Ashwagandha (Withania somnifera) is an Ayurvedic herb marketed for stress, anxiety, sleep, energy, brain function, hormones and exercise performance. The claimed health benefits of ashwagandha are much broader than the evidence. Human trials give the clearest, though still limited, signal for short-term perceived stress and sleep outcomes. They do not establish a cure for anxiety, insomnia, depression, infertility or chronic disease.
Products are not interchangeable. Ashwagandha root, root-and-leaf extracts, extraction ratios and withanolide concentrations can differ substantially. A dose from one trial cannot be transferred automatically to another bottle.
Safety deserves equal weight. On 7 July 2026, Australia’s Therapeutic Goods Administration (TGA) updated its alert after further reports of possible liver injury. The risk appears very rare, but cases can be severe. Sudden vomiting or diarrhoea can also occur after only one or two doses.
Ashwagandha may interact with medicines and is unsuitable for some people, including those with current or previous liver disease. A short, defined trial should never replace assessment or evidence-based care for persistent anxiety, poor sleep, thyroid symptoms or another health problem.
Written by: Charles Gumbley, BHSc Clinical Nutrition, DipHSc Western Herbal Medicine. Evidence checked: 20 July 2026.
What Is Ashwagandha Root Extract?
Ashwagandha is a shrub in the nightshade family. Traditional systems have used different parts of the ashwagandha plant and different preparations, while Australian listed medicines most often contain concentrated root extract. Withanolides are a group of constituents used to describe or standardise some products, but a higher percentage does not prove better clinical results.
The TGA notes that plant part, extraction method and extraction ratio alter the final composition. Some studies use root-only preparations; others use root and leaf. Labels may state a dry-herb equivalent, extract milligrams and a withanolide amount, which are three different measures.
“Adaptogen” is a marketing and traditional-use term, not a diagnosis or a guarantee that a product normalises stress hormones. The effect of ashwagandha depends on the population, outcome, formula, dose and duration studied.
Effect of Ashwagandha: How to Read the Evidence
Studies on ashwagandha often enrol healthy adults with self-reported stress rather than people with a diagnosed mental-health condition. Participants know they are testing a well-publicised herb, so expectation and reporting effects are difficult to eliminate even when a placebo is used. Small samples can also exaggerate a result.
The potential benefits of ashwagandha should be judged using both the size and certainty of change. A statistically lower questionnaire score may not be large enough to matter in daily life. A cortisol difference does not prove better health, and no short trial can establish that ashwagandha supplementation reduces future disease.
Formulation is another limit. “Standardised ashwagandha” may describe different withanolides, plant parts and solvents. An ashwagandha extract used in one trial may not match an ashwagandha powder, tea or gummy. Even two products labelled as an extract of ashwagandha root can have different extraction ratios.
The efficacy and safety of ashwagandha therefore need to be evaluated together for the exact product and person. Evidence of a small average benefit cannot cancel rare serious side effects, interactions or uncertainty about long-term use.
Benefits of Ashwagandha for Stress and Anxiety
A 2024 systematic review and meta-analysis examined the effect of ashwagandha on stress and anxiety. It found that ashwagandha groups had lower average stress, anxiety and cortisol measures than placebo, but the studies were small and used varied extracts, doses and scales. Follow-up was generally short. The impact of ashwagandha on stress questionnaires cannot be assumed to represent recovery from an anxiety disorder.
Studies suggest that ashwagandha may reduce stress scores for some adults. Participants who took ashwagandha did not all respond, and the pooled result does not identify who benefits. An ashwagandha extract may also perform differently from the product available to a consumer. These limits matter before translating a group average into individual advice.
These results suggest that ashwagandha could produce a modest short-term change in perceived stress for some adults. They do not show that it treats an anxiety disorder or prevents the consequences of chronic stress. Cortisol also varies by time of day, illness, sleep and sampling conditions; lowering one measurement is not automatically a health benefit.
People with persistent worry, panic, low mood, trauma symptoms, impaired work or relationships, or thoughts of self-harm need professional assessment. Psychological therapies and, where appropriate, medicines have stronger evidence and clearer monitoring. Ashwagandha should not be used to delay care or mixed with sedatives without advice.
