responses; no dose limit or numbers published on the page; FSA will pass responses to the Committee on Toxicity. Methods, limits and funding Read: summary-only
Fornalik 2026 Hormonal Modulation with Withania somnifera: Systematic Review and Meta-Analysis of Randomized-controlled Trials Planta Med · PMID 41740946 · DOI	Meta-analysis	1706 Adults in 23 randomised placebo-controlled trials	Oral ashwagandha (various extracts) unspecified Varied; subgroup suggests dose-response by withanolide content Varied · vs Placebo	Cortisol fell (SMD -1.18) and serotonin rose (MD 31.75 ng/ml). No effect on TSH or T3; T4 rose modestly (MD 0.61 ug/dL, p=0.02). Testosterone rose in men (MD 57.43 ng/dl) but not in women (MD 5.09 ng/dl); no effect on estradiol in either sex. Men testosterone MD 57.43 ng/dl; T4 MD 0.61 ug/dL; TSH and T3 no effect; cortisol SMD -1.18 Methods, limits and funding Outcomes: Circulating hormones: cortisol, serotonin, TSH, T3, T4, testosterone, estradiol Limitations: Heterogeneity and limited data on some endpoints (authors); mixed extracts; registered PROSPERO CRD42024611576 Registration: PROSPERO CRD42024611576 Read: abstract
Fornaro 2025 Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis "Nutra NMA SCZ". Molecular psychiatry · PMID 39026098 · DOI	Meta-analysis	2384 Schizophrenia/schizoaffective disorder (50 studies, 22 interventions)	Nutraceuticals/phytoceuticals as augmentation unspecified · vs Placebo/TAU	In the abstract, citicoline, L-lysine, N-acetylcysteine and sarcosine outperformed placebo; ashwagandha is not named among agents with significant total-symptom benefit in the abstract (full text not read). not reported for ashwagandha in abstract (not applicable) Methods, limits and funding Outcomes: Total symptoms, negative symptoms, cognition, depression Limitations: Abstract only; ashwagandha-specific result not visible in the abstract. Read: abstract
Fuladi 2021 Assessment of the Efficacy of Withania somnifera Root Extract in Patients with Generalized Anxiety Disorder: A Randomized Double-blind Placebo- Controlled Trial. Current reviews in clinical and experimental pharmacology · PMID 32282308 · DOI	Controlled trial	40 Patients with generalized anxiety disorder on SSRIs	Root extract root 1 g/day 6 weeks · vs Placebo	HAM-A fell 14 vs 8 units (P<0.05); difference present at week 2 (P=0.04) and week 6 (P=0.02). HAM-A -14 vs -8 Methods, limits and funding Outcomes: HAM-A Limitations: n=40; adjunct to SSRI; unbalanced arms (22 vs 18). Registration: IRCT20180615040105N1 Read: abstract
Gannon 2014 Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder J Ayurveda Integr Med · PMID 25624699 · DOI	Rct secondary analysis	60 Adults with bipolar disorder in an 8-week trial (10 had abnormal thyroid tests; 3 ashwagandha, 7 placebo)	Withania somnifera extract unspecified Not stated in abstract 8 weeks · vs Placebo	Three ashwagandha patients had T4 rises of 7%, 12% and 24%; six of seven placebo patients had T4 falls. Authors say ashwagandha may raise thyroxine and advise vigilance for hyperthyroidism while noting possible use in subclinical hypothyroidism. T4 up 7-24% in 3 ashwagandha patients Methods, limits and funding Outcomes: TSH, free T4, T3 (safety measures) Limitations: Thyroid tests were not the main goal; unequal tiny groups; no stratification Read: abstract
Gannon 2019 Effects of a standardized extract of Withania somnifera (Ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists · PMID 31046033	Controlled trial	66 Schizophrenia with positive-symptom exacerbation	Standardised extract (adjunct) unspecified 1000 mg/day 12 weeks · vs Placebo	Medium effect sizes favouring extract for depression single item and anxiety-depression cluster. d=0.683 and d=0.686 (0.16-1.21 for both) Methods, limits and funding Outcomes: Single-item depression and anxiety-depression PANSS clusters Limitations: Secondary/exploratory analysis of subscale items, not mood scales. Registration: NCT01793935 (secondary analysis) Read: abstract
Gerolymos 2026 Cognitive and affective effects of L-Theanine: a systematic review and meta-analysis of 31 randomized trials. Mol Psychiatry · PMID 42410082 · DOI	Meta-analysis	1168 Healthy and clinical adults; 31 RCTs	L-theanine not applicable Single 200 mg dose studied for attention; 400 mg/day for 8 weeks in one anxiety study Varied · vs Placebo	Attention improved with single 200 mg dose (SMD 0.51); acute stress effect modest (SMD 0.31) and driven by high-risk-of-bias studies; anxiety effects inconsistent. Choice reaction time SMD 0.51 (0.25 to 0.77) Methods, limits and funding Outcomes: Stress, attention, mood Read: abstract
Gierczuk 2025 Effects of Ashwagandha ( Withania somnifera ) Supplementation on Special Endurance and Response Time of Elite Wrestlers J Strength Cond Res · PMID 40845216 · DOI	Controlled trial	Elite national-team wrestlers	Ashwagandha extract unspecified 600 mg per day 8 weeks · vs Placebo	Both groups improved with training; no group or interaction effect. Authors conclude no added benefit. No between-group difference Methods, limits and funding Outcomes: Special endurance (dummy throws), choice reaction time Limitations: Null result; sample size not in abstract Read: abstract
Gopal 2021 Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study J Obstet Gynaecol Res · PMID 34553463 · DOI	Controlled trial	100 Perimenopausal women with climacteric symptoms (91 completed)	Standardised root extract root 300 mg twice daily 8 weeks · vs Placebo	Total MRS fell more than with placebo (p<0.0001) including psychological, somato-vegetative and urogenital domains; MENQoL improved (p<0.0001); estradiol rose (p<0.0001) while FSH (p<0.0001) and LH (p<0.05) fell; testosterone did not differ. MRS total p<0.0001; estradiol up; FSH down; LH down; testosterone no difference Methods, limits and funding Outcomes: Menopause Rating Scale (MRS), MENQoL, hot flash score, estradiol, FSH, LH, testosterone Limitations: Single-centre; 8 weeks; mild-to-moderate symptoms; hormone values not given in the abstract Read: abstract
Gopukumar 2021 Efficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled Study. Evidence-based complementary and alternative medicine : eCAM · PMID 34858513 · DOI	Controlled trial	130 Healthy stressed adults, PSS 14-24 (125 evaluated)	Sustained-release root extract (Prolanza/Ashwagandha SR) root 300 mg once daily 90 days · vs Placebo	Improved recall memory and fewer pattern-recall errors; PSS-10 13.0 vs 18.7 (p<0.0001); cortisol p=0.0443; PSQI p<0.0001. BDNF was a secondary outcome; its result is not stated in the abstract. PSS-10 13.0 +/- 5.0 vs 18.7 +/- 4.6 Methods, limits and funding Outcomes: CANTAB cognition (primary); PSS-10, serum cortisol, OHQ, PSQI, serum BDNF Limitations: BDNF result not reported in abstract; cognition effect shown as small differences in first-attempt memory (12.9 vs 10.1). Registration: CTRI/2019/11/021990 Read: abstract
Gupta 2013 Efficacy of Withania somnifera on seminal plasma metabolites of infertile males: a proton NMR study at 800 MHz J Ethnopharmacol · PMID 23796876 · DOI	Clinical trial uncontrolled	230 180 infertile men treated; 50 healthy controls	Root powder root 5 g per day 3 months · vs Healthy men as reference (no placebo)	Treatment shifted several seminal metabolites (lactate, alanine, citrate, GPC, histidine, phenylalanine) and semen quality toward those of healthy men. Direction of change only Methods, limits and funding Outcomes: Seminal plasma metabolites by NMR, sperm concentration, motility, lipid peroxide, hormones Limitations: No placebo group; same research group as the 2010 Fertility and Sterility study; mechanism study Read: abstract
Gupta 2015 Comparative transcriptome analysis of different chemotypes elucidates withanolide biosynthesis pathway from medicinal plant Withania somnifera. Sci Rep · PMID 26688389 · DOI	Transcriptome study in-vitro	leaf and root tissue of distinct chemotypes	Plant tissue leaf and root n/a n/a · vs none	Leaf and root tissues of different chemotypes differ in content and/or nature of withanolides; many genes differentially expressed. Methods, limits and funding Outcomes: Gene expression related to withanolide biosynthesis Limitations: Genomic study. Read: abstract
Gupta 2022 Safety, toxicity and pharmacokinetic assessment of oral Withaferin-A in mice. Toxicol Rep · PMID 36518386 · DOI	Animal toxicology and pharmacokinetics animal	mice	Pure withaferin A isolated compound oral 10, 70, 500 mg/kg daily for 28 days; IV 10 mg/kg vs oral 70 mg/kg for PK 28 days · vs dose groups	No toxicity at up to 500 mg/kg for 28 days; oral bioavailability of withaferin A 1.8%. Methods, limits and funding Outcomes: Toxicity and oral bioavailability Limitations: Mouse data; pure compound, not an extract. Read: abstract
Gómez Afonso 2023 Effects of Withania somnifera (Ashwagandha) on Hematological and Biochemical Markers, Hormonal Behavior, and Oxidant Response in Healthy Adults: A Systematic Review. Curr Nutr Rep · PMID 37428341 · DOI	Systematic review	Healthy adults; 10 studies (searched to March 2022)	Withania somnifera unspecified · vs Control or pre-post	Most studies reported beneficial changes in oxidative stress, inflammation and hormones; no serious adverse events were reported. Methods, limits and funding Outcomes: Haematological and biochemical markers, hormones, oxidant response Limitations: Small number of studies; mixed designs. Funding and conflicts: Authors declare no competing interests Read: abstract
Hayashi 2024 Painless Thyroiditis by Withania somnifera (Ashwagandha) Cureus · PMID 38559552 · DOI	Case report	1 47-year-old previously healthy Japanese man	Ashwagandha supplement unspecified Not stated in abstract 2 months before presentation · vs None	Thyrotoxicosis diagnosed as painless thyroiditis; improved after stopping. Single case Methods, limits and funding Outcomes: Thyroid tests, ultrasound, scintigraphy Limitations: Single case; product contents not verified Read: abstract
Health Canada Natural Health Product: Ashwagandha (Withania somnifera) monograph Natural Health Products Ingredients Database · Source	Authoritative guidance		unspecified	NOT READ DIRECTLY (site refused the connection). A web-search summary of the monograph says users should consult a health care practitioner before use if pregnant or breastfeeding and carries a drowsiness caution about driving or operating machinery; the summary says liver injury is not mentioned. Treat as unverified. Methods, limits and funding Outcomes: Risk statements for licensed products Limitations: Unverified secondary summary; monograph date unknown. Read: summary-only
Heyninck 2014 Withaferin A inhibits NF-kappaB activation by targeting cysteine 179 in IKKβ. Biochem Pharmacol · PMID 25159986 · DOI	In vitro study in-vitro	cell-free kinase assays and cells	Withaferin A isolated compound n/a n/a · vs none	Withaferin A directly inhibits IKK beta by targeting cysteine 179 in its catalytic site. Methods, limits and funding Outcomes: NF-kB signalling Limitations: In-vitro; concentrations used may exceed human blood levels. Read: abstract
Hidese 2019 Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients · PMID 31623400 · DOI	Controlled trial	30 Healthy adults, crossover	L-theanine not applicable 200 mg/day 4 weeks · vs Placebo	Sleep and anxiety-trait scores improved after L-theanine. Methods, limits and funding Outcomes: Depression, anxiety, sleep scores, cognition Limitations: 30 people. Read: abstract
Holzman 2025 Unmasking Potential Withdrawal Effects of Ashwagandha: A Case Report and Review. Cureus · PMID 40476122 · DOI	Case report	1 20-year-old man	Ashwagandha extract, abruptly stopped unspecified · vs none	Tachycardia, insomnia and anxiety symptoms after abrupt discontinuation; routine bloods, liver and thyroid tests normal; treated with hydroxyzine. Authors suggest a possible withdrawal syndrome mediated by GABA activity; recurrence of underlying anxiety not excluded. Methods, limits and funding Outcomes: Symptoms after stopping Limitations: Single case; mechanism speculative. Funding and conflicts: No conflicts declared Read: abstract
Honnutagi 2026 Ashwagandha ( Withania somnifera ) Root Extract Improves General Health in Elderly Men and Women: A Prospective, Randomized, Double-Blind, Placebo-Controlled, Efficacy and Safety Study. Phytotherapy research : PTR · PMID 41725116 · DOI	Controlled trial	50 Healthy adults aged 60-85 (46 analysed)	Root extract root 300 mg twice daily 8 weeks · vs Placebo	Greater OPQOL improvement vs placebo at week 4 (p=0.023) and week 8 (p<0.0001); ESS (p<0.001) and fitness sub-scales improved. OPQOL p<0.0001 at week 8 Methods, limits and funding Outcomes: Older People's Quality of Life (primary), Epworth Sleepiness Scale, Senior Fitness Test Limitations: Small trial. Read: abstract
Hore 2022 Health Remedies as a Source of Lead, Mercury, and Arsenic Exposure, New York City, 2010-2019. Am J Public Health · PMID 36179284 · DOI	Laboratory survey in-vitro	584 Health remedies collected in NYC poisoning investigations	Ayurvedic rasa shastra products and others not applicable Not applicable Not applicable · vs Lab analysis	Rasa shastra Ayurvedic medicines can contain very high levels; blood lead higher in users. Methods, limits and funding Outcomes: Lead, mercury, arsenic Limitations: Rasa shastra (metal-based) products are not herbal root supplements. Read: abstract
Ireland 2021 Drug-induced hepatocellular injury due to herbal supplement ashwagandha. J R Coll Physicians Edinb · PMID 34882134 · DOI	Case report	1 39-year-old woman	Over-the-counter herbal supplement containing ashwagandha root extract root Jaundice and nausea for one week at presentation · vs none	Hepatocellular enzyme pattern with jaundice; viral serology, autoantibodies and ultrasound unremarkable. Biopsy: acute cholestatic hepatitis with confluent necrosis, no chronicity. Treated with ursodeoxycholic acid. Methods, limits and funding Outcomes: Liver enzymes, biopsy, treatment Limitations: Single case; product may have contained other ingredients ('containing ashwagandha root extract'). Read: abstract
Ishaque 2012 Rhodiola rosea for physical and mental fatigue: a systematic review. BMC Complement Altern Med · PMID 22643043 · DOI	Systematic review	11 studies on Rhodiola rosea	Rhodiola rosea not applicable Varied Varied · vs Varied	Contradictory results; all trials high or unclear risk of bias. Methods, limits and funding Outcomes: Physical and mental fatigue Limitations: Flawed methodology. Read: abstract
J 2026 Steered molecular dynamics and free-energy analysis of withanolide unbinding from tau kinases TTBK1 and GSK-3β. J Biomol Struct Dyn · PMID 42806777 · DOI	Computational study in-vitro	in silico	Sominone, withanolide A, withanolide D, withanone, withaferin A isolated compounds n/a n/a · vs none	Computed binding free energies -9 to -13 kcal/mol; no laboratory or human test. Methods, limits and funding Outcomes: Binding to TTBK1 and GSK-3 beta by molecular dynamics Limitations: Pure computer simulation. Read: abstract
Jagim 2023 Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front Sports Act Living · PMID 37841887 · DOI	Narrative review	Athletes and supplements	Sport supplements not applicable Not applicable Not applicable · vs None	Review of adulteration in sport supplements. Methods, limits and funding Outcomes: Adulteration prevalence Limitations: Sport products only. Read: abstract
Jahanbakhsh 2016 Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Complementary therapies in medicine · PMID 27515872 · DOI	Controlled trial	30 OCD patients on SSRIs	Root extract root 120 mg/day 6 weeks · vs Placebo	Y-BOCS fell more with extract (median change -8 vs -2, P<0.001). Median change -8 vs -2 Methods, limits and funding Outcomes: Y-BOCS Limitations: n=30; adjunct to SSRI; median/range reported. Read: abstract
Jamshidi 2017 The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med · PMID 28400848 · DOI	Systematic review	Humans (24 studies on tulsi/holy basil)	Tulsi unspecified Dose and form unclear (authors ask for clarification) Varies · vs Varies	All 24 studies reported favourable outcomes; no significant adverse events reported. Methods, limits and funding Outcomes: Metabolic, cardiovascular, immune, neurocognitive outcomes Limitations: Many small, varied studies; authors say dosage and form need clarifying. Read: abstract
Javid 2026 From herbal hope to hormonal havoc: chronic ashwagandha use and HPA axis suppression Endocrinol Diabetes Metab Case Rep · PMID 41553875 · DOI	Case report	1 55-year-old postmenopausal woman with Cushingoid features	Ashwagandha extract unspecified About 950 mg per day More than 1 year · vs None	Low basal cortisol and weak ACTH-stimulation response (adrenal insufficiency); HPA suppression had not reversed at 3 months and hydrocortisone was needed. Single case Methods, limits and funding Outcomes: Basal cortisol, ACTH stimulation test Limitations: Single case; causal link inferred by authors from literature Read: abstract
Jillella 2026 A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Study of Efficacy and Safety of Ashwagandha Root Extract Capsule on Skin and Hair Health in Healthy Adults Phytother Res · PMID 41770039 · DOI	Controlled trial	Adults aged 18-60 with hair loss or skin conditions	Standardised root extract (oral) root 300 mg twice daily 75 days · vs Placebo	Better TEWL and hair density, growth, anagen/telogen ratio and quality-of-life scores than placebo (p<0.05). Direction only Methods, limits and funding Outcomes: TEWL, TrichoScan hair parameters, DLQI, Hair-specific Skindex-29 Limitations: Sample size not in abstract; cosmetic outcomes Read: abstract
Kalaiselvan 2025 Reproductive and developmental safety assessment of Ashwagandha (Withania somnifera) root extract in Wistar rats. Front Pharmacol · PMID 40606615 · DOI	Animal research animal	Wistar rats (OECD 421 reproduction/developmental screening)	Aqueous ashwagandha root extract root Up to 2000 mg/kg (NOAEL) 4 weeks · vs Control	NOAEL in adult rats 2000 mg/kg; no differences in body weights, reproductive organ weights, T4 or TSH; no evidence of reproductive or developmental toxicity with this extract. NOAEL 2000 mg/kg (rat) Methods, limits and funding Outcomes: Parental and pup body weight, reproductive organ weights, T4/TSH Limitations: Rat screening study; not proof of safety in human pregnancy. Funding and conflicts: No conflicts declared Read: abstract
Kale 2026 Safety and Efficacy of Ashwagandha Root Extract on Cognition, Energy and Mood Problems in Adults: Prospective, Randomized, Placebo-Controlled Study. Journal of psychoactive drugs · PMID 39498904 · DOI	Controlled trial	120 Adults aged 30-75 with self-reported cognitive and energy problems	Root extract root 600 mg/day 8 weeks · vs Placebo	Greater improvement in episodic memory, working memory and attention accuracy vs placebo (p<.05); mood, mental fatigue and executive function scores improved from baseline. COMPASS memory/attention p<.05 Methods, limits and funding Outcomes: COMPASS cognition; POMS-A, Mental Fatigue Scale, BRIEF-A Limitations: Secondary outcomes described as improvements from baseline rather than vs placebo in the abstract. Read: abstract
Kamal 2022 Ashwagandha as a Unique Cause of Thyrotoxicosis Presenting With Supraventricular Tachycardia Cureus · PMID 35475098 · DOI	Case report	1 73-year-old woman self-treating hypothyroidism for two years	Ashwagandha root extract root Not stated in abstract About 2 years · vs None	Presented with supraventricular tachycardia, hyperthyroid symptoms and low TSH; symptoms and labs resolved after stopping. Single case Methods, limits and funding Outcomes: TSH, symptoms, heart rhythm Limitations: Single case; causality inferred from timing and resolution Read: abstract
Kaushik 2017 Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction. PloS one · PMID 28207892 · DOI	Animal research animal	Mice	Leaf water extract; triethylene glycol leaf 10-30 mg/mouse (triethylene glycol) Acute · vs Control	Water extract of leaf (rich in triethylene glycol) increased NREM sleep; alcoholic extract rich in withanolides did not. Animal data (not applicable) Methods, limits and funding Outcomes: NREM and REM sleep Limitations: Mouse study; shows the sleep-inducing component may differ from the withanolides. Read: abstract
Kelgane 2020 Efficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Randomized, Double-blind, Placebo-controlled Study. Cureus · PMID 32226684 · DOI	Controlled trial	50 Adults aged 65-80	Root extract root 600 mg/day 12 weeks · vs Placebo	Improved WHOQOL-BREF total (140.53 to 161.84), sleep quality (P<0.0001) and mental alertness (P<0.034) vs placebo. WHOQOL-BREF 140.53 to 161.84 Methods, limits and funding Outcomes: WHOQOL-BREF, sleep quality, mental alertness on rising Limitations: Small trial; lacks effect sizes with CI. Read: abstract
