Ashwagandha Effects

Ashwagandha Effects

Ben Bunting BA(Hons) PGCert Sports and Exercise Nutrition Level 2 Strength and Conditioning CoachWritten by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.

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There is a lot of history behind the use of Ashwagandha (Withania Somnifera). In this article, we analyze its use, benefits, and effects

This article is supported by 72 cited references from reliable and reputable sources. 

How Does Ashwagandha Work?

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It is a simple enough question, and considering it is included in some sports and fitness supplements it must have some positive benefits.

In this article we shall cover the following topics:

  • What is ashwagandha
  • Ashwagandha use and benefits
  • Is Ashwagandha safe?
  • How to take ashwagandha
  • The take-home

What is Ashwagandha?

Ashwagandha is a herb which is commonly known as Withania Somnifera.

It has been used for millennia in traditional medical practices due to its supposed ability to promote feelings of youth and happiness.

As a result, it was given to the very young and old as a tonic to improve health and longevity.

The herb stems from a shrub that tends to hail from India, although it is grown and cultivated in other areas of dry stony soil such as China, Yemen, and Nepal.

Its physical characteristics include dark green leaves with green flowers but it does include a small orange-colored fruit. However, it is mainly sold or comes as a fine powder once processed.

Yet one of its most defining characteristics is not visual but actually its smell which is reported to be similar to that of a horse.

Therefore it is not surprising that learn that the name derives from the ancient Indian language of Sanskrit which means literally 'horse smell'.

Due to its phytochemical structure being similar to that of Panax ginseng it is often called Indian Ginseng. [1]

Ashwagandha Use and Benefits

Being hailed and compared to Panax Ginseng deserves some further investigation. 

What does Ashwagandha do?

According to the ashwagandha studies, there's plenty to get excited about.

We'll break this down into the key areas.

Insomnia

Insomnia is much more widespread than you may think. It is reported to affect up to 12% of the population of the US. [2]

Due to the highly disruptive nature of Insomnia, it is considered a serious public health concern.

There are three types of insomnia, and each classification is based around the amount of time a person is experiencing this sleep disorder.

The International Classification of Sleep Disorders [3] designates them as:

  1. Mild
  2. Moderate
  3. Severe

Let's take a look at the characteristics of each classification to get a better understanding of each.

Mild

This is a condition of irregular insomnia with little in the way of evidential cause. It may only happen a few times per week.

Moderate

This happens every night and prevents sufficient sleep to feel refreshed and can affect work and life relationships or performance.

Severe

This is a nightly episode of insufficient sleep and rest which has a significant impact on your social and occupational performance and relationships.

There are a variety of reasons why a person may suffer from Insomnia according to the UK's National Health Service. [4]

The most common causes are per the list below:

  • Stress, anxiety, depression
  • Noise
  • Extreme room temperatures
  • Uncomfortable beds
  • Drugs, alcohol, stimulants
  • Shift patterns
  • Jet Lag
  • Military operations and deployments

However, there could also be additional factors causing insomnia, these can be:

  • Pain
  • Sleepwalking
  • Sleep apnoea
  • Nightmares
  • Overactive thyroid
  • Restless leg syndrome
  • Mental health disorders
  • Alzheimer's or Parkinson's

As a result, insomnia can have a major impact on a person's health and well-being.

While there are some factors such as stress and anxiety that may cause insomnia, insomnia itself can potentially exacerbate these issues further according to the Anxiety and Depression Association of America. [5]

Furthermore, it is reported that prescription sleeping tablets come with some unwanted side effects, plus they do not cure the issue and become less effective over time. [6]

However, there has been an ashwagandha study which highlights the benefit of this herb for treating insomnia.

A placebo-controlled study of 60 patients over a 10 week period demonstrated that a twice-daily dose of 300mg of ashwagandha (the same amount included in Military Muscle) demonstrated to improve all sleep assessment parameters. [7]

These results provide a potential use of this natural herb to reduce insomnia and anxiety whilst being well-tolerated.

