OriginThe smell of the horse
„Ashwagandha“ translates to “horse smell” – referring to the strong smell of the fresh root.
Withania somnifera It is a grey-felted shrub, growing up to 1.5 meters tall, belonging to the nightshade family and widespread in India, the Middle East, and parts of Africa. It thrives in dry, poor soils and bears inconspicuous greenish flowers and small orange-red berries in a papery husk – similar to the related physalis. Almost exclusively the root is used.
The Sanskrit name ashvagandha consists of ashva (horse) and Gandha (Odor) together and refers to the strong, horse-sweat-like smell of the fresh root. A second interpretation, more popular in marketing, is that the plant bestows the strength of a horse; linguistically, this doesn't hold water, but the smell does. The species name somnifera It means "sleep-inducing" and refers to its traditional use in treating sleep problems.
In Ayurveda, Ashwagandha is one of the Rasayana - the regenerative and invigorating agents - and has been documented there for over two thousand years. Traditionally, the root is ground and taken with warm milk and ghee for exhaustion, weakness, old age, and after illness. The Western boom is recent: only since around 2010 has ashwagandha, under the collective term "adaptogen," become the best-selling Ayurvedic product outside of India. The name "Indian ginseng," which is often encountered, is botanically incorrect - ginseng is a member of the ivy family, while ashwagandha is a member of the nightshade family.
To useWhat the studies show – and what the authorities have done
There is no EMA monograph or Commission E assessment for ashwagandha; in the EU, it is predominantly marketed as a food supplement. However, there are a number of randomized, placebo-controlled studies – more than for most other plants in this category. These studies primarily investigated stress and anxiety, sleep quality, athletic performance, and testosterone levels in men.
The results tend to be positive: meta-analyses find reductions in stress and anxiety scores and morning cortisol, improvements in sleep parameters, and, in some studies, increases in strength and muscle mass. However, the limitations are significant and are acknowledged by the authors themselves: the studies are small, mostly short, almost exclusively from India, use different extracts, and often exhibit conflicts of interest. The evidence is regularly rated as low to moderate. This is better than for many other plants in this area, but still does not establish proven efficacy.
Now to the other side, which is equally important. Since 2019, cases of liver damage associated with ashwagandha supplements have been described in several countries—a case series from Iceland and the USA, and further individual reports from Europe and India. The damage typically occurred after two to twelve weeks of use, predominantly as cholestatic hepatitis with jaundice and itching, and usually resolved after discontinuation; however, there have also been severe cases. The Danish Food Standards Agency banned the sale of ashwagandha-containing food supplements in 2020, and Iceland followed suit.
No one knows how common this is – there's no systematic monitoring of side effects for dietary supplements. It's probably rare. But it's real, it's documented, and it's practically never mentioned in marketing. Anyone taking ashwagandha should therefore do two things: limit the duration of use, and stop taking it immediately and consult a doctor if they experience yellowing of the skin or eyes, dark urine, pale stools, persistent nausea, or itching.
IngredientsWithanolides - and the question of which extract
The characteristic constituents are withanolides, a group of steroid lactones found in this form only in nightshade plants. Withaferin A and withanolide A are the best studied. These are the components to which the extract is standardized – typical values range from two to five percent withanolides. Other constituents include alkaloids such as withanine and somniferin, as well as saponins.
An important point to consider when purchasing: The studies were conducted using very specific, patented extracts, and these differ significantly in their manufacturing process and withanolide profile. Results obtained with one extract cannot simply be extrapolated to any other product. Anyone wishing to benefit from the available research should look for a product that specifies the extract used in the studies and declares its withanolide content – anything else is a different product.
Traditionally, only the root is used. Some modern extracts also contain leaf material, which has significantly higher levels of withaferin A – withaferin A being the most cytotoxic component. Whether this is related to the observed liver reactions is unclear; as a precaution, a pure root extract is the more conservative choice.
To put the question of origin into perspective: Ashwagandha is a nightshade plant, related to tomatoes, potatoes, belladonna, and henbane. This doesn't mean it's poisonous—tomatoes aren't either—but it explains why the plant produces pharmacologically active steroids. Incidentally, the berries are traditionally used in India as a vegetable rennet for cheesemaking, not as food.
Enhanced combinationsIf so, then like this.
Anyone wishing to try Ashwagandha should do so under conditions that minimize the known risk.
Two to three months, then a break. The liver cases described usually occurred after two to twelve weeks – continuous use over years is unnecessary and lacks safety data.
And, if possible, a product that names the extract used in the studies. Without this information, it's impossible to assess what you're taking.
Traditionally, only the root is used. Leaf extracts contain more withaferin A – the root extract is the more conservative choice.
The classic Ayurvedic preparation: half a teaspoon of root powder in warm milk, in the evening. Significantly lower dosage than most capsules.
If you take it for an extended period, you should have your liver function checked. Stop taking it immediately if you experience yellowing of the urine, dark urine, pale stools, itching, or persistent nausea.
In cases of stress and exhaustion, these three are orders of magnitude more effective than any supplement. Ashwagandha is, at best, a supplement.
What contradicts itselfIt's best to avoid these combinations.
Ashwagandha is not recommended for patients with known liver disease or elevated liver enzyme levels due to documented cases.