Khanna 2026 Efficacy and safety of ashwagandha root extract on sexual health in healthy Men: a prospective, randomized, double-blind, placebo-controlled study Front Reprod Health · PMID 41766918 · DOI	Controlled trial	76 Healthy men aged 30-50	Standardised root extract root 300 mg twice daily 8 weeks · vs Matched placebo	Sexual desire and function scores improved versus placebo (p<=0.001). Reported semen changes: ejaculate volume +36%, total sperm count +38%, total sperm motility +87%. No adverse events reported. Volume +36%, total sperm count +38%, total motility +87% (abstract does not say whether versus baseline or placebo) Methods, limits and funding Outcomes: Sexual Desire Inventory-2, satisfying sexual events, International Index of Erectile Function, WHO-standard semen analysis, SF-12 Limitations: Healthy men with no stated fertility problem; percentage changes not defined against baseline or placebo in the abstract Registration: CTRI/2022/11/047501 Read: abstract
Kim 2023 Pharmacokinetics and bioequivalence of Withania somnifera (Ashwagandha) extracts - A double blind, crossover study in healthy adults. Heliyon · PMID 38144272 · DOI	Randomized double blind crossover	16 healthy adults	Two commercial root extracts: WS-35 (not less than 40% withanolides incl. not less than 35% glycosides) vs WS-2.5 (2.5% withanolides) unspecified (commercial extracts) dose normalised to 185 mg total withanolides each single dose, crossover · vs other extract	Half-life, Cmax and mean residence time of total withanolides were 5.18, 5.62 and 4.13 times higher with WS-35; per mg of extract the AUC(0-inf) was 280.74 times higher for WS-35 than WS-2.5. Methods, limits and funding Outcomes: Plasma PK of withanolide A, withanoside IV, withaferin A and total withanolides Limitations: Healthy volunteers, single dose, extract-maker authors; PK not clinical effect. Funding and conflicts: Last author has a patent pending with Arjuna Natural (extract maker) Registration: CTRI/2020/10/028397 Read: abstract
KrishnaRaju 2023 Efficacy and Anti-Inflammatory Activity of Ashwagandha Sustained-Release Formulation on Depression and Anxiety Induced by Chronic Unpredictable Stress: in vivo and in vitro Studies J Exp Pharmacol · PMID 37521489 · DOI	In vitro and animal in-vitro	Human THP-1 and HL-60 cell lines; rats under chronic unpredictable stress	AshwaSR sustained-release formulation unspecified In vitro dose range In vitro; rat study · vs Cells/rats untreated or escitalopram	Dose-dependent inhibition of TNF-alpha, IL-1 beta and superoxide in cells; anxiolytic-type effects in rats. Dose-dependent in vitro inhibition Methods, limits and funding Outcomes: TNF-alpha, IL-1 beta, superoxide in cells; behaviour in rats Limitations: Not human data Read: abstract
Kuboyama 2002 Axon- or dendrite-predominant outgrowth induced by constituents from Ashwagandha. Neuroreport · PMID 12395110 · DOI	In vitro study in-vitro	human neuroblastoma SH-SY5Y cells; rat cortical neurons	Compounds from root methanol extract root n/a n/a · vs vehicle	Six of 18 compounds enhanced neurite outgrowth; withanolide A extended axons; withanosides IV and VI extended dendrites. Methods, limits and funding Outcomes: Neurite outgrowth Limitations: Cell culture only. Read: abstract
Kulkarni 2026 Ayurvedic Interventions for Primary Insomnia in the Elderly: A Systematic Review of Clinical Evidence and Research Gaps. Global advances in integrative medicine and health · PMID 42694495 · DOI	Systematic review	Elderly primary insomnia, 11 studies of Ayurvedic treatments	Ashwagandha among several Ayurvedic interventions unspecified · vs Various	Most studies reported benefit; only two targeted the elderly; small samples, no comparators, absent trial registration. Qualitative (not applicable) Methods, limits and funding Outcomes: Insomnia Limitations: Ashwagandha contribution not separable in the abstract. Read: abstract
Kumar 2015 Efficacy & safety evaluation of Ayurvedic treatment (Ashwagandha powder & Sidh Makardhwaj) in rheumatoid arthritis patients: a pilot prospective study Indian J Med Res · PMID 25857501 · DOI	Uncontrolled pilot	86 Rheumatoid arthritis patients (78 completed)	Ashwagandha powder plus Sidh Makardhwaj (herbo-mineral) root 5 g twice daily for 3 weeks, then Sidh Makardhwaj 100 mg daily for 4 weeks 7 weeks · vs None	ACR20 response in 56.4%; improved joint counts, pain, ESR. Liver and kidney tests normal but urinary mercury rose after treatment. ACR20 56.4% (44/78) Methods, limits and funding Outcomes: ACR20, DAS28, joint counts, ESR, liver and kidney tests, urine mercury Limitations: No control, not randomised; combined with a mercury-containing preparation so ashwagandha effect cannot be isolated Read: abstract
Kumar 2018 Comparative study of effect of Withania somnifera as an adjuvant to DOTS in patients of newly diagnosed sputum smear positive pulmonary tuberculosis Indian J Tuberc · PMID 29933868 · DOI	Controlled trial	Newly diagnosed sputum-positive tuberculosis on standard drugs	Root extract (add-on) root Not stated in abstract 12 weeks · vs Placebo	Sputum conversion at 8 weeks 86.6% vs 76.6%; CD4 and CD8 counts rose significantly at 12 weeks in the ashwagandha group. CD4 and CD8 rose Methods, limits and funding Outcomes: Sputum conversion, CD4/CD8, liver enzymes, uric acid, quality of life Limitations: Group size wording unclear in abstract; add-on to anti-TB drugs Read: abstract
Kumar 2021 Investigation of CYP2B6, 3A4 and β-esterase interactions of Withania somnifera (L.) dunal in human liver microsomes and HepG2 cells. J Ethnopharmacol · PMID 33395575 · DOI	In vitro CYP interaction study in-vitro	human liver microsomes and HepG2 cells	Root extracts (methanol, ethanol, water, ethyl acetate) root extract concentrations n/a · vs none	Methanol and ethyl acetate extracts inhibited CYP2B6 (IC50 79.16 and 57.96 ug/mL); all extracts moderately induced CYP3A4; authors say herb-drug interactions are possible. Methods, limits and funding Outcomes: CYP2B6 inhibition, CYP3A4 induction Limitations: Cell and microsome work with solvent extracts; concentrations may not reflect supplements. Read: abstract
Kumar 2023 A critical assessment of the whole plant-based phytotherapeutics from Withania somnifera (L.) Dunal with respect to safety and efficacy vis-a-vis leaf or root extract-based formulation. Toxicol Mech Methods · PMID 37533233 · DOI	Narrative review in-vitro	literature	Whole-plant vs leaf vs root extracts whole plant n/a n/a · vs none	Withanosides found exclusively in roots; withanolides and withanones more abundant in leaves; reports conflict on where withaferin A is most concentrated. Methods, limits and funding Outcomes: Distribution of withanolides, safety Limitations: Authors linked to the whole-plant extract industry (W-ferinAmax); read abstract only. Read: abstract
Kumar 2026 Potential Adverse Effects of Ashwagandha: A Critical Review of Preclinical and Clinical Evidence. Phytother Res · PMID 41502355 · DOI	Narrative review	Preclinical and clinical literature	Ashwagandha unspecified	Review reports GI effects, immune hypersensitivity, liver toxicity and endocrine disruption with prolonged or excessive use; proposes that cytochrome P450 metabolism may form reactive intermediates (a hypothesis); links endocrine activity to thyrotoxicosis and adrenal suppression; calls for standardised dosing and long-term studies. Methods, limits and funding Outcomes: Adverse effects overview Limitations: Narrative review; mechanisms hypothetical. Funding and conflicts: No conflicts declared Read: abstract
Langade 2019 Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus · PMID 31728244 · DOI	Controlled trial	60 Adults with insomnia and anxiety	Highest-concentration full-spectrum root extract root 300 mg twice daily 10 weeks · vs Placebo (2:1)	Sleep onset latency shorter than placebo (29.00 vs 33.94 min, p=0.019); sleep efficiency rose from 75.63 to 83.48 vs 75.14 to 79.68; sleep quality better (p=0.002); anxiety improved. SOL 29.00 vs 33.94 min; SE 83.48 vs 79.68 at week 10 Methods, limits and funding Outcomes: Actigraphy SOL, TST, SE, WASO; PSQI; HAM-A Limitations: Randomised 2:1 (40 vs 20); placebo also improved SOL; 58 per-protocol. Read: abstract
Langade 2021 Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. Journal of ethnopharmacology · PMID 32818573 · DOI	Controlled trial	80 40 healthy volunteers and 40 people with insomnia	Root extract root 8 weeks · vs Placebo	Significant sleep improvement in both groups, larger in insomnia; SOL (p=0.013), SE and TST most improved. SOL p=0.013; SE p<0.0001; TST p<0.002; WASO p=0.040 Methods, limits and funding Outcomes: SOL, TST, WASO, time in bed, SE, PSQI, HAM-A, mental alertness Limitations: Dose not given in abstract; both groups improved from baseline. Read: abstract
Lee 2026 Adjunctive Ashwagandha (Withania somnifera) Supplementation and Resistance-Training Adaptations in Healthy Adults: A Systematic Review and Random-Effects Meta-Analysis of Muscular Strength, Chest Circumference, and Body Composition Nutrients · PMID 42738987 · DOI	Meta-analysis	161 Healthy adults doing structured resistance training (4 RCTs; 3 pooled)	Standardised extract, root or root-and-leaf unspecified Varied Varied · vs Placebo	Pooled SMD: bench 0.60, lower body 0.52, chest 0.86, body fat -0.32 (not significant). After a more conservative statistical adjustment (HKSJ) both strength effects lost significance. GRADE: low for strength and body fat, very low for chest. Authors conclude evidence does not establish that ashwagandha enhances resistance-training adaptations. Bench SMD 0.60; lower body 0.52; chest 0.86; body fat -0.32 (Bench 0.20-1.01; lower body 0.19-0.86; chest 0.41-1.31; fat -0.72 to 0.08) Methods, limits and funding Outcomes: 1-RM bench press, lower-body 1-RM, chest circumference, body fat Limitations: Only 3 pooled trials, all with some risk-of-bias concerns; not registered; results depend on one influential trial Registration: Not registered Read: abstract
Leonard 2024 Acute and Repeated Ashwagandha Supplementation Improves Markers of Cognitive Function and Mood. Nutrients · PMID 38931168 · DOI	Controlled trial	59 Healthy adults mean age 22.7	Liposomal root and leaf extract root+leaf 225 mg acute then 225 mg/day Acute (60 min) and 30 days · vs Placebo (gum arabic)	Improvements in word recall, choice reaction time, picture recognition, digit vigilance and Stroop; POMS tension and fatigue decreased. Not given in abstract (CIs reported in paper but not in abstract) Methods, limits and funding Outcomes: COMPASS cognitive battery, POMS Limitations: Retrospectively registered; many outcomes tested; effects 'more consistently' in ashwagandha group but with multiple comparisons. Registration: ISRCTN58680760 (retrospective) Read: abstract
Li 2023 Ginseng and Ginseng Herbal Formulas for Symptomatic Management of Fatigue: A Systematic Review and Meta-Analysis. J Integr Complement Med · PMID 36730693 · DOI	Meta-analysis	19 RCTs of ginseng and ginseng formulas for fatigue	Ginseng not applicable Varied Varied · vs Controls	Overall fatigue reduction not significant (SMD -0.36, CI -0.82 to 0.11); significant for general fatigue (SMD -0.48) and formulas; effect sizes small. SMD -0.36 (-0.82 to 0.11) Methods, limits and funding Outcomes: Fatigue Read: abstract
Li 2023 Ginseng and health outcomes: an umbrella review. Front Pharmacol · PMID 37465522 · DOI	Umbrella review	19 meta-analyses of ginseng	Ginseng not applicable Varied Varied · vs Varied	Beneficial for fatigue, sexual function, menopausal symptoms among others; methodological quality poor (14 critically low). Methods, limits and funding Outcomes: Many outcomes Limitations: Critically low quality reviews. Read: abstract
Li 2026 Evaluating the Safety of Ashwagandha as a Food Additive: A Focus on Reproductive, Thyroid, and Immune System Effects Phytother Res · PMID 41454545 · DOI	Narrative review	Literature on reproductive, thyroid and immune effects	Ashwagandha as a food additive unspecified	Authors conclude ashwagandha poses risks to pregnant women, people with thyroid disorders and people with liver or kidney dysfunction, and recommend stronger labels. Qualitative Methods, limits and funding Outcomes: Safety Limitations: Review conclusions are stronger than what trials in healthy adults show; authors' recommendation, not a regulation Read: abstract
Li 2026 Effects of Withania somnifera (Ashwagandha) Supplementation on Exercise Performance: A Systematic Review and Three-Level Meta-Analysis Nutrients · PMID 42356302 · DOI	Meta-analysis	599 Adults in 13 RCTs (mostly young adults or athletes)	Oral ashwagandha unspecified 500-600 mg/day best-supported range (hypothesis-generating) Varied · vs Placebo or control	Overall Hedges g 0.47; strongest for aerobic endurance (g 0.54); strength positive but uncertain; 95% prediction interval -0.40 to 1.33 crossed zero. Overall g 0.47; aerobic endurance g 0.54 (Overall 0.25-0.69; aerobic 0.22-0.85) Methods, limits and funding Outcomes: Objective exercise performance (aerobic, strength, power) Limitations: High heterogeneity (I2 60%); prediction interval crossed zero; sparse power data Read: abstract
Likhitsup 2024 Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults. JAMA Netw Open · PMID 39102266 · DOI	Cross sectional survey	9685 US adults in NHANES 2017-March 2020, nationally representative	Six potentially hepatotoxic botanicals including ashwagandha (28 ashwagandha users in the sample) unspecified Past 30 days use · vs none	Overall use of any of the 6 botanicals was 4.7% (95% CI 3.9-5.7%), an estimated 15,584,599 US adults. Turmeric was most common (n=236), then green tea (n=92), ashwagandha (n=28). Exposure data only, no liver outcomes. 4.7% used at least one of the 6 botanicals Methods, limits and funding Outcomes: Prevalence of use of 6 botanicals Limitations: Counts exposure, not injury; cannot give a liver-injury rate for ashwagandha. Read: abstract
LiverTox (NIDDK) 2012 Ashwagandha. · PMID 31643854	Authoritative guidance	LiverTox clinical record (NIDDK/NLM)	Ashwagandha unspecified	Record states ashwagandha 'has not been implicated in causing serum enzyme elevations during therapy but recently has been implicated in cases of clinically apparent liver injury' (record updated 3 Dec 2024). Only this opening statement was read; the likelihood score and case details were not available in the PubMed record. Methods, limits and funding Outcomes: Hepatotoxicity classification Limitations: Only the introductory sentence was read. Read: abstract
Logie 2020 Tackling Chronic Inflammation with Withanolide Phytochemicals-A Withaferin a Perspective. Antioxidants (Basel) · PMID 33182809 · DOI	Narrative review in-vitro	in-vitro and animal literature	Withaferin A isolated compound n/a n/a · vs none	Withaferin A acts on NF-kB and Nrf2 signalling in in-vitro and animal models of diabetes, obesity, neurodegeneration, cystic fibrosis, osteoarthritis. Methods, limits and funding Outcomes: Anti-inflammatory mechanisms Limitations: No human data. Read: abstract
Lopresti 2019 An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine · PMID 31517876 · DOI	Controlled trial	60 Healthy adults with self-reported high stress	Shoden standardised extract unspecified 240 mg once daily 60 days · vs Placebo	HAM-A reduction vs placebo (P=0.040); DASS-21 near-significant (P=0.096); greater reductions in morning cortisol (P<0.001) and DHEA-S (P=0.004); testosterone rose in males but not significantly vs placebo (P=0.158). HAM-A P=0.040; cortisol P<0.001; DHEA-S P=0.004 Methods, limits and funding Outcomes: HAM-A, DASS-21; morning cortisol, DHEA-S, testosterone Limitations: Small trial (n=60); DASS-21 primary-type stress measure did not reach significance. Registration: CTRI/2017/08/009449 Read: abstract
Lopresti 2019 A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males Am J Mens Health · PMID 30854916 · DOI	Controlled trial	57 Overweight men aged 40-70 with mild fatigue (50 completed first 8 weeks, 43 completed all 16)	Shoden (standardised extract) root 21 mg withanolide glycosides per day 8 weeks per arm, 16-week crossover · vs Placebo	DHEA-S rose 18% more (p=.005) and testosterone 14.7% more (p=.010) than with placebo. No between-group differences in cortisol, estradiol, fatigue, vigor or sexual well-being. Testosterone +14.7% vs placebo (salivary); DHEA-S +18% vs placebo Methods, limits and funding Outcomes: Fatigue, vigor, aging-male symptoms, salivary DHEA-S, testosterone, cortisol, estradiol Limitations: Small sample; salivary hormones; clinical outcomes (fatigue, vigor, sexual well-being) did not differ from placebo Read: abstract
Lopresti 2022 Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials. Nutritional neuroscience · PMID 33650944 · DOI	Systematic review	52 RCTs of plants/phytonutrients on HPA-axis hormones (several plants)	Ashwagandha among 26 plants unspecified · vs Placebo/control	For most plants HPA-axis effects were unclear; the most consistent finding was a morning cortisol-lowering effect from ashwagandha supplementation. Qualitative (not applicable) Methods, limits and funding Outcomes: Cortisol, cortisone, CRH, ACTH Limitations: Wide variability in study designs across plants. Read: abstract
Lopresti 2026 An Examination into the Anti-stress and Anti-fatigue Effects of an Ashwagandha Extract (Ashwa.30™) in Stressed Adults: A Randomised, Double-Blind, Placebo-controlled Trial. Advances in therapy · PMID 42593642 · DOI	Controlled trial	60 Adults aged 18-65 with self-reported stress	Ashwa.30 low-dose extract unspecified 30 mg/day 28 days · vs Placebo	Lower self-reported stress in full analysis set (p=0.046) but not significant in per-protocol set; lower stress rating during test (p=0.044); salivary cortisol stable in ashwagandha group vs rise on placebo (p=0.047); no other physiological differences. Stress p=0.046 (FAS only); cortisol reactivity p=0.047 Methods, limits and funding Outcomes: DASS stress (primary), daily mood, Chalder Fatigue, Socially Evaluated Cold-Pressor Test with salivary cortisol and chromogranin A Limitations: Primary result significant in full analysis set only; many secondary outcomes null; preliminary per authors. Registration: ACTRN12625000129482 Read: abstract
Lopresti 2026 Magnesium Supplementation for Sleep in Adults: A Systematic Review of Randomized Controlled Trials. J Diet Suppl · PMID 42661485 · DOI	Systematic review	Adults (12 RCTs in main synthesis)	Magnesium alone not applicable Varied Varied · vs Placebo	Inconsistent findings; certainty low to very low. Methods, limits and funding Outcomes: Sleep Limitations: Heterogeneous. Read: abstract
Lorca 2023 Plant-derived nootropics and human cognition: A systematic review. Critical reviews in food science and nutrition · PMID 34978226 · DOI	Systematic review	Human studies of plant-derived nootropics (256 papers)	Plant nootropics incl. Withania somnifera unspecified · vs Various	Review states Withania somnifera modulates anxiety and social-related cognitions (abstract, no numbers). Qualitative (not applicable) Methods, limits and funding Outcomes: Cognitive domains Limitations: Very broad review; ashwagandha-specific detail not in abstract. Read: abstract
Lubarska 2023 Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. Int J Environ Res Public Health · PMID 36900932 · DOI	Case report	1 Adult man, Poland, with jaundice	Ashwagandha taken for about one year unspecified About 1 year · vs none	Raised bilirubin, ALT, AST, GGT, ALP, cholesterol, triglycerides and ferritin; R-value indicated hepatocellular injury; 24-hour urine copper was above the upper limit twice. Improved after intensive treatment including four plasmapheresis sessions. Methods, limits and funding Outcomes: Liver tests, urinary copper, treatment Limitations: Single case; severe course; cause of raised copper not established. Funding and conflicts: Authors declare no conflict of interest Read: abstract
Ma 2025 Dietary Supplement Adulteration: Laboratory Approaches to Risk Mitigation. J Nat Prod · PMID 40700739 · DOI	Review	Dietary supplement quality	GMP and adulteration controls not applicable Not applicable Not applicable · vs None	US sellers must follow GMP including identity, purity, strength testing; certification and third-party testing are further tools. Methods, limits and funding Outcomes: Risk mitigation Read: abstract
Mah 2021 Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis. BMC Complement Med Ther · PMID 33865376 · DOI	Meta-analysis	151 Older adults with insomnia (3 RCTs)	Oral magnesium not applicable Varied Varied · vs Placebo	17.36 minutes shorter sleep onset latency; low to very low certainty. MD -17.36 min (-27.27 to -7.44) Methods, limits and funding Outcomes: Sleep onset latency Limitations: High risk of bias. Read: abstract
