Is ashwagandha safe for your liver?

Ashwagandha can damage the liver. This is not a single anecdote but a pattern that has emerged from multiple independent case series and review studies. Herbal supplements as a group now account for roughly 20% of all cases of drug- or supplement-induced liver injury in the American liver injury registry network, and ashwagandha is listed there as one of the most frequently cited causes.

The typical presentation is what is known as cholestatic hepatitis: bile flow becomes blocked, leading to jaundice and itching. In a European and American patient series of five cases, this occurred after two to twelve weeks of use. In all five patients the damage resolved on its own within one to five months after they stopped. The situation was more serious in an Indian series of eight patients: three of the five people who had a pre-existing liver condition did not survive.

In healthy people without liver disease, a short-term randomised study of eight weeks found no measurable abnormalities in liver function measurements. That sounds reassuring, but it comes with an important caveat: the study was small (80 participants) and the researchers themselves emphasised that long-term use and higher doses have not been studied.

An estimated 15 million American adults use supplements that are potentially liver-toxic, including ashwagandha. An additional risk factor is that supplements are poorly regulated: product contamination has already been ruled out in some case investigations, indicating that the ashwagandha itself caused the damage, not an unwanted byproduct.

The conclusion is that liver injury from ashwagandha is not rare enough to ignore. If you have a pre-existing liver condition, do not use ashwagandha. If you notice symptoms such as jaundice, dark urine or fatigue during use, stop immediately and consult your doctor.