Known as a multipurpose herb and "rejuvenator" used in ancient Ayurvedic1 and Chinese medicine for thousands of years, ashwagandha2 (Withania somnifera) is a plant native to India with a host of bioactive functions.

Ashwagandha is one of the few true adaptogenic herbs that helps your body adapt to stress3 by balancing your immune system,4 metabolism and hormonal systems.5 As noted in the medical review, "Scientific Basis for the Therapeutic Use of Withania Somnifera (Ashwagandha)":6

While some adaptogens are stimulants in disguise, this is not the case with ashwagandha. It can give your morning exercise a boost, yet when taken before bed it can help you get a good night's sleep as well. It's also capable of "intelligently" upregulating or downregulating your adre­nal cortisol as needed, which makes it a valuable adjunct against stress and anxiety.

In one placebo-controlled clinical trial,7 published in 2012, volunteers with a history of chronic stress who took 300 milligrams (mg) of a highly concentrated full-spectrum ashwagandha extract twice a day for 60 days reported significant reductions in stress, compared to controls who received a placebo.

While perceived stress scale (PSS) scores in the control group declined by a modest 5.5% over the 60 days, the treatment group receiving ashwagandha had a 44% reduction in PSS scores. And, as reported by the authors:8

Blood testing also revealed the cortisol levels of the treatment group decreased by an average of 27.9% after 60 days of supplementation, while the placebo group had a reduction of just 7.9%. In conclusion, the researchers stated:9

"The findings suggest that high-concentration full-spectrum Ashwagandha root extract improves an individual's resistance towards stress and thereby improves self-assessed quality of life. High-concentration full-spectrum Ashwagandha root extract can be used safely as an adaptogen in adults who are under stress."

Similar results were found in a 2009 study,10 in which patients diagnosed with moderate to severe anxiety lasting longer than six weeks who were treated with 300 mg of ashwagandha root for three months reported "significantly decreased" symptoms compared to those undergoing standard psychotherapy.

Beck anxiety inventory (BAI) scores decreased by 56.5% in the ashwagandha group after 12 weeks of treatment, compared to 30.5% in the psychotherapy group. According to the researchers:

A systematic review11 of five human trials published in 2014 also concluded that treatment with ashwagandha "resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales."

However, while all five studies supported this conclusion, the authors noted that "Current evidence should be received with caution because of an assortment of study methods and cases of potential bias."

A fourth study,12 this one published in 2015, found "empirical evidence to support the traditional use of [ashwagandha] to aid in mental process engaging GABAergic signaling." According to the authors:

Flavonoids and other compounds are the active ingredients that give ashwagandha its many powerful properties. These include but are not limited to:

• Withanolides — naturally occurring steroids — have been shown13 to suppress pathways responsible for several inflammation-based illnesses, including arthritis, asthma, hypertension, osteoporosis14 and cancer.

Withanolides in ashwagandha also have immunomodulating properties,15 described as substances that can either stimulate or suppress your immune system to help fight infections, cancer and other diseases.

• Somniferin — One of the alkaloids in ashwagandha, helps promote relaxation and sound sleep. A study16 at the University of Tsukuba in Japan also found it relieves related problems such as insomnia and restless leg syndrome.

• Triethylene glycol — Found in the leaves of the ashwagandha plant, this compound has also been shown to induce sleep and combat insomnia.17

• Ashwagandholide — a dimeric withanolide found in ashwagandha root — has been shown18 to inhibit growth of several types of cancer (including gastric, breast, central nervous system, colon and lung). It also inhibits inflammation by inhibiting activity and lipid peroxidation of cyclooxygenase-2,19 an enzyme that speeds up production of inflammatory prostaglandins.20

If you suspect ashwagandha might be beneficial for other ailments beside anxiety and stress, you'd be absolutely correct. It's not considered one of the most important herbs in Ayurvedic medicine for nothing. Importantly, a number of studies have shown it can treat several diseases and disorders better than medications, without all the side effects.