Mahadevan 2025 A New Ashwagandha Formulation (Zenroot™) Alleviates Stress and Anxiety Symptoms While Improving Mood and Sleep Quality: A Randomized, Double-Blind, Placebo-Controlled Clinical Study. Advances in therapy · PMID 40875185 · DOI	Controlled trial	90 Adults with non-chronic mild-to-moderate stress	Zenroot (1.5% total withanolides) unspecified 125 mg/day 84 days · vs Placebo	Significant improvements in PSS, BAI and PSQI at days 28, 56, 84; HRV improved at day 14 only; POMS improved days 56 and 84. NULL for serum cortisol and salivary alpha-amylase. p<0.05 for PSS/BAI/PSQI; cortisol and sAA not significant Methods, limits and funding Outcomes: PSS (primary), skin conductance, HRV (RMSSD, SDNN), BAI, POMS, PSQI, serum cortisol, salivary alpha-amylase Limitations: Cortisol and sAA did not differ; HRV effect early only; healthy mildly stressed adults. Registration: CTRI/2024/03/063786 Read: abstract
Mahdi 2011 Withania somnifera Improves Semen Quality in Stress-Related Male Fertility. Evid Based Complement Alternat Med · PMID 19789214 · DOI	Uncontrolled trial	60 Infertile men (plus 60 fertile controls)	Root powder root 5 g/day 3 months · vs None for the treated men	Stress down, antioxidants up, semen quality improved in many; 14% pregnancies. Methods, limits and funding Outcomes: Stress markers, semen quality Limitations: No placebo arm; grams, not comparable with extract milligrams. Read: abstract
Majeed 2023 A standardized Ashwagandha root extract alleviates stress, anxiety, and improves quality of life in healthy adults by modulating stress hormones: Results from a randomized, double-blind, placebo-controlled study. Medicine · PMID 37832082 · DOI	Controlled trial	54 Healthy adults with mild-to-moderate stress and anxiety (COVID-19 era)	Ashwagandha root extract 2.5% withanolides with 5 mg piperine root 500 mg once daily at night (12.5 mg withanolides) 60 days · vs Placebo	54 randomized, 50 completed. Improved PSS, GAD-7, QOL and CANTAB multitasking, concentration and decision time vs placebo; greater fall in morning salivary cortisol and rise in urinary serotonin; NO, GSH and MDA did not differ. See results; numeric effects not in abstract Methods, limits and funding Outcomes: PSS, GAD-7, QOL, CANTAB cognition, salivary cortisol, urinary serotonin and dopamine, NO, GSH, MDA Limitations: Small trial; extract includes piperine, which may affect absorption of other substances; two centres. Read: abstract
Majeed 2024 A Standardized Withania somnifera (Linn.) Root Extract with Piperine Alleviates the Symptoms of Anxiety and Depression by Increasing Serotonin Levels: A Double-Blind, Randomized, Placebo-Controlled Study. Journal of integrative and complementary medicine · PMID 37878284 · DOI	Controlled trial	70 Adults with mild-to-moderate depression and anxiety	Root extract 2.5% withanolides with 5 mg piperine root 500 mg once daily 90 days · vs Placebo	HARS, HDRS, GSQS and QOL improved more than placebo at days 30, 60, 90 (p<0.001); serum serotonin rose with extract and fell on placebo (p<0.001). p<0.001 for HDRS/HARS/GSQS; serotonin p<0.001 Methods, limits and funding Outcomes: HDRS, HARS, Groningen Sleep Quality Scale, QOL, serum serotonin Limitations: Piperine co-administered; both groups improved on scales; mechanism claim (serotonin) is correlational. Registration: CTRI/2022/05/042640 Read: abstract
Mamidi 2011 Efficacy of Ashwagandha (Withania somnifera Dunal. Linn.) in the management of psychogenic erectile dysfunction Ayu · PMID 22529644 · DOI	Controlled trial	95 Men with psychogenic erectile dysfunction (86 completed)	Root powder root Dose not stated in abstract 60 days · vs Wheat-powder placebo	Both groups improved (12.6% ashwagandha, 19.11% placebo) with no significant difference between groups (P>0.05). Neither group reached the 25% improvement the authors used as relief. No difference between groups Methods, limits and funding Outcomes: International Index of Erectile Function (IIEF) Limitations: Null result for erectile dysfunction; short; unspecified dose Read: abstract
Marchi 2025 The effect of Withania somnifera (Ashwagandha) on mental health symptoms in individuals with mental disorders: systematic review and meta-analysis. BJPsych open · PMID 41140145 · DOI	Meta-analysis	713 People with mental disorders (mostly anxiety disorders) in 14 RCTs; 360 treated, 353 controls	Withania somnifera, oral in 13 trials (median 600 mg/day) unspecified Median 600 mg/day Median 8 weeks · vs Any comparator	Improved anxiety, depression, stress and sleep quality; Bayesian model confirmed anxiety but NOT depression. No significant difference in safety/tolerability vs comparators. Anxiety outlier-corrected SMD -1.13; pooled SMD -1.962; depression SMD -1.28; stress SMD -0.95; sleep quality SMD -1.35 (Anxiety -1.65 to -0.60 (outlier-corrected); pooled -2.66 to -0.57; depression -2.40 to -0.16; stress -1.46 to -0.43; sleep -1.79 to -0.91) Methods, limits and funding Outcomes: Anxiety, depression, stress, sleep quality; tolerability Limitations: Authors cite small number of studies, substantial heterogeneity and outlier effects. Registration: PROSPERO CRD42023467959 Read: abstract
Mastrofini 2026 Modulating stress and sleep through a multi-compound dietary supplement: a randomized, double-blind, placebo-controlled trial. Journal of the International Society of Sports Nutrition · PMID 42829807 · DOI	Controlled trial	103 Healthy physically active adults	Ashwagandha 600 mg + Rhodiola 300 mg (morning) with/without evening magnesium/L-theanine/apigenin unspecified 600 mg ashwagandha plus 300 mg rhodiola 2 weeks supplement within 4-week study · vs Placebo	Morning ashwagandha/Rhodiola group lowered weekly perceived stress (p=0.034, eta-sq 0.020) with no change in daily stress. Weekly stress p=0.034; eta2 0.020 Methods, limits and funding Outcomes: Weekly perceived stress, affect, PROMIS sleep, PSQI, wearable sleep Limitations: Multi-compound; short 2-week supplementation; small effect size. Read: abstract
McIntyre 2026 Ashwagandha (Withania somnifera)-Associated Liver Injury: A Scoping Review of Clinical Characteristics and Safety Considerations. Cureus · PMID 42367407 · DOI	Systematic review	25 13 publications (case reports and series) covering 25 patients worldwide, searched to December 2025	Single-ingredient and multi-ingredient ashwagandha products unspecified Injury typically develops after weeks of use · vs none	Cholestatic or mixed injury predominated, usually with jaundice and itching; purely hepatocellular injury less frequent. Causality assessments generally 'probable' or 'likely'. Most recovered after stopping, usually over weeks to months. Severe outcomes: one acute liver failure needing transplant and three deaths among patients with pre-existing cirrhosis who decompensated. Authors conclude there is a reproducible idiosyncratic syndrome and that people with advanced chronic liver disease should be counselled to avoid ashwagandha. 25 patients (Scoping review (no pooled estimate)) Methods, limits and funding Outcomes: Clinical pattern, causality, outcomes Limitations: Scoping review of case reports only; publication bias towards unusual cases; no frequency data; non-English papers excluded. Funding and conflicts: Authors report no financial support Read: abstract
McKinney 2026 Effects of multi-herb and ashwagandha root formulas on stress modulation: a randomized, double-blind, placebo-controlled clinical study. Trials · PMID 41656269 · DOI	Controlled trial	186 Adults 18-65, BMI 18-29.9, high stress	Full-spectrum ashwagandha (VL-G-E12) and a Rhodiola/holy basil/Schisandra blend (VL-G-A57) unspecified 60 days · vs Placebo	Both arms reduced PSS vs placebo (p<0.0001), improved PSQI and restorative sleep, anxiety; no difference in mental alertness. PSS p<0.0001; PSQI VL-G-E12 p<0.0001 Methods, limits and funding Outcomes: PSS (primary), PSQI, restorative sleep, fatigue, mood, anxiety Limitations: Dose not given in abstract; the multi-herb arm is not ashwagandha alone. Read: abstract
Memorial Sloan Kettering Cancer Center 2026 Ashwagandha (About Herbs, Botanicals & Other Products) MSK website (page last updated 28 July 2026) · Source	Authoritative guidance		unspecified	Common: mild-to-moderate temporary drowsiness, upper GI discomfort, loose stools. Less common: giddiness, vertigo, nasal congestion, decreased appetite, nausea, constipation, dry mouth, weight gain. Case reports: thyrotoxicosis (resolved on stopping); ventricular tachycardia in 2 cases with herbomineral products; kidney transplant rejection (69-year-old); HPA-axis suppression; liver injury; acute dystonia and neurotoxicity (each in a 40-year-old man); reversible cerebral vasoconstriction in a woman also using SNRIs and cannabis; hemolytic anemia with abdominal pain after ashwagandha/mucuna pills with high lead content. Interactions: additive sedative/GABAergic effects with anticonvulsants, barbiturates, benzodiazepines (clinical relevance not determined); CYP2B6 inhibited in vitro; CYP3A4 moderate inducer in vitro but no significant CYP3A4/2D6 interaction in human liver microsomes in another study; may increase thyroxine; may cause false elevation in digoxin immunoassay. Avoid in hormone-sensitive prostate cancer and in pregnancy (higher doses may increase miscarriage risk); may trigger or worsen autoimmune disease. Methods, limits and funding Outcomes: Adverse reactions, drug and lab interactions, contraindications Limitations: Secondary summary of case reports; underlying reference papers for digoxin assay, lead case, dystonia were not located or read individually. Read: summary-only
Mikolai 2009 In vivo effects of Ashwagandha (Withania somnifera) extract on the activation of lymphocytes J Altern Complement Med · PMID 19388865 · DOI	Clinical trial uncontrolled	5 Five participants	Root extract root 6 mL twice daily with whole milk 96 hours · vs None (pre-post)	CD4 on T cells rose and CD56 natural killer cells showed activation (CD69) at 96 hours; authors call for further study. Receptor expression up at 96 h Methods, limits and funding Outcomes: CD4, CD8, CD19, CD56 and CD69 on blood cells (flow cytometry) Limitations: Five people; no control; 4 days Read: abstract
Mikulski 2017 Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation. Int J Occup Environ Health · PMID 29528276 · DOI	Laboratory survey in-vitro	252 Ayurvedic medicine samples from a lead-poisoning investigation	Ayurvedic products (not ashwagandha-specific) not applicable Not applicable Not applicable · vs EPA methods	Lead in 65% of 252 samples; mercury 38%; arsenic 32%. Methods, limits and funding Outcomes: Lead, mercury, arsenic Limitations: Samples came from a poisoning investigation, so not representative; many were mineral/metal preparations; not specific to ashwagandha. Read: abstract
Mishra 2024 Shoden promotes Relief from stress and anxiety: A randomized, double-blind, placebo-controlled study on healthy subjects with high stress levels. Heliyon · PMID 39286132 · DOI	Controlled trial	60 Adults meeting DSM-IV GAD criteria, HAM-A >20 and morning cortisol >25 ug/dL; no depression	Shoden root and leaf extract (35% withanolide glycosides) root+leaf 60 mg or 120 mg/day 60 days · vs Placebo	HAM-A fell 59% in both active arms vs 0.83% rise on placebo; morning cortisol fell 66-67% vs 2.22% change on placebo; PSS fell 53-62%. HAM-A -59% vs +0.83% (p<0.0001); cortisol -66%/-67% vs -2.22% Methods, limits and funding Outcomes: HAM-A (primary), morning serum cortisol, testosterone, PSS, CGI, PGIC Limitations: Very large percentage changes that are unusual for supplement trials; small n; single reported sponsor not verified. Registration: CTRI/2022/04/042133 Read: abstract
Movva 2026 Comparative Evaluation of Ashwagandha (Withania somnifera) Root Extract and Melatonin for Improving Sleep Quality in Adults: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Clocks & sleep · PMID 42029558 · DOI	Controlled trial	200 Adults aged 18-50	Root extract, alone and with melatonin root 600 mg/day (300 mg twice daily); melatonin 3 mg 8 weeks · vs Placebo and melatonin	SOL reduced across treatment groups with the combination best; ashwagandha and melatonin alone gave moderate, comparable benefit. Combination p<0.0001 for SOL, TST, WASO, SE Methods, limits and funding Outcomes: Actigraphy SOL (primary), TST, WASO, SE, PSQI, HAM-A Limitations: Abstract does not give mean differences; p-values within-group vs between-group not specified. Read: abstract
Movva 2026 Safety and tolerability of Ashwagandha (Withania somnifera) root extract in healthy adults: a prospective, non-comparative study. Frontiers in nutrition · PMID 42253745 · DOI	Trial single arm	145 Healthy adults	Root extract root 2000 mg/day 12 weeks · vs None	Well tolerated; SF-36 domains improved; lab changes within reference ranges. Uncontrolled Methods, limits and funding Outcomes: Safety labs, SF-36 Limitations: Single-arm; safety focus. Read: abstract
Mukherjee 2021 Withania somnifera (L.) Dunal - Modern perspectives of an ancient Rasayana from Ayurveda. J Ethnopharmacol · PMID 32783987 · DOI	Narrative review in-vitro	Ayurvedic texts and modern literature	Withania somnifera mixed n/a n/a · vs none	States use in Ayurveda for over 3000 years; Charaka Samhita, Susruta Samhita, Astanga Hridaya and nighantus describe it as balya (strength-giving), vajikarana, pustida (nourishing). Methods, limits and funding Outcomes: Traditional use, botany, phytochemistry Limitations: Narrative review; conclusion 'proven non-toxic' is stronger than the evidence. Read: abstract
Murthy 2022 Hydroalcoholic Extract of Ashwagandha Improves Sleep by Modulating GABA/Histamine Receptors and EEG Slow-Wave Pattern in In Vitro - In Vivo Experimental Models. Prev Nutr Food Sci · PMID 35465115 · DOI	In vitro plus animal study animal	rat C6 glioma cells, mice, rats	Shoden extract (35% withanolide glycosides) root+leaf 10-50 mg/kg in mice; 15-30 ug/mL in cells not stated · vs control	Receptor gene expression rose 1.38 and 1.94 fold (GABA-A rho1) at 15 and 30 ug/mL; at 50 mg/kg sleep onset fell 34% and sleep duration rose 47% in mice. Methods, limits and funding Outcomes: GABA-A rho1 and histamine H3 receptor expression, sleep onset and duration, EEG Limitations: Animal and cell data; extract-maker linked. Read: abstract
Mutha 2025 Efficacy and safety of eight-week therapy with Ashwagandha root extract in improvement of sexual health in healthy men: Findings of a prospective, randomized, double-blind, placebo-controlled study J Ayurveda Integr Med · PMID 40582043 · DOI	Controlled trial	100 Healthy men aged 30-50 (93 analysed per protocol)	Standardised root extract root 300 mg twice daily 8 weeks · vs Identical placebo	Better semen volume (p=0.005), sperm number (p=0.006), concentration (p=0.007) and morphology (p=0.007); better desire, orgasm and satisfaction scores. No adverse events and no change in liver or kidney blood tests. Semen volume, sperm number, concentration, morphology all p<0.01 vs placebo (values not in abstract) Methods, limits and funding Outcomes: Satisfying sexual events, SDI-2, IIEF, semen parameters, SF-12, blood liver and kidney tests Limitations: Healthy men, not infertile men; numeric values not given in the abstract Read: abstract
NCCIH (NIH) Know the Science: Tips on reading supplement labels · Source	Authoritative guidance		unspecified	Cited via the site's quality page; not re-read for this file. Methods, limits and funding Read: summary-only
Naik 2026 Efficacy and safety of ashwagandha root extract in children and adolescents with mild attention-deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled trial. Journal of medicine and life · PMID 42602386 · DOI	Controlled trial	58 Children and adolescents with mild ADHD	Root extract gummies root 150 mg twice daily 56 days · vs Placebo	Lower ADHD-RS-IV inattention, hyperactivity and total scores; sleep disturbance and anxiety improved vs placebo (P<0.001). P<0.001 Methods, limits and funding Outcomes: ADHD-RS-IV, BRIEF-2, PROMIS sleep disturbance and anxiety Limitations: Small n=58; children; very small p-values with small sample. Read: abstract
Narayanan 2024 Biosynthesis of the triterpenoid withanolides in Withaniasomnifera. Curr Opin Plant Biol · PMID 38878523 · DOI	Narrative review in-vitro	literature	Withanolide biosynthesis n/a n/a n/a · vs none	Withanolides are thought to arise from the sterol pathway with hydroxylation, oxidation, cyclization and glycosylation; the pathway is poorly understood. Methods, limits and funding Outcomes: Biosynthetic pathway Limitations: Pathway not fully known. Read: abstract
Narra 2023 A Study of Efficacy and Safety of Ashwagandha (Withania somnifera) Lotion on Facial Skin in Photoaged Healthy Adults Cureus · PMID 36937128 · DOI	Controlled trial	56 Healthy adults with photoaged facial skin (53 analysed)	Topical lotion with 8% standardised root extract root Applied to face (lotion) 60 days · vs Identical placebo lotion	Physician score improved 74.69% vs 48.68% with placebo (p<0.0001); better water loss, hydration, elasticity; melanin index same in both groups. Score -74.69% vs -48.68% Methods, limits and funding Outcomes: Physician assessment of wrinkles, pores, hydration, tone, pigmentation; TEWL; elasticity Limitations: Applied to skin, not swallowed; small Read: abstract
Nasimi Doost Azgomi 2018 Effects of Withania somnifera on Reproductive System: A Systematic Review of the Available Evidence Biomed Res Int · PMID 29670898 · DOI	Systematic review	Animal and human studies of the reproductive system	Withania somnifera (various) unspecified	Review concludes the herb enhanced sperm indices in men and sexual behaviour in females; some animal studies reported reversible spermicidal effects, so extract type and dose need study. Qualitative Methods, limits and funding Outcomes: Semen quality, hormones, sexual behaviour Limitations: Mixes animal and human data; no pooled estimates Read: abstract
National Center for Complementary and Integrative Health (NCCIH) 2023 Ashwagandha: Usefulness and Safety NCCIH Herbs at a Glance (last updated March 2023) · Source	Authoritative guidance	General public	Ashwagandha root, leaf or root/leaf extracts unspecified	States that some ashwagandha preparations may be effective for insomnia and stress, that evidence is unclear for anxiety, and that there is not enough evidence to determine usefulness for cognitive function, among other conditions. Methods, limits and funding Outcomes: Summary of evidence for use Limitations: Page last updated March 2023; predates the 2024-2026 meta-analyses. Read: full-text
Ng 2020 A systematic review of the clinical use of Withania somnifera (Ashwagandha) to ameliorate cognitive dysfunction. Phytotherapy research : PTR · PMID 31742775 · DOI	Systematic review	Older adults with MCI; adults with schizophrenia, schizoaffective or bipolar disorder (5 RCTs)	Withania somnifera extract unspecified · vs Placebo	Early evidence in randomized double-blind trials supporting cognitive benefits; extract improved performance on cognitive tasks, executive function, attention and reaction time in most instances; well tolerated. Qualitative (not applicable) Methods, limits and funding Outcomes: Cognitive tasks, executive function, attention, reaction time Limitations: Only five studies in heterogeneous populations (MCI, schizophrenia, bipolar). Read: abstract
O'Connor 2022 The Impact of Ashwagandha on Stress, Sleep Quality, and Food Cravings in College Students: Quantitative Analysis of a Double-Blind Randomized Control Trial. Journal of medicinal food · PMID 35984871 · DOI	Controlled trial	60 Healthy college students	Full-spectrum root extract root 700 mg/day 30 days · vs Placebo	Group x time MANOVA for sleep and stress was NOT significant; follow-up MANCOVA showed better final sleep (58.4 vs 48.2, p<.05); stress differences were not seen at 30 days; food cravings lower. Final sleep 58.4 +/- 12.4 vs 48.2 +/- 15.0 Methods, limits and funding Outcomes: Restorative sleep, perceived stress, food cravings Limitations: Main omnibus test non-significant; short 30-day duration; follow-up tests used. Registration: NCT05430685 Read: abstract
Obhrai 2026 Effects of Withania somnifera root extract on sleep quality, body composition, and menopausal symptoms in postmenopausal women: a randomized, double-blind, placebo-controlled trial. Menopause (New York, N.Y.) · PMID 42742071 · DOI	Controlled trial	66 Postmenopausal women aged 45-65 (63 completed)	Root extract root 600 mg/day 12 weeks · vs Placebo	PSQI change -5.2 vs -0.8 (P<0.001); menopause symptoms -8.1 vs -1.2 (P<0.001); body fat -0.6% vs +0.03% (P<0.01); no bone density difference. PSQI -5.2 vs -0.8 Methods, limits and funding Outcomes: PSQI, DXA body composition, Menopause Rating Scale Limitations: Single centre, small. Read: abstract