This evidence is further supported by research from 2011 on mice which saw that ashwagandha contains a potent molecule which is responsible for inducing sleep while not consisting of any unwanted dependency or side effects. [8]

Ashwagandha and Anxiety

Ashwagandha Effects

Anxiety has been described by the Royal College of Psychiatrists as being like fear. [9]

They also say that certain levels of anxiety can be helpful and spur us on to deal with issues or problems we may have while also physically preparing us for attack or the need to flee in danger.

This can actually help us to perform better as your body releases hormones such as adrenaline and cortisol. [10]

However, the issues arise when the feelings of anxiety continue or they become too intense. This can have a negative impact on your life and relationships.

One such outcome is the possibility of depression as continued anxiety can make you feel low, uneasy, and worry more.

So where does ashwagandha fit in?

A study published in 2009 saw that 300mg of ashwagandha daily over a period of 12 weeks significantly reduced the scores on the Beck Anxiety Inventory (BAI).

Post-treatment also saw an improvement of various health parameters including concentration, mental health, vitality, fatigue, and social functioning. [11]

In addition, a review of no less than three studies published in The World Journal of Biological Psychiatry involving ashwagandha to treat the symptoms of anxiety all came back with positive success and limited to no unwanted side effects. [12] 

Cortisol

Cortisol is a stress hormone, as mentioned in regards to anxiety, cortisol is released by the body in times of fear or uncertainty.

As previously discussed it can be helpful, it can heighten the senses and make you more alert. It can effectively save your life in times of danger.

That's because if there is physical or psychological threat cortisol releases surges. Being a catabolic hormone it breaks down fats and tissue for energy. [13]

However, just like anxiety, too much cortisol or continued cortisol release can put your overall physical and psychological health at risk.

This is because it can cause a number of unwanted symptoms such as the following as outlined by the University of Utah and a published report from the Journal of the American Physical Therapy Association. [14]

These symptoms can contribute to a decline in your day-to-day function which can have a negative impact on your overall quality of life.

Ashwagandha and cortisol, the effects

Ashwagandha has been described as a safe and effective adaptogen, that is, a herb that combats stress.

A study into the effects of stress and cortisol released in 2012 demonstrated that a daily dose of 600mg of ashwagandha safely reduced stress and substantially reduced cortisol levels. [15]

Further review and research into ashwagandha ad its effects on chronically stressed humans also found that on three separate occasions it was able to significantly reduce cortisol levels and feelings of stress. [16]

Ashwagandha for Depression

To be depressed affects people in different ways and cannot be comprehended by people who are not suffering from this condition.

It is described by Mind, the mental health charity, as being a low mood that is continuous and lasts for a very long time. [17]

Depression is a low mood that can be debilitating to everyday life and can affect your occupation, social function, and relationships.

Living with depression can make everyday tasks challenging, in extreme cases it can make people suicidal.

Furthermore, depression can affect anyone, of any gender, nationality, race, wealth or success.

It has been reported by the World Health Organization that over 300 million people worldwide are living with the illness. [18]

Sufferers of depression have different explanations of the feelings, yet mention that they feel isolated, numb, empty and smothered.

While these are anecdotal feelings, there are symptoms for depression, and it is said that having depression is also a symptom of other mental health issues such as bipolar disorder or schizoaffective disorder.

Further symptoms can include but are not limited to the following:

  • Low energy
  • Reduced appetite
  • Anxiety
  • Lack of concentration and focus
  • Restlessness
  • Guilt
  • Worthlessness
  • Hopelessness
  • Disrupted sleep
  • Self-harm

It may come as no surprise to learn that while depression affects the person suffering, it can have a wider impact across society.

Data from the UK government's department of the Health and Safety Executive show that 602,000 workers suffer from stress, depression or anxiety which equates to 12.8 million working days lost. [19]

So where does Ashwagandha fit in?

Studies of ashwagandha, when administered to patients suffering from depression, have been very positive.