For example, studies show ashwagandha has antitumor and blood production (hemopoietic) capabilities, and benefits the cardiopulmonary, endocrine and central nervous systems, all "with little or no associated toxicity."21Ashwagandha has also been shown to:22,23,24,25,26,27,28

Support healthy levels of total lipids, cholesterol and triglycerides that are already in the normal range

Enhance radiation therapy effects29 by reducing tumor GSH levels.30 It also reversed paclitaxel-induced neutropenia (low neutrophil count, a type of white blood cell) in mice31

Counteract osteoporosis32 (reduced bone density)

Protect your brain from oxidative stress,33 and lower your risk of Alzheimer's 34,35

Improve memory and cognitive function by slowing down the deterioration of brain cells, repairing brain cell damage and rebuilding neuronal networks and synapses

Stimulate proper thyroid function36 and treat subclinical hypothyroid — In one double-blind, placebo-controlled study,37 ashwagandha was pitted against some of the most popular drugs targeted for hypothyroid patients. The study involved 50 participants with elevated serum thyroid hormone (TSH), all between the ages of 18 and 50.

Divided into two groups, each was given either ashwagandha treatments or starch as a placebo for eight weeks. According to the researchers, ashwagandha effectively and significantly normalized serum thyroid stimulating hormone (TSH), T3 and T4 levels, compared to placebo, stating such treatment may be beneficial for hypothyroid patients.

As explained by Thyroid Advisor,38 ashwagandha "directs THS hormone to travel to the pituitary. TSH triggers the thyroid gland to produce sufficient amounts of T4 and T3." Improved thyroid function will also help stabilize mood39

Reduce blood pressure40

Inhibit inflammation — In animal studies, ashwagandha was found to be more effective against inflammation than phenylbutazone41 or hydrocortisone42

Protect nerve function and oxidation43

Provide natural pain relief44

Nourish and protect your liver

Increase red blood cell production

Improve adrenal function45

Increase energy and endurance

Promote healthy immune function

Treatment aid for ADHD

Improve incontinence

Treatment aid for Type 2 diabetes as it helps restore insulin sensitivity

Improve conjunctivitis

Treatment aid for vitiligo

Ease symptoms of Parkinson's disease

Improve hyperglycemia

Promote longevity46

Improve cardiovascular health — Ashwagandha helps maintain your heart health through its regulation of blood circulation. It helps prevent blood clots, and helps keep blood pressure levels within the normal range, which prevents the stress from burdening your heart47

Maintain youthful appearance of skin — Ashwagandha increases your estrogen levels, which in turn triggers the production of collagen. This allows the skin to keep its youthful appearance and helps in the production of natural oils. It also fights off free radicals that cause wrinkles, dark spots and blemishes48

Aid wound healing — Ashwagandha root powder can be used topically as a poultice to help treat wounds. Mix the powder with water to make a smooth paste, and apply to the wound. It will help fight off bacteria, alleviate pain and speed up the healing process

Treat arthritis — Ashwagandha has been noted in Ayurvedic manuscripts as well as modern medicine as being an effective remedy for rheumatoid arthritis (Amavata) and osteoarthritis (Sandhi-gata Vata).49

According to one study,50 "Patients of rheumatoid arthritis receiving Ashwagandha root powder showed excellent response. Their pain and swelling completely disappeared. A double-blind placebo controlled study, combining Ashwagandha, turmeric and zinc showed significant improvement in pain and inflammation"

Support sexual and reproductive health in men and women — In men struggling with infertility, ashwagandha has been shown to balance their luteinizing hormone,51 which controls reproductive organ function in both men and women. Ashwagandha can also help boost testosterone levels in men,52,53 which can have a beneficial effect on libido and sexual performance.

In one placebo-controlled trial,54 men between the ages of 18 and 50 were given either a placebo or 300 mg of ashwagandha root extract twice a day in addition to participating in a strength training program. After eight weeks, those taking ashwagandha had greater increases in testosterone, muscle size and strength, compared to those taking a placebo.

It's also been shown to improve the quality of semen in infertile men,55 in part by inhibiting reactive oxygen species and improving essential metal concentrations, including zinc, iron and copper levels. Other research56 suggests ashwagandha improves semen quality by regulating important reproductive hormones.