Pages-García 2024 Effectiveness of a Saffron and Withania Supplement on Mood in Women With Mild-to-Moderate Anxiety During the COVID-19 Lockdown. Depression and anxiety · PMID 40226680 · DOI	Trial open label	46 Women with mild-to-moderate anxiety during COVID-19 lockdown	Combination supplement (saffron, ashwagandha, tryptophan, vitamin B6) unspecified 2 tablets daily (ashwagandha amount not stated) 12 weeks · vs None (open-label single arm)	HARS fell 7.5 units from baseline (p<0.0001); lockdown period confounded. HARS -7.5 Methods, limits and funding Outcomes: HARS, HRQoL Limitations: Open-label, no control, multi-ingredient: cannot attribute to ashwagandha. Read: abstract
Pakhale 2025 Efficacy and safety of Ashwagandha (Withania somnifera) root extract on stress and weight management in adults: a prospective, randomized, double-blind, placebo-controlled study. Journal of medicine and life · PMID 41635453 · DOI	Controlled trial	100 Adults aged 19-65 with excess body weight and stress	Root extract root 300 mg twice daily 24 weeks · vs Placebo	Weight and BMI fell more than placebo; PSS, SF-12 and food-craving scores improved vs placebo (P<0.05). Weight -8.46 vs -2.41 kg Methods, limits and funding Outcomes: Body weight/BMI (primary), PSS, SF-12 QoL, food cravings Limitations: Primary outcome was weight; large weight loss unusual; 91 analysed. Read: abstract
Pakhale 2026 Safety of 8-Week Administration With Ashwagandha (Withania somnifera) Root Extract in Adults With Stress and Anxiety: Findings From a Prospective, Randomized, Multi-Center, Double-Blinded, Placebo-Controlled Study. Phytotherapy research : PTR · PMID 41943502 · DOI	Controlled trial	1002 Adults 18-65 with reported stress and anxiety (multinational)	Root extract root 600 mg/day 8 weeks · vs Placebo	Safety study: no serious adverse events; AEs 5.6% ashwagandha vs 9.2% placebo; no significant changes in liver, kidney or blood tests. Not an efficacy trial. AEs 28/498 vs 46/504 Methods, limits and funding Outcomes: Safety: adverse events and labs; tolerability Limitations: Primary outcome was safety, not stress; used here only for tolerability. Read: abstract
Palliyaguru 2016 Withaferin A induces Nrf2-dependent protection against liver injury: Role of Keap1-independent mechanisms. Free Radic Biol Med · PMID 27717869 · DOI	Animal and cell study animal	mice and cells	Withaferin A; root extract isolated compound n/a n/a · vs Nrf2-knockout mice	Withaferin A protected wild-type but not Nrf2-disrupted mice from acetaminophen liver toxicity and induced Nrf2 in part through a Keap1-independent, Pten/Pi3k/Akt-dependent route. Methods, limits and funding Outcomes: Nrf2 induction and protection from acetaminophen liver injury Limitations: Mouse study; dose and hepatic relevance for supplements unclear. Read: abstract
Pandit 2024 Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial. Nutrients · PMID 38732539 · DOI	Controlled trial	131 Adults with self-reported high stress (98 in final analysis)	Aqueous root and leaf extract root+leaf 125, 250 and 500 mg/day (three arms) 8 weeks · vs Placebo	Reduced mild-to-moderate chronic stress at all three doses vs placebo, in a dose-dependent manner; authors attribute to HPA-axis modulation. Numeric effects not in abstract Methods, limits and funding Outcomes: PSS-14 and biochemical stress parameters Limitations: Only 98 of 131 enrolled analysed; numbers not in abstract. Registration: CTRI/2019/11/022100 Read: abstract
Park 2023 Sleep-promoting activity of amylase-treated Ashwagandha (Withania somnifera L. Dunal) root extract via GABA receptors. Journal of food and drug analysis · PMID 37335157 · DOI	Animal research animal	Rodent models	Amylase-treated root extract root Acute · vs Control	Extract dose-dependently lengthened sleep, increased delta-wave and NREM sleep, relieved caffeine-induced insomnia, and raised brain GABA and GABAA/GABAB1/serotonin receptor expression. Animal data (not applicable) Methods, limits and funding Outcomes: Pentobarbital sleep test, EEG, GABA receptor expression Limitations: Animal study; cannot be assumed to apply to people. Read: abstract
Pattojoshi 2026 Safety and efficacy of ashwagen (a standardized withania somnifera extract) in stress and anxiety with hypertension and associated cardiometabolic risk factors: a randomized, placebo-controlled trial. Stress (Amsterdam, Netherlands) · PMID 42105298 · DOI	Controlled trial	60 Patients with stress, anxiety and pre-existing hypertension	Ashwagen extract unspecified 300 mg twice daily 60 days · vs Placebo	Reductions of 26.94% (HAM-A), 50.77% (GAD-7), 30.47% (PSS) and 28.99% in cortisol in the Ashwagen group; triglycerides -13.00%. HAM-A -26.94%, GAD-7 -50.77%, PSS -30.47%, cortisol -28.99% Methods, limits and funding Outcomes: HAM-A, GAD-7, PSS, CGI-I, Epworth, FSS, serum cortisol, lipids, BP Limitations: Small; percentages reported for the active group; between-group differences not detailed in abstract. Read: abstract
Patwardhan 2024 Danish ban on Ashwagandha: Truth, evidence, ethics, and regulations. J Ayurveda Integr Med · PMID 38969606 · DOI	Other	Editorial on Danish ban	Ashwagandha root root	Editorial states the Danish Veterinary and Food Administration banned ashwagandha based on a 2020 DTU report, quotes the agency website ('Do not eat Ashwagandha or supplements containing Ashwagandha'; root has negative effects on sex hormones and reproduction), and argues the report lacked systematic evidence synthesis and was not peer reviewed. Read in PMC full text. Methods, limits and funding Outcomes: Critique of the DTU risk assessment Limitations: Opinion piece by authors, several involved in ashwagandha research; the Danish agency page was not retrieved. Funding and conflicts: Some authors disclose involvement in ashwagandha research Read: full-text
Paul 2021 Withania somnifera (L.) Dunal (Ashwagandha): A comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspects. Biomed Pharmacother · PMID 34649336 · DOI	Narrative review in-vitro	literature	Withania somnifera mixed n/a n/a · vs none	Traditional Rasayana herb; reviews pharmacological activities and states in-depth clinical and toxicological studies are needed. Methods, limits and funding Outcomes: Ethnopharmacology, pharmacology, toxicology Limitations: Narrative; strong claims are mostly from preclinical work. Read: abstract
Philips 2023 Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol Commun · PMID 37756041 · DOI	Case series	8 Patients at Indian centres, Jan 2019-Dec 2022: 23 with ashwagandha liver injury, 8 with single-ingredient products analysed; male-predominant; 5 had underlying chronic liver disease	Single-ingredient ashwagandha formulations (retrieved and chemically analysed where possible) unspecified · vs none (case series)	Cholestatic hepatitis was the commonest presentation. Of 5 with chronic liver disease, 3 presented with acute-on-chronic liver failure and all 3 died on follow-up. In the others injury was prolonged but self-limiting; one progressed to chronic injury. Biopsy: cholestasis with hepatocellular necrosis and lymphocyte/eosinophil-rich portal inflammation. Chemical analysis showed only natural phytochemicals, no adulteration or contamination. 3 deaths among 5 patients with pre-existing liver disease Methods, limits and funding Outcomes: Presentation, outcome, mortality, product chemistry Limitations: Retrospective, small, single-ingredient subset of a larger 23-patient group; no denominator of users. Funding and conflicts: Authors report no conflicts Read: abstract
Pingali 2014 Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participants. Pharmacognosy research · PMID 24497737 · DOI	Controlled trial	20 Healthy males (crossover)	Aqueous extract of roots and leaves root+leaf 250 mg x 2 capsules twice daily 14 days per arm, 14-day washout · vs Placebo	Faster simple reaction, choice discrimination, digit-symbol substitution, digit vigilance and card sorting; no effect on finger tapping. Significant (values not in abstract) Methods, limits and funding Outcomes: Computerized psychometric tests (reaction times) Limitations: 20 men, short, reaction-time outcomes. Read: abstract
Pingali 2025 Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study J Menopausal Med · PMID 40347163 · DOI	Controlled trial	Postmenopausal women aged 40-55	Standardised aqueous extracts of ashwagandha, shatavari, or both unspecified Ws 250 mg or 500 mg; Ar 250 mg or 500 mg; combination 250 + 250 mg 24 weeks · vs Placebo (six arms)	Dose-dependent fall in MENQoL and reflection index versus placebo (P<0.0001); lower bone-breakdown markers (CTX, bone ALP, RANKL) and higher osteoprotegerin; lower hs-CRP and MDA, higher glutathione and nitric oxide (P<0.0001). All primary outcomes P<0.0001 vs placebo Methods, limits and funding Outcomes: MENQoL, bone turnover markers, reflection index (vascular), hs-CRP, malondialdehyde, glutathione, nitric oxide Limitations: Group sizes not in the abstract; very uniform P values; mixed with shatavari arms; bone mineral density result not stated Read: abstract
Pires 2020 Safety and pharmacokinetics of Withaferin-A in advanced stage high grade osteosarcoma: A phase I trial. J Ayurveda Integr Med · PMID 30904387 · DOI	Phase I dose escalation trial	adults with advanced high-grade osteosarcoma	Withaferin A formulation isolated compound 72-216 mg per day in 2-4 divided doses until progression · vs none	11 adverse events of grade 1-2; liver enzyme elevation in 5 of 11 events and rash in 2 of 11; no detectable withaferin A in circulation; authors conclude low oral bioavailability. Methods, limits and funding Outcomes: Safety and plasma pharmacokinetics Limitations: Cancer patients, pure compound at doses far above supplements; participant count not stated in abstract I read. Read: abstract
Prajapati 2026 Efficacy and Safety of Low-Dose Ashwagandha Supplementation on Exercise Endurance: A Randomized, Placebo-Controlled, Double-Blind, Clinical Trial Phytother Res · PMID 41846233 · DOI	Controlled trial	Healthy adults	Ashwa.30 low-dose root-only extract (over 15% withanolides) root 30 mg per day 8 weeks · vs Placebo	Authors report better VO2max and maximal heart rate, lower lactic acid and CPK, lower RPE and fatigue; no treatment-related adverse events. Direction only; numbers not in abstract Methods, limits and funding Outcomes: VO2max (modified Bruce treadmill test), lactic acid, creatine phosphokinase, RPE, fatigue Limitations: Sample size and numbers not in abstract; indirect VO2max method; product-specific Read: abstract
Pratte 2014 An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). Journal of alternative and complementary medicine (New York, N.Y.) · PMID 25405876 · DOI	Systematic review	Adults with anxiety or stress in 5 human trials	Withania somnifera (various regimens) unspecified · vs Placebo or psychotherapy	All five trials favoured Withania over comparator on anxiety or stress scales (significantly in most). No meta-analysis possible. All studies at unclear or high risk of bias. Qualitative; e.g. PSS fell 44.0% vs 5.5% in one trial (not applicable) Methods, limits and funding Outcomes: Hamilton Anxiety Scale, Beck Anxiety Inventory, Perceived Stress Scale Limitations: Reviewers: all studies unclear/high risk of bias, heterogeneous design; one trial compared a multi-component naturopathic package vs psychotherapy. Read: abstract
Pusec 2022 A Case of Supplement-Induced Hepatitis. Cureus · PMID 36407193 · DOI	Case report	1 Adult with acute steatohepatitis	Chronic high-dose ashwagandha plus other herbal supplements, alcohol and a multi-medication regimen unspecified 'high doses' (not specified) Chronic · vs none	Case of acute steatohepatitis in a person taking high-dose ashwagandha with other herbs, alcohol and several medicines. Methods, limits and funding Outcomes: Acute steatohepatitis Limitations: Heavily confounded (alcohol, other herbs, medicines): cannot separate ashwagandha's contribution. Read: abstract
Pérez Pérez 2026 Ashwagandha-Induced Herb-Induced Liver Injury Assessed With the Updated 2016 RUCAM. Case Reports Hepatol · PMID 42529606 · DOI	Case report	1 27-year-old previously healthy woman, Colombia	Ashwagandha (consumed for three days) unspecified 3 days · vs none	Jaundice and generalised itching after 3 days; infectious, autoimmune and metabolic causes excluded; MRI normal; biopsy classic cholestatic pattern, no fibrosis; RUCAM 7 (probable). Treated with corticosteroids and azathioprine with progressive improvement. Methods, limits and funding Outcomes: RUCAM causality, biopsy, treatment Limitations: Single case; 3-day onset; steroids and azathioprine used, so natural recovery cannot be separated. Funding and conflicts: No conflicts declared Read: abstract
Pérez-Gómez 2020 Effects of Ashwagandha (Withania somnifera) on VO2max: A Systematic Review and Meta-Analysis Nutrients · PMID 32316411 · DOI	Meta-analysis	142 Healthy adults and athletes (5 RCTs, 162 participants; 4 pooled, 142 participants)	Ashwagandha (various) unspecified Varied Varied · vs Placebo	VO2max improved (mean difference 3.00; abstract gives no unit), p=0.04, with high heterogeneity. VO2max MD 3.00 (0.18 to 5.82) Methods, limits and funding Outcomes: VO2max Limitations: Few trials; high heterogeneity; wide interval close to zero Read: abstract
Pérez-Piñero 2024 Effectiveness of Enriched Milk with Ashwagandha Extract and Tryptophan for Improving Subjective Sleep Quality in Adults with Sleep Problems: A Randomized Double-Blind Controlled Trial. Clocks & sleep · PMID 39189195 · DOI	Controlled trial	52 Adults with sleep problems	Ashwagandha-enriched lactose-free milk, with or without tryptophan unspecified 250 mg, 250 mg + tryptophan 175 mg, or 600 mg in 250 mL milk 90 days · vs Non-enriched milk	VAS sleep quality better in all three active groups (p=0.014); PSQI subscale differences not significant; insomnia severity fell more in active groups; no change in anxiety. VAS p=0.014 Methods, limits and funding Outcomes: VAS sleep quality, PSQI subscales, insomnia severity, daytime somnolence Limitations: Only 13 per arm; PSQI between-group null; not a pure ashwagandha capsule. Read: abstract
Quinones 2025 Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours. Journal of the American Nutrition Association · PMID 39254702 · DOI	Systematic review	Adults and animal studies in 51 studies on stress, ashwagandha and meditation	Ashwagandha (clinical and preclinical studies) and meditation unspecified · vs Various	Review concluded clinical studies indicate ashwagandha supports weight loss through reduced stress, cortisol and food cravings; preclinical data suggest effects on leptin, insulin sensitivity and dopamine. Qualitative (not applicable) Methods, limits and funding Outcomes: Stress response, cortisol, food cravings, weight Limitations: Narrative review mixing animal and human studies; critical appraisal tools differ by study type. Read: abstract
RIVM (Netherlands National Institute for Public Health and the Environment) 2024 RIVM advises against using products containing the herbs Huperzia serrata, Tabernanthe iboga or Ashwagandha RIVM news item, 8 March 2024 · Source	Authoritative guidance		unspecified	RIVM advises against food supplements containing ashwagandha (same advice assumed for tea). Reasons given: physicians in the Netherlands and elsewhere reported poisonings including harmful effects on the liver, which can be serious and occur at the instructed dose; ashwagandha has been used in some countries to induce abortion (not studied), so pregnant women are especially advised against it. The linked report is 'Risk assessment of herbal preparations containing Withania somnifera' (RIVM 2024-0029); the PDF text could not be extracted, so the report's own figures are not used here. Methods, limits and funding Outcomes: Consumer advice on food supplements Limitations: Report PDF unreadable in this session. Read: full-text
Rai 2025 Effect of ashwagandha (Withania somnifera) extract with Sominone (Somin-On™) to improve memory in adults with mild cognitive impairment: A randomized, double-blind, placebo-controlled study. Journal of psychopharmacology (Oxford, England) · PMID 40099725 · DOI	Controlled trial	40 Adults with mild cognitive impairment	Extract standardised with Sominone (Somin-On) unspecified 250 mg/day 60 days · vs Placebo	Better immediate, general and working memory and visuospatial processing; MoCA +14.77% and MMSE +19.21% from baseline at day 60 vs placebo. MoCA +14.77%; MMSE +19.21% (from baseline) Methods, limits and funding Outcomes: MoCA, MMSE, WMS-III, Shepard mental rotation Limitations: Pilot n=40; percentages are change from baseline. Read: abstract
Raichura 2025 Evaluation of reversible cytochrome P450 inhibition by Withania somnifera leaf and root extracts. Drug Metab Dispos · PMID 40023576 · DOI	Laboratory research in-vitro	Recombinant human CYP enzymes (7-in-1 cocktail assay)	Four ashwagandha extracts (root and leaf) root+leaf	No reversible inhibition detected at IC50 above 100 ug/mL of extract. Methods, limits and funding Outcomes: Reversible inhibition of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2D6, 3A4/5 Limitations: Test-tube study; does not test enzyme induction, time-dependent inhibition, or P-glycoprotein. Funding and conflicts: Not stated in abstract Read: abstract
Ramakanth 2016 A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain J Ayurveda Integr Med · PMID 27647541 · DOI	Controlled trial	60 Patients with knee joint pain and discomfort	Aqueous extract of roots plus leaves root+leaf 250 mg or 125 mg twice daily 12 weeks · vs Placebo	Both doses reduced WOMAC and swelling versus placebo (250 mg p<0.001; 125 mg p<0.05); 250 mg worked earliest (week 4). WOMAC p<0.001 (250 mg) Methods, limits and funding Outcomes: Modified WOMAC, Knee Swelling Index, pain VAS Limitations: 60 people split across three arms; root-and-leaf extract; not specified which knee condition Read: abstract
Ramapalaniappan 2025 Superior Bioavailability of a Novel 1.5% Ashwagandha Formulation (Zenroot™): A Randomized, Double-Blind, Single-Dose, Comparative, Oral Bioavailability Study in Healthy Adults. Adv Ther · PMID 40748423 · DOI	Randomized double blind crossover	20 healthy adults, fasting	Zenroot 1.5% extract 125 mg vs 5% extract 600 mg vs 10% extract 500 mg unspecified 125 / 600 / 500 mg single dose single dose per period · vs two reference extracts	125 mg Zenroot gave 2.1-fold higher total withanolide bioavailability than 600 mg of the 5% product and 1.3-fold higher than 500 mg of the 10% product; Cmax and AUC0-t significantly higher. Methods, limits and funding Outcomes: Plasma total withanolides (withanoside IV, withanolide A, 12-deoxywithastramonolide, withaferin A) Limitations: Healthy volunteers, single dose; two authors employed by the sponsor. Funding and conflicts: Three authors are employees of OmniActive Health Technologies (maker of the test product) Registration: CTRI/2022/11/047039 Read: abstract
Rao 2011 Detection of toxic heavy metals and pesticide residue in herbal plants which are commonly used in the herbal formulations. Environ Monit Assess · PMID 21210215 · DOI	Other	4 Four market samples of single herbs (including Withania somnifera), India	Withania somnifera crude drug unspecified	Heavy metals and pesticide residues were below detection limits in all four samples. Methods, limits and funding Outcomes: Arsenic, cadmium, lead, mercury; pesticide residues Limitations: One Withania sample (2011); cannot represent today's global supplement market. Read: abstract
Rathi 2025 Randomized, Double-Blind, Crossover Study Comparing the Bioavailability of 4 Ashwagandha (Withania somnifera (L.) Dunal) Extracts in Healthy Adults Under Fasting Condition. Curr Ther Res Clin Exp · PMID 40792075 · DOI	Randomized double blind 4 way crossover	16 healthy adults, fasting	Four commercial extracts: WS-35 (35% withanolide glycosides), WS-10 (10% glycosides), WS-5 (5% withanolides), WS-2.5 (2.5% withanolides) unspecified each dosed to 185 mg total withanolides single dose per period · vs other extracts	AUC0-t for total withanolides per gram of WS-35 was 118.28, 226.11 and 267.83 times that of WS-10, WS-5 and WS-2.5; WS-35 had higher Cmax, longer half-life, lower clearance. Methods, limits and funding Outcomes: Plasma levels of withanolide A, withanoside IV, withaferin A, total withanolides over 24 h Limitations: Healthy volunteers, single dose; extract-maker authors (same registration as p38144272); PK not clinical effect. Registration: CTRI/2020/10/028397 Read: abstract