One such clinical trial facilitated by the University of Pittsburgh Medical Center showed that a 12-week course of ashwagandha given to 66 patients reduced the effects of anxiety and depression. [20]
Further evidence also paints the effects of ashwagandha in a positive light.

When compared against a placebo, a dose of 600mg of ashwagandha per day saw up to a 79% reduction in the feeling of depression. As per the results of a clinical trial that featured in the Indian Journal of Psychological Medicine. [21]

Ashwagandha and Weight Loss

Ashwagandha Effects

There is evidence that closely links chronic stress, anxiety, and depression with weight gain and obesity. [22]

While chronic stress is a major health concern, arguably, it could be said that obesity is even more of a concern with data from the WHO stating that 650 million were obese in 2016. [23]

An important factor to note is that by and large, obesity is said to be a preventable disease and one that can encourage the development of further diseases such as cardiovascular disease, type 2 diabetes, and premature mortality. [24]

In addition, obesity is a huge drain on health care facilities and expenditure.

In the UK alone the National Health Service spent £6.1 ($7.8) billion on overweight and obesity-related illness between 2014/15. [25]

It was noted that figure was more than what was spent on the Police and Fire Services combined over the same period.

Therefore, preventing obesity and encouraging weight loss to those who are overweight can have significant health and economic benefits.

How can Ashwagandha help?

An increase in weight can be related to those suffering from high levels of stress as it can lead to changes of eating patterns and behaviors, as such, people may experience cravings for high calorific but low nutritional value foods. [26]

However, 600mg daily of ashwagandha over 2 months saw a significant reduction of weight when compared to placebo as per a report published in 2016. [27]

In addition to this study, a further examination saw that 600mg daily resulted in a significantly reduced body fat percentage compared to placebo for those involved in resistance training. [28]

Ashwagandha for Weight Gain

Whilst there is evidence that ashwagandha helps reduce body fat percentage and prevents the consumption of high-calorie foods, it may also help increase weight.

However, this is gain in weight could be lean muscle mass, not fat.

That's because as per the evidence from the aforementioned study, ashwagandha helped to significantly increase muscle mass while reducing fat.

A further study also demonstrated ashwagandha's ability to reduce body fat but also increase strength even without a training plan in place or practiced. [29]

Therefore, it can be speculated that ashwagandha can help increase healthy body weight through the increases of muscle mass while reducing unhealthy weight, such as fat levels.

Hypothyroidism

There's no way to preventing an underactive thyroid (hypothyroidism).

This is a condition whereby your thyroid gland doesn't produce enough of the thyroxine and triiodothyronine hormones. [30]

The thyroid gland is very important. It helps regulate many health functions, particularly growth and development.

Like a thermostat, it releases hormones depending on the needs of your body. Therefore if you are growing, or need energy more hormones are released.

Thyroid hormones are also connected to your metabolic rate, and as such, have an effect on body weight.

It can help breakdown food faster for energy and help improve concentration. [31]

Having an underactive thyroid can lead to some of the following symptoms:

  • Tiredness
  • Weight gain
  • Depression
  • Aching muscles
  • Sensitive to lower temperatures
  • Dry skin and hair

As you can see, it is not a pleasant condition to suffer with.

However, subclinical hypothyroidism occurs in 4% to 10% of the world's population but carries no obvious symptoms. [32]

Ashwagandha and Thyroid

A journal published study from 2018 discovered that even after just two months a 600mg daily dose of ashwagandha helped to normalize thyroid serum thyroid indices. [33]

While there is a fairly limited amount of research regarding hypothyroidism and treatment with ashwagandha, the preliminary results from recent studies are promising.

Energy and fatigue

When we think of fatigue, we think of late nights and long days at work.

However, simply feeling sleepy and drowsy, while these are symptoms of fatigue, are not the same thing.

Fatigue is a situation whereby the sufferer experiences no motivation or energy to do anything.

The feeling of fatigue cannot be resolved by adequate sleep and rest.

It is reported that 1.5 million Australians are affected by fatigue and seek medical help with their doctor. [34]

The causes of fatigue are generally broken down into four categories.