In otherwise healthy women, ashwagandha has been shown to improve arousal, lubrication, orgasm and overall sexual satisfaction.57 In addition, ashwagandha's ability to rebalance hormones (including thyroid hormone, estrogen and progesterone) has been shown to improve polycystic ovary syndrome58 and relieve symptoms associated with menopause.59

While generally safe, well-tolerated and nontoxic, side effects can still occur. Memorial Sloan Kettering Cancer Center cites case reports showing side effects from ashwagandha may include:

While ashwagandha appears to be beneficial for thyroid problems, if you have a thyroid disorder, use caution and consult with your doctor, as you may need to tweak any medications you're taking for it. Ashwagandha is also contraindicated60 for, and should not be used by:

Needless to say, making sure you're getting a high-quality product is of utmost importance. To ensure effectiveness, I recommend using 100% organic ashwagandha root, free of fillers, additives and excipients.

Ashwagandha oil61 is another form of ashwagandha that offers a wide variety of medicinal and practical uses. It's usually mixed with other essential oils (or diluted in a safe carrier oil). Ashwagandha oil has antioxidant properties, and may be used for topical pain relief for those with arthritis and rheumatism.

Unfortunately, adulterated ashwagandha products have been found on the market, so buyer beware. A bulletin62 by the Botanical Adulterants Prevention Program reveals many ashwagandha root powders and root extracts manufactured in India are being adulterated by adding leaves, stems and aerial parts of the plant, without declaring this on the label.

In some tests, up to 80% of products were found to be adulterated in this manner. The fraudulent addition on undeclared plant material is a cost-saving strategy that results in an inferior product with questionable efficacy. The take-home message is, when buying ashwagandha, it's worth doing your homework to make sure you're getting a quality product.

Getting back to anxiety, it's important to realize there are many ways to address this now pervasive problem.63 Ideally, drugs would be your last resort, not your first, as many can cause other severe problems.

While genetics, brain chemistry, personality and life events play a role in the development of anxiety disorders, stress is a common trigger. Anxiety is a normal response to stress, but in some people the anxiety becomes overwhelming and difficult to cope with, to the point that it affects their day-to-day living.64

A number of other situations and underlying issues can also trigger or exacerbate anxiety. This includes but is not limited to the following, and addressing these issues may be what's needed to resolve your anxiety disorder.

For more information about each, please follow the links provided:

Traumatic life events — Research published in 2015 concluded traumatic life experiences were the single largest determinant of anxiety and depression, followed to a lesser extent by family history of mental illness and other social factors. In the link provided, you'll find guidance on how to reprogram your body's reactions to traumatic events using a simple tapping technique

Exposure to microwave radiation— Common sources include devices like cellphones, Wi-Fi routers, portable phones, smart meters, baby monitors and cellphone towers. Lowering your exposure to electromagnetic fields and microwaves is an important step if you're struggling with anxiety or depression as it has been shown to have a direct impact

Food additives and food dyes — Food dyes of particular concern include Blue #1 and #2 food coloring; Green #3; Orange B; Red #3 and #40; Yellow #5 and #6; and the preservative sodium benzoate

GMOs and glyphosateexposure through your diet — Most nonorganic foods are contaminated with glyphosate these days, and glyphosate has been shown to produce anxiety and depression-like behaviors in mice by affecting gut microbiota65

Gut dysfunction caused by imbalanced microflora

Low vitamin D66

Lack of animal-based omega-3 — Research has shown a 20% reduction in anxiety among medical students taking omega-3s67

Lack of magnesium — Anxiety is one of a myriad symptoms of low magnesium, and as noted in the 2018 paper,68 "The Role of Magnesium in Neurological Disorders":

