Can this 4,000-year-old adaptogenic herb really help with weight loss, hypothyroidism, adrenal problems, and low sex drive?
I'm going to make the case (through a combination of scientific studies and personal experience) that Ashwagandha can/may help you with these stubborn conditions.
If you've been considering the use of Ashwagandha for any of these conditions please read this entire post which will outline not only what conditions this adaptogen will treat, but also how to properly take it and for what length of time.
Let's start by talking about how Ashwagandha can actually help treat weight loss resistance and who should consider using it...
Ashwagandha and Weight Loss
We are going to talk about the many benefits of Ashwagandha as it relates to hormone balance (including thyroid, adrenal, and sex hormones) but first, it's worth spending some time on how it alters weight.
To start let's answer the question:
Does Ashwagandha help with weight loss?
The truth is that this adaptogen has many beneficial properties that may actually influence weight loss and help some patients lose weight.
Now, this weight loss is not likely to be dramatic on its own, but if coupled with other therapies then ashwagandha may increase total weight loss.
And this is indeed how I use this adaptogen in my practice.
Never as a stand-alone supplement designed for weight loss by itself, but instead as part of a comprehensive treatment plan that will augment weight loss efforts.
So let's talk about how this Ashwagandha helps with weight loss using scientific studies and a touch of logic.
5 Ways Ashwagandha may Help with Weight Loss:
Remember we are going to be using our current understanding of weight loss, mixed with scientific studies showing the beneficial side effects of this adaptogen.
#1. Increases muscle mass
Hopefully, I don't need to convince you that the more muscle mass you have on your body, the higher your metabolism will be (1).
Not only does muscle mass increase your resting energy expenditure (AKA your metabolism) but it also improves longevity and leads to long-lasting and sustained health throughout life.
Think of it like this: your quality of life is improved, you're less likely to fall and break bones, you're more likely to maintain testosterone levels (and other hormones), etc.
So how does Ashwagandha fit in?
It turns out that studies have shown (2) that supplementation with Ashwagandha significantly increases muscle mass and strength.
This effect can be compounded with the addition of high intensity (slow weight training) to further maximize the benefits of muscle growth.
- Bottom line: Ashwagandha can help boost muscle mass and strength which may lead to an increase in your metabolism which may improve weight loss.
#2. Increases energy levels
This is another benefit that shouldn't need too much explanation.
As an adrenal adaptogen and as an Ayurvedic herb increasing energy is one of its main functions!
But let's also bring some science into the mix to talk about how this might be.
In this study (3), long duration cyclists taking Ashwagandha showed improvement in VO2 max, METS and time till exhaustion compared to other cyclists who were taking a placebo supplement.
What's even more interesting is how this likely happens:
Ashwagandha and other peripheral adaptogens can increase mitochondrial energy production by utilizing oxygen consumption and delivery, by increasing vascularity and by increasing the density and utilization of mitochondrial enzymes.
The net result is the increase in the subjective sense of energy that many patients feel while using Ashwagandha.
- Bottom line: Ashwagandha helps increase energy levels by increasing oxygen consumption and delivery in mitochondria (the powerhouse of the cells). This results in a subjective increase in energy levels.
#3. Boosts Thyroid Function
Proper thyroid function is critical to maintaining normal body weight.
Because your thyroid (in conjunction with other hormones) helps set the metabolism of your entire body.
T3 thyroid hormone is a major regulator of mitochondrial energy production (4) (and recall that mitochondrial energy production is what gives you energy and burns fat).
Not only does T3 set your baseline metabolism, but it's also responsible (in part) for your subjective sense of energy.
Ashwagandha has shown to increase free T4 levels (5) providing more substrate for T3 conversion (it gets a lot better and we will discuss the benefits to thyroid function below).
In this particular study, there was a random patient who also had subclinical hypothyroidism as diagnosed by TSH testing that was found to normalize after the use of Ashwagandha.
- Bottom line: Ashwagandha may improve thyroid function by helping to increase T4 levels of thyroid hormone. T4 is the substrate for T3 and T3 thyroid hormone sets your metabolism and energy levels.
