Who should not take ashwagandha?
There's been a lot of buzz around the internet about ashwagandha, especially in the fitness and hormone health community.
Ashwagandha has been part of traditional Indian medical practices and Chinese herbal medicine practices.
“ASHWAGANDHA is said to be a PHARMACY IN ITSELF”
To know more about the benefits of this miracle herb we need to get down to the basics.
Let's dive into the history of ashwagandha.
WHAT IS ASHWAGANDHA? WHERE DOES IT COME FROM?
Ashwagandha is a plant of the nightshade family [solanacea] belonging to the same group as your staple tomato and eggplant.
The name ashwagandha is of Sanskrit origin which loosely translates to “smell of a horse” referring to the herb's distinct earthy scent. the name is also a nod to its ability to give you the strength and virility of a horse.
Ashwagandha is referred to as the " KING OF AYURVEDA "
In Ayurveda, it is classified under the following:
- RASAYANA – a rejuvenating tonic that can promote overall health and well being
- BHALYA – which increases strength.
- VAJIKARA - a libido enhancer or aphrodisiac according to the kamasutra.
In Western terminology, it is called an ADAPTOGEN – a class of herbs that help the body adapt to stress promoting resilience and well-being.
The biological name of Ashwagandha is WITHANIA SOMNIFERA.
Withania due to its active component withanolides Somnifera because of its sedative properties.
WHAT ARE THE BENEFITS OF ASHWAGANDHA?
In ancient times ashwagandha was used to treat multiple ailments ranging from stress, anxiety, and digestive issues.
REDUCES STRESS AND ANXIETY
According to the Journal of Alternative and complementary medicine in 2014, Ashwagandha reduces stress by decreasing cortisol secretion by modulating the HPA axis [hypothalamic pituitary adrenal axis].
Ashwagandha affects the levels of serotonin, GABA, dopamine, and epinephrine.
Serotonin aka the happy hormone is the key constituent of most antidepressants
[ PROZAC, FLOATIN, etc ].
GABA [gamma amino butyric acid ] is the active component in the benzodiazepine drug [Ativan, gabapentin] which is prescribed for sleep issues and anxiety.
Dopamine is responsible for the control of movement deficiency which leads to Parkinson's.
Ashwagandha reduces the symptoms of tardive dyskinesia [involuntary repetitive body movements interfering with daily function] caused due to long-term use of antipsychotic medications.
Ashwagandha also acts as a good adjunct in the treatment of OCD as it reduces the intensity of compulsions.
MEMORY AND COGNITION
Ashwagandha improves long-term memory by increasing the levels of BDNF [ brain-derived neurotrophic factor].
According to the Journal of dietary supplements 2017, ashwagandha also increases neuroplasticity[the ability of the brain to form and reorganize synaptic connections]by decreasing inflammation and oxidative damage[causing neurogenesis] in the brain making it a really good neuroprotective agent, a property very much desired in the management of neurodegenerative diseases like Alzheimer's and Parkinson's.
It also inhibits the formation of beta-amyloid plaque and increases its removal by the liver[beta-amyloid is the key protein involved in Alzheimer's progression].
Ashwagandha also modulates the activity of acetylcholinesterase which causes the degradation of acetylcholine, a neurotransmitter involved in a wide range of functions from regulating heart rate to its actions at the neuromuscular junction.
Due to its effect on GABA ashwagandha has a sedative property .it increases the quality of sleep by increasing slow waves aka deep sleep period.
IMMUNE / ANTI-INFLAMMATORY ACTION
Ashwagandha boosts immunity and reduces the risk of infection by increasing white blood cells and stimulating phagocytosis due to its action on natural killer cells.
Ashwagandha causes a reduction in pro-inflammatory cytokines and increases anti-inflammatory cytokines.
Ashwagandha inhibits tumor growth and induces apoptosis [programmed death of cells] thereby slowing the progression of cancer.
According to multiple studies, ashwagandha was able to inhibit the growth of prostate cancer cells, ovarian cancer cells, colon cancer cells, and neuroblastoma cells in vitro making it a potential candidate as an adjunct to chemotherapy.
It also suppresses the oncogenes that promote ovarian cancer development and prevents its recurrence due to its effect on ALDH 1 and NOTCH1 genes.
Another study published in the Journal of medical research in 2012 found that ashwagandha supplementation was assoc with a reduction in chemotherapy-related nausea and vomiting thereby increasing the quality of life in patients undergoing chemotherapy.