Use of artificial sweeteners

Excessive consumption of sugar and junk food

Improper breathing

Exposure to toxic mold

Sources and References

1 Bioinformation 2008; 3(3): 100–110

2, 22, 60 Memorial Sloan Kettering Cancer Center, Ashwagandha

3 Indian J Psychol Med July 2012;34(3):255-62

4 Pharmacol Biochem Behav. 2003 Jun;75(3):547-55

5, 39 Thyromate, August 3, 2016

6, 21 Altern Med Rev. 2000 Aug;5(4):334-46

7, 8, 9 Indian J Psychol Med. 2012 July-September; 34(3):255-262

10 PLOS ONE Aug. 31, 2009;4(8):e6628

11 Journal of Alternative and Complementary Medicine 2014 Dec 1; 20(12): 901–908

12 J Ethnopharmacol Aug. 2, 2015;171:264-72

13 Curr Drug Targets 2011 October 1;12(11):1595-1653

14, 32 J Pharm Pharmacol. 2006 Apr;58(4):513-9

15 Journal of Biological Sciences 12(2):77-94,2014

16 PLOS One February 16, 2017

17 PLOS ONE 2017; 12(2): e0172508

18 J. Nat. Prod. 2006; 69(12): 1790-1792

19 Science Direct, Studies pertaining to cyclooxygenase-2

20 Medicinenet.com Medical Definition of Cox-2

23 The Renegade Pharmacist, Ashwagandha

24 Organic Facts, 15 Proven Benefits of Ashwagandha

25, 38 Thyroid Advisor 2017

26 My Gene Food, Ashwagandha Benefits

27 Gardner, Tanya. The Characteristics, Benefits and Application of Ashwagandha in the West. Ayuverda.college.com. December 2015

28 Science Direct, Ashwagandha studies

29 Cancer Letters 1995;95(1-2):189-193

30 Indian J Exp Biol. 1996;34(10):927-932.

31 Indian J Physiol Pharmacol. Apr 2001;45(2):253-257

33 Global Healing Center, February 27, 2015

34 Phytother Res. 2010 2010 Jun;24(6):859-63

35 J Geriatr Psychiatry Neurol. 2010 March; 23(1):63

36 J Pharm Pharmacol. 1998 Sep;50(9):1065-8

37 The Journal of Alternative and Complementary Medicine. August 22, 2017

40 Studies on Ethno-Medicine October 2, 2017; 6(2): 111-115

41 Indian J. Exp. Biol. 1988; 26(11): 877‐882

42 Journal of Medicinal Plants Studies 2016, Vol. 4 Issue 1, Part B

43 Drug Metabol Drug Interact. 2003;19(3):211-22

44 The People’s Pharmacy February 13, 2017

45 BMJ Case Rep. 2012 Sep 17;2012

46, 49 Afr J Tradit Complement Altern Med. 2011; 8(5 Suppl): 208–213

47 Smart-publications.com, Ashwagandha: The Rejuvenating Antioxidant That Calms The Heart and Mind

48 Food.ndtv.com. September 13, 2016

50 Pharmacognosy Reviews. Vol 1, Issue 1, Jan- May, 2007

51, 56 Fertil Steril. 2010 Aug;94(3):989-96

52 Fertility and Sterility 2010 Aug;94(3):989-96

53 Fitbodygoal.com Ashwagandha Can Boost Testosterone and Increase Fertility in Men

54 J Int Soc Sports Nutr. 2015 Nov 25;12:43

55 Reprod Biomed Online. 2011 May;22(5):421-7

57 Biomed Res Int. 2015;2015:284154

58 Integr Med Res. 2016 Dec;5(4):293-300

59 Ayu 2012 Oct-Dec; 33(4): 511–516

61 Ayurvedicoils.com Ashwagandha Oil September 2, 2016

62 American Botanical Council’s Botanical Adulterants Prevention Program, Adulteration of Ashwagandha Roots and Extracts

63 The CBHSQ Report, May 21, 2015

64 National Institute of Mental Health, What is Anxiety Disorder?

65 Neurotoxicol Teratol. 2018 May - Jun;67:44-49

66 Calmclinic.com, More Vitamin D, Less Anxiety?

67 Brain Behav Immun November 2011;25(8):1725-34

68 Nutrients 2018 Jun; 10(6): 730