Can Ashwagandha Improve Sleep Quality?
A 2021 systematic review and meta-analysis included five randomised trials with about 400 adults. Pooled sleep outcomes favoured ashwagandha, with larger signals in people with insomnia and in some higher-dose or longer-duration subgroups. Study numbers were small, formulations varied and most follow-up lasted only several weeks.
Ashwagandha may help some adults report better sleep quality, but the benefits for sleep remain formulation-specific and the evidence does not define an ideal product or long-term schedule. Sleep problems can reflect sleep apnoea, restless legs, pain, menopause, medicine effects, alcohol, depression or anxiety. A supplement will not correct those causes.
Regular sleep timing, morning light, physical activity and cognitive behavioural therapy for insomnia have broader evidence. Seek assessment for loud snoring, witnessed pauses in breathing, severe daytime sleepiness or insomnia lasting more than a few weeks.
Ashwagandha Benefits for Women, Hormones and Fertility
Claims about benefits for women often combine stress, menopause, libido, thyroid function and fertility. Although ashwagandha is often marketed for “hormone balance”, evidence for each outcome is small and product-specific. A change in a questionnaire or hormone concentration does not establish improved fertility, pregnancy outcomes or long-term endocrine health. Ashwagandha also has no established role as a general reproductive tonic.
Ashwagandha can influence thyroid measurements in some studies and case reports of thyrotoxicosis exist. People with thyroid disease or using levothyroxine, antithyroid medicines or iodine-containing products should not take ashwagandha without clinician review. Symptoms such as palpitations, tremor, heat intolerance or unexplained weight change require assessment.
Avoid ashwagandha during pregnancy. Certain Australian preparations require a pregnancy warning, and reliable safety evidence is lacking for pregnancy and breastfeeding. It is not a treatment for polycystic ovary syndrome, infertility, endometriosis or menopausal symptoms.
Brain Function, Exercise and Other Ashwagandha Claims
Small trials have examined cognitive function, memory, strength, testosterone, glucose, inflammation and sexual function. Results are inconsistent or limited to narrow populations and proprietary extracts. They do not support broad claims that ashwagandha improves brain function, boosts testosterone, builds muscle, treats diabetes or prevents dementia.
Athletic-performance studies often combine resistance training with an ashwagandha supplement, making it difficult to separate the herb from training, protein intake, sleep and baseline fitness. An average change in a short trial does not establish a meaningful advantage for every person.
Cancer claims are particularly unsafe. Laboratory findings about withanolides are not evidence that ashwagandha treats cancer in people. It may interact with cancer therapy or immunosuppressive treatment. The oncology team should review every complementary medicine.
Side Effects of Ashwagandha and Liver Injury
Commonly reported side effects include nausea, stomach upset, loose stools, drowsiness and headache. The TGA warns that sudden vomiting and/or diarrhoea can occur after only one or two doses. Stop the product and seek medical assessment rather than assuming food poisoning.
The July 2026 TGA update records 11 possible Australian liver-injury cases, six without another ingredient considered likely to contribute; four implicated Australian-listed products and two of those required hospitalisation. The TGA also cites international liver failure reports, including fatalities in people with acute-on-chronic liver failure. Reporting cannot establish the rate precisely, but the signal is credible enough for action.
Stop using ashwagandha and seek prompt medical advice for yellow skin or eyes, dark urine, nausea, vomiting, unusual tiredness, weakness, abdominal pain or loss of appetite. Avoid it if you currently have or have had liver problems. Do not restart after a suspected reaction unless a specialist specifically advises it.
The published liver-injury pattern is often cholestatic or mixed and may appear weeks after starting, although timing varies. Normal short-term safety results in a small trial cannot exclude a rare idiosyncratic reaction. The use of ashwagandha should be recorded when clinicians investigate unexplained liver-test abnormalities.
What Cannot Be Mixed With Ashwagandha?