#4. Improves sleep
If you didn't already know, a general lack of sleep (6) (this includes both a decrease in quality and length of sleep) can lead to weight gain.
This occurs through several mechanisms including changes in glucose homeostasis and inflammatory levels all of which lead to hormone imbalances that promote weight gain.
This makes addressing sleep very important if you are trying to lose weight.
In fact, the impact of lack of sleep on weight gain (and prevent weight loss) is so powerful that this becomes one of my main concerns when I treat patients.
Not addressing sleeping issues will blunt your weight loss efforts significantly.
And that's where Ashwagandha comes in:
Ashwagandha has been shown to improve the quality of sleep (7) and actually help some patients fall asleep.
This benefit seems to occur without addressing the length of sleep, so the mechanism of action is likely in the GABA pathway (or some other neurotransmitter pathway).
- Bottom line: Ashwagandha helps improve the depth and quality of sleep which may help patients with a general lack of sleep lose weight and improve glucose parameters.
#5. Helps manage stress
Stress (a nebulous term but one that we will define soon) has been shown many times to be associated with weight gain (8).
You might not have realized it, but look back on a time in which you were under a lot of stress - did you gain weight? did you lose sleep? did your eating habits change?
You may have noticed that MANY of these negative changes that alter weight seem to go together.
This response seems at least in part to be mediated through the hormone cortisol.
Cortisol is your stress hormone (released in response to perceived stress) and part of its release changes other hormones which allow the body to "handle" the stress that you are under.
So how does Ashwagandha help?
This adaptogenic herb helps the body tolerate stress by influencing stamina (9).
It also likely plays some role in cortisol regulation (most likely at the receptor level) to help the body "manage" high levels and prevent "tolerance" or receptor resistance.
- Bottom line: Ashwagandha helps the body tolerate and manage stress levels by improving stamina and likely impacts cortisol levels in some way. These benefits help blunt the negative effect that high cortisol has on weight.
Now I want you to take a minute and let what we just discussed sink in.
We talked about (and showed through many studies) that weight gain really isn't a product of calories.
Instead weight gain (and thus weight loss) is more a function of hormone levels and hormone balance than anything else.
This is why a comprehensive approach which includes evaluation of hormone levels, nutrient levels, and lifestyle factors will always be superior for weight loss than other methods.
Ashwagandha & Thyroid Function
Another huge benefit of using Ashwagandha is in its ability to improve thyroid function.
When we talk about using Ashwagandha there are 3 main categories of people (and conditions) where patients should consider using this adaptogen.
These 3 categories include:
- Patients with Weight loss resistance (we discussed this group above)
- Patients with Hypothyroidism <--- this group is our focus right now
- Patients with Adrenal related problems (we will discuss this group below)
Generally what you will find is that these 3 conditions tend to accompany each other, for reasons explained above.
What's important here is that we discuss how Ashwagandha can positively influence thyroid levels in the body and why you might want to consider using Ashwagandha if you have thyroid related problems.
That basically means you have 1 in 7 to 1 in 8 chance of having hypothyroidism.
This number is likely much higher but due to our current system and paradigm of diagnosis and management, it's probably incorrectly suppressed.
If you know for sure you have hypothyroidism then keep reading, if you feel you meet all of the symptoms of hypothyroidism but your tests are normal I would recommend you check out this post which outlines why standard thyroid lab testing is not very accurate.
If you have hypothyroidism and remain somewhat symptomatic (despite treatment with thyroid hormone) then this information should be very helpful to you.
Boosting Thyroid Function Naturally
When we talk about thyroid function we are predominately concerned with the hormone T3.
T4 is the inactive hormone and must be converted into T3 in order to be active.
To get an idea of what else you can do to boost T3 naturally you can check out this post.
So how does Ashwagandha help thyroid patients?
Ashwagandha has been shown in studies to do several important things:
So let's talk about these benefits...
First the increase in total T3.
This is obviously beneficial because the T3 thyroid hormone is the ACTIVE thyroid hormone.
Increasing this hormone is of utmost importance if you are looking for symptomatic improvement in your hypothyroid symptoms.