Ratnasekhar 2025 Machine learning-guided Orbitrap-HRAMS-based metabolomic fingerprinting for geographical origin, variety and tissue specific authentication, and adulteration detection of turmeric and ashwagandha. Food Chem · PMID 40187315 · DOI	Other	Authentic and adulterated market samples	Ashwagandha (root, leaf, variety samples) root+leaf	A mass-spectrometry plus machine-learning method distinguished tissue and variety of ashwagandha, including adulterated market samples, with 98% specificity and accuracy. The abstract does not give how many market samples were adulterated. Methods, limits and funding Outcomes: Metabolomic authentication, adulteration detection Limitations: Method paper; no prevalence of adulteration reported in the abstract. Funding and conflicts: No competing interests declared Read: abstract
Raut 2012 Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteers J Ayurveda Integr Med · PMID 23125505 · DOI	Open label dose escalation	18 Healthy volunteers aged 18-30	Aqueous root extract (8:1) root 750, then 1000, then 1250 mg per day, 10 days each 30 days · vs None	One volunteer withdrawn (increased appetite, libido, hallucinogenic effects and vertigo at lowest dose). Total and LDL cholesterol fell significantly and muscle strength rose; body fat showed a reduction trend. Organ function stayed normal. Total and LDL cholesterol down; strength up (values not in abstract) Methods, limits and funding Outcomes: Tolerability, organ function tests, grip, quadriceps and back strength, cycle ergometry, skin-fold body fat, lipids Limitations: Uncontrolled, 18 people, 30 days Read: abstract
Raut 2024 Evaluation of Withania somnifera (L.) Dunal (Ashwagandha) on Physical Performance, Biomarkers of Inflammation, and Muscle Status in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study Cureus · PMID 39381480 · DOI	Controlled trial	Healthy volunteers	Ashwagandha extract tablets unspecified 250 mg twice daily 60 days · vs Placebo	Distance 2.85 vs 2.16 km and speed 25.6 vs 22.2 km/h (p<0.05). hs-CRP, IL-6, TNF-alpha and myostatin showed a decreasing trend in the ashwagandha group. Distance 2.85 km vs 2.16 km; inflammatory markers: trend only Methods, limits and funding Outcomes: Cycle ergometer distance and speed, hs-CRP, IL-6, TNF-alpha, myostatin, body composition Limitations: Inflammation results reported as trends, not tested differences; sample size not in abstract Read: abstract
Rawji 2024 Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review. Cureus · PMID 38817505 · DOI	Systematic review	15 interventional trials	Magnesium not applicable Dose varied Varied · vs Varied	Most studies improved at least one parameter. Methods, limits and funding Outcomes: Anxiety and sleep Limitations: Heterogeneous. Read: abstract
Remenapp 2022 Efficacy of Withania somnifera supplementation on adult's cognition and mood. Journal of Ayurveda and integrative medicine · PMID 34838432 · DOI	Controlled trial	60 Healthy adults with perceived stress	NooGandha root and leaf extract root+leaf 400 mg or 225 mg/day 30 days · vs Placebo	Self-report scales improved over time in all groups with NO group or interaction effect (null vs placebo); cognitive flexibility, visual memory, reaction time, psychomotor speed and executive function differed significantly with ashwagandha groups often better; cortisol fell over time in the 225 mg group only. Self-report interactions non-significant Methods, limits and funding Outcomes: Salivary cortisol, CNS Vital Signs cognition, TAI, DASS, PSS, FCQ-15 Limitations: Placebo also improved on self-reports; no between-group effect on stress/anxiety scales; short 30 days. Read: abstract
Rodríguez Rodríguez 2026 Modulation of cytochrome P450 and P-glycoprotein by Ashwagandha (Withania somnifera): implications for CDK4/6 inhibitor therapy. Eur J Hosp Pharm · PMID 42236145 · DOI	Other	Pharmacy article (article type not stated in the record)	Ashwagandha unspecified	Only the title was read: 'Modulation of cytochrome P450 and P-glycoprotein by Ashwagandha (Withania somnifera): implications for CDK4/6 inhibitor therapy'. No findings are quoted here. Methods, limits and funding Outcomes: CYP and P-glycoprotein modulation, CDK4/6 inhibitor therapy Limitations: No abstract available. Read: summary-only
Roy 2026 Effects of Ashwagandha on Reproductive Health: A Systematic Review of Sex-Specific Hormonal and Fertility Outcomes Phytother Res · PMID 41249015 · DOI	Systematic review	Preclinical and clinical studies, both sexes	Ashwagandha (various) unspecified	Authors conclude ashwagandha has potential to improve sexual health and some reproductive disorders; more study needed on long-term effects and dosing. Narrative synthesis. Qualitative Methods, limits and funding Outcomes: Reproductive hormones, fertility and sexual function Limitations: Mixes animal and human work; no pooled estimate in abstract Read: abstract
Salve 2019 Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus · PMID 32021735 · DOI	Controlled trial	60 Healthy adults with PSS >20 (58 completed)	Ashwagandha root aqueous extract root Reported as 125 mg or 300 mg twice daily (abstract also states 250 and 600 mg/day) 8 weeks · vs Placebo	Significant PSS reduction (P<0.05 at 250 mg/day; P<0.001 at 600 mg/day), serum cortisol reductions at both doses (P<0.05, P<0.0001) and better sleep quality vs placebo. PSS P<0.001 (600 mg/d); cortisol P<0.0001 (600 mg/d) Methods, limits and funding Outcomes: PSS, HAM-A, serum cortisol, 7-point sleep scale Limitations: Abstract is internally inconsistent about the dose labelling; small. Read: abstract
Salve 2026 Safety of 12-Months Administration of Ashwagandha ( Withania somnifera ) Standardized Root Extract in Healthy Adults: A Prospective, Observational Study. Phytotherapy research : PTR · PMID 41063394 · DOI	Observational	191 Healthy adults 18-65	Standardised root extract root 12 months · vs None (uncontrolled)	Mild adverse events only; cortisol fell (p<0.001); SF-12 improved; CGI-I improved in 68.7%. Cortisol p<0.001 (uncontrolled) Methods, limits and funding Outcomes: Safety; CGI-I; SF-12; cortisol Limitations: Uncontrolled observational; no placebo. Read: abstract
Sampath 2015 Holy basil (Ocimum sanctum Linn.) leaf extract enhances specific cognitive parameters in healthy adult volunteers: A placebo controlled study. Indian J Physiol Pharmacol · PMID 26571987	Controlled trial	Healthy adults	Holy basil (Ocimum sanctum) ethanolic leaf extract leaf 300 mg/day 30 days · vs Placebo	Some cognitive measures improved versus placebo; salivary cortisol and anxiety changed over time only in the extract group. Methods, limits and funding Outcomes: Cognitive tests, cortisol, anxiety Limitations: Small; n not in abstract. Read: abstract
Sandhu 2010 Effects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) on physical performance and cardiorespiratory endurance in healthy young adults Int J Ayurveda Res · PMID 21170205 · DOI	Controlled trial small	40 Healthy young adults (mean age 20.6)	Standardised root extract (and Terminalia arjuna) root 500 mg per day 8 weeks · vs Placebo flour capsules (10 per group)	Ashwagandha alone increased velocity, power and VO2max; arjuna lowered resting systolic pressure. Ashwagandha alone is not reported to lower blood pressure. Direction only Methods, limits and funding Outcomes: Velocity, power, VO2max, balance, blood pressure Limitations: Only 10 per group; older study Read: abstract
Savai 2015 In vitro assessment of CYP1A2 and 2C9 inhibition potential of Withania somnifera and Centella asiatica in human liver microsomes. Drug Metab Pers Ther · PMID 25938222 · DOI	In vitro CYP inhibition study in-vitro	human liver microsomes	Withania somnifera crude extracts and principal constituents unspecified n/a n/a · vs Centella asiatica	Withania somnifera showed no significant interaction with either enzyme. Methods, limits and funding Outcomes: CYP1A2 and CYP2C9 inhibition Limitations: Lab study; two enzymes only. Read: abstract
Saxena 2026 A clinical assessment of the therapeutic effects of Ashwagandha root extract on cognitive performance, sleep, and fatigue in children aged 6-12 years. Frontiers in nutrition · PMID 41889719 · DOI	Controlled trial	85 Children aged 6-12 with parent-reported attention/concentration/memory concerns (73 completed)	Root extract gummies root 150 mg twice daily 8 weeks · vs Placebo	Better speed of information processing (p=0.040), delayed word recall (d=0.59), Stroop accuracy (d=0.61), Corsi span (d=0.66), choice RT accuracy (d=0.75); parent-reported sleep improved (p=0.035). d 0.59-0.75 Methods, limits and funding Outcomes: COMPASS attention/memory/executive function; SDQ, BRIEF2, SDSC sleep, PROMIS fatigue Limitations: Children; 12 dropouts; many outcomes; sleep by parent report. Registration: CTRI/2021/10/037126; ACTRN12621000656831 Read: abstract
Sharma 2018 Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial J Altern Complement Med · PMID 28829155 · DOI	Controlled trial	50 Adults aged 18-50 with subclinical hypothyroidism (TSH 4.5-10 uIU/L)	Root extract root 600 mg per day 8 weeks · vs Starch placebo	TSH (p<0.001), T3 (p=0.0031) and T4 (p=0.0096) improved versus placebo; authors say indices normalised. 4 mild temporary adverse effects (1 ashwagandha, 3 placebo). TSH, T3, T4 all improved vs placebo (values not in abstract) Methods, limits and funding Outcomes: Serum TSH, T3, T4 Limitations: Pilot, 50 people, 8 weeks, single centre; no symptoms or long-term outcomes; not enough to guide treatment Read: abstract
Sharma 2025 An open-label, single dose, safety and pharmacokinetic study of Withania somnifera root extract in healthy volunteers. Drug Metab Pers Ther · PMID 39963957 · DOI	Open label single dose pharmacokinetic study	healthy male and female volunteers	Root extract, 2.5% total withanolides, capsules root 2 x 200 mg = 400 mg single dose single dose · vs none	Cmax range 0.472-4.468 ng/mL, Tmax 1.000-1.416 h, half-life 1.696-4.377 h across the four compounds; no abnormalities in safety measures. Methods, limits and funding Outcomes: PK of withanoside IV, withaferin A, 12-deoxy-withastramonolide, withanolide A; safety Limitations: Participant number not stated in the abstract I read; single dose; no control. Read: abstract
Singh 2021 Elucidation of plasma protein binding, blood partitioning, permeability, CYP phenotyping and CYP inhibition studies of Withanone using validated UPLC method: An active constituent of neuroprotective herb Ashwagandha. J Ethnopharmacol · PMID 33460762 · DOI	In vitro ADME study in-vitro	rat and human liver microsomes, PAMPA, plasma	Withanone (pure) isolated compound n/a n/a · vs none	Stable in simulated gastric and intestinal fluid; high passive permeability; plasma protein binding 82-88%; metabolised extensively by CYP3A4 and CYP1A2; no CYP isoenzyme was potentially inhibited. Methods, limits and funding Outcomes: Stability, permeability, protein binding, CYP phenotyping and inhibition Limitations: Lab study of one compound. Read: abstract
Singh 2023 Ashwagandha (Withania somnifera) and Shunthi (Zingiber officinale) in mild and moderate COVID-19: An open-label randomized controlled exploratory trial Complement Ther Med · PMID 37482107 · DOI	Rct open label	60 Mild or moderate COVID-19 (48 analysed)	Ashwagandha tablets plus ginger (Shunthi) capsules unspecified Ashwagandha 500 mg + Shunthi 1000 mg twice daily 15 days · vs Standard care	Recovery 6.9 vs 13.0 days (p<0.001); viral clearance 76.0% vs 60.8% (not significant); inflammatory markers, IgG and CT were comparable. Recovery time 6.9 vs 13.0 days; viral clearance RR 1.24 (RR 0.841-1.851) Methods, limits and funding Outcomes: Clinical recovery time, viral clearance, inflammatory markers, IgG, CT findings Limitations: Open label; 12 of 60 not analysed; combined with ginger so ashwagandha alone not tested Registration: CTRI/2020/08/027224 Read: abstract
Smith 2021 Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review Adv Nutr · PMID 33150931 · DOI	Systematic review	Men aged 18 and over in 32 RCTs of 13 herbs	Single herbal extracts; ashwagandha root and root/leaf root+leaf Varied Varied · vs Placebo	Fenugreek seed extract and ashwagandha root and root/leaf extracts showed positive effects on testosterone. Overall 9 of 32 studies showed significant increases; 6 of 32 judged low risk of bias; half enrolled men under 40. 9 of 32 studies significant overall Methods, limits and funding Outcomes: Testosterone concentrations Limitations: Small samples, varied doses and extracts, mostly young non-clinical men (authors) Registration: PROSPERO CRD42020173623 Read: abstract
Smith 2023 Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin®) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. Journal of psychopharmacology (Oxford, England) · PMID 37740662 · DOI	Controlled trial	Overweight or mildly obese adults aged 40-75 with self-reported stress and fatigue	Witholytin root extract root 200 mg twice daily (400 mg/day) 12 weeks · vs Placebo	NULL on primary: PSS reduction was NOT significantly different from placebo (p=0.867). Fatigue (Chalder) improved vs placebo (p=0.016) and HRV rose (p=0.003); free testosterone and LH rose in men. PSS between-group p=0.867; Chalder p=0.016; HRV p=0.003 Methods, limits and funding Outcomes: PSS (primary), Chalder Fatigue Scale, heart rate variability, sex hormones Limitations: Primary outcome (stress) was not met; fatigue and HRV were secondary outcomes; n not given in abstract. Read: abstract
Sonar 2019 Ferulic Acid Esters and Withanolides: In Search of Withania somnifera GABA(A) Receptor Modulators. J Nat Prod · PMID 30998355 · DOI	In vitro bioassay guided isolation in-vitro	GABA-A receptor currents in cells	Root methanol extract fractions and isolated compounds root n/a n/a · vs none	Nine compounds isolated; docosanyl ferulate enhanced GABA-A inhibitory postsynaptic currents with IC50 7.9 uM; the activity came from ferulic acid esters, with new withanolides also isolated. Methods, limits and funding Outcomes: GABA-A inhibitory currents Limitations: Isolated compounds in cells; human relevance unknown. Read: abstract
Speers 2021 Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Current neuropharmacology · PMID 34254920 · DOI	Systematic review	Preclinical and clinical studies of WS on stress, anxiety, depression, insomnia	Withania somnifera root and leaf extracts root and leaf · vs Various	Review reports anti-stress and anti-anxiety activity in animal and human studies, and improved depression and insomnia in fewer studies; variability prevents consensus on best preparation or dose. Qualitative (not applicable) Methods, limits and funding Outcomes: Stress, anxiety, depression, insomnia Limitations: Narrative review; mixes animal and human work. Read: abstract
Speers 2024 Quantifying Withanolides in Plasma: Pharmacokinetic Studies and Analytical Methods. Nutrients · PMID 39599622 · DOI	Systematic review of pharmacokinetic studies	20 studies (16 animal, 4 human)	Isolated withanolides or withanolide-containing products mixed varies varies · vs none	Rodent Cmax range 5.6-8410 ng/mL; human Cmax range 0.1-49.5 ng/mL for withaferin A, withanolide A, 12-deoxywithastramonolide, withanoside IV. Methods, limits and funding Outcomes: Plasma pharmacokinetics of withanolides and the analytical methods used Limitations: Small number of human studies; concentrations vary by product, dose, route. Funding and conflicts: No conflicts declared Read: abstract
Speers 2026 Withanolides Are Detected in Human Urine Following Oral Administration of a Withania somnifera Product. Int J Mol Sci · PMID 42353009 · DOI	Single dose human urinary excretion study	healthy older adults	Shoden extract (roots and leaves) root+leaf 240 mg or 480 mg single dose, urine collected 12 h · vs none	Withaferin A, sominone (aglycone of withanoside IV), 3R-viscosalactone B and an unidentified metabolite isomeric with 4-oxo withaferin A were found in urine; recovery of the first three generally below 3% of the amount in the product. Methods, limits and funding Outcomes: Urinary withanolides measured by LC-MRM-MS Limitations: Participant number not stated in the abstract I read; urine only. Funding and conflicts: No conflicts declared Read: abstract
Sriperumbuduri 2020 Ashwagandha and Kidney Transplant Rejection. Kidney Int Rep · PMID 33305135 · DOI	Case report	1 69-year-old kidney transplant recipient (age per MSK summary)	Ashwagandha unspecified · vs none	Only the title and journal record were read ('Ashwagandha and Kidney Transplant Rejection', Kidney Int Rep 2020). MSK's summary says rejection occurred in a 69-year-old requiring graft nephrectomy and maintenance dialysis. Methods, limits and funding Outcomes: Kidney transplant rejection Limitations: No abstract; details taken from MSK summary, not the paper. Read: summary-only
Such 2026 System-Level, Molecular and Cellular Mechanisms of Selected Plant Adaptogens-A Review. Nutrients · PMID 41901106 · DOI	Narrative review in-vitro	preclinical and clinical literature (2010-2025)	Seven adaptogens including Withania somnifera mixed n/a n/a · vs none	Reports regulation of the HPA axis, Hsp70, JNK/FOXO/NF-kB; withanolides inhibiting PDE4D; clinical cortisol reductions 14-30% across adaptogens in general. Methods, limits and funding Outcomes: Molecular mechanisms of adaptogens Limitations: Narrative review across several herbs; cortisol figure not specific to ashwagandha. Read: abstract
Summan 2026 Safety Evaluation of an Aqueous Root and Leaf Extract of Ashwagandha ( Withania somnifera ). Phytother Res · PMID 41987003 · DOI	Animal research animal	Rats and bacterial/cell assays (OECD guideline studies)	Sensoril (aqueous root + leaf extract) root+leaf 1000, 2000, 4000 mg/kg/day in rats 90 days · vs Control	Not mutagenic or genotoxic. 90-day rat study: no mortality, adverse clinical signs, or test-item-related changes in body weight, food intake, haematology, biochemistry, thyroid or sex hormones, or microscopic pathology. NOAEL 4000 mg/kg/day. NOAEL 4000 mg/kg/day (rat) Methods, limits and funding Outcomes: Ames, micronucleus, chromosome aberration, 90-day toxicity Limitations: Animal data; manufacturer's own product; liver injury in people was not predicted by such tests (see Williamson & Brendler). Funding and conflicts: Funded by Natreon/Kerry Group; authors include company employee Read: abstract
Suryawanshi 2023 Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation. Am J Ther · PMID 36321995 · DOI	Case report	1 Adult with acute liver failure requiring liver transplantation (details not in the record we could read)	Ashwagandha supplement (details not available) unspecified · vs none	Only the title and journal record were read: 'Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation'. No clinical details are quoted here. Methods, limits and funding Outcomes: Acute liver failure outcome Limitations: No abstract available; clinical details not read. Read: summary-only
TGA (Australia) 2026 Withania somnifera (Ashwagandha) and very rare risk of liver injury TGA website, 7 July 2026 · Source	Authoritative guidance		unspecified	Per the TGA text quoted by three secondary reports (search result for the TGA page, NutraIngredients 20 July 2026, Medical Republic 23 July 2026; the TGA page itself timed out when fetched): 11 possible ashwagandha-related liver injury reports in total, 4 new since the 2024 advisory; 6 of 11 had no other likely contributing ingredient; no deaths or liver transplants in Australian consumers; at least 4 published international reports of liver failure including one transplant, and 3 deaths in patients with acute-on-chronic liver failure in an Indian series. Advice: consider complementary medicines when assessing liver injury; stop and seek medical attention for yellow skin/eyes or dark urine; people with current or past liver problems should avoid products containing W. somnifera. TGA calls the risk 'very rare' and keeps assessing. Earlier advisory: 2024. Methods, limits and funding Outcomes: Liver-injury reports and advice Limitations: Primary page not read directly; wording taken from secondary quotations. Read: summary-only
Tallon 2026 A Systematic and Ethnobotanical Review of Ashwagandha's ( Withania Somnifera ) Teratogenic and Abortifacient Potentials. Phytother Res · PMID 40887707 · DOI	Systematic review	Literature on teratogenic and abortifacient potential (PRISMA)	Ashwagandha unspecified	Historical ethnobotanical reports suggest abortifacient effects but the authors describe citation distortion and lack of primary-source validation. Animal studies show high tolerability with no significant reproductive toxicity at human-relevant doses. Authors conclude evidence for significant teratogenic or abortifacient activity is inconclusive and call for controlled studies. Methods, limits and funding Outcomes: Teratogenic and abortifacient evidence Limitations: Authors argue regulatory action should rest on data, not history; the abstract cites no controlled human pregnancy-outcome studies. Funding and conflicts: No conflicts declared Read: abstract
