Ashwagandha offers support during stressful times

Photo Cred: Nadi Lindsay/Pexels

By Bill Reddy, LAc, DiplAc

I’ve been recommending ashwagandha for the past 20 years for anxiety, insomnia, athletic performance enhancement, and general wellbeing. Ashwagandha is an herb found in both Traditional Chinese Medicine (TCM), referred in pinyin as Shui Qie, and the Indian Ayurvedic tradition, classified as a Rasayana herb. It is also referred to by its Latin name in medical literature as Withania somnifera. As the name implies, the herb is known to promote quality sleep.

Ashwagandha treats a broad spectrum of conditions including stress, inflammation, insomnia, fatigue, anxiety, depression, poor immune function, hypertension, low testosterone or sexual dysfunction, high cholesterol, and high blood sugar. Categorized as an adaptogen, it helps support adrenal function and is considered a nootropic since it can enhance athletic and cognitive performance. 

The side effect profile of ashwagandha and its extracts is minimal, and it is well-tolerated at therapeutic doses of 300 to 500 milligrams with meals. High doses, however, can cause diarrhea, stomach upset, and vomiting. Since ashwagandha can lower blood sugar levels, it may be problematic if taken with diabetes medications. There are also limited studies on pregnant and lactating women, so I recommend these patients avoid it until further studies are performed.

Though ashwagandha can promote healthy sleep, it is not considered a sedative. The best time to take ashwagandha to support restorative sleep is before noon, however if there’s little effect, one can add a second dose later in the day.

Studies have proven that supplementing with ashwagandha improves sleep quality, average sleep latency, and sleep efficiency. As an added bonus, ashwagandha also improves mental alertness upon waking. Standardized scores, such as the Hamilton Anxiety Rating Scale, have improved with supplementing with ashwagandha. Not surprisingly as an adaptogen, it also reduces cortisol levels and improves stress levels.

I have had several cases where ashwagandha proved beneficial. For example, a 44-year-old white female real estate agent presented with shoulder pain. In the initial intake, I found that she was having a difficult time falling and staying asleep. She denied being perimenopausal, and shared that she recently divorced, moved, and changed jobs within the past six months, life events that are considered some of the most stressful by experts.

Ashwagandha is one of the best ways to deal with this type of insomnia. A common question to ask related to cortisol rhythm disruption is if the patient crashes midway between waking and bedtime. For instance, if the patient wakes at 8 a.m. and goes to sleep at midnight, the midpoint is 4 p.m. where they’ll have a hard time keeping their eyes open, and usually reach for a cup of coffee or a caffeinated soda, which is one of the worst things a patient struggling with sleep can do.

I recommended she ease back on any caffeine usage in the afternoon and take 500 milligrams of ashwagandha just before noon. Not only did she sleep better, but within the first week of supplementation, she reported improved running times on her treadmill in further follow-ups.  

Another case that comes to mind is a 35-year-old Hispanic administrative assistant who came to see me for chronic migraines and a tight, painful upper back from long hours in front of her computer. During the initial intake, I found she also suffered from anxiety and has been on and off psychiatric medications for the past several years and was currently taking a break. While I can’t recommend a patient stop taking medications within my scope of practice, this proved beneficial as we were able to observe the true effects of my prescribed regimen.

We talked about computer ergonomics and reducing the size and contents in her purse, which, as it turned out, was causing extra strain on her neck and shoulder. She estimated her anxiety to be about seven on a scale from one to 10, where 10 is the worst. 

I recommended 500 milligrams of ashwagandha daily both in the morning and evening, and suggested she walk 15 to 30 minutes a day in nature to get out of her apartment and breathe fresh air. I also performed regular acupuncture treatments to help address her anxiety.

Within a few weeks, she said she felt significantly better, generally feeling lighter and less worrisome. Since I also addressed her anxiety with acupuncture treatments, it’s hard to identify which approach contributed most significantly to her anxiety reduction. I certainly feel there’s a synergistic effect than applying either intervention alone.

Ashwagandha can be a safe, effective way to manage anxiety, insomnia, stress, and improve general wellbeing and athletic performance for patients and practitioners.

References

Bone, K. (1996) Clinical Applications of Ayurvedic and Chinese Herbs. Monographs for the Western Herbal Practitioner. Australia: Phytotherapy Press.   

Langade, D., Kanchi, S., Salve, J., Debnath, K., and Ambegaokar, D. (2019) Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus. Retrieved from: https://www.cureus.com/articles/22928-efficacy-and-safety-of-ashwagandha-withania-somnifera-root-extract-in-insomnia-and-anxiety-a-double-blind-randomized-placebo-controlled-study

Lopresti, A.L., Smith, S.J., Malvi, H., and Kodgule, R. (2019) An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31517876/

Mishra, L.C., Singh, B.B., and Dagenais, S. (2000) Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Alternative Medicine Review. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10956379/