Ashwagandha and Gilbert’s Syndrome

What is Ashwagandha and what is it thought to do?

Ashwagandha (Withania somnifera) is an evergreen shrub that is thought to have many benefits. Relevant to people with Gilbert’s Syndrome is the ability to reduce anxiety (a Gilbert’s Syndrome symptom) and to aid sleep. Sleep and rest are important to reduce Gilbert’s Syndrome symptoms including fatigue.  

There has been a great deal of research published that demonstrates positive effects. ‘Meta analyses’ (which summarise a range of research) outline the benefits of ashwagandha. But there have also been documented cases of liver injury. These are important to look at because people with Gilbert’s Syndrome having a pre-existing enzyme deficiency which affects liver function. 

‘We found that Ashwagandha supplementation significantly reduced anxiety (SMD: -1.55, 95% CI: -2.37, -0.74; p = .005; I2 = 93.8%) and stress level (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005; I2 = 83.1%) compared to the placebo. Additionally, the non-linear dose-response analysis indicated a favorable effect of Ashwagandha supplementation on anxiety until 12,000 mg/d and stress at dose of 300-600 mg/d. Finally, we identified that the certainty of the evidence was low for both outcomes. The current systematic review and dose-response meta-analysis of RCTs revealed a beneficial effect in both stress and anxiety following Ashwagandha supplementation.’ https://pubmed.ncbi.nlm.nih.gov/36017529/

Ashwagandha generally has a protective effect on the liver due to its antioxidant and anti-inflammatory properties. It may help reduce liver damage caused by oxidative stress, toxins, and fatty liver disease. Some studies suggest it can improve liver enzyme levels and support detoxification.

In rare cases, excessive or prolonged use has been linked to liver toxicity, including elevated liver enzymes and liver injury. This is more likely in individuals with pre-existing liver conditions or those taking it alongside other hepatotoxic substances (chemicals which can damage the liver). Health+2Verywell Health+2Verywell Health+2

Overall, ashwagandha is considered safe for the liver when taken in recommended doses. However, individuals with liver disease should consult a healthcare provider before use.

If you want to find out more about other supplements and Gilbert's Syndrome check out these posts.

Evidence Illustrating Ashwagandha’s Effects:

• Liver Health: Although clinical trials have not commonly reported liver enzyme elevations, there have been isolated instances of liver injury associated with the use of ashwagandha. For example, a case series from India described patients developing cholestatic hepatitis after consuming ashwagandha supplements. Another report detailed a 20-year-old man who experienced liver dysfunction and hyperbilirubinemia following the intake of ashwagandha combined with anti-anxiety medications. These cases underscore the importance of monitoring liver function during ashwagandha use. This is particularly important in individuals with pre-existing liver conditions.​NCBI+1Lareb+1Lippincott JournalsResearchGate
  
• UGT1A1 Enzyme Activity: Currently, there is no direct clinical evidence indicating that ashwagandha affects the activity of the UGT1A1 enzyme, which is responsible for bilirubin metabolism. However, some studies have investigated the genetic determinants of UGT1A1 inducibility by other substances, such as phenobarbital. Given the limited research in this area, individuals with conditions like Gilbert’s syndrome, characterized by reduced UGT1A1 activity, should exercise caution and consult a healthcare provider before using ashwagandha.​ResearchGate
  

While ashwagandha offers several health benefits, its potential impact on liver function warrants careful consideration. Individuals with liver disorders or those taking medications metabolized by liver enzymes should seek medical advice before incorporating ashwagandha into their regimen.

Potential Effects of Ashwagandha on Gilbert’s Syndrome

1. Liver Enzyme Activity: Ashwagandha may influence liver enzymes, but there is no direct evidence showing that it affects UGT1A1 or bilirubin metabolism in Gilbert’s syndrome.
   
2. Detoxification Support: Its antioxidant properties may help support overall liver health, which could be beneficial.
   
3. Possible Risk of Liver Stress: Rare cases of liver enzyme elevation have been reported with ashwagandha use. Since people with Gilbert’s syndrome already have a unique liver metabolism, caution is advisable.
   There is no direct clinical evidence showing that ashwagandha affects UDP-glucuronosyltransferase 1A1 (UGT1A1), the enzyme responsible for bilirubin metabolism. However, some key considerations include:

Want to know more about UGT1A1 and Gilbert's Syndrome? Click here.

Potential Interactions Between Ashwagandha & UGT1A1

1. Liver Enzyme Modulation – Ashwagandha has been reported to influence liver enzymes, but its effect on UGT1A1 specifically remains unknown.
   
2. Glucuronidation Pathway Impact – Since UGT1A1 is involved in glucuronidation (detoxification), any herb that affects liver function could, in theory, influence bilirubin clearance.
   
3. Case Reports of Liver Enzyme Elevation – Though rare, some individuals have experienced liver toxicity from ashwagandha, suggesting a potential but unclear impact on liver metabolism.
   

Implications for Individuals with Gilbert’s Syndrome

• Since people with Gilbert’s syndrome have a reduced UGT1A1 function, any compound that modifies liver enzyme activity could theoretically alter bilirubin levels.
  
• If you have Gilbert’s syndrome, it’s best to monitor your bilirubin levels if taking ashwagandha, and consult your doctor if you notice changes in jaundice symptoms.
  

Conclusion

While ashwagandha is unlikely to directly worsen Gilbert’s syndrome, its impact on liver function suggests that moderation and medical supervision are best. If you have Gilbert’s syndrome, consult your doctor before taking ashwagandha, especially if you have other liver-related concerns.