Potential interactions are not mapped comprehensively. Check with a pharmacist before using ashwagandha with:
- sedatives, sleep medicines, alcohol or medicines that impair alertness;
- thyroid medicine or products containing high-dose iodine;
- diabetes or blood-pressure medicines, because additive effects are possible;
- immunosuppressants, because immune effects are uncertain;
- medicines with liver risk or multiple herbal products; or
- treatment around surgery, when sedation, blood pressure and glucose matter.
Use extra caution with autoimmune disease, stomach disorders, kidney disease or complex medicine regimens. Stop and seek advice for a new rash, swelling, breathing difficulty, severe gastrointestinal symptoms, jaundice or marked changes in mood, heart rate or alertness.
Ashwagandha Products: How to Take Ashwagandha More Safely
First define the goal and a review date. If stress or sleep is mild and professional review finds no major risk, choose one Australian ARTG-listed product whose plant part, extract, withanolides, full daily dose and warnings are clear. Do not combine several ashwagandha products.
There is no universal dose. Trials commonly study a particular ashwagandha root extract for six to twelve weeks, but doses of ashwagandha are not comparable across extraction ratios. The safety of ashwagandha beyond the studied period is uncertain. Use the label, not a social-media dose, and do not continue indefinitely without reassessing benefit and harm.
Record the product, batch, start date, medicines and baseline symptoms. Stop if there is no meaningful improvement at the planned review. An ARTG listing means the product meets the listed-medicine framework; it does not mean the TGA has independently proven every advertised benefit.
Nutrition Market sells ashwagandha products, creating a commercial conflict. No product is ranked or linked here until its plant part, extraction ratio, withanolides, TGA/ARTG claims and warnings, liver and interaction safeguards, stock, current cost and margin pass the governed feed rules.
Ashwagandha Benefits: Common Questions
What is ashwagandha actually good for?
The most credible evidence suggests a possible modest, short-term improvement in perceived stress and some sleep outcomes with specific extracts. Evidence is insufficient to treat diagnosed anxiety, insomnia, depression, thyroid disease, infertility, cancer or cognitive decline.
What cannot be mixed with ashwagandha?
Potential concerns include sedatives, alcohol, thyroid, diabetes and blood-pressure medicines, immunosuppressants, liver-risk medicines and perioperative treatment. Interaction data are incomplete, so a pharmacist should check the exact product and medicine list.
What are some side effects of ashwagandha?
Nausea, diarrhoea, vomiting, stomach upset, headache and drowsiness can occur. Very rare liver injury can be severe. Stop and seek advice for sudden severe gastrointestinal symptoms or signs such as jaundice, dark urine, unusual fatigue, abdominal pain or appetite loss.
What happens if you take ashwagandha daily?
Some people notice no change; some short trials report better stress or sleep scores; others experience adverse effects. Long-term safety and the best duration are not established. Daily use needs a defined goal, compatible medicines, a review date and immediate stopping for concerning symptoms.
Ashwagandha Evidence and References
- Arumugam V, et al. Effects of ashwagandha (Withania somnifera) on stress and anxiety: a systematic review and meta-analysis. Explore. 2024;20(6):103062. PMID 39348746. doi:10.1016/j.explore.2024.103062.
- Cheah KL, et al. Effect of ashwagandha (Withania somnifera) extract on sleep: a systematic review and meta-analysis. PLOS ONE. 2021;16(9):e0257843. PMID 34559859. doi:10.1371/journal.pone.0257843.
- Philips CA, et al. Ashwagandha-induced liver injury: a case series from India and literature review. Hepatology Communications. 2023;7(10):e0270. PMID 37756041. doi:10.1097/HC9.0000000000000270.
- Therapeutic Goods Administration. Herbal preparations containing Withania somnifera (Withania, Ashwagandha). Updated 7 July 2026; accessed 20 July 2026.
- US National Institutes of Health Office of Dietary Supplements. Ashwagandha: health professional fact sheet. Updated 2 January 2025; accessed 20 July 2026.
This article provides general educational information, not personalised medical advice. Seek urgent care for possible liver injury, severe vomiting or diarrhoea, breathing difficulty, or mental-health crisis symptoms.