Thanawala 2026 Efficacy and safety of Ashwagandha root extract sustained-release (AshwaSR) capsules in healthy adult, stressed subjects: A randomized, double-blind, placebo-controlled, parallel-group, 3-arm clinical trial. Medicine · PMID 41824889 · DOI	Controlled trial	135 Healthy adults with PSS 14-26 (126 completed)	AshwaSR sustained-release root extract root 150 mg or 300 mg/day 60 days · vs Placebo	PSS fell 38.6% (150 mg) and 41.6% (300 mg) from baseline; sleep, well-being and eating behaviour improved vs placebo; cortisol fell significantly in the 300 mg group. PSS change -38.6%/-41.6% (P<.001) Methods, limits and funding Outcomes: PSS, sleep quality, well-being, eating behaviour, serum cortisol Limitations: Cortisol result stated for 300 mg group only. Read: abstract
Thanawala 2026 Efficacy and safety of a sustained release ashwagandha root extract capsules on muscle strength and cardiorespiratory endurance in recreationally active individuals: a randomized, double-blind, placebo-controlled trial Front Nutr · PMID 42780946 · DOI	Controlled trial	84 Recreationally active healthy adults aged 25-50 (83 completed)	AshwaSR sustained-release root extract root 300 mg once daily 90 days · vs Placebo	1-RM +15.31 vs +7.33 kg and VO2max +30.56 vs +18.14 mL/kg/min at day 91 (p<0.001; values as reported). Testosterone rose within the ashwagandha group in men (+121.43 ng/dL, p=0.024) but the change was similar to placebo (p>0.05). 1-RM +15.31 vs +7.33 kg; testosterone not different from placebo Methods, limits and funding Outcomes: 1-RM bench press, VO2max, total testosterone, creatine kinase, LDH, SF-12 Limitations: Reported VO2max changes are unusually large (as printed in the abstract); product-specific Registration: CTRI/2025/04/084383 Read: abstract
Tiwari 2021 A double-blind, randomized, placebo-controlled trial on the effect of Ashwagandha (Withania somnifera dunal.) root extract in improving cardiorespiratory endurance and recovery in healthy athletic adults J Ethnopharmacol · PMID 33600918 · DOI	Controlled trial	50 Healthy athletic adults	Standardised root extract root 300 mg twice daily 8 weeks · vs Placebo	VO2max rose more than with placebo (p=0.0074); recovery scores and antioxidant level improved (p<0.0001). No adverse events. VO2max p=0.0074 vs placebo Methods, limits and funding Outcomes: VO2max, Total Quality Recovery score, RESTQ, DALDA, antioxidant level Limitations: Small; measurement method for VO2max not stated in abstract Read: abstract
Tóth 2023 Ashwagandha-induced acute liver injury: A case report. Clin Case Rep · PMID 36937644 · DOI	Case report	1 Adult patient (Heidelberg, Germany)	Ashwagandha (product not specified in abstract) unspecified Jaundice 2 weeks after starting · vs none	Jaundice developed 2 weeks after starting; recovered within 5 months after withdrawal without specific treatment. Methods, limits and funding Outcomes: Course after withdrawal Limitations: Single case; abstract gives no dose or product details. Funding and conflicts: None declared Read: abstract
Vaidya 2024 Clinical safety and tolerability evaluation of Withania somnifera (L.) Dunal (Ashwagandha) root extract in healthy human volunteers J Ayurveda Integr Med · PMID 38154316 · DOI	Non randomised open label	18 Healthy men aged 18-60	Standardised root extract (AgeVel/Witholytin) root 500 mg twice daily (1000 mg/day) 4 weeks · vs None	No significant changes in liver, kidney or thyroid function; no adverse events. No thyroid change Methods, limits and funding Outcomes: Vital signs, organ function tests including thyroid, ECG, endurance Limitations: Tiny, short, uncontrolled Read: abstract
Vaidya 2024 Clinical pharmacokinetic evaluation of Withania somnifera (L.) Dunal root extract in healthy human volunteers: A non-randomized, single dose study utilizing UHPLC-MS/MS analysis. J Ethnopharmacol · PMID 38122911 · DOI	Non randomized single dose pharmacokinetic study	18 healthy male volunteers aged 18-45	Root extract (AgeVel/Witholytin), capsules root 500 mg single dose (not less than 7.5 mg total withanolides), fasting single dose, plasma sampling · vs none (single arm)	Cmax (mean +/- SD) 0.639 +/- 0.211 (withanoside IV), 2.926 +/- 1.317 (withanolide A), 2.833 +/- 0.981 (withaferin A), 5.498 +/- 1.986 (12-deoxy-withastramonolide) ng/mL; Tmax about 0.9 to 1.6 h; withanoside V detected but below the lower limit of quantification. Methods, limits and funding Outcomes: Plasma levels of withanoside IV, withanoside V, withanolide A, withaferin A, 12-deoxy-withastramonolide Limitations: Single dose, men only, no control; authors' claim of 'high oral bioavailability' is not supported by an absolute-bioavailability comparison. Authors from the extract manufacturer's analytical lab. Funding and conflicts: Authors affiliated with Pharmanza Herbal (extract maker); declared no competing interests Read: abstract
Vaidya 2026 Safety and Tolerability of Withania somnifera Root Extract in Healthy Male Participants: A Pilot Randomized, Double-Blind, Placebo-Controlled Clinical Trial Food Sci Nutr · PMID 41458530 · DOI	Controlled trial	40 Healthy adults aged 50-70	Standardised root extract (at least 5 mg withanolides per capsule) root 200 mg twice daily 180 days · vs Placebo	Testosterone rose 15.7% in men in the ashwagandha group. Thyroid hormones showed no adverse changes. CRP fell 51.1% and NT-proBNP 28.70% in the ashwagandha group; CD3, CD4 and CD8 slightly improved. Liver, kidney and blood counts stayed in normal ranges. Testosterone +15.7% (men); CRP -51.1%; NT-proBNP -28.7% (group changes, as reported) Methods, limits and funding Outcomes: Safety labs, hormones, CRP, NT-proBNP, immune cell markers Limitations: Pilot safety trial of only 40 people; men and women pooled for several markers; between-group statistics not shown in the abstract Registration: CTRI/2023/11/059395 Read: abstract
Vani 2025 A prospective, randomized, double-blind, placebo-controlled study on efficacy and safety of Ashwagandha root extract (Withania somnifera) for managing menopausal symptoms in women Front Reprod Health · PMID 41561822 · DOI	Controlled trial	60 Women aged 45-55 with menopausal symptoms	Root extract (brand and dose not stated in abstract) root 56 days · vs Placebo	Total MRS fell more than placebo (p<0.0001) in all domains; estradiol and progesterone rose and FSH and LH fell (p<0.001); fewer hot flashes and lower perceived stress (p<0.001). MRS p<0.0001; hormones p<0.001 vs placebo Methods, limits and funding Outcomes: MRS, estradiol, progesterone, LH, FSH, hot flash events, SF-12, Perceived Stress Scale Limitations: Small; 8 weeks; dose not in abstract Registration: CTRI/2022/02/040551 Read: abstract
Vazirani 2023 Supplements Are Not a Synonym for Safe: Suspected Liver Injury From Ashwagandha. Fed Pract · PMID 38562158 · DOI	Case report	1 48-year-old man with severe alcohol use disorder	Testosterone-boosting supplement containing ashwagandha, plus alcohol unspecified · vs none	Cholestatic pattern of liver injury in the setting of alcohol and a testosterone-boosting ashwagandha-containing supplement. Methods, limits and funding Outcomes: Pattern of liver injury Limitations: Confounded by heavy alcohol use and a multi-ingredient product. Funding and conflicts: Authors report no conflicts Read: abstract
Verma 2021 Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers Complement Ther Med · PMID 33338583 · DOI	Controlled trial	80 Healthy adults (40 men, 40 women)	Standardised root extract root 300 mg twice daily 8 weeks · vs Placebo	No statistically significant change or abnormality in any measured parameter, including the thyroid hormone profile, in either group. No adverse events reported. No change in thyroid profile Methods, limits and funding Outcomes: Blood counts, liver and kidney chemistry, thyroid profile, vital signs Limitations: Healthy people with normal thyroid function; 8 weeks only Read: abstract
Verma 2023 Effects of Ashwagandha ( Withania somnifera) standardized root extract on physical endurance and VO 2max in healthy adults performing resistance training: An eight-week, prospective, randomized, double-blind, placebo-controlled study F1000Res · PMID 38988644 · DOI	Controlled trial	80 Healthy adults aged 18-45 doing resistance training (73 analysed)	Standardised root extract (over 5% withanolides) root 300 mg twice daily 8 weeks · vs Identical placebo	Greater improvement than placebo in bench press, leg press and endurance (VO2max) in both men and women (p<0.05 to <0.0001) and in arm, chest and thigh girth. No adverse events. All reported p-values favoured ashwagandha (values not in abstract) Methods, limits and funding Outcomes: 1-RM bench press and leg press, muscle girth, VO2max Limitations: Raw values not in abstract; 8 weeks Read: abstract
Vollmer 2026 Evaluation of Potential Hormonal Activities of Ashwagandha (Withania somnifera) Phytother Res · PMID 41454558 · DOI	Narrative review	Preclinical, clinical and case evidence on thyroid, HPA and gonadal axes	Ashwagandha unspecified	Ashwagandha appears to raise thyroid hormones in hypothyroid contexts, consistently lowers cortisol, and may raise testosterone in men and affect estrogen and gonadotrophins in women, probably via central regulation not receptor binding. Qualitative Methods, limits and funding Outcomes: Hormonal effects Limitations: High doses in animals; small human trials (authors) Read: abstract
Wankhede 2015 Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial J Int Soc Sports Nutr · PMID 26609282 · DOI	Controlled trial	57 Healthy men aged 18-50 with little resistance-training experience	Root extract (brand not stated in abstract) root 300 mg twice daily 8 weeks with resistance training · vs Starch placebo	Greater gains than placebo: bench press +46.0 vs +26.4 kg (p=0.001); leg extension +14.5 vs +9.8 kg (p=0.04); arm size +8.6 vs +5.3 cm2 (p=0.01); chest +3.3 vs +1.4 cm (p<0.001); testosterone +96.2 vs +18.0 ng/dL (p=0.004); body fat -3.5% vs -1.5% (p=0.03). Creatine kinase (muscle damage marker) differed (p=0.03); the abstract's wording is hard to interpret. Bench press +46.0 kg vs +26.4 kg; testosterone +96.2 ng/dL vs +18.0 ng/dL (Bench press: placebo 19.5-33.3, ashwagandha 36.6-55.5 kg) Methods, limits and funding Outcomes: 1-RM bench press and leg extension, arm and chest size, body fat, serum testosterone, creatine kinase Limitations: Beginners, 8 weeks, men only; gains in untrained men are large for both groups Read: abstract
West 2026 A proprietary herbal extract of ashwagandha root for stress and anxiety in healthy adults: a randomized, double-blind, three-arm, placebo-controlled efficacy and safety study. Journal of medicine and life · PMID 41815853 · DOI	Controlled trial	141 Adults 18-65 with moderate stress and anxiety	Proprietary root extract (APB) vs standard root extract (ARE) root 300 mg twice daily 8 weeks · vs Placebo	All groups, including placebo, showed significant reductions in serum cortisol and improved PSS, HAM-A and POMS; APB differed significantly from ARE and placebo on PSS, HAM-A, OHQ, POMS. P<0.0001 within-group changes; APB vs placebo p<0.05 Methods, limits and funding Outcomes: Serum cortisol (primary), PSS, HAM-A, POMS, Oxford Happiness Limitations: Placebo group also improved on cortisol and scales; abstract does not give between-group cortisol difference. Read: abstract
Wiciński 2023 Can Ashwagandha Benefit the Endocrine System?-A Review. Int J Mol Sci · PMID 38003702 · DOI	Narrative review	literature 2010-2023	Ashwagandha root extract root n/a n/a · vs none	Reports lower cortisol and rises in LH/FSH in men and changes in T3/T4/TSH; proposes HPA and HPT axis involvement. Methods, limits and funding Outcomes: Endocrine effects Limitations: Narrative review; mechanism inferred. Read: abstract
Williams 2020 The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review. Plant Foods Hum Nutr · PMID 31758301 · DOI	Systematic review	9 RCTs	L-theanine not applicable 200-400 mg/day Varied · vs Control	200-400 mg/day may help in people exposed to stress; larger longer trials needed. Methods, limits and funding Outcomes: Stress and anxiety Read: abstract
Williamson 2026 Ashwagandha: Is It Safe? Part 2: A Preclinical Evidence Review. Phytother Res · PMID 40968393 · DOI	Narrative review animal	Preclinical safety literature (animal, in vitro)	Ashwagandha extracts and constituents unspecified	Most studies conclude ashwagandha is very safe in animals, but liver toxicity (mainly reversible cholestasis, severe jaundice and itching) has been reported in people without being predicted by preclinical evidence. No genotoxicity or mutagenicity in standard tests. A folkloric reputation for causing abortion or sterility is not borne out by preclinical experiments; rare cardiotoxicity reports could not be substantiated. Methods, limits and funding Outcomes: General toxicity, genotoxicity, reproductive, liver Limitations: Preclinical only; constituents responsible for liver injury unknown. Funding and conflicts: No conflicts declared Read: abstract
Xing 2022 Effects of Acute Ashwagandha Ingestion on Cognitive Function. International journal of environmental research and public health · PMID 36231152 · DOI	Controlled trial	13 Healthy volunteers (crossover)	NooGandha extract unspecified 400 mg single dose 6 hours, 4-day washout · vs Placebo	Selected improvements in working memory (Sternberg), sustained attention and Go/No-Go response times; accuracy not improved. Not in abstract Methods, limits and funding Outcomes: Berg-Wisconsin Card Sorting, Go/No-Go, Sternberg, psychomotor vigilance Limitations: n=13 crossover; acute only; no accuracy gain. Read: abstract
Yalin 2026 Improving Cognition in Bipolar Disorder: A Systematic Review of Current Pharmacological and Nutraceutical Approaches. Neuropsychobiology · PMID 41843701 · DOI	Systematic review	Euthymic or partially remitted bipolar disorder, ages 18-65 (16 studies, 13 agents)	Withania somnifera among 13 agents unspecified · vs Placebo/various	Withania somnifera (ashwagandha) demonstrated cognitive benefits in a single study; NIH quality tools used; study quality good to poor. Qualitative (not applicable) Methods, limits and funding Outcomes: Cognitive functioning in bipolar disorder Limitations: Ashwagandha supported by a single study. Registration: PROSPERO CRD42024618397 Read: abstract
Yan 2025 Efficacy of botanical extracts for knee osteoarthritis: a network meta-analysis of randomized controlled trials Front Pharmacol · PMID 41126953 · DOI	Network meta analysis	3285 Knee osteoarthritis, 36 RCTs of botanical extracts	Botanical extracts incl. ashwagandha unspecified Varied Varied · vs Placebo or standard care	Ashwagandha extract reduced stiffness scores (MD 4.16); another plant (cucumber extract) ranked best. Authors call results exploratory. Ashwagandha stiffness MD 4.16 (2.43 to 5.90) Methods, limits and funding Outcomes: WOMAC, VAS, KOOS and others Limitations: Few ashwagandha trials in network; exploratory Registration: PROSPERO CRD42024617459 Read: abstract
Yousefi-Mohammadabad 2026 The effect of a multi-herbal product, C. autumnale, W. somnifera, and P. lentiscus, on knee osteoarthritis: a triple-blind randomized clinical trial Res Pharm Sci · PMID 41607420 · DOI	Controlled trial	70 Knee osteoarthritis patients	Multi-herb product: Colchicum autumnale, Withania somnifera root, Pistacia lentiscus gum root Not stated in abstract 6 weeks · vs Placebo	Better WOMAC pain, stiffness and function at 3 and 6 weeks and lower pain. WOMAC improved vs placebo Methods, limits and funding Outcomes: WOMAC, pain VAS Limitations: Three-ingredient product (includes colchicine-containing plant); ashwagandha effect cannot be isolated Read: abstract
Zhang 2022 Medicinal herbs for the treatment of anxiety: A systematic review and network meta-analysis. Pharmacological research · PMID 35378276 · DOI	Meta-analysis	Adults with diagnosed or subthreshold anxiety (29 trials, 12 herbs)	Withania somnifera among 12 herbs unspecified · vs Placebo/standard treatments	Withania somnifera was efficacious on HAM-A in the network analysis but trials were limited by small sample sizes. Withania somnifera MD -4.90 on HAM-A (95% credible interval -9.70 to -0.17) Methods, limits and funding Outcomes: HAM-A scores Limitations: Wide credible interval; small trials. Read: abstract
Zhu 2026 Effects of Withania somnifera (L.) Dunal (Ashwagandha) on cognitive and physical function in adults: a systematic review and meta-analysis. Frontiers in pharmacology · PMID 42199854 · DOI	Meta-analysis	1249 Adults in 20 RCTs	Withania somnifera (various) unspecified · vs Placebo	Improved memory, attention and processing speed, executive function; visuospatial ability improved only after excluding one heterogeneous study; only one study assessed global cognition. GRADE and RoB 2 applied (certainty per outcome not shown in abstract). Memory SMD 0.52 (I2 29.7%); attention/processing speed SMD 0.29 (I2 0%); executive function SMD -0.42 (I2 37.5%, lower score = better on those tests); visuospatial SMD 0.39 after exclusion (Memory 0.27-0.78; attention 0.07-0.51; executive -0.70 to -0.13; visuospatial 0.08-0.70) Methods, limits and funding Outcomes: Memory, attention/processing speed, executive function, visuospatial ability, global cognition; testosterone, muscle strength Limitations: Abstract only; mixed healthy and clinical populations; single study for global cognition; certainty grades not reported in abstract. Registration: PROSPERO CRD420261292996 Read: abstract
Ziegenfuss 2018 Effects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR Trial Nutrients · PMID 30463324 · DOI	Controlled trial	38 Recreationally active men (mean age 26.5)	Sensoril aqueous extract root+leaf 500 mg per day 12 weeks with progressive resistance training · vs Placebo	Squat 1-RM +19.1 vs +10.0 kg (p=0.009); bench +12.8 vs +8.0 kg (p=0.048); android/gynoid ratio favoured Sensoril (p=0.03); no other body composition differences. Only the Sensoril group improved significantly in squat power, peak bench power, time trial and perceived recovery. Squat +9.1 kg and bench +4.8 kg more than placebo (derived from reported gains) Methods, limits and funding Outcomes: 1-RM squat and bench, power, 7.5 km time trial, DEXA body composition, clinical chemistry Limitations: Small; recreational men; root-and-leaf extract (differs from root-only) Read: abstract
alternativemed.com (internal) 2026 Site page: Quality testing and certifications · Source	Authoritative guidance		unspecified	Internal page: NSF Certified for Sport and ConsumerLab describe their own programmes; USP pages could not be read (HTTP 403); NCCIH says 'standardized', 'verified' or 'certified' does not necessarily guarantee quality. Methods, limits and funding Read: summary-only
alternativemed.com (internal) 2026 Site page: Ashwagandha KSM-66, Sensoril and generic root powder compared · Source	Authoritative guidance		unspecified	Internal page that identifies KSM-66 as a root-only water-based extract standardized to at least 5% withanolides, Sensoril as a root and leaf water extract, and which trials used which, based on full papers read by the site team. Methods, limits and funding Read: summary-only
van der Hooft 2005 [Thyrotoxicosis following the use of ashwagandha] Ned Tijdschr Geneeskd · PMID 16355578	Case report	1 32-year-old healthy woman taking capsules for chronic fatigue	Ashwagandha extract capsules unspecified Dose raised during use; amount not in abstract Weeks · vs None	Thyrotoxicosis symptoms and labs after increasing the dose; resolved spontaneously after stopping. Single case Methods, limits and funding Outcomes: Thyroid tests, symptoms Limitations: Single case (Dutch-language report) Read: abstract
Łuszczak 2026 Clinical evidence for the adaptogenic effects of Withania somnifera and Rhodiola rosea - A systematic review with molecular interpretation of psychometric outcomes. Annals of agricultural and environmental medicine : AAEM · PMID 41906501 · DOI	Systematic review	Adults 18-75 in 24 RCTs (19 Withania, 5 Rhodiola)	Standardised extracts unspecified 120-1000 mg/day (Withania) 3-16 weeks · vs Placebo	Reviewers report reduction of stress and anxiety, alleviated depressive symptoms, improved sleep quality and cognitive functions; limitations: heterogeneity, short duration, small samples. Qualitative (not applicable) Methods, limits and funding Outcomes: Stress, anxiety, depressive symptoms, sleep, cognition, hormones Limitations: Narrative synthesis with no pooled estimate; abstract only. Read: abstract

