Should Ashwagandha Be Avoided In Those With Graves’ Disease and Hashimoto’s Thyroiditis?

Recently I attended an autoimmune conference via livestream, and one of the presenters was talking about the different herbs that can be beneficial in people with autoimmune conditions.  One of the herbs he spoke about highly was ashwagandha, which is an herb I absolutely love.  However, ashwagandha is also a member of the nightshade family, and those with autoimmune conditions are supposed to avoid nightshades.  And so the question I plan on answering in this blog post is whether or not those with autoimmune thyroid conditions should avoid taking ashwagandha.

But before I answer this question, I first want to answer this question: why would someone with an autoimmune thyroid condition want to take ashwagandha in the first place?  Ashwagandha, which is also known as Withania somnifera, is an adaptogenic herb.  It helps to support both the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes.  As a result, it can help people who have HPA axis dysregulation as a result of chronic stress, and by supporting the HPT axis it can also help to support thyroid function.

However, we need to remember that Graves’ Disease and Hashimoto’s Thyroiditis aren’t thyroid conditions, but are autoimmune conditions.  And so we also need to consider the effects of ashwagandha on the gut and immune system.  In the opening paragraph I mentioned how ashwagandha is part of the nightshade (Solanaceae) family, and how nightshades are excluded from an autoimmune Paleo diet.  But while it might make sense to avoid nightshade vegetables since they have compounds which can cause inflammation, does it make sense to avoid an herb like ashwagandha that has anti-inflammatory properties?  I’ll answer this question later on in this post.

What Are Some of The Health Benefits Of Ashwagandha?

If you’re wondering why ashwagandha is commonly recommended by healthcare professionals, it’s because this herb has many different health benefits.  Here are just a few of the benefits of ashwagandha:

Helps With Stress and Anxiety.  This is probably the main reason why many natural healthcare professionals recommend ashwagandha.  Without question this is one of the primary reasons why I sometimes recommend ashwagandha to my patients, as besides seeing some wonderful benefits of ashwagandha in some of my patients, the research shows that ashwagandha can help people to better adapt to stress and anxiety (1) (2).  Of course taking ashwagandha isn’t meant to be a replacement for eating well and incorporating mind body medicine techniques, but it can help to provide additional support in those who are dealing with high levels of stress and anxiety.

Modulates the Immune System and Reduces Inflammation.  This is one of the main arguments for using ashwagandha in those with autoimmune conditions.  Even though this herb is part of the nightshade family, and while nightshades can cause inflammation in some people, there is a lot of research which shows that ashwagandha has anti-inflammatory properties (3) (4) (5).  And some of these studies even involve autoimmune conditions, such as rheumatoid arthritis (6) (7).  One of these studies showed how ashwagandha significantly suppressed lipopolysaccharide (LPS) induced production of proinflammatory cytokines TNF-alpha, IL-1beta, and IL-12p40 in both normal individuals and patients with rheumatoid arthritis (7).  Another study showed that ashwagandha can help with chronic renal dysfunction by reducing inflammation (8).

Helps With Insomnia.  Ashwagandha also can help some people who are dealing with insomnia.  One way it does this is by lowering cortisol levels, although one study showed that this herb might help with insomnia by increasing levels of the neurotransmitter GABA (9).  However, a recent study from 2017 shows that triethylene glycol, which is an active component of ashwagandha, might be a sleep-inducing component of this herb (10).  However, the study mentioned that this component is in the leaves of ashwagandha, and usually the root is used in most ashwagandha supplements.

Improves Sexual Function and Fertility.  One study I came across showed that ashwagandha can help to improve sexual function in women (11).  I’m sure some of this is due to the effect of ashwagandha on the HPA axis, as in order to have healthy sex hormones you need to have healthy adrenals, and for more information on this I would read a blog post I wrote entitled “The Negative Impact of The Pregnenolone Steal“.  There is also evidence that ashwagandha can help males with a low sperm count (12).

Cognition.  A few studies show that ashwagandha can help to improve cognition and might even be helpful with certain neurodegenerative diseases, including Alzheimer’s disease (13) (14) (15).

Muscle strength and recovery.  One study I came across showed that taking an ashwagandha supplement is associated with significant increases in muscle mass and strength (16).

A Few Things To Know Before Purchasing An Ashwagandha Supplement

There are a few things you should know before you purchase an ashwagandha supplement.  First of all, you want to make sure you are purchasing a supplement that uses ashwagandha root.  Although most manufacturers of ashwagandha supplements do use the root, there are some that solely use ashwagandha leaves.  And while I did mention the study earlier that spoke about how triethylene glycol is found in the leaves, most of the studies demonstrating the beneficial effects of ashwagandha have used the root.  Of course if you can find a formulation that has both the leaves and the root then this is an option to consider, although using a product that just has the root should be fine in most cases.  In addition, typically the higher the concentration of withanolides the better, and this should be listed on the product label.

