The dark side of herbal medicine - risks of Ashwagandha (Withania Somnifera) consumption
DOI:
https://doi.org/10.12775/JEHS.2024.70.51094Keywords
ashwagandha, Withania somnifera, herbal medicine, thyrotoxicosis, liver injuryAbstract
Introduction: Herbal medicine has been growing in popularity over the last few years. One of the most often used herbal remedy is Withania somnifera, more widely known as Ashwagandha Now known for its anti-stress, anti-inflammatory, antioxidant, anti-cancer, anti-anxiety properties it ranks as a cure-all. However, there is a rising amount of alarming reports regarding its safety.
It has been observed that its effects are not always beneficial, and for some patients the risks of taking it may be greater than the promoted benefits.
Aim of study: The aim of this paper is to evaluate possible risks connected to Withania Somnifera consumption based on available research articles and case reports.
Materials and methods: This article is based on the literature found in the PubMed Database from the period of 2004-2024 with the use of keywords such as “Ashwagandha”; “Withania Somnifera”, “herbal medicine”;”complementary medicine”;“liver injury”; “thyrotoxicosis”; “adrenal insufficiency”;”autoimmune diseases”.
Results: The outcomes of all the reviewed studies in this paper indicate that Withania Somnifera might cause a wide range of side effects. They include herb induced liver injury, endocrine complications such as thyrotoxicosis and adrenal insufficiency, acute graft rejection in a kidney transplant recipient and possible contribution to the onset of new autoimmune disease in patient with the history of autoimmune disorders.
Conclusion: Further long-term research is needed on the Ashwaghanda’s benefits but particularly on its safety and potential side effects. The common education on the risks of taking herbal supplements should be carried out among health professionals and the rest of the society. Ashwagandha should not be used by patients with liver, endocrine and autoimmune disorders as well as transplant recipients.
References
National Cancer Institute. (2023, June 12). Complementary and Alternative Medicine. Www.Cancer.Gov.
Centrum Badania Opinii Społecznej. (2011). HOROSKOPY, WRÓŻBY, TALIZMANY – CZYLI MAGIA WOKÓŁ NAS. https://www.cbos.pl/SPISKOM.POL/2011/K_133_11.PDF
Welz, A. N., Emberger-Klein, A., & Menrad, K. (2018). Why people use herbal medicine: Insights from a focus-group study in Germany. BMC Complementary and Alternative Medicine, 18(1). https://doi.org/10.1186/s12906-018-2160-6
Ekor, M. (2014). The growing use of herbal medicines: Issues relating to adverse reactions and challenges in monitoring safety. In Frontiers in Neurology: Vol. 4 JAN. https://doi.org/10.3389/fphar.2013.00177
Polaris Market Research. (2024). Ashwagandha Extract Market Share, Size, Trends, Industry Analysis Report, By Type (Immunity Health, Stress and Anxiety, Weight Loss, General Health); By Form; By Application; By Distribution Channel; By Region; Segment Forecast, 2024 - 2032. https://www.polarismarketresearch.com/industry-analysis/ashwagandha-extract-market
Singh, N., Bhalla, M., de Jager, P., & Gilca, M. (2011). An overview on Ashwagandha: A Rasayana (Rejuvenator) of Ayurveda. African Journal of Traditional, Complementary and Alternative Medicines, 8(5 SUPPL.). https://doi.org/10.4314/ajtcam.v8i5S.9
Mikulska, P., Malinowska, M., Ignacyk, M., Szustowski, P., Nowak, J., Pesta, K., Szeląg, M., Szklanny, D., Judasz, E., Kaczmarek, G., Ejiohuo, O. P., Paczkowska-Walendowska, M., Gościniak, A., & Cielecka-Piontek, J. (2023). Ashwagandha (Withania somnifera)—Current Research on the Health-Promoting Activities: A Narrative Review. In Pharmaceutics (Vol. 15, Issue 4). https://doi.org/10.3390/pharmaceutics15041057
McKeown, M. (2023, June 2). Why did Denmark ban Ashwagandha? Www.Mcgill.Ca.
