Did a 2024 Review of 9 Clinical Trials Prove Ashwagandha Lowers Cortisol — Or Just Fuel the Hype?

De-Influencing Stress — a research-grounded look at what the evidence really says, from Vivacity Counselling & Consulting

If cortisol detox was last season's trend, ashwagandha is this one. Scroll through wellness content and you'll see it everywhere: gummies, powders, "adaptogen" blends, all promising to "balance your cortisol," "heal your adrenals," or "fix your stress hormones naturally." Unlike the cortisol detox trend, though, ashwagandha isn't pure myth — there's a real, growing body of clinical research behind it. The question is whether that research says what social media claims it says.

What ashwagandha actually is

Ashwagandha (Withania somnifera) is a root used for centuries in Ayurvedic medicine, classified as an "adaptogen" — a substance believed to help the body handle stress. That traditional use doesn't automatically mean modern clinical evidence backs every claim made about it, which is exactly why a proper review of the trials matters more than a testimonial.

"Adaptogen" itself isn't a strict pharmacological category with one agreed definition — it's a broader, somewhat informal term for substances thought to help the body resist stress generally, rather than treating one specific symptom. That looseness is part of why the marketing around adaptogens tends to run ahead of the evidence: the term itself invites big claims.

What the research actually did

In late 2024, a research team published a systematic review and meta-analysis in the peer-reviewed journal Explore. They searched five major databases — MEDLINE, EMBASE, PubMed, PsycINFO, and the Cochrane Library — for randomized controlled trials testing ashwagandha's effect on stress and anxiety. Nine trials met their criteria, covering 558 participants.

This is a smaller evidence base than the cortisol-and-exercise review we covered last time, which is worth naming upfront — fewer trials means more caution is warranted, even when the results look positive.

What they found

Compared to placebo, ashwagandha supplementation was associated with meaningful reductions across three measures:

Perceived stress dropped significantly on the Perceived Stress Scale, a standard self-report measure of how overwhelmed people feel.

Anxiety symptoms dropped significantly on the Hamilton Anxiety Scale, a clinician-rated measure.

Cortisol levels — actual blood measurements, not just self-report — also dropped significantly compared to placebo.

The trials used doses ranging from 125–600mg daily, taken for 30 to 90 days, using either root-only extracts or combined root-and-leaf formulations.

Where the caution belongs

This is a real, peer-reviewed finding — not an influencer claim. But a few things are worth knowing before treating it as a green light:

The evidence base is still small. Nine trials and 558 people is enough to take seriously, not enough to consider settled. The researchers themselves note more high-quality trials are needed.

Formulations vary a lot. "Ashwagandha" on a supplement shelf isn't one standardized thing — root extract, leaf extract, and combined formulations were all pooled together in this review, and they aren't necessarily interchangeable in effect or safety.

Supplements aren't regulated like medications. Unlike a prescription drug, there's no guarantee that what's on the label matches what's in the capsule — potency and purity vary by brand and manufacturer.

It isn't safe for everyone, and liver safety deserves particular attention. Ashwagandha is generally not recommended during pregnancy or breastfeeding, and caution is advised for people with autoimmune conditions, thyroid disorders, or those taking sedatives, thyroid medication, or immunosuppressants. A 2026 global scoping review identified 25 published cases of ashwagandha-associated liver injury worldwide; most people recovered fully within weeks to months of stopping the supplement, but the most serious outcomes — three deaths and one liver transplant — occurred almost entirely in people who already had pre-existing liver disease, particularly cirrhosis. If you have any history of liver disease, this is a supplement to avoid or discuss with your doctor first, not just something to try cautiously.

None of this means the research is wrong. It means "the evidence is promising" and "you should take this" are two different sentences, and only a doctor or pharmacist looking at your specific health picture can responsibly bridge that gap.

The takeaway you can actually use: the 3-Question Supplement Check

Rather than telling you whether to take ashwagandha specifically, we want to leave you with something more durable — a way to evaluate any trending wellness supplement before you try it. Ask:

1. Is there an actual clinical trial behind this claim — not a testimonial, not "studies show" with no citation, but a real randomized controlled trial or review you (or we) can look up?
2. What dose and duration were actually studied? "Ashwagandha helps with stress" and "600mg/day for 90 days of a specific root extract helped with stress in a research setting" are very different levels of specific.
3. What was it compared against, and how big was the real difference? A supplement that modestly outperforms a placebo in a small trial is a different claim than a "miracle fix."

If a product or influencer can't answer those three questions, that's information too.

How this connects to what we covered last time

In our first De-Influencing Stress post, we looked at what actually lowers cortisol — and the answer was gentle, consistent movement like yoga and qigong, not a quick fix. Ashwagandha research sits in an interesting middle ground: unlike the "cortisol detox" trend, it's backed by real trials, but like any single intervention, it's not a substitute for the underlying habits that shift stress physiology over time. If you're exploring supplements, the Steady-3 Practice we outlined previously is still the better-evidenced foundation to build on, not something a supplement replaces.

Frequently asked questions

Is ashwagandha safe to take long-term?
Most of the trials in this review only tracked participants for 30 to 90 days, so long-term safety data is genuinely limited. That's a real gap, not a minor detail — "safe for three months in a research setting" isn't the same claim as "safe indefinitely."

Can I take ashwagandha alongside anxiety or depression medication?
This is exactly the kind of question that needs a doctor or pharmacist, not a blog post. Ashwagandha can interact with sedatives and other medications, and combining any supplement with a prescribed psychiatric medication should always be reviewed by whoever prescribed it.

Does ashwagandha replace therapy or other treatment for anxiety?
No single supplement, however well-studied, is a substitute for professional support when anxiety is significantly affecting your life. The research reviewed here measured symptom reduction on standardized scales — it didn't test ashwagandha as a replacement for therapy or psychiatric care.

How is this different from the cortisol-and-exercise research in the last post?
Different intervention entirely — that post looked at physical movement (yoga, qigong), this one looks at an oral supplement. Both showed real evidence of lowering cortisol, through very different mechanisms, and neither is a "detox."

The bottom line

Ashwagandha has more going for it than the cortisol detox trend did — this is genuine, peer-reviewed clinical evidence, not a myth. But "promising early evidence" and "proven solution" aren't the same thing, and supplements sit outside the careful safety oversight that medications go through, with real, documented safety signals — including for the liver — that deserve to be taken seriously. If you're curious about it, that's a conversation for your doctor or pharmacist, ideally one who knows your full health picture — not a caption under a gummy bottle.

References: Arumugam, V., Vijayakumar, V., Balakrishnan, A., Bhandari, R. B., Boopalan, D., Ponnurangam, R., Thirupathy, V. S., & Kuppusamy, M. (2024). Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis. Explore (NY), 20(6), 103062. https://doi.org/10.1016/j.explore.2024.103062. McIntyre, D., Nguyen, P., Kim, Y., Meyer, B., & Salloum, M. (2026). Ashwagandha (Withania somnifera)-Associated Liver Injury: A Scoping Review of Clinical Characteristics and Safety Considerations. Cureus, 18(5), e109764. https://doi.org/10.7759/cureus.109764