Ashwagandha’s rising popularity has raised a fresh concern after multiple cases of liver injury reported by users in recent years.
This article investigates into the effect of Ashwagandha on herbal-induced liver injuries (HILI) and drug-induced liver injuries (DILI) based on patient cases that are available on public domain.
Ashwagandha (Withania somnifera), is an herb that has been used as a dietary supplement to promotes better mood, anxiety, sleep and other health benefits.
As the safe dosing requirements have not been well documented, the long-term use of Ashwagandha at daily doses of 500mg to 600mg raises concern on the liver toxicity against rising cases of liver injuries.
Rising cases of liver injury due to Ashwagandha were reported in USA, Japan, Iceland, Germany, India, Netherlands, Poland, and other EU countries which led Denmark to issue an official ban on Ashwagandha in April 2023 whilst Sweden and France are considering the same action in the near future.
Recent reports received by the Netherlands Food and Consumer Product Safety Authority of four liver toxicity cases of patients who used Ashwagandha raises further eyebrows from the health authorities.
As we investigate the severity of the liver injuries caused by Ashwagandha, it is important for users to observe any symptoms related to liver complications or issues.
Source: https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
Several research studies have reported liver injury associated with the consumption of ashwagandha with most cases found to be hepatoxic and hepatocellular. Most patients who consumed Ashwagandha exhibited a range of liver issues, from severe jaundice to enduring cholestatic liver damage.
Whilst Ashwagandha cause cholestasis hepatitis, experts warned that prolonged cholestasis can evolve into vanishing bile duct syndrome and result in chronic liver injury, cirrhosis and need for liver transplantation.
In a patient case study published in Pharmaceutical Journal in 2023 showed two new cases of Ashwagandha hepatotoxicity, which reaffirms the rising of ashwagandha-induced liver injury cases.
In the first case, a 36-year-old man used ashwagandha capsules (450 mg, three times daily) for 6 months before he developed nausea, pruritus, and dark-colored urine. In the second case, a 30-year-old woman developed pruritus after 45 days of using ashwagandha capsules (450 mg).
In both cases, the Ashwagandha showed an increase of serum bilirubin and liver enzymes (aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP), indicating disruption in the liver function.
Health experts have concluded that ashwagandha can lead to drug-induced liver injury (DILI), with the liver damage being categorized as hepatocellular, characterized by pronounced hyperbilirubinemia, indicative of jaundice resulting from damaged liver cells.
In a study conducted in 2020, the effects of ashwagandha on liver function were explored in five patients, revealing elevated liver enzymes. Some of these patients were diagnosed with drug-induced liver damage, which subsequently regressed over an eight-month period.
The study concluded that ashwagandha-induced liver injury typically manifests as cholestatic, accompanied by severe jaundice and pruritus. Liver function tests returned to normal within 1 to 5 months after discontinuing ashwagandha use.
Another study in 2021 by Weber et al. presented a case involving a 40-year-old man who experienced acute liver injury after consuming ashwagandha extract (500 mg) for a year and Ashwagandha Now (450 mg, Now Foods) for an additional 20 days. The report documented the development of jaundice, pruritus, and an elevation of transaminase levels following ashwagandha consumption.
Here is a summary of liver-related injuries caused by Ashwagandha based on patient records (cases). In most cases, taking consumption of ashwagandha in doses between 154mg to 500mg may induce common liver injury indicated by early symptoms such as jaundice, pruritus and fatigue. Whilst some of these liver-related symptoms may be acute or goes undetected for many years, it may lead to further severe chronic liver diseases if the patients continue taking ashwagandha on a long term basis.
| Patient’s Age & Gender | Dosage & Duration | Liver Injury Symptoms |
|---|---|---|
| 40 year-old man | 500mg (365 days) | Jaundice, pruritus |
| 40 year-old man | 450mg (20 days) | Jaundice, pruritus |
| 36 year-old man | 450mg (180 days) | Pruritus, dark-coloured urine, nausea |
| 30-year-old woman | 450mg (45 days) | Pruritus |
| 24-year-old-man | 450mg (7 days) | Jaundice, nausea |
| 62-year-old-woman | 450mg (5 days) | Jaundice, nausea, abdominal pain |
| 61-year-old-woman | 500mg (115 days) | Jaundice, fatigue, and pruritus |
| 39-year-old-woman | 154mg (42 days) | Jaundice, lethargy and pruritus |
There is a risk of liver injury and possible kidney damage from taking Ashwagandha more than 30 days. The risk exposure increases exponentially if you are taking Ashwagandha more than 6 months. US health experts warned users not to take ashwagandha more than 3 months, and it is best to take it for short duration (eg 7 days) to achieve your health goals (eg: during stressful situation). According to nutritionists and dietitians, ashwagandha is not designed or formulated to be taken as a daily supplement for long term use.
Based on patient reports, most patients recover from herbal-induced liver injures after stop taking Ashwagandha for 5 months or longer. In some cases, the liver function will return to normal after 1 month depending on your existing health condition. However, if you are regular alcohol user, or if you are diagnosed with liver issues, you may take longer to recover from liver injury.
Liver injury from Ashwagandha affects healthy patient as young as 20 years old to 65 based on reported cases in Japan, Germany, UK, USA, Iceland, Poland and several other countries.
Past patient records showed there is still risk of getting jaundice or toxic hepatitis by taking ashwagandha even if you had no prior history of liver disease, alcohol use or smoking.
It means you are still likely to experience asymptomatic or acute liver injuries from long term use of Ashwagandha at moderate doses of 400mg.
Whilst ashwagandha-induced hepatotoxicity liver injury cases have been reported worldwide, the percentage of severe injury cases is very small. However, the risk of getting liver injury from Ashwagandha is high if you are taking other a mix of herbal supplements on a daily basis. The risk exposure increases if you are a regular alcohol user, or if you are taking other form of medications.
Whilst users are reported to take up to 1,000mg daily, there are no safety studies to define the optimal or safe dosage for Ashwagandha. Most studies showed that individuals taking between 400mg to 500mg of ashwagandha appear to be at risk of liver damage, as evident in the patient reports. Although some of these reported liver injury cases are rare, the rising of liver injury from asymptomatic cases spark concerns on the safety of the current dosing protocols.
If you are diagnosed with liver injury, jaundice or other liver disease or symptoms, you should stop taking ashwagandha for a minimum of 5 to 8 months. This allows your liver to fully recover and function optimally. Please watch your diet by taking fruits and vegetables and avoid taking supplements in high doses.
Due to growing reported and unreported cases arising from liver injuries and symptoms related to liver function, it is best to avoid Ashwagandha if you care about your liver.
Those who opt to continue taking ashwagandha as their daily supplement, it is best to exercise caution on the dosing protocol and observe any symptoms of failing a liver function, particularly in older men and women who have a history of liver disease.
Naressa Khan contributes regularly on AKARALI. As a researcher and investigative journalist, Naressa is all about creating, deconstructing, and reassembling meaningful content through words and facts. With this approach always in mind, she eagerly explores the nuances in life via the aspects of lifestyle, culture, travel, health, and wellness in Malaysia .
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