»ªÌå»á

You may have seen social media influencers touting its benefits or have a friend who swears by it � ashwagandha has surged in popularity in recent years as a way to manage stress and improve overall health.

As rates of health problems like anxiety, burnout and sleep issues rise, people are turning to plant-based supplements, especially since they are more accessible over the counter. But how effective are they exactly?

»ªÌå»á Integrative Medicine Physician Mary Ella Blair Wood, DO, and Northwestern Medicine clinical nutrition manager Sandie Hunter, RD, offer two perspectives on herbal supplementation.

What is ashwagandha?

Ashwagandha, or Withania somnifera, is an adaptogenic substance, which means it comes from a plant and can help your body manage stress. 

“Used for centuries in Ayurvedic medicine, adaptogens are a unique class of botanicals that help the body regulate its stress response â€� essentially supporting our ability to ‘adapt’ to physical, emotional and environmental stressors,” says Dr. Wood. “Unlike pharmaceuticals, which often have a single targeted effect, adaptogens work more broadly to help bring the body back into balance.”

Ashwagandha is considered one of the more calming adaptogens. suggests that it may help:

• Reduce anxiety
• Improve sleep
• Support in people with hypothyroidism (underactive thyroid) conditions. Studies have shown that it can help increase your levels of thyroid hormones T3 (triiodothyronine) and T4 (thyroxine), likely because of its ability to regulate your stress response.
• Promote â€� particularly in cases where stress is a contributing factor to hair loss.

Hunter adds, “It can also reduce swelling, strain, fatigue, pain, skin disease and improve general health.”

Benefits of Ashwagandha for Other Health Conditions

Can ashwagandha help control high blood pressure?

There is not enough research to support that it can treat high blood pressure � yet.

“Some preliminary research and small clinical studies suggest that it may have a modest effect on lowering blood pressure,” says Dr. Wood. “However, more robust, large-scale trials are needed before it can be recommended as a treatment option for hypertension.”

Dr. Wood adds that stress is a well-known contributor to high blood pressure, so the calming properties of ashwagandha can help manage this root cause. 

Hunter agrees that the research for blood pressure control is promising. She recommends caution, though, as "the herb may interact with other medications people with high blood pressure are taking.”

Can ashwagandha increase testosterone levels?

Some suggests that ashwagandha may support healthy testosterone levels, particularly in men experiencing stress-related hormonal imbalances or fertility concerns. While the clinical trials have been promising, its potential to manage low testosterone is still being explored.

What are the potential side effects?

Some people experience:

• Gastrointestinal upset, including stomach irritation, nausea, loose stool and diarrhea
• Headache
• Drowsiness

Who should avoid ashwagandha?

• People with hyperthyroid (overactive thyroid) conditions because it can increase thyroid hormones in the body
• Pregnant people because it may stimulate the uterus
• People with certain autoimmune conditions should talk to their clinician before using it.
• People with cancer should also talk to their clinician before taking it, as it can impact hormones, which can feed certain cancers.

Ashwagandha Medication Interactions to Be Careful About

If you are on any medication, you should talk to your clinician before starting any herbal supplement. have shown harmful side effects of taking ashwagandha while on certain medications, including:

• Sedatives. Because both ashwagandha and sedatives can make you drowsy, they should not be used together. For example, sleep medications such as:
• Zolpidem (Ambien®)
• Benzodiazepines like alprazolam (Xanax®)
• Clonazepam (Klonopin®)
• Opioid pain medications like oxycodone
• Barbiturates like phenobarbital
• Thyroid medications. Because ashwagandha may increase thyroid hormone levels and thyroid medications are intended to regulate them, it is recommended to not mix the two. These include:
• Levothyroxine (Synthroid®, Levoxyl®)
• Desiccated thyroid medications (Armour Thyroid®)
• Liothyronine (Cytomel®)
• Methimazol and propylthiouracil

• Diabetes medications. Ashwagandha may lower your blood glucose levels, so it should not be combined with diabetes medications like insulin.
• Immunosuppressant medications. Ashwagandha may impact your immune system and interfere with medications that suppress your immune system. These include:
• Steroids
• Organ transplantation medications
• Biologics

• High blood pressure (hypertension) medications. Ashwagandha may lower blood pressure, similar to how high blood pressure medications do. For example:
• Beta blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics
• Hepatotoxic medications. Ashwagandha may increase your risk of liver damage when taken with medications that can cause liver damage, particularly with chronic use. These include pain relievers and anti-inflammatories such as:
• Acetaminophen
• Ibuprofen
• Naproxen
• Amoxicillin
• Erythromycin

What should you know before taking herbal supplements?

• Not all herbal supplements are regulated. “There can be benefits to certain herbs, but because not all brands sold on the market are thoroughly tested and regulated, they can cause potential harm,” says Hunter. “People should check with their physicians before consuming them.”
• Dosing and supplement quality matter. “In clinical studies showing benefits, specific doses and extract types are used â€� often much higher than what is found in many over-the-counter products,” says Dr. Wood. “Unfortunately, some supplements contain doses too low to be effective.” Choosing a reputable brand that undergoes third-party testing is essential to ensure product quality and safety.

“You want to be confident that the supplement contains what it claims â€� and is free from contaminants such as heavy metals, pesticides or undeclared ingredients,” says Dr. Wood. “Many of the reported adverse effects from supplements are not due to the herbs themselves, but to poor manufacturing practices or hidden additives.”

• Look for GRAS status. One of the key criteria for classifying an herb as an adaptogen is that it holds Generally Recognized As Safe (GRAS) status. This means that it is considered safe when used according to the instructions on the bottle.

Talk to Your Healthcare Provider Before Taking Any Herbal Supplements

Unlike many pharmaceuticals that contain just one compound, herbal supplements contain a variety of compounds that work together to support the body and provide a more holistic effect. However, because supplements contain multiple compounds, this also means more potential for interactions with medications or other herbs. Speak with a healthcare provider before starting any herbal supplements.

A clinician or integrative medicine practitioner can help you select safe, evidence-based products based on your personal health history.

“Ashwagandha is a perfect example of how traditional herbal medicine and modern science can intersect,” concludes Dr. Wood. “While the herb itself can offer benefits, especially for stress, sleep and hormone support â€� it is important to remember that supplements work best as part of a broader lifestyle approach that also includes eating a healthy diet, movement and other stress management techniques.”