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As women navigate the perimenopause transition, many consider various supplements, including ashwagandha (Withania somnifera), to support their well-being. When introducing any new supplement, understanding its potential impact on organ health, particularly the liver, is a common and important concern.
This article aims to provide an evidence-based overview of ashwagandha and liver health, focusing on what perimenopausal women need to know about its safety profile. We will review current research, including both instances where liver injury has been reported and studies suggesting potential protective effects in animal models. It’s important to note that the overall evidence on ashwagandha liver safety in humans is limited.
Understanding Ashwagandha and Liver Function
The liver plays a crucial role in detoxifying the body, metabolizing nutrients, and producing vital proteins. When considering any supplement, its interaction with liver function is a key safety aspect. Ashwagandha, an herb used in Ayurvedic traditions, contains various bioactive compounds, and its metabolism within the body involves the liver.
While some preclinical studies have explored ashwagandha’s effects on liver cells, human data specifically evaluating its long-term impact on liver health in the general population, and particularly in perimenopausal women, is still developing. This makes careful consideration of available evidence important when discussing ashwagandha liver safety.
Reported Cases of Ashwagandha-Induced Liver Injury
Despite its traditional use and general perception as safe, there have been documented instances of liver injury associated with ashwagandha consumption. A case series from Iceland and the US Drug-Induced Liver Injury Network reported several cases of ashwagandha-induced liver injury [1]. These cases highlight that while uncommon, liver reactions can occur in some individuals.
More recently, a publication in 2023 further discussed herb-induced liver injury by Ayurvedic Ashwagandha, assessing causality using the updated RUCAM (Roussel Uclaf Causality Assessment Method) [2]. This suggests that ashwagandha is emerging as a recognized cause of herb-induced liver injury in some cases. It’s important for individuals to be aware of these potential adverse effects when considering ashwagandha supplementation [3].
Characteristics of Ashwagandha-Related Liver Injury
When liver injury occurs, it can manifest with various symptoms, including jaundice (yellowing of the skin or eyes), dark urine, nausea, fatigue, and abdominal pain. The specific patterns and severity of ashwagandha-induced liver injury can vary among individuals. The reported cases often involve a cholestatic or mixed hepatocellular-cholestatic pattern of injury [1].
The onset of symptoms can vary, sometimes appearing several weeks after starting ashwagandha. While most reported cases have resolved after discontinuing the supplement, the potential for such reactions underscores the importance of monitoring for symptoms and consulting a healthcare professional if any concerns arise. The broader field of drug-induced liver injury, including botanical-induced liver injury, is an area of ongoing research and understanding [PMID 42092331, PMID 39304112].
Ashwagandha and Liver Protection: Preclinical Findings
Interestingly, some preclinical research, primarily in animal models, has explored potential protective effects of ashwagandha on the liver. For example, studies in rats have suggested that ashwagandha pretreatment might ameliorate bromobenzene hepatotoxicity, potentially involving its role in mitochondrial oxidative stress [4].
Further animal research indicated that Withania somnifera glycowithanolides might have an effect on iron-induced hepatotoxicity in rats [5]. Another study in rats suggested antihepatotoxic effects of Withania somnifera extracts against carbon tetrachloride-induced hepatotoxicity [6]. These animal studies provide interesting avenues for future research but do not directly translate to human liver safety or efficacy, especially in the context of typical ashwagandha supplementation for well-being.
Clinical Studies and Overall Safety Profile
While case reports highlight potential liver injury, larger clinical trials on ashwagandha have generally reported it to be well-tolerated. For instance, a randomized, placebo-controlled study on ashwagandha root extract in healthy volunteers found it to be safe [7]. However, such studies typically involve specific dosages and durations, and adverse events, including liver-related ones, are carefully monitored.
It’s crucial to understand that ‘generally safe’ does not mean ‘safe for everyone, always.’ Individual sensitivities, co-existing health conditions, concomitant medications, and variations in product formulations can all influence how an individual responds to a supplement. The limited number of reported liver injury cases relative to widespread ashwagandha use suggests it is a rare occurrence, but one that warrants awareness.
References
- Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver international : official journal of the International Association for the Study of the Liver, 2020
- Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel, Switzerland), 2023
- Potential Adverse Effects of Ashwagandha: A Critical Review of Preclinical and Clinical Evidence. Phytotherapy research : PTR, 2026
- Amelioration of bromobenzene hepatotoxicity by Withania somnifera pretreatment: Role of mitochondrial oxidative stress. Toxicology reports, 2014
- Effect of Withania somnifera glycowithanolides on iron-induced hepatotoxicity in rats. Phytotherapy research : PTR, 2000
- Antihepatotoxic effect of marrubium vulgare and withania somnifera extracts on carbon tetrachloride-induced hepatotoxicity in rats. Journal of basic and clinical pharmacy, 2010
- Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers. Complementary therapies in medicine, 2021
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease. Content is for informational purposes only and is not medical advice; consult a qualified healthcare provider before starting any supplement. As an Amazon Associate we earn from qualifying purchases.