Speers, A. B., Cabey, K. A., Soumyanath, A., & Wright, K. M. (2021). Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Current Neuropharmacology, 19(9), 1468–1495. https://doi.org/10.2174/1570159x19666210712151556
Chandrasekhar, K., Kapoor, J., & Anishetty, S. (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, 34(3), 255–262. https://doi.org/10.4103/0253-7176.106022
Lopresti, A. L., Smith, S. J., Malvi, H., Kodgule, R., & Wane, D. (2019). An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (United States), 98(37). https://doi.org/10.1097/MD.0000000000017186
Tharakan, A., Shukla, H., Benny, I. R., Tharakan, M., George, L., & Koshy, S. (2021). Immunomodulatory effect of withania somnifera (Ashwagandha) extract—A randomized, double-blind, placebo controlled trial with an open label extension on healthy participants. Journal of Clinical Medicine, 10(16). https://doi.org/10.3390/jcm10163644
Agnihotri, A., Sontakke, S., Thawani, V., Saoji, A., & Goswami, V. S. (2013, July). Effects of Withania somnifera in patients of schizophrenia: A randomized, double blind, placebo controlled pilot trial study. Indian Journal of Pharmacology. https://doi.org/10.4103/0253-7613.115012
Nasimi Doost Azgomi, R., Zomorrodi, A., Nazemyieh, H., Fazljou, S. M. B., Sadeghi Bazargani, H., Nejatbakhsh, F., … Ahmadi Asrbadr, Y. (2018). Effects of Withania somnifera on Reproductive System: A Systematic Review of the Available Evidence. BioMed Research International. Hindawi Limited. https://doi.org/10.1155/2018/4076430
Zahiruddin, S., Basist, P., Parveen, A., Parveen, R., Khan, W., Gaurav, & Ahmad, S. (2020, July 15). Ashwagandha in brain disorders: A review of recent developments. Journal of Ethnopharmacology. Elsevier Ireland Ltd. https://doi.org/10.1016/j.jep.2020.112876
Gupta, S. K., Mohanty, I., Talwar, K. K., Dinda, A., Joshi, S., Bansal, P., … Arya, D. S. (2004). Cardioprotection from ischemia and reperfusion injury by Withania somnifera: A hemodynamic, biochemical and histopathological assessment. Molecular and Cellular Biochemistry, 260(1), 39–47. https://doi.org/10.1023/B:MCBI.0000026051.16803.03
Inagaki, K., Mori, N., Honda, Y., Takaki, S., Tsuji, K., & Chayama, K. (2017). A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha. Kanzo/Acta Hepatologica Japonica, 58(8). https://doi.org/10.2957/kanzo.58.448
Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., … Augustine, P. (2023). Ashwagandha-induced liver injury—A case series from India and literature review. Hepatology Communications, 7(10). https://doi.org/10.1097/hc9.0000000000000270
Björnsson, H. K., Björnsson, E. S., Khan, I. A., Avula, B., & Navarro, V. (2019). Mo1462 – Liver Injury Due to Ashwagandha. A Case Series from Iceland and the U.S. Drug-Induced Liver Injury Network. Gastroenterology, 156(6). https://doi.org/10.1016/s0016-5085(19)40303-x
Lubarska, M., Hałasiński, P., Hryhorowicz, S., Mahadea, D. S., Łykowska-Szuber, L., Eder, P., Dobrowolska, A., & Krela-Kaźmierczak, I. (2023). Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. International Journal of Environmental Research and Public Health, 20(5). https://doi.org/10.3390/ijerph20053921
Suryawanshi, G., Abdallah, M., Thomson, M., Desai, N., Chauhan, A., & Lim, N. (2023). Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation. In American Journal of Therapeutics (Vol. 30, Issue 1). https://doi.org/10.1097/MJT.0000000000001466
Siddiqui, S., Ahmed, N., Goswami, M., Chakrabarty, A., & Chowdhury, G. (2021). DNA damage by Withanone as a potential cause of liver toxicity observed for herbal products of Withania somnifera (Ashwagandha). Current Research in Toxicology, 2. https://doi.org/10.1016/j.crtox.2021.02.002
Sharma, A. K., Basu, I., & Singh, S. (2018). Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. Journal of Alternative and Complementary Medicine, 24(3), 243–248. https://doi.org/10.1089/acm.2017.0183
van der Hooft CS, Hoekstra A, Winter A, de Smet PA, Stricker BH. [Thyrotoxicosis following the use of ashwagandha]. Nederlands Tijdschrift Voor Geneeskunde. 2005 Nov;149(47):2637-2638. PMID: 16355578
Hayashi, M., Hamada, H., Azuma, S., & Hayashi, K. (2024). Painless Thyroiditis by Withania somnifera (Ashwagandha). Cureus. https://doi.org/10.7759/cureus.55352
Kamal, H. I., Patel, K., Brdak, A., Heffernan, J., & Ahmad, N. (2022). Ashwagandha as a Unique Cause of Thyrotoxicosis Presenting With Supraventricular Tachycardia. Cureus. https://doi.org/10.7759/cureus.23494
Paul, S., Chakraborty, S., Anand, U., Dey, S., Nandy, S., Ghorai, M., … Dey, A. (2021, November 1). Withania somnifera (L.) Dunal (Ashwagandha): A comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspects. Biomedicine and Pharmacotherapy. Elsevier Masson s.r.l.
Fry, C. H., Fluck, D., & Han, T. S. (2022). Adrenal hypofunction associated with ashwagandha (Withania somnifera) supplementation: a case report. Toxicology and Environmental Health Sciences, 14(2), 141–145. https://doi.org/10.1007/s13530-022-00122-z
A Case of Ashwagandha Supplementation Preceding Onset of Optic Neuritis and Discovery of Multiple Sclerosis, (2018).
Khan, S., Malik, F., Suri, K. A., & Singh, J. (2009). Molecular insight into the immune up-regulatory properties of the leaf extract of Ashwagandha and identification of Th1 immunostimulatory chemical entity. Vaccine, 27(43). https://doi.org/10.1016/j.vaccine.2009.07.011
Sriperumbuduri, S., Umar, M. S., Lajoie-Starkell, G., Fairhead, T. R., & Hiremath, S. (2020). Ashwagandha and Kidney Transplant Rejection. Kidney International Reports, 5(12). https://doi.org/10.1016/j.ekir.2020.09.024
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Copyright (c) 2024 Katarzyna Burda, Karolina Czarnecka, Olga Łopacińska, Katarzyna Stańczyk, Aleksandra Korn, Emilia Wójcik, Anna Korczak, Justyna Jędrzejczyk, Oliwia Szewczyk, Ewa Olek
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