Why Are Nightshades Excluded From An Autoimmune Paleo Diet?

For more detailed information on nightshades you can read an article I wrote entitled “Nightshades and Thyroid Health”.  The main problem with nightshades is that they have compounds which can cause problems  in those with autoimmune conditions.  These compounds include lectins, alkaloids, and glycoalkaloids.  And the reason why these are problematic is because they can cause inflammation, and in some cases can even lead to an increase in intestinal permeability.  In other words, consuming nightshades might cause or contribute to a leaky gut, which is theorized to be a factor in all autoimmune conditions.

Based on this information it makes sense to look at some of the compounds found in ashwagandha.  According to the research, the roots of ashwagandha contain several alkaloids, withanolides, a few flavanoids and reducing sugars (17) (18) (19).  The active compounds reported in ashwagandha include the following (19):

• Sitoindosides VII–X
• 5-dehydroxywithanolide-R
• Withasomniferin-A, 1-oxo-5β
• 6β-epoxy-witha-2-ene-27-ethoxy-olide
• 4-(1-hydroxy-2,2-dimethylcyclpropanone)-2,3-dihydrowithaferin A
• 2,3-dihydrowithaferin A
• 24,25-dihydro-27-desoxywithaferin A
• Physagulin D (1→6)-β-d-glucopyranosyl-(1→4)-β-d-glucopyranoside
• 27-O-β-d-glucopyranosylphysagulin D
• Physagulin D, withanoside I–VII
• 27-O-β-d-glucopyranosylviscosalactone B
• 4,16-dihydroxy-5β
• 6β-epoxyphysagulin D
• Viscosalactone B
• Diacetylwithaferin A

Although I did do some research on these compounds, I admit that I need to do more.  I didn’t realize how many active compounds are in ashwagandha.  From the research I have done so far, most of these compounds should be beneficial in people with Graves’ Disease and Hashimoto’s Thyroiditis.  After all, the compounds in ashwagandha can help those dealing with stress and anxiety, which describes many people with these conditions.  And of course ashwagandha can have a positive effect on immune system health by decreasing inflammation, which is also a factor in thyroid autoimmunity, as well as other autoimmune conditions.

However, even though these compounds have beneficial effects, this doesn’t mean that everyone with an autoimmune thyroid condition can safely take ashwagandha.  If you do some searching on your own you’ll no doubt find some people with autoimmune conditions who had negative symptoms when taking ashwagandha.  On the other hand, you’ll also come across people with Graves’ Disease and Hashimoto’s Thyroiditis who have benefited from taking ashwagandha.  And this pretty much describes most of my patients, as while I don’t give ashwagandha to everyone, most of my patients who have taken ashwagandha haven’t had any negative side effects.  On the other hand, over the years I’ve had a few patients who didn’t do well when taking ashwagandha.

What’s interesting is that some people who don’t do well when eating nightshades such as tomatoes, eggplant, and peppers have no problems taking an ashwagandha supplement.  Is it possible that ashwagandha is causing inflammation in these people, but just not causing any overt symptoms?  Of course this is a possibility to consider, but I will add that it seems that most people who don’t do well when eating the nightshades experience overt symptoms, and I find this to be the case with those who don’t do well when taking ashwagandha supplements as well.

Should YOU Avoid Ashwagandha?

Sarah Ballantyne, author of the Paleo Approach, does a lot of research with regards to the autoimmune Paleo diet, and she excludes ashwagandha from the AIP diet.  However, in one of her posts she did mention (under the comments section) that many people who can’t tolerate nightshades seem to do okay with ashwagandha, and I also find this to be the case with many of my patients.  Over the years I have had many patients with autoimmune thyroid conditions do fine with ashwagandha.

Does this mean that taking ashwagandha is completely safe for those with Graves’ Disease and Hashimoto’s Thyroiditis?  I wouldn’t necessarily say this, as while many people with autoimmune thyroid conditions do fine with this herb, there are some people who do have a negative reaction.  As a result, when following a strict AIP diet it probably is a good idea to avoid ashwagandha during this time.  But of course everything comes down to risks vs. benefits, and there are times when I’ll recommend ashwagandha to a patient with thyroid autoimmunity.  Most of the time this won’t cause any problems, but of course if the person does experience a negative reaction, or if they don’t seem to be progressing when taking ashwagandha, then they obviously should stop taking it.

In summary, although those with autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis are supposed to avoid nightshades, many people do fine when taking ashwagandha.  This herb has numerous health benefits, such as helping people to better adapt to stress and anxiety, reduces inflammation, helps with insomnia, cognition, muscle strength and recovery, and can even improve sexual function and fertility.  However, there are some people that don’t do well when supplementing with ashwagandha, and if this describes you then of course it is best to avoid it.