In fact, this increase has been shown to be so potent that case reports have been cited as causing thyrotoxicosis (13) in a small handful of patients.
This risk for thyrotoxicosis is likely VERY small but still remains present nonetheless.
In general, other studies have shown that this increase in T3 is actually very small (but noticeable).
Second - the increase in free T4 levels.
This is another beneficial effect, but thyroid conversion must be taken into account when we talk about T4 levels.
And this may be the only place that Ashwagandha falls short in regards to thyroid function.
Ashwagandha (by itself) doesn't appear to increase T4 to T3 conversion. Instead, it increases individual thyroid hormones (and perhaps thyroid hormone availability).
The increase in T4 hormone is beneficial provided your body has no issues with thyroid conversion - but this isn't true for everyone.
One benefit to Ashwagandha is in its effects on cortisol levels which might positively influence thyroid conversion but through an indirect way.
Still - using Ashwagandha is still worth it if you have hypothyroidism, but potential downsides should be noted.
And third, Ashwagandha has been shown to improve subclinical hypothyroidism.
This might actually be one of the best and hidden benefits of Ashwagandha as it relates to thyroid function.
Because patients with subclinical hypothyroidism are often misdiagnosed and undertreated!
Subclinical hypothyroidism is defined as a TSH that is outside of the "standard" reference range in a patient who still has symptoms of hypothyroidism.
This nomenclature likely stems from the reluctance of providers to correctly diagnose and treat hypothyroidism because in reality patients with subclinical hypothyroidism still have hypothyroidism.
Having said that, a diagnosis of subclinical hypothyroidism usually goes untreated and this is where ashwagandha comes in.
Patients who fall into this category often have to seek resources and treatment themselves.
In one study ashwagandha was shown to improve the TSH levels in a patient with subclinical hypothyroidism and bring them back into the normal range.
This gives patients with this condition at least some form of treatment that they can trial and use if appropriate for their situation.
Ashwagandha & Adrenal Function
As you may have noticed all of these conditions (weight gain, hypothyroidism, and adrenal related-problems) are connected in some way.
Many patients who deal with one condition have a high chance of experiencing these other conditions listed.
Because each hormone influences other hormones in the body.
Take for instance the relationship between cortisol and TSH.
It has been shown that high TSH (14) (hypothyroidism) correlates with high cortisol levels (adrenal related problems).
What you may not have realized is that the term adrenal related problems is an umbrella term meant to encompass all aspects of cortisol levels and changes and it simply doesn't do the condition justice.
Instead of thinking about adrenal fatigue as simply high or low cortisol we really need a better system to evaluate cortisol to target treatment.
In reality, there are 3 main conditions as it relates to cortisol:
1) Low cortisol levels, otherwise known as hypocortisolism (these cortisol levels are low by the standard reference range but not low enough to be considered in the Addisonian range)
2) Normal cortisol levels usually accompanied by cortisol receptor resistance (often serum levels are preserved and remain "normal" in this condition)
3) High cortisol levels are known as hypercortisolism (serum cortisol levels in this condition can be outside of the reference range or on the high end of "normal")
Things get confusing when you consider that many of these conditions share similar symptoms.
And I think that's probably a big reason for the confusion surrounding adrenal fatigue and other adrenal related problems.
For today's discussion, we are going to focus on #1 and #2 because this is where Ashwagandha can be helpful.
#3 should be treated differently and usually reflects other hormonal changes in the body so we won't discuss that at length.
Symptoms of Adrenal problems + When to use Ashwagandha
The combination of symptoms + lab tests can help to identify which group you fall into and how cortisol may be impacting your health and symptoms.
Many patients with "normal" or "low normal" cortisol ranges tend to present with the following symptoms:
- Fatigue throughout the day with high energy levels at night (especially around 9-10pm)
- The sensation of being "wired but tired"
- Inability to get quality sleep, or difficulty falling back to sleep after waking up
- Racing mind, anxiety or lability in mood
- Inability to tolerate stress (sensation of being "overwhelmed")
- Weight gain, weight loss resistance or inability to lose weight
- Other hormonal problems like hypothyroidism, estrogen dominance and/or insulin resistance
- Specific food cravings, especially for carbohydrates & sugars
- Reliance upon stimulants such as caffeine (though often accompanied with a mid-afternoon crash around 2-3pm)
The list continues, but these are probably the most common signs and symptoms of adrenal related problems that I see day to day.