What we do not know yet

What the evidence supports: small, short trials suggest lower perceived stress and better sleep scores for some root extracts, and higher testosterone in some men.
What is uncertain: the size of the stress effect (reviews disagree), whether lab changes (cortisol, testosterone, thyroid hormones) translate into better health, and which dose is best.
Not studied: any controlled trial longer than about 6 months; trials in pregnancy, breastfeeding or children with strong designs; trials pairing ashwagandha with a named medicine; polycystic ovary syndrome; real sleep-lab recording.
Do trials match what is sold? Many positive trials used branded, standardized extracts. Many shelf products have no trial behind them, and a 2026 lab study found only 10 of 25 products met both pharmacopoeia standards.
Where results conflict: perceived stress (one 2025 meta-analysis found no effect), body weight, and exercise performance.
Clinical outcomes: most trials measure questionnaires or lab markers, not diagnoses, injuries avoided or time to recovery.
Source limits: for this page we read PubMed abstracts, not every full text, so funding, conflicts of interest and risk of bias are not assessed for most trials. Several pooled effect sizes look implausibly large and should be treated with caution.

How new research is added

New studies are found by a saved PubMed search and are placed in a review queue. A person reads each one before it changes any evidence rating, safety wording or dose information. New publications never change ratings automatically.

Dosage and forms

What researchers actually gave people in trials. These are study numbers, not advice for you.

250–600mg of extract a day in most trials

8–12weeks is how long most trials lasted

30–5,000mg a day: the full range tested

30studies with a stated dose

Study doses are not advice and may not suit you. Ask a clinician or pharmacist.

How to read these numbers: four different kinds of dose

There are four different kinds of numbers and they must not be mixed. (1) Studied doses are what volunteers took in trials: mostly 125 to 600 mg a day of a specific extract for 8 to 12 weeks, with outliers from 30 mg a day (a very concentrated proprietary extract) to about 1,000 mg a day, and grams a day for whole root powder. A review of 23 trials of root extract in healthy adults reports 125 to 600 mg a day and durations from a single dose to 180 days. Pooled analyses suggest a link between dose and effect (one found the stress effect at 300 to 600 mg a day; a sleep review found larger effects at 600 mg a day or more and 8 weeks or more), but these are cross-trial comparisons of different products, so they do not prove one dose is best. (2) Label serving sizes are what a company prints on a bottle. They are set by the maker, may be a whole-plant powder, a root extract, a leaf extract or a blend, and are not required to match any trial. The same milligrams of two products can contain very different withanolide amounts. (3) Official recommendations: we found no dose recommendation from NCCIH (its page gives no dose), no dose limit in the UK Food Standards Agency call-for-evidence summary, and could not verify any EFSA, Health Canada or Danish figure. Secondary press reports say Danish authorities (via a DTU assessment) found evidence too thin to set a safe intake limit and banned it; we did not read those documents. (4) Traditional amounts come from Ayurvedic practice, usually whole root powder taken with milk, and we could not verify authoritative figures. None of these four is a prescription. People with thyroid conditions, pregnancy, autoimmune disease or on medicines should ask a clinician.

Doses used in studies 30

600 mg/day

300 mg twice a day · 60 days

Stress, anxiety, cortisol. Adults with chronic stress, 64 people (vs Placebo)

High-concentration full-spectrum root extract (site page: KSM-66) · root · Withanolide % not in abstract (site page: KSM-66 at least 5%)

Result

Significant reduction on all stress scales and in serum cortisol versus placebo; adverse effects mild and similar in both groups.

Chandrasekhar 2012

600 mg/day

300 mg twice a day · 8 weeks

Strength, recovery. Young men, resistance training, 57 people (vs Placebo)

Root extract (site page: KSM-66) · root · Not in abstract

Result

Greater bench-press and leg-extension gains, arm and chest size, and testosterone rise versus placebo.

Wankhede 2015

250 mg/day

125 mg twice a day · 8 weeks

Stress, cortisol. Healthy stressed adults, 60 people (vs Placebo)

High-concentration root extract (aqueous) · root · Not in abstract

Result

Both doses reduced PSS and cortisol versus placebo (250 mg/day P<0.05; 600 mg/day P<0.001 for PSS). Authors call it a dose-response look at a high-concentration root extract.

Salve 2019

600 mg/day

300 mg twice a day · 8 weeks

Stress, cortisol. Healthy stressed adults, 60 people (vs Placebo)

High-concentration root extract (aqueous) · root · Not in abstract

Result

Both doses reduced PSS and cortisol versus placebo (250 mg/day P<0.05; 600 mg/day P<0.001 for PSS). Authors call it a dose-response look at a high-concentration root extract.

Salve 2019

600 mg/day

300 mg twice a day · 10 weeks

Sleep, anxiety. Adults with insomnia and anxiety, 60 people (vs Placebo)

Highest-concentration full-spectrum root extract · root · Not in abstract

Result

Sleep onset latency about 29 vs 34 min at 10 weeks (p=0.019); sleep efficiency and sleep quality improved versus placebo.

Langade 2019

600 mg/day

300 mg twice a day · 8 weeks

Memory, attention. Adults with mild cognitive impairment, 50 people (vs Placebo)

Root extract · root · Not in abstract

Result

Better memory and attention test scores versus placebo.

Choudhary 2017

600 mg/day

300 mg twice a day · 8 weeks

Stress, food cravings, weight. Adults under chronic stress, 52 people (vs Placebo)

Standardized root extract · root · Not in abstract

Result

Significant improvements in primary and secondary measures.

Choudhary 2017

600 mg/day

Daily (split not stated) · 8 weeks

TSH, T3, T4. Adults with subclinical hypothyroidism, 50 people (vs Starch placebo)

Root extract · root · Not in abstract

Result

TSH, T3 and T4 improved versus placebo (p<0.001, 0.0031, 0.0096).

Sharma 2018

Traditional preparations tradition, not clinical dosing

Root powder (churna) taken with milk

Ayurveda

Amount not verified. A retail label for one Indian-brand churna lists a single maximum dose of 2.5 g twice a day with milk; that is a product label, not the pharmacopoeia. The Ayurvedic Pharmacopoeia of India figure (often quoted as a few grams a day) could not be verified, so no number is given.

Milk decoction (ksheerapaka)

Ayurveda

Amount not verified. Named as a classical preparation in Ayurvedic texts but we could not retrieve an authoritative dose; left null.

Root powder in a modern trial

Research use of the traditional form

5 g/day for 3 months. One uncontrolled study in infertile men used 5 g/day of root powder. This is a studied dose of whole powder, not an official recommendation.

Traditional role

Ayurveda (rasayana tonic)

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 8

Liver injury has been reported, and it can be serious. Case reports from Iceland, the US, India, Europe and elsewhere describe jaundice (yellow skin or eyes), itching, nausea, tiredness and belly discomfort starting about 2 to 12 weeks after beginning ashwagandha. In the best-described series, liver tests returned to normal within 1 to 5 months in four of five patients, but one liver-failure case needed a transplant. No source we read gives a reliable rate. NCCIH calls it rare and Australia's TGA calls it 'very rare', but neither number comes from a measured denominator. Stop the product and seek medical care if you notice the warning signs. Case series Björnsson 2020 Philips 2023 McIntyre 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 TGA (Australia) 2026
People with existing liver disease should not use it. In an Indian series, three of five people with underlying chronic liver disease who developed ashwagandha-linked injury went into acute-on-chronic liver failure and all three died. A 2026 scoping review of 25 patients also reports three deaths in people with cirrhosis and advises counselling people with advanced chronic liver disease to avoid it. Australia's TGA says people with current or past liver problems should avoid products containing it. Case series Philips 2023 McIntyre 2026 TGA (Australia) 2026
Pregnancy and breastfeeding: avoid it. NCCIH says to avoid ashwagandha in pregnancy and not to use it while breastfeeding; Memorial Sloan Kettering says higher doses may raise miscarriage risk; the Dutch RIVM advises pregnant women especially to avoid it. These are precautions based on traditional abortifacient use and limited data, not on proven harm: a 2026 systematic review calls the evidence for teratogenic or abortifacient activity inconclusive, and one small open-label trial in 63 second-trimester women reported no adverse events. With no reliable data on birth outcomes, the cautious advice stands. Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 RIVM (Netherlands National Institute for Public Health and the Environment) 2024 Tallon 2026 Ajgaonkar 2026 Williamson 2026
It can change thyroid hormone levels. A meta-analysis of 23 randomised trials found thyroxine (T4) rose modestly (about 0.61 ug/dL) with no clear change in TSH or T3. Separate case reports describe thyrotoxicosis (an overactive-thyroid state) that cleared after stopping. NCCIH advises against use with thyroid disorders and lists thyroid-hormone medicines as a possible interaction. If you have thyroid disease or take thyroid medicine, speak to your prescriber first and ask for thyroid tests. Meta-analysis Fornalik 2026 Hayashi 2024 van der Hooft 2005 Gannon 2014 National Center for Complementary and Integrative Health (NCCIH) 2023
It may add to the effect of sedatives and sleep or seizure medicines. Drowsiness is a listed effect of ashwagandha. Memorial Sloan Kettering says patients taking benzodiazepines, anticonvulsants or barbiturates should likely avoid it because the sedative and GABA-related effects may be additive, and says the clinical relevance is not yet determined. This rests on lab and animal work, not on a trial pairing ashwagandha with these drugs. Pharmacological theory Memorial Sloan Kettering Cancer Center 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Immune system: avoid with autoimmune disease or an organ transplant. NCCIH does not recommend ashwagandha for people with autoimmune disorders and names immunosuppressant medicines as a possible interaction. Memorial Sloan Kettering lists a kidney transplant rejection in a 69-year-old patient who used ashwagandha. One case cannot prove cause, and no mechanism is established. Case report National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Sriperumbuduri 2020
Hormone-sensitive cancers: avoid unless your cancer team agrees. A meta-analysis found testosterone rose in men (about 57 ng/dl on average) but not in women, and estradiol did not change. NCCIH and Memorial Sloan Kettering say to avoid ashwagandha with hormone-sensitive prostate cancer because it may raise testosterone. We found no trial in people with hormone-sensitive cancers. Meta-analysis Fornalik 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Short-term studies look reassuring; long-term safety is unknown. In a review of 23 randomised trials (2,317 healthy adults) with standardised root extract at 125 to 600 mg/day for up to 180 days, no serious adverse events were attributed to the extract and mild effects occurred in both treatment and placebo groups. In a 1,002-person trial adverse events were 5.6% on ashwagandha vs 9.2% on placebo. But trials are short, mostly manufacturer-linked and exclude people most at risk, so they cannot rule out rare reactions. NCCIH says it may be safe up to 3 months and long-term safety is not established. Do not exceed studied doses: one case reports adrenal suppression after about 950 mg/day for over a year. Systematic review Coope 2026 Pakhale 2026 Verma 2021 Gómez Afonso 2023 National Center for Complementary and Integrative Health (NCCIH) 2023 Javid 2026

Side effects 17

Effect	How often	Severity and recovery	Evidence
Drowsiness or sleepiness Listed by NCCIH and MSK. A review of 23 trials describes transient drowsiness as infrequent and seen in both treatment and comparator groups. No pooled percentage was in the sources we read.	Not established	mild Reversible (transient in trials)	Controlled trial Coope 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Nausea Rates differ by study design; the higher-dose study had no placebo group.	2.0% ashwagandha vs 3.2% placebo (600 mg/day, 8 weeks, n=1,002); 5.5% in a single-arm 2,000 mg/day study (n=145)	mild Reversible	Controlled trial Pakhale 2026 Movva 2026
Stomach upset, diarrhea, loose stools, vomiting Named by NCCIH and MSK. A trial review lists gastrointestinal discomfort among mild events that occurred in both groups.	Not established	mild Reversible	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Coope 2026
Headache Headache was more common on placebo in that trial.	0.2% ashwagandha vs 2.2% placebo (n=1,002)	mild Reversible	Controlled trial Pakhale 2026 Coope 2026
Dry mouth	1.4% in both groups (n=1,002)	mild Reversible	Controlled trial Pakhale 2026
Dizziness (giddiness, vertigo), nasal congestion, reduced appetite, constipation, weight gain MSK lists these as less common; the underlying studies were not individually checked.	Not established	mild Presumed reversible	Authoritative guidance Memorial Sloan Kettering Cancer Center 2026
Liver injury (jaundice, itching, dark urine, raised liver enzymes) Typically cholestatic or mixed, starting about 2-12 weeks after starting. No source we read gives a measured rate. NCCIH: rare; TGA: very rare. Not predicted by animal studies.	Not established	serious Usually recovers over weeks to months after stopping; some cases prolonged, one chronic, one transplant, deaths in people with cirrhosis	Case series Björnsson 2020 Philips 2023 McIntyre 2026 Bokan 2023 TGA (Australia) 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Overactive thyroid (thyrotoxicosis) and raised thyroxine Meta-analysis: T4 up about 0.61 ug/dL, TSH and T3 unchanged. Case reports of symptomatic thyrotoxicosis: fatigue, weight loss, diarrhea, headache.	Not established	moderate Resolved after stopping in the case reports	Case report Hayashi 2024 van der Hooft 2005 Gannon 2014 Fornalik 2026
Low cortisol / adrenal (HPA axis) suppression One case after about 950 mg/day for over a year. Lowering cortisol is also a measured trial effect (SMD -1.18), so the issue is long-term, high-dose use and people on steroid replacement.	Not established	serious Not recovered at 3 months in the one case	Case report Javid 2026 Fornalik 2026
Raised testosterone (men) A laboratory change, not itself harmful; matters for hormone-sensitive cancers and in people undergoing hormone testing.	Mean difference about 57 ng/dl in men; not significant in women	mild Not studied after stopping	Meta-analysis Fornalik 2026 Vaidya 2026
Immune effects: possible worsening of autoimmune disease; kidney transplant rejection Single transplant case and a review statement of 'immune hypersensitivity'; no systematic data.	Not established	serious Graft lost in the one reported case	Case report Memorial Sloan Kettering Cancer Center 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Sriperumbuduri 2020 Kumar 2026
Heart rhythm problems (ventricular tachycardia) MSK lists 2 cases possibly linked to herbomineral products containing ashwagandha; a 2026 preclinical review says rare cardiotoxicity reports could not be substantiated.	Not established	serious Not stated	Case report Memorial Sloan Kettering Cancer Center 2026 Williamson 2026
Nervous-system events (acute dystonia, neurotoxicity, reversible cerebral vasoconstriction) Single cases listed by MSK; the vasoconstriction case also involved SNRIs and cannabis. Original papers not read.	Not established	serious Not stated	Case report Memorial Sloan Kettering Cancer Center 2026
Withdrawal-type symptoms after abrupt stopping (rapid heartbeat, insomnia, anxiety) One case; recurrence of underlying anxiety not excluded.	Not established	moderate Treated supportively	Case report Holzman 2025
Blood sugar lowering Small average effect; relevant mainly with diabetes medicines. We found no reports of hypoglycemia.	Fasting glucose -3.09 mg/dL on average (95% CI -5.61 to -0.58); certainty very low	mild Not studied	Meta-analysis Farrin 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Allergic or hypersensitivity reactions A review lists immune hypersensitivity among reported effects but we found no specific case report. Ashwagandha belongs to the nightshade family (Solanaceae).	Not established	unknown Not stated	Pharmacological theory Kumar 2026
Blood pressure change Named by NCCIH as a medicine-interaction area. We found no meta-analysis or reported episodes of low blood pressure.	Not established	unknown Not stated	Pharmacological theory National Center for Complementary and Integrative Health (NCCIH) 2023

Liver

Ashwagandha is now an established, if uncommon, cause of herb-induced liver injury. The first systematic description was a 2020 case series of five patients from Iceland and the US DILIN: all had jaundice with nausea, lethargy, itching and belly discomfort after 2 to 12 weeks, the injury was cholestatic or mixed (bile-flow type), and liver tests normalised within 1 to 5 months in four. A 2023 Indian multi-centre series of eight single-ingredient cases showed the severe end: three of the five patients with underlying chronic liver disease developed acute-on-chronic liver failure and all three died, while others had prolonged but self-limiting courses and one progressed to chronic injury. Biopsies showed cholestasis with necrosis and lymphocyte/eosinophil-rich inflammation. Analysis of the implicated products found natural phytochemicals only, no adulteration. A 2026 scoping review of 13 publications and 25 patients found most recover after stopping, but reports include one liver transplant and three deaths in people with cirrhosis. Some cases are hepatocellular rather than cholestatic. NIH's LiverTox records that ashwagandha had not been linked to enzyme rises during therapy but has recently been linked to clinically apparent liver injury. Several authors argue that products in case reports may have been multi-ingredient, but the Indian series excluded multi-herb products and Björnsson's chemical analysis found no other toxic compounds, so the signal cannot be dismissed as contamination alone. The mechanism is unknown, and standard animal toxicology did not predict it. How often it happens is not known: we found no study measuring injury per user. The only exposure figure we read is that 28 of 9,685 NHANES adults reported ashwagandha use in the past 30 days, a count with no liver outcomes. Short trials in healthy adults (for example 1,002 people for 8 weeks) show no liver-test differences from placebo, which is reassuring for common use but cannot exclude a rare idiosyncratic reaction. Hy's law (a rule that jaundice with a hepatocellular enzyme rise signals a risk of liver failure) is not mentioned in any abstract we read, so we do not state which cases meet it. Practical points: avoid with existing liver disease; avoid combining with alcohol or other liver-risky supplements; stop and seek care for jaundice, dark urine or itching. Björnsson 2020 Philips 2023 Bokan 2023 Suryawanshi 2023 Ireland 2021 Tóth 2023 Lubarska 2023 Pusec 2022 Almuzghi 2024 Pérez Pérez 2026 Vazirani 2023 McIntyre 2026 LiverTox (NIDDK) 2012 Likhitsup 2024 Pakhale 2026 Coope 2026 Williamson 2026 TGA (Australia) 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

How often. No source we read gives the number of injuries per user. Do not quote a percentage. 'Rare' (NCCIH) and 'very rare' (TGA) are the agencies' wording. TGA counted 11 possible reports in Australia, with 91 ashwagandha products on the ARTG per a trade-press report; this is a report count, not a rate.

Monitoring. Authors of the scoping review recommend asking about herbal supplement use in any unexplained hepatitis or cholestasis. Whether routine liver tests for ordinary users help is not established; we found no guideline.

Björnsson 2020 (5 patients). Mean age 43 (21-62), 3 male. Latency 2-12 weeks. Cholestatic or mixed (R 1.4-3.3). Jaundice with prolonged itching and bilirubin (5-20 weeks). No liver failure. Normal in 1-5 months in 4; one lost to follow-up. Other possible causes: 4 of 5 used other supplements; rhodiola a possible co-cause in one Björnsson 2020
Philips 2023 (8 patients). Single-ingredient products, 8 of 23 ashwagandha liver-injury patients. Male-predominant, cholestatic hepatitis commonest. 5 had underlying chronic liver disease; 3 had acute-on-chronic liver failure. Other possible causes: Multi-herb and other hepatotoxic exposures were excluded; analysis found no adulteration Philips 2023
Bokan 2023 (2 patients). 36-year-old man, 450 mg three times daily for 6 months, hepatocellular (R 11.1); 30-year-old woman, 450 mg for 45 days, mixed (R 2.6). RUCAM 7 (probable) in both. Other possible causes: not reported in abstract Bokan 2023
Suryawanshi 2023 (1 patients). Acute liver failure requiring liver transplantation (title only; details not read). Other possible causes: unknown Suryawanshi 2023
Ireland 2021 (1 patients). 39-year-old woman, one week of jaundice and nausea; hepatocellular enzyme pattern; biopsy acute cholestatic hepatitis with confluent necrosis. Other possible causes: product 'containing ashwagandha root extract' Ireland 2021
Tóth 2023 (1 patients). Jaundice 2 weeks after starting. Other possible causes: not stated Tóth 2023
Lubarska 2023 (1 patients). Man, ashwagandha for about a year; hepatocellular; raised urinary copper. Other possible causes: copper finding unexplained Lubarska 2023
Pusec 2022 (1 patients). Acute steatohepatitis in a patient on chronic high-dose ashwagandha with other herbal supplements. Other possible causes: alcohol, multiple medicines, other herbs Pusec 2022
Almuzghi 2024 (1 patients). 22-year-old woman; symptoms after 30 hours; hepatocellular (R 5.4); ALT peak 315 IU/L, bilirubin 12.85 mg/dl; RUCAM 7. Other possible causes: viral and autoimmune hepatitis tests negative Almuzghi 2024
Pérez Pérez 2026 (1 patients). 27-year-old woman, jaundice and itching after 3 days of use; cholestatic on biopsy; RUCAM 7. Other possible causes: infectious, autoimmune, metabolic causes excluded Pérez Pérez 2026
Vazirani 2023 (1 patients). 48-year-old man with severe alcohol use disorder; cholestatic injury. Other possible causes: alcohol; multi-ingredient testosterone-boosting supplement Vazirani 2023
McIntyre 2026 (scoping review) (25 patients). 13 publications; cholestatic or mixed predominant; causality usually probable/likely. Other possible causes: mix of single- and multi-ingredient products McIntyre 2026

This is a safety connection. It is not evidence that Ashwagandha supports liver health.