Only one category is classed as a medical issue, the other three can potentially be managed, prevented or alleviated through changes.

These categories are as followed:

  1. Medical
  2. Lifestyle
  3. Workplace
  4. Emotional

It is said that unrelenting exhaustion can be caused by other illnesses. Some of these we have already covered and may be alleviated by using ashwagandha.

Illnesses and conditions such as depression, stress, and anxiety. [35]

On the other side of the coin, it could be your current lifestyle that is the catalyst to you suffering from fatigue.

This could be the misuse of alcohol or recreational drugs. It could also be a lack of exercise and eating foods that are high in calories and low in nutritional benefit.

Ashwagandha and Sleep

Ashwagandha Effects

However, ashwagandha may be able to help with fatigue. That's if the science is to be believed.

One study that was published in 2012 concluded that ashwagandha has the potential to improve quality of life and reduce cancer-related fatigue based upon their findings. [36]

The use of ashwagandha is also seen as a remedy to alleviate the effects of aging whereby it is considered to counter chronic fatigue. [37]

However, on the other hand, in a 16-week trial ashwagandha seemed to have no effect on fatigue on the 40-70-year-old male who were categorized as being overweight. [38]

Can Ashwagandha cause Hair Loss?

Many people are concerned with hair loss and thinning hair.

It can affect their confidence, self-esteem and cause distress that can affect a person's quality of life. [39]

In lots of cases, people believe it to be a genetic matter that is hereditary.

However, lifestyle choices can be a contributing factor, such as not getting the right nutrients in your diet, illness, weight loss or using hash hair treatments for coloring and styling.

It has been noted that stress can also be an issue as it stimulates an increased release of cortisol which can harm hair growth. [40]

Yet, it was discovered that an additional benefit for treating congenital adrenal hyperplasia (CAH) with ashwagandha over a six month period was the reduction of scalp hair loss for the 57-year-old female patient as per the report published in the British Medical Journal. [41]

Further analysis of ashwagandha and hair health unearthed a review of ashwagandha and its benefits for hair color. In addition, nail calcium levels were also preserved amongst males between the ages of 50 and 59. [42]

Libido

The National Health and Social Life Survey discovered that 43% of women and 31% of men between the ages of 18 and 59 had no interest in sex and suffered from sexual dysfunction. [43]

Yet libido and alack of it has been under scrutiny for nearly a century, with research into the prevalence of female sexual disorder dating to 1929. [44]

It, therefore, makes sense to reference a study published by the BioMed Research International journal in 2015.

The study concluded on the basis of an 8-week study whereby 600mg of ashwagandha was administered across 50 women between the ages of 21 and 50 was useful for sexual dysfunction. [45]

In addition, ashwagandha has been noted as one of the best herbs available that can improve libido and act as an aphrodisiac in both men and women as per the article published in the International Journal of Basic and Applied Research from 2018. [46]

Fertility

It is estimated that there are at least 30 million men around the world who are infertile.

The highest regions of male infertility are in Eastern Europe and Africa. [47]

This rate of male infertility can affect around 15% of couples globally and is characterized by not being able to conceive after 12 months of unprotected sex. [48]

There are a number of factors that can contribute to male infertility. According to the British Medical Journal such as, but not limited to:

Ashwagandha and pregnancy

According to the NCBI, ashwagandha has proven itself over a 3 month period to reduce stress while increasing overall semen quality which resulted in higher pregnancy rates. [49]

Further study and scientific evidence have also resulted in researchers concluding that ashwagandha may have a positive effect on fertility rates in both genders. [50]

Ashwagandha and Blood Pressure

Having high blood pressure (hypertension) can often go unnoticed, although you may experience a headache.

It will naturally rise and fall throughout the course of the day, and increases when you start to move around and be active.

We need a certain amount of pressure to move the blood around the body, much like water in a hosepipe needs the pressure to get the water through the long length of pipe to wash the car.

