Ashwagandha, an herbal supplement commonly used in traditional Indian medicine, is the latest trending herb to hit social media.
herbs are medicine
The biggest problem with the herbal supplement industry and the rhetoric used to promote it is that it ignores the main reality of herbal products – herbs are medicines. They are nothing but pharmacological agents. This means that they can cause drug-drug interactions and have all the usual side effects and risks that medicines can have. It’s not a very good drug because it has an active ingredient.
The fact that there are multiple active ingredients is often marketed as an advantage, with the idea that there is a positive synergy between these ingredients. Plants evolve chemicals into toxins that prevent animals from eating them. There is no evolutionary pressure to be useful as a drug. Polypharmacy is also a messy business and is far more likely to enhance toxicity than beneficial effects. However, from a scientific point of view, the herb’s messy and variable polypharmacy should be viewed with the utmost caution.
The supplement industry is also notoriously poorly regulated.there is Issues of Substitution, Contamination and AdulterationThis carries significant risks for consumers. But it also means that clinical trials conducted with validated and measured extracts don’t necessarily translate into products on the shelves.
Herbal medicines can also be drug toxic even without contamination.The safety of herbs is often erroneously assumed, based on the fallacy of appeals to nature and simply on the fact that sufficient evidence of safety and toxicity is lacking. teeth Associated with cases of liver damagegeneral drug toxicity.
What we should do is isolate and purify specific active ingredients, isolate them and study them. If they are medically safe and have available efficacy, they can be offered in known doses with known safety profiles, pharmacokinetics, bioavailability, risks, and interactions. Of course, they are regular medicines, not magic herbs that can be marketed as “natural.”
Exaggerated Preliminary Evidence
The herbal industry is thriving on the basis of preliminary scientific results. We have spent years and thousands of articles carefully explaining in detail why preliminary medical evidence is unreliable and a predictor of real-world safety and efficacy. It is entirely possible that products have useful medical effects, but they are pharmaceuticals. There are potential mechanisms by which they may affect. And since some effects are easy to observe, most cultures have been able to find local plants that act as hallucinogens. requires careful scientific research.
The same pattern is seen with ashwagandha. Studies date back decades, but have yet to definitively answer questions of safety and efficacy. It seems to remain at this preliminary stage of evidence.
A recent systematic review showing similar results:
A current systematic review and dose-response meta-analysis of RCTs revealed beneficial effects on both stress and anxiety following ashwagandha supplementation. , more high-quality research is needed.
The individual studies are mostly small studies, often with methodological problems and often with subjective results. Again, it is very likely that ashwagandha contains one or more active ingredients with anxiolytic properties. Results are often false positive, and large, rigorous trials are needed to determine if the effects are real. This is a problem with herbs that may contain many active ingredients, some of which can have noticeable effects. There is no way to know unless you evaluate your vision.
Therefore, we are often left with the conclusion that “more research is needed”, and that state of affairs never seems to change.
Extrapolation from basic science
Here’s the side of the herb industry (and cam industry in general), this is what I find most frustrating. When the substance in question is given to animals or cultured cells, something happens. Whatever happens can be interpreted as a potentially beneficial effect. Immune function is a nearly ubiquitous target.
First of all, immune activity is highly reactive. It seems to change and respond to almost any stimulus. Anything that increases a marker of immune activity can be spun as “boosting” the immune system. Anything that decreases a marker of immune activity can be spun as “anti-inflammatory.” are sometimes claimed at the same time. Of course, it is also possible to simply explain increased immune activity as a cause of inflammation and decreased immune activity as “suppression” of the immune system. . Even beneficial anti-inflammatory drugs suppress the immune system, and anything that “boosts” the immune system can have negative inflammatory effects.
This is because the immune system is a double-edged sword. It fights off invaders, infections and cancer, but causes inflammatory stress and damage. Merely increasing or decreasing immune activity is neither intrinsically beneficial nor detrimental. It all depends on the specifics, targeting and regulation of immune activity. (See alpha-interferon and MS).
Same with steroids. Lowering levels of corticosteroids in the body may be a marker of reduced stress, but there is a reason these steroids are present in the body. Part of a finely tuned system. Changing this system in one direction is neither inherently good nor bad. The same applies to oxidative stress and antioxidants. This is another good example of simplistic herb thinking. Oxygen is good, except when it is bad.
Conclusion
Is ashwagandha a useful herb or just herbal snake oil? I don’t know, no one knows. I think that’s the point. Ashwagandha as an herbal remedy has some validity. Because (say it with me), it’s a drug, or really a combination of multiple drugs. Something happens, it can be helpful, it can be harmful. It may also be trivial.
The clinical evidence is also not convincing.Like most other herbs, ashwagandha lives in a world of preliminary evidence, like it’s stuck in scientific purgatory. cam/ The world of herbs. Even if there is no evidence to confidently show whether the herb actually worked for a particular indication, there is enough evidence to use it for marketing and promotion. (from NIH studies), the results are usually disappointing.
Reports of liver damage are also of great concern. This is not something that should be dismissed lightly. I am also concerned about long term use. Most over-the-counter uses may involve small amounts or low bioavailability. Lower doses are less likely to be toxic, but also less likely to have beneficial effects. As the concentration and dosage are increased, toxicity also comes out. The key is whether there is a safe dosage range. You can only know this if you carefully measure your dosage. This is not possible with messy and variable herbs.
This brings me to the ultimate conclusion – the problem is inherent in the herbal supplement industry itself. There is no advantage to this approach (other than companies selling questionable products with unsupported claims). Herbs should be treated as refined, researched and regulated medicines. The most likely result is wasting billions of dollars on products that don’t work.
