Ashwagandha. Is it the ultimate stress fixer + the facts behind the Danish ban

0:01Hi, I'm Sophie and this is Age Well with Dr Sophie Shotter, a space devoted to all things health, wellness and longevity. Because for me, ageing well is about looking and feeling like the best possible version of ourselves, inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women, and men finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

0:46Dr Sophie Shotter:All right, so let's start at the top. What is ashwagandha? So we're in the realms of herbal medicine here. Ashwagandha is a small yellow flower shrub native to India and North Africa. And in traditional Chinese medicine and Ayurvedic medicine, its roots and leaves are used in supplements. And it's said to have a nurturing, nourishing effect on the adrenal glands and the nervous system. For this reason, it's mostly used as a calming anti-stress supplement. It's definitely gone mainstream with people like Jennifer Aniston, Meghan Markle and Gwyneth Paltrow said to be fans. And a lot of functional doctors do prescribe and recommend it.

1:25But in 2023, Denmark actually banned it. So it's now become a little controversial. Then again, even the ban itself is controversial. Certainly, I've had my own experience, which I touched on during our recent chat with Dr. Tam Lewis. So I can definitely talk a little bit more about that.

1:43Dr Sophie Shotter:Yeah. Well, should we first dive a bit deeper into the claims made around its benefits and if there are any studies to back this all up. Sure, and ashwagandha isn't new. It's been used for thousands of years in Ayurvedic and Chinese medicine and it's what's known as an adaptogen. So to explain that, an adaptogen is a herb or plant or mushroom that helps us to adapt to stress, hence the name adaptogen. This is mostly about cortisol, the stress hormone and the HPA axis. So another explainer. The hypothalamus and pituitary glands are located at the base of our brain. And the adrenal glands are located on top of our kidneys.

2:22And these three glands communicate with each other to regulate stress hormones in our body. And when our body sends a threat, the hypothalamus starts a cascade of steps to initiate a stress response and release cortisol. The hypothalamus sends a chemical to its brain neighbour, the pituitary gland. and then this pituitary gland releases another chemical that travels all the way down to the adrenal gland near the kidneys and these adrenal glands then release cortisol, the stress hormone. But what ashwagandha is said to do is disrupt this line of communication by reducing the effects of both cortisol and adrenaline.

2:57It almost resets the system a bit and as a sidebar it's useful to know here that if we're continually under stress cortisol will take over the body and the brain's response to all this cortisol is actually to create more cortisol. So you end up in this catch-22, basically a chronic overactivation of the hypothalamic pituitary adrenal axis. And this then potentially causes burnout and adrenal fatigue, along with other things like inflammation, insomnia, and even things like weight gain around the middle. So the primary reported benefit of ashwagandha is this idea of calming the nervous system. But do hold on as Some people respond very differently to this, which I'm sure we'll get on to.

3:38As another side note, ashwagandha is also said to do other things. So the plant's root is said to have these antioxidants called withanolides, and these are said to improve the health of our cells and are also apparently anti-inflammatory, pain relieving and immune boosting. It's also been linked to better sleep, potentially better thyroid function, muscle strength and brain health. there are also some pretty big claims that it can help ward off heart disease diabetes obesity a weakened immune system and even autoimmune diseases but again it's not for everyone for example it can worsen hyperthyroidism and it can cause hypoglycemia or low blood sugar it can completely numb people's emotions so we definitely need to acknowledge the very different impacts it has on different physiologies because this is not to be underestimated.

4:29Dr Sophie Shotter:And this is what I'm hearing a lot and we definitely want to get onto your story but it's mostly taken for stress. Yes, looking at the data some studies have shown it enhances the production of GABA which is one of our calming neurotransmitters up in the brain and it's GABA's job to settle our nerves and make us feel calm and this in turn means we're less likely to go into fight or flight and start pumping out a lot of adrenaline and cortisol. So again ashwagandha increases this GABA and this is where some of the adjacent medical claims come in because by reducing stress this can help improve sleep and reduce inflammation and in turn we then get better heart health and reduce blood glucose levels.

5:08People do also report increased cognitive function, better libido and muscle strength but we have really very little data to go on with this. On the mental health side one rat study conducted over eight weeks claims results that are allegedly comparable to antidepressants. But as I always say, rats are very different to humans. What's really interesting is that ashwagandha creates what's known as hormetic stress, which is something we've talked about before on the podcast. And this is where we create a small stress in the body so we can better deal with bigger stress later. It's the same principle as cold water swimming, which is why experts say that taking it when you're already ill or stressed out or in burnout isn't a good idea because it can actually add stress to the system.