What you may notice is that many of these symptoms of adrenal problems overlap with hormonal problems like hypothyroidism (you can see a complete list of hypothyroid symptoms here).
If you are experiencing any or all of these symptoms then there is a good chance you have adrenal related problems in some form.
The next step would be to check your cortisol levels.
There are many ways to do this (and I won't go into detail here), but generally checking your 8 am serum cortisol levels is sufficient to start.
Many places will tell you to check expensive salivary and even urinary levels (which may be important) but are not always necessary to start.
You can get a lot of information from serum tests alone if you know what to look for.
If you have the symptoms outlined above with either "normal" or even "low" serum cortisol levels then Ashwagandha may help to reduce your symptoms and improve your energy levels.
Recall that high levels of serum cortisol need to be treated differently and won't be discussed in detail here.
So how does Ashwagandha help those with low and even normal cortisol levels?
Ashwagandha may help those with normal-high cortisol levels by helping the body tolerate stressful scenarios.
It has been shown in studies (15) that mean serum cortisol levels in the 14-16 range were lowered to around the 10-11 range after 60 days of using Ashwagandha.
These patients also experienced a significant reduction in stress as measured by the standard stress assessment forms.
Ashwagandha also appears to work by balancing (and reducing in some cases) adrenal hormone enzyme pathways (16).
Some studies have shown that androgen metabolites and even cortisol precursors (17) are reduced by long term use with Ashwagandha.
- Bottom line: Ashwagandha helps treat adrenal fatigue by normalizing serum cortisol levels in addition to balancing adrenal enzyme pathways. It's also possible this adaptogen may exert effects at the cellular level as well.
Treats Depression and Mood Disorders
I'm going to include a few other special benefits of Ashwagandha in addition to the three main categories listed above.
Because as I mentioned previously these symptoms and conditions tend to go together.
And because there are so many options in terms of supplements and vitamins, it's best to pick supplements that "kill two birds with one stone".
If you have thyroid problems + adrenal problems + depression then Ashwagandha may help you treat all of the conditions at once, as opposed to taking different supplements for each difference.
No matter how you look at it Ashwagandha has been shown to help both clinical anxiety and clinical depression (in addition to other mood disorders).
The effect of this adaptogen is comparable to even some prescription medications (18).
This benefit seems to stem from beneficial changes to neurotransmitter levels, particularly GABA levels (19).
- Bottom line: Ashwagandha should be considered if you have depression in addition to adrenal problems, thyroid problems or weight loss resistance. The benefit to mood likely has something to do with balancing neurotransmitter and GABA levels.
Using Ashwagandha to Boost Libido and Sex Drive
I probably don't need to let you know how important normal sex drive is as it relates to quality of life.
In fact, I recently wrote an entire article on how to deal with low sex drive (especially in women) so if you are struggling with low libido check out this post.
What's important to realize about low libido and low sex drive is that it almost always indicates some sort of hormone imbalance.
It's not normal for women (or men) to have a low sex drive for no reason.
So if you are experiencing low sex drive then it's important to get a hormonal evaluation (discussed in the post linked to above).
But what we are going to discuss today is how Ashwagandha can help improve sex drive and libido.
Some studies have shown that the use of Ashwagandha and help improve sexual function (20) in normal healthy women.
These studies also exist for men as well (21).
The benefit to sex drive appears to be secondary to Ashwagandhas ability to increase serum testosterone levels and balance pituitary sex hormones (22).
- Bottom line: Ashwagandha can help improve libido and sex drive in both males and females most likely through its impact on serum Testosterone levels (it leads to an increase in testosterone). This effect likely also plays a role in why Ashwagandha helps increase lean muscle mass.
How to Supplement for the Best Results:
How to Supplement with Ashwagandha
How to Use
- Dosage varies from 500-2,000 mg per day depending on tolerance and degree of symptoms
- Length of treatment varies by condition, for adrenal fatigue supplementation as long as 6+ months may be required.