However, when your blood pressure is continuously high that it can become a health risk.

Consistently high blood pressure places more stress on the heart and the arteries.

If ignored it can lead to cardiovascular illnesses such as a heart attack or stroke. [51]

Additional problems can include the following as listed by the British Heart Foundation:

  • Kidney failure
  • Heart failure
  • Sight issues
  • Vascular dementia

High blood pressure can also lead to your arteries being less flexible, more stiff and even constrict. This can make it easier for fatty deposits to decrease the diameter.

It is reported that 1.13 billion adults across the globe had hypertension in 2015 by the International Journal of Epidemiology.

This is broken down into 25% of men and 20% of women of the global population, which is a startling set of statistics. [52]

Research stemming from 2017 has demonstrated promise for ashwagandha to reduce blood pressure.

Ashwagandha with milk helped to gain a statistically relevant drop in blood pressure. [53]

Is ashwagandha a blood thinner?

There's a popular misconception that blood thinners are used to reduce blood pressure.

However, this is not the case, and blood thinners do not actually 'thin' the blood.

Blood thinners reduce the clotting abilities of blood for those that are susceptible to blood clotting and potentially preventing blood flow. [54]

Blood thinners are called anticoagulants, but there isn't any reputable evidence that suggests ashwagandha is a blood thinner.

Muscle Recovery, Size & Strength

Ashwagandha Effects

The fitness industry is booming. In the UK alone the health club industry revenue is worth $5.5 billion across 3,083 facilities in 2017.

In fact, the number of these facilities has grown from just 1,611 in 2008. That's almost doubled over a period of just 9 years. [55]

Clearly more and more people are understanding the benefits of regular exercise.

Then there's the popularity of bodybuilding. According to Wiki, the sport of bodybuilding was first developed in England during the late 1800s by a German man called Eugen Sandow.

This later evolved into the first bodybuilding contest of 1901 which took place in London.

The popularity of bodybuilding became more mainstream with the release of the documentary film, Pumping Iron.

This film featured notable characters such as Arnold Schwarzenegger and Lou Ferrigno. Both went on to become global film stars. [56]

With a desire for larger and more sculpted muscle comes a need for better nutrition.

A survey of nutritional supplements advertised in relevant publications saw that the most popular were for the promotion of muscle growth. [57]

How can Ashwagandha help?

Research into ashwagandha demonstrated significant evidence that it is beneficial for muscle development. [58]

It showed that 600mg daily of ashwagandha over 2 months presented the following benefits that were published in the Journal of the International Society of Sports Nutrition:

  • Increased muscle mass
  • Better recovery
  • Reduced body fat
  • Improved muscle strength

Ashwagandha and Endurance?

Another study from 2012 showed that ashwagandha had a significant effect on the endurance of elite cyclists.

When compared to placebo, there was a significant improvement of the athletes' VO2 Max demonstrating their cardiorespiratory endurance. [59]

These results are then further supported by another study which was published in 2015 which again demonstrates the effectiveness of ashwagandha on athletic performance.

When healthy athletic athletes were assessed over 20-meter shuttle runs their VO2 Max improved over a 12 week period. Their quality of life was reported to improve as well. [60]

Ashwagandha for Testosterone

Men from their mid-30's may experience a decline of testosterone by 1% per year.

However, this can be a larger percentage depending on each individual and any illnesses or conditions they may suffer from.

Besides, lifestyles and changes to lifestyle can also have an impact on the decline of testosterone.

A reduced level of testosterone can also affect body functions and accelerate conditions associated with aging.

This could be things such as fragility, cognitive decline, muscle waste, and erectile dysfunction.

A further insufficiency of testosterone can result in premature mortality. [61]

Results of hypogonadism (abnormally low testosterone) affect up to 7% of men, yet as little as 5% of those suffering from hypogonadism actually receive treatment. [62]

> Read more about the benefits of testosterone

Can ashwagandha increase testosterone?