5:52So for example, someone with adrenal fatigue will typically have very low levels of cortisol because the theory of adrenal fatigue is that prolonged stress leads to low cortisol levels. As the adrenal glands become fatigued and they're unable to keep up with the demand of pumping out more and more cortisol. So someone with adrenal fatigue doesn't need a supplement that lowers this even further. So if you're already burnt out, that's not the time to start taking ashwagandha.

6:20Dr Sophie Shotter:And so you've mentioned that not everyone gets on with it. What are people's different responses beyond what you've already touched on? Yeah, it's really quite incredible in that people seem to have radically different responses. For every person who said it's made a life-changing difference, there's someone else who said it made them feel the opposite of how they want to feel and that they become really depressed and sluggish. If you search on socials, you'll see half the commenters love it and the other half say it's a dreadful supplement that caused dreadful side effects. There's also the camp who say it made no noticeable difference whatsoever.

6:53And some people see a kinesiologist to test how well they might respond to it.

6:58Dr Sophie Shotter:So, OK, you've mentioned this before on our podcast with Dr. Tam Lewis, but let's go over this again. What was your experience on ashwagandha? So for me, I just found it absolutely crushed me. I was exhausted to the extent that I really struggled to get up with my alarm clock in the mornings. I felt so groggy. And it was at a time in my life where I was running a much higher stress lifestyle than I do now. Not that I don't still have stress in my life. I just manage it differently. So yeah, for me, I was one of the people who probably had slight burnout. And so my adrenals didn't thank me for lowering my cortisol even more.

7:36Dr Sophie Shotter:Yeah, so interesting. And so why has Denmark banned it? Well, this only happened quite recently, back in April 23. And even the ban is controversial, with some experts saying it's not based on credible data. So the ban was based on findings from the Danish Technical University, which found that ashwagandha has a possibly harmful effect on thyroid and sex hormones, and quite shockingly that it might even induce abortions. But, and this is a big but as far as abortion is concerned the report presents no clinical evidence instead reference is made to the world health association's advice that people shouldn't take it during pregnancy or breastfeeding and i quote there is information that the root has been used as an abortive facet and the issue is the origin and therefore the credibility of this information is really unclear we think it was likely passed down as part of the ayurvedic medical system but basically there's no clinical evidence that it can cause an abortion or a miscarriage.

8:34In fact, some journals state that ashwagandha was once used to boost health pre and post birth. Not only that, but a close examination of the Danish report reveals no new data, only a summary of past experiments. So one study in rodents found that ashwagandha reduced sperm quality and quantity, while a trial in humans found that it might increase thyroid hormones, which could be quite dangerous if left unchecked. But the cases mentioned by the authors are rare and many studies were included where no evidence of thyroid problems were found. But without clear evidence, the Danish health authorities said Denmark would ban it because they said it's impossible to find a safe dose given the current data.

9:13And to be fair to Denmark, I do think that dosing is an issue.

9:17Dr Sophie Shotter:Yeah, so let's talk about dosing. How much should we take if we're going to take it? So most benefits have been linked to people taking around 500 milligrams a day. In fact, the most common dosage in clinical trials is 600 milligrams divided over two 300 milligram doses a day. And this is using the full spectrum root extract and something called the KSM 66 extract in particular. There are no set directions for when to take it, but one suggestion is to supplement in the morning if you're taking ashwagandha for its immune boosting properties and in the evening for its sleep enhancing benefits. So half a dose in the morning and half a dose at night.

9:54But there's even a lot of disagreement on this and some herbalists say that you should only take it once in your life for six months continually. Then that's it, never take it again. Some people say to take a break every few months or you may build up a tolerance over time and some people tell you to continually take it as part of a stack. It would also be remiss of me not to mention one report that talks about cases of liver damage caused by ashwagandha and it mentions one patient admitted to hospital because of jaundice and apparently he'd been taking ashwagandha for a year. My advice would be to work with an expert practitioner and have your health and potentially your bloods continually checked and monitored and by the way I really wouldn't advise taking it in pregnancy despite what some influencers and advocates say.

