Ashwagandha for Health & Longevity - Quick Reference Sheet
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Ashwagandha for Health & Longevity

Created on 09/02/2026 – Quick Reference based on Evidence Review created using AI4L / Opus 5 – Audit

A root extract that softens the body's stress response. Clearest returns: calmer stress and anxiety, faster sleep onset in poor sleepers, added strength and aerobic capacity alongside training. Memory gains are less certain; no human lifespan data. Against this sits a serious liver-injury signal, a smaller thyroid effect, and short trials paid for by the companies selling the extracts. (Full Review)

Protocol

Standard dose
600 mg daily
Root extract standardized to at least 5% withanolides. 300 mg daily is the common lower-tier protocol.
Extract selection
Named standardized extract
KSM-66 (root only, roughly 5% withanolides) or Sensoril (root and leaf, roughly 10%). The trial evidence attaches to these, not to generic root powder.
Best time of day
Evening
Matches the sedative peak to bedtime. Split 300 mg twice daily is preferred where daytime stress is the target.
Time to effect
Stress and anxiety
2–4 weeks
Reaches its measured size at eight weeks. Nothing meaningful happens acutely.
Sleep
2–4 weeks
Reaches its measured size at eight weeks; pooled benefit clearest at eight weeks or longer.
Strength and cognition
8 weeks
Strength and cognitive effects were measured at eight weeks; no trial has run past twelve weeks.

Benefits

Contraindications
  • Transplant recipients or anyone on immunosuppressants (tacrolimus, cyclosporine, mycophenolate), at any time post-transplant
  • Pregnancy, attempting to conceive, or breastfeeding
  • Chronic liver disease (cirrhosis Child-Pugh A–C, hepatitis B or C, fatty liver with scarring)
  • Baseline alanine aminotransferase above 2× upper limit of normal, or raised bilirubin
  • Hyperthyroidism, Graves' disease, or autoimmune thyroid disease on treatment
  • Hormone-sensitive prostate cancer
  • Autoimmune disease on immune-suppressing treatment (rheumatoid arthritis, lupus, multiple sclerosis)
  • Prior drug- or herb-induced liver injury from any agent
  • Within two weeks of elective surgery under general anaesthesia
    •
Key Interactions
  • Thyroid hormone replacement (levothyroxine, liothyronine)
  • Sedatives and hypnotics (benzodiazepines, zolpidem, gabapentin)
  • Antidiabetic drugs (metformin, sulfonylureas, insulin)
  • Antihypertensives (angiotensin receptor blockers, beta-blockers)
  • Hepatotoxic drugs (acetaminophen, methotrexate, isoniazid)
  • CYP3A4 and CYP2B6 substrates (statins, direct oral anticoagulants, bupropion)
  • Over-the-counter sedating antihistamines (diphenhydramine, doxylamine) and alcohol
  • Over-the-counter analgesics containing acetaminophen
  • Sedative and calming supplements (valerian, kava, melatonin, 5-HTP, L-Theanine)
  • Hepatotoxic botanicals (green tea extract, Garcinia cambogia, red yeast rice)
    •

Risk & Side Effects

  • High: Gastrointestinal upset; daytime drowsiness and sedation
    •
  • Medium: Herb-induced liver injury; thyroid hormone elevation and thyrotoxicosis
  • Low: Headache; loss of immunosuppressant effect and transplant rejection; under-dosed and contaminated products
  • Speculative: Reproductive toxicity from non-root plant parts; harm in pregnancy and lactation

Monitoring

Marker Target Why
Alanine aminotransferase 10–26 U/L (men), 8–22 U/L (women) Primary detector of the reported liver injury
Aspartate aminotransferase 10–26 U/L Confirms liver-cell injury; separates liver from muscle sources
Alkaline phosphatase 45–90 U/L The bile-flow marker; often moves first in the reported injury
Total bilirubin 0.3–1.0 mg/dL Jaundice is the presenting sign; a rise marks serious injury
Thyroid-stimulating hormone 0.5–2.0 mIU/L Detects the small thyroid effect, visible only on replacement or at borderline values
Free thyroxine 1.0–1.5 ng/dL Thyroxine is the thyroid parameter that actually moves
Total and free testosterone (men) Total 600–900 ng/dL; free 15–25 pg/mL The documented male-specific hormonal response
Morning serum cortisol 10–15 µg/dL at 8 a.m. The proposed mechanism marker; falls substantially in pooled data
Fasting glucose 75–86 mg/dL Modestly lowered; matters alongside insulin or sulfonylureas
Complete blood count Within reference limits, no downward trend Screens for the blood-cell changes assessed in safety trials; none were found

Cadence: Liver panel before starting; liver enzymes at 8–12 weeks, then annually. Thyroid-stimulating hormone at 8 weeks on replacement or borderline; testosterone at 12 weeks in men tracking it. Stress and sleep questionnaires at 4 and 8 weeks.

Qualitative Assessment

  • Sleep-onset latency and night awakenings, recorded nightly rather than recalled weekly
  • Perceived stress and irritability, on a repeated validated questionnaire
  • Morning energy and daytime drowsiness, the latter separating benefit from over-sedation
  • Cognitive clarity, sustained attention and working memory during demanding tasks
  • Training performance: session quality, next-day soreness and recovery
  • Libido and sexual function in men, where the hormonal response is measurable
  • Gastrointestinal comfort, particularly in the first two weeks
  • Yellowing of skin or eyes, dark urine, unexplained itching or right-upper-abdominal discomfort — the trigger for immediate discontinuation
Not medical advice. Educational distillation of a single evidence review. Confirm any decision with a qualified clinician, especially in the presence of prescription drugs or chronic conditions.