A study from 2016 confirms that when compared to a placebo, ashwagandha does significantly increase testosterone. [63]

An additional study looking into the effects that ashwagandha has on semen quality also saw a significant improvement in male hormone levels. [64]

Estrogen

The female hormone acts like testosterone in the way it regulates fat, cognition, muscle mass and physical characteristics.

However, many of the characteristics of estrogen are the opposite of what is the result of testosterone.

Therefore, a higher level of estrogen will result in a high-fat percentage and less lean muscle mass for example.

Because there is clinical evidence that ashwagandha increase testosterone secretion, there is speculation that it may also affect the levels of estrogen.

However, while all studies have pointed to an increase of testosterone, it has not been the case for estrogen, and there appears to be no change. [65]

Is Ashwagandha a Stimulant?

Ashwagandha has been traditionally used as a tonic that has stimulant benefits. [66]

However, while it is known to treat fatigue, it is not seen as a traditional stimulant that can affect the central nervous system or raise levels of physiological activity in the body.

There aren't any reputable sources of scientific evidence confirming that ashwagandha can act as a stimulant similar to the effects of caffeine.

Cognitive Function

Cognition is the conscious and unconscious brain function that can encapsulate perception, judgment and the process of learning, knowledge, attention and retrieving memory. [67]

Cognitive decline is often coupled with the aging process.

This can present a number of issues and problems that can inhibit living independently.

The most common symptoms of age-related cognitive decline include, but are not limited to:

  • Inability to process information to make decisions
  • Reduced working memory
  • Brain processing speed
  • Lower executive functions

Associated age-related diseases can also accelerate and exacerbate cognitive decline which can develop into dementia. [68]

A study involving 50 adults and 600mg of ashwagandha daily saw significant improvements in their immediate and general memory functions.

They also demonstrated a greater improvement of their executive function, attention and the processing speed for information. [69]

Is ashwagandha safe?

According to clinical research and information regarding drug-induced liver injury, ashwagandha is safe.

There appears to be no liver serum enzyme elevation or signs of hepatotoxicity during ashwagandha therapy.

Furthermore, there seem to be very few unwanted, serious and adverse side effects or interactions. [70]

Yet, there are some possible effects concerning very large doses.

These can include the following:

  • Diarrhea
  • Vomiting
  • Nausea

This is most likely to be an irritation of the intestinal tract.

However, if you are suffering from hormone-sensitive prostate cancer. Ashwagandha and pregnancy do not mix well either.

Ashwagandha Interactions

It's also important to note that some medications may not interact well with ashwagandha.

Therefore, ensure you do not mix it with either of the following [71]:

  • Benzodiazepines
  • Anticonvulsants
  • Barbiturates

However, as ever, if you are taking something new, it is best to consult a medical professional.

In addition, if you are already taking prescription drugs it is best to read through any instructions and adhere to any safety warnings that accompany that product.

It is important to note that any clinical trials available for research have excluded people from their study if they are taking medication, are pregnant, suffer from chronic physical, hormonal or psychiatric illness, have abnormal ECG readings and are dependant on substances.

This should be a good guide to abide by if you are wishing to take ashwagandha.

Alcohol

One area of consideration is the effect ashwagandha may have on alcohol.

Initial clinical findings, when tested on mice, show that ashwagandha has anti-addictive properties and helps prevent alcohol withdrawal anxiety as well as reducing alcohol dependence. [72]

Ashwagandha: How to take

Ashwagandha usually comes either in powder form to mix with smoothies or other liquids.

Alternatively, it can be within a capsule which is potentially more convenient.

Supplements such as Military Muscle Testosterone Booster contain 600mg of ashwagandha within a daily dose of 6 vegan friendly capsules.

That may seem like a lot of capsules but ashwagandha is just one of eleven ingredients and a daily dose of 3850mg.

When to take

There is little information from good quality sources that recommend a time to take ashwagandha.

However, on the whole, any participants of trials are given two doses per day of 300mg.

Each dose given to the participants is taken with a meal.

As such, it is most likely taken with your first meal and last meal of the day or any food before bed. This gives almost equal periods of time between doses.