The risk increases when combined with alcohol, certain medications, or other dietary supplements that pose a risk to the liver. Do not stack.
Studies show increases in T3 and T4. This is unfavorable in hyperthyroidism, and can interfere with medication dosage – discuss beforehand.
This plant, advertised as having immunomodulatory properties, should not be used without medical supervision by people with an overactive immune system or those under immunosuppression.
Ashwagandha is traditionally considered abortifacient in higher doses. It is contraindicated during pregnancy, and data on its use during breastfeeding are lacking.
The species name somnifera This is not a coincidence; an additive dampening effect is plausible. Do not combine with other medications without consulting a doctor.
ApplicationApplication methods and precautions
- Root powder in milkThe traditional Ayurvedic form: half a teaspoon in warm milk with a little honey, in the evening.
- Standard extractCapsules containing 300 to 600 mg and declared withanolide content - the study form.
- Moon MilkWith turmeric, cinnamon and cardamom in warm milk - the modern version of the classic preparation.
- At eveningThe traditional time of intake, matching the species name somnifera.
- Withanolide contentTwo to five percent is typical; without this information, a product cannot be evaluated.
- Root instead of leafPure root extract is the more conservative choice.
- Limit timeTwo to three months, then a break.
- Know liver signsYellowing of the skin, dark urine, pale stools, itching, persistent nausea - stop use immediately and see a doctor.
- Do not stackDo not combine with other liver-damaging medications or regularly with alcohol.
- Medication listIf you are taking thyroid, immune, or sedative medication, consult your doctor beforehand.
As a home remedyThe traditional preparation – and what needs to be clarified beforehand
Ashwagandha in warm milk
- First question: Do you have liver disease or elevated liver enzyme levels? If so, then no. The documented case reports of liver damage are the reason we put this question first.
- Second question: Thyroid disease, autoimmune disease, immunosuppressants, pregnancy or breastfeeding? In all cases: consult a doctor beforehand.
- Once both of these points are clarified: stir half a teaspoon of ashwagandha root powder into a cup of warm milk (or plant-based milk).
- Add a pinch of cardamom or cinnamon and some honey to taste - the powder tastes earthy and bitter and smells strong.
- Drinking in the evening, about an hour before bedtime. That's the traditional time.
- Take a break after two to three months. If you experience yellowing of the skin or eyes, dark urine, pale stools, itching, or persistent nausea, stop use immediately and consult a doctor.
Traditionally in Ayurveda as Rasayana For exhaustion, weakness, and sleep problems. Modern studies primarily examine stress, anxiety, and sleep quality – with positive, but methodologically limited results.
Studies have used 300 to 600 mg of extract daily; traditionally, about 3 to 6 g of root powder. There is no officially approved dosage recommendation. Do not use if you have liver disease, are pregnant, or have thyroid or autoimmune diseases; consult a doctor before use.
Ayurveda & TCMWhat the old systems say
Ayurveda
Ashwagandha is native to this region. In Ayurveda, it belongs to the group of... Rasayana, the rejuvenating and regenerating agents, and especially to the Balya - the invigorating one. It is considered bitter, astringent, and sweet, warming, vata- and Kapha-lowering. Classic uses include exhaustion, emaciation, weakness in old age, insomnia, and convalescence. The traditional preparation with milk and ghee is not merely incidental: withanolides are fat-soluble, and the traditional form is pharmacologically sound.
Traditional Chinese Medicine
The Chinese materia medica lacks Withania somnifera. The function it fulfills there would correspond to drugs that "tonify Qi and blood" and calm the mind. Ren Shen, Huang Qi and Suan Zao Ren. In modern Chinese sources, Ashwagandha now appears with Western justification, but has no place in the classical system.
Warning noticesWhen you should be careful
Please note
- Liver damage is documented: Since 2019, there have been case reports of cholestatic hepatitis associated with ashwagandha preparations. Denmark and Iceland have banned its sale. If you experience yellowing of the skin, dark urine, pale stools, itching, or persistent nausea, discontinue use immediately and consult a doctor.
- Not suitable for those with existing liver disease: Not even in cases of inexplicably elevated liver enzyme levels.
- Thyroid: Studies show increases in T3 and T4. Consult a doctor beforehand if you have hyperthyroidism or are taking thyroid medication.
- Autoimmune disease and immunosuppressants: Not without medical supervision - Ashwagandha is advertised as having immunomodulatory properties.
- Not during pregnancy: Traditionally, it is considered abortifacient at higher doses; data is lacking regarding its use during breastfeeding.
- Limit the time period: Two to three months, then a break. There is no safety data on continuous use over several years.
This page provides information and does not replace medical advice. If symptoms persist, please consult a doctor.
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SourcesWhat is this based on?
- Björnsson HK et al.: Ashwagandha-induced liver injury: a case series from Iceland and the US Drug-Induced Liver Injury Network. Liver International 2020.
- Danish Food Agency: Risk assessment of Withania somnifera in dietary supplements, 2020.
- Salve J. et al.: Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults - a randomized, double-blind, placebo-controlled study. Cureus 2019.
- Della Porta M. et al.: Ashwagandha supplementation and health outcomes - a systematic review of randomized controlled trials. Nutrients 2023.
- Sharma AK et al.: Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients. Journal of Alternative and Complementary Medicine 2018.
