Ashwagandha can cause liver injury, though it appears to be rare. The NIH’s LiverTox database rates it a “B” for likelihood of causing clinically apparent liver damage, meaning it is a “likely” cause. Since the first case was reported in 2017, an increasing number of reports have surfaced from the U.S., Iceland, India, Germany, Japan, and Poland. A large systematic review of herb-induced liver injury covering 936 cases found ashwagandha responsible for about 1% of them, placing it well behind supplements like kava kava, green tea extracts, and certain traditional Chinese herbs.
Still, “rare” doesn’t mean trivial. The cases that do occur can be serious, and for people with pre-existing liver problems, the consequences have sometimes been fatal.
What the Reported Cases Look Like
Most people who develop liver problems from ashwagandha notice symptoms 2 to 12 weeks after starting the supplement. The typical signs are jaundice (yellowing of the skin and eyes), fatigue, nausea, and dark urine. In blood tests, liver enzymes rise significantly, and bilirubin levels climb high enough to cause visible yellowing.
In one well-documented series of five patients from Iceland and the U.S., ages 21 to 62, all five developed jaundice within that 2-to-12-week window. All of them recovered within 1 to 5 months after stopping ashwagandha, with no fatalities and no signs of lasting liver damage. That’s the reassuring pattern for otherwise healthy people: stop the supplement, and the liver heals, though the jaundice can linger for weeks.
The picture is very different for people who already have liver disease. A 2023 case series from India documented 8 patients with ashwagandha-related liver injury. Five of them had pre-existing chronic liver conditions. Three of those five developed acute-on-chronic liver failure and died. That’s a stark contrast to the outcomes in healthier patients, and it’s the strongest reason to avoid ashwagandha entirely if you have any form of liver disease.
Why Ashwagandha May Harm the Liver
Ashwagandha’s active compounds, called withanolides, contain chemical groups that are reactive enough to bind to and damage DNA inside cells. Normally, your body neutralizes these reactive molecules using glutathione, a natural protective molecule the liver produces in abundance. Think of glutathione as a chemical sponge that absorbs harmful compounds before they can do damage.
The problem arises when the amount of withanolides overwhelms the available glutathione supply, or when glutathione levels are already low. In laboratory studies, withanolides that weren’t neutralized by glutathione went on to damage DNA in ways that can trigger cell death. This is one plausible explanation for why most people tolerate ashwagandha fine while a small number develop significant liver injury: it may depend on individual differences in how much protective glutathione your liver cells can deploy.
People with existing liver disease naturally have less capacity to produce glutathione and process reactive compounds. That likely explains why they are so much more vulnerable.
The Contamination Problem
Not every case of liver injury from an ashwagandha product is necessarily caused by ashwagandha itself. Supplements are not regulated the way prescription drugs are, and contamination is a real issue across the industry. Some herbal products have been found to contain pesticides, heavy metals, or even undeclared pharmaceutical ingredients like anabolic steroids, all of which can independently damage the liver. One study from India found that 14% of analyzed protein supplements were contaminated with aflatoxins, a type of fungal toxin that directly harms liver cells.
Isolating the exact cause of liver injury from a multi-ingredient supplement is genuinely difficult. Some ashwagandha products contain additional herbs or fillers that could contribute to the problem. That said, cases have been reported with single-ingredient ashwagandha formulations as well. A 2023 Indian case series specifically screened for this, identifying 8 liver injury cases from products that contained ashwagandha alone. So while contamination may explain some cases, the plant’s own active compounds are a plausible cause on their own.
How Common Is This, Really?
To put the risk in perspective: an estimated 15 million Americans have used ashwagandha or other potentially liver-affecting supplements in the past 30 days alone. The total number of documented liver injury cases linked to ashwagandha across the entire medical literature, worldwide, sits at roughly two dozen. That makes the absolute risk very low for any individual user.
But those numbers come with a major caveat. Supplement-related liver injuries are dramatically underreported. Many mild cases likely go unrecognized because people don’t connect their symptoms to a supplement, or they stop taking it before the problem escalates. The true number of cases is almost certainly higher than what appears in published reports.
Who Faces the Highest Risk
Based on the available case data, some clear risk factors stand out:
- Pre-existing liver disease: This is by far the biggest risk factor. In the Indian case series, 5 of 8 patients already had chronic liver problems, and the 3 deaths all occurred in this group.
- Heavy alcohol use: Chronic drinking depletes glutathione stores in the liver, which may reduce your ability to safely process ashwagandha’s active compounds.
- Other medications processed by the liver: If your liver is already working hard to metabolize other drugs, adding ashwagandha increases the overall burden.
- Multi-ingredient supplements: Products that combine ashwagandha with other herbs make it harder to predict interactions and increase the chance of contamination.
Warning Signs to Watch For
If you’re currently taking ashwagandha, the symptoms to pay attention to are yellowing of the skin or whites of the eyes, unusually dark urine, persistent nausea, loss of appetite, and pain or tenderness in the upper right side of your abdomen. These signs typically appear within the first 2 to 12 weeks of use, though at least one reported case involved someone who had been taking the supplement for over a year.
If you notice any of these symptoms, stop taking ashwagandha immediately. In most otherwise healthy people, liver function returns to normal within 1 to 5 months after discontinuation. The jaundice can take its time resolving, which can be alarming, but in the documented cases involving healthy individuals, no one developed permanent liver damage.