ENERGY AND STAMINA
Due to its supportive action on adrenals and mitochondria, ashwagandha causes increased energy. It improves endurance due to its effect on hemoglobin levels [the protein in red blood cells responsible for transporting oxygen to the rest of the body].
This leads to a significant increase in VO2 MAX [ a measure of cardiovascular fitness/exercise capacity ] and performance thereby reducing exercise fatigue and leading to a smoother recovery.
Ashwagandha supplementation is associated with an increase in beneficial gut bacteria.
ENDOCRINE / HORMONAL
Ashwagandha stimulates the thyroid gland and increases the levels of thyroid hormone leading to reduced symptoms in the case of subclinical hypothyroidism.
It even supports a sluggish thyroid in patients with Hashimoto's or an underactive thyroid.
Ashwagandha improves body composition by reducing body fat and increasing muscle mass.
It reduces fasting blood sugar and improves insulin sensitivity in individuals with type 2 diabetes mellitus
It also reduces cholesterol and triglyceride levels and increases HDL in healthy adults.
SKIN AND HAIR
Ashwagandha decreases oxidative stress by increasing the action of glutathione peroxidase –an enzyme that fights premature aging caused by oxidative stress making it a great anti-aging agent.
It delays the signs of aging like fine lines and wrinkles.
It also boosts the level of estrogen and collagen giving your skin a feminine glow.
BONE AND MUSCLE
Ashwagandha triggers bone mineralization proving a possible benefit in osteoarthritis, rheumatoid arthritis, and osteoporosis.
Ashwagandha prevents the overactivity of glutamine thereby improving the pain in fibromyalgia.
GENDER-SPECIFIC BENEFITS OF ASHWAGANDHA
- In males, ashwagandha has significant sexual health benefits.
- It improves sperm quality by decreasing oxidative damage thereby preventing sperm death.
- It also increases testosterone levels potentially improving libido, sexual stamina, sexual desire [even in men with erectile dysfunction], fertility, and bone health.
- In females, ashwagandha improves hormonal balance reducing menstrual pain and leading to menstrual regularity in women with subfertility, PCOS, etc.
- It also improves lubrication, sexual function, and satisfaction in healthy females.
- It also helps in dealing with mood swings, hot flashes, and sleep issues during menopause.
- In conclusion, ashwagandha supports your monthly menstrual cycle reducing imbalances, and increasing the quality of life even during menopause.
ASHWAGANDHA IN CHILDREN
Children don’t require one type of supplement. They want something that can perform an overall role in different departments. Ashwagandha could be a one-word answer to every parent's woe.
Ashwagandha boosts immunity from a very young age.
Ashwagandha improves sleep patterns in children aiding their overall development.
Ashwagandha also works on children suffering from General Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Post-traumatic Stress Disorder (PTSD), and Obsessive-Compulsive Disorder (OCD).
Parents can rely on Ashwagandha, which is clinically suggested to promote attention even in ADHD children. It does so by breaking the enzyme acetylcholine; the neurotransmitter associated with cognition and memory.
NEGATIVE SIDE EFFECTS OF ASHWAGANDHA
GENERAL ADVERSE EFFECTS
Ashwagandha may also cause Giddiness, drowsiness, vertigo, nasal congestion (rhinitis), cough, cold, decreased appetite, nausea, constipation, and dry mouth.
As with any medication, you can have an allergic reaction to ashwagandha. The reactions may include skin rashes, itchiness, inflammation, chest pain, and difficulty in breathing. This could be a sign of anaphylaxis and may require medical intervention.
In the first few days of taking ashwagandha, you might have a sudden burst of energy and have akathisia[inner restlessness], which may lead to hyperactivity. Usually subsides after a couple of weeks. if it doesn’t subside even after 2 weeks better to discontinue taking ashwagandha.
CONTAMINATION AND TOXICITY
In preparations containing high amounts of lead hemolytic anemia and abdominal pain were reported.
Patients taking commercial herbal products containing Ashwagandha were found to experience liver injuries due to the contaminants.
Ashwagandha elevates your iron levels and may cause excess iron-induced liver damage [especially in people with hemochromatosis, or any other pre-existing liver pathology- fatty liver, alcohol-induced damage, etc].
CARDIAC SIDE EFFECTS
Ashwagandha may cause tachycardia (increased heart rate) and hypertension, particularly in those patients who are on other stimulants or have cardiovascular disease.
SEDATIVE SIDE EFFECTS
Due to its sedative activity, ashwagandha may cause confusion, lethargy, and drowsiness especially if there was too much physical activity the day before.
These effects typically disappear after a few hours after consumption.