Medicines and supplements 16

With	Why it matters	Importance	Evidence	What to do
Thyroid hormone medicines (levothyroxine, liothyronine) prescription	Ashwagandha may raise thyroxine (T4): about +0.61 ug/dL across trials, with no effect on TSH or T3, and case reports of thyrotoxicosis. Taken with thyroid medicine, the combined effect could over-replace hormone.	NCCIH lists thyroid hormone medicines as a possible interaction. We found no trial of ashwagandha with levothyroxine.	Meta-analysis Low certainty Fornalik 2026 Hayashi 2024 van der Hooft 2005 Gannon 2014 National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026	Do not combine without your prescriber knowing. If you do, ask for thyroid blood tests (TSH and free T4) at the start and after a few weeks. Report palpitations, tremor, heat intolerance or weight loss.
Benzodiazepines (for example diazepam, lorazepam, alprazolam) and sleeping pills prescription	Sedative and GABA-related effects in lab and animal work may add to the drug's effect (additive sedation).	MSK: clinical relevance not determined; patients on these drugs should likely avoid it. No human interaction study found.	Pharmacological theory Very low certainty Memorial Sloan Kettering Cancer Center 2026 National Center for Complementary and Integrative Health (NCCIH) 2023	Avoid unless the prescriber agrees. Do not drive if drowsy. Never stop a prescribed sedative on your own.
Barbiturates prescription	Additive sedative and GABA-related effects (as above).	MSK advises likely avoidance; no human data found.	Pharmacological theory Very low certainty Memorial Sloan Kettering Cancer Center 2026	Avoid unless your doctor agrees.
Anti-seizure medicines (anticonvulsants) prescription	Possible additive CNS depression; no data on seizure threshold in the sources read.	Named by NCCIH and MSK; relevance not determined.	Pharmacological theory Very low certainty Memorial Sloan Kettering Cancer Center 2026 National Center for Complementary and Integrative Health (NCCIH) 2023	Ask the neurologist before use; do not stop anti-seizure medicine on your own.
Antidepressants (SSRIs, SNRIs) and other psychiatric medicines prescription	No pharmacokinetic or trial interaction found. One reported reversible cerebral vasoconstriction case occurred in a woman who also used SNRIs and cannabis.	Cannot separate ashwagandha's role in that case. NCCIH does not list antidepressants specifically.	Case report Not enough evidence Memorial Sloan Kettering Cancer Center 2026	Tell the prescriber; watch for unusual headache, mood change or sleepiness.
Diabetes medicines (insulin, metformin, sulfonylureas and others) prescription	Ashwagandha modestly lowers fasting glucose on average (-3.09 mg/dL; 95% CI -5.61 to -0.58; very low certainty), so it could add to a glucose-lowering drug.	NCCIH lists diabetes medicines as a possible interaction. No hypoglycemia reports found; no trial pairing it with a named drug.	Meta-analysis Very low certainty Farrin 2026 National Center for Complementary and Integrative Health (NCCIH) 2023	Check glucose more often when starting; tell the diabetes team.
Blood pressure medicines prescription	Theoretical additive lowering of blood pressure; the sources do not describe a mechanism.	NCCIH names the group; we found no trial or case data.	Authoritative guidance Not enough evidence National Center for Complementary and Integrative Health (NCCIH) 2023	Check blood pressure at home when starting; tell the prescriber.
Immunosuppressants (tacrolimus, ciclosporin, mycophenolate, corticosteroids for transplant or autoimmune disease) prescription	Ashwagandha has immune-modulating activity in lab studies and MSK says it may trigger or worsen autoimmune disease; a kidney transplant rejection has been reported. Mechanism unproven.	Rejection or disease flare would be serious but the evidence is one case plus agency caution.	Case report Very low certainty National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Sriperumbuduri 2020 Kumar 2026	Do not use if you have a transplant or take immunosuppressants unless the transplant or specialist team approves.
Digoxin blood test (assay) prescription	MSK states ashwagandha may cause a false elevation in a digoxin immunoassay (a lab measurement artefact, not a change in the real drug level). The original study was not located.	A falsely high result could lead to wrong dose changes.	Authoritative guidance Very low certainty Memorial Sloan Kettering Cancer Center 2026	If you take digoxin, tell the clinician and lab that you use ashwagandha before levels are checked.
Drugs processed by liver enzymes (CYP3A4, CYP2B6, CYP2D6) and drug transporters (P-glycoprotein) prescription	MSK: CYP2B6 inhibited and CYP3A4 moderately induced in vitro; another study in human liver microsomes found no significant CYP3A4 or CYP2D6 interaction. A 2025 test with four root and leaf extracts found no reversible inhibition of 7 CYP enzymes at IC50 above 100 ug/mL. A 2026 hospital-pharmacy article addresses CYP/P-gp modulation and CDK4/6 inhibitor cancer drugs (title only read).	Conflicting lab results; clinical relevance unknown. No P-glycoprotein human data read.	Laboratory research Very low certainty Memorial Sloan Kettering Cancer Center 2026 Raichura 2025 Rodríguez Rodríguez 2026	Ask a pharmacist, especially for narrow-margin or cancer drugs (for example CDK4/6 inhibitors).
Cancer treatment, especially hormone-sensitive prostate cancer therapy prescription	Ashwagandha may raise testosterone (mean difference about 57 ng/dl in men) and could interfere with hormone-lowering treatment.	NCCIH and MSK advise avoiding it in hormone-sensitive prostate cancer. No trial in cancer patients on hormone therapy found.	Meta-analysis Low certainty Fornalik 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026	Do not use during cancer treatment without the oncology team's agreement.
Corticosteroid replacement (hydrocortisone) and steroid-induced adrenal suppression prescription	Ashwagandha lowers cortisol in trials (SMD -1.18) and one case reports lasting HPA suppression; combined effects with steroid therapy are unstudied.	Speculative; no interaction data.	Case report Not enough evidence Fornalik 2026 Javid 2026	Tell your endocrinologist if you take ashwagandha.
Anticoagulants, antiplatelets and anaesthesia (bleeding and surgery) prescription	NCCIH does not recommend ashwagandha before surgery without giving a mechanism; possible additive sedation with anaesthetics is theory. We found no bleeding reports.	Evidence insufficient; caution is precautionary.	Authoritative guidance Not enough evidence National Center for Complementary and Integrative Health (NCCIH) 2023	Tell the surgeon and anaesthetist; ask when to stop (commonly planned ahead of surgery).
Alcohol and over-the-counter painkillers (ibuprofen, paracetamol) otc	Liver cases described people also using alcohol and ibuprofen; ashwagandha's contribution could not be separated. Alcohol and drugs that stress the liver might add to risk (inference, not proven).	Confounded case reports only.	Case report Not enough evidence Memorial Sloan Kettering Cancer Center 2026 Vazirani 2023 Pusec 2022	Avoid heavy alcohol; do not combine with other liver-risky products without advice.
Other supplements and herbs that can injure the liver (for example rhodiola, green tea extract, turmeric, Garcinia, black cohosh) supplement	Stacking products can multiply liver risk and makes the culprit hard to identify. In Björnsson's series 4 of 5 used other supplements; rhodiola was a possible co-cause in one. These botanicals are among those most often reported for liver injury.	Observational only.	Case series Low certainty Björnsson 2020 Likhitsup 2024	Avoid taking several liver-risky supplements together; show your pharmacist every label.
Other sedating supplements and herbs (melatonin, valerian, kava, L-theanine, magnesium) herb	Possible additive sleepiness; no study of these combinations was found.	Unstudied.	Pharmacological theory Not enough evidence Memorial Sloan Kettering Cancer Center 2026	Start one at a time at the lowest dose; avoid driving until you know how you react.

Who should check first 15

Situation	Advice	Evidence
Pregnancy	Avoid. Precaution from NCCIH, MSK and RIVM. Evidence for harm is inconclusive, but there are no reliable human pregnancy-outcome data. One 12-week open-label trial in 63 second-trimester women reported no adverse events and no change in liver, kidney or thyroid markers; it is too small and short to settle safety.	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 RIVM (Netherlands National Institute for Public Health and the Environment) 2024 Tallon 2026 Ajgaonkar 2026 Kalaiselvan 2025
Breastfeeding	Do not use (NCCIH). We found no study measuring transfer into breast milk or infant effects.	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023
Children	Not recommended without a paediatrician. One 8-week trial in 85 children aged 6 to 12 (150 mg twice daily gummies) reported no significant adverse events but relied on self-reported events and cannot establish safety. A German BfR statement said to advise children against it, but we could not read that document.	Controlled trial Saxena 2026 BfR (Germany)
Older adults, especially those on several medicines	Trials of 600 mg/day for 12 weeks in 50 adults aged 65 to 80 and 200 mg twice daily for 180 days in adults 50 to 70 reported good tolerability, but numbers are small. More medicines means more interaction risk (sedatives, blood pressure, thyroid); sedation can raise fall risk.	Controlled trial Kelgane 2020 Vaidya 2026
Existing liver disease or unexplained abnormal liver tests	Avoid. Deaths in cirrhosis; TGA and a 2026 scoping review advise avoidance.	Case series Philips 2023 McIntyre 2026 TGA (Australia) 2026
Kidney disease	Ask a clinician. A review lists kidney dysfunction as a higher-risk group; a 12-week trial of 2,000 mg/day in healthy adults found creatinine and urea within reference ranges. No data in people with kidney disease.	Systematic review Li 2026 Movva 2026
Thyroid disease (overactive, underactive, or on thyroid medicine)	NCCIH does not recommend use. If a clinician agrees, monitor thyroid blood tests. Hyperthyroidism or a history of thyroiditis is the clearest reason to avoid.	Meta-analysis Fornalik 2026 National Center for Complementary and Integrative Health (NCCIH) 2023 Hayashi 2024 van der Hooft 2005
Autoimmune disease	Avoid (NCCIH). MSK says it may trigger or worsen autoimmune disease; evidence is review-level and case-level.	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026
Organ transplant or taking immunosuppressants	Avoid unless the transplant team agrees. One kidney transplant rejection has been reported.	Case report Sriperumbuduri 2020 Memorial Sloan Kettering Cancer Center 2026
Hormone-sensitive prostate cancer (and other hormone-sensitive cancers)	Avoid prostate cancer use (NCCIH, MSK) because it may raise testosterone. For breast or other hormone-sensitive cancers we found no study of effects; discuss with the oncology team.	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023 Memorial Sloan Kettering Cancer Center 2026 Fornalik 2026
Planned surgery	NCCIH does not recommend it before surgery. Tell the surgical and anaesthesia team and ask when to stop. We found no study of bleeding or anaesthesia effects.	Authoritative guidance National Center for Complementary and Integrative Health (NCCIH) 2023
Taking sedatives, sleeping pills, benzodiazepines, barbiturates or anti-seizure drugs	Avoid unless the prescriber agrees (MSK).	Pharmacological theory Memorial Sloan Kettering Cancer Center 2026 National Center for Complementary and Integrative Health (NCCIH) 2023
Nightshade (Solanaceae) allergy	No ashwagandha allergy case reports were found. Ashwagandha is in the nightshade family, so someone with a documented allergy to nightshades or to the plant should be cautious; this is theoretical, not an established cross-reaction.	Pharmacological theory Kumar 2026
Adrenal insufficiency or taking steroid replacement	Ask your endocrinologist; ashwagandha lowers cortisol in trials and one case of lasting HPA suppression is reported.	Case report Javid 2026 Fornalik 2026
Men trying to conceive or women with hormone-related conditions	The Danish authority advised against it for effects on sex hormones and reproduction (as quoted in an editorial), but a 2026 review found no adverse effects on hormonal balance or reproduction in human studies. Uncertain; ask a clinician.	Authoritative guidance Patwardhan 2024 Tallon 2026 Fornalik 2026

Overdose, product quality and regulators

Summary. No human overdose or lethal-dose data were found. Animal and lab studies give wide safety margins, but severe liver, thyroid and adrenal effects in people have occurred without being predicted by them.

Animal. Aqueous root-and-leaf extract (Sensoril) in rats at 1000, 2000 and 4000 mg/kg/day for 90 days: no mortality, clinical signs or treatment-related changes in blood, chemistry, thyroid or sex hormones, or tissue; NOAEL 4000 mg/kg/day; not mutagenic or genotoxic. Aqueous root extract in a rat reproduction screen: NOAEL 2000 mg/kg, no differences in pup or organ weights, T4 or TSH. A 2026 preclinical review calls ashwagandha 'a remarkably safe herb' in most animal studies yet notes that liver toxicity in people was not predicted.

Human doses studied. Up to 2,000 mg/day of root extract for 12 weeks in 145 healthy adults (85.5% no adverse events); 1,000 mg/day for 4 weeks in 18 men; 600 mg/day for 8 weeks in 1,002 people; 400 mg/day for 180 days in 40 adults. The 23-trial review covered 125 to 600 mg/day and up to 180 days.

High dose or long term signals. One case of adrenal (HPA) suppression after about 950 mg/day for over a year. A 2023 case report used 450 mg three times daily for 6 months before liver injury.

Overdose response. No overdose data found. Poison-control advice: call your local poison centre (US 1-800-222-1222) after a large amount or any child ingestion.

Genotoxicity. None in standard tests (Sensoril package; preclinical review).

The liver-injury series do not blame contamination: chemical analysis of products in the Icelandic/US and Indian series found ashwagandha and no adulterant or toxic compounds. Quality problems elsewhere are documented but not well quantified.

Heavy metals. MSK lists a case of haemolytic anaemia and abdominal pain after ashwagandha/mucuna pills with high lead content (resolved with standard treatment); the original paper was not read. A 2011 Indian lab test found arsenic, cadmium, lead, mercury and pesticide residues below detection in the single Withania sample it tested. No large survey of ashwagandha supplements was found. Memorial Sloan Kettering Cancer Center 2026 Rao 2011

Plant-part adulteration (leaf or stem sold as root). A 2026 review says analytical surveys document adulteration of root material with leaves and stems; leaf is richer in withaferin A and has less safety data. A 2025 metabolomics method can detect tissue-specific adulteration in market samples, though the abstract gives no prevalence. Dutta 2026 Ratnasekhar 2025

Mislabelled or variable potency. Not quantified in the sources we read. Trial products are standardised to withanolide content (for example 5 mg or 7.5 mg per capsule) but retail products vary. Vaidya 2024 Vaidya 2026

Multi-ingredient products. Many liver cases involved blends or additional supplements, which complicates attribution; Indian series authors excluded multi-ingredient products and still found injury. Björnsson 2020 Philips 2023

Standardisation and plant-part labelling. Safety conclusions in trials apply to specific standardised root extracts. Leaf and whole-plant extracts have sparse human safety data. Dutta 2026 Coope 2026

Body	Action	Date
RIVM (Dutch National Institute for Public Health) (Netherlands)	Advises against food supplements containing ashwagandha, especially in pregnancy, because of reported poisonings with harmful liver effects and traditional abortifacient use. Advice, not a legal ban. source	2024-03-08
Food Standards Agency and Committee on Toxicity (United Kingdom)	Call for evidence on ashwagandha food supplements (19 responses); expert Committee on Toxicity is reviewing; risk assessment to be published. No ban or consumer warning on the page read. source	Call for evidence 2024-07-08 to 2024-09-02; summary published 2026-06-25
U.S. Food and Drug Administration / NCCIH (United States)	No FDA ban or warning found in sources read. Sold as a dietary supplement. NCCIH advises short-term use only (up to 3 months), avoidance in pregnancy and breastfeeding, and caution with surgery, autoimmune and thyroid disorders; liver injury rare. source	NCCIH page updated March 2023
NIH LiverTox (United States)	Entry records ashwagandha as recently implicated in clinically apparent liver injury (record updated 3 Dec 2024). Likelihood score not read. source	2024-12-03

When to get medical help

Yellow skin or eyes (jaundice), dark urine or pale stools: stop ashwagandha and get medical care the same day.
Severe itching with nausea, vomiting, tiredness or pain in the upper right belly: stop and see a doctor promptly.
Very fast or pounding heartbeat, tremor, heat intolerance, sudden weight loss or sweating (possible thyroid overactivity): stop and contact a doctor.
Extreme drowsiness, confusion or trouble staying awake, especially if you also take sedatives or drink alcohol: do not drive; seek care if severe.
Swelling of the lips or face, hives or trouble breathing: call emergency services (US 911).
Severe weakness, dizziness, vomiting or fainting during or after long use (possible low cortisol), or shaking and sweating if you take diabetes medicines (low blood sugar): seek care.
Pregnancy: any vaginal bleeding or cramping while taking it, call your doctor.
Transplant recipients: new fever, pain or falling urine output near the graft, contact your transplant team at once.
If a child or anyone has swallowed a large amount: call poison control (US 1-800-222-1222) or emergency services.

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is ashwagandha good for?

It is mainly studied for stress, anxiety and sleep. Small trials often find lower scores than placebo, but most reviews rate the evidence as low certainty. Some small trials also report higher testosterone in men and more strength with weight training. Evidence for other uses, such as blood sugar, immunity or anti-aging, is weak or missing.

Is ashwagandha safe?

It may be safe for many healthy adults in the short term, but it is not risk-free. Cases of liver injury, including severe ones in people with existing liver disease, have been reported. It can affect thyroid hormone and add to sedatives. NIH advises against it in pregnancy and breastfeeding. Long-term safety is unknown.

National Center for Complementary and Integrative Health (NCCIH) 2023 Björnsson 2020 Philips 2023

Can ashwagandha damage the liver?

Yes, liver injury linked to ashwagandha has been described in published case series, with jaundice, itching and nausea usually starting 2 to 12 weeks after starting. Most people recovered after stopping, but some people with liver disease died. No study gives how often it happens, so we do not call it common or rare. Stop it and get care if you notice yellow skin or eyes, dark urine or severe itching.

Björnsson 2020 Philips 2023

Does ashwagandha lower cortisol?

Several trials measured lower cortisol than placebo. Cortisol is a lab marker. A lower number does not by itself mean you feel or function better, and one case report describes adrenal insufficiency in a woman taking it for over a year.

Chandrasekhar 2012 Lopresti 2019 Salve 2019 Lopresti 2022 Remenapp 2022 Gopukumar 2021

Does ashwagandha raise testosterone?

Several small trials in men found higher testosterone than with placebo, and a 2026 pooled analysis found an average rise. Researchers do not know whether this improves health. NIH advises that people with hormone-sensitive prostate cancer avoid it.

Wankhede 2015 Lopresti 2019 Lopresti 2019 Smith 2021 Chauhan 2022 Salve 2026 Vaidya 2026 Fornalik 2026 Coope 2026 Zhu 2026 Thanawala 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Is ashwagandha good for sleep?

A pooled analysis of trials found a small to moderate improvement in sleep quality, larger in people with insomnia, mostly with root extract at 600 mg/day or more for 8 weeks or longer. Certainty is low and most trials used questionnaires.

Kaushik 2017 Langade 2019 Kelgane 2020 Deshpande 2020 Langade 2021 Cheah 2021 Atul 2020 O'Connor 2022 Park 2023 Fatima 2024 Pérez-Piñero 2024 Mahadevan 2025 Marchi 2025 McKinney 2026 Honnutagi 2026 Thanawala 2026 Saxena 2026 Movva 2026 Baune 2026 Kulkarni 2026 Obhrai 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

Can ashwagandha affect the thyroid?

It may raise thyroid hormone (T4) and there are case reports of an overactive thyroid after use. Talk to your prescriber before using it if you have a thyroid condition or take thyroid medicine.

van der Hooft 2005 Gannon 2014 Verma 2021 Kamal 2022 Vaidya 2024 Hayashi 2024 Li 2026 Fornalik 2026 Movva 2026 National Center for Complementary and Integrative Health (NCCIH) 2023

How much ashwagandha is used in studies?

Trials used from 30 to 1,000 mg a day of extract, typically 125 to 600 mg a day for 8 to 12 weeks. That is what researchers tested, not a recommendation. Products differ in strength, so the same dose of two products is not equal. See the Dosage tab.

What are the side effects?

Reported effects include drowsiness, stomach upset, diarrhea and nausea. Serious effects reported in case reports include liver injury and an overactive thyroid. See the Safety tab for how often each was reported and the type of evidence.

National Center for Complementary and Integrative Health (NCCIH) 2023

Who should not take ashwagandha?

NIH says to avoid it in pregnancy and breastfeeding. It is also not recommended before surgery, with autoimmune or thyroid disorders, in people with liver disease, or in hormone-sensitive prostate cancer, unless a clinician agrees.

National Center for Complementary and Integrative Health (NCCIH) 2023

Is root or leaf extract better?

The root is the traditional part, and most trials used root extracts. Leaf and root-and-leaf extracts have different chemistry and have been studied less. No trial shows one is better, and safety cannot be assumed to be the same.

Is ashwagandha an adaptogen?

It is commonly called one. "Adaptogen" is a traditional and marketing term, not a medical category. It does not mean proven to help the body adapt to stress.

Is ashwagandha banned anywhere?

Denmark does not allow it in food, based on a risk assessment of the root. Some other countries have issued warnings or limits. See the regulatory table on the Safety tab.

Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-22
Last substantive update: 2026-10-24
How we research: We searched PubMed, NIH NCCIH, LiverTox and regulators' pages, opened each source and recorded the study design, people, product, dose and result as reported. Abstracts only for most studies; full texts for a few guidance pages. No study is cited that we could not verify.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. If one is added later it will be labelled and kept apart from the evidence.

References (232)

Each source was opened and checked. Where we read only the abstract, it says so.

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