My Recommended Brand and Product:
If you're interested in taking Ashwagandha to experience the positive effects I have noted above then spend some time going over how to properly use the medication, the length of time necessary for treatment, and tips/tricks to get the most benefit.
Like any other supplement, Ashwagandha may not provide you with 100% relief.
There is variability in terms of how each person metabolizes and utilizes nutrients and supplements and there is no way to determine if a supplement will benefit you prior to using it.
Having said that, I've successfully used this adaptogen for all of the conditions we discussed in detail above and have found great success.
I should point out though, that in order to get the best results you will want to use Ashwagandha as part of a comprehensive treatment plan and not in isolation.
Just so we are clear:
Taking Ashwagandha alone likely won't cause a huge difference in your symptoms.
Also, after we are done going over how to properly use this adaptogen I will give you the product that I recommend and the one I've been using in my clinic.
#1. Therapeutic Dosage
For maximum benefit, you will want to use a supplement that contains Withania somnifera extract root which has been standardized to contain 2.5% withanolides.
This will ensure that you are getting a quality product.
In my experience, most patients will need somewhere between 500-2,000mg per day.
Generally, I recommend starting out with a smaller dose of 500mg per day and titrating your dose up every 2-3 weeks as necessary.
This will ensure a smooth transition and should reduce any potential negative side effects.
#2. When to take it for the most benefit
I recommend taking this supplement without food (if possible) and if you know you don't have any gastric or GI related issues.
These issues may limit absorption.
If you have a known condition such as low stomach acid then taking your supplement with food may be of most benefit to ensure proper absorption.
Take care to avoid taking this supplement with other binders including anything containing calcium or viscous fiber such as glucomannan.
I also recommend taking this supplement away from thyroid medication.
In addition, Ashwagandha can be taken in the morning (as long as you don't find it stimulating) or in the evening (if you find that it has a calming effect). This process is individualized and may take some adjustment on the part of the patient.
#3. Combining Ashwagandha with other Supplements
Ashwagandha can be combined with other adaptogenic herbs and/or adrenal supplements to get a boost.
In fact, this is how I generally recommend this supplement to patients of mine.
Generally, patients present with multiple nutrient deficiencies and other problems that should be addressed concurrently along with adrenal/thyroid problems.
In this case (and for cases of extreme fatigue) it's often helpful to combine Ashwagandha with other adaptogens like Rhodiola, Cordyceps and/or Panax ginseng.
I will often pair Ashwagandha with this supplement for maximum benefit.
#4. Length of Treatment
The length of treatment will vary on individual and degree of the problem, but in general, I want you to think of therapy on the order of months.
Often times the minimum length of treatment time for adrenal related problems tends to be 6 months, and this can extend all the way up to 18+ months.
For thyroid related problems, and depending on the cause of your hypothyroidism, a standard 3-month trial should be used at a minimum.
For libido, 2-3 months is sufficient to determine if this product is working for you.
For depression, a minimum of 3 months should be used before you pass judgment on whether this supplement is working for you.
If muscle mass and weight loss is your primary concern, then as little as 60 days should be sufficient to notice an improvement (reduction) in weight and muscle mass.
Review + Recap
Ashwagandha is a great herb that may benefit multiple different medical conditions.
In my opinion, it seems to have the most beneficial effect on the following conditions:
- Weight loss resistance
- Hypothyroidism + Hashimoto's thyroiditis
- Adrenal related problems (predominately hypocortisolism and cortisol receptor resistance)
- Depression and other mood disorders
- And low Libido/decreased sex drive
While this adaptogen may work in other conditions, these are the conditions that I have personally tested and have seen significant results in my patients.
If you determine that Ashwagandha may be right for you based on a combination of symptoms + known diagnoses, then a trial of at least 60 days (or longer depending on condition) may be warranted.
Remember to give it enough time to kick in and you might be surprised by the results.
Now it's your turn:
Are you currently taking Ashwagandha?
Has it helped you? Why or why not?
Leave your questions or comments below!
References (Click to Expand)