How much ashwagandha to take

The majority of research uses doses of 500 to 600mg daily, with effective results. Take ashwagandha with water.  

This is why Military Muscle includes a daily dose of 600mg. As per the studies, take a dose with a meal.

The Take Home

Ashwagandha has proven itself to be a very important herb, with many benefits to general performance and health according to the results of publicly available research.

Ashwagandha's effects

The effects of ashwagandha are mainly positive.

Those who have participated in studies have reported improvements across multiple parameters.

The recorded benefits include:

  • Increased muscle size, strength, and recovery
  • Improved sleep and reduced symptoms of insomnia
  • Reduced symptoms of anxiety and depression
  • Fat loss
  • Normalize thyroid hormones
  • Reduce fatigue
  • Increased endurance
  • Libido and fertility improvements
  • Reduces blood pressure
  • Positive impact on scalp hair
  • Stimulates testosterone secretion
  • Helps to increase cognitive functioning
  • Reduces alcohol dependency

As you can see this is a lot of benefit and proves that ashwagandha is certainly a natural herb that is worthy of consideration.

However, these are the results from clinical trials under controlled conditions and further research is important to qualify every outcome.

Is ashwagandha good for you?

On the whole, it can be suggested that ashwagandha offers a wealth of positive benefits.

The research is very promising, and it is why we have included it in Military Muscle. 

There are very few negative effects to report, and few unwanted interactions with other substances.

As ever, before using including a new supplement to your diet and regime, be sure to consult a medical professional.

military muscle testosterone booster

References:

[1] https://www.researchgate.net/publication/286933238_ASHWAGANDHA_INDIAN_GINSENG_-_AN_ADAPTOGEN

[2] https://www.rush.edu/health-wellness/discover-health/5-facts-about-insomnia

[3] The international classification of sleep disorders: Diagnostic and coding manual, ICSD-2. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005. American Academy of Sleep Medicine

[4] https://www.nhs.uk/conditions/insomnia/

[5] https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders

[6] https://www.nhsinform.scot/illnesses-and-conditions/mental-health/insomnia

[7] https://www.cureus.com/articles/22928-efficacy-and-safety-of-ashwagandha-withania-somnifera-root-extract-in-insomnia-and-anxiety-a-double-blind-randomized-placebo-controlled-study

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313221/

[9] https://www.rcpsych.ac.uk/mental-health/problems-disorders/anxiety-panic-and-phobias

[10] https://www.nhs.uk/conditions/stress-anxiety-depression/understanding-panic/

[11] https://www.ncbi.nlm.nih.gov/pubmed/19718255

[12] https://www.tandfonline.com/doi/abs/10.1080/15622970902792365?journalCode=iwbp20

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/

[14] https://healthcare.utah.edu/healthfeed/postings/2017/10/cortisol.php

[15] http://www.ijpm.info/article.asp?issn=0253-7176;year=2012;volume=34;issue=3;spage=255;epage=262;aulast=Chandrasekhar

[16] https://tacticalvitality.com/wp-content/uploads/JANA-Vol-11-1.pdf

[17] https://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/#.Xd5C4lf7TIU

[18] https://www.who.int/mental_health/management/depression/en/

[19] http://www.hse.gov.uk/statistics/causdis/stress.pdf

[20] https://www.ncbi.nlm.nih.gov/pubmed/31046033

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/

[22] https://www.ncbi.nlm.nih.gov/pubmed/22378728

[23] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

[24] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1790820/

[25] https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2

[26] https://www.ncbi.nlm.nih.gov/pubmed/22709702

[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871210/#bibr2-2156587216641830

[28] https://www.ncbi.nlm.nih.gov/pubmed/26609282

[29] https://www.ncbi.nlm.nih.gov/pubmed/23125505

[30] https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/

[31] https://www.ncbi.nlm.nih.gov/books/NBK279388/

[32] https://academic.oup.com/jcem/article/86/10/4585/2848862

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[34] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue

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