Does ashwagandha help people sleep?
Q I've been struggling with sleep. My friends told me about ashwagandha, which seems like a natural solution. Should I try it?
A Before trying ashwagandha, see your health-care provider to understand what's causing your sleep issues. There are many reasons for insomnia, such as depression and sleep apnea, for which ashwagandha is not an ideal treatment.
Ashwagandha has become popular among celebrities and on social media for many reasons — they claim it improves sleep, anxiety, memory and even muscle mass. It has been used for ailments for thousands of years in countries like India, where Ayurvedic medicine — a traditional South Asian healing system — is practised.
Those who use ashwagandha to help with sleep are probably banking on its known sedating qualities. Studies in mice have found that a chemical compound in ashwagandha, triethylene glycol, may be responsible for promoting sleep as well as its effect on GABA receptors — the same receptors targeted by many prescription sedatives and anti-seizure medications.
A meta-analysis of five randomized controlled trials in humans found ashwagandha led to a modest improvement in total sleep time — up to about 25 minutes — compared with a placebo.
But is a sedative the best answer to your sleep troubles? Prescription sedatives, which are known to have long-term risks, are not typically prescribed indefinitely. So while ashwagandha may adequately induce sleep, it shouldn't be a long-term solution.
Here's what else we do and don't know about the ancient herb.
HOW HAS IT BEEN USED TRADITIONALLY?
Medicinal use of ashwagandha is described in an Ayurvedic textbook, the Charaka Samhita, that dates back to at least around BC100. There are differences in how ashwagandha has been traditionally used versus in recent studies. For instance, in Ayurvedic medicine, herbs like ashwagandha are usually recommended in low doses for a short period of time, such as for two weeks. It's also traditionally prepared into juices, teas or pastes along with other ingredients — as opposed to taking it as a gummy or in a capsule.
“In Ayurvedic philosophies, it's never like, `Oh, this is the one thing you need to take to be cured,'” said Darshan Mehta, medical and education director for the Osher Center for Integrative Health at Brigham and Women's Hospital and Harvard Medical School. “It's always part of a comprehensive plan which might include yoga and other healthy lifestyle changes.”
DOES IT HELP WITH STRESS AND ANXIETY?
Many people seek ashwagandha to combat stress and anxiety. But studies looking at this tend to be small and have mixed results.
A recent randomized controlled trial from Australia of 120 people found no significant differences between ashwagandha and a placebo in improving high stress and fatigue among middle-aged users. But another study of 60 participants found it improved anxiety scores by around 40 per cent compared with about 24 per cent in the placebo group after about two months. Both studies were funded by the company making the product used in the trials.
DOES IT BOOST TESTOSTERONE?
A few studies have found that ashwagandha increases testosterone levels. That alone isn't helpful — boosting testosterone in people who may have normal levels is associated with risks, including acne, sleep apnea and prostate growth, with unclear benefit.
But a handful of small studies suggest it could help. For instance, a randomized study analyzing 38 men found that ashwagandha supplementation improved strength-training performance after 12 weeks (the research was funded by the company selling the product being studied).
I would talk to your provider or a trainer about other ways to achieve your fitness goals.
CAN I TAKE IT DAILY?
“My advice is to use the herb for a limited time and then check in again,” said Chiti Parikh, co-director of Integrative Health at Weill Cornell Medicine.
Patients on higher doses often report worse gastrointestinal side-effects, like nausea or diarrhea, and serious liver injury is associated with increased doses.
In general, Mehta said, ashwagandha is safe. But he said adulteration or impurities in ashwagandha products is worrying. Both Mehta and Parikh reference third-party platforms that vet and test the chemical properties of supplements, such as Consumerlab.com. “Opt for products from reputable companies, and prioritize organic options whenever feasible,” Parikh advised.
WHO SHOULD AVOID IT?
These groups should avoid ashwagandha:
■ Pregnant or nursing women: Some experts worry that high doses of ashwagandha may induce an abortion.
■ Those on other sedatives: Check with your provider about possible interactions.
■ Those with nightshade intolerance: Ashwagandha belongs to the nightshade family, which some people don't tolerate well (other nightshades include eggplants, bell peppers and tomatoes).
The National Institutes of Health also recommends avoiding ashwagandha if you have autoimmune or thyroid disorders (it could interact with thyroid hormone medications) and if you have prostate cancer, given its potential effects on testosterone levels.
There's always tension in discussions about alternative medical therapies: Is it appropriate — or even feasible — to hold ancient Eastern treatments to Western clinical standards?
Herbal supplements like ashwagandha are not regulated by the Food and Drug Administration the same way as medications and don't go through the same experiments as a prescription drug. Ashwagandha has been studied for decades, albeit not in the same way as drugs seeking FDA approval. This doesn't mean it doesn't work. It just means we need to consider the potential benefits and risks before we take it.