DEAR MAYO CLINIC: I struggle with stress and feeling overwhelmed. I am 52 and juggle full-time work as a wife and mother to a teenage daughter. Recently I also began caring for an elderly relative. I often snap at the slightest comment, and sleep is elusive due to the many thoughts swirling in my head. I am not the biggest fan of medication, but I recently saw an ad for Ashwagandha on social media. Can you tell me what it is and if it may benefit me? 

ANSWER: Balancing family and work responsibilities can be challenging, but when you add in other things, such as caring for others, your stress burden can feel even heavier. As a caregiver, it is important that you intentionally identify ways to care for yourself, cope and manage stress. Ashwagandha is unlikely to be the solution, but it may still be a helpful option.

First, ashwagandha is a small shrub native to India and the Middle East that has been used traditionally, or historically, for centuries.  It has commonly been incorporated to help relieve stress, slow aging, enhance athletic performance and boost energy.

For medicinal purposes, the root of the ashwagandha plant is the part that is harvested and used. Its active components are called withanolides, which are naturally occurring chemicals with anti-inflammatory properties.

Even though you mentioned not being a fan of medication, I recommend that you speak to your healthcare team before starting any supplement to ensure there are no interactions with other medications or conditions.  Generally speaking, ashwagandha is safe for most people though some get headaches and nausea.

Given your chronic stress, there is some evidence to support using ashwagandha. In fact, this is the area in which the plant has been studied the most. Ashwagandha has been given to people who live with chronic stress and has improved their stress scores. Studies have also shown improvement in cortisol levels, a biological marker of stress.

Another potential benefit of ashwagandha is sleep. Ashwagandha doesn’t appear to make people sleepy directly, but in people with anxiety, ashwagandha helps improve sleep. So, this supplement may be a good choice for someone like yourself who has trouble quieting her busy brain at bedtime.

How to take ashwagandha – and how much?

Ashwagandha comes in several forms, including pills, powder, capsules and elixirs. Most clinical trials have used concentrated liquid preparations of the root. The best products are standardized to a specific percentage of withanolides, typically between 0.3% and 1.5%.

The doses should be a maximum of 1,000 mg daily and ideally contain at least 6 mg of withanolides. This dose is believed to be safe for at least three months, probably longer but the science is lacking.

Because of its effects on stress and anxiety, ashwagandha is commonly found in combination with stress formula supplements. It is possible that the synergy between stress-relieving botanicals provides an even greater effect, but more research is needed.

As with all natural products and botanicals, good manufacturing integrity is important when selecting the brand of supplement to take. Sometimes, ashwagandha products have been made from similar but not identical plants. Take time to read reviews and read labels.

While many women could benefit from incorporating ashwagandha into their health regime, it is important to know that in and of itself, ashwagandha will not completely remove stress or anxiety from your life. Make sure you take time to do other activities, such as personal care, yoga or meditation.

I always recommend that you speak to your healthcare team before starting any new supplement. I also recommend starting slowly and tracking your dosage and how you feel. Write down changes, both positive and negative, that you notice.

Ashwagandha is possibly unsafe in pregnancy. So, if you are pregnant, could be pregnant or might become pregnant, it is best not to use it. If you find that you are continuing to suffer from sleeplessness or increasing anxiety, stress or depression, seek out an integrative health specialist or primary medicine expert who can provide additional resources.  — Dr. Denise Millstine, Primary Care/Women's Health, Mayo Clinic, Scottsdale, Arizona. 

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