Research ·
Ashwagandha and the liver: what changed in 2026
Dr. Eric Steiner · 5 min read
Image by Jose Lorrue
Two regulators reviewed ashwagandha and liver injury this year. In July, Australia called the risk very rare and Canada said a link could not be ruled out. Both kept it on sale. The injury they looked at is real but uncommon. It usually starts 2 to 12 weeks after the first dose, shows up as jaundice and itching, and mostly clears after stopping. The deaths on record were in people who already had cirrhosis.
What regulators have done
| When | Where | What happened |
|---|---|---|
| July 2026 | Australia1 | 11 reports of possible liver injury, none fatal. Risk called very rare; no label change. |
| July 2026 | Canada2 | A link could not be ruled out. Health Canada will keep monitoring. |
| April 2026 | India3 | Root only in supplements; no leaf. No liver cases cited. Challenged in court. |
| 2024 | European Union4 | Short-listed by food safety agencies for review toward a possible restriction. |
| Since 2020 | Denmark5 | Illegal to sell as a food, over hormone and reproductive concerns. The liver isn't among the reasons. |
Australia's advice is the most practical. People with liver problems should avoid ashwagandha, and anyone who develops jaundice, dark urine or nausea should stop and seek care. 1
What the cases show
The injury follows a pattern. It begins weeks into use, with jaundice and itching, and liver tests show a cholestatic or mixed picture. Most people recover within one to four months of stopping, and NIH's LiverTox rates ashwagandha a likely cause. 6
It isn't a sign of overdose. In the first published series, three of five patients were taking the dose on the label. 7
The serious cases are in people whose livers were already damaged. Across 25 published patients, one needed a transplant, and the three who died all had cirrhosis. 8
Why the trials look clean
Trials of standardized root extract haven't shown liver problems. A 2026 review of 23 trials in 2,317 healthy adults, at 125 to 600 mg a day, found liver markers in the normal range wherever they were measured. 9
That is reassuring for most people, but a reaction this rare won't show up in trials of a few hundred healthy adults over a few months. The trials and the case reports answer different questions.
Root, leaf and the label
Where case reports name the plant part, it has been the root. None has tied the injury to leaf, so a root-only product doesn't rule out the risk.
On the shelf, 9% of 295 ashwagandha products contain leaf, mostly as Sensoril or Shoden, two branded extracts made from root and leaf, and 36% don't say which part they use. None of the 295 labels tells buyers what signs of liver injury to watch for, while 83% warn about pregnancy. The newest label was entered in September 2025, before this year's reviews. 10
What to tell a patient taking it
Ask about liver disease first. LiverTox and the TGA both advise people with liver disease to avoid ashwagandha, and the deaths have been in people with cirrhosis.
Then say what to watch for, since the label won't: yellowing skin or eyes, dark urine, itching or nausea, most often in the first three months. When a patient turns up with unexplained jaundice or abnormal liver tests, ask about supplements.
Ask about thyroid treatment too. In 50 adults with subclinical hypothyroidism, 600 mg a day of root extract for eight weeks lowered thyroid-stimulating hormone and raised T3 and T4 more than placebo did. 11
The ashwagandha monograph covers the stress, sleep and other trials, the extracts on the market and the interactions.
Sources
- 1TGA, 2026TGAMedicine Safety Update, 7 July 2026. In 6 of the 11 reports, no other ingredient was likely involved. No deaths or transplants in Australia.
- 2CanadaHealth CanadaHealth Product InfoWatch, August 2026. A link between ashwagandha and liver injury could not be ruled out, and Health Canada will keep monitoring.
- 3IndiaFSSAIFood Safety and Standards Authority of India advisory, April 2026. Ashwagandha leaves are not to be used in food products in any form; only the root is allowed. It cites no liver cases.
- 4European UnionBVLReport of the EU Heads of Agencies working group on food supplements, 2024, hosted by Germany's BVL. Ashwagandha is short-listed for review toward a possible restriction.
- 5DenmarkDanish Food AdministrationDanish Veterinary and Food Administration page on ashwagandha. It has been illegal to sell as a food since 2020, over hormone and reproductive concerns.
- 6LiverToxNCBINIH's reference on drug-induced liver injury. Likelihood score B, a likely cause. Rare deaths, mainly in people with cirrhosis. Last updated December 2024.
- 7Björnsson et al., 2020PubMedFive patients from Iceland and the US, 450 to 1,350 mg a day. Testing confirmed ashwagandha in the products and found no contaminants. None had liver failure.
- 8McIntyre et al., 2026PubMedReview of every case report published through December 2025, 13 papers. The product's formulation was often not reported.
- 9Coope et al., 2026PubMed23 randomized trials lasting up to 180 days. Liver markers were reported in 9 of them. Two authors have consulting ties to the supplement industry.
- 10NIH Dietary Supplement Label DatabaseNIH label databaseSearched October 7, 2026: 417 on-market labels with ashwagandha in the name, reduced to 343 products, newest label each. 295 state an amount. Warnings read from each label's precautions.
- 11Sharma et al., 2018PubMed50 adults with TSH between 4.5 and 10 mIU/L, 8 weeks of 600 mg root extract or placebo. TSH fell toward normal and T3 and T4 rose.