10:40Dr Sophie Shotter:So what did the science say in terms of the positives? So we only have a few small studies but they're worth looking at. One study published in the Indian Journal of Psychological Medicine took 12 years to develop and was double blind placebo controlled. It found that among 64 people with chronic stress those who took ashwagandha over 60 days had significantly lower stress and lower cortisol levels when compared to a placebo group. And again it tested with KSM 66 ashwagandha which is a high strength extract from the root of the ashwagandha plant which contains the majority of these antioxidants I talked about.

11:16Dr Sophie Shotter:So if somebody wants to take ashwagandha they should look out for the KSM-66? Yes it would seem so. Some supplements use ashwagandha powder which often uses the leaves of the plant rather than the root. So ideally look for KSM-66 extract or and I'm quoting here a high concentration full spectrum extract of ashwagandha roots as described in the Indian study. Okay and how long does ashwagandha take to work and I'd also love to know how long you notice the difference in you? For some it works really quite quickly but its real impacts are meant to be more gradual. It's said to be something that takes time to build up in the system and that's why experts say take it in the run-up to a potentially stressful event like two to three months in advance.

11:58Then after a few weeks you should feel calmer and more relaxed, your sleep might start to improve, you might find an increase in energy levels or, as in my case, you might not get on with it at all. The most recent research on how best to take ashwagandha suggests that it may take more than 10 weeks to see real results, but for some people that feeling of calm is apparently felt much sooner for some people in as little as two weeks. Another interesting point to mention for any midlife women is a process called the pregnenolone steal, which is when the body steals progesterone to make cortisol.

12:31to explain pregnenolone is a precursor for both progesterone and cortisol and when chronic stress triggers a high demand for cortisol the body diverts pregnenolone to ignore progesterone and simply produce more cortisol and that's because cortisol is considered more vital for survival so the body prioritizes it over progesterone but as many perimenopausal women know the decrease in estrogen and progesterone make us women far less stress resilient and far more anxious. So we really need progesterone as our calming anti-inflammatory hormone and in particular for our sleep, which is why so many midlife perimenopausal women take ashwagandha.

13:11And as for me, I was definitely in the quick camp. My side effects were really very rapid. Within like a week or two? Yeah, days, I would say.

13:22Dr Sophie Shotter:Wow. Okay. And are there any side effects beyond the fact that not everyone gets on well with it? some people get an upset tummy some get headaches but most people don't get either also some people have shown it can increase testosterone which could be an issue for men with prostate issues or for women with polycystic ovarian syndrome having said that some women with PCOS say they do brilliantly on ashwagandha and again I think this is the point people seem to react really differently either very well or not very well at all again it's a definite no for anyone pregnant or breastfeeding as there's just not enough research to prove it's okay.

13:59And anyone with a medical condition should check with their GP. So any final thoughts? I'm inclined to think that as with many supplements, this is possibly a regulation problem, not an ashwagandha problem. And it's also an issue of lack of data. One of the key issues is people don't realise how strong herbal medicines can be. It doesn't matter if it's a drug or a plant derived substance, they can still have strong physiological effects. And people assume that because it's quote unquote natural, it's fine to just buy a load and self-dose and be on it forever. And personally, I don't think this is the kind of supplement you'd want to take long term.

14:37I think it might be useful for some people with the caveats I've already mentioned. The other issue is that because it's not regulated, brands can make all kinds of claims and sell all kinds of products. So I do think it's one of those supplements that needs to be taken in conjunction with a really good functional doctor who understands both the risks and the contraindications. And personally, I'd also have your liver checked and monitored if you're planning on taking it for longer than six months. If it doesn't work and you suffer with anxiety, I have a few other options for you. Two other adaptogens to try a holy basil or schisandra.

15:11And there's also 5-HTP. For some, magnesium does the job or lion's mane or St. John's wort. There's also L-theanine, Saffron, CBD, apigenin, vitamin B12, rhodiola. Some people use canna, another herb, but this does need dosing carefully and monitoring. And if you remember our episode with Professor David Nutt here in the UK, you can also now get a legal prescription for medical cannabis. So if you suffer with anxiety, do your research and find out what works for you.

15:42Dr Sophie Shotter:oh such a useful episode Sophie thank you so much thank you so much V

15:52and that ends this week's podcast if you want to find out more about me and my work or maybe book a consultation head to dr sophieshotter.com and you can find me on socials at dr sophieshotter and again thank you so much for listening

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