Due to its sleep-inducing properties may cause hypersomnolence[excessive sleepiness]. To Avoid this take ashwagandha at bedtime.
Excess ashwagandha may irritate the gastrointestinal tract. Hence, those with stomach ulcers are suggested to avoid the herb.
Constipation was another side effect seen in a group that took ashwagandha. Take it with food to avoid an upset stomach.
The use of ashwagandha may increase body temperature in some individuals.
Ashwagandha may cause bleeding. Individuals with bleeding disorders are not recommended to take the herb. However, no concrete research supports this, except for anecdotal evidence.
Ashwagandha may cause anhedonia [demotivation], and decreased appetite due to its effect of reducing cortisol. Typically clears up in 1-2 weeks of taking ashwagandha.
Some people experience tremors when they take ashwagandha. If you experience tremors, it’s best to discontinue using ashwagandha.
DRUG INTERACTIONS OF ASHWAGANDHA / WHO SHOULD AVOID ASHWAGANDHA?
Ashwagandha potentiates the action of immunosuppressants, anti convulsants sedatives, and thyroid hormones.
If you take a drug meant to suppress your immune system, such as methotrexate or mycophenolate, they may have conflicting effects.
Ashwagandha needs to be avoided in individuals with autoimmune diseases like multiple sclerosis, and lupus as it stimulates
the immune system worsening the disease and decreasing the efficacy of the immunosuppression medications.
As ashwagandha has a potentiating action on the thyroid, taking it with drugs that increase levels of thyroid hormone (e.g. levothyroxine, desiccated thyroid) could potentially increase thyroid hormone levels too much, increasing the risk of side effects.
Ashwagandha may increase the risk of hypoglycemia. It should be used cautiously along with ani diabetic drugs like metformin, insulin, GLP-1 agonists, sulfonylureas, and SGLT-2 Inhibitors.
SEDATIVES AND ANTICONVULSANTS
Sedative medications to be considered include benzodiazepines, CNS depressants [alcohol], melatonin, and valerin.
It might interact with monoamine oxidase inhibitors (MAOI) and can cause manic episodes in patients.
BLOOD PRESSURE MEDICATIONS
As it causes a decrease in blood pressure ashwagandha needs to be avoided by people on antihypertensive medication or any medication that causes a decrease in blood pressure like ACE -Inhibitors [-PRILS], ARB[Sartans], Beta-blockers [-olols], and diuretics.
It interacts with oral anticoagulants, and antiplatelet agents and makes them ineffective, and increases bleeding.
Be sure to let your doctor know if you plan on adding ashwagandha to your medication list so you can be appropriately monitored.
ASHWAGANDHA AND SURGERY, ANAESTHESIA
People undergoing surgery that requires anesthesia should avoid ashwagandha as it interferes with the depth of anesthesia.
Taking it before surgery might also predispose the patient to perioperative bleeding.
In conclusion, it is suggested that ashwagandha has to be stopped for a week before a planned surgery unless such a surgery is very urgent to be performed or when the benefits outweigh the risks involved.
WITHDRAWAL DUE TO ASHWAGANDHA
No studies have looked into whether stopping ashwagandha causes withdrawal, but some anecdotal reports suggest that it can.
People stopping taking this herb might want to gradually taper down the dosage.
SIDE EFFECTS OF ASHWAGANDHA IN MALES
It should be avoided in individuals with hormone-sensitive prostate cancer as it may increase testosterone levels and interfere with your treatment
Ashwagandha interacts with Viagra [sildenafil] and makes the drug ineffective.
SIDE EFFECTS OF ASHWAGANDHA IN FEMALES
Because there haven’t been any studies that specifically look at the effects of ashwagandha on human pregnancy, the safest course of action is to avoid taking this supplement during pregnancy.
The other concern with ashwagandha use during pregnancy is the lack of clarity around the dosage. While studies show that too much of the supplement may cause side effects, there is little evidence for how much of the herb equals “too much” during pregnancy or otherwise.
Pregnant and breastfeeding women should avoid ashwagandha as the effects on the fetus and newborn are not yet established.
It is also known to cause early delivery and has an abortifacient action.
Since there are very few studies looking into ashwagandha while pregnant, you may want to wait to try out this trendy adaptogen until after your baby is born, and should be avoided during pregnancy.
Overall ashwagandha can be a part of your daily wellness plan – Do remember that it is not a miracle cure-all.
It might not cure the root cause of your symptoms but it will
definitely reduce the symptoms and streamline your physiology
while you figure out what is going on.
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