By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Ashwagandha safety: the ancient herb that became a wellness star
Ashwagandha safety is now at the center of a lively debate among researchers and health authorities. For thousands of years, traditional Indian medicine has used ashwagandha (Withania somnifera). In recent years, however, it has moved from the world of herbal remedies to the heart of the supplement industry. Companies market it to reduce stress, improve sleep, support memory and sometimes even boost performance. Yet as its use grows, regulators are asking two questions. How safe is it? And is every product that contains it really the same product?
Not all ashwagandha is the same ashwagandha
The first problem lies in the word itself. One product contains a root extract, another a leaf extract, and a third combines the two. I compare them in my article on ashwagandha root vs leaf. In addition, the concentration of active compounds varies widely. This mainly refers to withanolides, the group of active compounds in the plant.
The extraction method, dose, level of standardization and testing also differ from product to product. This distinction matters, because controlled studies have usually tested well-defined extracts. As a result, we cannot simply apply a good outcome for one extract to every capsule sold online or in a health food store.
What does the research say about ashwagandha safety?
A systematic review published in May 2026 in the journal Pharmaceuticals pooled 23 randomized trials. The trials included 2,317 healthy adults who took a standardized extract made from the root only. Doses ranged from 125 to 600 mg a day, and treatment lasted up to 180 days.
The results are fairly reassuring. Markers of liver, kidney, blood, hormone and heart function stayed within the normal range. Moreover, the researchers found no serious adverse event linked to the extract. Mild side effects, such as stomach discomfort, headache or passing drowsiness, were rare. In fact, they also appeared in the comparison groups.
Still, there is an important caveat. Most of the data are short- to medium-term, and there is almost nothing beyond 180 days. Also, the review looked only at standardized root extracts. So we cannot conclude that every product on the market is equally safe.
Ashwagandha safety and the liver
This is the issue that concerns regulators most. The US National Center for Complementary and Integrative Health (NCCIH) notes rare reports of liver injury after people took ashwagandha products. It also states that the herb is probably safe for short-term use, up to three months. However, there is not enough information to draw conclusions about longer use.
In Australia, too, the drug regulator (TGA) issued a second warning about liver injury in July 2026. According to the agency, this effect is very rare but can be severe. Since its previous warning in 2024, Australia has recorded four more suspected cases, and all of them resolved after the product was stopped.
The TGA advises people to stop the product right away and see a doctor if they notice warning signs. These include yellowing of the skin or eyes, dark urine, nausea or unusual fatigue. In addition, it recommends that anyone who has or has had liver disease avoid these products. The gap between the case reports and the trials once again highlights the standardization problem. After all, the product on the shelf is not always identical to the extract tested in a study.
Europe and the world start asking questions
The herb’s popularity has also drawn regulatory interest. Denmark banned ashwagandha in food supplements in 2023. Then, in 2024, the heads of Europe’s food safety agencies recommended opening a review under Article 8 of the EU regulations. This mechanism assesses the safety of substances added to food. In the end, it may lead to restrictions, labeling requirements or even a ban. However, as of late 2026 the process has not yet formally begun.
The concerns are not limited to the liver. The debate also covers possible effects on the thyroid, the reproductive system and the immune system. Furthermore, the wide variation between products makes it hard to set a safe daily dose. India, for example, banned the use of the plant’s leaves in food and supplements in April 2026 and now allows only root products.
Regulation may actually strengthen the field
This is not necessarily a story about a “dangerous herb.” To a large extent, it is a story about the supplement world entering a new era. Instead of relying on tradition alone, consumers and regulators now demand scientific standards, just as in other areas of medicine.
To know whether a supplement works and is safe, you need to know exactly what is in it. Which part of the plant was the extract made from? By which method? What is the withanolide concentration, and what is the dose? Finally, does the product resemble what was tested in research?
In July 2026, the company Kerry launched the Safeguard Ashwagandha initiative at the European Parliament. The initiative gathers scientific and regulatory information and promotes standardization. Even so, industry stands behind it. Therefore, its information is best read alongside the scientific literature and independent authorities.
Ashwagandha safety: who should be especially careful?
“Natural” is not a synonym for “right for everyone.” According to NCCIH, people should avoid ashwagandha during pregnancy and breastfeeding. It is also not recommended before surgery, or for people with autoimmune diseases or thyroid disorders.
In addition, it may interact with medications for diabetes and high blood pressure, immunosuppressants and sedatives. The same applies to anti-seizure drugs and thyroid hormone. For this reason, anyone with liver disease, or anyone who takes several medications, should talk to a doctor before starting it.
What about longevity?
Ashwagandha fits into the growing interest in healthy longevity. The reason is simple: chronic stress, poor sleep and mental health all affect our health across the lifespan.
Even so, it is important to keep things in proportion. Some studies suggest that certain products may affect stress and sleep. By contrast, there is currently no proof that ashwagandha extends life in humans or slows aging. So at most, it should be seen as one possible tool within a broader healthy lifestyle. You can also read my practical tips on sleep and metabolic health.
The bottom line on ashwagandha safety
The ashwagandha story reflects a new stage in the supplement world. On the one hand, there is a tradition thousands of years old and a growing body of clinical research. On the other hand, the market offers a huge range of extracts that do not always resemble the ones that were studied.
The data on standardized root extracts are encouraging. Among more than 2,300 participants, there was no signal of harm to the liver, kidneys or other systems during the study period. However, long-term data are still missing, there are rare reports of liver injury, and some people need special caution.
Ultimately, precise questions will decide ashwagandha safety. Which extract, at what dose, for whom and for how long? Above all, how closely does the product on the shelf match what was tested in research? If you have questions about supplements and your own health, you are welcome to contact my clinic.
The information in this article is general and does not replace personal medical advice.
Frequently asked questions
Is ashwagandha safe?
Standardized root extracts appear relatively safe for short- to medium-term use in healthy adults. However, there is not yet enough information about very long-term use.
Can ashwagandha harm the liver?
Doctors have described rare cases of liver injury. The overall risk appears low, but it calls for attention. Caution is especially important for people with liver disease and with non-standardized products.
Is ashwagandha right for everyone?
No. People need special caution during pregnancy and breastfeeding, and for people with thyroid or autoimmune diseases. The same is true before surgery and when it is combined with certain medications.
Is ashwagandha a longevity supplement?
There is currently no clinical evidence that it extends life or slows aging in humans. Certain products may have a role in supporting stress and sleep, and both of these matter for long-term health.
References
Ashwagandha: Usefulness and Safety
TGA makes second safety alert on ashwagandha and liver injury
Ashwagandha Safety Questioned in Europe and India
Ashwagandha armed with critical safety data as industry anticipates Europe-wide assessment
